Negative effect of frusemide pretreatment in glycerol induced acute renal failure. It is commonly assumed that the decrease in the effective circulatory volume (ECV) is the major event in acute renal failure (ARF) and the preferential ischemia of the cortex another major modification. Frusemide has been given to try to prevent this change in glycerol-induced ARF because of its effect in redistributing renal blood flow from medulla to cortex. Isontonic saline was also tried to avoid the ECV depletion. The pretreatment with frusemide not only fails to protect against the ARF but increases its severity. Isotonic saline adminstration and replacement of urinary losses almost prevent glycerol-induced ARF but when both isotonic  saline frusemide are administered together their effect is only a slight increase in the excretion rate of urea and creatinine during the first days of the experiment. The importance of the changes in the ECV or a possible direct action of frusemide on the renin-angiotensin axis are discussed. There is a good correlation between plasma creatinine levels and interstitial oedema. The importance of the oedema in the maintenance of ARF is discussed.


The determination of dissolved nitrogen in blood by gas phase chromatography. A method for measuring dissolved nitrogen in blood is described. Gas-phase chromatography is used. The apparatus  is provided with a column of 5 A molecular sieve material and with an extraction chamber. CO2 and O2 are absorbed. As in Lenfant's method, extraction  by equilibration is completed by elution. The main features are: the design of the extraction chamber, faciliting gas flow; an auxiliary circuit for freeing the chamber and the reagents from nitrogen, in which the pressure can be equilibrated against the inlet pressure of the column; the care taken to avoid any kind of contamination; the use of a special guide mounted on the blood-transfer syringe, which makes it possible to get reproducible samples at last the checking and measurement of the residual nitrogen which makes it possible to extract and measure the whole of the dissolved nitrogen. At the present stage, the accuracy of the method is better than 1.5% and the coefficient of variation of the reproducibility is 0.57%. These results make the method suitable for measuring (PaN2-PAN2) in cases of chronic respiratory insufficiency.


Bronchial lympho-epithelial nodules in the rat: definition and morphological characteristics in optical and electron microscopy. Three type of structures can be distinguished among the bronchial lymphoid tissue: lymph nodes, lymphoids cells aggregates and lymphoepithelial nodules. Such structures are encountered in many species and may be characterized by flattened epithelium, devoid of mucus producing cells, infiltrated with lymphocytes and containing of few ciliated cells. The lymphoepithelium surrounds the nodules, characterized by a high cellular density. Original structures may be observed, mainly inter and intracellular vacuoles. Peripheral lymphatic vessels and high endothelium veins contribute to the important lymphocyte transfer. Electron microscope, studies support the view that lymphoepithelium has an uptake function of particulate matter; more direct evidence is however attempted. An hypothesis of capacity for antigenic recognition of the lymphoepithelium nodules is discussed.


Discrepancies in nude mice.

Discrepancies in nude mice. With the increasing number of publications in which nude mice are used, there is a growing list of apparent discrepencies. To avoid such problems, we propose the use of nude mouse populations with a large gene pool which will leave, if possible, the nude allele as the only homozygote. All phenotypic characters consistently different between nu/nu, nu/+ and +/+ mice could then, with more certainty, be linked with the nude mutation.


Reversal of granulocyte adherence to nylon fibers using local anesthetic agents: possible application to filtration leukapheresis. The effects of the cationic anesthetic agents tetracaine and lidocaine on granulocyte function, morphology, and adherence to nylon fibers were studied in an attempt to improve current methods of granulocyte collection by filtration leukapheresis (FL). When dissolved in acid-citrate-dextrose (ACD) plasma, these drugs significantly increased granulocyte elution from the fibers in a dose-related fashion. Granulocytes exposed to tetracaine and lidocaine remained more than 95% viable, retained normal bactericidal capacity after the drugs were washed from the cells, and had preserved membrane integrity, as evidenced by the normal ultrastructural appearance of tetracaine-exposed cells and an absence of leakage of lysozyme or lactic dehydrogenase. Granulocytes eluted with the anesthetic agents were rounded in shape with a reduction in the number of filopodial cytoplasmic projections and a relative absence of cytoplasmic vacuolization when compared to granulocytes eluted with ACD plasma alone. Dose-related inhibition of phagocytosis and adherence, which was largely reversible after washing the granulocytes, was noted. Greater than 95% of the lidocaine could be removed from the eluate with a single centrifugation and resuspension, indicating that granulocytes prepared by FL with anesthetic-enhanced elution could be potentially transfusable.


X-linked syndrome of platelet dysfunction, thrombocytopenia, and imbalanced globin chain synthesis with hemolysis. An unusual family is described with a congenital bleeding disorder present in four males belonging to three generations. Of the three surviving affected males, all had splenomegaly and petechiae. The three had moderate thrombocytopenia (55-90 X 10(9)/liter) and markedly prolonged Ivy-template bleeding times (greater than 30 min). They were also noted to have reticulocytosis and, upon further investigation, imbalanced globin chain synthesis resembling that of beta-thalassemia minor. Studies on nine additional family members in four generations were normal except for slight elevations of reticulocyte counts in female members, one of whom had the abnormal globin chain synthesis ratio. In male members, the bleeding tendency and clinical signs always occurred in the presence of the globin chain synthesis defect and reticulocytosis. This previously undescribed condition was apparently transmitted as an X-linked disorder.


Autooxidation as a basis for altered function by polymorphonuclear leukocytes. To investigate the possibility that human polymorphonuclear leukocytes (PMN) elaborate sufficient amounts of hydrogen peroxide (H2O2) and other radicals of reduced oxygen to be autotoxic and retard directed cell movement and phagocytosis, the rate of ingestion of opsonized lipopolysaccharide-paraffin oil particles and movement through Nuclepore filters were studied. Ingestion rates were increased under anaerobic conditions and in normal aerobic conditions in the presence of extracellular catalase but not superoxide dismutase (SOD) or scavengers of singlet oxygen or hydroxyl radicals. Conversely, ingestion rates were decreased when cells were exposed to H2O2 or a superoxide anion (O2-)-H2O2 generating system of xanthine-xanthine oxidase. Catalase, but not SOD, prevented the effect and also enhanced the directed movement of PMN in normal aerobic conditions. PMN from volunteers administered 1600 U/day of the membrane lipid antioxidant alpha-tocopherol were hyperphagocytic but killed Staphylococcus aureus 502A less effectively than controls, suggesting that less H2O2 was available to damage PMN or kill bacteria. H2O2-dependent stimulation of the hexose monophosphate shunt, H2O2 release from phaogytizing PMN, and fluoresceinated concanavalin A cap formation promoted by H2O2 damage to microtubules were all diminished, but the release of O2- from phagocytizing PMN was not diminished in the vitamin E group. These results support the hypothesis that directed movement and phagocytosis by PMN are attenuated by autooxidative damage to the cell membrane by endogenously derived H2O2 and that the administration in vivo of vitamin E may prevent this damage by scavenging H2O2.


Arterial pressure development in neonatal and young spontaneously hypertensive rats. Systemic arterial pressure of spontaneously hypertensive rats (SHR) were not detectably different from control rats prior to 3 weeks of age. Arterial pressure was elevated in SHR at 4 weeks compared to Wistar-Kyoto rats. Thus, the term 'prehypertensive stage' should probably be reserved for animals less than 1 month of age when this model is examined.


Laser-induced thrombus formation and vascular reactivity in the microcirculation of the spontaneously hypertensive rat. Thrombi formation resulting from laser-induced injury to mesenteric circulation has been studied in spontaneously hypertensive (SH) and normotensive rats. The thrombotic reaction was enhanced in both venules and arterioles of the SH rats. In the arterioles of the hypertensive rats, the vasoconstriction which develops downstream from the thrombus is greatly intensified and the time to form microvascular haemostatic plugs significantly decreased in the arterioles of these animals. These phenomena have been explained on the basis of an increased reactivity of the vascular smooth muscle of the SH rats to vasoconstrictor substances liberated from platelets at the site of injury.


Mechanism of potassium relaxation of arterial muscle. Strips of arterial muscle were prepared from rat tail and femoral arteries and dog mesenteric arteries. All muscles developed a contracture slowly when exposed to a potassium-free solution, but relaxed rapidly when potassium was added to the bath to give a concentration as low as 0.1 mM. The slow contracture is caused by norepinephrine release from intrinsic nerve endings, but the rapid relaxation occurs while the norepinephrine concentration is still high. Contractions produced by exogenous norepinephrine or serotonin in a potassium-free bath were also made to relax by the addition of potassium. After several minutes these relaxations reversed abruptly and spontaneously to return to their original level of contraction. The rapid relaxation was found to be due to an electrogenic transport mechanism which caused hyperpolarization within several seconds after the addition of potassium. This hyperpolarization is believed to be caused by electrogenic ion transport since it exceeded the expected membrane potential based on the potential calculated from potassium concentrations, EK. Hyperpolarization declined within 5-15 min, allowing contraction to redevelop. Ouabain was found to prevent both the potassium-induced relaxation and the cessation of norepinephrine release. However, ouabain prevented relaxation as effectively in denervated as in innervated smooth muscle. We conclude that the initial relaxation of arterial smooth muscle that occurs when potassium is reintroduced into a potassium-free solution is caused by membrane hyperpolarization resulting from the enhanced activity of an electrogenic pump; it is not caused by cessation of norepinephrine release.


