Showing papers by "Medical University of South Carolina published in 1980"
TL;DR: The prevalence of scleroderma-type capillary abnormalities, as observed by in vivo microscopy, was determined in 173 patients from three rheumatic disease centers, finding enlarged and deformed capillary loops surrounded by relatively avascular areas, most prominently in the nail-folds were found in 82% of patients with sclerodma and in 54% with mixed connective tissue disease.
Abstract: The prevalence of scleroderma-type capillary abnormalities, as observed by in vivo microscopy, was determined in 173 patients from three rheumatic disease centers. The patients had a variety of connective tissue diseases: scleroderma (systemic sclerosis) 50; systemic lupus erythematosus 60; mixed connective disease 26; Raynaud's disease 11; other rheumatic disorders 26. Enlarged and deformed capillary loops surrounded by relatively avascular areas, most prominently in the nail-folds, were found in 82% of patients with scleroderma and in 54% with mixed connective tissue disease. The rarity of these abnormalities in systemic lupus erythematosus (2%) despite the presence of Raynaud's phenomenon suggests that they are not an expression of the Raynaud's phenomenon frequently associated with scleroderma and mixed connective tissue disease. The single patient with Raynaud's disease and sclerodermatype capillary changes subsequently developed scleroderma.
364 citations
TL;DR: This paper reviews available methods for assessing the nutritional status; their possible limitations when applied to uremic patients are discussed and Serial monitoring of selected nutritional parameters in the same individual may improve the sensitivity of these measurements to detect changes.
329 citations
185 citations
TL;DR: In a training programme to improve the accuracy with which family doctors rate psychiatric disturbances in their patients an agreement coefficient (kappa) was calculated for each trainees between their ratings of psychiatric disturbances and the symptom levels of their patients as reported on the General Health Questionnaire (GHQ-28).
158 citations
TL;DR: Occipital cortex was taken from fetal rats and transplanted to the tectal region of newborn rats, where it developed a specific structural identity reflecting in part its cortical origin.
Abstract: Occipital cortex was taken from fetal rats and transplanted to the tectal region of newborn rats, where it developed a specific structural identity reflecting in part its cortical origin. The implants showed locally distributing intratransplant connections, and the majority formed connections with defined regions of te host cerebral cortex and the brainstem. A sparse afferent projection from the host had its origin in visual, somatosensory, and cingulate areas of te cortex, pretectum, superior colliculus, central gray, hypothalamus, pontine reticular formation, raphe nuclei, and the locus coeruleus. No input was identified from either the retina or the dorsal thalamus. Efferent fibers were observed in normal fiber preparations as compact bundles running through the host brainstem along two main routes, one group of bundles in a dorsal position and a second group more ventral. Efferent fibers traveling rostrally along the first pathway distributed in the lower part of the stratum griseum superficiale and in the intermediate laminae of the superior colliculus, and in some cases they reached the pretectum and the lateral posterior thalamic nucleus. Deep efferent fibers ran rostrally and caudally in the central gray, and in some cases laterally directed fibers were seen to distribute in the midbrain tegmentum and reticular formation, in one case reaching the pontine gray. The finding that most afferent and many efferent connections of cortical transplants are uncharacteristic of normal cortex stands in marked contrast to retina and tectum, which, when transplanted to the same region, make relatively normal connections.
146 citations
TL;DR: It is suggested that a special affinity exists between the axons of the retinal transplants and host visual structures and factors, such as competition and timing, may be important in determining the distribution of the transplant axons within the specific target nuclei.
Abstract: Retinae were taken from fetal rats and transplanted adjacent to the superior colliculus of neonatal rats. After 1 month survival, the transplants were surgically removed from the hosts, locally damaged or injected with horseradish peroxidase (HRP) to determine the distribution of the transplant efferents in the host brains. Histological examination of the transplants revealed cell and plexiform layers characteristic of normal retinae. Since the retinae were undifferentiated at the time of transplantation, this layering developed within the host. The only obvious differences from normal retina were that the layers were organized in rosettes or folded sheets and lacked well developed photoreceptor outer segments. In animals which had lesions or HRP injections confined to the retinal transplant, proper staining of sections of the host brain revealed transplant projections. These projections were confined to the optic tract and nuclei which are normally retinorecipient such as the superior colliculus and dorsal lateral geniculate nucleus. Projections were found along the border of non-retinorecipient nuclei such as the lateral posterior nucleus, but did not appear to enter these nuclei. It was observed that within the superior colliculus the host retinal input had an effect on the distribution of the transplant projection. In one-eyed hosts the transplant projection was distributed throughout the stratum (s.) zonale, s. griseum superficiale, and s. opticum; whereas in the two-eyed hosts, the transplant projection was confined to the s. zonale and the border between s. griseum superficiale and s. opticum.
