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ABBREVIATIONS: EEG, electroencephalogram; Cl, clearance; Vss, volume of distribution at steady-state; Emax, maximal drug effect; N, constant expressing the sigmoidicity of the concentration-effect relationship; KPD, in vivo estimated receptor affinity; ePD, in vivo drug efficacy. 1067 A few days later Mr. Douglas called a t Crawley manor to show if possible his unexpressed apology for an intrusion that after all might have escaped attention. He could not openly excuse himself but vaguely hoped his feelings ght in some way express themselves. Margaret was touched by his embarrassment and spoke as if she had no suspicion that she had been spied upon. She questioned him al?out his parish and listened sympathetically as he bemoaned the spiritual indifference of the people. Then they were full of superstitions, belief in ghosts and elemental spirits and such remnants of barbaric days. Of course they denied all knowledge of such things if questioned by him, but things came to his ears through other channels. The servants gossiped and brought back tales to Mrs. Douglas, who was interested in psychology and would have joined the psychical research society if he had not protested. Maggie was curious to know, but dared not ask, what was the difference between village gossip and psychical research. He said his mother sometimes had extraordinary dreams, which he regretted; but which were not t o be accounted for along lines of ordinary reason. She had sometimes foreseen events that happened later just as shc had seen them in her dreams. But on the other hand, sometimes the dream was. not fulfilled, as far as he could see; as for instance when she saw a ship upon the rocks near Crawley Cove, where no wreck had been heard of by the coast-guards. But she declared they must have been mistaken; she had seen it all so clearly. And now he heard the story had gone round, and grown as stories do in the telling into a fabulous romance. He did his best to ridicule such tales, but could not cure the people of their love of such degrading superstitions as ghost and spirits. Again his listener would much have liked to ask if the dreams and ghoststories in the Bible were also degrading superstitions, and if not, why not. But she said nothing on that point, merely conveying a general impression of sympathy with him in his difficulties. And the result was he thought her one of the most sensible women he had met, and for a moment quite forgot that scene in old Sally's cottage; and when Mark joined them they were apparently on excellent terms. The vicar stayed to tea, and questioned Mark about his travels ineffectually. That subject was not welcome a t the manorhouse. And then he talked about the parish; and mentioned one or two hard cases, widows of fishermen who had a hard fight t o keep out of the dreaded poorhouse. And there he talked to some effect, and found a ready listener able and willing to give practical help. One of these widows had lost her husband precisely as was foreseen in a dream by Mrs. Douglas. The vicar told the story with a touch of pride and with the assurance that this particular prediction was exempt from the slur of superstition by the fact of its confirmation by experience. Launched on this subject he could not refrain from mentioning the fabulous romance which had grown out of the other dream that had failed to materialize in fact. I t was substantially the same as that which Jonas Micklethwaite had told to Mark, but Mark kept silence on that point. The improbability of the story.

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Three types of material have been and are still being used for that purpose. The oldest method is to use the skin from the thigh, buttocks, or back. Such skin is soft and contains relatively few hairs but has no natural lubrication. It is cut in thin transplants with the help of a special instrument, the dermatome. The transplants are placed around a rubber form, about two inches in diameter. The skin sections are then inserted into the pouch and are stitched to the skin of the perineum to prevent slipping. If all goes well, the skin segments will heal in and, with the help of artificial lubrication, the patient will then have a functioning vagina. The most striking studies in the physiology of the vaginal function and vaginal lubrication were made by W. H. Masters and V. E. Johnson. Those particularly interested in this special field would do well to peruse the pertinent articles by these two scientists. Dilatation, however, first with one or two fingers, then with an instrument, a test tube or a plastic mold, is essential. Some patients have to wear a mold for several months. If they do not or if they do not dilate regularly, the vagina is likely to contract more and more and eventually close up entirely. A new operation would then be required. Only if the wall between vagina and rectum is thin, the wearing of a mold would be inadvisable as the constant pressure could produce a fistula. In recent years a rather ingenious and, from what I have seen, so far the most successful method, has been perfected and is exelusively used by Dr. George Burou, a French surgeon in Morocco. Instead of using skin from the body to line the vaginal canal, the skin is stripped from the amputated penis and is inverted like the finger of a glove. This tubelike organ is then inserted into the previously prepared canal and utilized to form the inside of the tunnel that is destined to be a vagina. Penile skin offers advantages over skin from other areas because it has no hair at all and has nerve endings which cause it to bear the closest resemblance to that of a sexual organ. The two wound surfaces usually heal together without difficulty but dilatation is required the same as previously described. An uncircumcised penis is better because more skin is available, thus permitting the vagina to be made deeper. In any event, the outside skin of the penis, later on, represents the inner wall of the vagina. Complications in the form of contractions through scar formations, occasional granulations keloids ; , and insufficient depth of the vagina can occur after either method. They may necessitate additional minor surgery. Major surgery would be required only if the vagina has become obliterated and useless for normal sex relations.