Influence of desipramine on the uptake and efflux of radiolabelled bretylium and bethanidine in the adventitial and media-intimal layers of rabbit aortic strips. The desipramine-sensitive uptake (neuronal uptake) of 14C-bretylium and 14C-bethanidine into the rabbit aortic adventitial layer from 3 X 10(-6) M solutions increased with time during a 20 min incubation. For both compounds a neuronal uptake of 50 pmol/50 mg wet weight adventitia was associated with 10% block of the contractile response to field stimulation at 16 Hz and 150 pmol/50 mg with 60% block. The concentration of blocking agents inside the neuron at 50% blockade was calculated to be 260 X 10(-6) M, an 87-fold increase over the medium. The bretylium in the neuron decreased by 50% during 20 min washout, and bethanidine by 29%. Desipramine when added to the bath 20 min following the addition of the blocking agents led to a loss of bretylium but not of bethanidine from the adventitia. Desipramine had little or no effect on the uptake, washout or disposition of either blocking agent in the media-intimal layers. The data indicate that bretylium has a greater propensity than bethanidine to be lost from the neurons; however, it appears to be recycled back through the membrane via the amine pump more readily than bethanidine. The fact that conservative calculations indicate that the neuronal membrane slowly established a concentration of the blocking agents within the neuron that is known to produce rapid local anesthesia when topically applied to adrenergic nerve trunks and which approaches a concentration needed to inhibit sensory endings suggests that local anesthesia may play a role in the mechanism of neuron blockade.


Effects of chronic nicotine administration on RBC velocity in mesenteric capillaries of the rat. The purpose of this study was to determine the effects of chronic administration of nicotine on red blood cell (RBC) velocity in single capillaries of the mesentery. Ten male rats consumed an average of 2.38 mg nicotine/kg/day, an approximate '2 pack' equivalent, in their drinking water for a period of 15-20 weeks. At the end of this time RBC velocity was measured in single capillaries of the mesentery. The data were compared to RBC velocities measured in a group of matched control rats. Red cell velocities in the control and nicotine groups averaged 1.22+/-0.23 and 0.59+/-0.10 mm/sec SEM, respectively. These values were significantly different (p less than or equal to 0.01). It is concluded that chronic administration of nicotine to rats in levels equivalent to tobacco smoking reduces resting capillary blood flow in the mesenteric circulation as indicated by differences in erythrocyte velocity.


Occurrence of Su in a German family.

Occurrence of Su in a German family. Investigating a paternity case we observed a pretended opposite homozygosity of the S and s alleles between a mother and her child. The presence of the rare allele Su in this family could be demonstrated with the aid of dosage studies and blood group testing of the mother's parents. 22 additional genetic marker systems, including the HLA-system were examined, a biostatistical calculation was performed as well. The results obtained from these testings were in accordance with the hereditary rules and the posssibility of ilegitimacy or of children's substitution could be excluded. Only Caucasoid ancestry was known to the family. In addition, family members showed another rare blood group marker, the allele GPT0.


Ureteric urine examination.

Ureteric urine examination. Uterteric urine examination can give definitive evidence of upper urinary tract carcinoma and three cases are described and illustrated. The absence of carcinoma cells in such specimens, however, does not exclude malignancy for two reasons. First, the tumours may be well differentiated and the cells not recognized at cytological examination and, secondly, carcinoma cells may not appear in ureteric urine specimens since they can be reluctant to exfoliate.


Parasuicide in Edinburgh--a seven-year review 1968-74. Parasuicide admissions to the Regional Poisoning Treatment Centre in Edinburgh are reviewed over the seven year period 1968-74. Special emphasis is given to trends in parasuicide rates for Edinburgh City, but social and clinical data are also described. Though the mean annual increase for admissions is 10-6 per cent, recent years have shown a fall in the rates for men and a levelling off for women. There have been increases in the rates for the young, for men in social classes 4 and 5 and for divorced women, and in poisonings with psychotropic drugs and alcohol consumption among women. At the same time it is important to note variables which have not changed: the relative risks by age and sex, repetition rates, the diagnostic picture, poisoning with non-prescribed drugs, and the rank order of municipal ward rates: and variables which have diminished: the rates for divorced men, overcrowding, domestic gas and barbiturate poisoning, and drug misuse. A comprehensive explanation of parasuicide in the contemporary scene would have to explain both the consistencies and the changing trends. The answer to the central question of why parasuicide is changing remains elusive.


Cyclone Tracy and Darwin evacuees: on the restoration of the species. A validated objective measure of the state of psychological function was used to determine the incidence and course of psychological dysfunction in a group of evacuees from Darwin following disaster caused by a cyclone (Cyclone Tracy). While psychological dysfunction was increased initially (58 per cent) and at ten weeks (41 per cent), it had returned to an Australian general population control level (22 per cent) at 14 months. Factors influencing psychological dysfunction were examined, and it is suggested that the sample faced two different stressors at differing times. Initial psychiatric morbidity was most clearly associated with the experience of thinking that one might die or be seriously injured and therefore conceptualized as a 'mortality stressor'. Psychiatric morbidity at ten weeks appeared to be most closely associated with what has been conceptualized as a 'relocation stressor'. Reasons why psychiatric morbidity decreased to a general population control level are discussed.


The syndrome of Capgras.

The syndrome of Capgras. In eleven patients with the syndrome of Capgras, the clinical data and the results of electroencephalographic, echoencephalographic, air-encephalographic, psychological and brain-scanning investigations are presented and discussed. All patients were psychotic: six were schizophrenic, four were depressive and one suffered from an organic psychosis. A paranoid element was marked in all cases. The present evidence supports the view that organic factors are important in the pathogenesis of Capgras' syndrome.


Clinic attendance and opiate prescription status of heroin addicts over a six-year period. Home Office records were used to trace the current status of a sample of 128 persons of whom heroin was prescribed in 1969 at Drug Dependence Clinics in London. In October 1975, after a mean time since self-reported first use of heroin of 11-25 years, 51 per cent were attending clinics, 40 per cent alive and not attending, and 9 per cent dead. One third of the sample were still receiving heroin on prescription, and 23 per cent appeared to have received heroin without interruption since 1969. The report points to the need for career studies of addicts' lives and the need for follow-up interviews, especially for the 40 per cent no longer attending clinics.


Schizophrenia in a 46,XY male with the Noonan syndrome. We report for the first time the case of a male patient with the Noonan syndrome (Turner phenotype with a normal karyotype) who also had a psychiatric disorder which satisfied research criteria for schizophrenia.


Diagnostic classification of first-ever admissions to Chainama Hills Hospital, Lusaka, Zambia. All new female indigenous Zambian patients (180) admitted to Chainama Hills Hospital from 1 June 1974 to 31 May 1975 were seen by the authors and given a firm diagnosis before they were started on treatment. The diagnostic classification of these patients was compared to that of a similar group of patients (163) admitted to the same hospital from 1 June 1973 to 31 May 1974. Forty-two per cent of the patients in 1974/75 were given a diagnosis of depression as compared to 26 per cent in 1973/74; 14 per cent of those in 1974/75 had a diagnosis of schizophrenia as compared to 21 per cent in 1973/74, and 3 per cent of the patients in 1974/75 fell into the group of 'not yet diagnosed' as opposed by 27 per cent in 1973/74. The 'acute transient psychoses' were noted for their relative rarity in the two groups. A plea is made for all psychiatrists working in Africa to give diagnosis the importance it deserves.


A new technique for the treatment of guilt. A behavioural technique is described suitable for the treatment of patients with high levels of guilt who attempt to relieve their depression by risk-taking activities which reflect their individual wishes and fears, or who suffer anxiety due to unacceptable past behaviour. It is recommended as an alternative brief method of treatment to psychoanalysis and is based on the application of behaviour therapy to a patient's psychopathology. Three case histories are described to illustrate the principles of the technique.


Treatment of obsessive-compulsive neurosis with history of childhood autism. A young man was followed-up over three years who had severe obsessive-compulsive rituals and ruminations, interpersonal deficits, complicating depression and a history of childhood autism. Intensive behavioural treatment was given in an operant framework, with exposure in vivo, modelling, response prevention and social skills training. Compulsive rituals improved markedly and lastingly, but ruminations and social defects persisted. When intercurrent depression occurred dothiepin facilitated behavioural treatment. Adjustment remained fragile. Minimum maintenance treatment in the community could not be adequately arranged, so that gains made in hospital were partly lost at follow-up, despite continuing improvement in rituals.


The stability of mood and social perception measures in a sample of depressive in-patients. Forty depressives and 40 matched controls were compared in terms of a number of self-report variables and in terms of their descriptions and evaluations of both real-life and hypothetical social relationships. Clear differences between the two groups reveal poorer self-ratings in the depressive sample, together with a tendency to describe and to evaluate both real and imaginary relationships more negatively. A retest of the depressed patients at the time of discharge from hospital showed improvement only in the two depression measures and not in any of the other self-rating and perceptual measures used. The possibility is discussed that the perceptual variables are predisposing to depression rather than concomitant with it.


Changes in cognitive functioning in elderly psychiatric patients. Elderly psychiatric patients who were in contact with the hospital one year after in-patient admission were retested on a number of clinical and psychometric measures first done soon after admission. In general, changes were small; and for several measures very high correlations existed between the scores gained on the two occasions. When those patients with uncomplicated chronic brain syndromes were considered separately, increasing impairment was demonstrable.


Response times to stimuli of increasing complexity as a function of ageing. Twelve elderly and 12 young subjects were tested on a series of experiments with increasing complexity of perceptual-response mapping. As task complexity increased the differential slowing in performance between young and old increased and an ageXtask complexity interaction was observed. However, with practice this phenomenon disappeared leaving an apparent age lag constant. This slowing was due to increased central processing time rather than peripheral factors. No major differences in strategies were observed between the groups, though the old subjects tended to be less able to extract critical (useful) features from the display. Stimulus repetitions of a new kind were found where all characteristics of the stimulus (relevant and irrelevant) were important. Repetitions of coding rules rather than of particular signals or responses also facilitated RT. It was also found that later in practice old subjects were making fewer errors than the young, reversing earlier observations.


The processing of negative or incongruent perceptual and combined perceptual/linguistic stimuli. A psychological model of mediational processes based on the derivation of the meaning of perceptual or linguistic signs predicts increased processing times for signs that have negative affective meaning and conjoined signs with incongruent affective meanings. The procedure used in the experiments enables identical responses for positive and negative signs. The postulated effects are shown to be valid for perceptual as well as conjoined perceptual and linguistic cognitions, using schematic drawings of facial expressions and quotations attributed to persons with the expressions. The findings suggest that perceptual and linguistic cognitions share the same semantic systems, although the latter are more specific.