138 citations
TL;DR: Previous infection, although adequately controlled, may leave a heritage of pigment deposition, basement membrane thickening and immunopathological lesions which may account for both the high frequency of intra-uterine growth retardation and the rarity of congenital malaria in the presence of P. falciparum malaria.
Abstract: Histological and ultrastructural studies of four placentae heavily infected with Plasmodium falciparum revealed large intervillous accumulations of erythrocytes containing parasites together with monocytes which had ingested pigment. These appearances were associated with focal syncytial necrosis, loss of syncytial microvilli and proliferation of cytotrophoblastic cells. In addition, marked irregular thickening of trophoblastic basement membranes and protrusion of tongue-like projections of syncytiotrophoblast into the basement membrane were observed. In six other placentae which contained scanty amounts of pigment but no parasites, representing past or inactive infection, no large collections of monocytes or abnormalities of trophoblast were apparent but basement membrane thickening was evident. Immunohistological studies revealed no significant differences between placentae positive for parasites and those containing pigment only, although the amount of certain immunoproteins and clotting factors was clearly increased above normal. These findings establish that P. falciparum infection in the placenta may result in substantial damage although lesions within the villus are rare. Furthermore, previous infection, although adequately controlled, may leave a heritage of pigment deposition, basement membrane thickening and immunopathological lesions. These results may thus account for both the high frequency of intra-uterine growth retardation and the rarity of congenital malaria in the presence of P. falciparum malaria.
137 citations
TL;DR: Therapy based on the understanding of the pathogenesis ofatherosclerosis and of microvascular disease and an important role for the platelet has been postulated has been proposed, and is under investigation in large-scale cooperative studies of patients with diabetes mellitus.
Abstract: In spite of great advances in treatment of diabetes mellitus, accelerated disease of the microcirculation and the large vessels accounts for the majority of cases of blindness, renal failure, and sudden cardiac death. In insulin-dependent diabetes, life expectancy is 17 years less than the general population (Marks & Krall, 1973). Renal failure and sudden cardiac deaths contribute maximally to the mortality figures, while blindness from obliterative retinal vascular disease occurs in many diabetics of long duration. In non-insulin dependent diabetics, life expectancy is also shortened, either by atherosclerosis of the larger vessels of heart, legs or brain or by associated microvascular disease. Recent studies have improved our understanding of the pathogenesis ofatherosclerosis (Ross 8i Glomset, 1975) and of microvascular disease (McMillan, 1975; Colwell et al, 1979a, b) and an important role for the platelet has been postulated (Colwell et al , 1976; Sage1 et al , 1975). Many studies have now shown that altered platelet function occurs in diabetes mellitus, and the biochemical mechanisms which may underly these platelet functional abnormalities are becoming clear. Therapy based on these studies has been proposed, and is under investigation in large-scale cooperative studies of patients with diabetes mellitus.
135 citations
TL;DR: The simplification ofganglioside composition seems to be associated with transformation of the astrocyte with the accumulation of the simpler gangliosides, since the changes resemble those reported with in vitro transformation rather than those of analyses of preparations of purified glial cells.
Abstract: Ganglioside content and composition were examined in a series of 25 human gliomas, which were graded histologically by the criteria of Kerno-han. The concentration of total gangliosides (lpid-bound sialic acid [LBSA]) was decreased with respect to normal brain tissue in nearly all tumors and the extent of reduction correlated with the stage of tumor anaplasia. The distribution of individual gangliosides was altered in glial tumor tissue with an increase in proportion of the structurally simple gangliosides and reduction of polysialogangliosides. The most consistent and significant difference was the elevation of proportion of ganglioside GD3 from 4–5% of total LBSA in normal brain to 20% in the astrocytoma grade IV. The proportions of gangliosides GM2 and GD2 were also found to be elevated in all grades of the tumors. The simplification of ganglioside composition seems to be associated with transformation of the astrocyte with the accumulation of the simpler gangliosides, since the changes resemble those reported with in vitro transformation rather than those of analyses of preparations of purified glial cells.
