[Curative radiotherapy with hope of saving the breast in operable breast cancers 403 cases with 5-year survival]. Between 1960 and 1975, 1 078 operable mammary carcinomas were treated by caesium therapy with the objective of conserving the breast. The authors analyse the indications for and results of this treatment in the 403 cases which have had more than 5 years follow up (241 cases were irradiated as primary treatment, 162 after having a simple tumorectomy). For the whole group 92 mastectomies were ultimately carried out: in 30 of them no tumour was found in the operative specimen. The tumorectomy cases, restricted to stage 1 of the UICC classification (pre 1962) -- PRV 0 IGR yielded the best results: 86 per cent 5 yeat cures with 9 out of 10 women retaining both breasts. The primary irradiation cases, all types considered, gave results comparable with those for primary radical surgery: 58 per cent 5 year cures-but 2 out of 3 women retained both breasts. By itself caesium therapy is capable of eradicating tumour in breast and axilla in half of the cases. It really amounts to a "double chance strategy"--an attempt at cure if possible with avoidance of mastectomy, this being in reserve in the event of failure.


[Data bank experience on cancer patients in a radiotherapy department]. 6 000 cancer patients records are presently computerized in the department of Radiotherapy of the University of Liége. This registry is closely similar to a hospital based cancer registry. The aims of the registry are: clinical use, descriptive epidemiology and end results. The set up and the use of the registry have underlined the necessity to clarify a certain number of concepts to permit coding; the running cost of such a record estimated in December 1973 is of about 400 Belgian francs.


[Role of facilitating antibodies during pregnancy and growth of tumors]. Maternal antibodies can be detected by immunofluorescence techniques on mouse placenta. Following acid elution, it is possible to characterize them as mostly IgG, mainly IgG1. It can be shown that they specifically bind paternal thymocytes and promote allogeneic mast cell degranulation, mainly specifically, but also to a lesser extent non specifically. The prolongation of survival of paternal strain tumor injected into a maternal strain animal demonstrate their enhancing activity.


Metabolic fate of ethylenethiourea in pregnant rats. Metabolic fate of ETU was investigated in the rats administered orally 100 mg/kg of C14-ETU on the twelfth day of gestation. ETU was absorbed readily from the gastrointestinal tract and passed away from the whole body tissues including the fetus rapidly. Only the exception was the thyroid gland and the radio-activity was accumulated in the gland. Most of the administered activity (80.2%,4,5-C14-ETU) was eliminated into the urine in 24 hr and the tissues (including the fetus) levels of radioactivity from 2-C14-ETU reached maximal within 2 hr and fell down to negligible levels by 24 hr. Radiocarbon(s) of 4,5-C14-ETU was expired as radioactive carbon dioxide and was incorporated into the serum and fetal cell constituents (crude protein fraction), but that of 2-C14-ETU was neither expired or incorporated into the cell constituents. From the fetus extract ETU and several radioactive metabolites were detected.


[Study of worldwide nutritional requirements]. In 1972, for the first time in 20 years, world food production decreased and the resulting food crisis was aggravated by the energy and fertilizer crisis, the arrival of new and important countries on the internationl market and by the tendency to world wide inflation. Present food needs are shown in terms of mean share of protein and energy per person and from this it can be seen that in 1970 nearly 500 million people received a share inferior to maintain energy expenditure fixed at 1,5 time the basal metabolism. The projection of alimentary needs to the year 1985, taking into account population and revenue increase, show that a prodigious effort will have to be accomplished in the developing countries to meet the increasing demand and to supplement the production of the traditional food exporting countries who will soon reach their limit. Such an effort will only be able to be put into production if the industrialized countries, conscious of the need to promote development on a worldwide scale, agree to ensure a large part of the necessary financing.


[The socio-economic framework of nutritional problems in poor and in rich countries]. The explosive increase of population in almost all the underdeveloped countries--about 1900 it was round a milliard, now it is more than two milliard and at the turn of the century more than four milliard is to be expected--has given rise to serious concern that the Third World is approaching a nutritional catastrophe such as ROBERT MALTHUS has prophesied nearly two hundred years ago for the newly developing industrial countries. The actual development of the industrial countries has proved the opposite of MALTHUS' prognosis. And in the Third World also such pessimistic fears are not appropriate. The natural potential for the production of foodstuffs in most of the developing countries is immensely great. The nutrition of the additional milliard in this century could be kept at the approximately equal per capita level by cultivation of land reserves with traditional primitive methods without an increase of yield. In order to keep from hunger the number of consumers doubling once more in the coming twenty-five years, it is essential to apply the modern methods of food production developed in the industrial countries. This would allow double or threefold and more the yield on the same area of land. The available reserves of food production in all--taking the land reserves and the still more important progress in agricultural methods together--are so great that fear of general hunger through the exhaustion of resources, even with a world population of ten milliards, must be regarded as totally unfounded and misleading. This is so, however, only when all available forces for this great task are activated and put into productive action. In the industrial countries with their at present extremely high level of nutrition, which had never before in history been reached, a great increase of food production has been achieved in comparison with the former primitive and low productive agriculture. It would, however, be an inversion of the cause and effect to believe that the improvement of the nutrition standard was caused primarily by the increase in food production. The initial stimulus derived from the increase in income, purchasing power and demand at first for more, and later for better nutrition, which came with the industrialisation. This gave the impulse to agriculture to make better use of the given great possibilities to produce progressively more food by applying the continually improving agricultural technology and higher investment. Gradually the nutritional standard of the masses in the industrial countries has reached, thanks to the high purchasing power of the masses, many times the level at the beginning of industrialisation and also the level of most developing countries. A look back into the past and the present conditions in the Third World shows that each phase of development, with its typical average income, has a certain standard of nutrition...


Subclinical and covert malnutrition.

Subclinical and covert malnutrition. Obvious or overt malnutrition is diagnosed from characteristic clinical signs. Subclinical malnutrition is revealed only by biochemical changes but is an unstable state which, if untreated, will develop to clinical malnutrition. There appears to be a stable state where the subject has adapted to low levels of nutrient intake for which the name 'covert malnutrition' is suggested. Examples are: (1) vitamin C intake of 10 mg per day which is adequate to prevent scurvy and where no clinical signs appear until the stress of wounding is applied to the tissues; (2) inadequate intake of vitamin A without signs of deficiency because the poor diet limits growth--deficiency shows up when growth is resumed: (3) protein intake which is adequate to maintain N balance but not adequate to withstand stress. All dietary surveys reveal apparently healthy individuals whose intake of nutrients appears to be grossly inadequate--these may be 'suffering' covert malnutrition, although there is no evidence to indicate whether or not this stable condition is harmful.


