[Effect of extracts of different origin on primary cultures of cells from inbred mice]. The effect of allogeneic and syngeneic extracts from inbred male and female mouse spleens on the primary culture of fibroblasts obtained from subcutaneous connective tissue of CBA and C57BL/6j female mouse fetus was studied. Cytotoxic and growth-inhibiting effect on the cultures increased successively in using extracts from the tissues of syngeneic male mice, allogeneic female and male mice. Consequently, an increase in the degree of antigenic differences of the target=cells and extracts led to enhancement of the allogeneic inhibition phenomenon. For the first time it was shown that in the syngeneic system the extracts from male mouse tissues (containing weak H-Y antigen) exerted a cytotoxic action on the inbred female mouse cells, i.e. caused reaction similar to allogeneic inhibition.


[Autoradiographic study of stimulation of RNA synthesis in fibroblasts]. The rate of uridine-5 3H incorporation into the skin-muscle wound fibroblasts of control and experimental animals, and also into the fibroblasts of flocculent connective tissue of intact animals was studied. The character of incorporation and distribution of the isotope in the nuclei and cytoplasm in the flocculent connective tissue fibroblasts differed in intact mice from those in the wound fibroblasts only by intensity. Potassium orotate RNA synthesis stimulation in the fibroblast nuclei closely correlated with the increased rate and intensity of the labeled RNA passage from the cell nuclei to the sites of collagen synthesis.


[Migration of hematopoietic stem cells in thermal burns]. Experiments on mice (CBA X C57BL) F1 have shown that a high level of endogenous glucocorticoids in the blood 30 min to 6 hours after burn is accompanied by a 2--2 1/2-fold decrease of the circulating CFU. At this period CFU migration from the bone marrow area shielded during the irradiation (850 R) is inhibited. The stem cells migration is increased 3--4 days after the burn.


[Organ cultures of embryonal rat brain tissue (hippocampal area) in a study of the transplacental effect of nitrosoethylurea]. The transplacental action of nitrosoethylurea (NEU) was studied in organic cultures of the embryonic rat brain tissue (the hyppocampus region). The brain tissue proved to be highly sensitive to NEU. This was expressed in a greater survival of the experimental cultures in comparison with the control and in the appearance of epithelial proliferations of the vascular plexus resembling, in individual cases, adenomas. The amount of morphological changes observed in the experiment depended on the carcinogen dose.


[Effect of several extreme influences on the submicroscopic organization of rat liver following carbon tetrachloride poisoning]. Submicroscopic structure of parenchymatous cells was investigated in the liver of rats given CCL4 (0.12 ml/100 g body wt) for 25 days. After cessation of this treatment the animals were subjected to the action of extreme stimulants (immobilization or overheating under sunlight or both). CCL4 poisoning led to the appearance of many lipid incorporations in the cytoplasm of hepatocytes serving as the basis for fat infiltration in the liver. The action of extreme factors was followed by accumulation of lipids in the lumina of the granular cytoplasmic reticulum never found in any other pathological conditions, and apparently reflecting profound disturbances of intracellular metabolism.


[Cytophotometry of DNA in isolated mouse heart myocytes]. Submicroscopic structure of parenchymatous cells was investigated in the liver of rats given CCL4 (0.12 ml/100 g body wt) for 25 days. After cessation of this treatment the animals were subjected to the action of extreme stimulants (immobilization or overheating under sunlight or both). CCL4 poisoning led to the appearance of many lipid incorporations in the cytoplasm of hepatocytes serving as the basis for fat infiltration in the liver. The action of extreme factors was followed by accumulation of lipids in the lumina of the granular cytoplasmic reticulum never found in any other pathological conditions, and apparently reflecting profound disturbances of intracellular metabolism.


[Effect of hypoxic hypoxia on the shape and surface of erythrocytes (according to observations with transmission and scanning electron microscopes)]. Changes in the surface and intracellular structure of erythrocytes were studied under experimental conditions with consideration to the general morphological blood picture. Hypoxic hypoxia is accompanied by changes of mature erythrocytes and erythroblastic elements of the bone marrow tissue. At the early periods of hypoxia (the 1st-5th day) there is an increase in the count of erythrocytes, their respiratory surface enlarges and hemoglobin content becomes greater. These changes are adaptive. At later periods of hypoxia (the 10th--15th day) there occurs no increase of erythrocyte count, the number of reticulocytes falls, erythroblasts disappear, i.e. erythropoietic bone marrow capacity becomes exhausted and there appear signs of its decompensation. A rise of erythrocyte count and of blood hemoglobin content is the sequence of intensification of the bone marrow series function; this is indicated by the increase of the peripheral blood reticulocyte count and by the appearance of erythroblasts.


[Effect of CO2 on the excitable membrane of a single node of Ranvier]. Introduction into the chamber containing the preparation of a gaseous mixture with a 5% CO2 content failed to lead to any significant changes in the recorded parameters of the node of Ranvier. Elevation of CO2 concentration to 50% caused a significant increase of resistance, of the critical level of the membrane depolarization, a decrease of the spike amplitude, and of the maximum steepness of its increase. Two minutes after the beginning of the gas mixture introduction spike degeneration stopped. CO2 action was completely reversible. The trace potentials of the node of Ranvier remained unchanged with the CO2 action in the mentioned concentrations.


Systemic and regional flow distribution in normotensive and spontaneously hypertensive young rats subjected to lifetime beta-adrenergic receptor blockade. To determine quantitatively organ blood flow distribution as the result of lifelong beta-adrenergic receptor blockade, 23 and 24 normotensive Wistar-Kyoto (WKY) and spontaneously hypertensive (SHR) rats, respectively, were treated from conception with tap water (control; 10 WKY and 8 SHR), propranolol (0.5 mg/ml drinking water; 6 WKY and 8 SHR), or timolol (0.5 mg/ml drinking water; 7 WKY and 8 SHR) via placental circulation, mothers' milk, and drinking water. At 12 weeks of age all six groups were studied hemodynamically under ether anesthesia using an electromagnetic flowmeter and radioactive carbonized (15 micrometer) microspheres. Untreated SHR demonstrated normal cardiac output (CO) and CO distribution to all organs except for myocardium and testes, thereby confirming our previous work. With either propranolol or timolol treatment the course of development and maintenance of arterial pressure was no different than the pure-tap-water-fed WKY and SHR despite an approximate 30% reduction in CO. Further, with both beta-receptor antagonists CO distribution was significantly reduced to skeletal muscle (p less than 0.001), unchanged to the heart, and increased (p less than 0.05) to the remaining organs (including kidneys and brain) in both groups. Thus, as a result of lifelong beta-adrenergic receptor blockade, CO was reduced; and this was associated with a redistribution of blood flow so that flow to the kidney, brain, and splanchnic organs could be maintained at the expense of skeletal muslce perfusion.


The innervation of the rabbit ear artery. An ultrastructural study. An examination of sections of the central artery of the rabbit external ear with the transmission electron microscope revealed a single and uniform population of axons near the medial-adventitial border. The dimensions of the neuromuscular cleft (mean closest distance 0.5 micrometer) and of the approaches between smooth muscle cells (not less than 20 nm) were determined. On the basis of the morphology of the neuronal vesicles and their ability to take up 5-hydroxydopamine the axons were classified as adrenergic, confirming previous light-microscopic histochemical observations. The axons also exhibited a weak but definite acetylcholinesterase activity in association with their sxon membrane, as shown by a histochemical technique.


Differential counts of neutrophil, eosinophil, and macrophage colonies in cultures from human bone marrow and peripheral blood. Differential counts for neutrophil, eosinophil, and macrophage colonies were performed in 364 methylcellulose cultures of myeloid precursor cells. 2n bone marrow cultures from normals we found a mean total colony count of 56 +/- 17/10(5), of which 65% were neutrophil, 12% eosinophil, and 23% macrophages. In cultures from normal peripheral blood, the mean total colony count was 26 +/- 16/10(6) with 49% neutrophils, 44% eosinophils and 7% macrophages. There was an increase of eosinophil and macrophage colonies in cultures from patients with malignant hematological diseases, solid tumors and Graft-versus-Host disease. Highest eosinophil colony counts were found in Graft-versus-Host disease, highest macrophage colony counts in untreated Hodgkin's disease. Only 1 patient with extremely high eosinophil colony counts had eosinophilia in the peripheral blood. We conclude that in vitro conditions favor eosinophil "commitment". Its increase as nonspecific sign of disease is thus more likely to be recognized in vitro than in vivo.


Creatine kinase in human erythrocytes: a newly detected genetic anomaly. In a family of Italian origin, we found four members with a considerable activity of creatine kinase inside their erythrocytes. All other clinical and hematological findings were normal. The enzyme anomaly seems to be inherited in the autosomal mode. The creatine kinase CK) activity in freshly drawn blood was about 12 U/g Hb. The activity was higher in young red cells than in older ones. Studies with specific antibodies against human CK isoenzymes revealed the CK activity in the probands' red cells to be due to about 90% to the BB-isoenzyme normally found in brain and nerve tissue. The presence of CK in the erythrocytes does not seem to have any consequences for the energy metabolism of the cells. Creatine concentration was slightly elevated, but creatine phosphate could not be detected.


[Age and immunity: III. Circulating immune complexes in different age groups (author's transl)]. Circulating immune complexes were determined utilizing an immunofluorescence technique in sera of 271 healthy donors in different age groups. Practically no immune complexes were detected up to the age of 60. Among the donors ranging in age between 60 and 70 years, 20% revealed immune complexes in their sera. The incidence of circulating immune complexes increased up to 33% among the individuals between 70 and 75 years of age and up to 40% among those over 76 years. In view of earlier findings of decreased numerical and functional capacities of peripheral blood lymphocytes and functional capacities of peripheral blood lymphocytes and increased incidence of auto-antibodies, the observation, that the incidence of circulating immune complexes increases with age seems to support the hypothesis of an age-dependent immunological impairment. To what extent such an immunological insufficiency plays a role in the general aging process remains unknown. It can, however, explain some of the auto-immune diseases seen frequently among the elderly population.