131 citations
TL;DR: Specific patterns of the trait suggest its association with extraoral findings and may help to identify the etiology ofHypodontia.
Abstract: Hypodontia, agenesis of one or more teeth, is a common trait in modern populations and one that is often encountered by the dental practitioner. Specific patterns of the trait suggest its association with extraoral findings and may help to identify the etiology.
119 citations
TL;DR: The data show that a specific and sensitive direct RIA has been developed and that both the Tos-Arg-OMe esterase and kininogenase assays measure human urinary kallikrein activity specifically, at least in the described circumstances.
Abstract: Human urinary kallikrein was purified to homogeneity, and an antiserum to it was raised in rabbits. A RIA was devised which uses this rabbit antiserum (Keq= 2.75 × 1011 M-1) in a final dilution of 1:2,500,000 and the purified kallikrein labeled with 125I using a lactoperoxidase method. Assay sensitivity is 8 pg kallikrein. Thus far, the assay is specific for human and perhaps monkey urinary kallikrein. Correlations between this assay of immunoreactive kallikrein and the α-N-Tosyl-L-arginine-[3H]methylester (Tos-Arg-OMe) activity method or a kininogenase assay were highly significant (r = 0.94 and 0.96, respectively) and show that each assay measures human urinary kallikrein comparably. Low or high dietary sodium intakes,maneuvers known to change human urinary Tos-Arg-OMe esterase excretion, change immunoreactive kallikrein to an equivalent degree. Normal black children, already known to excrete significantly less Tos-Arg-OMe esterase than white children, excrete similarly reduced amounts of immunoreactive...
TL;DR: Results indicated that over separating distances of 5.4 cm 150 to 200 bands should be resolved and that considerable differences between two commercial carrier ampholytes exist, and Pharmalyte carrier Ampholytes from Pharmacia have better continuity and conductance over the range of pH 3–10 but require much higher field strengths to achieve maximal separation than do LKB Ampholines over a similar pH range.
Abstract: Polyacrylamide gel isoelectric focusing was carried out using 250 μm thick gels backed with polyester films at voltage gradients up to 460 V/cm. Peltier cooling was employed with berrylium oxide heat transfer plates to achieve adequate cooling. Visualization of low protein concentrations was obtained by the use of a highly sensitive silver staining technique. Results indicated that over separating distances of 5.4 cm 150 to 200 bands should be resolved and that considerable differences between two commercial carrier ampholytes exist. Pharmalyte carrier ampholytes from Pharmacia have better continuity and conductance over the range of pH 3–10 but require much higher field strengths to achieve maximal separation than do LKB Ampholines over a similar pH range.
TL;DR: Evidence for the formation of THβC's as well as their neurochemical, neuroendocrinological, and behavioral effects is described in this review.
TL;DR: In this paper, the authors examined the ability of human cells to bind transferrin and transferrin-specific proteins in normal human serum, including albumin, α-1-antitrypsin, and α-2-macroglobulin.
TL;DR: A time schedule of neuron generation in the cortical transplants similar to that observed during normal development of the cerebral cortex, which is not disturbed by the transplanting procedure is suggested.
Abstract: The neurogenesis of immature cerebral cortex transplants was investigated using tritiated thymidine (3HT) autoradiography. Cortical tissue taken from rat fetuses during their last week of gestation (E15-E21) was transplanted to the tectum or cerebral cortex of newborn rat hosts. At different times after transplantation, a single injection of 3HT was given to the host. Most of the experimental animals were killed after the transplants had grown to maturity (5–12 weeks), and some were studied shortly after the tracer had been given. In other experiments, donor tissue was used that was labeled in utero up to 1 day before being transplanted on E16, E17, E18, or E19.
TL;DR: In this paper, the authors test the hypothesis that rape victim fears are classically conditioned (i.e., present during or subsequent to the assault) and test whether or not they are present during an attack.
