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Two series of patients treated for primary hyperparathyroidism are reviewed for the incidence of associated pancreatitis. In an earlier series of 150 hyperparathyroid patients, six had documented pancreatitis as one of the primary clinical manifestations. Review of a more recent series failed to uncover a single case of pancreatitis in 26 patients with primary hyperparathyroidism. The incidence of pancreatitis associated with hyperparathyroidism appears to be steadily decreasing, possibly reflecting the earlier diagnosis of parathyroid disease, which is due to widespread screening testing methods currently available.

Topical citrate has been shown to significantly reduce the severity and incidence of corneal ulceration in alkali-burned rabbit eyes. Subcutaneous injection of citrate significantly reduced the severity of ulceration. This study was performed to determine the plasma citrate and ionized calcium levels after systemic administration of citrate. Repeated ingestion of citric acid capsules showed a small increase in the plasma citrate level, but no significant change in the level of ionized serum calcium 30 min after the last ingestion. A single dose of Polycitra-LC (6.672 g of citrate) more than doubled the baseline citrate concentration but only induced a 5% decrease in the level of ionized serum calcium 30 min after ingestion. Neither regimen of orally administered citrate produced any significant effect on the respiratory burst or adherence of in vitro polymorphonuclear leukocytes (PMNs) resuspended in their respective plasma. In comparison studies, higher levels of plasma citrate and lower levels of ionized serum calcium were achieved through plateletpheresis. The respiratory burst and adherence of PMNs were not statistically different from baseline PMNs. However, there was an inverse correlation between the micromolar increase in citrate or the micromolar decrease in calcium and the respiratory burst. These results suggest that the use of oral citrate alone may not be practical, but does not preclude the use of oral citrate as a supplement to topical citrate.

Sodium bicarbonate was added to complete mixed rations to characterize physiological, metabolic, and ruminal changes immediately postpartum when dairy cows are switched abruptly from a low energy ration prepartum to a high energy ration postpartum. Twelve Holstein cows were paired and assigned randomly to either a control or buffered ration containing .8% sodium bicarbonate. Rations consisted of 50% corn silage:50% concentrate. All All cows were fed a similar dry cow ration for a minimum of 7 days prepartum and experimental rations for 2 wk beginning at parturition. Blood, feces, and urine were sampled on days 1, 2, 4, 7, 10, and 14 postpartum. Rumen fluid was sampled on days 7 and 14. Dry matter intake and milk production were 2.75% of body weight and 30.3 kg/day for cows fed buffer and 2.49% and 27.6 kg/day for cows fed control. Higher partial pressure of carbon dioxide and base excess in blood in cows fed buffer existed on days 2 and 4 postpartum than for cows fed the control ration. Cows fed buffer had higher concentrations of ruminal ammonia than cows fed control. This difference was less pronounced in blood urea nitrogen and urinary ammonia. Urine pH was higher for cows fed buffer than for control. Addition of sodium bicarbonate improved the acid-base status after abrupt change of ration and may be associated with increased dry matter intake and improved ration adaptation. Concentrations of most minerals and metabolites in blood serum did not differ between rations.

The influence of added sodium bicarbonate on calf performance and on a possible sparing effect on dietary protein was studied with 48 Holstein calves. Calves were assigned randomly to one of four starter diets containing 10% chopped hay in a 2 X 2 factorial designed experiment: 1) 12% crude protein, 0% sodium bicarbonate; 2) 12% crude protein, 3% sodium bicarbonate; 3) 17% crude protein, 0% sodium bicarbonate; and 4) 17% crude protein, 3% sodium bicarbonate. All calves were fed fermented colostrum for 5 wk and offered their respective starter diets from birth until 10 wk of age. Average daily gains and daily dry matter intakes for wk 0 to 5 were .24, .25; .28, .24; .26, .19; and .27, .24 kg for diets 1 to 4 and for wk 6 to 10 were .52, 1.64; .50, 1.73; .67, 1.78; and .63, 1.87 kg. Addition of sodium bicarbonate (diets 2 and 4) stimulated greater growth (0 to 5 wk) and higher feed intake for the 10-wk trial. Digestibilities of all nutrient measures at wk 9 were lower with added sodium bicarbonate and may be related to higher feed intake. Added sodium bicarbonate did not influence nitrogen digestibility. However, the higher protein diet with sodium bicarbonate improved nitrogen utilization. Rumen samples collected at 9 wk tended to have a higher pH and ratio of acetate: propionate with added sodium bicarbonate. Calves fed the high protein diets gained more weight and consumed more feed than calves fed the low protein diets.