Thinking with restricted language. A personal construct investigation of pre-lingually profoundly deaf apprentices. By means of the deaf manual system of communication, Personal Construct grids were elicited from profoundly deaf apprentices. Contrary to expectation, the grids are not uni-dimensional, and they are as well elaborated as grids with the same supplied elements and constructs elicited from hearing subjects. Implications of the deaf subjects' grids are considered in the light of the relationship between thinking and language explored by Furth.


A 20-year prospective follow-up of childhood hiatal hernia. A long-term prospective follow-up of 113 children with vomiting due to a small hiatal hernia is described. When reviewed by the same clinical and radiological observers 20 or more years later, over 90% of unoperated non-stricture patients were asymptomatic whereas only 44% of the stricture and/or surgically treated group were without symptoms. Half or possibly more of the asymptomatic patients still had a hernia and it is possible that these may suffer a recurrence of symptoms later in adult life. The loculus of thoracic stomach tended to retain the same shape; there was a slightly better prognosis for the locular type of hernia compared with the tubular type. Complicating oesophageal strictures can decrease or disappear without surgery other than dilatation; the results of treatment by radical surgery were disappointing. There is need for an even more prolonged follow-up into later adult life.


Intracranial extravasation of contrast medium during carotid angiography. The results of 5184 carotid angiograms were reviewed and five cases of intracranial extravasation of contrast medium were found. In two cases an aneurysm ruptured during angiography and extravasation into the subarachnoid space was seen. In one case medium leaked from an angiomatous malformation into the subdural space. The fourth case was a patient who had suffered closed head trauma. Here extravasation was seen deep within the brain. The fifth case illustrates two forms which extravasation from meningeal arteries may take. The incidence and prognostic significance of this finding in different conditions are discussed.


The radiology of nasal injuries: problems of interpretation and clinical relevance. Films of 50 normal patients and 50 dry skulls were examined to detect lines which might stimulate a nasal fracture. These were visible on the occipito-mental view but on the lateral view any line which reaches the anterior cortex must be regarded as a fracture. The results of an analysis of 100 patients with trauma to the nasal bone are also presented. It is concluded that radiography of the nasal bone is an unnecessary examination unless requested by the E.N.T. surgeon, and this will in any case occur infrequently.


Thrombogenicity of arterial catheters and guidewires. Thrombus formation on the surface of a variety of arterial catheters and guidewires has been studies in dogs. Heparin-bonding of catheters and guidewires greatly reduced surface thrombus deposition even in the most thrombogenic material tested, and under the conditions of these experiements heparin-bonding was more effective than systemic heparinization.


The combined use of iron 52 and its contaminant iron 55 in studies of the bone marrow. A liquid scintillation counting technique has been used to measure 55Fe incorporation into red blood cells with counting efficiencies of the order of 10% for 0.1 ml whole blood. Measurements have been carried out over a period of two weeks following the intravenous administration of the shortlived cyclotron produced 52Fe which contains 55Fe (half-life 2.6 years) as contaminant. 52Fe, with its short half-life of 8.2 hours and suitable gamma-ray emissions, is the isotope of choice for bone marrow imaging and short term ferrokinetic studies such as plasma clearance and early organ uptake of iron. However, long term iron utilization cannot be measured with this radionuclide alone. By exploiting the presence of 55Fe this limitation has now been overcome.


Fast neutron effects on multicell spheroids. Accumulation and repair of neutron damage was measured using multicell spheroids irradiated with neutrons at the Hammersmith Cyclotron. A relative biological effectiveness (RBE) of about 1.5 (ratio of Do values) was found for aerobic single cells or small spheroids. Small spheroids accumulated more sublethal neutron damage than single cells, as indicated by a wider shoulder on the survival curve. However, neither single cells nor spheriods repaired sublethal damage when two doses of neutrons were separated by six hours or less. A "therapeutic gain" was observed for larger spheroids containing hypoxic cells, due to an increased RBE of fast neutrons for hypoxic cells amounting to about a factor of two.


When and how should we teach the basic concepts of radiation beam dosage? The difficulty that many trainees, including those medically qualified, have in achieving a sound working grasp of certain basic principles of radiation beam dosage is often underestimated. Since any failure of understanding may seriously impair the efficiency of the team treating the patient, the discussion of these problems (and especially the monitoring of the results of such discussion by means of oral and written tests) deserves a high priority. Contrary to traditional practice, there would seem to be no good reason why teaching of radiation beam dosage, and the effect on dose-rate of changes in the treatment distance or in the amount of scattered radiation, should not begin in the very first week of training and be immediately integrated with discussion of the dose-rate information available at every radiotherapy unit when the patient is treated. A preliminary course of physics lectures does not usually make the understanding of these principles any easier and can be done either concurrently or later. For many radiotherapy trainees and for many doctors in other fields, comparison with drug dosage and with the brightness and scatter of ordinary light beams, avoiding technical terms so far as possible, may achieve a better initial understanding of basic principles than is achieved by mathematical equations and theoretical physics.


Pseudoachondroplasia, a report of 13 cases. Pseudoachondroplasia is a heterogeneous inherited skeletal dysplasia in which dwarfism is a major feature. Affected individuals have a normal craniofacial appearance and the skeletal malformations do not become apparent until early childhood. Radiographic changes observed in 13 affected individuals include shortening of tubular bones, flaring of metaphyses, variable epiphyseal maldevelopment and some degree of vertebral end-plate malformation. Diagnostic precision is essential for effective management and genetic counselling.


The use of abdominal contrast tomography in liver disease. The value of a high dose infusion technique using urographic contrast medium followed by tomography was studied in 44 patients with liver disease. The method was found to be of value in showing cysts, abscesses and cystic disease of the liver. Large tumours, primary and secondary, can also be demonstrated. Normal bile ducts are not visible, but become apparent when they are dilated.


The mammographic demonstration of malignant spicules. A specimen of breast tissue containing a carcinoma with multiple spiculations was used as a test object and examined by a range of mammographic techniques. The images were compared with a photograph of the cleared specimen. A quantitative method of evaluating the performance of each technique is described and used to compare these images. Xeroradiography clearly excelled other imaging methods.


Uterine prolapse and urinary tract obstruction. Five patients are described with hydronephrosis and hydroureter associated with advanced uterine prolapse. Various hypotheses have been advanced in the literature to account for this neglected syndrome. A trial was carried out to assess whether all patients presenting with uterine prolapse should be screened to exclude urinary tract obstruction. Thirty-seven patients on the waiting list for surgery for various degrees of prolapse had an IVU and a blood urea estimation. No cases of ureteric obstruction were found, presumably because the lesser grades of prolapse predominated. It is, therefore, considered that all patients with prolapse do not need intravenous urography, which should be restricted to women with complete procidentia.


Clinical information from medical images. A comparison of two types of ultrasonic image in the detection of focal intrahepatic lesions. If the uncertainty in the diagnosis is measured before and after viewing a diagnostic image, the change in uncertainty is a measure of the information contributed by that image. The formal basis of information theory has been used to calculate the change in uncertainty. These analytical methods have been applied to assess two types of ultrasonic grey-scale image in the demonstration of possible focal intrahepatic lesions.


Non-linear bone loss in oophorectomized women. Sequential bone loss in 37 women with bilateral oophorectomy was monitored by radiographic morphometry. The changes in mean width of the cortices of the 2nd, 3rd and 4th metacarpals of both hands were determined using a semiautomated computer-controlled morphometer. It was found that a significantly greater rate of decrease of mean cortical width occurred in those women first observed within three years of the artificial menopause than in the other members of the group.


Sublethal damage in cells of the mouse gut after mixed treatment with X rays and fast neutrons. The effect of combining X ray and neutron irradiations on cell survival in the mouse intestine has been investigated. The irradiations from the two beams were given within minutes or at most a few hours of each other when recovery from sublethal damage was not always complete. The results show that cells surviving the first dose of radiation have accumulated the same amount of recoverable sublethal damage regardless of whether that first dose was with X rays or neutrons. The rate at which the sublethal damage is shed is the same after X rays or neutrons. It is reasoned that there is less sparing of damage by fractionation of neutron dose compared with fractionation of X ray dose not because there is less recovery from sublethal damage after neutrons but because there is relatively more lethal damage; the recovery from any sublethal damage is the same as if it were from X rays. If X rays and neutron doses are separated by times long enough to allow the full repair of sublethal injury then the combined effect is simply additive.


Pulmonary function in the early postoperative period. To the author's knowledge, an intensive investigation of pulmonary function during the first 2 postoperative days has not previously been reported. Consequently, in this study the effect of regional surgery on respiratory function, monitored every 4 h during the first 2 postoperative days, was analyzed. Hypoxaemia was a constant finding in all patients undergoing general anaesthesia. The degree and duration of hypoxaemia and spirometry changes were related to the site of surgical incision. Clinical signs of atelectasis were commonly observed during the first postoperative day and occurred after the change in PO2 and spirometry. Atelectasis was more common in patients having upper abdominal surgery. The current investigation reveals that the earliest postoperative change indicative of atelectasis is the fall in PO2; that auscultatory changes do not always occur in the presence of postoperative hypoxaemia; that auscultatory signs are not indicative of the extent of the PO2 fall; and that radiology represents a crude method of assessing postoperative atelectasis.


Postoperative hypoxaemia and oxygen therapy. To observe the duration of hypoxaemia 8 patients were monitored every day for the first 7 days following upper abdominal surgery. Three of these patients who had failed to regain their preoperative PO2 value by the seventh postoperative day were further monitored on alternate days until the fourteenth postoperative day. A further 3 patients were similarly monitored on alternate days for 14 days. In another group of 10 patients blood gases were monitored every 4 h for the first 48 h following major abdominal surgery, during which time the patients were given 35 per cent oxygen for the first 24 h after operation. (All patients in this group had a diminished respiratory reserve preoperatively to a sufficient degree to warrant admission to the intensive therapy unit postoperatively, and these patients were treated with oxygen for 24 h, as is the practice in our unit and in other surgical units.) Oxygen was administered using a Ventimask at 8 l/min (British Medical Journal, 1972). Nine of the 10 patients did not show postoperative hypoxaemia while being treated with 35 per cent oxygen, although the PO2 value attained were lower than expected. On withdrawal of oxygen after 24 h, the PO2 decreased below preoperative levels in all patients. The PO2 of 7 patients in this group decreased below 8 kPa during the second 24 postoperative hours, in 4 of whom the level fell below 6-7 kPa. Some recommendations to improve the respiratory care of the surgical patient are presented.


