Flavin-dependent substrate photo-oxidation as a chemical model of dehydrogenase action. As a model of flavin-dependent biological dehydrogenation, flavin-sensitized photodehydrogenation and photodecarboxylation were studied by variation of substrate, flavin, pH and solvent. Evidence for the following rules is given. (1) When the reactive site of a photosubstrate is an alpha-carbon atom of the type CH-CO2-, decarboxylation is preferred over dehydrogenation, whereas the reverse is true for the neutral CH-CO2H. (2) Consequently these reactions do not exhibit a measurable isotope effect with C2H-CO2-, in contrast with the findings by Penzer, Radda, Taylor & Taylor [(1970) Vitam. Horm. (N.Y.) 28, 441--466], which could not be reproduced. When the substate does not contain a carboxylate group, isotope effects occur, in verification of previous reports, e.g. for benzyl alcohol C6H5-C2H20H. (3) The mechanism of flavin-sensitized substrate photodecarboxylation is assumed to consist in a primary carbanion fixation at the flavin nucleus (position 4a, 5 or 8) with concomitant liberation of CO2. This step is followed by rapid fragmentation of the adduct CH-Fl-red., provided that the substrate contains a functional and electron-donating group X, e.g. X = OH, OCH3 or NH2 (but not NH3+ !) in X CH-CO2-. (4) The minimal requirement for flavin-sensitized C-H dehydrogenation is the presence of a hydroxyl group. For example, methanol as substrate and solvent is dehydrogenated at pH sufficiently alkaline for detection of the presence of the active species CH3O-, whereas at more acidic pH substrate dehydrogenation is competing with flavin autophotolysis, which depends on the substituents in the flavin nucleus.


Lymphocyte depletion by continuous flow cell centrifugation in rheumatoid arthritis: clinical effects. Four patients with active, severe rheumatoid arthritis were subjected to the removal of circulating lymphocytes (lymphapheresis) for a 6-week period by use of a continuous flow cell centrifuge. Repetitive venous access was gained through forearm arteriovenous fistulae. In all patients the Ritchie-Camp articular index declined rapidly in the first week and more slowly therafter for a total mean drop of 61% below the initial value. The index continued to decline after lymphapheresis but exacerbation of disease activity developed at an average of 19 weeks. No significant untoward effects of the procedure were observed; occasional transfusions were required to compensate for the small, unavoidable erythrocyte loss.


Cardiac involvement in polymyositis: a clinicopathologic study of 20 autopsied patients. Cardiac involvement in polymyositis was investigated in 20 autopsied cases. Clinically, 13 of 18 patients had abnormal electrocardiograms, and 9 of the 20 patients had previous evidence of congestive heart failure. Histologically documented myocarditis was detected in 6 patients (4 with congestive heart failure and 2 without), 4 of whom also had small vessel disease of the myocardium. Patients with polymyositis may have a cardiopathy in the absence of overt myocardial inflammatory disease.


Articular cartilage preservation and storage. II. Mechanical indentation testing of viable, stored articular cartilage. Mature rabbit articular cartilage in the form of distal femoral condyles, composite osteoarticular structures, were incubated in the presence of alpha-tocopherol (200 micrograms/ml) over a period of time. Indentation testing and 35S uptake indicate preservation of sustained load carrying capacity and viability, respectively, in the presence of alpha-tocopherol for up to 30 days in organ culture. Condylar cartilage stored in the absence of alpha-tocopherol as well as frozen cartilage demonstrated progressive inability to resist sustained loading over time. Nonoptimal synthetic function apparently occurred in these latter two groups when compared to alpha-tocopherol stored material.


In vitro hexosamine depletion of intact articular cartilage by E-prostaglandins: prevention by chloroquine. Short-term incubations of intact canine articular cartilage slices with prostaglandins E1 and E2 caused significant losses of hexosamine from cartilage matrix compared to controls. Chloroquine, an inhibitor of DNA primer, prevented this prostaglandin-induced hexosamine depletion. These data suggest that E-prostaglandins may degrade articular cartilage directly through DNA-dependent RNA synthesis of cathepsin-like proteases. Catabolism of articular cartilage probably involves degradation of existing matrix in addition to inhibition of synthesis.


Evaluation of smoking-induced effects on sympathetic, hemodynamic and metabolic variables with respect to plasma nicotine and COHb levels. The effect of smoking cigarettes containing 1.5 mg and 0.08 mg nicotine per cigarette and of sham-smoking was studied in six healthy habitual smokers. Levels of carboxyhemoglobin (COHb) and plasma nicotine were measured simultaneously with hemodynamic variables, such as heart rate and blood pressure, and with the metabolic parameters, plasma DBH, cortisol, blood glucose, lactate and free fatty acids. All variables, with the exception of COHb are dose related to plasma nicotine levels. Blood pressure, heart rate and lactate show simultaneous peaks together with maximal nicotine levels, while DBH and cortisol, blood glucose and free fatty acids show a delayed reaction compared to nicotine concentrations. No effects of COHb, even with levels up to 5.6 +/- 0.5% have been observed on the variables investigated. These results demonstrate, that it is nicotine which induces considerable hemodynamic and metabolic alterations after smoking.


Blood levels, tissue distribution and the duration of action in rats of ciprofibrate, a new hypolipidemic agent. The blood levels, distribution and duration of action of ciprofibrate, an orally active hypolipidemic agent, was investigated in rats. Serum concentrations of 30 micrograms of ciprofibrate/ml are associated with significant reductions in both serum cholesterol and triglycerides in rats on a hyperlipidemic diet. Increasing the plasma concentrations of ciprofibrate to 69 micrograms/ml resulted in only a modest incremental reduction in serum lipids. The distribution of radioactivity from [14C]ciprofibrate within rat tissues was not affected by prior treatment for 14 days with ciprofibrate at either 1.5 or 3.0 mg/kg/day. Varying the dosage regimen of ciprofibrate at 30 mg/kg, with medication at intervals of one, 2 or 3 days resulted in similar peak plasma levels of about 300 micrograms/ml, 4 h after medication. The half-life of ciprofibrate, during the terminal disposition phase, was about 82 h. Levels of serum cholesterol remained suppressed up to 3 days after medication with ciprofibrate was discontinued; triglyceride levels returned to control values more slowly.


Reduction of serum cholesterol in two patients with homozygous familial hypercholesterolemia by dichloroacetate. Dichloroacetate is known to reduce plasma cholesterol and triglyceride in patients with Fredrickson Types IIb or IV hyperlipoproteinemia. We now report the effects of chronic, oral dichloroacetate administration (as the sodium salt) in two patients with severe homozygous familial hypercholesterolemia. Dichloroacetate markedly reduced serum total and low density lipoprotein cholesterol levels and lowered the low density lipoprotein to high density lipoprotein cholesterol ratio. One patient developed a polyneuropathy while receiving dichloroacetate which resolved following discontinuation of the drug. Because of its apparent toxicity, dichloroacetate cannot be recommended for chronic oral use. Investigation of the mechanism of its lipid-lowering effect, however, may provide insight into the pathogenesis and treatment of hypercholesterolemic disorders.


Effect of various isoflavones on lipid levels in triton-treated rats. The isoflavone content of some commonly used legumes was determined. In Triton-WR1339-induced hyperlipidemia in male albino rats, biochanin A, formononetin and pratensein showed hypolipidemic activity, while diadzein did not, when these isoflavones were administered as individual compounds by gastric intubation.


Renal papillary necrosis and pyelonephritis accompanying fenoprofen therapy. Renal papillary necrosis occurred after fenoprofen calcium administration in a patient with systemic lupus erythematosus and urinary tract infection. Possible mechanisms of renal damage may be hypersensitivity, decreased blood flow, and decreased production of a prostaglandin E-like substance.


Subcellular distribution of radio-labelled iron during intestinal absorption in guinea-pig enterocytes with special reference to the mitochondrial localization of the iron. 1. 59Fe-labelled ferric chloride was introduced into tied loops of guinea-pig jejunum. 2. After 5--30 min the loop was removed, the enterocytes were isolated, homogenized and subjected to analytical subcellular fractionation. 3. Uptake of 59Fe was extremely rapid and after 5 min 45% of the radioactivity sedimented in the mitochondrial fraction. 4. Density gradient centrifugation indicated that approximately 80% of this radioactivity was associated with the mitochondria themselves; the remainder was in brush-border fragments. 5. Selective disruption of the mitochondria demonstrates that the iron is localized to the matrix and the inner membrane, indicating transport of the absorbed iron into the organelle. 6. It is suggested that mitochondria are actively implicated at an early stage in the intestinal transport of iron.


Effects of 'elemental' diets on absorptive and enzymic activities and on 5-fluorouracil toxicity in rat small intestine. 1. Water absorption and cytoplasmic dipeptidase activities were determined in isolated rat small intestine after animals had fed on various 'elemental' diets or a standard rat diet and after a single injection of 5-fluorouracil. 2. Vivonex diets were associated with a decrease in dry weight of the small intestine and an increase in glucose and water absorption in vitro. 3. The nature of the dietary nitrogen profoundly affects the activities of intestinal peptidases. 4. Water absorption was severly depressed 3 days after 5-fluorouracil administration: the extent of depression was independent of the diet. Thus, any ameliorative effects of 'elemental' diets on 5-fluorouracil toxicity are unlikely to be mediated by direct protection of intestinal absorption.


Dependency upon salbutamol inhalers.

Dependency upon salbutamol inhalers. A case of dependency on salbutamol inhalers has been described. This has been discussed in relation to abuse of other drugs by alveolar absorption and other effects of salbutamol. It is not known whether the dependency is due to the salbutamol itself or to the fluorinated hydrocarbons used as propellants.