Hatching success and early performance of chicks from eggs sprayed with 2,4-D,2,4,5-T and picloram at various stages of embryonic development. Aqueous solutions of 2,4-D, 2,4-5-T and picloram were sprayed on hens' eggs at 10x normal rate (11.2 kg/ha). Eggs used were stored prior to incubation over a 24 day period and application on each age egg occurred at the start as well as 4 and 18 days after the onset of embryonic development. No adverse effects on any parameter used to evaluate either incubation or subsequent live performance could be attributed to either spray treatment or embryonic age when applied. Although extended preincubation storage significantly reduced hatching success, it was independent of herbicide contact and germ stage when contaminated. Chicks derived from eggs stored 1--2 and 23--24 days before incubation performed comparably and were uninfluenced by all treatments during incubation.


Insecticidal and neuroexcitant actions of DDT analogs on the cockroach, Periplaneta americana. The American cockroach (Periplaneta americana) was used to test 14 DDT analogs for their ability to cause a) death and b) repetitive firing in the abdominal nerve cord. P,p' -DDT, p,p' -DDD, p,p' -methoxychlor, and o,p -DDT were all found to induce repetitive firing in the nerve cord after a twice threshold stimulus, but only p,p' -DDT, p,p' -DDD, and p,p' -methoxychlor produced mortality within 4 days from injection of the pesticides. Also, cockroaches exposed to sublethal doses of p,p' -DDT and p,p' -methoxychlor were found to exhibit repetitive firing in the abdominal nerve cord three weeks after injection of the pesticide. The 'cause and effect' relationship between neuroexcitation and lethality is therefore questioned, at least in the case of cockroaches.


Toxicity and sublethal effects of No. 2 fuel oil on the supralittoral isopod Lygia exotica. 1. No. 2 fuel oil was of relatively low toxicity to the intertidal isopod Lygia exotica as indicated by the TLm values of over 100% for the WSF and 73 ppm at 24 and 48 hours and 36.5 ppm at 96 hours for the OWD. 2. Respiration was not significantly affected by short term exposure to several concentrations of No. 2 fuel oil prepared as either a WSF or OWD. 3. Lygia contamined by a spill of No. 2 fuel oil and Bunker C residual oil contained high concentrations of dibenzothiophenes. It is not known whether the dibenzothiophenes were accumulated by the Lygia tissues or absorbed to the exoskeleton. Therefore, the high mortality of Lygia following the spill cannot yet be attributed to the dibenzothiophenes.


Trace metals in some fish species of South Carolina. Samples of fish from freshwater and saltwater sources of ocean, rivers, and lakes over the state of South Carolina were collected. The fish collected were Shrimp, Silver Snapper, White Bass, Catfish, Mudfish and Trout. The sample flasks were incubated in a constant temperature stirring water bath at 58 degrees C until clear solution in reagent-grade nitric acid. Triplicate samples of fish muscle tissue were analyzed by wet digestion and dry digestion methods. Trace metal levels were determined by flame atomic absorption using a Perkin-Elmer Model 306 spectrophotometer. Mercury determination was made by Coleman MAS-50 mercury analyzer. A significant finding of this report is that saltwater fish have more trace metal levels than freshwater fish, and larger fish have higher trace metals than smaller fish. Iron and zinc levels were much higher in Shrimp than any other species analyzed.


A plankton net designed to exclude air-sea interface phenomena. For use in trace pollutant studies a description is presented of a protected closed plankton net whose purpose is to minimize the exposure of collected samples to surface films and debris. Tests described in this paper appeared to show that the protected closed net was not necessary for the environmental conditions encountered during our field studies. However, additional calculations based on the data of other investigators strongly imply that employment of such a net is heavily polluted surface waters may be highly advantageous.


A water-extractable toxic compound in vinyl upholstery fabric. A compound, highly toxic to goldfish, was found to be released from a vinyl (polyvinyl chloride) automotive upholstery fabric when the material was immersed in their water. The compound, a flame retardant used in such material, was identified by specific detector gas chromatography and mass spectrometry as triphenyl phosphate. Fish exposed to the immersed fabric or pure triphenyl phosphate showed neurologic intoxication and extensive histopathologic lesions.


Humoral immunity in mice following oral administration of selected pesticides. Five pesticides (carbaryl, DDT, parathion, chlordimeform, and ametryne) were tested for their effects on the immunocompetence of Balb/c mice. All five of the test pesticides were observed to induce statistically significant suppression of the humoral immune response if administered orally, at near lethal doses, during an ongoing immune response. Ametryne and chlordimeform were also observed to have a suppressive effect on humoral immune competence if orally administered in a sufficiently large quantity, 1 LD50, at the time of, or prior to, immunization. Administration of 0.1 LD50 parathion per day, over an extended period of time, resulted in a statistically significant suppression of the humoral immune response.


Books and other endangered species: an inquiry into the values of medical librarianship. Major values of medical librarians, as exemplified in their periodical literature 1903-1977, are identified as "professionalism," "cooperation," "sense of community with health sciences practitioners," and "knowledge orientation." These values are examined in terms of interdisciplinary research into human values. Professionalism is studied in greater depth in relation to criteria on a scale of professionalism. Medical librarians have been most concerned with the criteria of organization, specialized education (with more emphasis on continuing education than on introductory medical library education), and service orientation. Indication of challenge to long-held values exists in the contradictions among certain related assumptions underlying our self-image, our current lack of standards, and changing societal views toward commitment to a single, life-long specialization. It is suggested that there is unexplored potential for support of our traditional values and the development of new ones by comparing them with the value systems of health scientists and educators of health sciences practitioners.


A survey of computer search service costs in the academic health sciences library. The Norris Medical Library, University of Southern California, has recently completed an extensive survey of costs involved in the provision of computer search services beyond vendor charges for connect time and printing. In this survey costs for such items as terminal depreciation, repair contract, personnel time, and supplies are analyzed. Implications of this cost survey are discussed in relation to planning and price setting for computer search services.


Systematic serials selection analysis in a small academic health sciences library. This paper describes the implementation of a straightforward quantitative technique to analyze the serials collection of the Medical Library at the University of Missouri-Kansas City (UMKC). Our simplified operations research approach resulted in a savings of nearly $1400 per year in subscriptions costs without reducing the net number of seven hundred titles or causing an imbalance in the subject distribution of our collection. By detailing both the rationale behind the process and the actual steps followed at UMKC, we hope to demonstrate that operations research techniques can be used practically and successfully even in small health sciences libraries. In the Appendix a more general and more rigorous operations research approach to the analysis of serials collections is also presented in a fashion that is, as far as possible, not mathematically forbidding.


Management data for collection analysis and development. Sound management data are needed to evaluate the collections of health sciences libraries. This study reports the utilization of computer data bases to compare the libary collections of The University of Texas Health Science Center at San Antonio. The University of Texas Medical Branch, and the National Library of Medicine's CATLINE data base. The imprint dates of the records of two libraries are compared to measure acquisitions rates. Subject profiles for the Q and W classes demonstrate the similarity of the collections. Reasons for the variances are considered.


Fees for information services to hospitals: a California experience. The project was directed toward planning, developing, and implementing a subregional biomedical information network among the forty-three health care facilities (hospitals) of the four-county area served by Loma Linda University's health sciences library. The project coordinator contacted administrators and health care professionals in the forty-three institutions to present a plan for the network. The health care facilities were encouraged to support the continuation of the network through contract fees. The availability of specific information services was assured through contractual agreements. It was anticipated that the subregional network would be self-supporting after the twelve-month project period (December 1, 1976-November 30, 1977). The working territory (40,429 square miles) encompassed Mono, Inyo, Riverside, and San Bernardino counties. The project resulted in nine of the forty-three hospitals signing annual contracts for library services. It is recommended that projects of this kind extend beyond a year's duration in order to educate health professionals concerning the value of access to biomedical literature in improving patient care.


The clinical librarian and the patient: report of a project at McMaster University Medical Centre. In June 1975 a clinical librarian project was initiated in the Gastroenterology Programme of McMaster University Medical Centre. The objectives of the project were to assist patients in participating more knowledgeably in their own health care and to assist health professionals in applying the latest information from biomedical literature to patient care. The implementation and development of the service are described, including the use of feedback from patients and health professionals to assess the impact of the librarians' participation in clinical settings. Benefits included: 1) increased accessibility of information resources to patients, 2) a greater awareness by health professionals of the usefulness of biomedical literature and the library in patient care, and 3) an opportunity for the librarian to gain a first-hand view of activities and information needs in a clinical setting. Key points in determining the successful implementation of the project are given.


Area health education center libraries and medical school libraries: establishing an interface. Establishing an interface between area health education center (AHEC) libraries and medical school libraries requires careful planning, including: the overall plan, needs assessment, resource evaluation, a developmental plan, monitoring and evaluation, institutional agreements, and publicity. This paper reports on the development of AHEC libraries in North Dakota.


The CHIPS project: a health information network to serve the consumer. CHIPS (Consumer Health Information Program and Services/Salud y Bienestar) is a Library Services and Construction Act Title I-funded project that has as its major goal the formation of a health information network to serve the consumer, the public library client, and the hospital patient. Funded for two years, 1976-1978, this bilingual project coordinates efforts of the Los Angeles County Harbor General Hospital Regional Medical Library and the Los Angeles County Carson Regional Public Library to provide health information resources and services to the public. The target population is over two million people of diverse ethnic backgrounds. This paper discusses the project's objectives and encourages an active role for all libraries in the consumer health education movement.


An information service for practicing veterinarians. Many Indiana veterinarians are relatively isolated from colleagues and information sources. Their information needs cannot be easily met by public or medical libraries. The Veterinary Medical Information Center (VMIC) at Purdue University, which began operation in the fall of 1977, offers information services designed to meet the specific needs of veterinary medical practitioners in the state of Indiana. Questions received by the center have covered all facets of animal medicine and management. After two years of free service, VMIC will begin charging clients for services and will consider expansion of the service to other states. VMIC operations will be evaluated through data collected by the center and follow-up surveys.


