Subtle Indicators Research Articles

The anterior diaphragmatic attachments: an anatomic and radiologic study with clinical correlates.

A study of the anterior attachments of the respiratory diaphragm was performed using gross anatomic specimens, plain radiography, and computed tomography with multiplanar image reformatting. The anterior portions of the diaphragm are affixed to the lower six ribs and the sternum. The line of attachment of each hemidiaphragm begins at the anterior axillary line and extends cranially and medially to meet at the xiphoid process. These structures can be visualized along with contiguous pathologic subdiaphragmatic and/or infradiaphragmatic air collections. In the semierect patient, free intraabdominal air may preferentially collect in the anterior subdiaphragmatic regions rather than below the domes of the diaphragm, providing a subtle but reliable indication of pneumoperitoneum. An understanding of the normal anatomy of the anterior diaphragmatic attachments is valuable in assessing a variety of anterior paradiaphragmatic air collections.

Oxygen-derived free radicals in postischemic tissue injury.

It is now clear that oxygen-derived free radicals play an important part in several models of experimentally induced reperfusion injury. Although there are certainly multiple components to clinical ischemic and reperfusion injury, it appears likely that free-radical production may make a major contribution at certain stages in the progression of the injury. The primary source of superoxide in reperfused reoxygenated tissues appears to be the enzyme xanthine oxidase, released during ischemia by a calcium-triggered proteolytic attack on xanthine dehydrogenase. Reperfused tissues are protected in a variety of laboratory models by scavengers of superoxide radicals or hydroxyl radicals or by allopurinol or other inhibitors of xanthine oxidase. Dysfunction induced by free radicals may thus be a major component of ischemic diseases of the heart, bowel, liver, kidney, and brain.

Otosclerosis: A generalized disorder of glycosaminoglycan (CAG) metabolism?

There are numerous indications that otosclerosis represents a local manifestation of a generalized disorder of GAG and/or collagen metabolism, a contention supported by the heritable nature of the disease. Zechner and Manolidis reported a pronounced increase of total GAGs in urine of patients with active otosclerosis [Arch. Klin. Exp. Ohren Nasen Kehlkopfheilkd. 202, 634 (1972)]. We were not able to confirm their reported increase in total urinary GAGs. Therefore we searched for more subtle indicators of aberrant GAG metabolism, such as changes in ratios of individual GAGs. For this purpose it was necessary to develop a highly sensitive technique to quantitate individual GAGs; however, again no significant differences were found: dermatan sulfate (0.48 ± 0.06 and 0.32 ± 0.04), heparan sulfate (0.43 ± 0.06 and 0.40 ± 0.04), chondroitin‐4‐sulfate (0.60 ± 0.07 and 0.71 ± 0.08), and chondroitin‐6‐sulfate (1.25 ± 0.14 and 1.41 ± 0.16) in controls (N = 22) and active otosclerosis (N = 20), respectively (X ± SE...

Intracrystalline Porosity--A Newly Discovered Pore Type in Dolostone Reservoirs and Implications for Dedolomitization and Pseudospiculites: ABSTRACT

Intracrystalline porosity consists of hollow dolomite crystals. It forms when anhydrite, which had replaced cores of dolomite crystals, was dissolved. Significant volumes of intracrystalline porosity have been preserved in subsurface Permian dolostones of the Permian basin and in outcrops of Lower Cretaceous dolostones of Texas. Anhydrite can be seen replacing organic-rich cores of dolomite crystals in Permian and Jurassic (Smackover) dolostones. Dolomite crystals, which replace original carbonate, commonly appear because of organic inclusions. After dolomitization, continued flux of the dolomitizing fluid causes precipitation of clear rims on the cloudy crystals. Anhydrite tends to replace the organic-rich cores, leaving the clear epitaxial rims to form pill box structures. When anhydrite was dissolved, many hollow dolomite crystals collapsed and fragments became transported as vadose internal sediment. Obtuse and acute angles of these hollow dolomite rims superficially resemble sponge spicules, and pseudospiculites are layers of vadose internal sediment in which numerous fragments of hollow dolomite rims have been deposited in solution channels. Hollow dolomite crystals and pseudospiculites constitute evidence for disconformity and also represent subtle indications of vanished sulfates. In many instances, calcite cement was precipitated within intracrystalline pores and is misinterpreted as partial dedolomitization. Such calcite cement can be distinguished from dedolomite, because the calcite is not syntaxial with dolomite rims, as it would be in dedolomitization. In some Permian dolostone intervals, intracrystalline porosity is the predominant pore type. Molds formed by dissolution of replacement porphyroblasts and nodules of anhydrite also commonly were formed along with intracrystalline pores and all represent tertiary (third order) voids. End_of_Article - Last_Page 491------------