Reaction of tetraethylammonium with the open and closed conformations of the acetylcholine receptor ionic channel complex. The effect of tetraethylammonium (TEA) bromide on the neurally and iontophoretically evoked endplate current (EPC) of frog sartorius muscle was investigated using voltage-clamp and noise analysis techniques, and its binding to the acetylcholine (ACh) receptor ionic channel complex was determined on the electric organ of Torpedo ocellata. TEA (250-500 microM) produced an initial enhancement followed by a slow decline in the amplitude of the endplate potential and EPC, but caused only depression in the amplitude of the miniature endplate potential and current. In normal ringer's solution, the EPC current-voltage relationship was approximately linear, and the decay phase varied exponentially with membrane potential. Upon addition of 50-100 microM TEA, the current-voltage relationship became markedly nonlinear at hyperpolarized command potentials, and with 250-2000 microM TEA, there was an initial linear segment, an intermediate nonlinear segment, and a region of negative conductance. The onset of nonlinearity was dose-dependent, undergoing a 50 mV shift for a 10-fold increase in TEA concentration. The EPC decay phase was shortened by TEA at hyperpolarized but not depolarized potentials, and remained a single expotential function of time at all concentrations and membrane potentials examined. These actions of TEA were found to be independent of the sequence of polarizations, the length of the conditioning pulse, and the level of the initial holding potential. TEA shifted the power spectrum of ACh noise to higher frequencies and produced a significant depression of single channel conductance. The shortening in the mean channel lifetime agreed closely with the decrease in the EPC decay time constant. At the concentrations tested, TEA did not alter the EPC reversal potential, nor the resting membrane potential, and had little effect on the action potential duration. TEA inhibited the binding of both [3H] ACh (Ki = 200 microM) and [3H]perhydrohistrionicotoxin (Ki = 280 microM) to receptor-rich membranes from the electric organ of Torpedo ocellata, and inhibited the carbamylcholine-activated 22Na+ efflux from these microsacs. It is suggested that TEA reacts with the nicotinic ACh-receptor as well as its ion channel; the voltage-dependent actions are associated with blockade of the ion channel. The results are compatible with a kinetic model in which TEA first binds to the closed conformation of the receptor-ionicchannel complex to produce a voltage-depdndent depression of endplate conductance and sudsequently to its open conformation, giving rise to the shortening in the EPC decay and mean channel lifetime.


Gonorrhoea in women in Scotland. Evidence of cohorts having a higher or lower incidence than expected. Incidences of genital gonorrhoea in women higher or lower than expected occurred in patients aged 15--19 years four years after similar findings in those aged 10--14 years. This pattern was followed five years later in those aged 20--24, 11 years later in those aged 25--34, and 20 years later in those aged 35--44 years. Thus, cohorts of women at greater or lesser risk of acquiring gonorrhoea appear to exist. Most cohorts with a high incidence could be identified when in the 10--14 age group. Especially high rates of infection are predicted in the 25--34 age group in the mid-1980s and in the 35--44 age group in the late 1980s. These findings will affect the timing of health education on sexually transmitted diseases in schools and will demand a high degree of awareness among general practitioners, gynaecologists, and those working in family planning and well-women clinics of the possibility of gonorrhoea occurring in women in these age groups.


How often are gonorrhoea and genital yeast infection sexually transmitted? Although gonorrhoea is often regarded as the sexually transmitted disease against which others are measured, its infectivity is not clearly understood. Estimates of the infection rate have varied from 5--90%. In this study, 50 couples with gonorrhoea were matched with 50 couples with genital yeast infection. Gonorrhoea was diagnosed in both partners of 32 couples and genital yeast infection in both partners of 21 couples. These figures provide an indication of the sexual transmission of these conditions. The higher figure for gonorrhoea may be related to a greater urgency in tracing contacts.


The need for a chlamydial culture service. In a prospective study of unselected, female patients attending a sexually transmitted disease clinic one in eight patients would have been errouneously declared free of infection in the absence of a chlamydial culture service. Chlamydia trachomatis is now accepted as a causative organism of non-specific urethritis and post-gonococcal urethritis in men and non-specific genital infection in women. Thus, facilities for isolation of C. trachomatis should be an essential aid in the management of women attending STD clinics. Male patients would also benefit if such facilities were readily available.


[Statistical analysis of a neonatal service opened within a 2-year period]. We present a statistical study of unit 2 for newborns in Children's Hospital R. Gutiérrez, of the Buenos Aires municipality. An investigation was made which covered newborns who left the hospital from August 1976 to July 1978; during that period, 381 newborns finished their treatment. Summarizing the data assigned to death rate (22%) we could see a greater number during the first week; this tells us about the severe illness of the newborns that come into our service; we could also observe a significant mortality in newborns of high weight for their gestational age. The newborns with malformations have presented increased degree of illness and higher percentage of deaths (36%). From this review we had the idea of making a prospective study of our medical work, introducing, for a more correct evaluation, the degree of severeness when they come into the hospital and the classification of levels of high risk of the newborns.


[Counterimmunoelectrophoresis in the diagnosis of Bordetella pertussis]. The serum of 50 patients between 25 days to 15 years old who were admitted with the diagnosis of pertussis syndrome were investigated for precipitating antibodies by means of discontinuous counterimmunolectrophoresis (CIED). The presence of antibodies for Bordetella pertussis antigen was shown in 28 cases. All samples were taken within the first 24/48 hours of admission and at convalescence. The technique is easy to carry out, quick and of low cost. This test offers an adequate and fast means to differentiate a Bordetella pertussis syndrome form others produced by different viral etiologies. Besides, this serologic technique shows earlier results and of lower cost than classic techniques such as agglutination and complement fixation which are more difficult to apply.


[The triad syndrome].

[The triad syndrome]. The triad syndrome includes manifestations from urologic pathology to orthopedics, passing through the gastrointestinal to the respiratory pathology. Treatment of these syndromes calls for an intensive management, carried out by a multidisciplinarian pediatric team, to whom the surgical technique is as important as the genetic counseling; this is the only way to offer these children, who have been precociously damaged, a happy infancy. On the other hand, it is the purpose of this work to make an early discovery of congenital malformations, detecting their minimal expressions, which is the only manner to reach an early diagnosis so as to indicate an adequate therapy at the opportune moment. All this added to the fact that in 1973-1975 we gathered a few cases of triple syndrome, plus our limited bibliography (Rahman) resulted in the necessity to bring up-to-date the topic. At present, 5 years later, the satisfactory course in these patients has allowed us to indicate guidelines in the diagnosis and treatment.


[Noonan syndrome: differential diagnosis with Turner's syndrome]. Clinical and laboratory evidences assure an unequivocal identity to the syndrome described by Noonan. We believed that the terminology used by many authors has contributed to maintain confusion with Turner's syndrome from which it is clearly differenciated. The signology of both syndromes was confrontated in order to delineate the syndrome. Emphasis was made to point out the signs which are proper to each syndrome and the signs which are common to both of them stressing those that, occur with equal or significant difference. Two new signs are described in Noonan syndrome: alopecia of the hund portions of the eyebrows and keratosis rubra pilaris (Ulerythema ophriogenes).


[Problems in the management of patients with inoperable cardiac anomalies]. A general review of the main problems found in the management of inoperable heart anomalies is made by the author. He determines the reasons why a heart disease cannot be corrected by surgery, the complications found in such cases, the cautiousness that must be taken and the psychological aspect of these problems in relationship with the family and the patient.


[Nutrition surveys in children attending kindergartens in the city of Cordoba]. A nutritional inquest was carried out in 1857 children attending kindergartens in Córdoba, Argentina, in 1974. Determinations were made for the socioeconomical level each child belonged (NES) and clinical and anthropometric examinations. Nutritional inquests were carried out in 414 of these children, psychological examinations in 51, and biochemical inquests in 61 children.


[Recovery of breast feeding practice].

[Recovery of breast feeding practice]. The failure to recover the period of motherly suckling originated the creation of a community institution: Mother's Help Group NuNu, which is looking for a conherence promotion. In this way, not only do women make the community and individual diffusion of the human lactation but a pediatric doctor also contributes to bring up children, with human resource, laying aside technical excess.


[Incidence of social factors in the care of children in the urban and semiurban area of Salta]. The authors analyse the social histories of 1000 children taking into account their place of origin, state of nutrition, age of the child and of his parents; their social condition, number of offsprings, wages, degree of instruction and profession of the parents, ledging: quality, running water, sanitary and electric services: type of feeding, conditions for preservation of food. All this information is important to the physician because it implies that the patient treated in the hospital should not return to an adverse environment where he will find the same factors that will lead him again to disease.


[Acute benign ataxia in childhood].

[Acute benign ataxia in childhood]. The patogenesis and etiology of acute ataxia in childhood is not well known. It may occur without previous symptoms or may be the expression of specific infectious diseases. Forty patients hospitalized at the Hospital de Niños de Buenos Aires en 1972-1978, were studied. The neurological manifestations showed an acute onset, being ataxia the main sign, associate to tremor, nystagmus, dysartria, oculo-motor paresia, muscular weakness, and hyporeflexia. Most of the patients (82%) became cured within the first four weeks. It is advisable to establish a follow-up with periodic controls, mainly in those patients in whom an association with previous infectious diseases did not exist to be able to detect an association with degenerative or desmyelinizing diseases.


[Mediastinal emphysema in children].

[Mediastinal emphysema in children]. A review of 25 infants developing pneumediastinum and subcutaneous emphysema was done. These observations suggested that increasing airways presure creates excessive alveolar distention. Pulmonary interstitial emphysema results from movement of air out of alveoli into interstitial areas. From this point air could dissect along the perivascular or interstitial spaces to the mediastinum.


[Infantile and juvenile violent death].

[Infantile and juvenile violent death]. Infantile and youth violent death has been analyzed with a new approach using an informative source different from traditional ones by means of a dynamic statement with a retrospective study of the process. We call attention to the great number of violent deaths that affect the newborn, the infant and the adolescent. We insist on the way that violent death occurs through its three mechanism: accidental, suicide or homicide. We set the difference among natural, sudden, doubtful and violent death. We observe the increasing number of infantile and youth necropsies made at the judicial morgue under the name: violent death, in the studied periods. We stress the preponderance of males in all the causes of infantile and youth violent death by means of programs related to the three ways in which violent death occurs: accident, homicide and suicide.


