Sequential intravenous glucose tolerance: responses of newborn and adult. Acute sequential intravenous glucose tolerance tests were performed at an interval of 120 min in 12 normal fasting adults, 5 normal infants, and 6 infants of gestationally diabetic mothers. Glucose disposal (Kt) and plasma insulin elevations were remarkably similar in the paired adult studies. In contrast, the studies in all infants were highly variable although they had similar initial plasma insulin levels (less than 10 micronU/ml). The rates of glucose disposal in the infants (1.43 and 1.47%/min) were slightly slower than the adult rates (1.66%/min). The plasma insulin responses, in contrast, were higher and more sustained throughout the second half of the test in the infants as a group. There was remarkable heterogeneity in the responses of the infants which obscured any differences between the groups.


The effects of thyroid hormones on myelination in the developing rat brain. Rats radiothyroidectomized 1 day after birth received daily subcutaneous injections of 1 microgram/10 g body weight of thyroxine (T4) or an equimolar amount of triiodothyroacetic acid (T3AC) from day 6 through day 25. The number of myelinated axons, myelinated axon area, and area of the myelin sheath in the corpus striatum were investigated. Hypothyroid neonates demonstrated a normal number of myelinated axons with a decrease in the area of these axons. T4 treatment resulted in an increased number of smaller axons while T3AC treatment produced fewer but larger axons than the T4 treatment. The myelin area changed as the axon area changed with the myelin thickness remaining constant in all groups.


Gas phase carboxylate anions fron p-nitrobenzyl esters of fatty acids. Gas phase carboxylate anions have been efficiently generated from the p-nitrobenzyl esters of nine fatty acids ranging in size from C6 to C22. The process involves the dissociative resonance capture of 2.9 e V electrons by the derivatives. The procedure is specific and gives the carboxylate anions as the base peak in all but two of the derivative. The technique gives extremely simple spectra, with little additional fragmentation and no rearrangement ions.


Metabolism of [14C] terbutryn (2-(t-butylamino)-4-(ethylamino)-6-(methylthio-s-triazine) by rats and goat. Sixteen metabolites of terbutryn were isolated from the urine and feces of either rats or a goat given single oral doses of terbutryn-[14C](2-(t-butylamino)-4-(ethylamino)-6-(methylthio)-s-triazine). The metabolites resulted from one or more of the following changes: S-demethylation, conversion of the methylthio group to a hydroxy group; N-deethylation; oxidation of the terminal carbon of the ethyl group to a carboxylic acid; oxidation of a terminal carbon of the t-butyl group to either an alcohol or a carboxylic acid; or conjugation with glucuronic acid.


Mass spectral characterization of the glucuronide conjugates of terbutryn (2-(t-butylamino)-4-(ethylamino)-6-(methylthio)-s-triazine) metabolites from rats and goat. Five metabolities from terbutyrn (2-(t-butylamino)-4-(ethylamino)-6-(methylthio)-s-triazine) were characterized to be glucuronide conjugates by interpretation of mass spectral data of their trimethylsilyl derivatives. These were isolated from rat and goat urine. Three of these glucuronides were characterized to be triazinyl-S-glucuronides and two were characterized to be alkyl-O-glucuronides.


Mass spectrometry of N-nitrosamines.

Mass spectrometry of N-nitrosamines. The preparation of a series of N-nitrosamines for carcinogenicity studies presented an opportunity to study mass spectral fragmentation schemes in detail. Condensed spectra are listed for 146 N-nitrosamines of widely differing structures, including nitroso derivatives of commercial drugs and insecticides. Aliphatic nitrosamines were generally characterized by molecular ions and loss of OH. Subsequent fragmentation via alpha-cleavage is similar to that of aliphatic amines. The loss of OH is believed to result in a cyclic ion. Subsituted aliphatic nitrosamines varied in fragmentation schemes with structure and position of the substitutent groups. However, most showed alpha-cleavage at some point in fragmentation. When substituted with aromatic groups prominent peaks due to the aromatic moiety were observed. The alicyclic nitrosamines showed losses of NO, NOH and OH and subsequent alpha-cleavages. Nitrosamides were characterized by rupture of the carbonyl to nitrogen bond. Spectra of substituted ureas usually showed charge retention by the carbonyl fragment, while carbamate esters showed ions from both fragments.


Mass spectra of aniline glucuronides.

Mass spectra of aniline glucuronides. Mass spectra of TMS derivatives of aniline glucuronide and pentachloroaniline glucuronide are presented, and the fragmentation of these derivatives is compared with that of TMS aryl-O-glucuronides. Fragmentation yielding ions entirely from the glycone moiety was sufficiently similar to  establish these N-glucuronides as TMS glucuronides in the same manner used for TMS-O-glucuronides; however, differences observed may be diagnostic for TMS-N-glucuronides.


Identification of a nitrone as an in vitro metabolite of N-methylamphetamine. The relatively labile nitrone, alpha-methyl-(N-methylene) benzeneethanamine N-oxide was isolated from incubates of (+/-)-N-methylamphetamine with fortified liver honogenates from rats and rabbit. Identification of the nitrone was confirmed directly by gas chromatography and gas chromatography mass spectrometry and, after its conversion to isoxazolidine adducts by the action of methyl and ethyl acrylate. An authentic sample of the nitrone was synthesized unequivocally form N-hydroxyamphetamine and formaldehyde. The isomeric nitrone, N-(alpha-methylbenzeneethylidene) methylamine N-oxide, was also synthesized and its gas chromatographic and gas chromatographic mass spectrometric characteristics determined to confirm that the metabolically formed nitrone was not N-(alpha-methylbenzeneethylidene) methylamine N-oxide. Two previously unreported metabolites of (+/-)-Nmethylamphetamine, N-hydroxyamphetamine and 1-hydroxy-1-phenyl-2-propanone, were isolated from rat in vitro experiments; the latter metabolite was not produced in vitro by rabbit liver homogenates.


A "carrier effect" observed in assay of antidiarrhoeal drug compounds. A carrier effect has been shown to exist in a stable isotope dilution assay for diphenoxylate. When a tetradeuterated analogue is used as a carrier and internal standard a sevenfold increase in sensitivity is observed for the unlabelled compound. Examination of a related pharmacologically active compound (SC-27166) showed a much smaller effect.


Bile acids. LIV--mass spectra of conjugated bile acids. The electron impact mass spectra of conjugated bile acids, their 5alpha-analogs and methyl esters of glyco conjugates were determined by direct insertion into the ion source and their fragmentation patterns were found to be basically similar to those of methyl esters of the free bile acids. The conjugates are additionally characterized by a significant loss of [NH2CH2CO2H] from the glycine moiety and [CH2 = CHSO3 H] from the taurine group. Several 5 alpha- and 5 beta-isomers can be differentiated, but no general pattern of recognition is discernable. Field desorption mass spectra contain [M + Na]+ and [m + Na]2+ ions.


Determination of double bond positions in fatty acids with conjugated double bonds. The positions of the double bonds in fatty acids with conjugated double bonds may be determined by mass spectrometry of the methyl esters of their trimethylsilyl ether derivatives obtained by hydroxylation of the double bonds followed by silylation of the resulting polyols. The method has been applied to trans-9,trans-11- and trans-10, trans-12-octadecadienoic acid.


Application and evaluation of limited mass monitoring with a gas chromatograph mass spectrometer computer system. The technique of scanning a preselected set of ions employing a combined gas chromatography mass spectrometer computer system has been investigated to ascertain the advantages and disadvantages of such a procedure. This technique allows one to determine gas chromatographic retention data with with a high degree of precision and accuracy, in rapid temperature programming operation, due to shortening of the mas spectral scanning interval. Signal-to-noise ratio in ion abundance recordings can be enhanced by increasing the dwell time for as many as 100 ions without lenghtening the scanning interval. The utility of such an approach was demonstrated by analysis of complex mixtures isolated form human urine and cerebrospinal fluid.


Structural verification of 15-oxo-13,14-dihydrothromboxane B2. The mass spectra of three stable isotope derivatives are presented to confirm ion assignments in the spectrum of the methoxime, trimethylsilyl ether, methyl ester from 15-oxo-13,14-dihydrothromboxane B2.


Rearranged glucuronic acid conjugates of bilirubin-IX alpha in post-obstructive bile. Structure elucidation  of azopigments beta and gamma as ethyl anthranilate N-glycosides derived from 2-, 3- and 4-o-acyl glucuronides. Azopigment analysis was performed on conjugates of bilirubin-IXalpha in bile of man and rats obtained after obstruction of the bile duct or in bile incubated under N2. The azopigments beta and gamma, formed by applying a pH 2.7 diazonium reagent containing an excess of ethyl anthranilate, correspond to rearranged ethyl athranilate N-glucuronides having the azodipyrrole acyl group on positions 2, 3 and 4 of the sugar. These assignments were verified, first by conversion of the structurally known 2-, 3- and 4-O-acyl glucuronide azopigments, unsubstituted at C-1, into ethyl anthranilate N-glucuronide reference compounds, and second, by mass spectrometry of trimethylsilyl ether methyl ester derivatives of unknown and reference compounds. The C-1 ethyl anthranilate group of the N-glucuronides triggers characteristics fragmentation reactions of the carbohydrate moiety revealing the position of the azodipyrrole O-acyl group.


Development of a procedure for the assay of an experimental steroid drug in dog plasma. Studies of the estimation of 16alpha-cyano-3beta-cyclopentyloxypregn-5-en-20-one (an experimental drug) in dog plasma are described. Extraction using a salt/solvent pair (ammonium carbonate/ethyl acetate) is followed by a rapid chromatographic procedure employing Lipidex 5000, which affords a substantially purified fraction. After preparation of the t-butyldimethylsilyloxime, quantification of the drug is performed by selected ion monitoring. The [2H9]cyclopentyloxyl analogue is used as an internal standard. In a preliminary experiment, the advantages (in terms of both sensitivity and selectivity) of the use of an open tubular GLC column are demonstrated.