Absence of positional change in pulmonary diffusing capacity in systemic sclerosis

Patients with systemic sclerosis frequently have pulmonary function abnormalities, and recent evidence suggests that pulmonary vascular involvement is a common manifestation. To test the hypothesis that patients with systemic sclerosis have impaired ability to recruit or distend the pulmonary vascular bed, the postural change in the coefficient of carbon monoxide diffusing capacity was measured in 11 patients with systemic sclerosis, and the results were compared with results from age-, smoking-, and sex-matched control subjects with rheumatoid arthritis and with results from healthy subjects. In normal subjects and patients with rheumatoid arthritis increased, the coefficient of diffusion by 9.4 percent (p < 0.005) and 8.4 percent (p < 0.01), respectively, when they moved from the sitting to the supine position. In contrast, patients with systemic sclerosis did not show a significant increase in coefficient of diffusion, even those who had otherwise normal pulmonary function. Regression analyses showed that the change in coefficient of diffusion decreased with increasing age (r = −0.57) in normal subjects, and that the change in coefficient of diffusion was a function of the percent predicted forced vital capacity, both in patients with systemic sclerosis (r = 0.59) and in those with rheumatoid arthritis (r = 0.70). Thus, these findings indicate that patients with systemic sclerosis have a nondistensible pulmonary capillary bed and that the absence of positional change in the coefficient of diffusion in systemic sclerosis is a subtle indicator of pulmonary involvement.

DEMONSTRATION WITH MONOCLONAL ANTIBODIES OF AN UNUSUAL MONONUCLEAR CELL INFILTRATE AND LOSS OF NORMAL EPITHELIAL MEMBRANE ANTIGENS IN HUMAN BREAST CARCINOMAS

Monoclonal antibodies to two differentiation antigens normally expressed on the membranes of breast epithelial cells were used in immunoflourescence studies on frozen sections of malignant breast tumours. It was demonstrated that most tumours did not express these antigens on their cell membranes, and it was possible to classify histologically indistinguishable tumours according to whether they expressed the antigens. The absence of these membrane antigens is likely to be a subtle indicator of cellular differentiation and to have metabolic and other functional implications for the tumour. The demonstration that otherwise indistinguishable tumours can be classified in this way therefore has obvious potential for clinical exploitation. In addition, it was demonstrated that the majority of the mononuclear cells in those tumours with intense mononuclear cell infiltrates expressed an antigen not normally found on mature lymphocytes and macrophages.

Acute Hyperthyroidism Precipitated by Trauma

An adolescent girl presented to the emergency ward with a fracture of the femur and subtle indications of acute hyperthyroidism which progressed. The diagnosis was confirmed and treatment was instituted. In the care of acute trauma, the less obvious signs of an endocrinopathy must not be overlooked.

Black Economic Gains in the Sixties: A Methodological Critique and Reassessment

Recent publications heralding black economic in the sixties are found to share a common preoccupation with gaps (rather than distributions) and to rely on a common methodology. We contend that their findings are, at least in part, an artifact of their method. A new measure of trends in income inequality is developed, resulting in quite different findings. The substantive implications of the pattern of actual gains and losses is discussed. Since the recent publication of the 1970 census data on income distribution, a number of researchers have attempted to assess the magnitude of black economic gains in the previous decade. Most have concluded that these gains have been substantial. In the most well-publicized' of these attempts, Wattenberg and Scammon (1973) called the gains since 1960 a achievement. Others (e.g., Farley and Hermalin, 1972; Freeman, 1973) have been somewhat less euphoric, but have nonetheless pointed to large and meaningful black gains. All have failed to focus on distributional changes and instead have based their analyses in large degree upon comparisons of the ratios of black to white median income over time, which shows a steady increase; and upon comparisons within each group of median income at T, to median income at T2, which invariably shows a greater percentage gain for blacks. Yet there are other data which make these findings suspect. For example, nonwhites made up 26.9 percent of those below the poverty level in 1959, and 31.] percent in 1970 (Bureau of the Census, 1973a). Also, nonwhites made up 20.4 percent of the unemployed population in 1960 and 18.4 percent in 1970 (and this latter figure had increased to 19.8 percent by 1972) (Bureau of the Census, 1973a). And for a more subtle indicator, the ratio of black to white infant mortality rates remained virtually constant from 1959-70, with the black 1970 rate (30.211000) still higher than the white 1950 rate (26.811000) (Bureau of the Census, 1973a). These, and a great many other statistics from related areas, seem at variance with the notion of substantial black economic gains. Wattenberg and Scammon (1973:41) shrug off such contraindicators by asserting that . . the fact that some blacks have been 'left behind' does not in itself negate the fact of massive black success. But the existence of a prospering majority is moot and has been debated at length. Those insisting on substantial gains point to the undeniably larger ratio of black to white median income, while those denying success point to similar black-white absolute gains in median family income and discount ratio gains. In a recent article