[Early diagnosis and significance of avitaminoses]. For the early recognition of vitamin deficiencies, those methods are especially suitable in which changes in the biochemistry of blood or urine are measured. Here a low level of concentration of vitamins or their metabolites is seen, or a lowered activity of vitamin-dependent enzymes or hormones, and finally a disturbance of the actual metabolism. It is only when such metabolic disorders occur that there are functional disturbances or morphological changes. From the example of vitamin A, it is seen that in regions with endemic deficiency such functional disorders and morphological changes can be used to determine the degree of endemic deficiency, whereas in regions or population groups in which there are not manifest symptoms of deficiency, the certain criteria are lacking and there remain only indications. The same is true for the other vires of preventive medicine must be taken in the meanwhile. Certain arbitrary decisions as to the desirable level of blood and urine concentrations of vitamins and their metabolites, and the activity of vitamin-dependent enzymes and hormones, are indispensable. In the preparation of programs for prevention, the first consideration is whether it is for a region in which there is a general nutritional deficiency, or not. In the actual hunger regions, an improvement of the vitamin supply is vital where the vitamin deficiency is leading to irreversible damage, which represents a severe social burden. Such a situation is seen especially in the case of endemic vitamin A shortage. For the other vitamins, it can be assumed that an improvement in the supply of proteins and calories will include an improvement in the vitamin situation. Where this is not the case, the problems are similar to those of the industrial nations. ishort term measures should attempt the enrichment of the basic foodstuffs, on a legal basis, with certain essential food factors. How far nutritional habits can be changed by education is uncertain. In any case, this should be attempted as part of any longterm planning. Biochemical methods of early recognition of vitamin deficiency are suited for testing the success of such preventive actions. The duration of such actions which have been made on a world-wide scale, or are planned, and are tested by these methods is too short to allow any definite statement to be made as to their success.


Nutritional problems of children.

Nutritional problems of children. In the underdeveloped areas of the world malnutrition frequently starts "in utero" as indicated by a high proportion of low birth weight babies. These "small for date" babies have a high risk of death and contribute significantly to the high infant mortality rates observed in these populations. After birth inadequate physical growth is the most frequent manifestation of malnutrition. It is not yet clear if the observed mental retardation is directly related to malnutrition or more to psycho-social deprivation, but is is anyhow an important problem. The effects of transculturization resulting in early weaning is complicating the situation even more by producing severe malnutrition at earlier ages.


[The infantile psychoorganic syndrome--a developmental psychological disorder?]. Many symptoms of infantile psychoorganic syndrome can be regarded as developmental variants or as the result of retarded development, particularly where they are not of marked degree. However, many symptoms are not assignable to either of these categories but, with respect to their pathology, must be classified otherwise. Thus it follows that infantile psychoorganic syndrome as a total entity--and only as a totality, of course, is it to any extent specific--cannot be viewed as a disorder of development.


[Neuropsychological examinations in childhood]. Three groups of children aged 8-12 years have been investigated by a test battery to gain insight into the problems surrounding the relationship between cerebral and behavioral development. One group was of children with circumscribed cortical lesions, one was a group of dyslexics with neurologic anomalies, and the third was a control group of children without brain lesions. General test intelligence did not differ significantly in the three groups. Marked differences between the various lesion groups are observable in some tests but not in others. For example, the results of children with left temporal lesions in the verbal part of the intelligence test and in fresh language memory were inferior to those of all other lesion groups and the controls, while the dyslexics showed a similar if less marked deficit. Non-linguistic (figural) memory did not differ as between groups. On the other hand, children with right frontal lesions were notable for inferior results in a visual learning test and a classification test. In a linguistic-dichotic test all the groups of brain lesions and the dyslexics differed from the control group, a fact which suggests retarded development of hemispheric dominance for speech functions. From these provisional results it can be concluded that the brain areas do not all specialize simultaneously, and that compensation of cerebral lesions in relation to different functions probably results in retardation of overall brain development and anatomico-functional specialization.


[Perceptual disorders in childhood].

[Perceptual disorders in childhood]. Cross-sectional findings in form of performance profiles of 71 severely language disturbed children three to ten years old corroborate the hypothesis that beside disturbances of complex performances, such as language, disturbances of earlier developmental performances mainly of the sensory-motor level can be observed. The prerequisites of these complex and of sensory-motor performances include different levels of perceptual integration. In each of the prefil constellation a different type of perceptual dysfunction can be observed: auditory dysfunction, or tactile-kinesthetic, or intermodal, or serial dysfunction. 15 children with intermodal and 8 with serial problems were exposed to therapy for several years. The therapy attempted to stimulate the disturbed perceptual processes. Longitudinal observations demonstrated that progress became first apparent in more primitive performances, and secondly, with a time lag, in more complex performances. These findings not only confirm the original hypothesis that in these children language disturbances are secondary to perceptual disturbances, but demonstrate also the possibility of early diagnosis and treatment of children with language difficulties.


[Drug therapy of early-childhood minimal brain damage]. Drug therapy in a child with juvenile psychoorganic syndrome is only one part of a comprehensive therapeutic program in which the main emphasis is on training and education, which are sometimes accompanied by psychotherapy. In many cases drug therapy is totally unnecessary. It may however provide essential support for the efforts of educators and therapists and is sometimes the factor which renders these possible at all. Not all symptoms respond equally well: the best results are obtained in disorders of drive and often in psychogenic disorders which have developed on the basis of the psychoorganic syndrome. Promotion of personality development, which is virtually always retarded in the child with psychoorganic syndrome, remains the exclusive preserve of training. Drug administration has psychogenic as well as chemical effects. It depends to a large extent on the reaction of the environment to the fact that drugs are being given at all, and to the behavioral changes exhibited by the treated child. Drug effects are thus modified, and, with time, determined by the environment, and thus in many cases treatment is possible only on a short-term or (sometimes) periodic basis. Where treatment is on a long-term basis the danger of drug dependency must be borne in mind, since patients with psychoorganic syndrome are particularly exposed to the risk of addiction. For this reason care is necessary in administering amphetamine-type substances. These drug should not be prescribed from puberty onwards; previously initiated treatment with them should be terminated before purberty. It should however be pointed out that the results registered with amphetamines and drugs with similar effect can usually be obtained equally with drugs involving fewer risks in this respect.