Determination of isamoxole (N-butyl-N-(4-methyloxazol-2-yl)-2-methylpropanamide, LRCL 3950) in plasma by selected ion monitoring using a stable isotope internal standard. A selected ion monitoring method for the estimation of an anti-allergy compound isamaxole (N-butyl-N-(4-methyloxazol-2-yl)-2-methylpropanamide, LRCL 3950) in plasma has been developed. The method uses a stable analogue containing nine deuterium atoms as internal standard. The assay is sensitive to 2 ng ml-1 plasma and has been used to examine plasma levels of isamoxole after doses of the compound to animals and man.


[Histologic and radiometric studies of the immunocompetent system in rabbits with atherosclerosis]. Changes in the immunocompetent organs were studied in rabbits during atherosclerosis by the histological and radiometric methods. An increase of cells of the plasmocyte series in the sinuses of the medulla of the mesenteric lymph nodes was observed when the total proliferative activity was reduced. The cells of immune response in atherosclerosis are supposed to be formed not on account of active proliferation, but by means of differentiation of the initial small lymphocytes. The results obtained contribute to out knowledge of immunogenesis of atherosclerosis.


[Histocytochemical features of immunopathologic changes in inflammation of the lungs]. The authors present the results of a comparative cytochemical study of the phagocytes' and lymphocytes' lysosomal membranes state in the rabbit blood, trachea and lungs in immunization with sorbed staphylococcus toxoid and human serum albumin in experimental pneumonia and in this disease against the background of immunization. It was shown that the changes resulting from immunization (the phagocytes' and lymphocytes' lysosomal membranes systemic destabilization, microcirculatory disorders, and cell infiltration in the lungs) were premorbid to pneumonia and intensified the inflammation. The authors considered these changes to be structural and functional signs of the immunopathological reactions accompanying pneumonia.


[Effect of extirpation of the cervical sympathetic ganglia on the postnatal development of the paraventricular nucleus of the rat hypothalamus]. The importance of trophico-adaptive influences of the sympathetic nervous system for the postnatal hypothalamus development was shown experimentally on rats. Using kario-cytometric method it was found that cervical ganglia extirpation was followed by retarded ontogenetic development of the neurosecretory cells of the paraventricular nucleus, and also by blood vessel changes. The sympathectomy effect coincided with the beginning of an intensive cytoplasm growth in the paraventricular nucleus cells. Sympathectomy proved to be more effective in ratlings than in adult animals.


[Immunoisotachophoresis on cellulose acetate film]. Acetate-cellulose strips of "Cellogel" type have been shown to be a suitable maintenance medium for performance of isotachophoresis. For immuno-isotachophoresis antigen (from 0.5 to 20 microliter) is applied to a strip of acetate-cellulose film. 1--2 microliter of ampholine solution is placed in front of the antigen zone. All the components present on the strip are made in 0.06 M tris-HCl buffer (pH 6.7), and 0.012 M tris-glycine (pH 8.3) is used as an electrode buffer. Electrophoresis produces migrating Kolraush boundary, which at first is the area of antigen concentration into a narrow starting zone, and then of antigens separation with ampholites. The antigens separated on a cellogel strip are subject to cross-electrophoresis on a film saturated with the respective antiserum, with formation of precipitation peaks for each individual antigen. The method permits to operate with low antigen concentrations since electrophoresis ensures their preliminary concentration and the width of the zones is independent of the time of separation.


[Method of electron autoradiographic study of RNA synthesis in gastric gland cells]. A method of electron microscope autoradiographic investigation of gastric mucosa pieces obtained by clinical gastrobiopsy and incubated with uridine-5H3 was suggested. Comparison of the preparations with electron microscope radioautographs prepared after the administration of uridine-5H3 into the organism and with the results of control treatment with RN-ase permitted the authors to conclude that the method proposed reflect the RNA synthesis in the gastric gland cells.


[Model of disseminated intravascular coagulation]. Vascular-thrombocytic and plasma hemostasis was studied in dogs after blood loss (40--50 ml/kg weight) and subsequent hypervolemic (60--65 ml/kg weight) transfusion of homologous (from 3 donors) platelet and leukocyte rich in plasma. After a short phase of hypercoagulation all the tested dogs displayed hypocoagulation accompanied by a decrease in the count of platelets and a fall of their aggregation function, prolongation of bleeding time, diminution of capillary wall resistance, a decrease of plasma fibrinogen concentration and factor XIII activity, and by a rise of blood fibrinolytic activity. The data obtained show the development of the acute disseminated intravascular coagulation syndrome (DIC). DIC model is porposed on the basis of the results obtained.


[Mechanism of formation of epileptic activity complexes in the cerebral cortex under the influence of a determinant focus]. It was shown in the experiments on cats anesthetized by nembutal that by forming a hyperactive focus with a high level of excitation in the temporal cortex and a number of foci with a less higher level of the excitation in other parts of neocortex, it is possible to create a functional complex, working in a single routine, determined by the activity of hyperactive focus. The latter plays a role of a determinant structure. The inhibition of the determinant focus results in the disturbance of the epileptic complex. Focus nature has no sufficient importance in the realization of the following interrelations: both the determinant focus and dependent foci may be created by means of strychnin and penicillin, disturbing different forms of the inhibition. The results of our investigations evidence a common conception on the role of determinant structures in the activity of the nervous system.


[Changes in the properties of enterocyte membrane structures in acholia using carbohydrases with different microtopographies as an example]. The level of surface and intracellular carbohydrases was compared in rats with complete chronic loss of bile. The function of glycocalyx marke (adsorbed amylase) proved to be deranged much more in comparison with the function of the plasmic membrane proper marker (invertase).


[Blood gases in craniocerebral hypothermia]. Experiments were conducted on dogs; cranio-cerebral hypothermia (a reduction of body temperature from 38 to 28 degrees C) led to increase of oxygen and to reduction of carbon dioxide tension in the blood. In case of marked hypothermia (24 degrees C) the blood gaseous concentration became less than at 28 degrees C, but remained above the initial level. This indicates prolonged preservation of adequate lung ventilation in the hypothermic organism.


[Reciprocal influence of cortical zones in normal cats and after creation of an experimental pathologic process]. Acute experiments were conducted on non-anesthetized lystenon-restricted cats. The evoked potentials method was applied to the study of interaction of various cortical areas of one hemisphere and interhemispheric relations using stimuli of different modalities. It was shown that the action of somato-sensory areas on the visual cortex responses in the intact brain were mainly of a releasing character; these effects disappear in the formation of an experimental pathological focus. On the basis of the data obtained a conclusion was drawn on a possible participation of functional reorganization of the interhemispheric relations in the compensatory process mechanisms.


[Functional difference between the magnocellular neurosecretory nuclei of the rat hypothalamus]. The supraoptic, paraventricular, and postoptic nuclei (SON, PVN, and PON, respectively) of the hypothalamus were studied under conditions of 3 months training of rats to hypoxia (exposure for 6 h daily in a low pressure chamber under 7600m of simulated altitude). All the three nuclei were activated during the first 5 days, and then the state of the SON cells normalized. Functional activity of the PVN and PON decreased (the nucleolar volume of the neurosecretory cells diminished to 70--80%, the amount of the neurosecretory substance in the cells and the posterior lobe of the hypophysis was reduced). Such a decreased activity of the PVN and PON persisted till the end of the experiment. A positive correlation of the thyroid epithelium height and the nucleolar volume of the PVN and PON cells was established for both the PVN (r=0.81, P less than 0.05) and the PON (r=0.82; P less than 0.05); no significant correlation was revealed for the SON (r=0.51; P less than 0.05). Thus, functional similarity of the PVN and the PON, and some peculiarities in the SON reaction under conditions of the experiment described was demonstrated.


[Changes in energy metabolism in the tissues of animals subjected to the effects of constant and intermittent low frequency vibration]. The exposure of rats to 1 month continuous low-frequency vibration did not cause any changes in the brain adenylic fund and led to significant decrease in ATP content and total adenine nucleotides in the muscles of the extremities. For 3 months after the vibration there was a significant exhaustion of the brain and muscle adenylic fund. Under exposure to the interrupted vibration the state of adenine nucleotide system depended upon the duration of intervals limiting the continuous vibration effects. Under the vibration with the shortest intervals between each of the 30-minutes exposure there were no changes in the muscle and brain energy metabolism. 8- and 15-minute intervals for muscle adenine nucleotide and 8-minute interval for the brain proved to be unfavourable.


[Mechanism of the effect of diazepam on acetylcholine concentration in mouse brain]. Intraperitoneal injection of diazepam (20 mg/kg) caused an increase of free and bound acetylcholine in the mouse brain. Diazepam pretreatment (20 mg/kg) increased galanthamine anticholinesterase activity and its toxicity; as to physostigmine, armine, and paraoxon toxicity--it remained unchanged. It is supposed that diazepam blocks the release of aetylcholine from the cholinergic nerve terminals which should result in a decrease of functional acetylcholine concentrations in the synapse.


[Participation of prostaglandins in regulating myocardial catecholamine absorption]. In vitro experiments showed PGE1 (2.10(-6) and 5.10(-6) M) to decrease adrenaline and noradrenaline uptake by the rat myocardium homogenates. On the other hand, neither PGE1 nor PGA1 influenced the interaction between troponin and noradrenaline. Apparently, the capacity of PGs to decrease catecholamine uptake by the myocardium was not mediated by their effect on troponin.


[Quantitative assessment of the degree of stomach cancer cell morphologic dedifferentiation]. Quantitative estimation of the nucleic acids content in the preparations stained with gallocianine-chromic alum was made in 20 cases of stomach cancer. Coefficients of the ratio of the nucleus section surface and the cytoplasm, the ratio of DNA + RNA of the nucleus to RNA of the cytoplasm, and of DNA of the nucleus to the sum total quantity of RNA in the nucleus and the cytoplasm, the index of DNA accumulation were compared in adenocarcinomas (210 cells) and undifferentiated cancers (390 cells) of the stomach. The ratio of the nucleus surface and the cytoplasm, DNA + RNA of the nucleus to RNA of the cytoplasm was higher (statistically significant value) in adenocarcinomas as compared with undifferentiated cancers of the stomach. This allows to suggest a lower differentiation of adenocarcinoma cells in comparison with tumour cells of undifferentiated forms of stomach cancer.