[Diabetes mellitus in childhood and adolescence. Clinical types]. It is today's general medical opinion that children's diabetes mellitus was uncommon in the past. It was generally admitted at that time the initail stages were so sudden as to make difficut its early diagnosis. It's increased incidence is at present an alarming truth; however, a parallel increase of diabetic coma or of mulminant types has rather dropped. Diabetes may be diagnosed by just considering the main symptoms at the onset which are polydipsia, polyuria and weight loss. If an early diagnosis is not made, acidosis (abdominal pain, nausea, vomiting) may appear within a few days or weeks followed by coma (Kussamul's acidotic respiration and dehydration). Coma may be avoided by an early diagnosis and a life may be saved. It must be stressed that an important percentage of children and adolescents show a slow and gradual evolution (week or months) of their diabetes: gradual weight loss, sometimes with noticeable polyphagia, occasional enuresis, but without other associated symptoms. Asymptomatic, intermittent glucosurias are also frequent; they vary in magnitude an almost always they appear without ketonuria and with fasting normal glycemia. According to our experience they may precede in weeks or months the clinical manifestations of the disease. Postprandial glycemia is a sure diagnostic resource; it is of greater trustworthines than fasting glycemia; therefore we advise it as a routine diagnostic procedure which we recommend widely. In uncertain situations, the oral glucose tolerance test is advisable.


Low voltage electrical activity preceding right atrial depolarisation in man. Electrical recordings were made in the high right atrium in 28 patients undergoing cardiac catheterisation and in 3 healthy volunteers. After filtering and amplification by 3 to 10 million times, the signals were passed through a signal averaging process in a digital computer. Of the 28 subjects who had technically satisfactory recordings, 23 showed low voltage electrical activity preceding the conventionally-recorded atrial depolarisation. The low voltage activity started 50 to 200 ms before the atrial deflection and was variable in shape. These early signals may be the result of activity in the region of the sinus node.


[Various aspects of the influence of infection on growth and development]. It is pointed out how infections can delay growth and development through an aggressive and long-standing action, through direct action of an infecting agent (virus, bacteria, parasites). or through sequelae in main organs (brain, kidney, growth cartilage, muscular system, etc.). how infections impair nutrients' absortion, metabolism and excretion. The role of the leukocytes is evidenced in the liberation of two factors: MEL and pyrogen factor. Metabolic responses are classified in an anabolic anda catabolic phase. The second mechanism that interfers on growth and development is a specific action of various agents, particularly viruses on different tissues. Intrauterine infection is pointed out as determinant of growth disorders with increased IgM levels in cord blood; confirmed fetal infection on the 6th up to 8th week of gestation interferes with organogenesis. The action of CMV and rubella virus is mentioned as example. The action of viral infections on growth during the first three months of gestation, is mentioned. TBK and typhoid fever are mentioned as causative agents of corporal and urinary nitrogen loss. Negative action of infection on growth and development, particularly in malnourished patients, is discussed. Diarrhea, under certain condition, is pointed out as determinant of the kwashiorkor syndrome. The role of various parasite diseases on growth is mentioned with range according to the action of each agent on nutrients' absortion. A third mechanism which causes fail to thrive through sequelae lesions is considered. This disorders are ruled by the age of the patient with the onset of disease by the causative agent, by the inflammatory process involved, by the early diagnosis and appropriate treatment. The need of enhancing the actions to prevent communicable diseases and to diminish malnutrition rates is pointed out and the significance of taking into account calorie and protein intake in patients with severe and/or long-standing infectious disease.


Effect of nifedipine on atrioventricular conduction as compared with verapamil. Intracardiac electrophysiological study. Intravenous nifedipine, a powerful calcium antagonist, had no obvious effect on atrioventricular conduction when administered to 11 patients during routine intracardiac electrophysiological studies. Verapamil on the other hand showed potent antiarrhythmic properties, depressing atrioventricular nodal conduction. Nifedipine thus appears safe in patients with angina pectoris who have disorders of atrioventricular nodal conduction, and in those receiving beta-adrenergic blocking drugs. There appear to be differential effects on the slow inward channels of cardiac cells with different 'calcium antagonists'.


Recurrence of myocardial infarction in an exercising population. The Ontario Multi-Centre Exercise-Heart trial is making a prospective study of 751 male subjects following well-documented episodes of myocardial infarction. Comparison is here made between the 50 participants who sustained a recurrence of their myocardial infarction, and the 701 participants who did not. Reinfarction was a little more likely with a history of multiple previous infarctions, but was unrelated to such indicators of infarct severity as symptoms, electrocardiographic abnormalities, enzyme changes, cardiac arrest, arrhythmia, or minimum systolic blood pressure. Features noted on admission to the trial, which may have an adverse effect, include smoking history and related symptoms, residual disability, shortness of breath, and angina of effort. The main physiological warning sign was a low and decreasing cardiac output at a submaximal work load, with a compensatory widening of arteriovenous oxygen difference. With the possible exception of exercise non-compliance, none of the adverse findings is sufficiently consistent to be of value when advising individual patients.


Assessment of pulmonary valve echogram in normal subjects and in patients with pulmonary arterial hypertension. To assess the validity of ultrasound criteria for pulmonary arterial hypertension, we studied pulmonary valve motion in 28 patients and 20 normal subjects. In the latter group, we categorised normal movement of the posterior leaflet of the pulmonary valve in a fashion not previously described. Of the 28 patients, 19 had pulmonary arterial hypertension (pulmonary artery mean pressure more than 20 mmHg, range 22 to 72). Negative, flat, and positive e to f slopes occurred equally in normal subjects and patients. Maximal a wave excursion was less than 2 mm in 9 of 13 patients with pulmonary hypertension who had sinus rhythm, but was more than 2 mm in all normals and in the 9 patients with normal pulmonary artery pressure (69% sensitivity and 100% specificity). The b to c slope was more than 450 mm/s in 6 of 18 patients with pulmonary arterial hypertension and was less than 450 mm/s in all others (33% sensitivity and 100% specificity). The normalised right ventricular pre-ejection period was more than 0.095 (range 0.10 to 0.16) in 13 of the 19 patients with pulmonary arterial hypertension and less than 0.095 in all others (68% sensitivity and 100% specificity). A midsystolic notch occurred in patients with pulmonary arterial hypertension and in no normal subjects or patients with normal pulmonary arterial pressure. Of the 19 patients with pulmonary arterial hypertension, 18 were identified by one or more ultrasound criteria. Of the 5 patients who met only 1 criterion (increased normalised right ventricular pre-ejection period), 4 had atrial fibrillation. We conclude that measurement of the pulmonary valve e to f slope is useless for identifying pulmonary arterial hypertension. However, changes in normalised right ventricular pre-ejection, maximal a wave excursion, b to c slope, and the presence of a midsystolic notch, while insensitive, are highly specific for pulmonary atrial hypertension.


Heart rhythm during permanent cardiac pacing. Heart rhythm was analysed with regard to spontaneous or pacemaker-induced heart activity, in a consecutive series of 282 patients paced for at least 1 year. The mean duration of pacing was 59 (13 to 180) months. The mean age of the patients was 76 (39 to 93) years. Spontaneous heart activity at all routine examinations was found in 33 (12%) of the patients. Pacemaker-induced rhythm only was recorded in 42 per cent of the patients whereas the remaining 46 per cent had varying electrocardiographic patterns. Of the patients with spontaneous rhythm at each visit, 10 had had complete heart block before pacing. Regular sinus activity was recorded at every routine examination in 74 per cent of the patients paced for reasons other than the sick sinus syndrome. This indicated that a substantial number of paced patients might be candidates for atrial triggered pacing. Patients treated with digitalis more often had asystole at the time of replacement of the pacemaker (32%) than those not so treated (19). This suggests an increased risk of sudden death in paced patients on digitalis if the pacemaker fails.


Use of digitised left ventricular echocardiograms in assessment of mitral stenosis. In order to establish a new echocardiographic index of the severity of mitral stenosis, left ventricular echocardiograms were digitised using manual tracing and a computer. The instantaneous left ventricular dimension was measured in 15 patients with mitral stenosis. The peak rate of change of left ventricular dimension (peak dD/dt) and the normalised peak rate (peak dD/dt/D) during early diastole were significantly lower in mitral stenosis than in normal subjects. Also, the time between the second heart sound and peak dD/dt was significantly shorter in patients with mitral stenosis than in normal subjects. Correlation between the mitral valve area calculated from the Gorlin formula and peak dD/dt/D was good, while valve area was poorly correlated with the EF slope of the anterior mitral leaflet echo. It is suggested that by continuous measurement of left ventricular dimension and of its first derivative, the reduced atrioventricular blood flow in mitral stenosis can be shown, and that peak dD/dt/D during early diastole is a possible index of its severity.


Patterns of atrial activation during right ventricular pacing in patients with concealed left-sided Kent pathways. A 'concealed' accessory pathway was suspected in 12 patients because of eccentric left atrial activation during tachycardia. Retrograde conduction during ventricular pacing may occur over the atrioventricular node, the accessory pathway, or both. There were 4 patterns of ventriculoatrial conduction in response to ventricular extrastimuli (V2) at various coupling intervals: (1) exclusive accessory pathway conduction throughout the cardiac cycle in 2 patients; (2) exclusive accessory pathway conduction at long coupling intervals and exclusive atrioventricular node conduction at short coupling intervals in 2 patients; (3) variably fused accessory pathway/atrioventricular node conduction at long coupling intervals but exclusive accessory pathway conduction at short coupling intervals in 4 patients; (4) fused accessory pathway/atrioventricular node conduction at long coupling intervals but exclusive atrioventricular node conduction at short coupling intervals in 4 patients. With increased prematurity of V2 the ventricle to right atrial interval prolonged conspicuously in 11 of 12 patients whereas the ventricle to left atrial interval remained constant until the refractory period of the accessory pathway in all but 2 instances where intraventricular delay occurred. This study emphasises the importance of left atrial recordings in these patients.