[Minimal early-childhood brain damage in the pediatric practice and disability insurance]. In modern practice the pediatrician is called upon daily to take preventive, curative and rehabilitative action in children with cerebro-organic and psychosocial risk factors: 1. Eearly diagnosis of handicaps by POLTIBAC on the occasion of individual vaccinations and infectious diseases. 2. Fitness programs for infants to improve the mother-child relationship and reduce frustrations in children's homes and day nurseries. 3. Psychohygiene and mini-psychotherapy of ambivalent mothers during every pediatric consultation. The pediatrician's second patient is the mother. 4. The self-help mentality in pediatrician, parents and educationists assumes increasing importance as economy cames to rule pediatric practice in view of the cost explosion in the health sector. 5. In the Canton of St. Gall increasing numbers of children with cerebral lesions have been registered with the Disablement Insurance since 1970: in 1972 12%, in 1973 14% and in 1974 19% of first-registered minors. Since 1961 all definitely cerebral motor disorders have been registered with the Disablement Insurance, and since 1971 the infantile psychoorganic syndrome and questionable minimal "dyskinesias" have also been registered. The diagnostic and therapeutic costs for infantile minimal brain lesions according to Disablement Insurance tariffs are computed.


[Coding of the acoustic information in the superior auditory centers]. The internal ear may be considered analysing acoustical signals in the frequency domain. This spectral analysis appears in the auditory pathways as a place code, each neuron being activated for a narrow and well defined frequency band. But in addition to this place code, temporal information on the phase and the period of low frequency signals is preserved in the low auditory centers. In the medial geniculate body, the last relay before the cerebral cortex, the place code shows the same properties as in lower centers but with a greater diversity in the response patterns and tuning properties. The tonotopic organization is less precise and, for the pars lateralis, follows the histological lamellar organization of this region. The most lateral laminae are composed of cells responding to low frequencies, the most medial ones of high frequency cells. In the auditory cortex intracellular recordings confirm the importance of an active inhibition underlying the diverse response patterns observed. Persistance of a time code is shown by certain cells presenting responses precisely time-locked to individual clicks in a train for rates ranging from 50 to 1000 Hz. Other cells respond selectively for certain click train frequencies without marking the temporal structure of the stimuli. Thus a temporal and a place code are still both present at the cortical level for this particular kind of signals.


[Brain development: genetic and exogenous factors]. Growth disorders and differentiation of cerebral structures may be caused by mutations of exogenous noxae. The period of most active brain development is between the tenth week of pregnancy and the tenth year of life. In this period the brain is particularly sensitive to exogenous noxae. Basic research has revealed mechanisms that are responsible for normal development, and at the same time has led to the discovery of factors which may be associated with disturbance of these regulatory processess. Disorders of cerebral development may underlie minimal organic brain damage, though there is no proof of this as yet. Closer cooperation between basic and clinical research will be necessary to provide greater insight into the mechanisms of cerebral development. The knowledge thus obtained is one of the preconditions for the prevention, diagnosis and treatment of infantile minimal organic brain damage.


[Neuropsychology and pathology of the cerebral cortex]. In all clinics we are faced with questions about certain aspects of cerebral dominance. We consider first the problem of recognition of faces where the right hemisphere plays a leading role. However, the disorders manifesting that function appear only bilateral lesions. This suggests that the left hemisphere participates in this process. The reception of language raises a problem which is analogous with the preceding: we propose the participation of both hemispheres in this activity: the left hemisphere is dominant in the analysis of phonemes and syntax, the right hemisphere seems implicated above all in the processing of prosodic aspects--in particular intonations and individual features of the voice.


[Minimal cerebral lesions, peri- and prenatal, as a possible cause of the minimal brain dysfunction syndrome]. The existence of organic lesions in Minimal Brain Dysfunction is hypothetical. It is possible however that some of the minor lesions resulting from pre- or perinatal brain damage could explain this syndrome. Such lesions are described briefly. In the perinatal period a transient perfusion failure can result in localized brain damage in the cortex, white matter or more rarely basal ganglia. Before birth lesions occuring in the last trimester of pregnancy do not significantly differ from those occuring at birth, and their origin is also circulatory. During the first semester, a particular type of post migratory malformation also due to perfusion failure, microgyria, may remain localized to one cortical segment. A brief note is made of the possible relation between virus infections and disturbances of brain circulation. The problems of microcephaly without evident brain destruction, and the possible absence of all cerebral morphological alteration in certain mental defective are discussed.


[Neurology of the so-called early-childhood, minimal, organic brain damage]. Infantile minimal brain damage is expressed through a wide range of behaviour disorders, learning disorders, speech disorders, short attention span and motor anomalies in combinations and degrees of intensity which vary with the individual. Neurologically it is frequently characterized by a delay in the development of sensomotor functions which is manifested, for example, by clumsiness, coordination disorders and motor restlessness. Special attention is drawn to the problems surrounding the so-called "soft" neurologic signs. Instead of generalizing, and therefore imprecise, diagnostic labels such as "minimal cerebral dysfunction", the physician should, if a more precise diagnosis is impossible, draw up a list of findings or problems as a basis for further diagnostic and therapeutic measures, if any.


[Psychiatry of minimal, early-childhood brain damage]. Early psychoorganic syndrome in the child is the result of a diffuse cerebral lesion which usually occurs in pregnancy, during delivery or immediately post partum. In the majority of cases the symptoms are biological, normally of a neurologic character, and serve to underpin the diagnosis. They mainly comprise psychomotor disturbances, linguistic disorders and malregulation of central nervous functions. From the psychic viewpoint both intellectual and emotional disturbances are observable. Intellectually the disorders are chiefly of attention, perception and concentration, and in most cases lead to seriously impaired school performance. They are accompanied by an ideation which is frequently retarded and exhibits a tendency to perseveration. The psychoorganic child's affectivity is marked by pathologic lability, increased irritability and imperfect control of impulse and emotion. Secondary infantilism is nearly always observable. In very many cases reactive, and notably neurotic, disorders are superimposed on the psychoorganic substratum. There are thus a wide variety of clinical pictures. A broad spectrum of therapeutic resources is available, covering education, drugs and psychotherapy of superimposed reactive disorders.


[Electroencephalographic contribution to the differentiation of functional and structural disorders]. Parametric and symptomatologic studies of the EEG in large populations have served to define stages of maturation and criteria of "normality". The younger the subjects, however, the wider are the variations. In the first stage of life only massive cerebral lesions afford unquestionable EEG evidence: in evaluating dysrhythmias it is necessary to bear in mind their high incidence in normal subjects. Hence their meaning is to be understood only by prolonged longitudinal studies. The reference here is not only to diffuse or focal slow anomalies, but also to specific pathologic rhythms. The difficulty of interpreting such anomalies is particularly evident when epileptogenic potentials are found, since they may be signs of a lesion but their clinical correlations are uncertain. The concept of "masked epilepsy" must be rejected. Only the diagnoses of latent or proven epilepsy are admissible, and these epilepsies may be without direct relationship to the clinical, psychiatric or central nervous findings in the affected subject. Numerous genetic, afferential, emotional or biologic factors are involved in the development of non-lesional disorders. Accordingly, the EEG has only a minor contribution to make in the definition of mild focal or diffuse pathologic anatomy of the brain in the very young subject.


