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To the Editor: I was shocked by Victor Davis Hanson's comment that America's successes in the war in Iraq were achieved 'all at a cost of a little over 400 […]

Physiologic response has been assessed in a twoperson interaction where one of of the two participants coped actively with a challenging situation, the other participant assuming a passive observer's role. The experimental challenge was that of responding aloud to a set of standardized interview questions physiologic parameters considered were those of plasma free fatty acid FFA concentration and heart rate. Irrespective of whether the individual was an active or passive participant, the interview situation evoked a marked rise in plasma FFA and heart rate in both volunteers. The possibility was considered that this response might reflect a physiologic counterpart to the transactional process of empathy.

A study of 20 male survivors of myocardial infarction confirmed a clinical impression that moderate to severe invalidism often occurs in the absence of definable physical residuals of the infarction. The cultural meaning of the heart attack was found to be prominently concerned with fear of sudden death and fear of physical activity. A failure in the revision of concepts derived from the acute phase of the infarction was observed in the invalid patients and their spouses. Physician uncertainty regarding the source of somatic symptoms in invalidism was observed to exert both a delay in the recognition of the syndrome and a perpetuating effect.

The management of many disease processes requires that the patient learn new patterns of living. This is particularly true for individuals with chronic illnesses whose course cannot be easily modified by a specific medication or procedure. In this setting, the physician frequently must ask the patient that he "learn to live with the illness" and, in so doing, the patient must then establish new ways of dealing with the problems of daily life. The success with which the patient accomplishes this goal will depend upon many factors, one of which is simply how well he can carry out the process of learning. Since many patients appear to have difficulty in learning new patterns of behavior, it is important that the physician begin to develop a more detailed understanding of the physiologic correlates of the learning process so that he may adequately assess the importance of

THE SENSORY system carried in the dorsal columns and medial lemniscus has been clearly shown by Mountcastle and others1,2 to have the neurophysiological attributes essential for discriminative touch: its neurons are somatotopically organized at each successive level and subtend small contralateral peripheral receptive fields that are activated by mode specific mechanoreceptive stimuli. The security of synaptic transmission of this afferent information concerning the spatial and temporal sequence of stimuli is its most distinguishing feature. The ability to detect a change in the position of a limb and the ability to detect vibration have been considered functions of this sensory system.3,4 Pathological lesions confined solely to the dorsal columns are believed to affect both modalities. However, there have been numerous reports of patients with dorsal funicular lesions in whom vibration sensibility and proprioception were not affected to the same degree, and many in whom no clinical deficit was

Urinary excretion of norepinephrine and epinephrine was measured in 30 patients with myocardial infarction for five days after admission to a cardiac care unit. Patients with uncomplicated hospital courses or those with primary ventricular fibrillation or complete atrioventricular block showed a similar pattern, ie, high initial levels with a slope to normal range over the five-day period. Patients with multiple complications, particularly of a hemodynamic nature, showed lower initial levels and a different slope over the five-day period. Some instances of catechol elevation at time of psychological stress are presented.

INTEREST in the possible causal relationship of disorders of lipid metabolism to development of atherosclerosis, particularly coronary artery disease, has stimulated the search for agents which can normalize serum lipid levels with few undesirable symptoms and no toxic effects.A mixture of clofibrate (ethyl p-chlorophenoxyisobutyrate) and androsterone (Atromid) was synthesized in 1962 by Thorp and Waring 1 and made available for oral administration in the form of 250 mg capsules each containing 2.5 mg clofibrate and 5.5 mg of androsterone.The mode of action of this mixture has not been established. Thorp 2 suggested that the chlorophenoxyisobutyrate anion displaces serum albumin-bound acidic substrates, coenzymes, or hormones and that the effects of the displaced acids are predominantly localized in the liver, causing a reduction in lipid synthesis. Further investigation has demonstrated that the effective compound is clofibrate unaided by the addition of androsterone in combination.3-5This compound has been

The dynamic state of adipose tissue lipid has once again become the focus of intense investigative interest. In the past decade, the relationship of lipid metabolism to disease, particularly in disorders of the blood vessels and the heart, has received emphasis. As the primary area of lipid deposition and concentration, adipose tissue itself has become the subject of study. As a result of these studies, the widely held notion that adipose tissue is a relatively inert storehouse is no longer tenable. In 1948 Wertheimer and Shapiro1 clearly summarized the evidence that indicated the dynamic qualities of adipose tissue. The salient features of that review included the abundant vascular and neural supply to the tissue, the importance of carbohydrate metabolism within adipose tissue, and the marked mobility of adipose tissue in response to various stimuli. This property of mobility—affording the opportunity for lipid to be rapidly available to all tissues—