The Medical Library Association's international fellowship programs. This article describes the two international fellowship programs administered by the International Cooperation Committee of the Medical Library Association: (1) the program supported by the Rockfeller Foundation from 1948 to 1963; (2) the Eileen R. Cunningham program, supported by Mrs. Cunningham's bequest to the association, from 1971 to date. Comments and suggestions received from Cunningham Fellows in response to a letter sent to each by the author in the summer of 1977 are listed. The cost of the fellowship program, not only in terms of financial support but also in terms of human resources, is documented. While the program receives enthusiastic support from the International Cooperation Committee and many members of MLA, the membership needs to examine its mission with regard to the training of medical librarians from other countries, to determine whether future funding is to be sought.


Self-help groups.

Self-help groups. The 1970's have been described as the self-help decade. This paper has shown how the groups explicitly focus on certain specific but simple technical problems while implicity addressing a whole range of everyday problems of living. Self-help groups attempt to solve these technical and social problems by a process based on shared experience in a context of mutual understanding. An essential ingredient of the self-help solution is to do things together, while social activities with members outside the group meetings sustain the self-help method and give new meaning to a member's life and to his conception of his place in the world.


Hepatic osteodystrophy.

Hepatic osteodystrophy. Hepatic osteodystrophy consists of three types: osteomalacia, osteoporosis, and periosteal reaction with new bone formation. Secondary hyperparathyroidism is very rare, if it occurs at all. The cause of osteomalacia appears to be vitamin D deficiency due to a lack of vitamin D substrate. In the presence of adequate substrates, 25-OHD and dihydroxy vitamin D metabolites are formed. The vitamin D deficiency results in osteomalacia and malabsorption of calcium and phosphorus. The osteomalacia can be treated successfully with vitamin D supplements. In some patients calcium, phosphorus, and magnesium supplements may be required. The aetiology and treatment of the osteoporosis and the periosteal reactions remain obscure.


Replantation of an entire scalp and ear by microvascular anastomoses of only 1 artery and 1 vein. We present a successful microvascular replantation of a scalp and ear, where almost the entire scalp and right ear survived on 1 artery and 1 vein.


Local and regional lymph node response to ruptured gel-filled mammary prostheses. A case of augmentation mammaplasty is described in which spontaneous rupture of a gel-filled prosthesis was followed by the appearance of silicone in the regional lymph nodes.


Long-term follow-up of clefts of the secondary palate repaired by von Langenbeck's method. In analysing our small series with caution we tend to support the findings of Lindsay (1971) and Blocksma et al. (1975). Thus the combination of no facial growth deformity and a reasonable rate of velopharyngeal competence has encouraged us to continue using this simple and safe procedure for the treatment of cleft palates with intact lip and alveolus.


Further evidence for the prevention by guanethidine of noradrenaline efflux from rabbit ventricular slices induced by a low external sodium concentration. When guanethidine was applied to rabbit ventricular slices at 37 degrees C for an initial 30 min incubation period, doses of 4 X 10(-5) and 8 X 10(-5) M irreversibly inhibited increases in efflux of noradrenaline induced by the subsequent reduction of external sodium concentrations to 18 mM. This inhibition was prevented if the temperature was reduced to 0 degrees C during the drug application period. Guanethidine transported into adrenergic nerve endings appears to increase permeability to Na+, thereby leading to the reduction in efflux.


An investigation of the role of ganglia in the innervation of the rat anococcygeus muscle: an electrical and mechanical study. 1 A preparation is described which allows the rat anococcygeus muscle to be stimulated via its two extrinsic nerves. Each nerve contains both excitatory and inhibitory fibres. A ganglionated nerve plexus lies on the surface of the muscle. 2 The possibility that at least part of the excitatory pathway was interrupted as a ganglion synapse lying in one of the nodes of plexus close to the muscle was suggested by the observations that (a) the excitatory response to extrinsic nerve stimulation was reduced by the nicotinic antagonists tubocurarine (0.13 to 0.26 mM) and dihydro beta-erythroidine (0.1 to 0.14 mM). (b) Fibres from one extrinsic nerve were shown to synapse on a ganglion cell from which intracellular recordings were made while the output from this ganglion cell was traced microscopically to the muscle. 3 Intracellular recording from ganglion cells in this plexus indicated that cholinergic synaptic transmission occurred in these ganglia. Tubocurarine (0.13 mM) and hexamethonium (1.3 mM) reversibly abolished intracellularly-recorded synaptic potentials. 4 Hexamethonium (0.1 to 1 mM) initially enhanced the motor response to nerve stimulation and raised muscle tone, probably by an action involving pre- and postsynaptic sites. Subsequently, hexamethonium inhibited the response to extrinsic nerve stimulation presumably by an effect at ganglia lying along the excitatory pathway. Hexamethonium enhanced, without subsequently inhibiting, the response to exogenously added noradrenaline in both untreated and 6-hydroxydopamine-treated rats. These results suggest that the initial enhancement produced by hexamethonium involved sites at postganglionic nerve endings and on smooth muscle receptors. 5 Inhibitory responses were obtained following extrinsic nerve stimulation when the tone of the muscle was raised and the excitatory response abolished by either guanethidine (3 micron) alone or by carbachol (10 micron) followed by phentolamine (3 micron). The inhibitory response was not reduced by hexamethonium (up to 2.8 mM) tubocurarine (up to 1.3 mM) or by atropine (up to 1 micron).


The effects of putative 5-hydroxytryptamine antagonists on the behaviour produced by administration of tranylcypromine and L-tryptophan or tranylcypromine and L-DOPA to rats. 1 The putative 5-hydroxytryptamine (5-HT) receptor blocking drugs methysergide (10 mg/kg) and methergoline (5 mg/kg) were found to abolish some components of the hyperactivity syndrome, including head weaving and forepaw treading, which follow administration to rats of tranylcypromine (20 mg/kg) and L-tryptophan (100 mg/kg). Hyperactivity and hyper-reactivity were potentiated with a resultant increase in automated locomotor activity counts. In contrast (-)-propranolol (20 mg/kg) inhibited all features of the syndrome. The same results were obtained with these drugs when the behaviour was elicited by p-chloroamphetamine (10 mg/kg) or by tranylcypromine and tryptamine (10 mg/kg). 2 Methysergide and methergoline had similar effects on the syndrome produced by tranylcypromine and L-DOPA (50 mg/kg) whereas propranolol was without effect. 3 None of the putative 5-HT receptor antagonists affected brain 5-HT turnover as assessed by rate of accumulation of 5-HT following monoamine oxidase inhibition with tranylcypromine. 4 Microinjections of 5,7-dihydroxytryptamine into the spinal cord resulted in a 70% fall in cord 5-HT concentrations without an effect on brain 5-HT concentrations. The behavioural response to the putative 5-HT receptor agonist, 5-methoxy N,N-dimethyltryptamine (2 mg/kg), was potentiated in these animals suggesting that 5-HT receptors become supersensitive on denervation, and that some components of the behavioural syndrome are mediated by spinal cord 5-HT receptors. 5 Pretreatment with alpha-methyl p-tyrosine (2 X 200 mg/kg) delayed the onset of all components of the behaviour elicited by tranylcypromine/L-tryptophan by 60 min, indicating an involvement of catecholamines in the syndrome. 6 p-Chloroamphetamine-induced 5-HT depletion had no effect on any component of the tranylcypromine-L-DOPA behaviour.


The release of prostaglandins and thromboxanes from guinea-pig lung by slow reacting substance of anaphylaxis, and its inhibition. 1 Rabbit aorta contracting substance (RCS; consisting mainly of thromboxane A2) and prostaglandin-like material were released from guinea-pig isolated perfused lungs by injection of slow reacting substance of anaphylaxis (SRS-A). 2 SRS-A was resistant to boiling and proteolytic enzymes and was therefore distinguished from rabbit aorta contracting substance releasing factor (RCS-RF). 3 The release of RCS and prostaglandin-like material by SRS-A was anatagonized by indomethacin (1 microgram/ml), betamethasone and dexamethasone (4 to 50 microgram/ml). 4 Imidazole (200 microgram/ml) inhibited the formation of thromboxane A2 but not that of prostaglandins. 5 The activity of SRS-A on guinea-pig ileum and its ability to release RCS and prostaglandins were destroyed by incubation with arylsulphatase (0.83 microgram to 1 mg/ml) and with lipoxidase (16.5 to 50 microgram/ml): SRS-A lost activity on incubation with bovine serum albumin (9 microgram/ml) due to protein binding.


Age-related changes in the response of rabbit isolated aortae to vasoactive agents. 1 In helically-cut strips of aortae from rabbits of different ages (2 to 360 days old), responses to vasoconstrictor and vasodilator agents were compared. 2 The passive tension developed by the same magnitude of stretch was markedly less in aortae from immature rabbits than in aortae from mature rabbits. 3 Contractile responses to noradrenaline and K+ increased with age in the range from 2 to 90 days. High concentrations of noradrenaline (10(-5) and 5 X 10(-5) M) produced relaxation of aortic strips from immature rabbits (2 to 30 days). The response to histamine was not altered with age. Age-dependent reductions (90 to 360 days) in the response to 5-hydroxytryptamine were observed. 4 Relaxations induced by isoprenaline of aortic strips contracted with prostaglandin F2alpha increased with age in the range from 2 to 30 days but decreased with age from 30 to 360 days. Similar age-related alterations in the relaxant response to adenosine were observed. 5 It is concluded that aortae from immature rabbits are more distensible than those from mature rabbits; alpha-adrenoceptors mature during an early postnatal period (2 to 30 days), and 5-hydroxytryptamine receptor mechanisms deteriorate with age (older than 90 days). The beta-receptor mechanism does not seem to alter greatly with age.


Some observations on the development of adrenergic innervation in rabbit intestine. 1 Stimulation of periarterial nerves to the ileum of 1 to 12 day old rabbits with supramaximal voltages and frequencies of 1, 2, 5, 10 and 20 Hz with square wave pulses of 2--5 ms duration for 30--40 s produced responses that were initially contractor. In the course of the first week, the responses changed from motor to inhibitory, the change occurring first at the highest rates of stimulation. By the 7th day of life, almost all responses were inhibitory. 2 The motor responses were potentiated by physostigmine and blocked by hyoscine suggesting that they were mediated by acetylcholine. 3 In preparations from rabbits older than 3 days, motor responses could be converted to inhibitory ones by prior exposure to noradrenaline (NA, 1 microgram/ml) for 20 min. This procedure also significantly increased the responses which were already inhibitory. 4 The ability of the ileum to take up NA increased with age. This uptake was blocked by cocaine. 5 The following explanations are possible: (a) changeover from cholinergic to adrenergic transmission in sympathetic fibres; (b) existence of 'parasympathetic' splanchnic nerves or a permanent cholinergic 'sympathetic' component of splanchnic nerves and (c) temporal delay in the development of adrenergic nerves (compared with cholinergic nerves) in the intestine.