Crush syndrome: a report of 2 cases and a review of the literature. The crush syndrome was first defined as a clinical entity in 1941. This paper reports 2 patients suffering from the syndrome as a result of being trapped for several hours during the Moorgate tube train disaster. An account of the initial course, management and complications is presented and discussed with reference to the available literature on the subject.


The medical dissolution of phytobezoars using cellulase. Phytobezoars are plant fibre concretions occurring in the stomach as a complication following some types of gastric surgery. Symptoms include distension, pain and vomiting. Ulceration, gastric bleeding and even perforation can occur. If untreated, they result in a significant mortality. Dissolution of the phytobezoar can be achieved without operative intervention. Enzymes and especially cellulase help to break up the mass and it can then be aspirated or allowed to pass on. Five patients with phytobezoars were thus treated and the cellulase method was confirmed to be simple, safe and effective.


Intermittent sigmoid volvulus in the younger age groups. Sigmoid volvulus is a well-recognized clinical entity, occurring more commonly in the male in middle or old age. In younger age groups the diagnosis is therefore often delayed. We report here 11 patients of an average age of 31 years (range 12-57 years), with a preponderance of females (7 : 4), who have presented to us in the past 2 years with intermittent sigmoid volvulus. The average age at onset of initial symptoms was 26 years. All had the diagnosis confirmed radiologically by colonoscopy or at operation. The diagnostic features of the condition are described.


The significance of starch powder contamination in the aetiology of peritoneal adhesions. The presence or absence of starch granulomas on the peritoneal surface or within peritoneal adhesions is reported in 20 patients subjected to a second laparotomy. Evidence is presented to show that starch granuloma formation is common in the early months following operation and that adhesions associated with starch granulomas cause intestinal obstruction. It is suggested that although starch is usually absorbed within 2 years, associated band adhesions may persist. Glove powder contamination of the peritoneal cavity may thus be a common cause of band adhesion obstruction.


Intersphincteric excision of the rectum. Wide excision of the rectum in inflammatory bowel disease is both unnecessary and undesirable as the healthy pelvic floor is damaged and the pelvic nerves put at risk. An operative technique is described which includes dissection of the anal canal and rectum in the intersphincteric plane, i.e. the plane of fusion between the visceral rectum and anal canal and the somatic pelvic musculature, which minimizes these undesirable elements. Fifty-three cases are presented. Perineal wound healing rates are comparable with those of other methods of resection and only 1 of 14 men reported partial sexual dysfunction following this operation.


Results of colectomy for diverticular disease of the colon. A retrospective study of 71 patients who had a colonic resection for diverticular disease at one hospital during a 7-year period was undertaken. Patients were divided into those undergoing surgery for complications of diverticular disease (49) and those in whom abdominal pain and an altered bowel habit were attributed to the presence of diverticular disease in the absence of any detectable complication (22). In both groups major complications occurred after operation. The incidence of complications was greater when surgery was undertaken in stages to effect colonic resection and restoration of intestinal continuity. Symptoms were more often cured or relieved in those patients undergoing surgery for complicated diverticular disease than in those with 'uncomplicated' disease. These poor results may be due to incorrectly attributing symptoms to diverticula which happened to be present.


Acute ischaemic enteritis in Goa.

Acute ischaemic enteritis in Goa. Acute ischaemic enteritis is an uncommon condition which mainly affects young people. It is characterized by ischaemic changes in the small or large bowel which may be reversible in the early stages. The exact aetiology is not known. The condition may be due to toxins produced by either roundworms or Gram-negative bacilli or may be due to a localized allergic reaction. It is possible to make a preoperative diagnosis in most cases from the presence of abdominal pain, bloody diarrhoea and shock. Conservative treatment may be best in early cases but surgery is necessary in those cases where gangrene or perforation has occurred.


Changes in plasma lactate, phosphate and uric acid during postoperative carbohydrate infusion. Eighteen patients undergoing elective abdominal surgery had pre- and postoperative carbohydrate infusion tests with glucose, fructose or sorbitol. All three substrates produced significant hyperlactataemia postoperatively, the elevations of plasma lactate with fructose and sorbitol infusion being significantly greater than with glucose. Plasma uric acid was unchanged but there were moderate falls in plasma phosphate postoperatively. Intravenous nutritional regimens containing fructose and sorbitol may potentiate the development of harmful metabolic acidoses in 'at risk' patients and should always be used cautiously. Glucose is the carbohydrate calorie source of choice.


Recurrent massive haemorrhage from benign hepatic tumours secondary to oral contraceptives. Liver cell adenoma as a cause of spontaneous haemoperitoneum has been noted with increasing frequency since Baum's initial report (Baum et al., 1973). The relationship between the use of oral contraceptives and bleeding from a hepatic tumour makes awareness of this condition mandatory for the physician involved in the differential diagnosis of the acute abdomen. The report presented here is that of a woman who, while taking oral contraceptives, subsequently bled from her liver 3 years after an initial hepatic haemorrhage.


An unexpected complication of a liver biopsy. A case of anaphylactic shock after percutaneous liver biopsy is described. This was due to rupture of a large echinococcal cyst localized in the liver. Diagnosis and treatment with a review of the literature are discussed with emphasis on the complete removal of both the cyst and the surrounding capsule of fibrous liver tissue.


Cervical chordoma: report of a case and the technique of transoral removal. A case of cervical chordoma in a man of 27 years is described. The clinical features were of progressive spinal cord compression. Treatment was by transoral decompression of the second cervical vertebra and postoperative radiotherapy. The result was favourable and remained so at follow-up after 27 months. The relative merits and scope of the various approaches to the upper cervical vertebrae and the role of radiotherapy and chemotherapy are discussed.


Saddlebag hernia.

Saddlebag hernia. Saddlebag hernia occurs most commonly as a small indirect sac in association with an obvious direct inguinal hernia. It may be easily overlooked at operation. Hoguet's manoeuvre is the most satisfactory method of operative treatment of saddlebag hernia. It is suggested that an overlooked indirect sac associated with a direct inguinal hernia is a common cause of recurrent inguinal hernia.


Hypothyroidism following partial thyroidectomy for thyrotoxicosis and its relationship to thyroid remnant size. One hundred and twenty-two patients were reviewed 1-7 years after partial thyroidectomy for thyrotoxicosis by two surgeons who had left thyroid remnants of different size. There was no significant difference in the prevalence of hypothyroidism or in the serum levels of thyroxine, tri-iodothyronine or thyroid-stimulating hormone between the two groups of patients. The overall prevalence of hypothyroidism was 16 per cent.


Pulse wave from transit ratios in the assessment of peripheral vascular disease. This paper presents a ratio of the pulse wave form transit times in the proximal and distal arterial tree, produced by a simple, non-invasive, repeatable and reproducible technique. It has been shown to be highly significant in separating normal from disease states and the proximal from the distal lesion. It has been shown to be independent of the effects of age. In the clinical situation the ratio is of value in the initial assessment of the patient (by separating ischaemic from now-ischaemic limb pain); in elucidation of significant occult proximal lesions in the presence of distal disease; in indicating the type of angiography required (femoral arteriography rather than translumbar aortography in suitable subjects); in following the progress of patients in operative and conservative management régimes; and in the long term follow-up of the natural history of obliterative vascular disease.


Changing pattern of alcoholic liver disease in Great Britain: relation to sex and signs of autoimmunity. A survey of 293 patients with alcoholic liver disease showed that women, particularly those aged under 45, had a significantly higher incidence of alcoholic hepatitis, with or without superimposed cirrhosis, than men. The long-term prognosis for both women who continued to drink and those who stopped drinking was worse than that for men. Autoantibodies were more common in women, which suggested that immune mechanisms may play a part in the pathogenesis and progression of alcoholic liver disease in women.


Study of fatal bone marrow depression with special reference to phenylbutazone and oxyphenbutazone. The histories of 269 patients whose death certificates did not mention a drug as the cause of aplastic anaemia or agranulocytosis were investigated. Eighty-three deaths were probably caused by drugs, the most common cause of aplastic anaemia being treatment with phenylbutazone (28 deaths) and oxyphenbutazone (11 deaths). Thirteen out of 17 deaths from agranulocytosis were attributed to co-trimoxazole treatment. A separate survey of general practitioners' prescriptions enabled the mortality to be estimated. With the addition of one death due to oxyphenbutazone and four deaths due to phenylbutazone that were reported independently to the committee, the mortality from oxyphenbutazone was 3-8 per 100 000 and from phenylbutazone 2-2 per 100 000. With phenylbutazone the rates varied from under 1 death per 100 000 for men aged under 65 years to 6 per 100 000 for women aged 65 and over. Small numbers precluded estimates for oxyphenbutazone in these subgroups, although a similar trend was suggested. No particular indication for treatment seems to carry a higher risk, the main concern being the use of these two drugs in elderly patients.


Haemodynamic effects of beta-adrenergic blockade in hyperthyroid patients with and without heart failure. Haemodynamic studies were performed in 10 patients with uncomplicated thyrotoxicosis and seven with thyrotoxic cardiac failure. The cardiac output of those with uncomplicated hyperthyroidism was higher than normal at rest. After 2 mg of intravenous propranolol there was a 13% fall but the level was still higher than normal. In patients with thyrotoxic cardiac failure the resting cardiac output was normal, but it fell after propranolol by 30% to subnormal levels. In both groups there was an increase in right heart pressures and fall in the rate of increase in arterial pressure, which indicated a decrease in myocardial contractility. These results indicate that increased autonomic activity is a compensatory phenomenon in hyperthyroid heart failure and that its abolition by beta-blocking drugs has a deleterious effect on cardiac function. They are therefore contraindicated in patients with thyrotoxic heart failure.