Assessment of left ventricular performance and myocardial viability using quantitative radioisotope techniques. The diagnostic value of a combined radionuclide technique was compared with conventional angiocardiographic techniques in 60 patients with coronary artery disease. Quantitative 201Tl myocardial imaging combined with radionuclide angiocardiography using 99mTc-HSA provided a safe and accurate method for the assessment of left ventricular performance. The defects on the 201Tl images correlated with the severity of asynergy seen on the contrast ventriculogram. Static imaging alone distinguished hypokinetic from akinetic or dyskinetic areas. However, using both tracer techniques, akinesis could bedistinguished from dyskinesis. In patients with disturbed left ventricular function, cardiac transit times correlated with haemodynamic changes, and left ventricular ejection fraction was the most sensitive index. Thus, this combined radionuclide approach provides data for the evaluation of overall and regional wall function. A major advantage of this non-invasive auantitative technique is its applicability to the critically ill patient at the bedside.


Plasma adrenaline and noradrenaline concentrations and dopamine-beta-hydroxylase activity in myocardial infarction with and without cardiogenic shock. In patients with myocardial infarction, with or without cardiogenic shock, plasma noradrenaline and adrenaline concentrations are increased. However, plasma noradrenaline concentrations are considerably higher in patients with cardiogenic shock when compared with those with uncomplicated myocardial infarction. Plasma noradrenaline and adrenaline concentrations showed a sustained increase until death in patients with cardiogenic shock whereas those concentrations were back to normal levels by the end of the third day in patients with uncomplicated myocardial infarction. Plasma dopamine-beta-hydroxylase activities in both the groups were within normal range and did not show any significant variation throughout the period of study.


Myxoma of the mitral valve.

Myxoma of the mitral valve. A case of myxoma of the mitral valve is reported. The clinical features were indistinguishable from left atrial myxoma with prolapse through the mitral valve. Because of the known tendency for these tumours to recur it was treated by wide excision which necessitated replacement of the mitral valve.


Constrictive endocarditis. Report of a case with successful surgery. An 18-year old white youth presented with severe right heart failure and was found to have an obliterated and funnel-shaped right ventricle, massive tricuspid regurgitation, and mitral regurgitation. The haemodynamic findings were those of cardiomyopathy with obliteration on the right side. He underwent surgery consisting of decortication and peeling off of a thickened right ventricular endocardium, tricuspid valve replacement, and mitral valve repair. After surgery there was pronounced haemodynamic as well as clinical improvement. The pathological picture was that of constrictive endocarditis. We recommend this method of treatment for patients with obliterate cardiomyopathy on either side of the heart.


Lone aortic regurgitation, sacroiliitis, and HLA B27. Case history and frequency of association. An account of aortic regurgitation complicating ankylosing spondylitis is given. Twenty patients with lone aortic regurgitation and without overt spondylitis were examined clinically and radiologically and tissue typed. No evidence of sacroiliitis could be found in any patient. HLA B27 was absent from this group, and no significant disturbance in antigen frequency was noted.


The characteristics of the binding of 12-alpha-[3H]-digoxin to the membranes of intact human erythrocytes: relevance to digoxin therapy. 1 The characteristics of the binding of 12-alpha-[3H]-digoxin to the membranes of intact human erythrocytes are described. 2 Only one class of binding site can be demonstrated. Binding is time- and temperature-dependent, saturable and slowly reversible; it is inhibited by other cardiac glycosides and by potassium. 3 Pre-incubation with unlabelled digoxin reduces the subsequent binding of 12-alpha-[3H]-digoxin in stoichiometric fashion. 4 The possible application of the measurement of the binding of 12-alpha-[3H]-digoxin to the study of biochemical pharmacological events occurring during digoxin therapy is discussed.


Changes in cardiac glycoside receptor sites, 86rubidium uptake and intracellular sodium concentrations in the erythrocytes of patients receiving digoxin during the early phases of treatment of cardiac failure in regular rhythm and of atrial fibrillation. 1 Measurements of the binding of 12-alpha-[3H]-digoxin to the membranes of intact erythrocytes, erythrocytic 86rubidium uptake and intraerythrocytic sodium concentrations have been made in the red cells of patients receiving digoxin in the short-term for atrial fibrillation or cardiac failure in regular rhythm. 2 During the first few days of treatment [3H]-digoxin binding and 86rubidium uptake fall and intraerythrocytic sodium concentrations rise. 3 Subsequently parallel fluctuations occur in [3H]-digoxin binding and 86rubidium uptake but not in intraerythrocytic sodium concentrations and the significance of the fluctuations is discussed. 4 The values of all three measurements correlate significantly with the response of the heart in sinus rhythm as measured by QS2I. 5 Plasma digoxin concentrations do not correlate with QS2I.


The acute changes seen in cardiac glycoside receptor sites, 86rubidium uptake and intracellular sodium concentrations in the erythrocytes of patients during the early phases of digoxin therapy are not found during chronic therapy: pharmacological and therapeutic implications for chronic digoxin therapy. 1 Measurements of the binding of 12-alpha-[3H]-digoxin to the membranes of intact erythrocytes, erythrocyte 86rubidium uptake and intraerythrocytic sodium concentrations have been made in the red cells of various groups of patients--those who have not received digoxin, those during the early phases of treatment, those during chronic (greater than 2 months) treatment, and those toxic. 2 The values of those measurements in the patients in the early phases of therapy and in the toxic patients differed significantly from those of the untreated patients. 3 However, the values in the chronically treated patients were not different from those of the untreated patients. 4 The results suggest that the biochemical pharmacological effects of digoxin which occur during the early phases of therapy do not persist in the long-term. 5 The possible clinical significance of these observations is discussed.


Plasma concentrations of propranolol and 4-hydroxypropranolol during chronic oral propranolol therapy. 1 The plasma levels of propranolol and 4-hydroxypropranolol have been measured in 17 hypertensive patients receiving chronic oral therapy with propranolol. 2 The range of plasma propranolol concentrations was from 5.3 to 300 ng/ml, and that of 4-hydroxypropranolol was from 2.1 to 36.0 ng/ml. 3 The mean (+/- s.d.) plasma concentration ratio of 4-hydroxypropranolol to propranolol was 0.130 (+/- 0.005); however, a very wide range was observed with individual values ranging from 0.057 to 0.241. 4 A statistically significant correlation was observed between the plasma concentration of 4-hydroxypropranolol and that of propranolol. 5 Propranolol and 4-hydroxypropranolol plasma concentrations were each significantly, but poorly, correlated with daily propranolol dose. 6 The clinical significance of the results has been discussed.


Determination of viloxazine in plasma by GLC. 1 A gas chromatographic procedure for the determination of viloxazine in therapeutic concentrations in human plasma, with use of a flame ionization detector, is described. 2 The drug is extracted at pH 12 into hexane, back extracted into HCl, re-extracted into hexane after alkalinization of the HCl and derivatized with acetic anhydride. 3 An imipramine-butriptyline mixture is used as an internal standard. The coefficients of variation for a concentration of 0.75 microgram/ml are 9.4% and 13.1% for within day and day to day precision respectively. For a 1.75 micrograms/ml solution the within day precision was 5.7%. 4 The method has been applied to a patient receiving 300 mg/day viloxazine treatment.


Concentration effect studies with oral metoclopramide. 1 The effects of single oral doses of 10 mg and 20 mg metoclopramide have been compared to placebo in six normal male volunteers. 2 The drug did not significantly increase the rate of gastric emptying as measured by ethanol absorption. 3 Sedation during the absorption of ethanol was only observed 1 h after the 20 mg oral dose of metoclopramide (P less than 0.05). 4. Akathisia, a central nervous system side effect of metoclopramide, occurred only in subjects who had peak plasma concentrations above 100 ng/ml. 5 It has not been possible to define a concentration-effect relationship for the action of metoclopramide on the stomach and comparison with previous results after intravenous dosing suggests that the route of administration is of major importance in determining the action of this drug.


Distribution of misonidazole in human tumours and normal tissues. Levels of misonidazole in human tumours, normal tissues and blood have been measured in patients given a 1g oral dose of drug before surgery or biopsy. The results show that 50--70% of the blood level was found in a wide range of tumours and that similar levels were found in adjacent normal tissues. Good penetration of drug was achieved within tumours, and up to 90--100% of the blood level was found in the necrotic cyst fluid at the centre of some tumours. CSF studies showed free diffusion into the CNS, which was confirmed by finding 50--70% of the blood level within brain tumours. A delay of passage of drugs into the CSF was noted, which was not found for drug diffusion into bile and saliva.


Misonidazole and MTDQ in combination: cytotoxic and radiosensitizing properties in hypoxic mammalian cells. A combination of misonidazole and MTDQ (6,6'-methylene-bis-2,2,4 trimethyl-1,2-dihydroquinoline) has been tested for its radiation-sensitizing properties and cytotoxicity, using Chinese hamster V79 cells cultured in vitro. Both compounds sensitize hypoxic cells to the effects of X-rays, and when used in combination their sensitizing properties are additive. By contrast, the presence of MTDQ completely inhibits the cytotoxicity that misonidazole exhibits towards hypoxic cells. These experiments shed some light on the mechanism of action of electron-affinic hypoxic cell sensitizers, and the combination of radiosensitizers suggested may have an application in human cancer radiotherapy by eliminating the neurotoxicity experienced by patients receiving misonidazole during radiotherapy.


ICRF-159 enhancement of radiation response in combined modality therapies. I. Time/dose relationships for tumour response. The combined effect of the chemotherapeutic agent ICRF-159 and irradiation were evaluated using the Lewis lung tumour (LL). At a daily dose of 25 mg/kg, ICOF given alone prevented the progressive growth of LL. Daily pretreatment also potentiated the effects of radiation (600 rad) on tumour growth, provided the pretreatment kinetics of the tumour permitted a response to radiation alone. Single acute doses of the drug failed to alter the growth of LL, and when combined with radiation failed to enhance the radiation effect. Fractionation of the drug (25 mg/kg; 4 doses at 3h intervals) before irradiation, however, results in immediate effects on tumour growth which are more than additive. The results suggest that a low dose of ICRF-159 for extended periods is more effective in enhancing radiotherapy than a high dose provided acutely.