General anaesthetics and the acetylcholine-sensitivity of cortical neurons. 1The effects of general anaesthetics on neuronal responses to iontophoretically-applied acetylcholine have been examined in slices of guinea-pig olfactory cortex maintained in vitro. 2 Acetylcholine excited 61% of the prepiriform neurones tested. The excitation was blocked by atropine, but not by dihydro-beta-erythroidine or gallamine. 3 Alphaxalone reversibly depressed the acetylcholine-sensitivity of prepiriform neurones. Pentobarbitone did not consistently depress the acetylcholine sensitivity of these cells. 4 Ether, methoxyflurane, trichloroethylene and halothane caused a dose-related augmentation of acetylcholine-induced firing. 5 These results show that general anaesthetics do not necessarily depress the sensitivity of nerve cells to all excitatory substances and that different anaesthetics may affect a particular excitatory process in various ways.


The inhibitory effect of gallamine on muscarinic receptors. 1 The inhibitory effect of gallamine (1.1 muM-1.1 mM) on negative inotropic responses to acetylcholine (ACh) or carbachol (CCh) was investigated in isolated electrically stimulated atria of the guinea-pig. Gallamine caused parallel rightward shifts of the dose-response curves to the agonists, with no depression of the maximal response. 2 Gallamine (0.11 - 1.1 mM) produced a greater degree of antagnism towards CCh than towards ACh. With either agonist, the degree of antagonism produced by gallamine in high concentrations was less than that expected for a competitive antagonist.. 3 Similar findings were made when either negative inotropic or chronotropic responses were recorded in spontaneously beating guinea-pig atria. The inhibitory effect of gallamine against the negative inotropic response to cholinomimetics in electrically stimulated atria was not altered either in the presence of propranol (17 muM) or in atria obtained from guinea-pigs pretreated with diisopropylphosphorofluoridate (DEP) 12.5 mumol/kg, in divided doses over 3 days). 4 When ACh was used as the agonist, combination of gallamine with atropine (0.05-0.4 muM) produced dose-ratios which were less than expected for combination of two competitive antagonists. The same phenomenon was observed in atria obtained from guinea-pigs pretreated with DFP. 5 It is suggested that the antagonism produced by gallamine is a type of non-competitive inhibition, which has been termed "metaffinoid antagonism". An antagonist of this type allosterically alters the affinity of the agonist for its binding site, rather than changing the effectiveness of the agonist-receptor interaction.


Prostaglandin antagonism by sodium p-benzyl-4-[1-oxo-2-(4-chlorobenzyl)-3-phenylpropyl]pheenyl phosphonate (N-0164). 1 The ability of sodium p-benzyl-4-[1-oxo-2-(4-chlorobenzyl)-3-phenylpropyl]phenyl phosphonate (N-0164) to antagonize contractions produced by prostaglandins E2 and F2a on isolated preparations of gerbil, rat and guinea-pig gastrointestinal muscle has been studied. 2 N-0164 was found to be a potent, partially selective prostaglandin antagonist in these isolated smooth muscle preparations. The blockade produced by N-0164 in the isolated stomach strip of the rat had some, but not all, the characteristics of a competitive antagonism. 3 N-0164 produced a dose-dependent decrease in tone in the rat stomach strip that was abolished by pretreatment of the preparation with indomethacin. 4 N-0164 prevented diarrhoea induced by prostaglandin E2 in mice when given by intraperitoneal injection but was less effective when given orally. 5 N-0164 inhibited oedema induced with croton-oil and pyridine-ether in the mouse ear. 6 N-0164 delayed the onset of erythema following ultraviolet irradiation of guinea-pig skin only when an equimolar amount of pralidoxime chloride was added to the vehicle. 7 It is concluded that N-0164 is a potent, partially selective prostaglandin antagonist on several isolated smooth msucle preparations. N-0164 exhibits activity in vivo particularly following local application when problems associated with penetration and distribution are minimized.


Glutamate antagonists in rat hippocampus. 1 Hippocampal cellular responses to acidic amino acids and some of their antagonists were measured in the rat anaesthetized with urethane. The effects of these antagonists of the field responses of the rat hippocampus to afferent stimulation were measured in acute as well as chronically prepared rats. 2. Hippocampal pyramidal cells were excited by microiontophoretic application of glutamate and aspartate. These responses were antagonized by glutamic acid diethyl ester (GDEE), glutamic acid dimethyl ester (GDME) and by proline. Partial specificity could be seen as excitatory responses to acetylcholine were less susceptible to the antagonists. 3 field responses of the hippocampus to commissural stimulation were reduced significantly in both an acutely prepared or the conscious rat following parenteral administration of GDEE and GDME but not proline. Responses to perforant path stimulation were not affected by these drugs. 4 It is suggested that an acidic amino acid may serve as a neurotransmitter in the commissural path to-area CA1 of the dorsal hippocampus.


Anaesthetics depress the sensitivity of cortical neurones to L-glutamate. 1 The effects of general anaesthetics on the responses of neurones to iontophoretically applied L-glutamate have been examined in slices of the guinea-pig olfactory cortex in vitro. 2 Concentrations of pentobarbitone, ether, methoxyflurance, trichloroethylene and alphaxalone that are known to depress synaptic transmission in the prepiriform cortex also depressed the sensitivity of prepiriform neurones to L-glutamate. 3 Halothane, in concentrations that depress synaptic transmission (less than 1%) did not alter sensitivity of neurones to glutamate. Higher concentrations (greater than 1% produced a dose-related depression of the glutamate sensitivity of neurones. 4 All four volatile anaesthetics tested caused some cells to alter their glutamate-evoked firing pattern to one in which the spike discharges were more closely grouped. Pentobarbitone and alphaxalone had no such effect. 5 If the sensitivity of the neurones to the endogenous excitatory transmitter is affected by anaesthetics in the same way as the glutamate-sensitivity, these results suggest that halothane depresses synaptic transmission by decreasing the amount of transmitter released from the nerve terminals, whereas the other anaesthetics depress the sensitivity of the post-synaptic membrane to the released transmitter.


Mazindol anorexia is mediated by activation of dopaminergic mechanisms. 1 Anorexia in rats following injections of mazindol (0.1-8 mg/kg i.p.) could be antagonized by pretreatment with a dopamine receptor blocker (primozide) but not by pretreatment with an alpha-adrenoceptor blocker (phenoxybenzamine), a beta-adrenoceptor blocker ((-)-propranolol), or a 5-hydroxytryptamine receptor blocker (methergoline). 2 In rats with a unilateral lesion in the substantia nigra made by stereotaxic injection of 6-hydroxydopamine, mazindol caused a dose-dependent turning towards the lesioned side, indicating an indirect mechanism of action. This effect could be antagonized by pretreatment with a dopamine receptor blocker. 3 In rats pretreated with reserpine and alpha-methyl-p-tyrosine, mazindol did not have any motor stimulant action. 4 In vitro studies with synaptosomes prepared from rat brain, indicated that mazindol blocks uptake and causes release of dopamine. 5 It is concluded that the anorectic action of mazindol is mediated by a dopaminergic mechanism.