Abstract: To test the hypothesis that rape victim fears are classically conditioned (i.e., present during or subsequent to the assault), 20 rape victims and 12 nonvictims completed a Modified Fear Survey which contained standard items from the Wolpe and Lang fear survey as well as items originating from victim reports of fearful situations. The survey was scored for rape fears and total fears. No difference was found between groups on mean rape fears or total fears. However, a significantly greater variance of rape fear scores was observed for victims. Subsequent analyses of items rated as extremely fear-provoking revealed differences between victims and nonvictims. Items and situations rated as most disturbing for rape victims support the hypothesis that victims are significantly disturbed by rape-related situations and associations. Content analysis of highly ranked items suggests that the violent, rather than sexual, aspects of the assaults are most fear-engendering.
TL;DR: In this article, a stochastic version of catastrophe theory is presented, using stochastically differential equations, and it is shown that there is a nontrivial relationship between the potential functions of deterministic models and the stationary probability density functions of the stochiastic models.
TL;DR: A highly enriched sarcolemma preparation was isolated by a combination of homogenizations and differential centrifugations of a homogenate of canine ventricular tissue followed by centrifugation of a membrane fraction layered over 24% (w/v) sucrose, suggesting that the preparation contains a large fraction of intact right-side-out vesicle but that about 24% of the vesicles in the preparation may be freely permeable.
TL;DR: A 3-year-old boy with prune"-belly syndrome during a urinary tract infection with Proteus mirabilis develops hyperammonemia, which rapidly improved following parenteral antibiotic therapy and continuous catheter drainage of the urinary tract.
Abstract: Hyperammonemia with coma, tachypnea, and respiratory alkalosis developed in a 3-year-old boy with prune"-belly syndrome during a urinary tract infection with Proteus mirabilis. Hyperammonemia is thought to have resulted from the production within the massively dilated urinary tract of excessive amounts of ammonia due to bacterial urease, and its subsequent reabsorption into the systemic circulation. The patient rapidly improved following parenteral antibiotic therapy and continuous catheter drainage of the urinary tract.
TL;DR: A significant contribution of HO‐P to pharmacologic effects is suggested at low single and long‐term oral doses of propranolol and saturation of naphthalene ring oxidation as a main determinant of proPRanolol bioavailability is suggested.
Abstract: The disposition of the pharmacologically active 4-hydroxypropranolol (HO-P), its glucuronic acid conjugate (HO-P-G), and propranolol were compared after single intravenous and oral doses of propranolol in 6 normal subjects and after long-term therapy in 32 patients with hypertension or coronary artery disease The areas under the plasma concentration/time curves (AUC∞, ng · hr/ml) after 4-mg intravenous doses of propranolol were 66 ± 22 (mean ± SEM) for HO-P and 55 ± 11 for propranolol After 20- and 80-mg oral doses the AUC∞ for HO-P were 59 ± 9 and 162 ± 21 and for propranolol were 72 ± 9 and 306 ± 46 Peak HO-P concentrations were reached at 1 to 15 hr after the oral doses Although there was a rapid decline in plasma HO-P between 15 and 3 hr when HO-P-G was still rising to levels above HO-P levels 35- to 5-fold, the apparent half-lifes (t½s) after 3 hr were in the same range for HO-P, HO-P-G, and propranolol (30 to 42 hr) While during long-term therapy plasma HO-P rose over the whole dose range (40 to 960 mg daily) in an apparently linear fashion, the HO-P/propranolol plasma level ratio fell from 107 ± 013 at 40 mg daily to only 009 ± 001 at 640 mg daily Plasma HO-P-G rose exponentially with dose and demonstrated significant cumulation HO-P and HO-P-G in urine accounted for about 9% of long-term propranolol doses This study suggests a significant contribution of HO-P to pharmacologic effects, in particular at low single and long-term oral doses of propranolol and saturation of naphthalene ring oxidation as a main determinant of propranolol bioavailability
Clinical Pharmacology and Therapeutics (1980) 27, 22–31; doi:101038/clpt19804
TL;DR: Application of cytochemical methods for complex carbohydrates at the light and electron microscopic levels served further to differentiate secretory cells of the rat tracheobronchial surface epitheliuim into serous and mucous categories, and permitted subclassification of serous cells into four types and of mucous Cells into three types.