[Growth of syngeneic transplantable tumors in Syrian hamsters immunized with hamster embryonic tissue]. The effect of immunization of Syrian hamsters with the hamster embryonic tissue on the growth of two syngeneic transplantable tumours was studied. Immunization of the inbred hamsters with embryonic hamster tissue with subsequent transplantation to them of transplantable syngeneic tumours led neither to inhibition nor to enhancement of the tumour growth. It is suggested that the embryonic antigens do not participate in the formation of the transplantation antitumour immunity.


[Experimental use of extracorporeal hemosorption during the postresuscitation period]. Hemosorption on activated charcoal was used during an early postreanimation period of detoxication of the organism. Hemosorption in experimental dogs resuscitated after a 15-minute circulatory arrest caused by electrotrauma promoted earlier restoration of the corneal reflexes and improved the outcome of resuscitation considerably both on account of elimination of acid metabolites and possibly of other toxins.


[Effect of helium-neon laser rays on the process of regeneration of irradiated transplanted skeletal muscle]. Three series of experiments on the gastrocnemius muscle of rats were conducted. In the first series entire muscles were autografted on both hind extremities. In the second series autografting of the muscles was preceded by irradiation of both hind extremities with 1000 R. In the third series irradiation with the same dose and autografting of the muscles were followed by lazer rays treatment of both extremities for 10 days. The transplantation regeneration was studied histologically at periods of 1 week--3 months. The results showed the laser rays to stimulate regeneration depressed completely by X-irradiation. Regeneration proceeded not only in the peripheral, but also in the interior zone of the muscle, and resulted in formation of a muscle organ capable of contraction.


[Proliferative activity in several tissues of unilaterally nephrectomized mice subjected to surgery at different times of the day]. Unilateral nephrectomy was performed in mice in the morning and in the evening. Mitotic activity in the proximal parts of the nephron tubules of the resting kidney and in the corneal epithelium was examined 48 and 60 hours after the operation. As compared with control, after the operation performed in the morning the mitotic index proved to increase 4.3 times and remained at a high level for 60 hours; after the operation performed in the evening mitotic index increased 9.3 times and decreased in 60 hours. It is concluded that the cells of the kidney epithelium entered into division more synchronously in the animals operated in the evening than in those operated in the morning. Nephrectomy had no influence on the level and rhythm of cell proliferation in the corneal epithelium.


[Hepatocyte regeneration following Kupffer cell stimulation with prodigiosan]. The effect of Bac. prodigiosum polysaccharide named "prodigiosan" on DNA synthesis and the hepatocyte mitotic rate in the regenerating liver of male Wistar rats was studied. Being injected intraperitoneally in a dose of 50 microgram/rad per 24 h before partial hepatectomy prodigiosan markedly increased the mitotic rate and indices of labeled hepatocyte nuclei which reached the maximum values earlier than in control nonstimulated hepatectomized animals. It is suggested that the stimulatory effect of prodigiosan was due to the Kupffer's cells activation.


[Effect of changes in the concentrations of Na, K and Ca ions in the medium on rhythmo-inotropic relationships in pathologically altered myocardium]. The following criteria of the myocardial insufficiency were revealed on myocardial fragments of the human auricule tissue (auricula atrii) removed in correction of the valvular cardiac defects: 1) fall of the contraction amplitude in the rhythmic row even with the stimulation frequency of 1--3 Hz (normal mycadrium is characterized by increased contraction amplitude--positive Bowdwitch steps) 2) monophasic character of the frequency-force curve (in a normal myocardium the curve is three-phasic in shape); 3) the absence of positive or the appearance of negative inotropic effect in response to reduction of the external Na concentration or removal of K ions from the solution. The data obtained permit to suggest that disturbed Ca ion transport through the surface membrane and reduction of the capacity of the sarcoplasmic reticulum to sequestrate Ca ions underlay myocardial insufficiency of the cardiac cells of the affected heart.


[DNA concentration in cells of the glandular epithelium of the endometrium during the menstrual bleeding phase]. DNA content in the endometrial gland cells (9 women of fertile age) was studied during menstruation by microspectrophotometry. It was shown that DNA content (mainly 2n) remained unchanged during different days of menstruation, both during the desquamation (the 1st--2nd days of the cycle), and during the regeneration stage (the 3rd--4th days). Along with this the mitotic activity in the glandular epithelium was absent completely (36 samples of endometrium).


[Effect of acute hypoxia on embryonal death and the sex ratio of the progeny]. The effect of acute hypoxia on mouse embryogenesis and its influence on the sex ratio in the progeny was studied. On the 7th--10th day of pregnancy mice were subjected to hypoxia at 230 mm HG for 3 hours. They were sacrificed on the 18th day of pregnancy, and gonads of their embryos were taken for investigation. The sex ratio was determined as the ratio of the number of males to that of females. It has been shown that acute hypoxia on the 7th--10th days of pregnancy, resulting in high mortality of adult animals, had no substantial effect on the embryonic development. No selective death of the embryos of either sex was observed both in experimental and control groups.


[Effect of preliminary neurosensitization of rats on the postnatal development of the cerebral cortex of the progeny]. The author investigated the cerebral cortex of 30-day ratlings born of rats preliminarily neurosensitized with a homologous cerebral cortex antigen, and of intact, control rats. In comparison with control, there was a reduction of the width of the sensory-motor region of the cortex, chiefly on account of the lower layers, diminution of the size of cell bodies of large neurons in the layer, inadequate development of the cytoplasm, and retarded accumulation of basophilic substance in it.


[Qualitative-quantitative analysis of changes in rat caudate nucleus neurons during postnatal ontogenesis]. Changes of the neurons of the caudate nucleus were analyzed in rats of different age (newborn, 7-, 14-, and 30-day-old) by qualitative and quantitative methods. Complication of the structural components of the nerve cells during the early postnatal ontogenesis was shown. The process of the neuron maturation proved to be most intensive during two postnatal weeks and was practically complete by the 30th day of the postnatal period. The results suggest that at this period of ontogenesis the caudate nucleus takes part in the integral activity of the brain.


[Number of clonogenic stromal precursor cells in the hematopoietic organs of guinea pigs at different ages]. The content of clonogenic stromal precursors in the femoral bone marrow, spleen and the thymus of guinea pigs of different age was studied by the in vitro colony assay method (monolayer cultivation of hemopoietic and lymphoid tissue). The concentration and the total amount of the stromal precursor cells was shown to be age-dependent. In the femoral bone marrow and in the spleen the amount of fibroblast precursors was maximal by the age of two months; then, with ageing, it remained at the former level in the spleen, but decreased essentially in the bone marrow. The number of stromal precursors was rather constant in the thymus during the period of its active functional activity, but these cells were absent in the thymus of old animals.


[Skeletal morphology of inbred rats during hypokinesia and variants as a result of rehabilitation]. Statistically significant dependence between physical loading and drug treatment in hypokinesia, on the one hand, and bone adaptation, on the other hand, was shown. Correction variants studied were expressed unequally in the animals of different strains. This indicates genetic growth determination and formation of limb bones.


Efficacy of granulocyte transfusions in the control of systemic candidiasis in the leukopenic host. An experimental canine model was designed to evaluate the effect of granulocyte transfusions on systemic infection with Candida albicans in the granulocytopenic host. Each of a pair of dogs was rendered granulocytopenic with a single intravenous (i.v.) dose of cyclophosphamide (50 mg/kg body weight) and challenged with 10(6) Candida albicans organisms administered i.v. when granulocyte counts were less than or equal to 500/mm3. Granulocytes procured by leukofiltration were infused into six experimental dogs 1, 24, 48, and 72 hr after challenge with Candida. An average of 13 +/- 1.3 X 10(9) granulocytes were administered per infusion, producing an average 1-hr increment of 588 +/- 146 granulocytes/mm3 over the pretransfusion granulocyte count. Experimental and control dogs were killed 96 hr after challenge and organs examined grossly and by quantitative culture techniques to measure the extent of infection. All animals receiving granulocyte transfusions had significantly less tissue infection than nontransfused controls (p less than 0.05). It was concluded that granulocyte transfusions are effective in reducing the severity of infection by Candida albicans during periods of leukopenia.


Membrane mechanical properties of ATP-depleted human erythrocytes. Although the relations between the metabolic state and the mechanical properties of human red blood cells (RBC) continue to be of current interest, literature reports in this area are not in agreement. The present investigation was designed to determine several intrinsic mechanical properties of human RBC membranes before and after metabolic depletion via incubation at 37 degrees C for 24 hr. Using micropipette and flow channel techniques, three properties were measured: (1) mu, surface shear modulus of elasticity; (2) K, elastic area compressibility modulus; (3) etap, shear viscosity in the plastic domain. Our results indicate no significant differences in these parameters between fresh and ATP-depleted human RBC membranes. These present data are thus in disagreement with other literature reports indicating large changes in membrane mechanical properties consequent to metabolic depletion. A brief discussion of the possible reasons for this disagreement is presented.


Nonreversible loss of platelet aggregability induced by calcium deprivation. Platelets lose their ability to aggregate when deprived of divalent cations. This usually was studied by incubating human citrated platelet-rich plasma with EDTA or EGTA and then adding enough CaCl2 to combine with the chelating agent. Incubation for 5-7 min at 37 degrees C caused irreversible loss of the platelets' ability to adhere to glass and to aggregate with ADP, epinephrine, A23187, vasopressin, or serotonin or upon rewarming after chilling and markedly reduced aggregation with collagen or thrombin. Control samples incubated with saline, CaEDTA, or CaEGTA were not inhibited. Untreated platelets washed and incubated in solutions treated with resins that remove divalent cations lost their ability to aggregate in 30 min. More than about 0.26 mM Mg2+ partially protected the platelets. Unlike aggregation, ADP-induced shape change, clot retraction caused by thrombin or ADP plus reptilase, and thrombin-induced 14C-serotonin release were not inhibited after incubation. Aggregability was not restored by prolonged incubation with CaCl2, adding normal plasma, or washing the platelets. Its loss was temperature and pH dependent, occurring in 2 min at 43 degrees C but not in 7 min at 30 degrees C, and at pH 7.8 but much less at pH 7.2. The defect was not associated with an increase in platelet cyclic AMP, a decrease in metabolic ATP, or the presence of free ADP.