Structure-activity relations of excitatory amino acids on frog and rat spinal neurones. 1 A series of compounds structurally related to glutamic acid has been tested on frog and rat spinal neurones. The substances were added to procaine-containing medium bathing the isolated hemiscected spinal cord of the frog, and their potencies in depolarizing motoneurones were assessed by the magnitude of the potential produced in the ventral root. The electrophoretic technique was used to administer the substances around single interneurones of the rat spinal cord and the relative potencies of the compounds as excitants assessed by the magnitude of the currents required to produce similar rates of neuronal firing. 2 Parallel structure-activity relations were observed in the two series of experiments, suggesting that the receptors for excitatory amino acids on frog and rat spinal neurones are similar. 3 Quisqualate, domoate and kainate were the strongest excitants in both animals, with potencies around two orders of magnitude higher than that of L-glutamate. 4 2,4,5-Trihydroxyphenylalanine (6-OH-DOPA) was a stronger excitant and L-3,4-dihydroxyphenylalanine (L-dopa) a weaker excotamt than L-glutamate on frog spinal motoneurones. The former compounds was also a more potent convulsant than L-glutamate on intraventricular injection into mouse brain. The lack of activity of 6-OH-DOPA on electrophoretic administration was attributed to oxidation. 5 Unlike the majority of amino acid excitants, several of the compounds shown in the present work to have moderate excitatory activity are not anionic at physiological pH. This indicates either that two negatively charged groups are not essential for interaction with a common excitatory receptor, or that more than one type of receptor is involved in the actions demonstrated.


Actions of carbon tetrachloride, hexachlorotethane and the products of their metabolism in sheep on Fasciola hepatica. 1 An invitro preparation of Fasciola hepatica is described which responded to electrical stimulation with tetanic spasms. Both carbon tetrachloride (20-500 nl/ml), and its metabolite chloroform (50-1000nl/ml), produced contractions in the preparation which extinguished the responses to electrical stimulation. It is suggested that the spasmogenic action of carbon tetrachloride and its metabolite may contribute to the fasciolifugal action of the drug. 2 Hexachloroethane, another fasiolifuge, had very little effect in the preparation. However, pentachloroethane and tetrachloroethylene, the main products of the metabolism of hexachloroethane in sheep, were potent spasmogens in preparations of Fasciola hepatica. Pentachloroethane was about twice as potent as carbon tetrachloride. 3 Tetrodotoxin (2mug/ml) did not antagonize the responses of the preparation to electrical stimulation of carbon tetrachloride.


The effect of nandrolone, an anabolic steroid on putrescine metabolism in the mouse. 1 The catabolism of injected 14 C-putrescine was studied in mice treated with nandrolone phenpropionate, an anabolic steroid. 2 The putrescine was rapidly metabolized; almost 50% of the injected radioactivity was recovered within 2 h as 14 CO2 in the expired air. 3 Considerable amounts of radioactive gamma-aminobutyric acid (GABA) and an unidentified compound were found in the kidney and in the urine in addition to radioactive putrescine, spermidine and spermine both in controls and nandrolone-treated mice. 4 Nandrolone elevated the concentration of endogenous putrescine in the kidney and urine, eightfold and twentyfold, respectively, and the concentrations of spermidine and spermine were also increased 5 after the injection of 14C-putrescine the incorporation of 14C into spermidine was significantly increased in the kidney of mice receiving nandrolone.


Volunteer adolescents in adolescent group therapy. Effects on patients and volunteers. The effects on patients, volunteers and staff of using volunteer adolescents in adolescent group therapy are examined. From 40 candidates eight volunteers were selected and oriented to the group process. Four volunteers and four patients were placed in each of two groups, and eight patients were placed in the third group. Patients and volunteers were aware of their identities in the first group session. Attendance in the groups with volunteers was better than in the group without. The volunteers themselves gained new knowledge and skills, and their presence was even helpful to the group leaders.


On the psychopathology of transitivism and appersonation. While the phenomena described under the terms transitivism and appersonation are well known, they have not been studied in detail either from the descriptive or from the psychopathological standpoints. Here only a brief reference is made to the descriptive data. An account of the psychopathological hypotheses on which an explanation of the phenomena is based is followed by a discussion of the relevance of the clinical manifestations for a theory of psychosis.


Psychiatric service for the elderly: how many beds? Reported here is a cohort study of five years' bed usage in the Goodmayes Psychiatric Unit for Old People. Patients first admitted in 1970 continued to use beds, by readmission or by continuing stay, over the next four years; subsequent cohorts of admissions made correspondingly extended use of beds. Bed-usage by men appears now to have stabilized, whilst for women it is still rising. Over the first six years the bed complement was reduced by 40%, despite an increase in referrals of over 40%; this is because the Unit's style of work prevented newly admitted patients from accumulating in beds made available by deaths. It looks as if in future not only will patients who die by replaced by new female admissions but more beds will be needed for these admissions. The present bed-usage is just within the Government's recommended guidelines, and the local issues are considered in the context of national policy.


Some features of 'new long-stay' male schizophrenics. From an original cohort of 471 admissions of male schizophrenics (260 individuals) to Leverndale Hospital, Glasgow, in the years 1967-70 inclusive, 39 patients were found who in December 1973 had become long-term residents by virtue of over three years' stay. These patients were followed up two years later, when it was found that 33 remained. Three had died and two had been discharged, though one was later admitted elsewhere. Those remaining had an average age 45-4 years, and an average duration of illness of 15 years. The patients are considered in terms of their clinical state, management problems, accommodation, occupational grade, and social circumstances. It is concluded that they represent a hard cord and that very few of them are likely to be suitable for such alternative forms of care as are at present available.


A cross-national epidemiological study of mania. An epidemiological study of the first admission rate for mania was carried out in London and Aarhus. The case registers in these two centres were used to conduct a retrospective study of case notes covering several years, and a screening procedure was used for the prospective collection of new cases over the course of one year. The annual incidence of mania was found to be virtually identical in both centres. The retrospective study gave a figure of 2-6 per 100,000 population in both Aarhus and London. But the London sample was found to contain 45 per cent of immigrants in contrast to the Aarhus sample in which only a negligible proportion were born outside Denmark. Male West Indians, in particular, were over-represented in the London sample.


