Pulmonary oedema at necropsy: a combined pathological and radiological method of study.

Fixation of lungs at necropsy by inflation with formaldehyde vapour was used in a combined radiological and pathological study of pulmonary oedema. Pulmonary oedema was found in 79% of lungs examined. The earliest phases affect the interstitial tissue with oedematous connective tissue planes and distension of pulmonary lymphatics. These changes may be associated with reduction in the compliance of the lung. Alveolar filling is a late stage in the accumulation of oedema fluid in the lungs.

Morphological basis of radiological band shadows on chest radiographs.

Lungs of unselected cadavers were fixed at necropsy using a formalin vapour technique. "Band shadows" were identified in the excised lungs and these were correlated with in vivo radiographs and with the morphological changes in the lung. Persistent shadows were produced by pulmonary infarction, subsegmental atelectasis, and septal fibrosis singly and in combination. Potentially transient shadows were seen in association with atelectasis and pulmonary oedema.

The incubation theory of fear/anxiety: experimental investigation in a human laboratory model of Pavlovian conditioning.

The aim of this work was to test Eysenck's incubation theory of fear/anxiety in human Pavlovian B conditioning of heart rate (HR) responses. The conditioned stimuli (CSs) were phobia-relevant slides (snakes and spiders) and the unconditioned stimuli (UCSs) were aversive noises. The subjects were presented with two levels of noise intensity during acquisition and three levels of nonreinforced CS presentation (CS-only) in a delay differential (CS+/CS-) conditioning paradigm (2 x 3 x 2). Consistent with the incubation theory, conditioned HR acceleratory responses were sustained (resistance to extinction) for high-noise intensity and short-presentations of CS-only subjects. During the extinction phase, HR acceleratory responses quickly extinguished in low-noise intensity groups after the first presentations of CS-only. These findings were interpreted as support for the incubation theory of phobic fear.

Validation of the spanish version of the Anxiety Sensitivity Index in a clinical sample.

In this study we validated the Spanish version of the Anxiety Sensitivity Index (ASI) in a sample of anxiety disordered patients. The results revealed that: (1) ASI scores were higher for anxiety disordered patients than for normal control subjects, and higher for patients with panic disorder (PD) than for patients with other anxiety disorders (OAD). In contrast, there were no differences among the groups on the Cognitive-Somatic Anxiety Questionnaire (CSAQ). (2) Using discriminant analysis, we were able to differentiate PD patients from patients with OAD on the ASI, but not on the CSAQ. (3) Results supported a unidimensional factor-structure for the ASI. (4) Data provide cross-cultural evidence for construct validity and concurrent validity of the Spanish ASI, and provide further evidence for the usefulness of the concept of anxiety sensitivity.

Anxiety sensitivity index: normative data and its differentiation from trait anxiety.

In the present study we report: (1) normative data on the Spanish version of the Anxiety Sensitivity Index (ASI); and (2) empirical evidence related to differentiation between the constructs of anxiety sensitivity and trait anxiety. A sample of 390 university students (ranging in age from 18 to 34 years) completed the ASI and Spielberger's Trait Anxiety Scale (STAI-T). The means and standard deviations for the Spanish version of the ASI are similar to the ones reported by Peterson and Reiss (Anxiety Sensitivity Index Manual, 2nd edition. Worthington, OH: International Diagnostic Systems, 1992) for the English version. Factor analysis of the joint ASI and STAI-T items yielded two different factors; the STAI-T items load onto one factor (i.e., the trait anxiety factor) and the ASI items load onto the other factor (i.e., the anxiety sensitivity factor). Findings provide empirical support for validation of the Spanish ASI and are consistent with a construct distinction between anxiety sensitivity and trait anxiety.

Radiological definition of a new model of portal diversion in the rat.

Diversion of portal blood away from the liver can be accomplished in the rat by two straightforward surgical procedures: subcutaneous transposition of the spleen followed later by portal vein ligation. This experimental model has great potential value in the study of liver cell transplants, porto-systemic shunts and hepatic porto-privation. Contrast medium radiology has been used to clarify and define the model further. Splenography, achieved by direct percutaneous puncture, demonstrated the developing spleno-subcutaneous vessels. Collaterals are seen as early as 3 days and appear extensive by 21 days after transposition. Almost all emanate from the convex outer surface of the spleen and course cranially and caudally in the subcutaneous tissues to drain into the subclavian and iliac veins. The appearance of these collaterals correlates well with survival after portal vein occlusion subsequent to splenic transposition. Direct portography demonstrates that, following portal vein ligation, contrast medium is diverted away from the liver into the splenic veins, through and around the spleen, before draining into the systemic circulation through spleno-subcutaneous collaterals. These radiological studies have demonstrated the changed circulatory pathways of this model of portal diversion and have confirmed that it is the splenic veins and the spleno-subcutaneous collaterals which are fundamental to its successful outcome.

