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Patients with histories of recurring calcium oxalate renal stone formation have been given daily oral supplements of 200 mg of MgO and 10 mg of pyridoxine for extended periods of time. Thirty of 36 patients maintained on this program for 5 years or more have shown no recurrence or decreased recurrence of stone formation. After 1 year on this regimen, urines obtained from 51 patients showed a marked increase in their capacity to maintain calcium oxalate in solution, significantly raised calcium and citric acid levels, and decreased xanthurenic acid levels. No significant changes were observed in urinary magnesium, oxalic acid, phosphate-P or pyrophosphate-P values. Decreases in serum β-lipoproteins were also observed in a group of 25 of these subjects.

In an 18 hospital study, 205 patients hospitalized with a diagnosis of manic-depressive illness, manic type, were treated upon discharge with lithium carbonate or placebo for a two-year period. Lithium carbonate was significantly more effective than placebo in preventing relapses (ie, affective episodes severe enough to require hospitalization or use of nonstudy drugs). The difference in treatment outcome between lithium carbonate and placebo was due mainly to the lower incidence of manic relapses on lithium carbonate. Patients on lithium carbonate also had a lower incidence of depressive relapses than patients on placebo but the limited incidence of severe depression in this sample makes it difficult to draw any conclusions regarding the prophylactic efficacy of lithium carbonate in depressive illness. The results from this trial coupled with those from other studies indicate that lithium carbonate combined with regular clinical appraisals is a safe and effective treatment for preventing relapse in manic-depressive illness.

In an 18-hospital collaborative study, 83 newly admitted patients with a diagnosis of schizo-affective psychosis, excited state, were randomly assigned to lithium carbonate or chlorpromazine hydrochloride for a three-week period. Patients were classified as highly active or mildly active on the basis of degree of hyperactivity shown at admission.The results showed that lithium carbonate was less effective than chlorpromazine in treating highly active patients. This was due primarily to lithium carbonate's relatively poor control of hostile, excited behavior. There was no major difference between lithium carbonate and chlorpromazine among mildly active patients; both treatments showed a significant reduction in affective and schizophrenic behavior. The possibility that lithium carbonate may have neuroleptic properties is considered in a discussion of the therapeutic and diagnostic implications of these results.

In an 18-hospital collaborative study, 255 newly admitted manic patients were randomly assigned to lithium carbonate or chlorpromazine for a three-week period. Patients were classified as highly active or mildly active on the basis of degree of motor activity shown at admission. Treatments were compared in terms of early terminations, symptom change, and toxicity. The following results were obtained: (1) Chlorpromazine was clearly superior to lithium carbonate in treating the highly active patient. Chlorpromazine acted more quickly, produced significantly fewer dropouts, and had a lower incidence of severe side effects. (2) The difference between lithium carbonate and chlorpromazine was less pronounced among mildly active patients. Lithium carbonate, however, appeared to be the better treatment. Both drugs effectively reduced manic symptomatology but lithium carbonate left the patient feeling less sluggish and fatigued. Lithium carbonate also produced fewer severe side effects than chlorpromazine.

THIS STUDY on the efficacy of high dose chlorpromazine treatment in chronic schizophrenia was developed under the National Institute of Mental Health (NIMH) psychopharmacology program during 1964 and was initiated in seven collaborating public mental hospitals early in 1965. The hospitals participating in this study were Boston State Hospital, Boston; Broughton State Hospital, Morganton, NC; Dorothea Dix State Hospital, Raleigh, NC; Kentucky State Hospital, Danville, Ky; Manhattan State Hospital, New York; St. Louis State Hospital, St. Louis; and Springfield State Hospital, Sykesville, Md. These hospitals were selected to represent the entire urbanrural continum. Three hospitals admitted patients exclusively from large urban centers, two hospitals served areas which included both urban and rural communities, and two hospitals served areas which were almost exclusively rural. BACKGROUND During the past 13 years, a large number of studies have been published on the use of chlorpromazine with chronic schizophrenic

• Glucuronides increase the solubility of calcium phosphate. Excretion of glucuronides in the urine can be increased by administering compounds, such as the salicylates, that conjugate with glucuronic acid.Acetylsalicylic acid was therefore given orally to a series of patients with frequently recurring calcium-containing calculi. One patient had passed approximately 100 calculi in 14 years, and 12 patients had collectively undergone 23 major operations for removal of calculi. All patients in this series had had a "stone episode" within a year of starting treatment or had renal calculi in situ at the time. In addition to 2 gm. of acetylsalicylic acid, treatment included liberal water and low-calcium intake.It was almost always possible to double the pretreatment urinary output of glucuronides; sometimes it was tripled or quadrupled. Salicylamide proved even better than acetylsalicylic acid and is used in all cases now. In 17 out of 19 patients there was no recurrence of calculi. In one patient there was recurrence, and in another some preexisting calculi increased slightly in size. The therapy prevented the common incrustation of inlying catheters in eight out of nine patients whose catheters previously became obstructed in one or two weeks. Salicylates are recommended for further trial as means for preventing recurrence of calcium-containing urinary calculi.