Abstract: Application of cytochemical methods for complex carbohydrates at the light and electron microscopic levels served further to differentiate secretory cells of the rat tracheobronchial surface epitheliuim into serous and mucous categories, and permitted subclassification of serous cells into four types and of mucous cells into three types. The granules in different serous cells and Clara cells varied in staining with the periodic acid-thiocarbohydrazide-silver proteinate (PA-TCH-SP) method, but generally lacked dialyzed iron (DI) affinity and apparently contained neutral glycoprotein. However, in some focal areas, serous and Clara cell granules showed a pattern of DI staining similar to the PA-TCH-SP reactivity. The PA-TCH-SP and DI methods stained granule glycoconjugate comparably in the three mucous cell types. The lack of high iron diamine (HID) affinity in these sites testified to carboxylated, periodate-reactive mucosubstance, presumably sialylated glycoprotein. The luminal surface of the apical plasmalemma of all surface epithelial cells stained with DI but lacked HID affinity. The PA-TCH-SP technique stained the surface of the apical plasmalemma of mucous cells, serous cells, and Clara cells in decreasing order of intensity. Microvilli of cililated cells were PA-TCH-SP-positive, but cilia were unreactive and apparently contained a glycosaminoglycan rather than the presumed sialylated glycoprotein of the other surfaces. DI and PA-TCH-SP reactivity of the apical far exceeded that of the basolateral plasmalemma in all surface epithelial cells. Two strata, presumed to be the lamina lucida and the lamina diffusa of the basement membrane under all the surface epithelial cells, stained with the DI but not the PA-TCH-SP method and apparently contained glycosaminogycan. Intraepithelial cells, interpreted as globule leukocytes, appeared to represent mast cells infiltrating the epithelium and carrying out endocytic activity.
TL;DR: Serial recordings of SEPs in patients with spinal cord injury can provide valuable information concerning the extent of the lesion (diagnosis), an index of changes in cord function (monitoring), and predictive data regarding outcome (prognosis).
Abstract: The use of evoked response techniques in the evaluation of patients with nervous system trauma is now an accepted procedure and an area of intense investigative activity. In comatose head injuries, studies with a combination of visual evoked potentials, somatosensory evoked potentials (SEPs), auditory evoked potentials, and auditory brainstem responses have shown that there is a close correlation between the degree of evoked response abnormality and the clinical outcome of the patient.' This was particularly evident with regard to the SEP since it was found that the presence of a relatively undistorted response early after the injury was the single most important prognostic indicator of a good recovery. There has been increasing interest lately in the application of the SEP technique to the study of patients with spinal cord injury.*-\" The technique would seem well suited to the noninvasive study of spinal cord conduction through an injury site. Potential limitations include the fact that the response is mediated mainly through the posterior columns and the fact that the response may be affected by factors unrelated to the extent of spinal injury, e.g., the patient's age, level of arousal, drugs, and the presence of any associated brain injury. Despite these caveats, serial recordings of SEPs in patients with spinal cord injury can provide valuable information concerning the extent of the lesion (diagnosis), an index of changes in cord function (monitoring), and predictive data regarding outcome (prognosis). Evoked responses recorded over the and short-latency or far-field SEPS'~-' ' also show promise as electrodiagnostic tools for the analysis of pathologic lesions of the spinal cord. At this time there is also great interest in the use of SEP recording intraoperatively as a monitor of cord function during corrective surgery for scoliosis and the removal of intraspinal neoplastic, vascular, or other lesion^.'^-^^
TL;DR: Results suggest that previously cryptic antigens were revealed by the activity of neuraminidase on the plasma membranes of the treated RBC, and reacted specifically with the less dense RBC subpopulations.
01 Oct 1980
TL;DR: It is proposed that the pathognomonic lamellae of ALD basically represent bilayers or bimolecular leaflets of very long chain saturated fatty acids, while lamellar-lipid profiles and clefts contain cholesterol esterified to these abnormal fatty acids.