Prenatal progesterone and educational attainments. Children whose mothers received prenatal progesterone have been shown to be advanced in development at one year and to have greater academic achievement at 9-10 years. This study compares the educational attainments at 17-20 years of 34 progesterone children with 37 normal and 12 toxaemic controls. More progesterone children continued schooling after 16 years compared with controls; a higher proportion left school with 'O' level and 'A' level passes, the average number of passes per child was greater at both levels and more obtained a university place. The best academic results were in those whose mothers had received over 5 grams of prenatal progesterone, and for whom administration commenced before the sixteenth week and treatment lasted longer than eight weeks.


A fatal case of pancytopenia due to levomepromazine. A fatal pancytopenia occurred in a patient with an history of depression with hypomanic rebounds, admitted for a manic episode and treated with levomepromazine, diazepam and lithium carbonate.


Schneider-oriented versus Conrad-oriented psychiatric diagnosis in the same German clinic. The Chair of the University Nervenklinik in Homburg/Saar was held by Klaus Conrad from 1949-58 and by H.-H. Meyer, a former pupil and colleague of Kurt Schneider, from 1962-72. As the catchment area and admission policy of the clinic remained substantially unchanged throughout, comparison of the relative proportions of all admissions allocated to different diagnostic categories in 1949-58 and 1962-72 can be used to elucidate the similarities and differences between Conrad's and Schneider's diagnostic criteria. The results of this comparison indicate that Schneider's concept of schizophrenia was broader than Conrad's, and his concept of manic-depressive depression more restricted. More detailed comparisons are complicated by differences in nomenclature and in the varieties of functional mental illness recognized in the two periods. However, it seems that Conrad's concept of mania was wider only when the atypical schizophrenia-like psychoses diagnosed during the Conrad era were added to the Conrad-oriented cases of mania; when this was not done, the Schneiderian concept of mania was broader.


Respiratory ventilation and carbon dioxide levels in syndromes of depression. The breathing rate and PCO2 in end-tidal air have been studied in controls and in patients with endogenous depression (retarded and non-retarded), with neurotic depression, and with schizophrenia. It has been shown that breathing rate goes up and PCO2 down in non-retarded and neurotic depression. Schizophrenia gives more anomalous results. The fact is emphasized that such changes must lead to alterations in pH and other variables. Studies showing some small chemical differences between these clinical entities and control subjects might therefore be explained by these findings.


A city looks at its problem of drug abuse by injection. A retrospective, multi-source screening study has detected 148 users (110 males, 38 females) of intravenous drugs who presented to all relevant agencies between 1971 and 1973 in Bristol, a city where maintenance therapy is a very infrequent practice. The peak prevalence was found in the age group 20-24 years, and it appeared that the chief sources of drugs were burglaries of chemists' shops and general practitioner prescriptions. Sixty-four per cent of our users had not been notified to the Home Office. Suggestions are made for the future monitoring and development of services.


Seasonal patterns of suicide, depression and electroconvulsive therapy. This study examined the hypothesis that there are seasonal variations for suicide, hospital admissions for depressive illnesses and electroconvulsive therapy and that these are inter-related. It was found that the seasonal variations did coincide, with peaks occurring in the Ontario spring and autumn. The importance of depression as a cause of suicide and the effect of electroconvulsive therapy upon the suicide rate are discussed.


Comparison of antipsychotic depot injections in the maintenance treatment of schizophrenia. 122 Schizophrenic patients treated with injections of fluphenazine ethanate, 97 with fluphenazine decanoate and 199 with flupenthixol decanoate were followed up for mean times of 41, 33 and 21 months respectively. Their progress was compared by examining reasons for discontinuing injections and outcome in three separate groups defined according to first preparation given; relating the events causing patients to discontinue injections or be readmitted to patient-months spent on each drug; and analysing reasons for inter-drug transfers 43 per cent, 24 per cent and 23 per cent respectively of these three groups of patients discontinued the injections. Severe extrapyramidal effects were most frequent with fluphenazine ethanate, intermediate with fluphenazine decanote, and least frequent frequent with flupenthixol. Lack of cooperation was rather more frequent with flupenthixol than with the other drugs. Severe depression occurred with all three. More patients on fluphenazine injections were transferred for any reason to flupenthixol than vice-versa. A case of 'irreversible' movement disorder was seen with each preparation. It is suggested that current maintenance doses of flupenthixol decanoate are too low.


Generalization of behaviour therapy with psychotics. Generalization of improvement in the behavioural treatment of psychotic patients must be planned in after-care settings, and for durability over time. The transfer of clinical gains is not an automatic by-product of treatment with severely and chronically impaired mental patients. Treatment strategies that facilitate generalization from hospital to community are illustrated in a case study using empirical data. Systematic and specific treatment programmes were co-ordinated between a state hospital ward and a community-based day hospital. Setting step-wise and limited goals is a feature of successful outcomes. Maintaining consistency in reinforcement contingencies from hospital to community settings, using natural reinforcers, pinpointing functional behaviours as therapeutic goals, over-learning, and training natural caregivers are methods that promote generalization.


Urological follow-up of 99 spinal cord injured patients initially managed by intermittent catheterisation. 99 spinal cord injured patients who were initially managed by intermittent catheterisation have been followed up for an average of 36 months (6 to 81 months) since their discharge from hospital. The urological results in this group of patients have been compared with those of 2 series in which indwelling catheters were used in the initial period. It appears that initial bladder management by intermittent catheterisation allows a higher percentage of patients to become catheter-free and gives a lower incidence of urological complications. The average incidence of re-infection of the urinary tracts and the condition of the upper tracts compares favourably with those reported after management by indwelling catheterisation.


An apparatus for Helmstein's hydrostatic pressure treatment. A new method of producing a balloon catheter for distension of the bladder is presented and an appropriate infusion set for the balloon is described. Various advantages and disadvantages have been discussed.


Composition of bladder stones in Rwanda. A small area of endemic bladder stone formation occurs in Rwanda, Central Africa. The X-ray diffraction of 13 of these stones revealed that they were mainly composed of calcium oxalate monohydrate. By X-ray fluorescence the presence of considerable amounts of rubidium was demonstrated which was measured by atomic absorption spectrometry. The concentration of rubidium was about 2-5 times greater than that of zinc. Thy hypothesis that rubidium is an important lithogenic element is formulated. It might explain this endemic bladder stone formation which is exceptional for Central Africa.


The effects of drugs and anaesthetic agents on the urinary bladder and sphincters. The influence of sedative, anaesthetic and neuromuscular blocking drugs on diagnostic urethral pressure profiles and cystometrograms has been investigated. These agents have marked effects on the results obtained; in particular, the urethral pressure profile was raised by opiates and lowered by anaesthetic induction agents. Bladder capacity as measured by the cystometrogram was greatly increased by halothane. These findings indicate that urodynamic studies should be performed only on conscious unsedated patients.