Localization of vasodilator dopamine receptors in the canine hindlimb. 1 Vascular responses to local injection of dopamine and isoprenaline have been compared in the blood-perfused gracilis muscle and hind paw pads of dogs anaesthetized with chloralose. 2 In the paw pads, dopamine (0.5 to 5.0 microgram) caused a transient vasoconstriction followed by dose-dependent vasodilatation. alpha-Adrenoceptor blockade converted this response to pure vasodilatation, which was attenuated or abolished by the dopamine-receptor antagonist, haloperidol (1 to 2 mg i.a.). In the gracilis, dopamine produced only vasoconstriction. Following alpha-adrenoceptor blockade this was abolished, but only a very small dilator response was revealed. 3 Isoprenaline (0.05 to 0.5 microgram) caused dose-dependent dilatation in both beds, which was attenuated by propranolol (0.1 mg/kg i.v.). 4 Glyceryl trinitrate (0.2 to 5.0 microgram) was used to assess vascular reactivity. When responses to isoprenaline and dopamine were compared with those to glyceryl trinitrate, both beds had approximately equal reactivity to isoprenaline. In contrast the paw pads were 10 fold more responsive to dopamine than was the gracilis. 5 We conclude that the vessels of the paw pads play an important part in the femoral dilator response to dopamine.


Cardiovascular effects of acebutolol following coronary artery occlusion and reperfusion in anaesthetized dog. 1 The effects of 5 mg/kg acebutolol given intravenously were investigated in anaesthetized dogs after (a) ligation of the left anterior descending coronary artery and (b) coronary reperfusion following 60 min of ligation of the anterior descending coronary artery. 2 Coronary artery ligation produced, after 4 to 6 h, persistent multiple ventricular ectopic beats and abnormalities of R and T waves and of the S-T segment. Administration of acebutolol, after the development of persistent ventricular arrhythmias, restored normal sinus rhythm within 5 min of injection. Electrocardiographic abnormalities were also reduced. 3 Coronary artery reperfusion (following 60 min of ligation) resulted in multiple ventricular ectopic beats, ventricular tachycardia and/or ventricular fibrillation. Pretreatment with acebutolol, 15 min before starting reperfusion, markedly reduced the arrhythmias. 4 Acebutolol did not affect peak inspiratory airway pressure. 5 Acebutolol produced significant bradycardia and slight, transient, hypotension. It was without effect on left ventricular systolic pressure, left ventricular end-diastolic pressure, cardiac output or pulmonary arterial pressure. 6 These results suggest beneficial effects of acebutolol in myocardial ischaemia and coronary reperfusion, without any significant risk of cardiodepression or bronchospasm.


The pharmacokinetics of lithium in the brain, cerebrospinal fluid and serum of the rat. 1 Addition of lithium carbonate (55 mmol/kg dry wt.) to the diet of rats for 4 days resulted in ratios between lithium in the brain and serum and between the cerebrospinal fluid (CSF) and serum of approx. 1 and 0.4, respectively. The relationships between the concentrations were linear. 2 After single intraperitoneal injections of lithium chloride (5 mmol/kg body wt.) the concentration of lithium in the CSF was greater than that of the brain for 2 h. 3 Repeated subcutaneous injections of lithium chloride (0.9 mmol/kg body wt.) resulted in steady state ratios corresponding to those observed when lithium was given in the diet. The rate of elimination from the CSF was intermediate between that of the serum and cerebral tissue until a new equilibrium was reached after approx. 24 h. At that time the ratios between lithium in the brain and serum, and in the CSF and serum were increased to approx. 5 and 0.8, respectively. 4 These results are consistent with passive transfer kinetics of lithium in the CSF and elimination of lithium from the cerebral tissue via the CSF. 5 The results may explain some of the phenomena observed in patients during intoxication with lithium.


Demonstration of 5-hydroxytryptamine receptors through inhibition by methergoline in cat pial arteries in vitro. 1 In an attempt to characterize further the nature of the 5-hydroxytryptamine (5-HT)-induced contraction of intracranial vessels, cat's middle cerebral artery was exposed to this amine and the specific 5-HT receptor antagonist, methergoline, under standardized conditions in vitro. Methergoline, in increasing concentrations, produced a parallel shift of the log dose-response curve for 5-HT. 2 The Arunlakshana-Schild plot gave a straight line with a slope of -0.85. The figure corresponding to the pA2 value was 8.80. 3 The findings offer further support for the assumption that the 5-HT-induced intracranial vasoconstriction is mediated by specific 5-HT receptors.


The influence of sodium and potassium supplements on the diuretic responses to frusemide administration in normal subjects. 1 Twelve normal subjects received (1) normal diet, (2) normal diet with 100 mmol supplementary sodium chloride and (3) normal diet with 96 mmol supplementary potassium chloride, each for 10 days, in a balanced cross-over study according to a Latin Square design. At the end of each study period, the subjects received 80 mg frusemide orally. Each study period was separated from the other by 10 days. 2 Changes in urinary electrolyte excretion occurred within the first four days of each dietary period then remained constant, with significant differences in urinary Na/K ratio between the dietary regimes. 3 Between-subject correlations, using the mean values over the three study periods, demonstrated significant associations between plasma uric acid and urinary Na/K ratio and between plasma prolactin and urinary potassium excretion. 4 Urinary potassium excretion and Na/K ratio following frusemide were influenced significantly by alteration of diet but there was no change in sodium excretion. 5 Between-subject correlations of pretreatment variables with diuretic response, using the mean values over the three study periods, demonstrated significant associations between both pretreatment urinary Na/K ratio and plasma uric acid and respectively the urinary potassium excretion and urinary Na/K ratio in response to frusemide. 6 While the response to frusemide was altered by short-term changes in dietary sodium and potassium, the difference was less than expected from observations in two populations with customary diets differing in similar manner.


Inhibition by N-acetyl neuraminic acid of platelet thrombogenesis induced by laser injury to rat and hamster venules. 1 In rats and hamsters under barbiturate anaesthesia, laser radiation to venules about 50  micrometer in diameter in mesoappendix and cheek pouch respectively caused the formation of platelet thrombi which occluded the vessels in about 9 min. 2 This occlusion time was significantly prolonged by the intravenous injection of N-acetyl neuraminic acid (NANA) but not by D-glucuronic acid or beta-methoxyneuraminic acid, in doses which had no effect on blood pH or on the condition of the animals. 3 The results confirm the anti-thrombotic effect of NANA previously demonstrated with another technique.


Changes in plasma noradrenaline concentration as a measure of release rate. 1 A method is described for repeated sampling of plasma noradrenaline (NA) in freely moving rats. Na concentration does not change during the day or after adrenalectomy. 2 Exogenous NA has a half-life of 1.5 min; drugs which block neuronal and extra-neuronal uptake lengthen this to 6.3 min. 3 Swim-stress leads to a steep rise followed by a rapid decline in plasma NA concentration. 4 This method of plasma NA sampling can serve as a measure of both steady and rapid changes in release rate over long periods of time.


Effects of somatostatin on gastric acid secretion and on lipid and carbohydrate metabolism in the rat. 1 Studies were conducted to examine the effects of somatostatin on pentagastrin-induced gastric acid secretion, and on bile, plasma and liver lipid composition in the rat. 2 In addition, liver glycogen and plasma glucose concentrations were measured. 3 Somatostatin was administered intravenously as a bolus (100 microgram) at the start of the experiment followed by a continuous infusion (50 microgram/h) for 2 h. 4 Controls were infused with isotonic saline (1 ml/h) throughout the experiment. Gastric secretions and bile were collected during the infusions. 5 Somatostatin significantly decreased the volume of gastric secretion as well as total gastric acid output but it had no effect on bile or bile lipid composition. 6 Plasma and liver lipids were not affected. Plasma glucose concentrations were significantly elevated but liver glycogen was not changed. 7 Our results suggest that somatostatin probably decreases glucose uptake by peripheral tissue. The effect of somatostatin on bile composition and glucose levels in the rat is different from observations reported in other species.


The pattern of mortality in severe neuroses. Is there an increased relative risk of death in severe neurosis? 1,482 patients from three psychiatric units in different hospitals in Birmingham were followed-up after a mean of 10.9 years. 91 per cent of the sample were traced and 139 patients were found to have died; a highly significant increased mortality for both sexes for all causes of death. Although suicide and accidents contributed disproportionately, particularly in early follow-up, there was still a markedly increased mortality from the combined categories of nervous respiratory and cardiovascular disease, more evenly distributed in time.


Psychiatrists' versus patients' concepts of unpleasant emotions. A semantic differential technique was used to elicit concepts of anxiety, depression and irritability from twenty patients suffering from neurosis and ten experienced psychiatrists. It was found that psychiatrists hold concepts of these unpleasant affects that are much more differentiated than those held by patients. In particular, the psychiatrists' concepts of anxiety and depression showed a correlation of zero, whereas the patients' concepts of these affects overlapped to a considerable degree. Patients were unable to discriminate between anxiety and depression on the basis of 11 somatic symptoms, but were able to use these symptoms to distinguish anxiety and depression from irritability. The psychiatrists were in close accord with the patients over the somatic symptoms that distinguished anxiety from irritability.


Agoraphobia: a critical review of the concept. Phobic avoidance has been widely accepted as the central feature of the agoraphobic syndrome, and the presence of agoraphobia has been used to define groups of subjects for clinical research. A review of the evidence suggests that agoraphobia should not be classified with the phobias; several lines of inquiry point to the conclusion that it is a variable feature of patients suffering from anxiety neurosis. Implications for research and problems with the present classification of neurotic affective disorders are noted.