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Objective. To report our changing trend in the operative management of adnexal torsion. Design. Retrospective study covering a period of 13 years. Setting. University affiliated teaching hospital. Patients. One hundred eighty-seven women with adnexal torsion. Intervention. Operative laparoscopy and laparotomy. Measurements and Main Results. One hundred eightyseven operations performed for adnexal torsion following the demonstration of an ovarian mass were reviewed. The mean age of the patients was 32 years range 195 years ; . Eight patients 4.3% ; were premenarchal and 20 patients 10.6% ; were postmenopausal. Eighteen patients 9.6% ; were diagnosed with adnexal torsion during pregnancy. The vast majority of the histopathological specimens were benign. Malignant ovarian lesions were found in 4 2.2% ; including 2 borderline ovarian tumors, one epithelial ovarian cancer stage 1a, and one ovarian germ cell tumor. Detorsion, cystectomy, or oophorectomy were performed in these women. Forty percent of the patients underwent laparotomy and 60% underwent laparoscopy, reflecting the changed surgical approach. During the last decade our management of torted adnexa changed and virtually all surgical procedures for adnexal masses are based on laparoscopy and are also more conservative and tissue preserving. Conclusion. The optimal management for adnexal torsion should be laparoscopic, with emphasis on tissue preservation during the reproductive years and earlier. 123. Laparoscopic Surgery in Management of Adnexal Tumors and caverject. Whole group Number of relapsed patients % ; DFS months, median, 95% CI ; Five-year DFS h % ; 95% CI ; Five-year OS b % ; 95% CI ; All relapsed patienls Locoregional Distant met Local + distant Contrl Breast 80 55 68 ; 30.4 + 5 2 ; 100 ; 17 30 9. Blanche Alter, MD National Cancer Institute, Rockville, Maryland FA is an autosomal recessive disorder, in which parents are carriers heterozygotes ; , with one normal and one mutant FA gene. There is a 1 random chance in each pregnancy of having a child who receives a mutant FA gene from both parents 1 in 2 chance from mother x 1 in chance from father ; . Cells from FA patients are sensitive to DNA cross-linking agents, which lead to aberrations in the chromosomes which can be detected under the microscope. There are more cases of FA reported in the medical literature than any of the other inherited bone marrow diseases Diamond-Blackfan anemia, Shwachman-Diamond syndrome, dyskeratosis congenita, severe congenital neutropenia, thrombocytopenia absent radii, amegakaryocytic thrombocytopenia, and Pearson's syndrome ; . The median age at diagnosis of FA is years of age, with a range from birth to over 50. Approximately 75% of FA patients in the literature have physical findings, including pigmented skin, caf-au-lait spots, short stature, thumb and radial anomalies, abnormal gonads, and structural kidney abnormalities. There are at least 7 or 8 different genes involved in FA, although a given patient has mutations in both copies of only one of the genes. The "complementation groups" which define the genes were assigned by identifying cells from patients which, when cultured with cells from other patients, corrected the sensitivity to DNA cross-linkers. They thus complemented each other, or provided the factor which was missing. If cells fail to complement, they belong to the same group. The protein products of 5 of the groups A, C, E, F, G ; form a complex in the nucleus, which permits the D2 protein to accept a small molecule called ubiquitin. This modified D2 then may interact with other proteins which form complexes in response to DNA damage. See Dr. Shimamura's report. Somatic mosaicism is the term used to describe the appearance in the blood of some cells which are not sensitive to DNA cross-linkers. At the level of the blood stem cell, a molecular event most often presumably a cross-over ; occurred, in which both mutations ended up on one chromosome, and the other was repaired. This is most easily explained in cases where the parental mutations were in different positions on the same gene. A bone marrow clone is defined as cells derived from a single stem cell, identified because they have an abnormal and identical chromosome pattern, such as missing one chromosome e.g., monosomy 7; the normal pattern would be 2 or disomy 7 ; , or mixing up pieces translocation ; of chromosomes. If at least 2 cells have the same translocation, or at least 3 the same deletion, the patient has a clone. Since only 20 cells are normally examined, the proportion or even presence of a clone may vary from time to time. The significance of a clone is under study, but in general it is the appearance of the bone marrow cells under the microscope morphology ; , rather than the clone itself that is most important. Myelodysplastic syndrome MDS ; is defined when the marrow looks myelodysplastic, with many abnormal cells, in a patient who has clinical problems because the marrow function is impaired, independent of the type or presence or amount of a clone. If the clone increases to 100% of cells, or if it is specifically monosomy 7, there may be a reason for concern regarding evolution to leukemia, but further data are needed. Treatment of FA will be described in the summaries of several other speakers, and cancer surveillance in the FA Cancer summary and cefazolin.