ICRF-159 enhancement of radiation response in combined modality therapies. II. Differential responses of tumour and normal tissues. The combined effect of the chemotherapeutic agent ICRF-159 and radiation on the proliferative status of tumor/normal systems has been evaluated using the Lewis lung tumour in BDF1 mice. We have previously shown that a 25 mg/kg dose of ICRF-159, given at 3h intervals X4 before irradiation, significantly enhanced tumour growth retardation relative to a single dose of 100 mg/kg before irradiation. Whilst both single and fractionated drug treatments produced a transient inhibition of cell proliferation, comparisons of the temporal recovery from the antiproliferative effect of radiation in both tumour and intestinal epithelium suggested that single acute doses of ICRF-159 fail to potentiate the radiation response of either tissue. Protracted drug administration before irradiation, however, markedly decreases the post-radiation proliferative recovery of the tumour, without significantly altering intestinal recovery. The data suggest that both drug concentration and/or exposure time determine the interactions seen with combined modes.


25-Hydroxycholecalciferol receptors in human breast cancer. Cytosol receptors for 25-hydroxycholecalciferol, oestradiol and progesterone were measured in human mammary carcinomas. Significant positive correlations were found between the concentrations of all three receptors.


Elastosis and response to endocrine therapy in human breast cancer. Response to endocrine therapy in 51 patients with advanced breast cancer was compared with the amount of elastosis in histological sections from their primary tumours. There appeared to be an association between elastosis and response: tumours with no elastosis showed a lower rate of response than those with gross elastosis, indicating that this simple method might provide a useful predictive index for response to endocrine therapy. In addition, tumours with oestrogen-receptor activity (a feature associated with a high rate of response) but with no elastosis were unlikely to respond, suggesting that a combination of the 2 predictive indices might be more valuable than either taken alone.


Evidence for serum binding of oxidized spermine and its potent G1-phase inhibition of cell proliferation. Serum polyamine oxidase (EC 1.4.3.4) is known to react in vitro with radio-labelled spermine4+ to produce di-oxidized spermine which must incorporate the label. Di-oxidized spermine was compatible with a radio-labelled compound2+ separated from the reaction mixture by ion-exchange chromatography. The compound was measured and had a half-life of about 2.3 h in tissue culture medium. It also rapidly and tightly bound to an unidentified serum component (gel-filtration chromatography indicated a complex of mol. wt 70,000) so that dissociation required treatment with strong acid (10N HCl). Findings suggest that the di-oxidized spermine, in either its free cationic or bound form, potently arrested cell proliferation. This arrest was non-cytotoxic and was confined to the G1 phase of the cell cycle. Products of di-oxidized spermine autodegradation, including trace amounts of stable and cytotoxic acrolein (arrested S phase), were unlikely to have contributed significantly to the arrest.


Monocytes and macrophages in malignant melanoma IV. Effects of C. parvum on monocyte function. Assays for the capacity of peripheral-blood monocytes (a) to mature in vitro into macrophages, (b) to reduce nitro-blue tetrazolium (NBT) and (c) to lyse antibody-coated human Group A red cells, were applied to a group of 82 patients with histologically proven malignant melanoma. In patients with micrometastatic disease there was an enhancement of red-cell lysis and NBT reduction, suggesting that their monocytes are in some way "activated", whereas NBT reduction was suppressed in those with overt dissemination. Monocyte maturation in vitro was impaired in all patient groups to an extent which correlated with overall tumour burden. Corynebacterium parvum was administered i.v. to 12 patients with disseminated disease and by the intradermal route to 24 patients with micrometastatic disease. The 3 monocyte functions were significantly enhanced by C. parvum.


An approach to the problem of heterogeneity of human tumour-cell populations. 1. Successive sampling of ovarian cancers during cytostatic treatment showed several cases of notable changes in their ploidy distribution and one change in model chromosome number, indicating selection of a resistant tumour-cell population. 2. Studies of cell suspensions from human tumour specimens incubated with [3H]-TdR after exposure in vitro to various cytostatic agents have shown variation in labelling between different parts of the same tumour, as well as between the primary tumour and its metastases or ascitic tumour-cell population, which may be accounted for by variation in sensitivity of the tumour-cell population. 3. Studies of nuclear morphology in 20 endometrial cancers before and after progesterone therapy demonstrate considerable variation in the proportion of cells undergoing secretory conversion within the same tumour, indicating primary heterogeneity of the tumour-cell population in response to progesterone.


Evaluation of leg ulcer treatment with stereophotogrammetry. A pilot study. This report describes stereophotogrammetric measurements of leg ulcers. A basic technical description of the method and its application in a pilot study are presented. The clinical evaluation of the healing of leg ulcers is compared to the photogrammetrically determined parameters--edge length, surface area, and volume--of the ulcers, and seems to fulfil the need for an objective method in the evaluation of leg ulcer treatment.


Mepacrine pigmentation in systemic lupus erythematosus. New data from an ultrastructural, biochemical and analytical electron microscopic investigation. A case of mepacrine pigmentation occurring in a patient with systemic lupus erythematosus has been investigated by fluorescent light microscopy, gas--liquid chromatography and analytical electron microscopy. There is strong evidence for the presence of mepacrine itself within the typical granules, which have been shown by electron microscopy to be membrane bound and intracellular. Analytical electron microscopy also showed that the granules contain large quantities of iron and smaller quantities of sulphur.


Acid hydrolases in blister fluid. 7. Influence of dimethyl sulphoxide and heat. Increased acid hydrolase activity has been demonstrated in suction blister fluid 1.5 h after the application of established lysosomal labilizing agents. Both the pattern of enzyme activity and the magnitude of the increases were similar to those following cutaneous inflammation. These data confirm our previous observations that acid hydrolases do indeed play a role in cutaneous inflammation, but their release is not the initial event in this process.


Geographic tongue--a manifestation of atopy. One hundred patients with geographic tongue have been studied for evidence of an association with atopy. There was a significantly high frequency of personal and/or family history of asthma, eczema and hay fever amongst the patients when compared to a control population. A raised total serum IgE( greater than or equal to 200 u/ml) was significantly more frequent in patients compared to a control population. These findings confirm the impression that in some patients geographic tongue is a sign of atopy.


The effects on epidermal DNA synthesis of topically applied cycloheximide. An animal model for investigating topically applied epidermal cytotoxic drugs to determine optimum therapeutic doses and schedules is described. It is used here to examine the effects of cycloheximide on epidermal DNA synthesis, as measured by 3H-thymidine incorporation in vivo, in terms of dose/response and activity/time profiles and potential systemic toxicity.


The treatment of cutaneous malignancies with topically applied cycloheximide. Results obtained from an animal test system for epidermal cytotoxic drugs prompted the topical use of 1% cycloheximide in the treatment of histologically confirmed superficial basal cell carcinomata of the skin. Excellent clinical clearing of lesions has been demonstrated and this has been confirmed by post treatment biopsies. Preliminary findings in solar keratoses and intraepidermal carcinomata of the skin are also reported.


Trichophyton violaceum abscesses.

Trichophyton violaceum abscesses. Two patients with deep cold abscesses due to Trichophyton violaceum are described. Both have depressed cellular immunity.


Familial cutaneous collagenoma: genetic studies on a family. Familial cutaneous collagenoma is an inherited condition characterized by the presence of multiple dermal nodules symmetrically distributed on the trunk and upper arms. In this study, six patients, the proband, his four siblings and a niece, representing a kindred of fifty-two subjects, were examined for aymptomatic cutaneous nodules mainly on the back and chest. The individual lesions varying from a few millimetres to several centimetres in size, were indurated, and showed minimal epidermal changes. Histologically, the nodules were characterized by an excessive accumulation of dense, coarse collagen fibres in the dermis. The elastic fibres appeared diminished in number, and in some areas they were abnormally thin and fragmented. The lesions, therefore, were connective tissue naevi of the collagen type. On the basis of the family history and histological observations the patients were diagnosed as having familial cutaneous collagenoma. Examination of the family pedigree indicated that the dermal nodules in familial cutaneous collagenoma were inherited in an autosomal dominant pattern. It was also observed that the lesions had an onset at the age of 15 to 19 years, and their number increased significantly during pregnancy. It is conceivable that familial cutaneous collagenoma is an inherited condition whose expression may be under a hormonal control.


Disseminated dermal melanocytosis terminating in melanoma. A human condition resembling equine melanotic disease. A detailed account is given of a progressive, punctate dermal melanocytosis which, commencing in childhood, terminated in the fifth decade as disseminated melanoma with no primary site discoverable. The terminal findings were characterized by prominent melanophagia. In the author's opinion there are resemblances between the unique condition described and a form of equine melanotic disease.


Pernicious anaemia and granulomatous skin lesions in a case of common variable hypogammaglobulinaemia. A 45-year-old woman is reported with a history of recurrent bacterial infections since childhood; at the age of 37 years she developed recurrent ulcerated lesions around her mouth, in the groins and buttocks, which histologically contained small, non-caseating granulomas. A year latter when being treated for empyema, she was found to have common variable hypogammaglobulinaemia. Three years after this she developed a megaloblastic anaemia of vitamin B12-deficiency type.


A comparison of predictions from peripheral and central theories of emotion. Peripheral and central theories of emotion differ in the role they ascribe to cognitive and physiological variables in arousal. This study compared the responses of quadriplegics and normal controls to sexually arousing stimuli under various conditions of false heart-rate feedback. The results support a centralist position and the relatively greater importance of cognitive factors in emotional responsiveness.


Clinical responses of A and B practising psychotherapists to schizoid and neurotic patient prototypes. Eighty-three male psychotherapists varying on A-B type and experience orally responded to tape-recordings of simulated schizoid and neurotic patients in the privacy of their own offices. Five dimensions of therapist response were studied: accurate empathy, positive social-emotional reactions, negative social-emotional reactions, length of response and proportion of declarative statements. Although the simple A-B interaction effect was not found, significant second-order interactions were found for both accurate empathy and positive reactions which indicated that the predicted interaction effect tends to be upheld for inexperienced therapists but attenuated or reversed for experienced therapists. A significantly reversed interaction for experienced therapists' response length was also found. Examination of the results from this study and previous studies suggested a revision of the A-B interaction hypothesis: for inexperienced therapists, As will be more effective with schizoids/schizophrenics than Bs, whereas Bs will surpass As with neurotics; for experienced therapists, however, this interaction will be attenuated or reversed. Speculations about underlying processes in A-B interaction phenomena were offered.