In 1951 Butt reported clearance of turbidity of the urine of persons predisposed to calculus formation after the subcutaneous injection of the enzyme hyaluronidase. In 1952 the same author, in association with Häuser and Seifter, published further studies on the mechanism of this phenomenon and also reported its use in the prevention of recurrence of urinary calculi. It was stated that the subcutaneous injection of hyaluronidase results in the release of hyaluronic acid from the subcutaneous connective tissues and its excretion in the urine in a degraded or hydrolyzed form in which the individual particles act as protective colloids. The protective colloid "not only disperses crystalline matter already present but also inhibits the formation and growth of new crystalline matter."The importance of the urinary colloids in increasing the solubility of the stone-forming crystalloids has been debated for many years. What the proponents of the colloid theory were able to

Present-day endemic urinary stone disease of the Near and the Far East also existed in varying degrees in the countries of Europe prior to the present century, and disappeared gradually with improvements in economic and nutritional conditions. In the endemic form of the disease, stones of uric acid and urate mainly involve the bladder of young boys. Contrariwise, in present-day Western stone disease, primary calcium stone commonly originates in the kidneys of adults. Two distinct calcium stone waves, which followed World Wars I and II in the involved combatant and adjacent noncombatant countries, are inexplicable on the basis of nutrition and psychic stress. Stone disease is changing even today. Consideration of the possible factors of causation reveals confusing paradoxes and inconsistencies.

The report by Shapiro et al1 in this issue of the Archives raises a number of issues regarding multicenter collaborative studies and their analyses. Our general comments pertain primarily to publicly funded collaborative trials. Multicenter studies sponsored by pharmaceutical companies or other private sources raise a different set of issues that are discussed elsewhere.2See also pp 397 and 401.The report by Shapiro et al1 stemmed from a request from the authors to reanalyze data from the National Institute of Mental Health (NIMH) (Rockville, Md) Collaborative Study on Maintenance Drug Therapy in Affective Disorders3 by using a life-table regression model. The authors had not participated in the collaborative study or in the preparation of earlier reports of findings. Their results demonstrate that large collaborative studies can benefit from infusion of different analytic approaches from outside the collaborative study group. Unfortunately, some multicenter collaborative projects often

The artifactual development of endothelial necrosis, pulmonary congestion, and oedema that has been reported in dogs, cats, and monkeys when the animals were killed with 1-1·5 ml/kg body weight of the euthanasia agent T-61 was reproduced in adult ewes of the merino breed. This species also exhibited a marked pulmonary congestion with intra-alveolar haemorrhages, septal oedema, and a diffuse cellular damage of the alveolar septa when the recommended dose of 0·3 ml/kg body weight was administered after forcing blood flow through one lung by clamping the contralateral hilum. The red coloration of the damaged lung areas may be due to haemolysis, another aspect of T-61 induced cell damage in this species. The degree of haemolysis increases with increasing blood concentration of the agent and approximates complete haemolysis at a T-61 blood concentration of 5%. The blood concentration dependent degree of haemolysis in sheep suggests a similar relationship between blood concentration of the agent and degree of pulmonary tissue damage.

Carbon monoxide is hypothesized to be produced by the enzyme heme oxygenase predominantly in liver and spleen, bound to hemoglobin, and excreted by the lungs. Thus, venous carboxyhemoglobin is expected to be higher or equal to arterial carboxyhemoglobin. Unspecific inflammatory stimuli have been shown to induce heme oxygenase in lung tissue possibly leading to pulmonary carbon monoxide production. Arterial and central venous carboxyhemoglobin levels were measured in critically ill patients on the third day of ICU stay (n = 59) as well as in otherwise healthy humans prior to orthopedic surgery (n = 29). Arterial and central venous carboxyhemoglobin were higher in ICU patients than in healthy humans, respectively. In both groups, arterial carboxyhemoglobin was significantly higher than central venous carboxyhemoglobin. The arterio-venous carboxyhemoglobin differences were similar in both groups. The data suggest (a) increased CO-generation in critical illness and (b) pulmonary CO-production in healthy and critically ill humans.