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S.C. Chopra Indian Council of Agricultural Research, Krishi Bhavan, New Delhi-110001, INDIA SUMMARY Goats have an important place in the Indian economy. There is a need for proper description anid evaluation of existing genetic resources and determining the need for their conservation. The paper explains the philosophy of progeny testing in goats for production of proven bucks. It contains the observations on existing selection programmes and recommendations for an improved system to provide the knowledge required to adapt record keeping and progeny testing technology to the unique Indian environment. Key words: Progeny Test, Selection Schemes RESUME Les caprins occupent une place importante dans 1'conomie de 1'Inde. II serait ncessaire de raliser une description et une valuation des ressources gntiques qui existent pour dterminer le niveau de besoin de conservation. Cet article prsente la philosophie des tests sur les descendents avec les caprins pour la production de boucs amliors. On prsente les observations reprises dans diffrents programmes de slection existants et les recommandations pour un systme amlior an d'obtenir les connaissances ncessaires pour adapter les donnes recueillies et la technologie des tests sur la descendence 1'environnement particulier de 1'Inde. Mots cls: Test sur les descendents, Schmas de slection and cefprozil. B15 EQUIPMENT MANAGER KIT - Designed with the equipment manager in mind. Four full length interior sleeves. Six small exterior pockets. Tie down strap. Adjustable hip belt. 7.5"l x 3.5"w x 9.5"h BUS-B15 59.85. Nary function study of greater than 75% predicted value. All patients were informed of the investigational nature of this study and informed consent was obtained from each patient in accordance with institutional guidelines. The patient characteristics are shown in Table 1. There were 17 males and three females with a median age of 31 years range 19 to 54 ; Stage at diagnosis included stage I1 4 patients ; , stage 111 5 patients ; , and stage IV 11 patients ; . Eleven patients had highgrade 7 immunoblastic; 3 small noncleaved, non-Burkitt's; and 1 Burkitt's ; , 8 had DLCL, and 1 had diffuse mixed cell lymphoma. Immunologic characterization showed 18 B-cell phenotypes and 2 T-cell phenotypes. Fifteen patients had extranodal involvement at presentation. All patients had received combination chemotherapy and were in first CR at the time of transplantation. The median number of cycles of combination chemotherapy administered was 6 range 3 to 10 ; Patients receiving MACOP-B methotrexate, doxorubicin, cyclophosphamide, vincristine, prednisone, and bleomycin ; had completed 12 weeks of treatment as described.' Four patients also received involved field radiation to sites of bulky disease as part of their initial therapy including mediastinal two patients ; and abdominal radiation two patients ; . The median time from diagnosis to BMT was 7 months range 3 to 11 ; The median Karnofsky Performance Status at BMT was 90% range 80% to 100% ; . Preparative regimen and supportive care. As part of the sequential studies investigating the preparative regimen for lymphoma, three different preparative regimens were used in this study. Fifteen patients received fractionated total body irradiation FTBI ; 1, 200 cGy at 200 cGy per fraction with 50% transmission lung blocks for a total of six treatments from day -8 to -6, in combination with etoposide VP-16 ; 60 mglkg on day -4 and cyclophosphamide 100 mg kg on day -2. Two patients received single-dose TBI 750 cGy on day -6. Another three patients who had prior radiation treatment received carmustine BCNU ; 450 and ceftriaxone.