The patient's view of therapy.

The patient's view of therapy. Recent research has suggested an increasing rapprochement between behaviour therapy and psychotherapy, especially in terms of the patient's perceptions. Two hypotheses were tested in this study - (1) that patients would report 'relationship' or 'non-specific' factors to be more useful in treatment than behavioural or psychotherapeutic activities, and (2) that there would be no difference between patients who had received behaviour therapy and patients who had received psychotherapy with respect to the rated importance of non-specific, relationship-type activities. Forty-nine patients who had received either behaviour therapy or psychotherapy were asked to complete in retrospect a questionnaire relating to aspects of therapy which they found useful and 37 (76 per cent) completed questionnaires were returned. Both hypotheses were accepted, and the findings are now discussed in relation to the growing realization of the importance of 'non-specific' factors in therapy.


An analysis of contemporary East African folk psychotherapy. In an effort to identify the characteristics of folk psychotherapy that could account for its tenacity in East Africa, a total of 31 Tanzanian shamans were studied. It was found that patients with emotional problems make use of both the folk and Western therapists and that a clear conceptual distinction is made between the services offered. The range of techniques used, style of service delivered, and the fundamental (or underlying) model of causation were all analysed. It was concluded that folk therapy is an effective approach to psychosocial disorders which, in the future, should be considered a dynamic supplement to Western practices. Additionally, based on the appeal of the medicine man, new directions for Western psychotherapy were suggested.


Exhibitionism - a biological hypothesis. Twenty-four male genital exhibitionists were interviewed in detail and followed up for periods of from 1 to 5 years. Biographical, attitudinal and behavioural data obtained from them were examined with a view to providing information about the aetiology of this behaviour. The evidence presented and discussed is consistent with the hypothesis that exhibiting represents the expression of an innate disposition. Exhibitionism is found to be widespread and patterned in form, to have a driven quality and to coexist with a variety of personality types. This hypothesis is further developed by discussion of anthropological and ethological data.


Panic-fear research in asthma and the nuclear conflict theory of asthma; similarities, differences and clinical implications. Recent research with the MMPI panic-fear scale has identified personality traits implicated in the psychological maintenance of the medical intractability of asthma. Intensity of prescribed medication, length of hospitalization, and rates of rehospitalization have been found to relate to MMPI panic-fear scores independent of the objective medical severity of the illness as indexed by longitudinal pulmonary functions. In the present study, MMPI panic-fear scores are related to separation and protection conflicts arising in childhood. While the nuclear conflict theory of asthma maintains that such conflicts occur in nearly all asthmatics and form a genetic component of the asthma, the present study finds that childhood separation and protection conflicts occur in a minority of patients, but may be instrumental in maintaining the medical intractability of the illness.


Overt and covert personality traits associated with coronary heart disease. Some authors suggested the existence of contradictory traits in the personality pattern associated with coronary heart disease: while presenting overt, active, adult-like traits, coronary subjects would be, at a more covert or repressed level, characterized by passive and infantile tendencies. To test this hypothesis, coronary and control subjects were submitted to three types of personality questionnaire, each of them measuring the same four personality traits (seclusion, impulsiveness, dependence and passivity) which, in the adult individual, are considered by Murray's (1938) theory of personality as persisting from infancy. No difference appeared between the two groups on type 1 questionnaires, describing behavioural features of individuals outwardly displaying the four traits. On type 2 questionnaires, describing tastes and similar areas less subject to social norms, coronary subjects revealed themselves higher than control subjects for passivity (P less than 0.05). and dependence (P less than 0.05). Similarly, they were higher for passivity (P less than 0.05), dependence (P less than 0.001) and impulsiveness (P less than 0.05) on type 3 questionnaires describing symptoms expected to occur occasionally among adults having such traits. Supplementary scales also showed coronary subjects to be more ego-defensive (P less than 0.001) and more self-assertive (P less than 0.05) than controls. These data were considered as supporting the hypothesis.


Orality and smoking.

Orality and smoking. This study was designed to investigate the relation of orality and smoking, smoking motivation and anticipatory pleasure in smoking. Ninety-seven male and female subjects completed questionnaires designed to elicit information about their motivation and behaviour. Results indicated that difficulty in stopping smoking was positively related to three non-nutriment oral preoccupations. Smoking for psychological as opposed to social reasons was positively related to two-nutriment oral preoccupations. Anticipation of pleasure in smoking before becoming a smoker was negatively related to nutriment orality, positively related to smoking because of a craving, and, for females only, positively to one type of non-nutriment orality. The results are discussed in relation to the role of oral ingestion and the reaction of the central nervous system to the drug.


Techniques of economic analysis in psychiatric practice. Since there is a limit to the amount of money that society can and will spend on health care, economic analysis is becoming increasingly important. This article attempts to review the use that has been made of economic analysis in psychiatric practice. It has been shown that treatment costs are a small part of the total cost of mental ill health, although 'expensive treatments' may reduce the cost of illness to society. In the USA the treatment of schizophrenia has been studied from the economic viewpoint. The economics of the alternatives of hospital and community care have been investigated. Cost-benefit analysis has been modified for application to the monitoring and assessment of psychiatric treatment. Economic analysis can and should be used, in conjunction with clinical analysis, to determine policies for better mental health care.


The specificity of schizophrenic thought disorder. Bannister and Salmon (1966), in a repertory grid study, reported that 'thought-disordered schizophrenics lost significantly more reliability and social agreement when shifted from object to people construing than normal'. This conclusion is of doubtful validity, since the between-grids variable, people vs. objects, was confounded with at least five other variables of possible relevance, three of which have been found by subsequent workers (McPherson & Buckley, 1970; Williams, 1971; Heather, 1976) to affect performance on grids. The main aim of the present experiment was to determine the effects of as many as possible of these variables. The subsidiary aim was to replicate, or otherwise, the findings of Frith & Lillie (1972) and Haynes & Phillips (1973) that the effective discriminator between thought-disorder schizophrenics and other groups on repertory grid tests is not intensity of relationship between constructs but pure (element or internal) consistency. Six grids involving all feasible combinations of rating familiar and unfamiliar people and objects on psychological and physical constructs were administered to 10 thought-disordered schizophrenics, 10 non-thought-disordered schizophrenics and 10 normals. As regards the main aim of the experiment it was found that there was no significant grids x diagnoses interaction on pure consistency, but that there was one on intensity, even with pure consistency partialled out. Taking previous work into consideration, it appears that this effect is weak, inconsistent from experiment to experiment, and anomalous in the present study. As regards the subsidiary aim, the findings of the two previous experiments cited above were confirmed. The discrepant results of McPherson et al. (1973) are considered, and it is noted that they held only for a subsample of the schizophrenic group in that experiment, the results for the total sample of schizophrenics, manics and depressives not being inconsistent with those of other experiments. The theoretical and practical implications of these and previous finding are indicated.


Therapist A--B score and treatment outcome with psychiatric in patients: a table of random numbers. The study evaluated the relationship between therapist personality and treatment success for 141 schizophrenics and 94 non-schizophrenics randomly assigned to short or long hospitalization. The 47 therapists were self-rated on the Whitehorn--Betz A--B scale in both the original and the Campbell versions. Outcome was assessed on the Health--Sickness Rating Scale and the Psychiatric Evaluation Form at discharge and at 1 and 2 year follow-up. The hypothesis of greater success for A--type therapists with schizophrenics was not confirmed, nor were alternative relationships evident in the data.


Effects of anxiety on attitudes--a semantic differential study. Eighteen female out-patients suffering from chronic anxiety states and 25 normal women matched for age filled in an anxiety inventory and completed semantic differential forms on 21 concepts grouped into four areas: characters, locations, human interactions and abstractions. Each concept was rated on 15 scales grouped into four types: evaluation, activity-potency, sex evaluation and danger. The normal subjects were divided into high anxiety and low anxiety subgroups on the basis of their trait anxiety scores. Anxious patients rated themselves with lower self-esteem and confidence. They reacted with apprehension to unfamiliar locations and perceived danger in other people. Sexual activity and the human body were viewed negatively. Anxious patients' apprehension were particularly raised by vague abstractions.


Are there different types of neurotic depression? The classification of depression remains controversial (Kendell, 1976). Overall et al. (1966) used the Brief Psychiatric Rating Scale (PBRS), a computer classification procedure and derived three depressed groups: anxious, hostile and retarded depressives. Paykel (1971, 1972) reported four groups derived from a multivariate cluster analysis: psychotic depressives and '...three groups, anxious, hostile and young depressives with personality disorder, from the diversity of patients subsumed under neurotic depression'. Amongst 85 women treated with amitriptyline 'this typology predicted outcome significantly'. This paper presents the results of a cluster analysis of a group of 60 female out-patient neurotic depressives.


A method of structured brief psychotherapy. Structured brief psychotherapy is a method of organizing treatment along problem-solving lines. The features of this method are the selection of problem areas, the translation of insight into specific activity, the structuring of psychodynamics and a concentration on termination events. The method is illustrated by clinical examples.


Problems in a 'creative marriage' following the birth of the first child -- an account of a conjoint marital therapy. This description of the marital therapy of a couple treated conjointly by the authors illustrates the profound effects of the couple's childhood experiences of their respective parents' relationships on their own subsequent marriage. The precipitating effect of the birth of the child in the marriage in awakening dormant unconscious conflicts stemming from these early experiences also emerges in the history of the couple and in the material of the therapeutic sessions.