The urethral closure pressure profile. A new technique using gas and simultaneous EMG-recording from the urethra. A new technique for recording of the urethral closure pressure profile using gas-inflation and simultaneous EMG-recording from the urethra is described. With the present technique, the parameters of the urethral closure pressure profile in healthy volunteers were in accordance with previous reports using water-infusion. The effect of alpha-adrenergic blockade on the pressure profile was studied in a series of patients. Half of the patients showed a marked reduction of the intraurethral pressure in the presphincteric part of the profile after alpha-adrenergic blockade. This indicated that sympathetic innervated smooth musculature gives a significant contribution to the total intraurethral pressure.


Relative contributions of smooth and striated muscles to the canine urethral pressure profile. Canine urethral pressure profiles were analysed using pharmacological and nerve sectioning techniques. The presence of significant sympathetic and somatic neural components was detected and their locations along the proximal urethra were identified. The neural components peaked at different points in the urethra but overlapped. The non-neural component appeared to form an even base along the whole proximal urethra. It was concluded that in the proximal part of the profile the non-neural and the sympathetic components are significant. The sympathetic component becomes larger in the peak pressure zone. More distally and overlapping with the sympathetic component is the contribution of the striated external sphincter.


The response of lymph node metastases of testicular teratoma to radiation therapy. The response to radiation therapy of lymph nodes metastases from testicular teratomas has been examined in 117 Stage I and II patients treated between 1962 and 1972. It is not possible to obtain reliable estimates of the percentage Stage I patients with occult retroperitoneal node metastases; however, available evidence suggests that spread of tumour to the lymph nodes has occurred in a proportion (possibly as many as 50%) of patients in this category. Radiation therapy is an effective method of achieving tumour eradication and overall survival results in this group are good (84%). In a smaller group of Stage II patients with unequivocal lymphographic evidence of nodal spread, the effectiveness of irradiation is dependent upon tumour volume. In those patients with metastases 2 centimetres or less in diameter, the results of treatment are similar to Stage I and we have designated this group Stage IIa. In those patients with larger volume metastases, two thirds have developed abdominal node relapse, in most cases associated with distant spread. We have designated this group Stage IIb. The implications of these observations for overall management are discussed.


Leukoplakia associated with renal tuberculosis in the chemotherapeutic era. The association of renal tuberculosis and leukoplakia of the renal pelvis was quite common in the prechemotherapy era of tuberculosis but has apparently not been seen since effective drugs became available. Despite a prompt response of the tuberculosis to chemotherapy the leukoplakia formation with intermittent passage of keratinised material continued. Surgical removal of the accumulated material was of no lasting benefit.


Urodynamic studies in the district general hospital. The information given by urodynamic investigations has been of practical value in clinical practice and we feel that the time and money spent has been worthwhile. The results are particularly useful in patients with neuropathic bladders, women and stress incontinence in whom detrusor instability is also suspected, young men with "obstructive" symptoms and in men with post-prostatectomy problems. Its value in te large group of women with frequency, urgency and nocturia is debatable given our present lack of satisfactory treatment for these patients.


Major disasters: hospital admission procedures. Triage in the accident and emergency department and the admission of all patients needing further care to one ward can form the basis of the successful hospital management of the victims of a major disaster.


Blast injuries of the lungs.

Blast injuries of the lungs. Up until 1968 Northern Ireland was a relatively peaceful community. The outbreak of civil disturbance has resulted in many patients being admitted to hospital with severe injuries from bullets and bomb explosions. Initial resuscitation must not be unduly delayed to be effective and should be carried out by experienced personnel. Respiratory failure from bomb explosions is rare and invariably fatal. The mechanism is discussed and is thought to be due to direct compression.


Limb and abdominal injuries: principles of treatment. In the period reviewed, the Royal Victoria Hospital received over 7000 casualties, representing approximately half of the civil disturbance injuries for the province. Primary resuscitation did not differ from that of road traffic accidents, but the surgical management did. Extensive débridement was essential, followed by delayed primary suture some days later. Two hundred and nine penetrating abdominal wounds were reviewed, and the necessity of exploring the abdomen in all such injuries is emphasized.


A new approach to the treatment of renal failure. There is an apparent need for an alternative form of treatment for renal failure. This study, therefore, sought to determine the feasibility of dialysing across an isolated loop of colon and its possible application to augment failing renal function in chronic uraemic patients. Haemodialysis and renal transplantation are undisputedly effective in treating renal failure but have many drawbacks. They are unavailable in the underdeveloped world, extremely expensive to institute and maintain, and their need and expense are compounded every year by the discovery of new cases. Colonic loops were isolated in sheep and studies performed to find an effective solution in terms of urea clearance. The best solution was then used in animals in which acute or chronic uraemia was induced and, compared with controls, prolonged life significantly (P less than 0-05). Once it had been established that urea could be removed across the colonic mocosa, it was used in patients with established isolated loops of colon. Even though they had normal blood levels, urea was recovered in the dialysate. Results indicate that colonic dialysis, which is simple and inexpensive, may have a place as an adjunctive therapy in the treatment of chronic renal failure.


Complications of supraduodenal choledochotomy: a comparison of three methods of management. The complications of elective choledochotomy in a prospective study of 116 patients with suspected intraduct calculi are reported. Management included T tube drainage (n = 59), primary closure of the bile duct (n = 29) and choledochoduodenostomy (n = 28). Septicaemia occurred in 12 patients (10%), with 1 death, and was unrelated to the type of operation. Thirty patients (26%) developed wound infection; this complication was more common after T tube drainage than the other procedures. Intra-abdominal abscess occurred in 3 patients only. Thrombo-embolism was recorded in 10 patients (9%), 7 of whom had an intraduct drain. Postoperative pancreatitis occurred in 5 patients (4%), with 2 deaths; a third of the patients in whom sphincteroplasty had been combined with supraduodenal choledochotomy developed this complication. Reoperation for stones was required in 3 patients with T tube; 3 patients developed a temporary biliary fistula after choledochoduodenostomy. The hospital stay was 9-5 days after primary closure, 14-0 days after choledochoduodenostomy and 16-8 days after T tube drainage. Wound sepsis (32%) and thrombo-embolism (12%) were more common in patients with bacterbilia than in patients where the bile was sterile at operation (13 and 3% respectively). Furthermore, wound sepsis, septicaemia and thrombo-embolism were reduced in patients who were given effective antibiotic cover.