Chronic lymphocytic leukemia (CLL) terminating in multiple myeloma: report of two cases. Two cases of multiple myeloma (MM) developed late in the course of chronic lymphocytic leukemia (CLL). An 81-yr-old white female developed, after 6 yr of CLL, IgAk MM with sheets of plasma cells abutting sheets of lymphocytes in the bone marrow, multiple pathologic fractures, and 0.26 g/24 free k light chains in the urine. A 74-yr-old white male developed, after 16 yr of CLL, k light chain MM with 20% plasma cells in the bone marrow, multiple panthologic fractures, and 3.7 g/24 hr free k light chains in the urine. In both cases the CLL had responded well to intermittent low-dose chlorambucil therapy, but the MM failed to respond to cyclic melphalanprednisone therapy. A review of 105 cases of CLL seen at the Geisinger Medical Center failed to turn up any other cases of MM developing during the course of CLL. The suggestion that there is an increased prevalence of MM in CLL is an attractive one because both diseases are B cell neoplasms and because of the increased frequency of asymptomatic monoclonal gammopathies in CLL found by others.


Synthesis of a peroxidase activity by the cells of hairy cell leukemia: a study by ultrastructural cytochemistry. The nature of cells present in the blood, marrow, and spleen of patients with hairy cell leukemia is largely debated. These cells have been tentatively categorized on the basis of either monocytic or lymphocytic markers, and the accumulating data points to the fact that they share some characteristics of both cell types. Although hairy cells are known to lack myeloperoxidase-positive granules, present in normal human monocytes, we investigated the possible presence of other peroxidase activities differing from the granule-bound myeloperoxidase. The study was carried out with several methods based on the incubation of fixed and unfixed cells in the presence of diaminobenzidine and hydrogen peroxide. A peroxidase activity was found in hairy cells, located always in the endoplasmic reticulum but not in the Golgi apparatus or in any granule. By its cytochemical characteristics it appears to be closely related to that of tissue macrophages, activated blood monocytes, and other nonlymphocytic hematopoietic cells. This peroxidase is not found in lymphocytes with B or T phenotypes.


Effect of acute alcohol intoxication on granulocyte mobilization and kinetics. Granulocyte mobilization into skin abrasions in human volunteers was significantly inhibited by acute alcohol intoxication (45,-800 cells in 8 hr versus 353,000 in normal controls). Alcohol applied locally did not inhibit granulocyte delivery, and protection of the abrasion against heat loss did not reduce the inhibited delivery in intoxicated volunteers. Intoxication inhibited granulocyte adherence and local mobilization in parallel. Alcohol administration to rabbits shifted granulocytes from marginal to circulating pool in a manner similar to epinephrine. Mobilization of bone marrow granulocytes by glucocorticoid or endotoxin administration was not inhibited by intoxication, nor did it prevent the endotoxin-induced shift of granulocytes from circulating to marginal pool.


Modified method of erythropoietin (ESF) bioassay in vitro using mouse fetal liver cells. I. Effect of serum iron on 59Fe incorporation into heme. Investigations on the mouse fetal liver cell bioassay for erythropoietin (ESF) have revealed that iron present in test sera significantly dilutes the radiolabel (59Fe) and thus decreases 59Fe incorporation into heme. A method of correction for the influence of iron on the dose-response relationship of human sera is presented. Application of this method made it possible to assay human sera up to culture concentrations of 150 microliter/ml. It was shown that a corrected serum dose-response curve showed parallelism to the curve of an ESF standard preparation. This suggests similarity of the active principles and allows valid estimation of a potency ratio.


Modified method of erythropoietin (ESF) bioassay in vitro using mouse fetal liver cells. II. measurement of ESF in human serum. A modification of the mouse fetal liver cell bioassay for erythropoietin (ESF) that allows quantitative detection of ESF in human serum is described. The modification consists of (1) correction for the effect of serum iron on 59Fe incorporation into heme and (2) the use of an "internal standard," i.e., a standard ESF preparation dissolved in the assayed test serum. As a result of this modification the statistical method of bioassay analysis had to be changed fundamentally. The mean serum concentration of ESF measured in 20 normal males was 48 microunit/ml, as compared to 29 microunit/ml in 18 females. The difference was significant at p = 0.017. The stimulatory activity of a human serum on 59Fe incorporation into heme could be neutralized by an anti-human ESF immune serum.


Detection of factor XIIIa (active fibrin-stabilizing factor) in normal plasma. Factor XIIIa (active fibrin-stabilizing factor) generated in heat-defibrinated plasma by the addition of thrombin can be measured by 14C-putrescine incorporation into casein. Modification of this assay be substituting 3H-putrescine of high specific activity as the donor amine permits measurement of amine incorporation by plasma even in the absence of added thrombin. Incorporation is calcium dependent, inhibited by iodoacetamide, and absent from congenital factor XIII-deficient plasma and from normal platelets. The transamidating activity detected by radioenzymatic assay catalyzed the formation of gamma-gamma dimers and alpha polymers of fibrin and was thus biologically functional. This fibrin cross-linking activity was absent from factor XIII-deficient plasma. These experiments show (1) some factor XIII is present in plasma as factor XIIIa; (2) this factor XIIIa can cross-link fibrin and thus has biologic activity as well; and (3) this activity is not present in factor XIII-deficient plasma. Factor XIIIa in normal plasma is possibly activated in vivo, perhaps by circulating thrombin, factor Xa, or other proteolytic enzymes.


Lymphocyte surface immunoglobulin density and immunoglobulin secretion in vitro in chronic lymphocytic leukemia (CLL). Lymphocyte surface immunoglobulin (SIg) and immunoglobulin (Ig) secretion were studied in 14 patients with chronic lymphocytic leukemia (CLL) and 12 healthy subjects. The determination of SIgM-bearing (SIgM+) cells by immunofluorescent staining and the quantification of SIgM by radioimmunoassay (RIA) permitted the calculation of the SIgM density. In 12 normal subjects the percentage of SIgM+ cells averaged 8% (range 4%-12%) and the SIgM density 10.2 ng antigenic equivalent/10(6) SIgM+ cells (SD 4.3). In 12 patients with CLL the respective figures were 68% (range 35%-90%) and 0.68 ng (SD 0.57). Ig secretion from pokeweed mitogen-stimulated CLL cells was markedly diminished as compared with normal lymphocytes. In coculture experiments CLL cells had no suppressive effect on Ig secretion of normal lymphocytes and normal lymphocytes did not enhance Ig secretion leukemic lymphocytes. These results indicate that the impaired secretory activity of CLL cells results from an intrinsic anomaly of these cells.


Comparison of intracellular bactericidal activities of human neutrophils and eosinophils. Eosinophils from a patient with hypereosinophilia were observed to phagocytize radiolabeled E. coli or S. aureus as effectively as neutrophils from a normal control. This was observed at a number of bacteria/cell ratios and a various time intervals following initial challenge and was confirmed by direct microscopic examination. In spite of comparables rates of phagocytosis, the eosinophils were consistently less capable of killing the bacteria. This correlates with an inability of eosinophil peroxidase to catalyze the peroxidase-H2O2-CI--mediated decarboxylation of amino acids; in contrast, both eosinophil and neutrophil peroxidases showed similar capabilities to iodinate protein in vitro. These data are compatible with the importance of the chloride-mediated mechanism in the bactericidal activity of intact phagocytes.


Abnormal splenic uptake of red cells in long-lasting iron deficiency anemia due to self-induced bleeding (factitious anemia). The authors report on six cases of chronic iron deficiency anemia in which a diagnosis of factitious anemia was made. Erythrokinetic studies demonstrated iron deficiency and blood loss. Besides these features, two kinetic abnormalities are described: precocious splenic sequestration of red cells and excess hemolysis. This hemolytic syndrome seems to be correlated to the duration of anemia rather than to its severity.


[A modified MOPP regimen in the treatment of Hodgkin's disease stage III B and IV (author's transl)]. In a retrospective study 80 patients with Hodgkin's disease of stage III B (n = 32) and IV (n = 48) were investigated, who had been treated with a modified MOPP regimen. 28 patients (35%) were previously untreated. A completed remission was reached in 51 patients, a partial remission in 16, and 13 patients failed to respond. 16 patients had died in the observation period. Complete remissions were twice as frequent with 90% in stage III as compared with 45% in stage IV. The group of patients surviving 4 years was 92% in stage III and 62% in stage IV.


The spreading of leukocytes released from their liquid environment. It is known that while leukocytes in conventional blood smears reveal their structures, in smears of erythrocyte-free suspension (EFS) they show a tendency to pyknosis. From the present study it appears that: 1. When any leukocyte suspension is subjected to drying on slides the cells undergo shrinkage (pyknosis in stained state) because their water content is extracted by the suspending fluid that is rendered increasingly hypertonic during drying. 2. When the leukocytes, which while floating within physiological fluids are ball-shaped, are entirely released from their suspending fluid, they suddenly spread into flat cells because the capillary force between the cell membranes and glass overcomes the surface tension of the cells. 3. In contrast to shrunken or even normal (spherical) cells, spread cells are able to display their morphology. Using the smear technique, the cell density of the suspension will determine whether spreading or shrinkage are to occur; with normal blood (high density) the release and consequently the spread are achieved; with EFS (usually of low density) an inadequate release and consequently shrinkage occur. 4. A device (cell spreader) for spreading leukocytes of EFS is presented.


Influence of hen dietary calcium and phosphorus on the integrity of the egg shell as it would influence hatching success and the consequences of preincubation 2, 4, 5-T spraying with and without a high TCDD level. Commercial strain laying hens were fed practical rations deficient in calcium and/or phosphorus to affect weak shelled eggs. Spraying these eggs prior to incubation with 2, 4, 5-T preparations having extremes in TCDD contamination at 10x recommendation was without effect on all parameters used to evaluate embryological development and subsequent early performance of resultant chicks. Analyses for 2, 4, 5-T residues indicated that the shell though weakened was unaffected as a barrier to herbicide contamination.