Monitoring the prescribing patterns of psychiatrists is a challenging and now necessary professional responsibility. The authors describe a peer review and feedback system in a decentralized CMHC, linked to continuing education in psychopharmacology, that made staff psychiatrists familiar with the state of the art and accountable for practice within its guidelines. Data are presented that confirm shifts from polypharmacy toward more appropriate use of psychotropic medications.

The picture naming articulation test, one of the most widely used speech assessment procedures, provides an excellent paradigm to study the potential of microcomputers with young, speech involved children. The stimulus-response format of the articulation test is structurally similar to assessment and management procedures crossing the spectrum of speech disorders. Findings from three studies comparing booklet-presented pictures to microcomputer-presented graphics indicate that microcomputers have certain control advantages in motivating children's repeated trials. However, spontaneous articulation testing by microcomputer may take more time than booklet testing if the graphics are less readily identifiable and due to associated novelty effects. Discussion of findings includes suggestions for enhancing the client-clinician-computer interface as this discipline experiences the entry of microcomputers into the speech-language clinic.

Few controlled data are available on the efficacy of microcomputers for speech management with children. The focus of this second report in a study series using microcomputers with speech-delayed children (Shriberg, Kwiatkowski, & Snyder, 1986) is on the response stabilization stage of speech management. Two repeated-measures designs were conducted with two samples of preschool children (n = 18) to compare tabletop management with comparable computer-assisted activities. Findings indicate that response stabilization tasks in the two intervention modes were equally effective, efficient, and engaging. Additional analyses suggest that the two modes engage the children in different ways, however, and that children may have individual needs for mode-specific features.

We report two cases of heterotopic pregnancy in women who were previously infertile. One of these patients conceived with the aid of ovulation stimulatory drugs, and the other from in vitro fertilization. In each case an ultrasound of the pelvis revealed a viable intrauterine pregnancy (twins in one case). Both patients presented in hypovolemic shock and required exploratory laparotomy. At the time of surgery a ruptured ectopic pregnancy with accompanying hemoperitoneum was found in each. Simultaneous ectopic and intrauterine pregnancy, though rare, should be suspected in patients who conceive with the aid of ovulatory drugs or in vitro fertilization.

Frequency-dependent fitness was studied at the Pgm-1 locus of Drosophila pseudoobscura with respect to two fitness components: rate of development and larva-to-adult survival. The Pgm-1 locus is very polymorphic with only two alleles, Pgm-1(100) and Pgm-1(104), occurring at high frequencies. For each of these two alleles, 20 homozygous strains were obtained from a sample of 1,140 wild-inseminated females. First-instar larvae of the two genotypes were combined in a set of eight different frequencies: 0.0, 0.10, 0.25, 0.40, 0.60, 0.75, 0.90, and 1.0. Frequency-dependent fitness effects were observed for the two survival-related fitness components examined: larvae of the less common genotype develop faster and have a higher probability of survival than larvae of the more common genotype. The rate of survival at intermediate genotypic frequencies is similar to that in pure cultures. If selection acted solely as frequency-dependent effects on survival-related components of fitness, the equilibrium frequency of the Pgm-1(100) allele would be 0.615 for a two-genotype system, which fits an observed frequency range for this allele in nature between 0.55 and 0.71. Experimentally created linkage disequilibrium was excluded from the experiment by using a large number of independent strains. It is nevertheless possible that the frequency-dependent selection may not affect the Pgm-1 locus per se, but may reflect a linkage disequilibrium present in the natural population. Even if this were the case, the frequency-dependent selection could affect the frequency of the Pgm-1 alleles in nature.