Penetrating injuries: how easy is it to see glass (and plastic) on radiographs?

The radiopacity of objects commonly associated with penetrating wounds and made from modern glass was assessed. It is concluded that all glass fragments should be detected because they are all radiopaque. Occasionally thin slivers of glass may be difficult to detect, but should be visualised with good radiography and careful scrutiny. Plastic from the housing of motor vehicle lamps is not radiopaque.

Schizophrenic strategies of survival.

This quotation contains a message as to how a robotlike and dead reality comes alive, or let us say-how the innate ego potential emerges as a personal ego experience. An individual can on the basis of this felt experience leave an early isolation and enter into a personal being, that being the individual came into the world equipped to take over but has been unable to do so because of a neglected ego development with its attendant deficient capacity to integrate an inner and outer reality.

Axon regeneration and vascularisation of nerve grafts. An experimental study.

An experimental model has been designed to assess the effect of vascularisation on axon regeneration in nerve grafts. The vascular status of the grafts has been demonstrated by microangiography and histology. Rat sciatic nerve grafts in which the vascular pedicles were left intact retained a normal vascular pattern which was not adversely affected by wrapping the graft in a polythene sleeve. In devascularised grafts, revascularisation commenced at three days and was complete at nine days. If the devascularised grafts were wrapped in a polythene sleeve, revascularisation was impeded and at fifteen days the middle segment of the graft was avascular and infarcted. The rate of axon regeneration was measured electrophysiologically in the above four groups of nerve grafts. There was a linear relationship between the rate of axon regeneration with time post-graft, axon growth proceeding at a mean rate of 1.150mm/day (S.E. +/- 0.084) after a mean delay of 4.85 days. There was no significant difference in the rate of axon regeneration in the four groups.

Effects of UCS intensity and duration of exposure of nonreinforced CS on conditioned electrodermal responses: an experimental analysis of the incubation theory of anxiety.

Eysenck's incubation theory of fear or anxiety was examined in a human Pavlovian conditioning experiment with skin-conductance responses as the dependent variable. The conditioned stimuli (CSs) were fear-relevant slides (snakes and spiders) and the unconditioned stimuli (UCSs) were aversive tones. Different groups of subjects were presented two tone intensities during the acquisition phase and three durations of nonreinforced CS (extinction phase) in a delay differential conditioning paradigm. Resistance to extinction of conditioned skin-conductance responses (conditioned fear responses) exhibited was largest for high intensity of tone and short presentations of the nonreinforced CS (CS+presented alone). The result tends to support Eysenck's incubation theory of anxiety.

Life events and stress reactivity as predictors of cancer, coronary heart disease and anxiety disorders.

The topic relative to the differential psychobiological mechanisms between cancer and coronary illness has been showing for the last years. In this sense, some theoretical models which have been formulated by relevant authors have suggested the possibility of differentiating cancer and cardiovascular disease, both the onset and the progression, from coping strategies, personality variables and affective states, as well as the different categories of psychosocial stress. Likewise, the implication of psychological distress, such as anxiety, anger and depression for the occurrence of somatic disease has been reported frequently. This research was designed to analyze the psychosocial patterns which could explain the incidence of heart disease, cancer and anxiety based disorders. Measures of life events and stress reactivity were obtained from a total of 109 patients diagnosed as having breast cancer (37), infarct (37), and anxiety (35), and from 72 normal control subjects. Our data tend to show that the cancer group was strongly predicted by lost and illness events, while the coronary group was more associated with work events. The anxiety disorders group lacked a life events dimension, but shared the same category of the infarct group. We also found a strong relationship between depressive reactions and cancer in contrast to the anxiety-anger variable that was more relevant in the infarct patients. The interaction between internal and external stress factors in the etiology of disease is also discussed.

Changes in pancreatic morphology associated with aging.

Retrograde pancreatography has been carried out at necropsy in 120 cases and the results have been analysed in statistical detail. With increasing age, changes in pancreatic anatomy occur which must not be taken to indicate pathology. These changes are: (1) low or ptotic position of the pancreas so that the papilla of Vater is below the level of L3; (2) calcification of the splenic and superior mesenteric arteries which produce calcific densities around the pancreas; (3) increasing width of main pancreatic duct along its whole length at about 8% per decade; in the elderly, widths of 1 cm can occur in the main duct in the head of the pancreas without evidence of obstruction; (4) formation of ductular ectasia which affects mainly the interlobular ductules but also intralobular ductules; (5) some ectatic ducts reach the dimensions of cysts, ie, 1-2 cm in diameter. OTHER MORPHOLOGICAL CHANGES WHICH HAVE BEEN DEMONSTRATED AND WHICH MAY PRODUCE DIFFICULTIES IN RADIOLOGICAL INTERPRETATION ARE: (a) narrowed ducts not due to stricture; (b) space-occupying lesions due to superior mesenteric artery, splenic artery, aorta, vertebral osteophytes, sympathetic ganglion, and lymph nodes; (c) metastases in the pancreas-these must be distinguished from primary pancreatic carcinoma. The implications of these findings for endoscopy and isotope pancreatic scanning will be mentioned.