The use of Cerenkov radiation in the measurement of 115mCd in blood and other tissues. A new method for the activity measurement of 115mCd in biological samples was proposed. After tissues mineralization with 60% perchloric acid and 30% hydrogen peroxide (I) or with 0.5 M ethanolic sodium hydroxide (II) the solutions were measured in automatic liquid scintillation counter SL-30 by CERENKOV technique. The channels ratio method was successfully applied for standardization. The recoveries of 115mCd varied in the ranges: 93.6-102% and 82.7-99.3% for method I and II, respectively.


Chlorinated tyrosine in municipal waste treatment plant products after superchlorination. Previous work has shown that 3, 5-dibromotyrosine acts as a thyroxine production/secretion inhibitor which may imply a similar response to chlorotyrosine derivatives. Chloro- and dichlorotyrosine have been produced in the laboratory by the action of aqueous chlorine upon tyrosine at low pH, and have been found in the effluent from superchlorination facilities in use at three municipal waste treatment plants. The extent to which these and other possible chlorinated amino acids occur in superchlorinated waste products, and their fate in receiving streams is not known, and is under investigation by this laboratory.


Toxic responses in gerbils treated topically with aflatoxin B1 and dimethylformamide. Male and female Mongolian gerbils failed to show observable pathological responses in the liver to topically applied AFB1 and DMF indicating that percutaneous absorption of AFB1 is absent in this species. In males, some responses in weight changes were attributed, proportionally, to increased doses of DMF. Unexplained and currently under investigation is the possibility that AFB1 may have reduced the response of some animals to DMF. This response may relate in some way to the modification of absorption of DMF in the gerbil since AFB1 is known to have an influence on cell membranes.


A union catalog of monographs: another approach. The rationale for and the production of the 1977 TALON Union Catalog of Monographs are described. The 158,859 records include the existing machine-readable records for six health sciences libraries plus the cataloging of six others, converted by matching other data bases and by keypunching. The method and costs of production are discussed. Use of Computer-Output-Microfiche (COM) significantly decreased the cost and time required for publication. The $.076 unit cost per entry, with both author and title access for the COM method, is almost one-half the unit cost for the previous method which offered only main-entry access. The TALON Catalog compares favorably with the Midwest Medical Union Catalog. The addition of the title index significantly increases its usefulness. However, the unique feature of the TALON Catalog may be its machine-readable form which offers the potential for quantitative analyses of health sciences library collections. Such data may be essential for rational management of limited library funds.


Toward hospital library standards in Canada. A report is given on Canadian hospital library standards as recently developed and incorporated in a new Guide to Hospital Accreditation, 1977. The new Canadian standards are compared with MLA recommendations to the Joint Commission on Accreditation of Hospitals. Their development is sketched and the contribution from Quebec of a model of hospital classification is examined. This model provides differential minimal library standards based on the function of the hospital rather than on its size alone. Use of these minimal standards as a practical means of developing hospital libraries is discussed and their implications for accreditation visits are underlined.


Friends of the library groups in health sciences libraries. The Houston Academy of Medicine--Texas Medical Center (HAM--TMC) Library collected data on friends of the library groups from 103 health sciences libraries, using a mail questionnaire. Sixteen of the responding libraries had independent friends groups; seven had friends groups that were subordinate to a university group. The sixteen independent groups gave as their major purposes (1) to raise money for their associated library and (2) to develop support for their library. These groups contributed an average of $4,870 a year to their libraries, the money being used primarily to purchase rare books and working-collection books and to sponsor social events. The subordinate groups contributed relatively little money to the health sciences libraries responding to the survey.


Evaluation of a clinical medical librarian program at the Yale Medical Library. A clinical medical librarian (CML) program in a large university-based teaching hospital setting is viewed by the majority of clinicians as education-oriented, with slightly fewer clinicians viewing it as patient care oriented. The CML service has been utilized for research purposes only when it is clear that case-relevant information can evolve into research intended to have "clinical" impact. This study reports the results of a questionnaire circulated among clinicians receiving CML support by a large medical school library. Results indicate that (1) the CML effected a change in information-seeking behavior by the clinicians--they obtained information that would not have been available to them if the CML had not been present in patient-management conferences; (2) relevancy of information provided by the CML was judged by the clinicians to be very high; (3) the accuracy of the CML's search, coupled with the rapidity of delivery, was found to be highly satisfactory; (4) acceptance of the CML within the patient care setting was acknowledged by the majority of clinicians, who contact the CML in-hospital and overwhelmingly prefer to do so; and (5) there was no statistically significant variation in the manner in which different medical specialties use the services of a CML. These findings justify implementation of a clinical medical librarian program, on a modified basis, as an additional service to already existing reference services offered by a large medical school library.


In search of an ethic of medical librarianship. Why is the literature on the ethics of librarianship so sparse? Some of the codes of ethics proposed or officially adopted during this century are examined, with an informal commentary on the reasons why they seem to have aroused so little sustained interest and discussion. Attention is directed particularly to library--user relationships and to some of the unique ethical situations in medical libraries.


Silicone sheet and bead implants to correct the deformities of inadequately healed orbital fractures. Following severe trauma to the middle third of the face, a common deformity requiring secondary correction is a combination of lowered orbital floor and enophthalmos often associated with diplopia and ptosis. Silicone discs are used to elevate the orbital floor and silicone beads inserted subperiosteally to correct the enophthalmos. In a series of 44 cases we have had no instance of infection or rejection although some beads had to be removed in 1 patient because of increased pressure on the eye. Close collaboration between plastic and ophthalmic surgeons is essential.


Vulnerability factors and depression in women. A matched controlled study of 84 depressed women confirms the findings of Browm et al, that loss of mother before 11, three or more children at home under 14 years of age, lack of a confiding marital relationship and lack of employment may be vulnerability factors predisposing to depression in working-class women.


Evaluation of a social work service for self-poisoning patients. Four hundred patients aged at least 17 who came to Casualty in one year after deliberately poisoning themselves were randomly assigned between an Experimental social work service (task-centered casework) and a Control (routine) follow-up service. 139 patients were excluded from the trial, most of whom were already in continuing psychiatric treatment. After one year there was no difference in the proportions of E and C patients who repeated self-poisoning (about 14 per cent), but significantly more of the excluded group had repeated (36 per cent). A random half of the trial patients were re-interviewed four months after admission. Both E and C groups had improved to a significant extent on measures of depressed mood and of social problems. E patients showed more change in social problems and were more satisfied with the service they had received.


Specific psychological deficits in alcoholism. Forty alcoholics and 40 controls were compared on tests of frontal lobe functions, abstracting ability, and verbal and picture memory. Alcoholics were inferior to controls, and heavy drinkers poorer than moderate ones (life-time alcohol consumption) on picture memory and a verbal fluency test of frontal lobe functions. Verbal memory and abstracting ability were not significantly impaired. Although this pattern may indicate that frontal and right temporal areas of the brain are particularly vulnerable to the effects of chronic alcoholism, the possibility that it may merely reflect general sensitivity of the tests to brain damage cannot be ruled out.


Recurrent unipolar depressions with a 48-hour cycle: report of a case. Since 1804 there have been twelve case reports of patients with mood disorders showing a regular periodicity of 48 hours, eight bipolar and four unipolar. This paper describes an additional patient, a 57-year-old man with a 48-hour unipolar cycle. Although his 24-hour serum cortisol pattern was abnormal, there were few clear-cut biological abnormalities. Possible mechanisms are discussed, and comparisons made with previous reports of similar patients.


Age disorientation in schizophrenia: a constant prevalence of 25 per cent in a chronic mental hospital population? The prevalence of age disorientation was estimated in the population of patients with a diagnosis of schizophrenia in a large mental hospital. Of these 357 patients 25 per cent demonstrated age disorientation, defined as a five-year discrepancy between true and subjective age, and 11 per cent of the population believed themselves to be within five years of the age they were at admission, although they were a mean 28.9 years older. Age-disorientated patients differed from the age-orientated in being significantly older. However, when age-matched, they were younger at first admission and had a longer duration of stay than patients with a diagnosis of schizophrenia without age-disorientation. Age-disorientation may thus be a feature of a type of schizophrenic illness of early onset and poor prognosis.


Age disorientation in chronic schizophrenia: the nature of the cognitive deficit. In an interview survey of temporal orientation in chronic schizophrenia, patients with age disorientation (n = 77) were much less likely than patients without age disorientation (n = 222) to be able to give correct answers to simple questions about dates and the passage of time (e.g. their date of birth, the present year and the duration of their hospital stay). The age disorientated systematically under-estimate the present year and their duration of hospital stay; in individual patients the errors they make are consistent with their concept of their own age. "Time stands still" for these patients. However, there are patients in whom an incorrect appreciation of their own age co-exists with correct awareness of the present year. Between these patients and those for whom subjective time stands still, there appears to be a continuum of increasing temporal disorientation. This dimension may be a clinical correlate of intellectual impairment.


Clinical laboratory abnormalities and their follow-up in a mental hygiene clinic. In a retrospective study, there were clearly abnormal laboratory findings in 4.8 per cent of 4,994 adults who attended for psychiatric evaluation at a mental hygiene clinic. In particular high fasting blood sugars, abnormal blood counts, eosinophilia, VDRL and abnormalities of chest X-ray or urinalysis were found. Just under half of these abnormalities led to further medical follow-up. Old and young, schizophrenic and neurotic were equally likely to be followed up, but tests which were clinically not alarming might be ignored. The implications are discussed.


The influence of videotape feedback on the self-assessments of psychiatric patients. The effects of videotape feedback on patients' self-perception were assessed in a study which was a partial replication of an investigation reported by Griffiths and Hinkson (1973). Subjects were randomly allocated to one of three groups. After a semi-structured interview, they were either (1) shown a videotape of the interview, or (2) shown a videotape of another person being interviewed, or (3) engaged in other activities not involving videotape. Patients' self-ratings indicated that videotape feedback has immediate effects on self-assessments of social ease and physical attractiveness. Feedback produced changes in ratings of social ease, but individuals differed in the direction of the change (i.e. whether social ease was "better" or "worse"). The direction of the change was predicted by a questionnaire measure of response style. Feedback also tended to make patients rate themselves as less attractive in the eyes of other people. All changes were, however, temporary and had disappeared at a two-week follow-up. The results are generally consistent with those reported by Griffiths and Hinkson in that they indicate temporary and specific changes in response to videotape feedback. The implications of the results are discussed.