Abstract: Thirty adrenal glands from patients with adreno-leukodystrophy (ALD) have been studied by light microscopy, three by enzyme histochemistry, three by electron microscopy and two by tissue culture. Cytoplasmic ballooning and striations result from proliferation of smooth endoplasmic reticulum and accumulations of lamellar-lipid profiles and clear clefts (crystalloids). Striated adrenocortical cells, the only pathognomonic adrenal lesion in ALD, display cytoplasmic lamellae, decreased amounts of rough endoplasmic reticulum and depression of several enzymes (alpha-glycerophosphate dehydrogenase, 3 beta-hydroxysteroid dehydrogenase and TPNH diaphorase). The striated cells also demonstrate decreased ability to adapt to changes in microenvironment, both in vivo and in vitro. A blunted response by striated cells to focal peripheral cytolysis leads to cytoplasmic erosion, atrophy and macrovacuoles. ACTH has a pivotal role in the evolution of these lesions. We propose that the pathognomonic lamellae of ALD basically represent bilayers or bimolecular leaflets of very long chain saturated fatty acids, while lamellar-lipid profiles and clefts contain cholesterol esterified to these abnormal fatty acids. The similarity of lamellar-lipid profiles of ALD to cytoplasmic lesions induced by long chain saturated fatty acids suggests that the very long chain saturated fatty acids isolated in ALD are cytotoxic and are responsible for adrenocortical cell dysfunction in this disease.
TL;DR: The finding of pigment in all Gambian placentae examined, of which seven were thought initially to be uninfected, indicates that malaria may complicate pregnancy more frequently than hiterto anticipated.
Abstract: To facilitate investigations of the consequences of malarial infection during human pregnancy, several methods for the recognition of pigment and parasites in the placenta were evaluated. Pigment was visualized in infected blood smears and placental tissue using both white light and modified fluorescence microscopy. However, the characteristic pigment dots observed with fluorescent light were also apparent in unstained cryostat and deparaffinized placental sections, and following reaction with immunohistological reagents. Intact parasites were recognized immunohistologically in placental sections and blood smears using rabbit antisera to Plasmodium falciparum and P. berghei. Using these procedures, numerous erythrocytes containing parasites associated with small pigment dots were seen in intervillous spaces in heavily infected placentae. In these organs, larger irregular pigment aggregates were present within maternal cells which were shown to be monocytes by esterase staining. Pigment was also observed in the cytoplasm of the trophoblast and not infrequently in the mesenchymal stroma, but no intact parasites were observed within chorionic villi. These simple and sensitive methods thus confirm placental localization of parasites and pigment. Furthermore, the finding of pigment in all Gambian placentae examined, of which seven were thought initially to be uninfected, indicates that malaria may complicate pregnancy more frequently than hitherto anticipated.
TL;DR: Cytochemical staining observed here provided evidence on synthesis and intracellular metamorphosis of mucous droplets and on formation of glycocalyx.
Abstract: Ultrastructural and complex-carbohydrate cytochemical studies were carried out on guinea pig gastric mucosa to assess the histochemical properties of the secretions of different gastric epithelial cells and to investigate the differentiation, origin, and renewal of certain cell types. The observations disclosed heterogeneity or variability of the secretory granules within individual mucigenic cells and zymogen cells. The cytochemical methods also served in characterizing and distinguishing five cell types in the gastric glands, including the isthmus cell, a mucous cell considered comparable to the mucous neck cell, the chief cell, and forms transitional between the isthmus and mucous cells and the mucous and zymogenic cells. The several cell types differed widely in the cytochemical properties of the secretory granules and of the apical plasmalemma, and each had a distinctive distribution in the gastric gland. Cytochemical staining observed here provided evidence on synthesis and intracellular metamorphosis of mucous droplets and on formation of glycocalyx.
TL;DR: Resistant cells, removed from FdUrd for several generations, did not proliferate immediately upon reintroduction of the drug; however, loss of sensitivity was much more rapid than upon initial exposure, suggesting that the primary mode of drug action is to diminish thymidine metabolites.
TL;DR: The present research measured the interview techniques of 12 trainee family doctors who made inaccurate assessments of their patients’ degree of psychiatric disorder, and offered them 4 sessions each of teaching based on acquisition of a simple model and videotaped feedback in an attempt to modify their interview techniques.
Abstract: Recent studies indicate that family doctors fail to detect a substantial proportion of minor psychiatric disorders, and there is considerable variation between doctors in their ability to make accurate assessments. Previous research had indicated that such ability was correlated with certain interviewing techniques and variables relating to the doctors’ personality. The present research measured the interview techniques of 12 trainee family doctors who made inaccurate assessments of their patients’ degree of psychiatric disorder, and then offered them 4 sessions each of teaching based on acquisition of a simple model and videotaped feedback in an attempt to modify their interview techniques. The interview techniques were then measured again 1–4 months later. The reliability of the ratings of interview techniques is given, together with details about those medical behaviours which were capable of modification, and those which persisted unchanged.