Verbal conditioning of affect responses of process and reactive schizophrenics in a clinical interview situation. Sixteen process and 16 reactive schizoprenics out-patients were compared on a verbal conditioning task in an alternating conditioning-extinction design, using verbal and non-verbal positive social reinforcement to influence the emission of self-referred affect statements. It was found that process subjects failed to condition during the time periods used, while reactives demonstrated a significant trials effect showing trends consistent with those hypothesized from the type of design used. This differential conditionability between groups was shown not to be a function of diagnosis, sex, motivation, severity of illness, medication, hospitalization history, or general speech output. It was concluded that the degree of social responsiveness manifested in the premorbid history of the two groups is also operative in behaviour during the psychotic period, specifically, in responsiveness to positive social reinforcers in a verbal conditioning task.


The dietary chaos syndrome: a useful new term? Following typical primary anorexia nervosa some subjects enter a state characterized by disordered eating behaviour and emotional instability whilst remaining at or above a normal weight. Other subjects may reach a similar position without having been in a state of anorexia nervosa. Surprisingly the state seems to lack a satisfactory name. The term 'Dietary chaos syndrome' is proposed.


Crisis intervention: an experimental study of the effects of a brief period of counselling on the anxiety of relatives of seriously injured or ill hospital patients. This study was designed to examine the effects of anxiety levels, as measured by the Gottschalk & Gleser (1969) and the Viney & Westbrook (1976) content analysis scales, of a brief period of supportive counselling of relatives who arrived at a hospital emergency admitting ward with a seriously ill or injured patient. Verbal samples were taken for analysis from the subjects before and after a period of counselling (or a period of no counselling for the control group). The results showed that the initial anxiety levels for subjects in both groups was very high. For both the psychoanalytically oriented Gottschalk & Gleser anxiety scale and the Viney & Westbrook scale of cognitive anxiety there was a decrease in the level of anxiety for the counselled group compared with the non-counselled group. The results showed that such crisis intervention in hospitals for relatives who accompany patients to the hospital can reduce their very high levels of diffuse and generalized anxiety.


Intersubject agreement concerning relationships between the positive and negative poles of constructs in repertory grid tests. Previous research indicate that there is more intersubject agreement concerning patterns of correlations between constructs than concerning how specific elements are rated on each construct. In this study, Canadian undergraduates (15 women, 15 men) rank-ordered eight photographs of strangers separately on the basis of the positive and negative poles of six constructs. The results indicated that there is more consensus concerning specific patterns of relationships between the positive poles of constructs than concerning those between their negative poles. Some implications of this finding for repertory grid assessment and research were discussed.


Agoraphobic women married to abnormally jealous men. Of 36 married female agoraphobics treated by the author over a period of 3 years, seven were married to men who displayed abnormal jealousy. In all these cases the husbands' jealousy adversely influenced their wives' response to treatment, and improvement in wives was associated with increased morbidity in their husbands.


The modification of personality disturbance in a therapeutic community for drug abusers. Two personality questionnaires, the MMPI and 16PF, were administered routinely to drug abusers admitted to a newly established hierarchical type of therapeutic community. Questionnaires were repeated at 6 and 12 months with those residents who remained. Comparison of the results with other studies suggests that drug abusers admitted to different treatment centres display a recognizable pattern of personality disturbance, characterized by a combination of neurotic, psychopathic and psychotic elements and an unusual degree of willingness to admit to socially undesirable traits. Twenty-five per cent of residents stayed longer than 6 months. They showed a significant reduction in measured personality disturbance, and at 1 year anxiety was the only outstanding indication of disturbance. The relationship between these results, possible sources of bias and other indices of behaviour change is discussed.


An analysis of individual treatment on a token economy for chronic schizophrenic patients. Fifty-one individually designed treatment programmes carried out over a 22 month period on a token economy ward for 12 female chronic schizophrenic patients were analysed. Level of withdrawal was found to be a critical factor in patients' response, both in terms of the rate and extent of improvement during the treatment stage, and presence or absence of deterioration during 'weaning' and follow up. No difference in response between type of behavioural problem and methods of treatment or weaning were found.


Contrasting resources in disturbed and non-disturbed family systems. Previous research has shown that problems in family functioning and psychological disturbances in children are closely related. To increase understanding of this complex interaction the present review sets out to make explicit certain aspects of the relationship between child psychopathology and the quality of family life. The usefulness of the concept of resources for analysing major aspects of family functioning (contextual, intra-familial and extra-familial) is discussed within a systems framework and is then applied to a wide range of empirical studies which relate important features of family functioning to disturbed behaviour in children. It is found that interpersonal conflict in the lives of parents before marriage may severely constrain their own psychological development. When the psychological effects of such early disadvantage are amplified by marital conflict other family members are also affected. The notion of resources requires such disabilities to be assessed as well as directing attention to non-family interactions which offer compensating supports.


Mental hospital experience, classroom instruction and change in conceptions and attitudes towards mental illness. Changes in conceptions and attitudes towards mental illness and the mentally ill were investigated in Israel. Questionnaires were presented to 69 student nurses, assessing stereotyped image, authoritarianism, social restrictiveness, benevolence, mental hygiene ideology and interpersonal aetiology before and after psychiatric affiliation in two kinds of mental hospitals, or before and after classroom instruction only. The findings lend cultural generality to previous observations and demonstrate that: (a) classroom instruction is ineffective as an agent of change; (b) practical experience involving personal confrontation with mental patients in a progressive psychiatric hospital, which contradicts the stereotyped image of mental patients and inculcates positive attitudes towards them, results in a change to a more professional scientific orientation and a more humane, accepting and liberal attitude; (c) under hospital conditions which support the stereotyped conception and authoritarian restrictive attitudes, the confrontation will result in preservation, even consolidation and strengthening, of the stereotyped image and undesirable attitudes towards mental patients. The findings were discussed and the implications for training programmes were drawn.


Preferences for behavioural, analytic and gestalt psychotherapy. This study investigated preferences for behavioural, analytic and gestalt psychotherapy among a sample of 40 SES class III and IV adult females and 67 college freshmen who had never been actual therapy patients. A scaled survey assessed general preference, preference given an imagined long-standing depressive disorder, preference given an imagined specific phobia, and preference for the therapist-patient relationship. Three audio tapes were designed, each describing one of the modalities. High inter-rater reliability and agreement were determined by three independent judges. Results showed that young females had a general preference for gestalt therapy. Young and old females, but not young males, significantly preferred behavioural therapy for a specific phobia. Under forced-choice conditions the group as a whole significantly preferred gestalt therapy. No differences were found for the relationship or preference given a depressive disorder. Preference was hypothesized as a cognitive structure with potential use in therapist-client matching.


Towards a conceptual framework of psychotherapy: a personal view. A conceptual view of psychotherapy is put forward for discussion and debate. The view is a personal one based upon experience of life and the practice of psychotherapy over a 10 year period. Harmony between the therapist's personality, the process of therapy and the nature of good human relationships is important. Therapy is seen as a practical discipline and a creative art in which the focus should be upon the patient's existence now and what it could be tomorrow.


The observing self and the development of cohesiveness. This paper presents a detailed analysis of the movement from fragmentation to rudimentary cohesiveness in the severely disturbed patient. In potentially psychotic patients this progression is necessary before analysis of the narcissistic transferences can occur. A dynamic and behavioural analysis of this progression offers a clear focus for the initial phase of treatment: The development of the observing self.


Capgras: case study and reappraisal of psychopathology. A case of the Capras phenomenon in a man of 58, arising during the course of a depressive illness, is described. Physical, electroencephalographic and psychometric investigations gave no sign of organic disease, and recovery was complete. Factors leading to the development of a depressive psychosis and its particular manifestation in the Capgras delusion are traced in detail. The psychopathology of the condition and the implications for treatment are discussed.


Arachnoid hyperplasia in optic nerve glioma: confusion with orbital meningioma. A case is reported of an optic nerve glioma with a marked degree of arachnoid hyperplasia which was initially diagnosed as an optic nerve meningioma. Hyperplasia of the arachnoid was also the underlying cause for expansion of the optic canal. The relationship between arachnoid hyperplasia in optic nerve glioma and meningioma of the optic nerve sheath in childhood is discussed.


Clinical presentation and management of lacrimal gland tumours. This paper presents the clinical and pathological findings in 40 consecutive patients seen with primary tumours arising from the lacrimal gland. Twenty patients had a benign mixed-cell tumour. They presented in a recognisable clinical manner with a painless mass in the region of the lacrimal gland which slowly enlarged over a period of at least 1 year before consultation. Twenty patients had a carcinoma of the lacrimal gland. They had a short history and experienced pain. On clinical grounds they could not be distinguished from inflammatory lesions in the region of the lacrimal gland. The method of treating these 2 groups of patients is described and methods of dealing logically with their problems are suggested.


Optic nerve injury in fracture of the canal. A case of unilateral blindness following blunt injury to the skull is presented. The patient died 4 days after the initial injury, presenting the rare opportunity of a detailed histopathological study of the acute features of the condition. The findings are discussed in the context of current theories of the pathogenesis of optic nerve injury in fractures of the optic canal.


Phlyctenular eye disease in association with Hymenolepis nana in Egypt. It had been previously noticed that infection with parasites was common in children suffering from phlyctenulosis. In the present study the stools of 471 patients suffering from phlyctenular disease were examined and it was found that 62.6% of them had Hymenolepis nana ova in their stools as compared with 10.8% of the controls. All patients had Hymenolipis nana immune sera. Many of these patients had abdominal symptoms. Hymenolepis nana is a cestode parasite discovered by Bilharz in Cairo in 1851. Infections with it have the same age incidence and geographical distribution as phlyctenular eye disease. It has a tissue stage responsible for a state of hypersensitivity which is thought to be responsible for the phlyctenules.


Surgical management and histopathology of invasive tumours of the cornea. Four cases of conjunctival squamous carcinoma invading the cornea are presented. The surgical technique of excising the tumours from the cornea by lamellar keratectomy is described. Histology of the lesions showed well differentiated squamous carcinoma invading the superficial layers of the cornea only. Large invasive squamous cell carcinomas of the cornea result because of neglect of small paralimbal tumours and can be adequately removed by lamellar keratectomy, leaving the globe intact.