Symptom patterns among chronic schizophrenic in-patients. The Delusions-Symptoms-States Inventory (DSSI) was administered to 33 chronic non-paranoid schizophrenic patients resident on long-stay wards. It was found that the vast majority of cases (81 per cent) produced symptom patterns conforming to the hierarchy of classes of personal illness model, but with a radically different distribution among the classes from that in acutely ill patients. Within the model a half of the patients were allotted to the two lowest classes--Class 0 (Symptom-free) and Class 1 (Dysthymic States). When each set of items was considered separately and independently of the model, it was found that a half of the group professed to have recently experienced delusions. Affective states and depressive symptoms were reported by over a third of the patients.


Factors influencing the response latencies of subnormal children in naming pictures. The times taken to name 56 drawings of objects on five separate occasions were analysed for 21 ESN(M) and 21 ESN(S) children, matched for picture-naming vocabulary. The ESN(S) group not only had a higher mean response latency but also showed greater inter- and intra-subject variance. Nine objects were selected whose names have a Thorndike-Lorge language frequency of 50 words per million or greater, and nine others were selected with a frequency of less than 50 words per million. Each object was drawn in two ways, one giving a two-dimensional outline with the addition of important detail, the other drawing also incorporating cues indicating the depth of the object. An analysis of variance of the children's latencies in naming the selected 36 pictures of 18 objects over five trials indicated that the method of drawing had no effect upon naming latencies. Pictures with high-frequency names were named faster than those with lower frequency names, the ESN(S) group showing a greater rate of increase in naming latency for the lower frequency words than the ESN(M) children. Results were discussed in terms of the Oldfield and Lachman models of lexical memory storage and of the search processes required for the retrieval of names.


Memory effects in visual spatial information processing. Eight, ten and twelve year old children were tested on a novel procedure involving the successive presentation of the standard and comparison stimuli. Two hypotheses were evaluated, one dealing with memory effects, and the other with children's pre-testing of choice responses in spatial information processing. It was found, in general, for both spatial perception and coordination of perspectives tasks, that there was no short memory decay for spatial information, but that opportunities to pre-test choice responses improved performance. It was inferred from these data that the performance superiority under simultaneous than successive conditions is attributable to opportunities to pre-test responses and not to memory effects, as opposed to successive conditions is attributable to opportunities to pre-test responses and not to memory effects.


Acquisition and performance difference between normal and mentally handicapped adults on a complex assembly task. Several single studies concerned with work training with the mentally handicapped have been reported in the literature (Bitter & Bolanovich, 1966; Huddle, 1967; Gold, 1969; Screven, Straka & Lafond, 1971). Most have been concerned with issues of acquisition and motivation to perform. No studies have been reported which focus on the evaluation of different techniques of training or which assess rate of acquisition against that of non-handicapped controls. The aim of this experiment is twofold. It uses a complex task, analysed by MTM-2, to enable comparison between the performances of mentally handicapped adults and adults from a 'normal' population, in the acquisition of new work skills. Various strategies of training were compared and the increase in the rate and quality of performance following acquisition was measured for both, in terms of speed and accuracy of production. Results add further support for the notion that the potential of mentally handicapped individuals is commonly underestimated. It is hoped that the findings provide a basis from which further experiments can be developed and evaluated.


Evidence for language recoding in autistic, retarded and normal children: a re-examination. In a replication and extension of earlier studies by Hermelin & O'Connor, language recoding abilities in autistic, retarded and normal children matched for mental age and digit span, were compared in a verbal recall task. Random word lists, sentences, and anomalous sentences, eight or 12 items in length (for high and low memory span subgroups) were presented and the number of words recalled from each type of input was scored. All low span children recalled sentences better than random lists with normal children superior to retarded and autistic children and the latter group poorer than the retarded group. Autistic children showed a recency effect with both types of input. There were no group differences amongst high span children and sentences were again better recalled than random lists. In Expt II sentences were better recalled than anomalous sentences, with autistic and retarded children equivalent in performance and poorer than normal children. Although low span autistic children were clearly deficient in recall of sentence material when compared with the two control groups, the effect of conditions showed that they were able to use structure to improve recall. Since high span autistic children did not perform differently from controls it is suggested that results from this kind of study may not be generalizable, and that claims for a specific coding deficit in autistic children need further substantiation.


Computed tomography in spontaneous intracerebral haematomas. The typical computed tomographic (CT) features of a recent intracerebral haematoma are a homogenous region of increased attenuation surrounded by a well demarcated relatively narrow low attenuation ring (LAR). The pathology of the LAR is controversial, but it corresponds well with a zone of ischaemic necrosis which is observed around most intracerebral haematomas exmined at autopsy. Observations are made on spontaneous intracerebral haematomas and on blood samples which confirm that extravasated blood clot undergoes a variable degree of retraction which is completed within six hours. This suggests that the LAR in recent haematoma is due to damage caused by the greater volume of the precontracted haemorrhage on the surrounding brain. CT abnormalities in intracerebral haematomas were studied; features which were useful in distinguishing spontaneous haematomas and those which affected prognosis are discussed.


The hip joint in Paget's disease (Paget's "coxopathy"). Three hundred patients with Paget's disease around the hip joint are compared with 300 control patients who did not have Paget's disease. The incidence of joint degeneration in the two groups is similar at all ages, and there appears to be no predisposition to joint degeneration in patients who have Paget's disease. A feature of the hip joints is that in approximately half there is joint narrowing to less than 3 mm affecting a portion or the whole of the joint surface, which, together with the incidence of protrusio acetabuli, is probably a specific manifestation of the joint changes associated with Paget's disease.


Renal tubular sludging of meglumine iodipamide (Biligrafin). Linear densities which were thought to represent meglumine iodipamide were seen in the renal papillary tubules of three patients for respectively four, six and nine days following intravenous cholangiography (IVC). All three patients were children with hepato-biliary disease. Two patients had biliary roundworm infestation, and one patient had hepatic dysfunction and intestinal ascariasis with possible biliary involvement. Haematuria and renal enlargement were seen in one patient, but the cholangiogram was not conclusively implicated as a cause. This renal tubular "sludging" of biliary contrast medium is recorded because of its potential nephrotoxic significance. The possible causes are discussed.


The early development of the human skeleton: a radiographic study of fetuses impregnated with silver nitrate. The use of a silver nitrate impregnation technique and radiography for delineation of the bones of the developing skeleton is not widely known. Using this method, a study of skeleton development was undertaken over a three-year period and special attention was paid to 20 fetuses under the age of 16 weeks. The dates at which ossification in cartilage occurred and the sequence of bone development were noted. Although the technique may be used to delineate skeletal dysplasias in the stillborn, it is best suited to fetuses aged 9--20 weeks. It may become possible to show the earliest age at which bone dysplasias affect the skeleton though this is speculative at the moment.


Pneumatosis intestinalis in children.

Pneumatosis intestinalis in children. Pneumatosis intestinalis in children is well documented condition, and is accepted as a manifestation of differing gastrointestinal tract disorders such as mechanical obstruction, vascular disturbances of the bowel with or without bacterial contamination. However, the total spectrum of the mechanisms of production of pneumatosis is not yet fully understood. The presence of pneumatosis in necrotizing enterocolitis is a very serious condition and the mortality rate is very high. Transient ischaemia in infants due to perinatal stress is considered as an important aetiological factor. Gas in the portal venous system and pneumoperitoneum are also well-known associations. Gross peritonitis and perforation of the bowel are regarded as an indication for urgent surgery. Pneumatosis due to other causes follows a benign course, and does not influence the management.


Ultrasound and hepatic metastases.

Ultrasound and hepatic metastases. Recent advances in ultrasonic technology have permitted differentiation of tissue within an organ. Fifty-nine patients in whom satisfactory follow-up could be obtained underwent grey-scale ultrasonic examination of their livers. Fifty-three patients were scanned successfully and of these a correct diagnosis as to whether metastases were present or not was given in 46. Ultrasound is a safe non-invasive way of detecting hepatic metastases.


An evaluation of the use of 99Tcm-dimercaptosuccinic acid (DMSA) as a static renal imaging agent. The clinical value of 99Tcm-dimercaptosuccinic acid, utilized as a static renal imaging agent, has been analysed in 366 patients. It proved to be diagnostically most useful in space occupying lesions of the kidney when equivocal on IVU and provided useful additional information when used in the determination of divided renal function or the distribution of intrarenal function. Its use is contraindicated in the determination of divided renal function in obstructed kidneys because of accumulation of significant amounts of DMSA that are excreted by glomerular filtration. When DMSA uptake at three hours after injection is compared with 99Tcm-DPTA uptake from 90 to 150 seconds after bolus injection, there is a good correlation between the two methods of determination of divided renal function.


Response of aneurysmal bone cyst to low doses of cobalt 60 gamma radiation with prolonged treatment. Successful treatment of two cases of aneurysmal bone cyst by cobalt 60 gamma radiation using low doses over prolonged periods (1400 rad in seven weeks and 1600 rad in eight months) is reported. Follow-up of four to ten years duration does not reveal any recurrence or complications. The merit of low dose, prolonged interval irradiation over surgery is discussed. This technique is recommended for aneurysmal bone cysts in children, especially at inaccessible sites.


Implementation of the Philips treatment planning system for use in radiation teletherapy. The Philips TPS is a dedicated computer system primarily for the calculation and display or radiotherapy dose distributions resulting from multiple field and rotational beam teletherapy techniques. Although a comprehensive range of planning facilities is offered by the system, including calculations in a number of parallel slices taken through the patient, the amount of basic data required to program the system is modest. This paper describes the beam checks which are necessary in order to obtain the input data, and then examines how well the computed radiation beams compare with independently measured isodose distributions. Other features of the system are discussed and an assessment of its operational reliability is given. The recently developed interstitial program is not examined here.