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2.5% Baseline Risk of Clinical UGI Event With Conventional NSAID 2.50 1.25 1393 1.25 Baseline Risk of Clinical UGI Event With Conventional NSAID 6.5 3.25 1393 3.25. Scales with him and weighed the lot, and portioned it all out amongst us just the same as Mr. Scott, the banker, used to do for us at the Turon when we brought in our month's washing-up. We had 5000 oz. Starlight had an extra share on account of being captain, and the rest had somewhere about 8000 oz. or 9000 oz. among them. It wasn't so bad. Dad wasn't long before he had our lot safely packed and on his two pack-horses. Warrigal and he cleared out at a trot, and went out of sight in a jiffy. It was every man for himself now. We waited a bit to help them with their swag; it was awful heavy. We told them that their pack-horses would never carry it if there was anything of a close run for it. `Suppose you think you've got the only good horse in the country, Dick Marston, ' says Daly. `We'll find a horse to run anything you've got, barrin' Rainbow. I've got a little roan horse here as shall run ever a horse ye own, for three mile, for a hundred notes, with twelve stone up. What do you think of that, now?' `Don't take your shirt off, Patsey, ' I said. `I know the roan's as good as ever was foaled' so he was and celestone.

Dolecek TA, Grandits G. Dietary polyunsaturated fatty acids and mortality in the Multiple Risk Factor Intervention Trial MRFIT ; . World Rev Nutr Diet 1991; 66: 205-16. Ascherio A, Rimm EB, Stampfer MJ, Giovannucci EL, Willett WC. Dietary intake of marine n-3 fatty acids, fish intake, and risk of coronary disease among men. N Eng J Med 1995; 332: 977-82. Morris MC, Manson JE, Rosner B, Buring JE, Willett WC, Hennekens CH. Fish consumption and cardiovascular disease in the Physicians' Health Study: a prospective study. J Epidemiol 1995; 142: 166-75. Siscovick DS, Raghunathan TE, King I, Weinmann S, Wicklund KG, Albright J, Bovbjerg V, Arbogast P, Smith H, Kushi LH, Cobb LA, Copass MK, Psaty BM, Lemaitre R, Retzlaff B, Childs M, Knopp RH. Dietary intake and cell membrane levels of long-chain n-3 polyunsaturated fatty acids and the risk of primary cardiac arrest. JAMA 1995; 274: 1363-7. Roche HM, Gibney MJ. Effects of long-chain n-3 polyunsaturated fatty acids on fasting and postprandial triacylglycerol metabolism. J Clin Nutr 2000; 71 suppl ; : 232S-7S. Harris WS. Fish oils and plasma lipid and lipoprotein metabolism in humans: a critical review. J Lipid Res 1989; 30: 785-807. Harris WS. n-3 fatty acids and serum lipoproteins: human studies. J Clin Nutr 1997; 65 suppl 5 ; : 1645S-54S. Rissanen T, Voutilainen S, Nyyssnen K, Lakka TA, Salonen JR. Fish oil-derived fatty acids, docosahexaenoic acid and docosapentaenoic acid, and the risk of acute coronary events; the Kuopio Ischaemic Heart Disease Risk Factor Study. Circulation 2000; 102: 2677-9. National Research Council. Toxicological effects of methylmercury. Washington, D.C.: National Academy Press, 1999. Burr ML, Fehily AM, Gilbert JF, Rogers S, Holliday RM, Sweetnam PM, Elwood PC, Deadman NM. Effects of changes in fat, fish and fibre intakes on death and myocardial reinfarction: Diet and Reinfarction Trial DART ; . Lancet 1989; 2: 757-61. de Lorgeril M, Salen P, Martin J-L, Monjaud I, Delaye J, Mamelle N. Mediterranean diet, traditional risk factors, and the rate of cardiovascular complications after myocardial infarction: final report of the Lyon Diet Heart Study. Circulation 1999; 99: 779-85 and carmustine.