Men remanded into custody for medical reports: the selection for treatment. In a sample of men remanded into custody for medical reports during a three-month period, it was found that those who received recommendations for treatment had a diagnosis of acute mental illness, had in the past been admitted more frequently to mental hospitals and had spent a longer period as in-patients. They were also assessed as being difficult to manage, i.e. they were considered to be nuisances, were threatening and potentially violent. The men who were not recommended for treatment had a history of excessive drinking and drink-related offences; they also had more extensive criminal histories and a diagnosis of psychopathic disorder.


Men remanded into custody for medical reports: the outcome of the treatment recommendation. Over a three-month period, 634 men were remanded into custody at Brixton Prison for medical reports; 87 received recommendations for psychiatric treatment and 82 individuals were actually referred to hospitals for treatment. Fourteen months later nearly three-quarters of the men who went to hospital had been discharged. They fell into three groups by outcome: men with acute psychoses for whom treatment was definitely beneficial; men who remained behaviourally disturbed after receiving treatment although their mental states improved; a group with chronic disorders for whom admission was not beneficial. The two groups with improved mental states represented only 5 per cent of the initial receptions to Brixton Prison.


Combination of hormonal and psychological treatment for female sexual unresponsiveness: a comparative study. Thirty-two couples with the presenting problem of female sexual unresponsiveness were treated in a controlled study using a balanced factorial design. Treatment involved a combination of drug therapy and counselling. Half the subjects received testosterone and half diazepam, half received weekly and half monthly counselling. They were assessed before treatment, at the end of treatment and at six months follow-up. Those receiving testosterone did significantly better on a number of behavioural and attitudinal measures than the diazepam group. There were no notable differences in outcome between the two counselling regimes. There were no undesirable side-effects with the testosterone. Further work is needed to establish the indications for testosterone therapy for unresponsive women.


Season of birth among the sibs of schizophrenics. The season of birth distribution of 1,039 sibs of Canadian schizophrenic patients was compared with that of births in the Canadian general population over the same time period. The excess of winter births observed among the schizophrenics was not found among their sibs.


Childhood behaviour in schizophrenia, personality disorder, depression, and neurosis. Teachers' comments in the childhood school records (grades K-12) of 143 psychiatric patients and their matched controls were coded along 23 bipolar dimensions. Two methods of grouping these scales were compared: rational clusters and factor analysis. Factor analysis yielded more numerous and narrowly defined behavioural groupings. Schizophrenics, personality disorder patients, neurotics, and depressives were compared to their matched controls on each of the cluster and factor scores. Both schizophrenics and personality disordered patients were significantly less agreeable in childhood than their respective controls. Pre-schizophrenics also were significantly more unstable. Depressives were more independent than their controls, while neurotics did not differ significantly in any respect from normals in childhood. The data suggest that schizophrenia may have specific developmental patterns of possible aetiological or early diagnostic significance.


Depot injections and tardive dyskinesia. A prospective study was undertaken on 374 out-patients receiving depot fluphenazine or depot flupenthixol to determine the incidence of tardive dyskinesia. In three years the percentage showing the bucco-linguo-masticatory syndrome rose from 8 per cent to 22 per cent, though patients had received various neuroleptics for a mean of 13 years previously. Fluphenazine and flupenthixol were equally involved though 75 per cent of affected patients had the condition in mild degree. Six additional cases of generalized chorea were all receiving flupenthixol. Reduction of dose or the substitution of pimozide produced marked improvement, but results suggest that it is unlikely that this will be permanent. Substitution of depot fluspirilene also produced favourable results. Careful monitoring, minimal neuroleptic dosage, and periods of neuroleptic abstinence are recommended.


Pseudopolyposis in Crohn's disease.

Pseudopolyposis in Crohn's disease. Eight cases of pseudopolyposis occurring in Crohn's colitis are described. Emphasis is placed on the variability of the lesions. Four of the cases demonstrate localized giant pseudopolyposis which has until recently been regarded mainly as a complication of ulcerative colitis.


Hepatic oil embolism following lymphography. Lymphograms of 1,000 patients were reviewed with special reference to the occurrence of hepatic oil embolism following the procedure. Oily contrast medium ("Lipiodol" ultra-fluid) was found in the liver in seven cases, five of whom had carcinoma of the cervix uteri. Hepatic oil embolism was not encountered in patients with lymphomas in this series. Complete or partial lymphatic obstruction was present in all seven cases and one patient had almost complete obstruction of the inferior vena cava. Malignant disease need not always be the predisposing factor since hepatic oil embolism occurred in one patient with retroperitoneal fibrosis. The routes through which the contrast medium may reach the liver are discussed and lymphaticoportal communications in the mesentery are thought to play an important role. Contrast was invariably seen in the liver within two hours of commencement of the injection and was still faintly visible in one case three and a half months later. The way in which the contrast-pattern in the liver changes with time is described. An attempt is made to correlate the radiological appearances with the fate of the contrast medium in the liver.


Volume changes in the rat renal cortex during urography. At different periods of urography rat kidney were instantly frozen at -165 degrees C. Using appropriate histological techniques and planimetry of different cortical compartments and fractions the structural background of renal cortical volume variations during urography was elucidated. The renal cortex reacted to intravenous injection of hypertonic contrast medium with an immediate increase of volume, followed by a decrease from 30 to 60 seconds. Measuring the volume shares of different cortical compartments, the complex nature of cortical volume variations during the first minutes of urography could be demonstrated. Subdivision of the tubular compartments into cellular and luminal fractions showed even greater complexity of volume variations. All the major cortical volume changes came to an end approximately three minutes after the injections.


Contrast media during coronary arteriography: electrocardiographic changes in the presence of normal coronary arteries. In forty patients with normal coronary arteries, the electrocardiographic changes secondary to Urografin 76 and Hypaque 85 injection into both coronary arteries were monitored. Hypaque caused significantly greater prolongation of the PR interval (p less than 0.001), depression of the ST segment (p less than 0.05) and depth of T wave inversion (p less than 0.05). These effects were more noticeable during right coronary artery injection. Both contrast media slowed the heart rate equally during right and left coronary artery injection. In the absence of coronary arterial disease the ECG changes secondary to contrast media injection probably reflect a direct toxic effect. It is possible that premedication  with atropine will reduce these effects. Urografin 76 appears the less toxic of the two media, although one case of ventricular fibrillation occurred with each.


The tolerance of mouse tails to necrosis after repeated irradiation with X rays. The reduction in the "tolerance" dose for the production of tail necrosis in adult mice seven weeks after irradiation has been measured in tails which had previously received various single or multiple tolerable doses. The major findings are: A. The ability of heavily-irradiated and healed tails to tolerate about a further 90% of the first dose was found to apply between six weeks and ten months after the first irradiation. B. The tolerance dose was reduced to about 65% of the original at the third irradiation, and this dose (approximately) remained tolerable at the fourth, fifth and sixth irradiation, all delivered at six week intervals. C. Subsequent to seven weeks after the sixth dose, late effects were observed as an atrophy of the tail, mostly distal to the healed irradiated region. The occurrence was very marked (occurring in about 40% of tails by eight months) compared with that observed after only one dose (not more than 4% by eight months). Hence, if the assay time was extended to eight months after irradiation to include these late effects, the tolerance dose for the tail after the sixth dose would be reduced to about 55% of the original value.


Head injuries in children--aetiology, symptoms, physical findings and x-ray wastage. One thousand and thirty-two consecutive children with head injuries have been studied. All were outpatients, and 1000 had X-rays requested and performed. Of those X-rayed, only 21 (2.1%) had fractures, whilst 129 cases (12.9%) required admission for observation. No patient developed complications from their injuries. The presence or absence of a fracture neither correlated with the clinical situation nor affected the management. The fact that two thirds of all new casualty attendances at UK hospitals have an X-ray examination (British Medical Journal, 1977) is an unjustified wastage. Much of this wastage is related to skull X-rays in trauma, especially in children. In only a minority of patients does the presence of a fracture result in any modification of treatment. Some suggestions as to indications for skull X-rays in trauma have been made to help select patients for radiography and to avert wastage.


Visualization of the cystic artery after injection of Pancreozymin. In 84 patients selective angiography of the common hepatic artery before and after injection Pancreozymin was performed. The results prove that: 1. Pancreozymin produces visualization of the cystic artery and its branches and of the gall-bladder wall in the majority of these normal gall-bladders that are not visualized during angiography without Pancreozymin. 2. Pancreozymin improves visualization of many normal and pathological gall-bladders seen only faintly on angiography without Pancreozymin. 3. In a patient with an angiographically normal liver the non-visualization of the branches of the cystic artery or of the gall-bladder wall after injection of Pancreozymin is a reliable sign of organic gall-bladder disease, or of a collapsed gall-bladder seen sometimes in patients with bile duct or pancreatic tumour.


Hepatobiliary imaging: the use of 99Tcm-pyridoxylidene glutamate scanning in jaundiced adults and infants. 99Tcm-pyridoxylidene glutamate (99Tcm-PG) scans have been carried out in 24 jaundiced adults (mean total bilirubin 255 mumol/l and 11 infants with prolonged obstructive jaundice (mean total bilirubin 165 mumol/l). Absence of radioactivity in the gut was interpreted as complete biliary obstruction which was the cause of jaundice in ten adults and six infants. Using this criterion occlusion or patency of the bile ducts was correctly determined in 21 adults and eight infants. False-negative gut images were found in one adult and two infants, and three scans were inconclusive (two adults, one infant). The scan was unable to show details of the site of obstruction or pathology but the technique was simple and atraumatic and was safely performed in patients with serious complications, e.g. renal failure, coagulation defects, septicaemia. In infants the 99Tcm-PG scan compared well with the 131I rose bengal faecal excretion test and with liver biopsy in the investigation of prolonged obstructive jaundice. Repeat scans in infants with biliary atresia were used to assess postoperative bile drainage. It is suggested that 99Tcm-PG scanning is useful screening test in difficult cases of jaundice. It is especially useful in frail patients, and patients with complications.