Influence of dosage and dietary sodium on the first-dose effects of prazosin. The effects of the first dose of prazosin were assessed in hypertensive patients on different sodium intakes. Patients received 250, 100, or 30 mmol sodium per 24 hours for a week before taking 2 mg or 0-5 mg prazosin. The acute effects of prazosin on blood pressure and pulse rate were milder with a high sodium intake. On the 100-mmol intake symptomatic postural hypotension occurred in five out of seven patients given 2 mg prazosin and in two out of four given a 0-5-mg dose, whereas those taking 2 mg or 0-5 mg and a 250-mmol sodium intake experienced no postural symptoms. These findings indicate that particular care should be taken in starting prazosin treatment in sodium-depleted patients.


Erythema nodosum associated with pregnancy and oral contraceptives. Erythema nodosum recurred in a woman during each of her four pregnancies and every time she was started on oral contraceptives. The lesions always disappeared in the fifth month of gestation or when contraceptives were withdrawn. Erythema nodosum is mediated by immune mechanisms, and both pregnancy and oral contraceptive use can interfere with the immune system. The concentrations of oestrogen and progesterone or the ratio between them may be critical to the development of erythema nodosum. The observation that the lesions spontaneously resolved in the fifth month of pregnancy supports this hypothesis.


Use of medicines in general practice.

Use of medicines in general practice. The prescriptions issued by general practitioners to a population of about 40 000 people were studied. During one year 53-8% of all males and 65-7% of all females had at least one drug dispensed. The proportion receiving medicines increased with age and was higher among females at all ages. Psychotropic drugs were prescribed more often than any other group and accounted for almost one-fifth of all prescriptions. Altogether 9-7% of the males in the population and 21-0% of the females received at least one psychotropic drug during the year. Among women aged 45-59 33-0% received a psychotropic drug, and 11-2% were given an antidepressant. Althoug antimicrobial drugs were prescribed less often than psychotropic drugs, they were given to more people.


May mothers given warfarin breast-feed their infants? Warfarin was measured with a sensitive and specific method in the plasma and breast milk of 13 mothers. Less than 0-08 micronmol warfarin per litre (25 ng/ml) of breast milk was found in each instance. Seven of the mothers were breast-feeding their infants, in none of whom was warfarin detected in the plasma; furthermore, in three the British corrected ratio of the plasma was appreciably less than that of the mother and was within the expected range. We conclude that nursing mothers given warfarin may safely breast-feed their infants.


Diagnosing familial hypercholesterolaemia in childhood by measuring serum cholesterol. The serum cholesterol concentrations of 134 children aged 1-16 years who had at least one first-degree relative with presumed familial hypercholesterolaemia showed a bimodal distribution, and, using the maximum likelihood technique, two overlapping curves could be fitted. The mean value of the affected children (heterozygotes) was 8-9 mmol/l and that of the unaffected 4-9 mmol/l. The two curves intersected at 6-77 mmol/l, and at this point 5% of the unaffected children had values over 6-77 mmol/l and 3-5% of the heterozygotes had values under 6-77 mmol/l. If this cholesterol concentration is used as a cut-off point 4-25% of cases would be misdiagnosed.


Fluctuations of serum and bile lipid concentrations during the menstrual cycle. We measured fasting serum and bile lipid concentrations at three intervals during the normal menstrual cycles of 11 healthy women not taking oral contraceptives. In nine of them cholesterol saturation of bile, and therefore presumably the risk of developing gall stones, was higher nine days after midcycle than at the end of menstruation. This change in bile cholesterol saturation was preceded by a significant fall in serum lipid concentrations: during the nine days after mid-cycle serum triglyceride and cholesterol concentrations fell in nine and eight of the 11 women respectively. Changes in the composition of serum and biliary lipids during the menstrual cycle are presumably due to a direct effect of sex hormones on the liver.


Trends in hospital necropsy rates: Scotland 1961-74. Examination of mortality statistic for Scottish hospitals showed that from 1961 to 1974 necropsy rates fell by almost 0-6% a year; by 1974, the rate over the whole country was 23% of hospital deaths. The fall resulted from a reduction in the number of necropsies and a coincident rise in the number of number of deaths in hospital. The necropsy rate fell with increasing age, was rather lower for women than men, and was lower for some diseases than others. There were considerable inaccuracies in the figures from which these trands were drawn, and these were in turn due to inaccurate recording of clinical and necropsy data. Examination of necropsy returns from the Scottish teaching hospital departments showed that, while a similar fall in necropsy rates was seen in some, there was no consistent pattern.


High mortality in obese women diabetics with acute myocardial infarction. The factors associated with mortality in 89 diabetics and 793 non-diabetics with acute myocardial infarction who were initially admitted to a coronary care unit were analysed retrospectively. During their stay in hospital diabetics had twice the mortality of non-diabetics. The higher mortality among diabetics was largely accounted for by obese women, who had a hospital mortality of 43%. There was an increased incidence of congestive heart failure in such patients. A therapeutic trial should be performed in such patients to assess whether insulin has an effect on infarct size.


Persistent measles infection in malnourished children. Thirty malnourished and 25 well-nourished children were studied six to 31 days after the onset of a measles rash. Evidence of the virus was found in 40% of the malnourished children but in none of the well-nourished controls. Giant cells were found in the nasal secretions of five out of 17 malnourished children and measles antigen was detected in the lymphocytes of eight out of 28. The malnourished children showed depressed cell-mediated immunity to measles and candida antigens and a low response to meningococcal vaccine. Fifteen died from intercurrent infections. Malnutrition was thought to have depressed the immune response in these children, resulting in a severe and prolonged attack of measles. This, in turn, led to further damage to the immune system and more severe malnutrition. Thus these children were made susceptible to intercurrent infection.


The natural history of chronic airflow obstruction. A prospective epidemiological study of the early stages of the development of chronic obstructive pulmonary disease was performed on London working men. The findings showed that forced expiratory volume in one second (FEV1) falls gradually over a lifetime, but in most non-smokers and many smokers clinically significant airflow obstruction never develops. In susceptible people, however, smoking causes irreversible obstructive changes. If a susceptible smoker stops smoking he will not recover his lung function, but the average further rates of loss of FEV1 will revert to normal. Therefore, severe or fatal obstructive lung disease could be prevented by screening smokers' lung function in early middle age if those with reduced function could be induced to stop smoking. Infective processes and chronic mucus hypersecretion do not cause chronic airflow obstruction to progress more rapidly. There are thus two largely unrelated disease processes, chronic airflow obstruction and the hypersecretory disorder (including infective processes).


Prognosis of Henoch-Schönlein nephritis in children. All the survivors of a series of 88 patients with Henoch-Schönlein nephritis were examined after a follow-up of six and a half to 21 years (mean 9-9). Sixty-one patients had no demonstrable abnormality; six had minor urinary abnormalities; five had hypertension without urinary abnormally or renal dysfunction; four had heavy proteinuria; eight were in chronic renal failure, three of whom were on regular dialysis; and four patients had died within 25 months of onset. Neither corticosteroids nor immunosuppressive drugs alone or in combination appeared to influence the outcome. A clinical presentation with a combination of acute nephritis and a nephrotic syndrome and a high proportion of crescents in renal biopsy specimens was associated with a poor outcome. Neither the clinical presentation nor the renal morphology were, however, precise determinants of outcome. Outcome was not related to age, associated streptococcal infection, or recurrences of the rash. The clinical state two years after presentation was compared with the state six and a half years or more after presentation in 76 patients. The clinical state had changed in 32 patients, in 17 of whom it had deteriorated. It was not possible to identify with any certainty the patients who would deteriorate (or improve). Patients who have had Henoch-Schönlein nephritis should be followed up for at least five years.


Mycoplasma pneumoniae infection and arthritis in man. Seven patients developed arthritis after Mycoplasma pneumoniae infection. Their joint symptoms persisted for up to one year. One patient developed an articular erosion and in another rheumatoid factor was present in serum transiently. Mycoplasma infection often causes ill-defined arthralgias and myalgias, but the migratory polyarthropathy of middle-sized joints that occurred in these patients is much less common. The prognosis seems to be good.


Spontaneous premature birth in twin pregnancy. Factors associated with spontaneous premature birth were investigated in 459 consecutive twin deliveries at this hospital. Low maternal age, low parity, and zygosity were significantly related to the incidence of this complication. The number of previous abortions, sex combinations and related birth order, and mode of presentation of the first twin were not related to the incidence of spontaneous premature delivery. We conclude that apart from low maternal age and low parity there are no obvious factors that would permit early identification of twin pregnancies at risk from spontaneous premature birth.


A haematuria diagnostic service.

A haematuria diagnostic service. In a haematuria diagnostic service, covering experience with 95 patients, 12 new cases of cancer of the bladder, one of cancer of the kidney, and one of cancer of the penis were identified--all at an early stage. Patients presenting with haematuria were investigated rapidly without disruption of the routine work of the urological unit. Patients who identified the symptoms and sought advice early were given a definite diagnosis quickly, and treatment for any malignant disease was started early. The delay that undoubtedly endangers patients' lives has been considerably reduced by this service.


Effects of solid foods on growth of bottle-fed infants in first three months of life. We studied 821 infants who were bottle-fed from birth to determine whether non-milk solids begun within the first 3 monts of life affect early growth. The infants were seen seven to 10 days and three months after birth. They were divided into three groups-those who had started solids before 6 weeks of age (657 infants); those who had started solids between the ages of 6 weeks and 3 months (124 infants); and those given cow's milk formulae alone during the first three months (40 infants). The infants were weighed and measured seven to 10 days after birth and at three months. Mean weekly rates of weight and length gain over the 3 months were calculated and did not differ significantly between the three groups. As no record was made of quantities of food taken we cannot explain the failure of solid foods to affect growth. Studies of how young infants utilise these foods are needed.