ObjectiveRecently the potential long-term effect of sports-related head injuries has been discussed. To develop effective injury prevention strategies, epidemiological information is required. The aim of this study was to analyse the incidence and characteristics of head and neck match injuries.DesignProspective cohort study.SettingFIFA tournaments and Olympic Games.ParticipantsAll football teams participating in FIFA tournaments and Olympic Games between 1998 and 2015 were included in the study. The team physicians reported injuries from 2106 matches from 65 outdoor tournaments (20 women’s and 45 men’s). The average response rate was 96%.Outcome measuresIncidence rates per match and a variety of injury characteristics (type, severity, cause, gender) of head/neck injuries compared to other football injuries were analysed.Main results4756 injuries (2.4 injuries/match) were reported. Most injuries affected the lower extremity (70%), followed by the head/neck (15%), trunk (8%) and upper extremity (7%). Head injuries (n=674; 14.4%) were more frequent than neck injuries (n= 34;0.7%), and the incidence was higher in female (18%) than in male (14%) players. Most head/neck injuries were contusions (n=362; 50.3%) and non-time-loss injuries (n= 164;22.8%). Of the 108 (15%) reported concussions, 62% resulted in time-loss. Only one head injury (fracture) had an estimated time-loss of more than four weeks.ConclusionWhile neck injuries are rare, head injuries are more frequent, and particularly concussions often result in time-loss. No career-ending injuries of the head or neck were reported. Potential long-term effects of head/neck injuries warrant further evaluation in clinical studies.Competing interestsNone.

A series of substituted salicylates and other structurally unrelated compounds having the common property of metal-ion complexation have been examined for the ability to inhibit the incorporation of sulfate into mucopolysaccharide. Several very potent inhibitors have been found among the mercaptoamines. It may be stated that the course of mucopolysaccharide sulfation is definitely affected by metal-binding agents, generally by inhibition. A close correlation between per cent inhibition of sulfation and metal-binding strength was observed, which establishes that the mode of inhibition is one of metal binding of the metalloenzymes involved in mucopolysaccharide sulfation.

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Although triamterene has been known to contribute to urinary calculus formation, it has been presumed to be a rare phenomenon. Our review of stone analyses performed during the last decade by a single laboratory reveals an increasing incidence of triamterene stones. Awareness of the calculogenic potential of triamterene-containing medications should be re-emphasized.

The Leadership Opinion Questionnaire (Fleishman, 1969) is a 40-item questionnaire designed to measure two important dimensions of leadership style, consideration and initiating structure. This research provides evidence from one sample which contradicts previous results involving this instrument and technically does not support the view that these two styles of leadership are unrelated to each other or to other measures of individual differences.

Lithium has been used in the treatment of schizophrenic and schizoaffective disorders with inconclusive results. Interpretation of the results has been limited either by inadequate sample sizes or by the scarcity of adequately controlled trials. An additional problem in interpreting studies of the therapeutic use of lithium in schizoaffective disorders arises from the lack of universally accepted criteria for classifying such disorders at the time of the study. SCHIZOPHRENIA In general, there are three prevailing opinions regarding the efficacy of lithium in schizophrenia: 1. Lithium is not effective in schizophrenia and may actually be deleterious because of the increased susceptibility of schizophrenics to lithium-induced CNS toxicity.1-3 2. Schizophrenic patients who respond to lithium treatment are in reality "atypical" manic-depressives. Since severe mania may mimic schizophrenia (including appearance of first-rank Schneiderian symptoms), a favorable response to lithium indicates a need for rediagnosis.4-6 3. There is a subgroup of "pure"

In discussing the current state of the evidence concerning the prophylactic use of lithium in recurrent affective disorders, it is informative to focus on recent decisions made by two important committees in the United States—the Neuropsychopharmacology Advisory Committee to the Food and Drug Administration and the American Psychiatric Association (APA) Task Force on Lithium Therapy. Both committees concluded that lithium has demonstrated superior efficacy over placebo in the treatment of bipolar recurrent affective illness. The FDA Committee's conclusion was made part of the revised Lithium Carbonate Package Insert, issued in 1974 by Smith Kline & French Laboratories, Rowell Laboratories Inc, and Roerig Division of Roerig Laboratories, Pfizer Inc, which approves the use of lithium for the long-term maintenance treatment of bipolar affective illness. The APA Task Force Report on Lithium Therapy,1 published in 1975, concurs with the FDA's position that lithium is effective in preventing or attenuating recurrences

One case of malaria in pregnancy at 23 weeks of gestation in a woman returning from Ghana is presented. The patient complained of diarrhea and abdominal pain and was admitted to the department of Gynecology and Obstetrics. Under suspicion of appendicitis an exploratory laparotomy was performed. Diagnosis was missed and treatment delayed five days. Outcome was favorable for both woman and fetus.

A factor analysis of 10 student activity dimensions (N= 48) yielded 3 factors named: social activities performance, structured achievement, and unstructured achievement.

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