Constancy of radiation output during diagnostic x-ray expousers. Variation in X-ray output and quality during a diagnostic exposure can be undesirable and may result in unnecessary dose to the patient. When significant build-up or decay periods are present errors will arise if factors obtained under steady-state conditions are employed to estimate the exposure. These parameters must be taken into account when calibrating X-ray generators. A variable speed spinning film device and a spectrometry system have been used to measure the variations under fluoroscopic and radiographic conditions for a number of generators. Variations in output due to filament heating, voltage supply and rectification, cable capacity and target pitting have been demonstrated. At low fluoroscopic currents, large surges and long decays have been observed; the significance of these effects is considered.


Vascular permeability in the ears of rats after x-irradiation. Late fibrosis in normal tissue is a complication which develops gradually after radiotherapy. It may be related to increase in vascular permeability induced by radiation. Plasma proteins leak into irradiated tissue where fibrinogen may be converted into fibrin which is gradually replaced by fibrous tissue. Vascular changes in the rat ear were investigated for six months after X-irradiation; Blood volume and vascular permeability were measured in vivo by monitoring the radioactivity in both irradiated and control ears after intravenous injection of phosphorus 32 labelled red cells and either iodinated (iodine 125) albumin or fibrinogen. After a single dose of 40 Gy there was an early increase in vascular permeability to both albumin and fibrinogen. After 20 Gy permeability to albumin was only increased during desquamation but extra-vascular fibrinogen accumulated at earlier times. Extravascular albumin was removed rapidly from irradiated ears, whereas some residual fibrinogen remained. Vascular permeability returned to normal but six weeks and showed no further changes up to six months after irradiation. Differences between the accumulation of extravascular albumin and fibrinogen at early times after irradiation could be due to some fibrinogen being fixed in the tissue. However, the rat ear showed no late changes comparable to the gradual development of late fibrosis seen in man.


The relationship between total dose, number of fractions and fractions size in the response of malignant melanoma in patients. The response of melanomas was assessed retrospectively from the clinical notes on 52 patients from three centres in the United Kingdom. The response was very variable. A tentative isoeffect curve was fitted to the UK data which gave a good fit to data from a prospective study from Yale. Clinical data from the Melbourne Clinic on response and fraction size showed a similar response to that from the UK and the combined data showed that the response to fraction sizes of 400-800 rad was significantly better (p about 0.01) than to fraction sizes of 200-299 rad.


Renal growth following reimplantation of the ureters for reflux. Renal growth after reimplantation of a refluxing ureter was measured in 17 patients (26 renal units). Measurements of renal length were made from intravenous pyelograms 1, 3 and 5 years post-operatively. Our findings showed that after successful antireflux surgery the rate of renal growth was greater than normal in the first post-operative year but between 1 and 5 years post-operatively was normal.


An evaluation of techniques used for the production of temporary renal ischaemia. Five techniques of producing temporary renal ischaemia have been evaluated in the rat. Damage was assessed by measuring inulin clearance, change in renal cortical intracellular water and 125I-fibrin deposition. Continuous renal artery occlusion produces significantly less renal damage than the other techniques commonly used.


The pattern of urolithiasis in the Sudan. Vesical stones in children are the commonest stones in the Sudan. In recent years there has been a progressive increase in the number of operations for upper tract stone, suggesting a change in the pattern of urolithiasis.


Reimplantation of the wide ureter.

Reimplantation of the wide ureter. A modification of the technique of Politano and Leadbetter for reimplantation of wide ureters is described. Nine patients with obstructive megaureter (10 ureters) and 6 with gross vesicoureteric reflux (9 ureters) were treated. A satisfactory result was obtained in 6 of the obstructed patients (7 ureters) and ultimately, after re-operation, in 1 of the remaining ureters. Reflux was corrected in all 6 patients. This method requires less extravesical dissection than others involving extensive remodelling of the wide ureter. There is therefore less risk of damage to the distal ureteric blood supply and the natural flap valve mechanism at the ureteric orifice may be more effectively emulated.


The behaviour of the bladder during physical activity. The technical difficulties of obtaining reliable recordings of bladder, rectal and detrusor pressures from patients who are standing, walking or exercising have been largely overcome by a method described in this paper. The recordings help us to understand the behaviour of the lower urinary tract during physical activity and are of value in the diagnosis of urological problems, especially incontinence.


Bladder neck incision--a treatment for retention with overflow in the absence of adenoma. Twenty-five cases of outlet obstruction with decompensated bladders and minimal adenomatous enlargement were treated by transurethral bladder neck incision. The results showed that bladder neck incision was as effective as transurethral resection of bladder neck and prostate and was a useful operation, especially for the elderly uraemic patient. There were no complications and operating time was considerably less than that required for a formal transurethral resection. The operation should be reserved for cases of outflow obstruction with no or minimal adenomatous hyperplasia.


The effect of pelvic nerve stimulation and some drugs on the urethra and bladder of the dog. Pelvic nerve stimulation caused an increase in pressure in both the urethra and bladder of anaesthetised dogs. The increases were only partially blocked by intravenous injection of atropine and were not significantly reduced by phentolamine, propranolol or methysergide. Quinidine produced some reduction in the bladder but not the urethral response. Hexamethonium reduced but did not abolish the responses to pelvic nerve stimulation. Close arterial injection of acetylcholine and 5-hydroxytryptamine increased the bladder and urethral pressures; noradrenaline produced a biphasic increase in urethral pressure but had no effect on the bladder; ATP increased bladder pressure but the response of the urethra was variable. The results indicate that some fibres in the pelvic nerve to the urethra as well as to the bladder are atropine resistant and suggest that transmission does not involve 5-hydroxytryptamine or noradrenaline and probably not ATP. The significance for treatment of detrusor dysfunction is discussed.


One-stage excision urethroplasty for stricture. Forty-two patients have had a one-stage excision urethroplasty for localised strictures in the bulbous urethra. The stricture recurred in 2 patients, one requiring a scrotal flap urethroplasty and the other a further excision and repair with a good result. With careful selection this operation gives very good results and has been used successfully in the primary repair of complete rupture of the bulbous urethra.


Can follicle stimulating hormone estimation replace testicular biopsy in the diagnosis of obstructive azoospermia? Sixty azoospermic men were investigated by means of testicular biopsy and estimation of serum follicle stimulating hormone (FSH) levels. High FSH levels when associated with small testes indicated severe testicular damage. We suggest that these findings offer sufficient evidence to regard such patients as infertile and that further investigation is unnecessary. In men with normal FSH levels testicular biopsy is still necessary for accurate diagnosis; in practice this may often be done at the same time as epididymovasostomy.


Immunological studies of testicular tissue in oligozoospermic and azoospermic patients. Testicular biopsies from 6 oligozoospermic and 12 azoospermic patients were examined histologically and immunohistologically. Evidence of maturation arrest and of Type II allergic reactions involving tubular basement membranes was found in all oligozoospermic patients. No evidence of an immune reaction was found in 9 azoospermic patients with maturation arrest. Unilateral or bilateral germ cell aplasia with evidence of mixed Type II and III or Type III and IV reactions was present in 2 oligozoospermic and 2 azoospermic patients. The findings have been interpreted to indicate that maturation arrest and germ cell aplasia may occasionally be linked in a chain of immunological events, initiated possibly by damage to tubular basement membranes. No correlation was demonstrable between the histological and immunohistological findings and indirect immunofluorescent tests for sperm antibodies. It is suggested that testicular biopsy is a potentially hazardous procedure in the investigation of infertility, and that prepubertal testicular tissues as well as sperm be used as antigens in the immunological investigation of infertility.


The role of ultrasound scanning in the diagnosis of thyroid swellings. This study has determined the ability of grey scale ultrasound to assess if a thyroid is normal or abnormal, if the appearances of the gland are specific for one disease and if the probability of malignancy can be determined. One hundred patients were studied, 65 with histologically confirmed diagnoses. It was found that the normal gland was distinguished from the abnormal with 99 per cent accuracy, simple cysts were diagnosed with 100 per cent accuracy and a specific disease diagnosis was given with 84 per cent accuracy. It was correctly stated in 87 patients that the disease was definitely benign, but in the remaining 12 patients (3 with cancer) it was stated that malignancy could not be excluded.


Intraoperative autotransfusion for elective aortic surgery. Intraoperative autotransfusion using the Bentley ATS 100 was used in 23 patients requiring Dacron replacement of their abdominal aorta. An average 2000 ml of blood was reinfused and a total heparinization dose was given. The mean haemoglobin fell 2.8 g/dl and on average 2 pints of banked blood were given in the postoperative period. Coagulation studies performed before and after surgery showed minimal alteration. We feel that further evaluation of this system is essential so that an alternative is established for when banked blood is not available. The system is particularly useful at the present time for such emergencies as a leaking abdominal aortic aneurysm and severe trauma to the liver.


The clinical scope and potential of isotope angiology. Arterial imaging using a gamma-camera to follow an intravenously injected bolus of 98Tcm has been performed in over 200 patients. The technique has been found useful in the evaluation of emergency vascular problems, in routine cases where arteriography cannot be performed or is inadvisable and in the assessment and follow-up of patients with intermittent claudication and digital vessel disease.


The long term sequelae of deep vein thrombosis. Five hundred and sixty-four patients undergoing abdominal surgery, who were carefully assessed at the time of operation for evidence of venous thrombosis, have been followed up to determine the incidence of leg symptoms, varicose veins and post-thrombotic syndrome. Patients are frequently troubled by pain, swelling and phlebitis, which can persist for up to a year after operation. New varicose veins developed by 1 year in 20 per cent of patients. These occurred with increased frequency in patients who also developed a deep vein thrombosis, but they were also seen in patients who showed no clinical or isotopic evidence of thrombosis. The post-thrombotic syndrome was present in 26 patients by 3 years after the operation; half of these patients had suffered the syndrome before the definitive operation. Assessment of the long term effects of venous thrombosis must be carried out against the background of similar effects seen in patients without thrombi, and the development of the post-thrombotic syndrome may best be considered as the summation of a number of incidents, overt or occult, occurring throughout a lifetime.