Campylobacter enteritis: a "new" disease. By selective culture campylobacters (C jejuni and C coli) were isolated from the faeces of 57 (7-1%) out of 803 unselected patients with diarrhoea; none were isolated from 194 people who had not got diarrhoea. Specific agglutinins were found in the sera of 31 out of 38 patients with campylobacter enteritis and 10 of them had a rising titre. Half the patients were aged 15 to 44 years, but the incidence was highest in young children. All the patients with campylobacters had a distinctive clinical illness with severe abdominal pain. Campylobacters are a relatively unrecognised cause of acute enteritis, but these findings suggest that they may be a common cause. Spread of infection was observed within 12 out of 29 households, and in these cases children were usually implicated. Several patients were apparently infected from chickens, both live and dressed, and poultry may be the primary source of the organism. In two cases dogs with diarrhoea were found to be infected with strains indistinguishable from their human contacts. Ten patients acquired their infections while travelling abroad.


Geriatric medicine in Hull: a comprehensive service. A partially age-related admission policy coupled with a "single-ward" scheme for treatment and rehabilitation was introduced by the Hull geriatric department in 1970. With rare exceptions, elderly patients needing hospital care have been admitted directly to the geriatric unit, and the proportion of the retired population admitted by the general physicians has been greatly reduced. The proportion of inpatients needing continuing care has been reduced to less than 20%, the mean length of inpatient stay has fallen to under 30 days, and separate long-stay wards are no longer needed. More than 91% of patients are admitted without preceding domiciliary assessment, and only 5-6% of admissions are transferred from other units within the area.


Clinitest ingestion.

Clinitest ingestion. Eight patients who had ingested Clinitest tablets were seen in one hospital over four years. Nineteen reported cases were also reviewed. Clinitest ingestion seems to be more common than was thought. Gastric lesions are common, though the frequency of serious sequelae has been overestimated in reports. Some features of Clinitest ingestion differ from those produced by ingesting other alkalis. These include a higher frequency of adult and accidental ingestion, a lower prevalence of pharyngeal lesions, and oesophageal strictures that tend to be more proximal, shorter, and earlier in onset. The incidence of accidental ingestion by adults would probably be reduced if other methods of testing urine were used in patients who are likely to misunderstand instructions or mistake the tablets for others and if Clinitest tablets could be made in a distinctive size and shape.


Comparison of mortality of patients with heart attacks admitted to a coronary care unit and an ordinary medical ward. During a 32-month period 2047 patients suspected of having heart attacks were admitted to hospital and were followed up prospectively. Out of 1480 eventually found to have definite or probable myocardial infarction, 483 had initially been admitted to an ordinary medical ward because of the shortage of coronary care unit (CCU) beds. More patients aged over 65 had been admitted to a ward than to a CCU, and more patients aged 65 or less had been admitted initially to a CCU. Within each age group, however, patients admitted initially to a CCU were clinically similar to those admitted initially to a ward. There was a higher proportion of successful resuscitations among patients admitted to a CCU, but there was no significant difference in mortality in either age group between patients admitted to a CCU and a ward.


Portable oxygen and exercise tolerance in patients with chronic hypoxic cor pulmonale. Breathing 30% oxygen during exercise alleviated arterial hypoxaemia and reduced minute ventilation in patients with severe chronic bronchitis. A similar level of oxygen (2 or 4 litres of oxygen/minute) from nasal prongs also increased their exercise tolerance, as assessed by the distance that they could walk on the level in 12 minutes. Nevertheless, a single-blind controlled study showed that the effort of carrying their portable supply of liquid oxygen, in the Union Carbide Oxygen Walker, abolished this gain in exercise tolerance. The improvement in walking distance was restored when oxygen on exercise was provided by wheeling the oxygen walker on a light-weight shopping trolley.


Visual complications of mitral leaflet prolapse. Four young women and six older men with mitral leaflet prolapse presented with visual disturbances consistent with embolism in the ophthalmic or posterior cerebral circulation. Cardiac arrhythmias were common, but these are rarely associated with focal ischaemia. The evidence that mitral leaflet prolapse caused the embolism in these patients is suggestive but not conclusive. Further studies are needed. All patients with acute cerebral or ocular ischaemia should undergo through cardiovascular assessment, which should include routine echocardiography.


Television epilepsy and pattern sensitivity. Properly functioning domestic television sets may induce seizures in epileptic patients (TV epilepsy). We investigated the effects of different types of visual stimuli on paroxysmal electroencephalographic (EEG) activity in 32 patients known to be sensitive to intermittent photic stimulation (stroboscopic light). We monitored sensitivity to patterns of horizontal and vertical lines, both stationary and vibrated (pattern sensitivity), and to normal broadcasts on a domestic, black and white (405- or 625-line) TV receiver (TV sensitivity). Twenty-three of the 32 patients were sensitive to pattern. Twenty-two were sensitive to vibrated patterns, and 11 to static patterns (P less than 0-01), All patients sensitive to pattern were also sensitive to TV; The association between sensitivity to pattern and to TV was significant. Clinical history of TV epilepsy (16 out of 32 patients) and laboratory evidence of pattern or TV sensitivity were not significantly associated. The high incidence of pattern sensitivity among flicker-sensitive patients and its association with TV sensitivity suggests that linear patterns produced by the raster of a black and white set as it scans, or "line-jitter" produced by the raster in areas of low TV-signal strength may contribute to the epileptogenic effect of TV.


Association between gas cooking and respiratory disease in children. A four-year longitudinal study of the prevalence of respiratory symptoms and disease in schoolchildren and related environmental and socio-economic factors is in progress. We report results for the first year of this study (1973). A total of 5758 children aged 6 to 11 years from 28 randomly selected areas of England and Scotland were examined. In an analysis of the effects on health of possible indoor pollutants, boys and girls from homes in which gas was used for cooking were found to have more cough, "colds going to the chest", and bronchitis than children from homes where electricity was used. The girls also had more wheeze if their families used gas for cooking. This "cooking effect" appeared to be independent of the effects of age, social class, latitude, population density, family size, overcrowding, outdoor levels of smoke and sulphur dioxide and types of fuel used for heating. It was concluded that elevated levels of oxides of nitrogen arising from the combustion of gas might be the cause of the increased respiratory illness.


Dextrostix-Eyetone in the insulin hypoglycaemia test. The Ames Dextrostix-Eyetone system was evaluated for monitoring the blood glucose concentration during insulin-induced hypoglycaemia. The results agreed well with laboratory values for plasma glucose, obtained by an orthotoluidine method, and the method was practicable as a bedside technique. In two cases quick results obtained with the Eyetone enabled the insulin tolerance test to be interrupted to prevent severe hypoglycaemia before the clinical indications were obvious. The extra time and effort required were minimal, and its value seems to far outweigh the disadvantage of the extra work entailed. Nevertheless, care in using the system was important, and the operator must familiarise himself with the system before the most reliable results can be obtained.


Hepatic drug acetylation and oxidation: effects of aging in man. The half lives of acetanilide and isoniazid ("model" substrates for oxidation and acetylation respectively) were measured in populations of young (aged 20-35 years) and elderly (aged over 65 years) people. Whereas acetanilide half lives were significantly longer in the elderly, isoniazid half lives were distributed similarly in both populations. The results suggest that liver function does not decline uniformly with age and that heterozygotes for acetylation do not possess survival advantages during their middle years of life.


Circulating immune complexes after repeated halothane anaesthesia. A patient developed hepatitis after receiving three halothane anaesthetics in 22 days. Twenty-four hours after the onset of jaundice she developed an acute serum sickness syndrome with polyarthralgia, proteinuria, and transient impairment of renal function. Serum concentrations of complement components C1q, C4, and C3 were substantially reduced, and immune complexes capable of activating the complement system via the classical pathway were present in  the serum and synovial fluid. A metabolite of halothane was associated with these complexes. Fourteen months after exposure to halothane her lymphocytes were stimulated in vitro by this metabolite. The conditions under which stimulation occurred were unusual--namely, a 7S fraction of the serum, presumably IgG, was necessary. Our results provide strong evidence that halothane may be immunogenic and that its immunogenicity is dependent on the non-covalent binding of one of its metabolites to plasma proteins.


Cryoglobulinaemia in Henoch-Schönlein purpura. Sera from patients with Henoch-Schönlein purpura were examined for cryoglobulinaemia. Thirty patients had acute Henoch-Schönlein purpura, with or without renal diseas; 14 had chronic nephritis after a previous episode of purpura; and 17 were well, without urinary abnormalities, after recovering from Henoch-Schönlen purpura. Raised concentrations of cryoglobulins were present in 14 (47%) of those with acute purpura, nine (64%) of those with chronic nephritis, but none of those who had recovered completely from Henoch-Schönlein purpura. This suggests that acute Henoch-Schönlein purpura and the chronic nephritis that sometimes follows it have an immune-complex pathogenesis. IgA and properdin were found in several cryoglobulins, which suggested that complement had been activated via the alternative pathway, but isolated cryoglobulins capable of splitting C3 in vitro did so via the classical pathway.


Disappearance of vesicoureteric reflux during long-term prophylaxis of urinary tract infection in children. Seventy-five children aged 3 weeks to 12 years and found on investigation of symptomatic urinary infection to have vesicoureteric reflux were managed conservatively with continuous low-dose prophylaxis. Serial cystographic and renal growth studies were performed during seven to 15 years' follow-up. Reflux disappeared spontaneously in 53 children (71%) and from 79% of the affected ureters. This occurred at any age and not only in infancy or at puberty. The initial severity or reflux was the most important factor affecting the outcome. Reflux disappeared from 85% of ureters of normal calibre but from only 41% of dilated ureters. Gross reflux associated with existing severe renal scarring was least likely to disappear. Nevertheless, reflux stopped in 12 of the 19 initially scarred renal units (63%). Reflux was as likely to disappear in children who had a recurrence of urinary infection as in those who had no further infection. Renal growth appeared to be normal in 93% of kidneys and fresh or extending scarring was seen in only two children. Management programmes for children with vesicoureteric reflux should take into account the self-limiting nature of three-quarters of the reflux found on investigating uncomplicated urinary tract infection.