Calf serum, pooled human plasma, polyvinylpyrollidones (PVP) and polyethylene glycols (PEG) were required as medium components by many cultures of group A.S. pyogenes for intracellular polysaccharide accumulation. These supplements produced a stabilizing effect, probably at the cell surface, and were not associated with nutrition during intracellular iodophilic polysaccharide (IPS) storage. Medium stabilization and the presence of maltose or maltose yielding polysaccharides was found to be a property unique to the group A streptococci. Cariogenic streptococci and Streptococcus agalactive did not require medium stabilization for IPS storage although addition of PVP or PEG was stimulatory. Different degrees of IPS storage in group A.S. pyogenes was found to be strain related and probably dependent on the size and degree of branching of the storage polymer.

Effects of forage particle size and sodium bicarbonate on milk production, ruminal fermentation, ruminal fluid dilution rate, dry matter passage from the rumen, and nutrient digestion were measured in four Holstein cows in a 4 X 4 Latin-square experiment. Cows were fed ad libitum amounts of a diet of approximately 46% concentrate and 54% alfalfa hay. The 2 X 2 factorial arrangement of treatments were: 1) long stem alfalfa hay, 2) long stem alfalfa hay + 1.4% sodium bicarbonate (3.0% of concentrate), 3) chopped alfalfa hay (1.3 cm), and 4) chopped alfalfa hay + 1.4% sodium bicarbonate. Feed intake, milk yield, and milk composition were similar among treatments. Ruminal pH and concentration and molar percentages of volatile fatty acids were not altered. Decreasing feed particle size reduced ruminal fluid outflow as estimated by polyethylene glycol and chromium ethylenediamine tetraacetic acid dilution rates. Digestion of nutrients was decreased with chopped alfalfa hay but was not related to faster rate of passage of smaller size feed particles as determined by rare earth markers. Sodium bicarbonate increased water intake and tended to improve nutrient digestion. Absence of a significant effect of sodium bicarbonate upon rate of passage of chopped hay indicates that feed particles of this size are not significantly affected by small increases of dilution rate of ruminal fluid. Addition of sodium bicarbonate to an alfalfa hay (forage)-based diet did not improve production responses but did increase nutrient digestion.

Tuberculous mediastinitis can be an elusive diagnosis. Computed tomography may be performed in patients before establishing this diagnosis, and one should consider this disease when mediastinal mass with infiltration of adjacent fat planes is noted. Five such cases are described.

The therapeutic effect of citrate on alkali-burned eyes is thought to be the result of inhibition of PMN activities while ascorbate apparently stimulates the production of new collagen by scorbutic fibroblasts. Attachment of PMNs to the vascular endothelium is the initial PMN response to mediators and must occur before diapedesis and chemotaxis can produce a tissue infiltrate. The present study was undertaken to test the effects of citrate or ascorbate on the in vitro adherence of resting and leukotriene B4 (LTB4)-treated PMNs. Citrate preincubation of resting or LTB4-treated PMNs inhibited adherence in a dose-dependent manner. Inhibition of LTB4 augmented adherence by 12 mM citrate was effectively reversed by the addition of Ca2+ and Mg2+ (6 mM each). Ascorbate had no significant effect on the adherence of resting or LTB4 treated PMNs. In addition we wished to test the effectiveness of the breakdown product(s) from alkali burned collagen (Type 1) as an augmentor of adherence because of its effectiveness as a locomotory and respiratory burst stimulant. These break-down product(s) had no effect on the adherence of resting or LTB4-treated PMNs unless bovine serum albumin (BSA) was omitted from the incubation mixture. In the absence of BSA, these breakdown products inhibited both types of adherence in a dose-dependent manner with dilutions from 1:10 to 1:1000. This inhibition is probably not clinically meaningful since PMN adherence takes place in the vasculature where BSA would always be present. As a consequence of citrate inhibition of adherence in vivo, PMNs would be denied access to the injury site, trapping them in a resting state within the circulatory system.

A case of lumbar spinal subdural hematoma in a patient who had been on anticoagulant therapy is reported. Thus far 19 cases of spinal subdural hematoma have been reported in the literature, the majority in patients with a bleeding diathesis and after a lumbar puncture. Our case is the third reported to be in association with anticoagulant therapy. The hematoma was lumbosacral, in contrast to the usual location in the dorsal-lumbar area. A possible mechanism for the production of spinal subdural hematoma after a lumbar puncture is discussed. An early decompressive laminectomy and evacuation of the hematoma is the recommended treatment to obtain the best possible recovery of neurological function. (Neurosurgery, 5: 614--616, 1979).