Trabeculectomy in Nigerian patients with open-angle glaucoma. Filtering procedures for glaucoma in Africans are considered to be failures owing to their propensity for increased fibrosis. However, favourable results from trabeculectomy in African patients with glaucoma are reported. Most of these are from such modifications of technique as non-suturing of flaps, sclerectomy, posterior lip cautery, or administration of high doses of steroids. In this study 95.4% success with a virtual absence of complications is reported from a standard technique of trabeculectomy and no steroids.


Trabeculectomy versus Scheie's operation: a comparative retrospective study in open-angle glaucoma in Kenyans. A comparative retrospective study was performed on 39 patients with open-angle glaucoma in whom the right eye was subjected to Scheie's operation, the left to trabeculectomy. Trabeculectomy without the use of additional therapy or reoperation brought the intraocular pressure to under 22 mmHg in 80% of the cases compared with 74% treated by Scheie's operation. Reduction of visual acuity postoperatively was 4 times more frequent with Scheie's operation than with trabeculectomy. A report on a second group of patients in whom 47 trabeculectomies were performed is also given.


Assessment of the heart-rate method for determining energy expenditure in man, using a whole-body calorimeter. 1. The heart-rate (HR) method for determining the energy expenditure of free-living subjects has been evaluated using a whole-body calorimeter in which individuals lived continuously for 27 h while carrying out normal daily activities. Eight male volunteers each occupied the calorimeter on at least two occasions when HR and energy expenditure were measured continuously. 2. After each session in the calorimeter a calibration was obtained using standard techniques by determining HR and heat production (HP) over periods of 10-15 min at several levels of activity. Energy expenditure in the calorimeter was then predicted, by each of five methods, from the mean HR in the calorimeter. Additionally, one session in the calorimeter was used to obtain a calibration and was used for predicting the subject's energy expenditure while in the calorimeter on other occasions. 3. Standard methods of prediction using one calibration point at rest and several points during activity were unreliable for predicting the energy expenditure of an individual. The 24 h HR was at the lower end of the calibration scale and there were considerable over-estimates or underestimates of energy expenditure, particularly during the night when the mean (+/- SD) difference between the actual and predicted HP was -66 +/- 38.6%. A linear regression fitted to points at the lower levels of activity improved the prediction of 24 h HP while a logistic plot reduced the error even further. The best estimate of energy expenditure was that obtained from a calibration over 24 h within the calorimeter; the mean (+/- SD) difference between the actual and predicted 24 h HP was +3 +/- 10.5% for light activity and -3 +/- 6.7% for moderate activity. Thus current procedures for calibrating subjects may lead to large errors which could be reduced by using a respiratory chamber.


The differential effect of magnesium deficiency on isoenzymes of alkaline phosphatase (EC 3.1.3.1) in rat tissues. 1. Alkaline phosphatase (EC 3.1.3.1) from many rat tissues was separated into two or three bands by electrophoresis on polyacrylamide gel. Ten of the bands had different electrophoretic mobilities, but some were present in more than one tissue. 2. Bands from the corresponding tissues of magnesium-deficient and control rats were qualitatively similar, but there were quantitative differences in the distribution of enzyme activity between them. 3. Mg deficiency had differential effects on the absolute activity of individual bands, but two main types of response were observed. There was an increase in the activity of the first bands from liver and kidney, the second band from femur and both bands from spleen, whereas the first band from femur, the first and second bands from intestinal mucosa and the second bands of serum, liver and kidney all decreased in activity during the deficiency. 4. The change in total alkaline phosphatase activity of a tissue during Mg deficiency depended on the ratio between the enzyme components within it.


A comparative study of the absorption of calcium and the availability of phytate-phosphorus in the golden hamster (Mesocricetus auratus) and the laboratory rat. 1. Balance studies were carried out with rats and golden hamsters (Mesocricetus auratus) given diets high and low in calcium (10.8 and 5.1-5.2 g Ca/kg respectively) and high and low in phytate (3.4 and 1.6 g phytate-phosphorus/kg respectively) in a 2 X 2 factorial experiment. 2. Values for Ca absorption and phytate availability (relative to the amount ingested) and for urinary excretion of Ca and P were significantly higher in the hamster than in the rat for all four diets. 3. Phytate  availability was significantly greater on the low-Ca than on the high-Ca diets with both species. 4. Ca absorption was greater on the low-phytate than on the high-phytate diets but the differences were significant only for the hamster. 5. Absorption of both Ca and P was poorly controlled in the hamster compared to the rat.


Kinetics of native and modified Bowman-Birk soya-bean trypsin inhibitor on growth and enzymes activities of the chick pancreas. 1. The Bowman-Birk soya-bean trypsin inhibitor (BBTI) begins to cause pancreatic enlargement and increased enzymic activity in the pancreas of chicks after a minimum of 7 d of feeding. 2. The active inhibitory site of BBTI against trypsin is the factor involved in the pancreatic enlargement and increase of pancreatic enzyme activity in chicks.


The effect of a low-protein ration on milk yield and plasma metabolites in Friesian heifers during early lactation. 1. Sixteen first-calf Friesian heifers were used in a continous treatment design experiment. For 2 weeks after calving they were given a 750 g concentrate, 250 g hay/kg ration with 169 g crude protein (nitrogen X 6.25; CP)/kg dry matter (DM). They were then divided into two groups of eight and given a high-protein (223 g CP/kg DM) or low-protein (107 g CP/kg DM) ration at the rate of 10.8 kg concentrate + 3.6 kg hay for 8 weeks. 2. Milk yield and composition, live weight and blood composition were monitored throughout. A digestibility trial was carried out with six animals on each treatment. 3. The low protein ration reduced DM, organic matter, energy and fibre digestibility significantly (P less than 0.001) so that intakes of digestible energy were not equal and the low-protein group lost more weight than the high-protein group. 4. Milk yield and the fat content of milk were lower in heifers given the low-protein ration (P less than 0.01). The lactose content of the milk was not affected and protein content only slightly reduced (P less than 0.01) by low-protein feeding. When the heifers were all changed onto an adequate protein (190 g CP/kg DM) ration in mid-lactation, those which had previously been under-fed protein appeared to recover in milk yield to the point they might have been expected to reach is given an adequate-protein ration throughout. 5. Concentrations of urea (P less than 0.001) and albumin (P less than 0.05) were reduced by underfeeding protein, but albumin concentration was affected less by diet than by stage of lactation. Blood concentrations of total protein, glucose, sodium, potassium, calcium, inorganic phosphate, iron, copper, haemoglobin and packed cell volume were unaffected by treatment. Blood magnesium concentration was slightly lower (P less than 0.01) with low-protein feeding.


Absorption of vitamin C from the human buccal cavity. 1. Ascorbic acid was absorbed across the mucosa of the human mouth. 2. Omission of sodium ions from the medium decreased the  absorption of ascorbic acid. 3. The presence of D-glucose, or 3-O-methyl-D-glucose, increased the absorption of ascorbic acid but D-fructose had little effect and D-mannitol had no effect. 4. Calcium ions also increased ascorbic acid absorption probably by a secondary effect on "Na+ fluxes. 5. Buccal mucosa was also permeable to dehydroascorbic acid and D-isoascorbic acid.


Long-term vitamin status and dietary intake of healthy elderly subjects. 1. Riboflavin. 1. Long-term clinical and biochemical riboflavin status and dietary intake of riboflavin were monitored for 18 months in a group of twenty-three relatively-healthy elderly subjects living at home in the north of England. 2. Both dietary intake and biochemical status, as measured by the activation coefficient (stimulated:basal activity) of NAD(P)H2:glutathione oxidoreductase (EC 1.6.4.2), remained fairly constant for each individual and for most subjects the usual intake and biochemical status were characterized quite accurately by a single week's intake dietary record and a single measurement of the activation coefficient. 3. The expected relationship between biochemical status and dietary intake was present, but not strongly evident. There was a significant within-subject correlation between alpha values and the immediately preceding dietary intake; however the between-subject correlation between alpha values and dietary intake approached zero if the two subjects receiving long-term riboflavin supplements were omitted. Over the limited range of intakes observed in unsupplemented subjects, non-dietary factors evidently obscure the relationship. 4. Although eight subjects had average values above 1.2 for the activation coefficient, no excessively high values were observed, and no subject showed any clear-cut clinical deficiency symptoms.


Site differences in the fatty acid composition of subcutaneous adipose tissue of obese women. 1. Adipose tissue samples were obtained by needle biopsy from three subcutaneous sites (thigh, abdomen and upper arm) in twenty-two obese women. The fatty acid composition was determined using gas-liquid chromatography and the results presented relate to eleven component fatty acids. 2. The fatty acid composition of adipose tissue obtained from the arm and abdomen was remarkably similar, with the exception of the levels of lauric acid. 3. The analyses showed that the majority of the saturated fatty acids were present in smaller proportions whilst the majority of unsaturated fatty acids were present in larger proportions in the thigh than in the two other sites. Highly significant inter-site differences were demonstrated for six of the major fatty acids and also for both the total amounts of saturated and unsaturated fatty acids and their ratios. 4. No marked differences in the fatty acid composition of adipose tissue from obese subjects were revealed during this study when compared with previously reported results obtained from 'normal-weight' subjects.


The effects of defaunation of the rumen on the growth of lambs on low-protein-high-energy diets. 1. The effects of defaunation of the rumen of lambs given low-protein-high-energy diets were studied using animals fed ad lib. a basal diet of sugar and oaten chaff which was supplemented with fish meal at various levels. These diets supported relatively large populations of protozoa in the rumen. 2. A nonyl phenol ethoxylate (15 g. Teric GN9:ICI Australian Ltd) given intraruminally, was shown to be an effective means of defaunating the rumen and the lambs were maintained protozoa-free by isolation. 3. In lambs given low levels of fish meal in the diet, the absence of rumen protozoa increased growth rate and improved the food conversion efficiency (g dry matter intake/g growth). These effects were not apparent at high levels of protein supplementation. 4. These results suggested that the absence of rumen protozoa resulted in an increased availability of nutrients supplying both energy and amino acids since the efficiency of food utilization and the rate of wool growth (which is sensitive to amino acid supply) were increased in lambs on the low level of protein supplementation without apparently increasing food intake.