Pullthrough operation with delayed anastomosis for rectal cancer. The technique of pullthrough resection with delayed anastomosis for carcinoma of the rectum as performed at the Cleveland Clinic is described. A series of 84 cases of rectal cancer treated in this way is reported. The average tumour diameter was 4.5 cm, the average margin of resection was 4.1 cm and the average distance of the tumour from the anus was 7.6 cm. The incidence of necrosis of the pullthrough was 1.2 per cent. The overall 5-year survival was 63 per cent with 100 per cent, 57 per cent and 53 per cent for Dukes' A, B and C tumours respectively. The quality of bowel function following surgery is described in detail. It is felt that this procedure has an important place in sphincter conservation in carcinoma of the middle third of the rectum.


Immediate resection in the treatment of large bowel emergencies. In a consecutive series of 122 patients who required an emergency operation for disease or injury of the colon or rectum, 80 (65 per cent) had an immediate resection of the diseased segment of bowel, with an operative mortality of 15 per cent. The free use of immediate resection is of benefit to patients, but good results depend on the experience of the surgeon and the use of a number of special techniques.


Parathyroid hormone and calcium homeostasis in acute pancreatitis. Sequential daily measurements of plasma parathyroid hormone (PTH) have been performed in 89 patients with acute pancreatitis. A total of 439 PTH assays was obtained during 98 episodes of the disease. Three main patterns of PTH response were found. These responses were correlated with severity of disease graded by objective criteria and also to corrected serum calcium levels. The first type of PTH response was characterized by significantly elevated PTH levels soon after hospitalization with a subsequent decrease in levels to within the normal range by the third or fourth day of illness. This type of response was specifically associated with transient severe hypocalcaemia (corrected calcium less than 2.0 mmol/l). It was also associated with the most severe forms of disease and 6 of the 7 deaths. The second type of PTH response revealed initial PTH values in the upper level of the normal range (400--600 ng/l) while persistently low PTH levels were characteristic of the third type of response. Persistently low PTH levels were associated with normocalcaemia, and no patient in this group died. None of a group of 14 control patients exhibited the type 1 PTH response. An effective PTH response to an unidentified hypocalcaemic stimulus results in satisfactory calcium homeostasis in most patients with acute pancreatitis.


The effect of highly selective vagotomy on the relationship between gastric mucosal blood flow and acid secretion in man. Previous work has shown that the duodenal ulcer population can be defined by a lower ratio between gastric mucosal blood flow and acid secretion (during pentagastrin stimulation) than is found in normal subjects. The results of the present investigation have shown that the ratio is restored to normality by highly selective vagotomy. This suggests that increased tonic activity of the vagus on the parietal cell is one of the important disorders in duodenal ulceration.


Evidence for an enterotropic hormone: compensatory hyperplasia in defunctioned bowel. The relative contributions of luminal and systemic factors to the development of compensatory intestinal hyperplasia were assessed by comparing the adaptive response to jejunal resection in functioning and defunctioned ileum. In Thiry--Vella loops of upper ileum, mucosal contents of RNA and DNA increased by 16--21 per cent 2--7 days after jejunectomy (P = 0.05--0.01), but DNA specific activity was unchanged. In lower ileum remaining in continuity with the nutrient stream, nucleic acids were elevated by 27--86 per cent (P less than 0.001) and specific activity by 34--36 per cent (P = 0.05--0.005). Proximal to the site of resection, duodenal hyperplasia was equally rapid but less intense than in the distal bowel. Full adaptation requires both intraluminal nutrients and enterotropic hormones to be present.


Assessment of the nutritional state of patients with an intestinal fistula. The arm muscle area, derived fat-free mass, urinary excretion of 3-methylhistidine and creatinine were measured serially in a group of patients with an intestinal fistula receiving prolonged nutritional support. While the two anthropometric tests appeared reasonable indicators of changes in muscle mass in these patients, the marked intra-individual variability in excretion of 3-methylhistidine and creatinine created problems in interpretation. It is suggested that more use be made of serial anthropometry in district general hospitals as an alternative, simple, measure of nutritional status.


Amoebic perforation of the bowel: experiences with 26 cases. Over a period of 14 1/2 years, 26 instances of amoebic perforation of the bowel occurring in 25 patients were treated surgically. Nineteen perforations occurred in males and 7 in females, whose ages ranged from 3 to 74 years. The duration of symptoms varied from 12 h up to 5 months (average 15 days). All patients were toxic and a right lower quadrant mass was present in 14. The correct diagnosis was made or suspected in 14 (54 per cent). Amoebic perforation of the bowel should be suspected in patients presenting with an acute abdomen if a past history of fever, pain and diarrhoea is obtained, particularly if a large tender mass is present in the right iliac fossa. Resectional surgery was performed in 7 patients, with a mortality of 71 per cent, whereas procedures designed to divert the faecal stream were carried out in 19, with a mortality of 43 per cent. All 6 patients with concomitant liver abscesses died. If these patients are excluded, the mortality from resections was 60 per cent and from faecal diversion 27 per cent. Faecal diversion with wide drainage is the treatment of choice for amoebic perforation of the colon.


Low-cholesterol diet: enhancement of effect of CDCA in patients with gall stones. Fifteen patients with gall stones who were taking chenodeoxycholic acid(CDCA) 15 mg/kg at bedtime participated in two separate experiments to investigate the effects of altering sterol intake on the cholesterol saturation index (SI) of fasting gall-bladder bile. In experiment I the 15 patients on an unrestricted diet had a SI of 0.87 +/- 0.04 (mean +/- SE of mean), which fell to 0.75 +/- 0.04 after one week in hospital on a diet of 100 mg cholesterol daily. In experiment II seven of the patients were given four different dietary regimens lasting one month each in random order as outpatients. On a diet of 600 mg of cholesterol daily the mean SI was 0.72 +/- 0.05, which fell to 0.67 +/- 0.05 when the patients were put on a 100 mg cholesterol diet. The addition of plant sterols (3 g daily) to both diets raised the mean SIs to 0.80 +/- 0.05 and 0.77 +/- 0.05 respectively. The percentage CDCA in bile was unaffected by alterations in the cholesterol and plant sterol intakes. We conclude that a low-cholesterol diet but not a high intake of plant sterols enhances the effect of CDCA in patients with gall stones.


Mortality and morbidity of reusing dialysers. A report by the registration committee of the European Dialysis and Transplant Association. The practice of reusing dialysers in renal units in the UK was surveyed by examining the patient questionnaires returned to the EDTA registration committee for 1976 and by a special questionnaire sent to all UK renal units. Altogether 65.6% of the 1785 patients treated with non-disposable dialysers and 49.6% of the 1109 treated with disposable dialysers reused their equipment. Reuse of dialysers caused some morbidity but no mortality. Most centres where disposable dialysers were used accepted that their reuse was necessary because of financial constraints and was ethically defensible.


A method for self-assessment of disability before and after hip replacement operations. A standardised form was developed to review the daily problems suffered by patients with arthritis of the hip and provide clinicians with information for planning treatment and in judging subsequent progress. The reports made by various patients in a preliminary study provided 81 statements on pain, restricted movements, and restricted activities that were then tested to identify the most reliable. The responses of 32 patients waiting for hip replacements and 66 patients who had undergone operation were compared with independent assessments of pain and physical limitations. The 33 statements eventually selected were chosen mainly on the basis of their sensitivity to differences between preoperative and postoperative patients and their correlation with the independent assessments. The final questionnaire provides a valid and concise summary of a patient's disabilities and is simple enough for the patient to complete while waiting to see the doctor.


Screening for impaired visual acuity in middle age in general practice. Screening for impaired distant visual acuity was one component of a controlled trial of multiphasic screening in middle age carried out in two general practices. The prevalence of impaired visual acuity (6/18 or worse in the better eye) at the initial screening in 1967 was 9.6% overall, ranging from 5.9% in people aged 40-49 years to 16.3% in those aged over 60. The question "Do you have difficulty seeing distant objects?" had a low sensitivity and high specificity, rendering it unsatisfactory for use in mass population screening for visual impairment. The prevalences of impaired visual acuity in the screening and control groups at the survey in 1972 showed no significant differences in any age group. Mass screening for defects of visual acuity in the course of a multiphasic examination is thus unlikely to reduce the prevalence of impaired distant visual acuity in the community.


Effect of cirrhosis of the liver on the pharmacokinetics of chlormethiazole. The pharmacokinetics of chlormethiazole were studied in eight patients with advanced cirrhosis of the liver and in six healthy volunteers after oral and intravenous administration of the drug. In the patients the systemic bioavailability of oral chlormethiazole was increased about tenfold, whereas its elimination was only slightly retarded. The increased bioavailability was clearly due to decreased first-pass metabolism of chlormethiazole in the cirrhotic liver. The results indicate that chlormethiazole should be used in reduced dosage when given by mouth to patients with cirrhosis of the liver.


Surma and lead poisoning.

Surma and lead poisoning. Blood lead concentrations were measured in 62 Asian children, of whom 37 had definitely had surma applied to their eyes and 25 were thought not to have done. The mean concentration in those who had not used surma was 0.98 +/- SD 0.42 mumol/1 (20.3 +/- 8.7 microgram/100 ml) compared with 1.65 +/- 0.68 mumol/4 (34.2 +/- 14.1 microgram/100 ml) in those who had. Analysis of 29 different samples of surma showed 23 of them to be composed largely of lead sulphide. We conclude that the use of surma is associated with high blood lead concentrations. In our cases most of it had been obtained abroad, and hence government restrictions might be ineffective in limiting its use: a better method of prevention might be to inform the leaders of Asian communities of the risks.


Heart valve replacement in the elderly.

Heart valve replacement in the elderly. From January 1973 to December 1976, 70 operations for heart valve replacement were performed on 68 patients aged 65--75 years. These comprised 40 aortic valve replacements, 27 mitral valve replacements, and three aortic and mitral valve replacements. Three patients died within 30 days of operation (early mortality 4.3%), and five died 12 weeks to three years after operation. Four patients showed no improvement. The results were excellent or good in the remaining 56 patients. Valve replacemnt can restore to a useful independent life elderly patients who would otherwise be a burden on costly social and medical domiciliary services. The indications for valve surgery in the elderly should therefore be the same as in any other age group.