Wellsite Diagnosis of Pumping Problems Using Minicomputers

The truck-mounted computer system described here greatly enhances the efficiency of the sucker rod diagnosis technique. Using an example well, the paper shows how the method and the equipment can be used to increase production and decrease lifting costs. With this system, more definitive production and decrease lifting costs. With this system, more definitive and timely results can be obtained more efficiently, thus lowering the cost of applying the technique. Introduction The Sucker Rod Diagnostic Technique was perfected by Shell during the 1960's. Its concept was suggested by the work of British physicians who wanted to analyze human electrocardiograms more accurately and definitively. To do this, they subjected cardiograms to Fourier analysis, hoping to reveal subtle indications of heart disease that might be overlooked if only visual interpretations were made. Similarly the sucker rod method was designed to derive the maximum amount of information from a pumping-well dynamometer card and to make the analysis of the card a science rather than an art. This paper describes a portable computer system for implementing the sucker rod method. Brief Theoretical Review The basis for the diagnostic technique is a stress wave propagation problem based on the one-dimensional propagation problem based on the one-dimensional wave equation (1) The wave equation models the rod string and permits the use of surface data to deduce down-hole conditions in pumping wells. This is directly analogous to the human cardiogram where easy-to-measure surface data are used to infer conditions within the body. The boundary conditions measured at the surface are time histories of the load and position of the polished rod. These are expressed as truncated polished rod. These are expressed as truncated Fourier series of the following type: (2) (3) Solutions to the wave equation that satisfy the measured boundary conditions give operating conditions in a given well at a particular time in its producing life. The basic diagnostic solutions give producing life. The basic diagnostic solutions give displacement and load at arbitrary depths in the rod string. These are (4) and (5) The procedure for solving and generalizing for the case of tapered strings is detailed in Refs. 1 and 2. By cross-plotting the solution for displacement (Eq. 4) vs load (Eq. 5) at a given depth, a dynamometer card at that depth is obtained, This is equivalent to the card that would be measured with a dynamometer instrument placed at that depth. JPT P. 1319

The pediatric emergency department. Locus for recognition of psychosocial disability.

The prevalence of known psychiatric dis turbance in one or both parents of a 15 per cent sample of children seen over a three month period in the emergency de partment of the University of Rochester Medical Center was 12 per cent. Compari son of this group with a control group of children utilizing the emergency depart ment whose parents did not have a known psychiatric disturbance showed no signifi cant differences for race, age, or sex of the children, in frequency of use of the emer gency department, inappropriate use of the emergency department, or frequency of ap pointment breaking. Parents with charac ter disorders and anxiety reactions were most apt to use the pediatric emergency department inappropriately.Since the demographic and utilization characteristics reported upon are of no help in identifying emotional illness in par ents of children brought to the emergency department for care, more subtle indicators of psychosocial difficulties in parents are presented and methods of helping the phy sician in training to recognize and respond to them are outlined.

The time factor in a single nerve impulse

Methods for studying the time factor in arousal processes have long been a subject of discussion. The question is related not only to the study of isolated muscles and nerves, but also to clinical studies, since reflex changes in the response time of tissues can serve as a subtle indicator of functional states and neurodynamics in the higher regulatory parts of the whole organism.

An effect of tolbutamide on nucleotides of incubated whole human blood.

Fresh human blood collected in heparin and glucose was incubated without and with tolbutamide for up to 48 hours. ATP levels in the tolbutamide samples were less than in the control samples although glucose utilization appeared to be the same. It was concluded that the changes in the blood nucleotide pattern were more subtle indicators of effects of tolbutamide on energy metabolism than more conventional measures such as glucose utilization, but the implications of the findings are not entirely clear.

On the clinical significance of the study of the morphological composition of the cantharidin bladder in allergic conditions

Ressle's experimental work on the study of inflammatory processes in allergies and the connection of morphological changes with the phenomena of immunity gave him the opportunity to come to an important conclusion that "morphological processes in the foci of inflammation are one of the most subtle indicators of the onset of allergies, even the mildest degrees of it."

Takata-Aga reaction in the study of cerebrospinal fluid

The technique of this reaction, suggested by two Japanese authors, Takata and Aga, in 1926, consists in adding 1 drop of a 10% Na carbonici solution and 0.3 of a freshly prepared mixture of equal parts 0.5% sulfa solution and 0.02% fuchsin (non-acid) solution to 1 cc of liquid. The mixture is shaken well and left in a test tube, and examined now after shaking, after h, after h, and after 24 h. Having tested this reaction in 60 patients, D.K. Bogoroditsky found that it is a very subtle indicator of the state of the central nervous system.