Release of copper from copper-bearing intrauterine contraceptive devices. We measured the rate of release from copper-bearing intrauterine contraceptive devices (IUDs) with varying copper surface areas. Over 135 days of observation the release rate decreased exponentially. This decrease in the release rate was associated with the deposition of a protein layer on the surface of the metal. The bioavailability of copper on IUDs was not related to the volume of copper remaining on the device. Consequently any increase in the copper surface area of an IUD is unlikely to affect the duration of its copper-dependent contraceptive action.


Acetylator phenotype in diabetic neuropathy. The proportions of slow and fast acetylators in a group of diabetics with symptomatic peripheral neuropathy were compared with those in a group of diabetics who had had the disease for at least 10 years without developing neuropathy. There was a significantly higher proportion of fast acetylators in the group of diabetics without neuropathy than in those with neuropathy or in the normal population. Hence genetic factors separate from the diabetic diathesis may determine the development of neuropathy in any particular diabetic.


Occupational scabies.

Occupational scabies. A localised epidemic of scabies lasting nearly a year occurred among crews on river pleasure craft. There was a sharp contrast between the paucity of scabietic lesions, especially burrows, and an unusually high infectivity. Scarcely a crew member was free from itching, yet individually diagnosis proved extremely difficult.


Why 103 women asked for reversal of sterilisation. Between 1975 and 1976 103 women requesting sterilisation reversal were interviewed at Hammersmith Hospital. Their average age at sterilisation was 26-7 years; 65 (63-1%) had been sterilised immediately after pregnancy, and many patients had previously used contraception inadequately when they were sterilised. When they had been sterilised 78 (75-7%) patients were unhappily married and remarriage was the chief reason for the request for reversal. Sexual dissatisfaction after sterilisation was common, but there was no obvious increase in menstrual disturbance. Thirty-nine (37-8%) patients had been sterilised by irreversible methods, and in only half the cases sterilised by tubal ligation were conditions technically suitable for reversal surgery. It therefore seems unwise to sterilise women under 30 particularly immediately after pregnancy or if their marriage is in jeopardy.


Neonatal conjunctivitis caused by Neisseria gonorrhoeae and Chlamydia trachomatis. In a selected group of 103 babies referred with neonatal conjunctivitis Neisseria gonorrhoeae was isolated from 11 and Chlamydia trachomatis from 33. Concurrent infection was present in three. On toddler sibling developed chlamydial conjunctivitis. After treatment C. trachomatis was re-isolated from six babies during the follow-up period. The discharge started one to three days after delivery in only three babies with gonococcal conjunctivitis and at five to eight days in eight babies. One baby was delivered by caesarean section. N. gonorrhoeae was isolated from four asymptomatic fathers, all of whom had urethritis. The mean onset of discharge in the 33 babies from whom Chlamydia was isolated was 7-1 days. One baby was delivered by caesarean section. Chlamydial conjunctivitis was associated with a high incidence of prematurity and of postpartum infection in the mother. Ten fathers of Chlamydia-positive babies were examined. C. tachomatis was isolated from four, all of whom were asymptomatic but had low-grade urethritis. These findings confirm the pathogenic role of C. trachomatis in the cervix and indicate the importance to the family of an adequate microbiological investigation of neonatal conjunctivitis.


Urethritis due to Chlamydia trachomatis. Ninety-five men suffering from gonococcal urethritis were treated and observed. Forty-nine developed postgonococcal non-specific urethritis (PGU). Seventeen men were demonstrated to be free from PGU after careful observation; these formed a control group. Chlamydia trachomatis was isolated from urethral material from 26 (53%) of the PGU group but from none of the controls. This difference was highly significant (P less than 0-001). It confirms that C. tachomatis is a pathogen in the urethra. The presence of specific IgM antibody to C. trachomatis in serum from some men developing PGU, from whom that organism was isolated, suggests that the infection was recent in those cases. Ureaplasma urealyticum (T strain mycoplasma) was isolated from urethral material taken from 22 (45%) of the 49 men in the PGU group, and from 12 (71%) of the 17 in the control group. Mycoplasma hominis was isolated from 10 (20%) of the 49 men in the PGU group, and from four (24%) of the 17 men in the control group. Thus, no evidence was obtained that mycoplasmas (U. urealyticum, M. hominis) are patogenic in the urethra.


Isolation of Chlamydia trachomatis from throat and rectum of homosexual men. Isolation of Chlamydia trachomatis is reported from homosexual men: from the throat with no abnormal symptoms and from the rectum in two cases of proctitis.


Role of sexual and non-sexual practices in the transmission of hepatitis B. Medical, social, and sexual histories were taken from 198 men attending a department for sexually transmitted diseases. Their blood was tested for hepatitis B surface antigen and its antibody, and also for syphilis and liver function. Infection with hepatitis B virus was found to be common among practising homosexuals and to occur much more frequently in them than in heterosexuals. Hepatitis B appeared to be transmitted sexually rather than by other means, but it was not possible in this study to link its transmission with any particular homosexual practice. However, risk of infection increased considerably with the number of sexual partners and nearly half of those with more than 40 sexual partners had been infected.


Keratopustular variety of framboesiform syphilis: a case report. An unusual form of secondary syphilis is presented, characterised by eruption of keratopustular syphilides which became confluent on the genitals and on other surfaces of the body. Histologically an intensive intraepidermal multilocular pustule formation was followed by equally intense but incomplete keratinisation. Abundant oozing lesions forced the patient to keep the genitals in a plastic bag which led to the formation of an uncommon, giant condylomatous surface covering the scrotum and penis.


Buschke-Löwenstein's tumour presenting with urinary fistula. A case of Buschke-Löwenstein's tumour presenting with urinary fistula is described. The large lesion in the subpreputial sac occluded the preputial opening and infiltrated beneath the skin of the shaft of the penis resulting in a fungating growth encasing the fistulous tract. The lesion responded well to 25% podophyllin, which is reportedly unusual.


Behavioral asymmetries following olfactory tubercle lesions in cats. 13 of 17 cats which received unilateral olfactory tubercle lesions exhibited contralateral sensory inattention and ipsilateral circling and hyperresponsiveness. The possible neural substrates involved in these asymmetries are discussed, including ascending amine systems and ascending and descending connections with the orbital cortex.


Effects of lesions of the optic tectum on the ability of turtles to locate food stimuli. In a previous experiment, it was demonstrated that the removal of portions of the optic tectum in a turtle, Podocnemis unifilis, impaired its ability to perform a horizontal vs. vertical line discrimination task. To further elucidate the nature of this deficit, turtles (P. unifilis) were operantly conditioned to locate a food object at varying positions in an aquarium. Preoperatively, all of the animals approach a food object in a direct manner. Animals with a bilateral lesion of the optic tectum approach the food object in an indirect manner. One animal, with a unilateral lesion approached the food object in both an indirect and a direct manner depending on the position of the object in the visual field.


Individual differences in the sea-finding mechanism of hatchling leatherback turtles. When hatchling leatherback turtles, Dermochelys coriacea, are unilarerally blindfolded, some circle toward their open eyes and some toward their covered eyes. If tests were performed immediately after one eye had been blindfolded, in cases where the turtle circled toward the open eye there was a transient potentiation of circling at the start of the test. In contrast, in cases where the turtle circled toward the covered eye, circling was decreased at the start of the test. Similar transient phenomena occurred when the position of a blindfold was reversed from one eye to another. Following removal of a blindfold, circling toward the previously covered eye was increased. The transient effects in all these tests waned by about 2 min. There was no evidence of transient circling tendencies in turtles that were tested after a unilateral blindfold had been in position for 4 min. The results suggest that ipsilateral and contralateral retinotectal turning systems differ in strength among individual turtles and individual eyes, and that following unilateral blindfolding there is a potentiation only of the ipsilateral turning system associated with stimulation of the still open eye.


Uptake of serotonin by intrinsic neurons of the myenteric plexus grown in organotypic tissue culture. The myenteric plexus contains axons, not found elsewhere in the peripheral nervous system, which are distinguished by a specific, high affinity transport system for serotinin (5-HT). This study was undertaken to determine the location of the cell bodies of origin of these axons. Vagotomy decreased uptake of [3H]5-HT and tritiated norepinephrine ([3H]NE) by the myenteric plexus. However, while examination by histofluorescence revealed the presence of descending vagal adrenergic fibers, no evidence was found for the presence or accumulation of 5-HT above a vagal ligature. Vagus nerves thus contain adrenergic but not serotonergic axons. The gut was also denervated of all extrinsic axons by growth of intestinal explants in organotypic tissue culture for 3 weeks. Uptake of [3H]5-HT persisted while uptake of [3H]NE was lost. Light and quantitative electron microscopic radioautography revealed that, as in intact gut, the elements of the cultures responsible for uptake of [3H]5-HT were axons distinguished by varicosities containing large dense cored vesicles. In conclusion, these experiments establish that the mammalian gut contains intrinsic neurons which selectively take up 5-HT. The capacity of these neurons for 5-HT uptake may be influenced by the vagus nerves.


Stable long-term recordings from cat peripheral nerves. A procedure has been developed for the stable long-term recording of nerve signals in unanesthetized mammals, which should have wide application in basic research on the nervous system and also in clinical areas such as the derivation of control signals for powered prostheses. Methods are fully described for constructing devices consisting of (1) Silastic nerve cuffs containing three or more electrodes, (2) coiled leads insulated with Silastic which extend from the cuffs to an integrated circuit socket, (3) a vitreous carbon transcutaneous connector which surrounds the integrated circuit socket and makes a good interface with the skin. Neural activity has been recorded from mammalian nerves for many months during normal behaviour. The peak-to-peak amplitude and latency of the recorded compound action potentials remain stable and may continue at a constant level more or less indefinitely. A tripolar recording configuration between a central lead and the two end leads, which are connected together, permits good rejection of EMG signals from surrounding muscles. The amplitude of single unit potentials increases as the square of the conduction velocity of the nerve fibre. Thus, the largest nerve fibres will dominate the signals recorded during behaviour. The reasons for premature termination of a few experiments are given together with methods for overcoming these problems. For example, platinum-iridium electrodes remain relatively stable, whereas silver wires tend to fracture after being in an animal for several months. This and other relationships are discussed which permit an optimal design of nerve cuffs for a given recording situation.