Lack of relation between venous plasma total catecholamine concentrations and ventricular arrhythmias after acute myocardial infarction. Electrocardiographic tracings were recorded continuously to monitor ventricular tachycardia and R-on-T and R-on-apex-T ventricular premature beats, and repeated estimations of venous plasma total catecholamine concentrations were carried out in 26 patients admitted to a coronary care unit with acute myocardial infarction. No relation existed between the increased catecholamine concentrations found in these patients and the incidence of ventricular arrhythmias occurring six to 48 hours after the onset of symptoms.


Pupillary signs in diabetic autonomic neuropathy. Pupillary function was investigated in 36 insulin-dependent diabetics and 36 controls matched for age and sex. About half of the diabetics had evidence of peripheral somatic or autonomic neuropathy, or both. The diabetic patients had abnormally small pupil diameters in the dark and less fluctuation in pupil size (hippus) during continuous illumination than the controls. They also had reduced reflex responses to light flashes of an intensity adjusted for individual retinal sensitivities. The pupillary findings were compared with results of five tests of cardiovascular function and five tests of peripheral sensory and motor nerve function. Almost all the patients with autonomic neuropathy had pupillary signs, which we therefore conclude are a common manifestation of diabetic autonomic neuropathy.


Taking medical histories through interpreters: practice in a Nigerian outpatient department. Consultations through interpreters in the medical outpatient department of a Nigerian hospital were tape-recorded. These recordings were translated completely into English and transcribed, and the performance of the interpreters was analysed. The interpreters often did not provide word-for-word translations of what the doctor or patient had said. Some of these deviations were helpful, but others were confusing or incorrect. In particular, interpreters were inclined to conduct much of the consultations themselves. Hospitals using interpreters should ensure that they have no conflicting duties during consultations and that they have some training in language and interpretation. The quality of interpretation should be checked by native-speaking doctors and by using recordings. Doctors using interpreters should try to make sure that everything said is translated and check the patient's answers by asking questions in several ways.


Obstetric care in the central Canadian Arctic. All pregnancies that occurred during 1971-5 among 4000 Canadian Eskimos living in isolated settlements in a district of the North-west Territories were reviewed. Obstetric care was provided in settlement nursing stations, at a base hospital manned by general practitioners, and at a teaching hospital in Winnipeg. Of the 622 infants delivered in 1971-5 218 were delivered in nursing stations by midwives, 338 in the base hospital, and 54 in the teaching hospital. Caesarean sections were performed in 10 cases, and the perinatal mortality was 25.7 per 1000 births. Though it is hard to defend patients delivering their babies in remote areas with no medical help, the results seemed to be acceptable. The credit for this goes to experienced midwives, a liberal evacuation policy, close co-operation from general practitioners, and the specialist visiting and consulting service.


Drug treatment of psychiatric patients in general practice. The prescribing of psychotropic drugs by general practitioners was assessed by analysing the drug treatment of all patients referred from general practice to a psychiatric outpatient clinic over four years. Of the 287 patients, 220 were taking one or more of 56 different psychotropic drugs at referral, diazepam being the most common. Benzodiazepines and barbiturates had been taken for significantly longer than other drugs, and, of a total of 342 drugs, 61 had been prescribed regularly for over a year. Half of the drugs were considered to be incorrectly prescribed on pharmacological grounds, the main errors being unnecessarily prolonged regular treatment, incorrect dosage (particularly common with antidepressants), and polypharmacy with drugs of similar pharmacological action. A basic grounding in the pharmacology of psychotropic drugs might help practitioners to avoid prescribing errors of this kind.


Neonatal death in Northern Ireland.

Neonatal death in Northern Ireland. A survey of neonatal deaths occurring over two years in Northern Ireland disclosed that many hospitals where babies could be born probably could not be staffed and equipped to deal effectively with major perinatal problems. The incidence of congenital malformations, especially neural tube defects, was high. A reduction in neonatal deaths from this cause might be expected if facilities for antenatal diagnosis and termination of pregnancy were made available, although this raises grave ethical problems. Many infants died of prematurity and the idiopathic respiratory distress syndrome. A considerable reduction in neonatal deaths might be expected with improved care at the place of delivery backed by a regional centre with facilities for transporting and treating severely ill infants needing intensive care.


National Childhood Encephalopathy Study: an interim report. Data from the first year of the National Childhood Encephalopathy Study were reviewed to see whether any relation was apparent between pertussis vaccination and brain disease. Three hundred and eighty-seven cases of encephalitis and other specified neurological conditions in which the children were admitted to hospital were reported, of which 267 satisfied the study criteria. Control children were matched for age with the index cases, and medical and immunisation histories were reviewed. Few of the index cases had been vaccinated within 28 days before admission to hospital, so that no close association between vaccination and brain disease existed in most cases. The number of children who had recently been immunised was too small for any statistically useful conclusion to be reached about the risk associated with pertussis vaccine. The study is continuing.


Untrained community help in the rehabilitation of stroke sufferers with language disorder. The Newcastle Speech-After-Stroke Project is one of many schemes in Britain that have used untrained helpers to set up community clubs and home visiting for dysphasic stroke sufferers. To examine the contribution to rehabilitation made by such activities, patients' language abilities and social confidence were assessed when they entered the project and after about six months. Formal tests of language showed no significant improvement after six months, but social confidence increased. Such projects can make a valuable contribution in helping dysphasic people to regain a role in the community. Nevertheless, too much should not be expected of them in the way of direct help in the patients' recovery of language.


Decreased first-pass metabolism of labetalol in chronic liver disease. The effect of chronic liver disease on the rate of elimination and extent of "first-pass" metabolism of labetalol was studied. Pharmacokinetic measurements were made after both oral and intravenous administration to seven healthy subjects and to 10 patients with chronic liver disease. Plasma half life was similar in the two groups. Plasma concentrations were considerably higher in the patients than in the healthy subjects after oral administration but similar after intravenous injection. Thus the bioavailability of labetalol was increased in liver disease due to reduced first-pass metabolism. Bioavailability in the group of patients correlated negatively with serum albumin concentration. There were falls in supine heart rate and blood pressure which tended to be greater after oral administration in the patients with liver disease, suggesting an exaggerated response related to the increased bioavailability. Oral dosage requirements of labetalol and possibly other drugs susceptible to first-pass metabolism are reduced in the presence of liver disease.


Anti-acetylcholine-receptor antibody concentrations after thymectomy in patients with myasthenia gravis. Serum concentrations of anti-acetylcholine-receptor (anti-AChR) antibody were measured in patients with myasthenia gravis. In those patients undergoing thymectomy concentrations were measured before and after the operation to see whether there might be a connection between the thymus and antibody production. We found no correlation between antibody concentration and either thymectomy or duration and severity of the disease before the operation. Our results suggest that if anti-AChR antibodies are the principal pathogenic factor in myasthenia gravis then immunological and neurophysical variables other than the total serum anti-AChR antibody concentration contribute to the severity of the disease.


A different kind of day hospital--for patients with preterminal cancer and chronic disease. A new day hospital has been set up in Sheffield for patients with preterminal cancer and chronic disease. During the first 26 months 197 patients with cancer and 66 chronically sick patients attended. Of the 2701 attendances by patients with cancer, breast cancer accounted for 38%. One hundred and forty of the patients with cancer died, 83% in the terminal-care unit and 12% at home. Ninety per cent of respondents to a questionnaire thought that the support provided was of great importance to both patient and family; and over two-thirds of the patients were said to have benefited from improved control of symptoms. A similar facility could be developed within existing day hospitals without major revenue consequences, and should produce a genuine improvement in care. This study suggests, however, that it would not shorten the terminal stay in hospital.


Deaths under 50. Medical Services Study Group of the Royal College of Physicians of London. The Medical Services Study Group has started a collaborative study in the Mersey, West Midlands, and Grampian regions to examine the causes of death among medical inpatients aged 1 to 50. The cause of death is determined from the case notes and the consultant's opinion. The rate of ascertainment of cases was initially low, though it is increasing; despite this limitation an analysis of the first 250 cases showed one important finding. No fewer than 98 patients contributed to their own deaths through overeating, drinking, smoking, or not complying with treatment. Despite the present statistical limitations of the study, it has been valuable in enlisting the good will of the participating physicians, which will help to ensure the success of other projects, and it has avoided the problems inherent in determining the cause of death from death certificates alone.


Death certification and epidemiological research. Medical Services Study Group of the Royal College of Physicians of London. The cause of death shown on 191 death certificates was compared with the cause indicated by the hospital case notes, the consultants' opinions, and the necropsy findings. All 191 deaths occurred among medical hospital patients aged under 50. In 39 cases there was a major discrepancy between the two sources over the cause of death and in another 54 ther was a minor but epidemiologically important difference. Death certificates are not primarily intended for epidemiological research, but researchers often rely on them. This and other studies have shown, however, that death certificates are often inaccurate records of the cause of death--even coroner's certificates issued after a coroner's necropsy. The accuracy of death certificates might be improved if coroners consulted clinicians more closely and if senior hospital staff completed hospital death certificates.


Changing social-class distribution of heart disease. Analysis of mortality trends over 40 years in England and Wales showed that mortality from coronary heart disease had become progressively more common in  working-class men and women than in those from the middle and upper classes. The change was most noticeable for men. Whereas in 1931 and 1951 heart disease was more common in men of social classes I and II, by 1961 it was more common in men of classes IV and V. This change in social-class distribution can only partly be explained by changes in diagnostic methods. The worsening mortality of classes IV and V correlated with relatively more smoking, a higher consumption of sugar, and a lower consumption of wholemeal bread in these classes. There was no correlation between change in heart disease and change in the social-class pattern of fat consumption.


How often should patients be reviewed after treatment with iodine-131 for thyrotoxicosis? Six to 18 years after treatment with iodine-131 for thyrotoxicosis 69 euthyroid patients with raised serum thyrotrophin (TSH) concentrations (mean 25.0 +/- SE 2.0 mU/l) and 61 with normal concentrations (mean 4.0 +/- 0.2 mU/l) were included in a prospective five-year follow-up study beginning in 1972. During this period 13 patients from the original group with raised serum TSH concentrations became hypothyroid. In contrast it was five years before hypothyroidism developed in a single patient from the group with normal serum TSH concentrations in 1972, although raised concentrations were recorded in 19 of these patients during the study.