Pavlovian conditioning of phobic fear: effects on skin and salivary pH.

This experimental work was designed to investigate the relationships between pH and conditioned fear. The levels of pH were measured in skin and saliva, and were studied in connection with conditioned electrodermal and heart rate (HR) responses (extinction versus resistance to extinction or enhancement). The results of this investigation show that the changes in skin and salivary pH have a tendency to occur in an inverse pattern to the changes in skin conductance and HR. The data are interpreted in terms of skin and salivary pH as new psychophysiological variables and as new tools for psychopathological and psychosomatic research.

The ossification of the costal element of the seventh cervical vertebra with particular reference to cervical ribs.

During 16 years of study at Northwick Park Hospital 715 fetuses were radiographed to determine the incidence of skeletal malformations. A technique using low kV and industrial film provided higher resolution radiographs than would have been possible in live births because of dose considerations. Gestational age calculated from LMP and ultrasound findings ranged from less than 18 weeks to 42 weeks. A separate costal element of C7, the possible precursor of a cervical rib, could be identified in 63% of fetuses. Males outnumbered females 403:311 but there was no intersex difference in the presence of such rudimentary cervical ribs with 63 and 64% respectively in each group. Of the 452 cases with separate costal elements, 73% were bilateral. Of the unilateral group 60% occurred on the right and 40% on the left. There was no significant difference in the incidence between the gestational age groups from 20 weeks onwards, confirming that the disappearance of the separate element occurs predominantly after birth, 394 cases (87%) of fetuses had an otherwise normal skeleton.

Extrarenal arterial connections of the normal renal artery.

An angiographic study in cadavers has demonstrated connections between the renal artery and remote vessels including the intercostal, testicular, and inferior mesenteric arteries in subjects with no known history of renal disease. Such communications are a potential route by which embolic material introduced into the renal artery may inadvertently reach other organs.

Intralobar septal oedema: 'D' lines.

A combined radiological and autopsy study of pulmonary oedema enables recognition of oedema lines other than Kerley 'A', 'B' and C lines. These have been designated 'D' lines. At least three varieties have been noted: (i) thick, long often angular lines seen mainly anteriorly overlying the heart shadow on the lateral film. These may also appear as horizontal or vertical band shadows, on the frontal view. (ii) Short and straight lines, occurring basally and often slightly thicker at the pleural surface, which on autopsy lung radiographs are associated with puckering of the pleura. They have also been recognised on lateral films where they resemble the pleural end of a fissure but have been seen in positions where fissures do not mormally occur, or in addition to the normal fissure. (iii) A subpleural reticular pattern surrounding spaces 1-2 cm in diameter. This has been noted only on autopsy-inflated lungs and not detected on in vivo chest radiographs. The long 'D' lines or D(i) lines occur in areas where 'B' lines are inconspicuous or absent and vice versa. Whereas 'B' lines are most prominent in areas of macroscopic alveolar pulmonary oedema, D(i) lines occur where macroscopic alveolar pulmonary oedema is often inconspicuous. The recognition that lines other than 'A', B and 'C' occur in case of pulmonary oedema greatly assists in the interpretation and diagnosis of the shadows on chest radiographs associated with pulmonary oedema.

Development and factor analytic validation of the SPANAS among women in Spain: (more) cross-cultural convergence in the structure of mood.

We reported our findings on the development and preliminary validation of a Spanish-language measure of positive and negative affect. Using confirmatory factor analytic techniques on data generated by 708 women in northern Spain, we obtained reasonable construct validity and reliability data for the measure. Consistent with past cross-cultural studies, a two-factor Positive Affect-Negative Affect (PA-NA)structure emerged, with PA and NA as relatively independent entities. The structure in this sample converged with that reported for a culturally separate group of participants. This factor structure has therefore revealed invariance across a number of cultural groups in Asia, Europe, and North America.

The radiology of stillbirths and neonatal deaths.

Whole body radiographs were made in a consecutive series of 488 infants who were either stillborn or died within the first month of life; autopsies were done in 378. The radiographs were considered to have been useful, or diagnostic in 16% overall, in 100% of infants with dwarfism, in 40% where there were external malformations; and in 9% where there were no external malformations.