Corticofugal cells responding antidromically to stimulation of the cuneate or gracile nuclei of the cat. Neurones have been identified and precisely located in the Sm 1 and S II cortex of the cat, which responded antidromically to stimulating the contralateral gracile or cuneate nucleus. They were much more numerous in Sm 1, with corticogracile cells medial and corticocuneate cells lateral, many lying buried in the roof of the cruciate or the coronal sulcus. Their position corresponded with cutaneous inputs to the cortex from hind- or fore-parts of the body respectively. Corticogracile cells lay mainly in area 3a with some extension towards area 4. Corticocuneate cells were also mainly in 3a but showed more spread into adjacent rostral and caudal areas. Although some cortical cells project both to these nuclei and to the spinal cord, none were found in the sample tested. The mean latency of antidromic response was much longer (6.9 msec, n = 29) for corticogracile than for corticocuneate cells (3.7 msec, n = 17), the former having a prominent group of slower fibres. The significance of this disparity is discussed in relation to other efferent projections from this region of cortex and a possible relation to the timing of feedback from moving limbs is proposed. The probable complexity of cortical control over these nuclei is emphasized.


Further characteristics of hippocampal CA1 cells in vitro. The effect of intracellular current injection on synaptic potentials and spike initiation were studied in hippocampal CA1 pyramidal cells in the in vitro slice preparation. Measures of cell charging time constant, resistance, and rheobase level were similar to those reported by other investigators working with intact preparations. Studies of spike initiation induced by injection of depolarizing ramp currents gave little evidence for a threshold accommodation in Ca1 cells. Small amplitude fast-rising spike potentials occurred spontaneously and in association with synaptic excitation of neurons. It is argued that these potentials reflect active spike generation in the dendrites.


The cerebellar control of the pupillary light reflex in the cat. The effect of cerebellar lesions upon the pupillary light reflex was examined in anesthetized cats. The pupillary response elicited by a step and sinusoidally modulated light stimulus was used. In acute cerebellectomized cats, the high frequency cutoff of the frequency response of the pupillary reflex was moved to a lower level after cerebellar lesions. Selective lesions were made in the deep cerebellar nuclei and the frequency responses of the pupillary reflex were compared. The fastigial lesions produced the most prominent change in the frequency responses. Electrical stimulation of the deep cerebellar nuclei, especially the fastigial nuclei, induced pupillary dilatation. Thus the cerebellum appears to participate in the control of the pupillary light reflex by improving the frequency responses of the pupil so that it can follow changing light stimuli better, and this control is exerted via the bilateral fastigial nuclei.


Neurotrophic effects on the electrical properties of cultured muscle produced by conditioned medium from spinal cord explants. The passive electrical properties of cultured chick skeletal muscle are significantly altered when the muscle is co-cultured with spinal cord explants. A reduced transverse membrane resistance appears to be responsible for the smaller values of input resistance, space constant, and time constant observed in co-cultures relative to those observed in pure muscle cultures. In this report, we show that neuromuscular junctions are not required in order to observe this neurotrophic effect because medium from spinal cord explant cultures is capable of producing the same reduction in transverse membrane resistance as the co-culturing of spinal cord explants with muscle. Control medium from liver explant cultures has no effect on muscle passive electrical properties. These results indicate that a trophic substance which is capable of regulating the electrical properties of excitable cells is released into the culture medium by spinal cord explants.


Release of [3H]acetylcholine from rat hippocampal slices: effect of septal lesion and of graded concentrations of muscarnic agonists and antagonists. To establish the existence and sensitivity of presynaptic muscarinic receptors on central cholinergic neurons, the electrically evoked release of [3H]ACh from hippocampal slices was measured after medial septal lesion or in the presence of graded concentrations of muscarinic agonists and antagonists. One week after septal lesion, the evoked release of [3H]ACh was abolished, indicating that septo-hippocampal cholinergic fibres are the source of this release. The muscarinic agonists, Oxotremorine, carbamylcholine and arecoline reduced the rate of evoked release of [3H]ACh with an ED50 similar to the ED50 required to displace specific [3H]quinuclidinyl benzilate (QNB) binding as found by Yamamura and Snyder. However, the antagonists QNB, antropine and scopolamine were 10 times weaker in increasing the rate of [3H]ACh release than in displacing [3H]QNB binding. Results suggest that the lower affinity of muscarinic antagonists to presynaptic receptors prevents the demonstration of the specific labelling of these receptors with [3H]QNB.


Food intake and body weight: effects of specific and non-specific lesions in the midbrain path of the ascending noradrenergic neurons of the rat. Bilateral injections of 4.8 or 12 microgram of 6-hydroxydopamine hydrobromide were made in the midbrain path of the ascending norepinephrine (NE) fibers. Maximum NE depletion was obtained with the 4 microgram dose. Increasing the dose did not increase NE depletion in either the hypothalamus or the telencephalon. Increases in food intake were observed following the 12 microgram dose only. Electrolytic, copper sulfate, or 5,6-dihydroxytryptamine lesions at the same site caused increases in both food intake and body weight with only moderate (-32 to -58%) decreases in NE levels. Behavioral changes were seen in only those groups in which a large amount of non-specific tissue damage was also observed. Therefore, the behavioral effects were attributed to general tissue damage in the area and not the NE fibers specifically.


Visual discriminations during eyelid closure in the cat. We were able to train cats raised with sutured eyelids to perform simple brightness discriminations before their lids were parted. If, and only if, a small hole was present in a lid, could some of the cats also perform a grating orientation discrimination. By establishing their thresholds for the brightness discrimination before and after dark adaptation and before and after the lids were opened, we reached three main conclusions. (1) During dark adaptation (with pupils maximally dilated and retinae most sensitive, regardless of lid suture), the cats were 3-4 log units more sensitive with the lids open than with the lids closed. This indicates a 3-4 log unit attenuation for the lids which is in agreement with our photometric measurements. (2) During light adaptation, the sensitivity difference between the conditions of opened and closed lids was only 1-2 log units. We concluded that factors (such as pupil dilatation and retinal sensitivity) partially compensated for the lid attenuation, since the open eye could have a smaller pupil and less sensitive retina during light adaptation. (3) Given these potential compensatory features of the pupil and assuming consensual pupil sizes, the deprived eye of a monocularly sutured cat may suffer more photic deprivation (since the pupil behind the closed lid would be as constricted as the pupil in the open eye) than would either eye of a binocularly sutured cat (where both pupils can be relatively large).


Quantitative multiregional blood flow measurements during cervical sympathetic stimulation. The ethanol tissue sampling method for rCBF measurement was used to obtain information on the effects of cervical sympathetic stimulation in 8 cerebral structures in the non-anaesthetized rabbit. Sympathetic stimulation induced flow decreases of 12-29% according to structure, confirming the capability of this nerve to significantly reduce rCBF. Furthermore, a regional differentiation of cerebral structures into an 'anterior' group (mean decrease 22%) and a 'posterior' group (mean decrease 12%) with different reactivity to stimulation was established, thus confirming previous work in this laboratory with a local thermoclearance technique, and histochemical studies on sympathetic innervation to cerebral arteries and arterioles. These results provide strong evidence of the functional nature of the sympathetic nervous system in CBF regulation. The complementary nature of the ethanol technique (quantitative, multiregional measurement) and the local thermoclearance technique (continuous, semiquantitative measurements in 2-3 regions), and the absence of anaesthesia and significant trauma, means that combination of these two techniques offers considerable advantages in research on dynamic phenomena of the kind studied here.


Localization of monoamine fluorescence in the stomatogastric nervous system of lobsters. Explorations into the crustacean stomatogastric nervous system have focused on the stomatogastric ganglion as a paradigm of neural mechanisms and integrative circuitry. Emerging evidence implicates dopamine as a fundamental modulator of the bursting pacemaker neurons and many of the intraganglionic rhythms. The present paper has employed formaldehyde-induced fluorescence in freeze-dried specimens, a microscopic histochemical technique which demonstrates anatomical structures containing particular putative transmitters, indoleamines and catecholamines. We have localized specific, formaldehyde-induced fluorescence in the lobster stomatogastric nervous system. This fluorescence occurs throughout the stomatogastric ganglion neuropil, in 4-8 cell bodies of the bilaterally paired commissural ganglia and in discrete and continuous neurites interconnecting these 3 ganglia. Variations of the basic fluorescence technique suggest that the specific fluorescence is catecholaminergic. Evidence from related biochemical studies supports this observation and indicates that the catecholaminergic fluorescence is dopaminergic since tests for norepinephrine are negative while concomitant tests for dopamine are positive.


Cardiovascular responses and lateral hypothalamic self-stimulation: anatomical differentiation and functional significance. Heart rate was telemetrically recorded from rats self-stimulating in a two-day shuttle-box. Blood pressure changes to intracranial stimulation (ICS) were determined in acute studies with the same subjects. Stimulus-bound heart rate decreases were found only at sites in the anterodorsal aspect of the lateral hypothalamus, whereas no changes in heart rate were observed at ventral or posterior sites. In the acute experiments, stimulation of the anterodorsal sites produced either decreases or no change in blood pressure. Stimulus-bound blood pressure increases were observed only in the ventrolateral hypothalamus. The differential topographical distribution of the electrode sites producing the heart rate and blood pressure changes suggests that these two aspects of cardiovascular function are subserved by separate neural systems in the hypothalamus and that the bradycardia during self-stimulation is a primary response to ICS and is not a reflex elicited by blood pressure increases. Blockade of the bradycardia with the peripheral cholinergic blocker methyl-hyoscine HBr had no effect on the initiation of or escape from ICS indicating that peripheral parasympathetic activity is not causally related to either the rewarding or aversive components of hypothalamic ICS.