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Care of the hand with rheumatoid arthritis requires a team approach with continued input from the rheumatologist, physiatrist, hand surgeon, and hand therapist. A problem- oriented approach is presented to guide the physician through the varied and complex deformities that may occur. Serial examinations are necessary to monitor the constantly changing process of the advancing disease. Prompt treatment of individual problems and accurate prediction of ensuing problems can help prevent future deformity and disability.

The general principles of upper extremity orthoses are discussed in this article, and the materials used to fabricate the orthoses are described. Static and dynamic splints and their indications are reviewed.

The gravitational constant G is the least well known fundamental constant. Our unique method of measuring G is described, followed by a report on discovered systematic errors and thereupon realized upgrades to significantly reduce those errors. We will present the first results obtained after the upgrade.

Kabuki make-up syndrome (KMS) is a mental retardation/congenital malformation syndrome of unknown aetiology. We report a child with the unbalanced karyotype 46,XY,-6,+der(6)t(6;12) (q25.3;q24.31)mat. who has several features of KMS and suggest a possible cause for this condition.

The basic conservative therapy programs for elderly patients with arthritis include adequate physical rest and mental relaxation, analgesics, aspirin, and physical rehabilitation consisting of occupational and physical therapy with a good home therapy program providing appropriate balance between rest and activity. Proper protection from trauma and overuse of the involved joints, and appropriate nutrition can afford optimal improvement in health status and general resistance. Proper orientation of the patient regarding the nature of his disease and treatment program usually is required to obtain his full cooperation. A kind, encouraging, and understanding approach is most helpful in the elderly patient. Physical rehabilitation can help to relieve pain, decrease edema and deformities, improve muscle weakness and incoordination, and increase stamina. Difficulties with gait, transfers, and self-care can be solved or improved. Physical medicine and rehabilitation measures are important components of the challenging treatment of patients of all age groups who are afflicted with severe arthritis. It is most important to tailor these components of the treatment program to the problem presented by geriatric arthritic patients.

The results of computerised axial tomography (CAT) in 80 children with neurological symptoms and/or signs of less than 3 months' duration are discussed in relation firstly to intracranial pathology and secondly to clinical presentation. 26 children had intracranial space-occupying lesions (tumour, abscess, haemorrhage, infarct). CAT was abnormal in 25 of these and diagnostic in 18. A further 20 children had meningitis or encephalitis, and CAT was abnormal in 12. In contrast with this high rate of scans showing pathology, CAT was abnormal in only 4 of the remaining 34 children who had less definite or no intracranial disease. Analysis of clinical presentation showed that 42 of 69 children presented with persisting neurological signs and of these, 25 had an intracranial space-occupying lesion and 29 had abnormal CAT. Only 5 of 27 children who had symptoms alone or signs lasting less than 24 hours had abnormal CAT, and no intracranial lesion requiring specific treatment was missed. CAT is useful for demonstrating the site, size, and nature of many lesions. The scan may not initially be abnormal in brain stem gliomas and in small subdural collections of fluid.

Fifteen normal children with large heads (circumference greater than 0.5 cm above the 98th centile) were studied. CAT scans were pefrormed to exclude hydrocephalus, and ventricular size was compared with that of hydrocephalic children. In 11 of the 13 families in which the parents' heads were measured, one parent (10 fathers and one mother) was found to have a large head, as had 6 of 17 siblings. Head circumference at birth was large in 7 of 10 babies and rate of head growth was excessive in 8 of 13. Skull x-ray showed suture diastasis in 7 infants. These families have a benign familial megalencephaly. It is important to recognise this so as to avoid unnecessary investigation and anxiety about normal children with large heads.

The isolation of measles virus in newborn mice and Vero cell cultures from biopsy specimens obtained from two cases of S.S.P.E. is reported. Under the described experimental conditions the newborn mice proved to be as sensitive as Vero cells to one of the isolated viruses. Evidence for the presence of cell-free virus was obtained from first and second mouse brain passes of the isolates. It is considered that mouse inoculation may prove of greater value than co-cultivation for the initial isolation of virus from biopsied brain tissues from some cases of S.S.P.E.

Summary An individualized physical therapy program can be helpful in preparing a patient with arthritis for surgery. The therapy program can minimize fibrositis, muscle tightness, and muscle atrophy of immobilization and help to maintain the range of joint motion and muscle strength. Postoperatively the patient with arthritis should have physical therapy as soon as indicated for the type of surgery done. This therapy is given not only to the area operated on but also to other joints involved if maximal functional results are to be maintained. Each patient's therapy program will vary depending on the goals desired, the stage of the disease, and the surgery performed. The treatments should be simple but effective so that the patient can carry them out in his home with minimal help after dismissal from the hospital. Successful, effective, rehabilitative therapy depends on an alert, intelligent, cooperative, informed patient. The physician's interest, optimism, encouragement, thoroughness, follow-up, and guidance can mean the difference between success and failure in the overall rehabilitation of the patient with arthritis.

(1929). A guide to English studies: The study of the medieval drama. English Studies: Vol. 11, No. 1-6, pp. 11-17.