Mean skeletal dose factors for beta-particle emitters in human bone. Part I: volume-seeking radionuclides. Based on calculations by Whitwell and Spiers, mean skeletal dose factors for beta-particle emitters have been derived for application to dosimetry in nuclear medicine, radiobiology and radiation protection. The dose factors apply to bone-seeking radionuclides that are depostited more or less uniformly throughout the human mineralized skeleton and are defined as: (1) vDM/DB, the mean dose to the haemopoietic marrow in trabecular bone as a fraction of the "dose to bone", DB; (2) vDs/DB, the mean dose to endosteal (osteogenic) tissue lying in a zone 0--10 micron from trabecular surfaces, also as a fraction of the dose DB. Dose factors are given for three ages, 1.7, 9 and 44 years and for eight radionuclides, ranging in mean beta-particle energy from 0.05 MeV (14C) to 0.93 MeV (90Y). Dose factors, calculated for a single lumbar vertebra of an infant aged 3.5 weeks, enable approximate values of mean skeletal dose factors to be estimated for ages less than 1.7 years. Limited data are also reported on dose factors for the femoral cortex from subjects aged 9 and 50 years.


The injuries of terrorist bombing: a study of 1532 consecutive patients. Of 1532 explosion victims only 9 died in hospital. Injury to the chest or abdominal organs was rare (10 patients of whom 5 died). Primary blast lung was apparent in only 2 patients. Major limb amputations occured in 16 patients of whom 4 died. None of the 50 patients with burns required skin grafts. Injuries were predominantly to the head and neck and limbs, suggesting the protective effect of clothing. Half of the patients suffered from emotional shock, most with no physical injury and 82 per cent of whom were female. Eighty-three per cent of patients arrived at hospital between 10.00 a.m. and 7.00 p.m.


Major arterial trauma: review of experience with 267 injuries. Experience with 267 arterial injuries treated over a 3--4-year period is reported. Vessels in the lower limb were involved most commonly (43 per cent), but there was also a relatively high incidence of carotid (13 per cent) and subclavian (9 per cent) injuries in this series. Penetrating wounds (stab and gunshot) were most commonly responsible. We found that serious distal ischaemia is uncommon in upper limb injuries, but expanding haematoma at the root of the limb is a cause of mortality and serious morbidity. Selective use of preoperative angiography is recommended. Successful results follow liberal use of interposition grafts after wide excision of doubtful vessel, rigorous wound excision, delayed primary closure and fixation of associated fractures. Repair of concomitant venous injuries should always be attempted but is more important in the lower than the upper limb. Late revascularization in the presence of critical ischaemia yields a 50 per cent limb salvage rate, but great care must be taken to avoid renal insufficiency and, if it occurs, energetic treatment is necessary for survival.


Isolated complete transection of the common bile duct by blunt abdominal trauma. Isolated complete transection of the common bile duct due to blunt trauma is rare. Its occurrence and successful treatment in an 8-year-old boy are described. Inital minor peritonism resolved quickly, followed by a deceptive asymptomatic period and insidious development of jaundice, anorexia, vomiting, pain, acholic stools and progressive abdominal distension due to sterile biliary ascites. A preliminary cholecystostomy was followed by construction of a Roux-en-Y cholecystojejunostomy.


Intrathoracic rupture of the spleen.

Intrathoracic rupture of the spleen. The case is reported of a 15-year-old girl who presented following trauma and was found to have a massive congenital diaphragmatic hernia through the foramen of Bochdalek. The spleen, which was intrathoracic, had ruptured. No other similar cases have been reported in the literature hitherto.


Depot penicillin as prophylaxis in accidental wounds. A series of 285 patients attending an accident and emergency department with wounds which required suturing was divided at random into two equal groups. The first group received a single dose of depot penicillin at the time of suture and the second group received no antibiotic cover. The incidence of subsequent wound infections was not significantly reduced in patients who received penicillin.


Use of the carbon dioxide laser in an abdominoperineal resection for epidermoid anal carcinoma: a case report. An abdominoperineal excision of the rectum was performed on a 52-year-old male who had epidermoid anal carcinoma. A steel scalpel was utilized for the abdominal component, but the entire perineal resection was accomplished with a carbon dioxide laser beam. We believe this to be the first reported case of an abdominoperineal resection using this new modality, which may become a useful and modern adjunct in extirpative surgery. The haemostatic effects of the laser were well demonstrated in our patient.


The effect of reversed jejunal segments on the myoelectrical activity of the small bowel. Short reversed jejunal segments increase intestinal transit time clinically. In view of the correlation between motility and myoelectrical activity, we have investigated the effect of jejunal reversal and transection on the latter in 10 mongrel dogs. There is a significant decrease in the basic electrical rate in and below both transected and reversed jejunal segments. There is a 3 per cent incidence of retrograde electrical activity within a transected segment and a 24 per cent incidence in the intestine distal to it. In reversed segments the incidence of retrograde activity is 60 per cent within the reversed segment and 61 per cent in the jejunum distal to it.


Adenocarcinoma arising in a duplication of the rectum. A case of adenocarcinoma arising within a rectal duplication is reported.


Peritoneal dialysis in obstructive jaundice: an experimental study. Rats were subjected to common bile duct ligation, after which intermittent peritoneal dialysis with a buffered solution containing rat plasma proteins was carried out in an attempt to reduce plasma bilirubin levels. Plasma bilirubin increased significantly (P less than 0.01) on the seventh day and was still rising 12 days after ligation of the common bile duct. Dialysis was performed during the second postoperative week. Provided that rat plasma protein was present in the dialysing fluid, dialysis significantly reduced (P less than 0.01) the levels of total plasma bilirubin, conjugated bilirubin and serum GPT in the experimental animals.


An isotope clearance method for measurement of liver blood flow during portasystemic shunt in man. The clearance from the surface of the liver of krypton 85 following its injection into the portal vein was measured in 10 patients. Six control patients (i.e. those not suffering from portal hypertension) averaged flow values of 142 ml per 100 g liver weight per min. A repeat flow estimation in these patients was not significantly different. Four patients with portal hypertension were studied. In 2 with congenital hepatic fibrosis the portal vein was temporarily occluded to allow prediction of the degree of hepatic perfusion likely to be achieved by the hepatic artery alone after portal deviation. The flow after portal venous clamping was unaffected in one of these cases but reduced by 45 per cent in the other. In a patient undergoing a Warren distal splenorenal shunt there was no change in flow after the procedure. If measurements are performed before and during temporary portal vein occlusion, an assessment of the flow reduction to be expected after a shunt procedure can be made. We suggest that a knowledge of liver tissue perfusion might influence the choice of operative procedure.


Non-operative treatment of retained bile duct calculi in patients with an indwelling T tube. The results of combined instrumental and chemical treatment of retained bile duct calculi in 18 patients with an indwelling T tube are reported. The instrumental extraction of stones was carried out through the T tube channel using a modified Dormia apparatus. The chemical method involved continuous infusion through the T tube of heparin in saline alternating with sodium cholate. The treatment was successful in 16 of 18 patients with from 1 to 14 residual stones. The instrumental extraction of stones is recommended as the treatment of choice 5--6 weeks after choledochotomy in patients with residual stones and an indwelling T tube. Subsequent chemical treatment is recommended if remnants of stones are left in the bile duct after instrumental treatment.


Clinical experience with silicone rubber grafts as shunts in portal hypertension. We report the use of a woven silicone rubber graft as an alternative prosthesis for a shunt in 8 patients with portal hypertension. Four patients were operated on as emergencies and 4 electively. In 4 cases the graft was used as a standard mesocaval H graft, in 2 as a portocaval H graft and in 2 cases it was used to simplify the Warren selective distal splenorenal shunt. The material has properties which make it a superior graft to existing prostheses and autogenous vein. Our results confirm the experience of others, that the poor risk patients do badly whatever form of shunt is performed, and of those who survive, the total portal shunt carries the risk of postoperative encephalopathy.


Aneurysms of the extracranial carotid arteries. Aneurysms of the extracranial carotid arteries are unusual; they present difficulties in diagnosis and may cause death or cerebrovascular accidents in a majority of patients. This report describes three different types of aneurysm of the carotid arteries and their presentation and discusses their management.


Respiratory viruses and cot death.

Respiratory viruses and cot death. Respiratory viruses and histological appearances of the lung were studied prospectively in an unselected series of 104 children who died between 1 week and 2 years of age. Thirty-one of the cases were cot deaths. Seven of these showed evidence of active virus infection in the lower respiratory tract. Similar evidence was found in two children who died from known causes and did not have a severe respiratory illness terminally. Although in some cases of cot death respiratory viruses may be responsible for a severe and rapidly overwhelming illness, the present results are compatible with an alternative hypothesis-namely, that minor respiratory illness may trigger sudden apnoea.


Contribution of general practitioner hospitals in England and Wales. A survey of a one-in-seven sample of general practitioner hospitals in England and Wales, performed to determine the contribution they make to overall hospital work load and the attitudes of the general practitioners working in them, showed that 3% of acute hospital beds in England and Wales were in general practitioner hospitals, which provided initial hospital care for up to 20% of the population. Altogether 16% of general practitioners and 22% of consultants were on the staffs, and they coped with more than 13% of all casualties, 6% of operations, and 4% of x-ray examinations. Nearly a million casualties were treated at no cost to the National Health Service. Twenty new district general hospitals would be needed to cope with the work load currently dealt with by general practitioner hospitals. The results of this survey indicate that these smaller hospitals deal efficiently and cheaply with their work load, and that morale is high. General practitioner hospitals could have an important part to play in providing certain types of care, but there are no financial incentives to enable general practitioners to realise this potential fully.


Benefits of total hip replacement to older patients and the community. The benefits of total hip replacement in 49 people aged 55-84 with osteoarthrosis of the hip were evaluated. The main benefit was relief of symptoms, 40 patients being pain free after operation. Range of hip movement and mobility improved moderately in most patients. After operation most patients were better able to perform certain activities of daily life, though only six were completely independent, the rest requiring aids or help from others. Nevertheless, 18 of the patients' main helpers estimated that they had more time free of tasks previously performed for the patient. There was a small reduction in the need for community medical resources such as home visits from general practitioners or district nurses. Thirteen patients were still taking antiarthritic drugs. Older patients needed to spend longer in hospital after operation because of complications. It was concluded that total hip replacement contributed to improving the quality of life of patients and their helpers, while also helping to reduce the demand for community health and welfare services.