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Guerin, C, Laterra J, Masnyk T, Golub LM, Brem H. "Mechanisms of antiangiogenesis: relationship of anticollagenase activity and endothelial cell growth." AANS, San Francisco, CA., April 1992. Weingart J, Olivi A, Brem H. "Tumor growth inhibition by minocycline." American Association of Neurological Surgeons, San Francisco, CA, April, 1992. Brem H, Olivi A, Greenhoot JH, Sisti, M. "Interstitial chemotherapy with BCNU-loaded polymers for the treatment of newly diagnosed malignant astrocytomas: A clinical study." American Association of Neurological Surgeons, San Francisco, CA, April, 1992. Sills AK, Davis JD, Brem H. "Prolongation of survival by interstitial dexamethasone in a rat glioma model." American Association of Neurological Surgeons, San Francisco, CA, April, 1992. Olivi A, Park HC, Epstein JI, Domb AJ, Brem H. "Biocompatible polymers as means to reduce the postoperative epidural scar in a rat model." American Association of Neurological Surgeons, San Francisco, CA, April, 1992. Weingart J, Tamargo R, Brem H. "Minocycline, an anti-angiogenesis inhibitor, inhibits brain tumor growth."American Association for Cancer Research, San Diego, CA, 33: 75, 1992. Weingart J, Brem H, Long DM, Zinreich J. "Application of a computer-associated localizing probe using 3-D CT MRI images in neurosurgery." Congress of Neurological Surgeons, Washington, D.C., October 31 - November 5, 1992. Buahin KG, Colvin OM, Brem H. "Interstitial chemotherapy of a brain tumor model: comparison of intratumoral injection versus polymeric controlled release." Congress of Neurological Surgeons, Washington, D.C., October 31 - November 5, 1992. Buahin KG, Ludeman SM, Colvin OM, Brem H. "Efficacy of deuterated 4hydroperoxycyclophosphamide against a rat glioma model." Congress of Neurological Surgeons, Washington, D.C., October 31 - November 5, 1992. Weingart J, Brem H. "Minocycline, an angiogenesis inhibitor, acts synergistically with carmustine BCNU ; to control 9L gliosarcoma growth. The American Society for Cell Biology Denver, Colorado, November 15-19, 1992. Rothman GB, Holliday MJ, Brem H, Mattox DE, Long DM. "Posterior fossa meningiomas: A retrospective review." North American Skull Base Society, Scottsdale, Arizona, 1993, Vol 3, p. 11. Mattox DE, Long DM, Brem H, Bryant N, Trebo S, Zinreich SJ. "Imaging-based computer-assisted surgery for skull base and intracranial surgery: Experience of 81 cases." North American Skull Base Society, Scottsdale, Arizona, 1993, Vol 3, p. 13. Brem H, Cahan MA, Caterall M, Tyler B, Pinn M, Weingart J, Domb A, Ringel I, Hilton J, Colvin M. "Inhibition of brain tumor growth by taxol." American Association of Neurological Surgeons, Boston, Massachusetts, p. 479, 1993. Buahin KG, Hilton J, Brem H. "Effect of interstitial chemotherapy with polymeric delivery of a cyclophosphamide congener on glucose metabolism in the brain." American Association of Neurological Surgeons, Boston, Massachusetts, p. 524, 1993. Weingart J, Brem H. "Interstitial delivery of minocycline, an angiogenesis inhibitor, acts synergistically with carmustine BCNU ; to prolong survival in a 9L gliosarcoma intracranial model." American Association of Neurological Surgeons, Boston, Massachusetts, p. 498, 1993.

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Hospital, Potomac Ridge Behavioral Health System, Adventist Rehabilitation Hospital of Maryland, Adventist Senior Living Services and Adventist Home Health. Headquartered in Rockville, Maryland, AHC is the largest private employer in Montgomery County and one of the largest employers in Maryland. Arc's mission is to "Demonstrate God's care by improving the health of people and communities through a ministry of spiritual, mental and physical healing." 2007 marks the 100th anniversary of the founding of Washington Adventist Hospital, the first member of the Adventist HealthCare family of organizations and cerezyme.
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