Acarbose (O-4,6-dideoxy-4-[[(1S, 4R, 5S, 6S)-4,5,6-trihydroxy-3- (hydroxymethyl)-2-cyclohexen-1-yl]amino]-a-D-glucopyranosyl-(1---- 4)-O-a-D- glucopyranosyl-(1----4)-4-glucopyranose, Bay g 5421), an a-glucosidase inhibitor from Actinoplanes, has been developed for the treatment of diabetes mellitus. To investigate the pharmacokinetics and the biotransformation, 14C-labelled acarbose ([14C]Bay g 5421) was required. About 37 GBq (1 Ci) D-[U-14C]glucose was used as a precursor to obtain [14C]acarbose with a radiochemical yield of between 1.58 and 2.56%. For fermentation purposes resting cells of the Actinoplanes mutant SN 1667/47 were used under cometabolism conditions with a 10-fold excess of maltose. The specific radioactivities achieved in individual preparations were 7.77 MBq/mg (210 microCi/mg), 8.03 MBq/mg (217 microCi/mg), and 9.14 MBq/mg (247 microCi/mg), with a radiochemical purity of greater than 98% in each case. By hydrolysis and subsequent investigation of the hydrolysis products it was shown that [14C]carbon atoms originating from the radioactive glucose are present only in the core and not in the maltose unit of [14C]acarbose.

The alpha-glucosidase inhibitor acarbose has been successfully used in diabetic patients to decrease the postprandial rise in blood glucose. The aim of the present experiments was to investigate the fate and effects of acarbose along the small intestine using a slow-marker perfusion technique. In 8 healthy volunteers, jejunal and ileal loads of acarbose, glucose, and total carbohydrates were determined following a liquid, 400-kcal formula meal containing either 200 mg of acarbose or placebo. Preprandial and postprandial plasma concentrations of glucose and several polypeptide hormones were determined. Recovery of acarbose during 4 h was 65% +/- 9% (mean +/- SEM) of ingested dose in the ileum but 94% +/- 9% in the jejunum, indicating that the compound was neither degraded nor absorbed by the intestine to a major degree. After acarbose administration, ileal loads of glucose and total carbohydrates were considerably higher, whereas postprandial plasma concentrations of glucose, insulin, and gastric inhibitory polypeptide were lower when compared with placebo. The retardation of carbohydrate digestion to be inferred from these findings is confirmed by significantly elevated plasma concentrations of enteroglucagon after acarbose administration compared with placebo administration.

The rate of energy storage in adipose tissues is, at least in part, dependent on the concentration of nutrients and hormones in the blood. A delayed absorption of ingesta from the intestine should cause lower concentrations of fat, glucose and insulin and, thus, reduce the triglyceride storage rate. Non-selective agents retard the absorption irrespective of composition of food. Inhibitors of intestinal alpha-glucosidases delay the degradation of complex carbohydrates to absorbable monosaccharides and thus decrease the rate of their absorption. Inhibitors of pancreatic lipase interfere with the degradation of dietary triglycerides and decrease the postprandial triglyceride increment in blood and tissues. Recently a compound was found which inhibits the absorption of carbohydrates as well as triglycerides.

Addition of small amounts of NH4 + (at final concentration 10-4 M, for example) to suspensions of E. coli which have grown in ammonium-free medium leads to a rapid inactivation of glutamine synthetase (1, see figure 1). Pursuit of this observation led to the discovery of an ATP- Open image in new window Fig. 1. Time course of the inactivation of glutamine synthetase in E. coli after addition of 10 -4 M NH 4 + at 0° and 37°. Cells were cultivated in glutamate-medium and at zero time ammonium sulfate was added. Samples were withdrawn at various times, sonicated 15 sec, and centrifuged. Symbols o and x denote data from two separate experiments. Taken from ref. 1 and glutamine-dependent, glutamine synthetase-inactivating enzyme (2). Further research by Earl Stadtman’s group in Bethesda and ours in Freiburg (3,4) elucidated a system for the regulation of glutamine synthetase by effector-controlled, enzyme-catalyzed, covalent modification schematized in figure 2. The findings collected in figure 2 are based on studies with extracts of E. coli and with the purified enzymes.

1. The liver and muscle tissues of 14 human anencephalic babies were examined for glycogen content and structure, and for the activities of several glycogen-metabolizing enzymes. 2. In both tissues glycogen content increased with gestation age; the muscle glycogens had a slightly but significantly lower degree of branching than the corresponding liver glycogens. 3. All the expected glycogen-metabolizing enzymes were present; acid maltase activities were higher and phosphoglucomutase activities were lower than the results reported for human adult tissues. Glucose 6-phosphatase activity increased significantly with gestation age.

An unusual outbreak of nosocomially acquired bacteriuria due to gentamicin-resistant strains of Proteus rettgeri and Providencia stuartii occurred in 48 patients with indwelling urethral catheters. All strains of both species were susceptible to kanamycin. The cause of the outbreak proved to be a common source of contamination of urinary leg bags. Many strains in both species agglutinated in anti-P. rettgeri 0:26 serum.

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Disabling neck injuries to women in auto accidents are common in metropolitan regions, 6.7/1,000 women year. Near Newark, NJ, the rate was 14.5/1,000/year, half occurring from rear-end collisions. Absence from work averaged eight weeks. Delayed onset was not associated with longer absence. Symptoms continued more than six months in about 75% of those without, as well as with pending litigation. These and other data do not support the opinion that prolonged symptoms are commonly due to litigation neurosis or malingering. Reports of electroencephalographic abnormalities in a high proportion of humans and animals with whiplash injury plus damage to the sympathetic and cerebrospinal nervous systems and rupture of stabilizing ligaments indicate possible organic bases for "neurosis." Proper headrests prevent whiplash injury to humans. Federal regulations require headrests in automobiles made after Dec 31, 1968.