Failure to detect intra-abdominal metastases from breast cancer: a case for staging laparotomy. Two studies were performed to assess the accuracy of non-invasive methods in detecting intra-abdominal metastases from breast cancer. Firstly, the sites of spread detected at the time of first presentation with metastases were compared with the sites of spread shown at necropsy in the same patients. Although about two-thirds of the patients with bone and lung metastases at necropsy had had metastases detected at these sites when they first presented with metastases, only a third of the patients with liver metastases and none of those with other intra-abdominal metastases had had evidence of disease at first presentation with metastases. The second study confirmed a poor detection rate of liver and other intra-abdominal metastases in patients with breast cancer undergoing laparotomy and oophorectomy who were staged immediately before operation.Pre-mastectomy staging laparotomy should be considered in those patients with primary breast cancer who are most likely to have disseminated disease beyond the regional nodes. In the presence of occult gross metastases detected by staging laparotomy, mastectomy will not provide additional protection against loca recurrence of disease. Patients with occult gross metastases should also be excluded from studies on adjuvant chemotherapy (designed to treat micrometastases). Aggressive methods of staging are justified to protect the patient as far as possible against unnecessary mastectomy and to identify those patients who should be treated by therapeutic chemotherapy rather than adjuvant chemotherapy.


Comparison of performance of various sphygmomanometers with intra-arterial blood-pressure readings. Seven types of sphygmomanometer were used in random order on each of nine hypertensive patients and the readings compared with simultaneous intra-arterial blood-pressure recordings. All the devices gave significantly different values for systolic pressure, and only two measured diastolic pressure without significant error. Systolic pressure was consistently underestimated (range 31-7 mm Hg), and all but one instrument overestimated diastolic pressure (range 10-2 mm Hg). The variability of readings was least with the standard mercury sphygmomanometer and the random-zero machine, while with some of the more automated devices single readings were in error up to -68/33 mm Hg. The strong correlations found between intra-arterial and cuff systolic pressures with all devices tested and significant correlations for diastolic pressure with all but one device indicate that, with one possible exception, the sphygmomanometers would give accurate results where a change in blood pressure was the main concern.


Oxamniquine for treating Schistosoma mansoni infection in Sudan. The efficacy and acceptability of oral oxamniquine were assessed in Sudanese patients infected with Schistosoma mansoni. Cure rates, determined by the absence of viable eggs in the stools six months after treatment, were 94.9% in patients treated with a total of 60 mg/kg, 78.8% in patients treated with 40 mg/kg, and 68.9% in patients treated with 30 mg/kg. All treatment regimens considerably reduced the egg count in those patients not cured. The drug was well tolerated and the side effects were minimal and transient, the most common being dizziness. Most of the patients noticed a reddish discoloration of their urine, which was probably caused by a metabolite of the drug. In patients who received 60 mg/kg oxamniquine there were transient rises in eosinophil counts and in serum alanine aminotransferase concentrations. Though 60 mg/kg was by far the most effective dose in terms of cure rate, egg counts were significantly reduced on all three doses. The lower doses could therefore be useful in a low-cost control programme in reducing transmission of S mansoni infection.


Screening for breast cancer. Report from Edinburgh Breast Screening Clinic. As part of a trial to determine the feasibility of screening for breast cancer, 3952 women aged 40--59 years were screened once or more over two years. They represented 82% of those invited by a personal letter from their GPs. Each woman underwent mammography, two clinical examinations, and, usually, thermography. Further investigations included needle aspiration of cysts, xeromammography, and biopsy. Of the 125 women who underwent biopsy, 18 proved to have cancer. Because of the high response rate and consequent large sample of normal women the biopsy and cancer detection rates were low. Clinical examination and mammography together were more effective in detecting significant lesions than either procedure alone, and knowledge of the mammographic findings enabled the examiner to detect more abnormalities. Screening was expensive: each cancer detected cost about 6000 pounds, excluding data processing, surgical, and pathological costs. The clinic has now adopted a more simplified screening regimen, which should reduce costs, but more accurate imaging techniques and ways of identifying high-risk cases are needed.


Do drug offences matter?

Do drug offences matter? Drug offences in addicts are often thought to indicate little more than continued dependency. In a four-year follow-up study of 60 men attending a drug clinic a history of repeated convictions for drug offences was found to be strongly related to patterns of delinquency. The following variables were associated with a history of repeated drug offences: a higher conviction rate for "non-drug" offences; younger age at first conviction; conviction preceding drug use; convictions for offences of sex and violence; longer prison sentences; and regular narcotic use and continued dependency at follow-up. Receiving a clinic prescription was not associated with a lower incidence of drug offences. Repeated drug offences identified a subgroup of drug users who were characterised by extensive sociopathic behaviour. Such offences should not be dismissed as an unavoidable, unimportant part of addiction.


Perinatal mortality and morbidity associated with eclampsia. Out of all the women who were delivered in Cardiff maternity units during 1965-74, 43 developed eclampsia, an incidence of 72/100 000 deliveries. The incidence in residents of Cardiff was 53/100 000 deliveries. None of the mothers with eclampsia died, but 10 of the 47 babies were lost, all but one having been born to women with antepartum eclampsia. The perinatal deaths were mainly associated with chronic placental insufficiency and preterm delivery. The extent to which the wide range of complex drug regimens used influenced perinatal outcome is not clear, although polypharmacy should be avoided. Because eclampsia is rare we advocate that its management should be planned and rehearsed and that a simple, standardised treatment regimen should be used. Failing placental function may be detected by monitoring fetal growth by ultrasound.


Delayed small-intestinal transit in tropical malabsorption. The time of breath hydrogen appearance (T) after oral lactulose was determined in 98 patients in London who had been to the tropics. Fifty-six controls from three different ethnic groups had no evidence of gastrointestinal disease; 23 had tropical malabsorption, which was severe in 10; and 19 had chronic diarrhoea without malabsorption. Mean T was significantly delayed in patients with tropical malabsorption compared with controls, indicating that their mouth-caecum transit rate was abnormally slow. In six patients with tropical malabsorption who were reinvestigated after treatment a fall in the value for T seemed to parallel clinical improvement. Three patients with diarrhoea due to chronic colonic disease had delayed T. Patients with tropical malabsorption have bacterial colonisation of the small intestine, which is important in the pathogenesis of the disease. Bacterial overgrowth, which sometimes occurs after infective diarrhoea in the tropics and gives rise to tropical sprue, is a result of stasis.


Dyspnoea, disability, and distance walked: comparison of estimates of exercise performance in respiratory disease. Forty-four patients with airway obstruction and 18 with pulmonary infiltration were studied in an attempt to correlate exercise tolerance, as assessed by a simple walking test, with basic respiratory function values and differing subjective assessments of exercise performance. The distance walked in 12 minutes was significantly correlated with the response to a structured questionnaire and with the patients' assessment of performance using an oxygen-cost diagram. The distance walked did not agree well with simple subjective estimates obtained in the clinical history. It was better correlated with forced vital capacity than with forced expiratory volume in one second in both groups of patients, and was well correlated with carbon monoxide transfer factor in those with pulmonary infiltration. The scatter of results, however, was such that exercise performance could not usefully be predicted from the respiratory function values or from subjective assessments. Simple exercise tests are an essential part of assessing disability and response to treatment in patients with respiratory impairment.


Weight reduction in a blood pressure clinic. Forty-nine hypertensive patients who were overweight were randomly allocated to one of three strategies for attaining weight reduction and were followed for one year. Those referred to a dietitian lost more weight (mean 5.1 kg) than those given a diet sheet (mean 2.64 kg) or simply advised by the doctor to reduce weight (mean 2.15 kg). One-third of all the patients lost 6 kg or more. Successful weight loss was associated with a highly significant and substantial improvement in blood pressure control and with less frequent increases in antihypertensive treatment.


Scope of surgery for intracranial aneurysm in the elderly: a preliminary report. Thirty-two elderly patients were reviewed six months to six years after intracranial surgery for subarachnoid haemorrhage. Out of 24 patients whose surgical outcome had been satisfactory, one had died from an unrelated illness and the remainder were well and leading normal lives. Eight patients had a poor outcome, which in some cases was due to factors other than age. In only three could a poor outcome be attributed to early surgery and advanced age. The results confirm that in at least three-quarters of patients aged 60-65 the risk of further haemorrhage can be removed by surgery without causing a major neurological deficit.


Clinical check list for diagnosis of dementia. A clinical check list for testing speech and parietal function as well as memory was used on 200 people admitted to a psychogeriatric assessment unit and repeated four to six weeks later, to see whether those with true dementias could be identified. The finding of errors in all three areas, particularly at the second test, accurately predicted cases with a poor outcome at six months follow-up. Amnesia alone was an unreliable indicator of dementia.


Stroke after acute myocardial infarction: relation to infarct size. In a consecutive series of 783 patients with acute myocardial infarction, 13 (1.7%) suffered a stroke. In all but one case the strokes occurred among the 255 patients whose peak creatine kinase (CK) concentrations fell in the upper third of the range of values (over 1160 IU/l, about eight times the upper limit of normal); the exception was a patient with a pre-existing ventricular aneurysm. The incidence of stroke in the patients with CK over 1160 IU/l was 4.7%, 24 times the incidence when peak CK was below this value (0.2%). Higher peak serum enzyme concentrations were associated with an even higher incidence of stroke. Comparison of peak enzyme concentrations with cumulated CK showed a close correlation (r = 0.90 with peak CK; r = 0.85 with peak aspartate transaminase), suggesting that the peak enzyme values reflected infarct size. Thus the risk of stroke after infarction was a function of the size of the myocardial infarct; two-thirds of the patients had negligible risk of stroke and did not need anticoagulant prophylaxis.


Effect of cigarette smoking on gastric emptying. Gastric emptying after a test meal was studied in 17 normal volunteers--10 habitual smokers and seven non-smokers. The solid component of the test meal was labelled with technetium and the liquid component with indium. After one meal the habitual smokers smoked two cigarettes. Emptying curves were produced for both technetium and indium, and the differences between curves for meals with and without cigarettes were analysed. Cigarette smoking accelerated the rate at which the liquid component of a meal left the stomach. This may be important in the pathogenesis of duodneal ulcer and the delay in healing caused by cigarette smoking.