A clinical index for selection of breast cancer patients for adrenalectomy. Selection of patients with disseminated breast cancer for endocrine surgery has not been facilitated by sophisticated biochemical techniques. The present study was designed to produce a method of prognosis based exclusively on clinical data. Eighteen features were studied in 95 patients who underwent adrenalectomy and oophorectomy, and correlated with their degree of response to produce predictive variables. In a further group of 90 patients a prognostic score (the sum of the predictive variables) was calculated. There were 17 patients who scored less than 0 and in no case was a good response to endocrine surgery achieved. There were 40 who scored over 10, 29 of whom had a good response. The remaining 33 scored between 0 and 10 and there was no correlation between score and response. This predictive system offers significant advantages over accepted methods of clinical assessment (chi2 = 6-61, P less than 0-02). When patients with a score between 0 and 10 are excluded, its advantages are even more obvious (chi2 = 11-26, P less than 0-001). Patients who are likely to respond to endocrine surgery can be selected by clinical parameters alone, and total failure to respond can be forecast with complete accuracy. Between these two there is a third group whose response is unpredictable.


The plain X-ray in the acute abdomen: a surgeon's evaluation. The plain abdominal X-rays of 277 patients suffering from five acute abdominal conditions were reviewed and specific radiological features found to occur in not less than 48% of the cases. In a second series of 249 patients admitted to hospital with an acute abdomen due to all types of disease, the plain abdominal X-rays were helpful in 42% of cases. A questionnaire of 50 plain abdominal X-rays was answered by surgeons and radiologists of varying clinical experience, the scores of the senior radiologists being higher. It is suggested that plain abdominal X-rays should become a routine investigation in the acute abdomen, and should be reported by senior radiologists at the time of the investigation.


Evaluation of biliary tract disease by ultrasonic B-mode scanning. To establish the value of diagnostic ultrasound (sonar) in the diagnosis of bilitary tract disease, 140 patients were scanned and also had a plain film of the biliary tract. Of these, 105 had contrast radiography and 123 were subjected to laparotomy. The results obtained suggest that in the absence of jaundice, sonar compares well with oral cholecystography in demonstrating the gallbladder, but is not as good as intravenous cholangiography in showing the duct system. In the presence of jaundice, however, sonar is considered the imaging investigation of choice.


Acalculous gallbladder disease: a prospective study. A prospective study of 62 cases of acalculous gallbladder disease is reported. The clinical, radiological and pathological features are described as well as the results of cholecystectomy with a minimum follow-up of 3 years. The results compare favourably with those for calculous disease, and it is concluded that there is no clear-cut distinction between acalculous and calculous biliary disease.


Is colostomy closure a hazardous procedure? A comparison of elemental diet and routine bowel preparation. Morbidity after closure of a colostomy is low if a simple antiseptic technique of intraperitoneal closure is used. In 26 patients there was no example of major wound sepsis and only 2 faecal fistulas both of which rapidly closed spontaneously. A randomized study of preoperative bowel preparation incorporating an elemental diet showed no apparent advantage for this method using our criteria for assessment.


Results of jejuno-ileostomy for gross refractory obesity. The results of jejuno-ileostomy in 182 patients have been studied. The operative mortality was 1-1% and the overall mortality 6-6%, of which 3-3% was attributable to the effects of the small bowel bypass. Weight reduction usually ceased at about 18-24 months postoperatively, by which time the average fall was 36-3% of the mean original body weight. Males and younger patients achieved better than average results. The main side-effects were fatty infiltration of the liver, polyarthralgia, excessive diarrhoea and electrolyte upsets.


Experimental studies on the aetiology of acute scorpion pancreatitis. This study examined the action of the venom of the scorpion Tityus trintatis on the pancreas and gastrointestinal tract in anaesthetized dogs, on the isolated extracorporeal haemoperfused canine pancreas and on the isolated canine sphincter of Oddi. The venom induces exocrine secretion in both the isolated and intact pancreas and causes contraction of the isolated sphincter of Oddi. These results are discussed in relation to the pathogenesis of acute scorpion pancreatitis and possibly of some other forms of acute pancreatitis.


The value of preliminary bone scanning in staging and assessing the prognosis of breast cancer. Preliminary bone scans have been performed on all patients with early breast cancer. The incidence of positive scans has been recorded and several factors determining scan status have been enumerated. Particular attention has been focused on the natrual history of scan positive and scan negative patients. Eighteen per cent of stage I and 41 per cent of stage II cancers had positive bone scans. Scan results were correlated with age, menopausal status, tumour position, tumour size and histological node status. Postmenopausal patients were found to have a significantly increased risk of being scan positive (P less than 0-01). Follow-up studies have confirmed that the lesions demonstrated by scanning actually represent metastatic foci. At 18 months 85-7 per cent of scan positive patients had evidence of disseminated disease compared with only 11-4 per cent of scan negative patients (P less than 0-01). Clinically overt advanced disease evolves from positive scan lesions. It is clear that a significant percentage of patients felt to have early breast cancer already have widely disseminated disease at the initial presentation. The biological significance of bone scan lesions makes a sensitive screening test for dissemination an essential part of the preliminary assessment of patients with breast cancer. Bone scans provide an excellent prognostic index at a patient's initial assessment.


A prolonged course of cyclophosphamide as an adjunct to mastectomy in the primary treatment of breast carcinoma. Cyclophosphamide given after mastectomy for 4-6 months to a consecutive series of patients seen in one surgical practice in the years 1964 and 1965 significantly improved the 10-year survival rate of the treated patients as compared with the patients seen consecutively in the same surgical practice in the years 1957-63. Staging showed that the improvement was due to a significant increase in the survival rate in the patients with histologically negative axillary nodes (P less than 0-01). There was no significant difference in survival in the node positive or advanced disease groups.


Reconstruction of the breast as a primary and secondary procedure following mastectomy for carcinoma. During a period of 8 years over 200 cases of carcinoma of the breast have had replacement procedures carried out as either a primary or a delayed procedure. The end results do not appear to be in any way inferior to those of conventional treatment of this condition. Selection of cases is important, but equally vital is meticulous dessection technique, haemostasis and planning of incisions together with preservation of the blood supply. Recurrence locally appears to be somewhat less than anticipated when compared with other methods of treatment. It can be treated by irradiation or excision without removal of the prosthesis.


Scanning electron microscopy of normal human scar tissue and keloids. The fibrous architecture of 5 normal human scars between 1 week and 1 year old and 4 keloid scars has been studied by scanning electron microscopy. In normal wounds, significant changes in fibril and fibre orientations and mode of aggregation take place as the scars mature, indicating that remodelling carries on for many months. There are also major differences between the edge and centre of the wound. These changes can be related to the stresses placed on the fibroblasts which have responded by laying down collagen aligned in such a way as to resist these forces. It is suggested that keloid fibroblasts may lack this ability to respond appropriately to orientational stress.


Impact of the new generation coronary care unit. A 30-bed coronary care unit with facilities for fluoroscopy, haemodynamic monitoring, mechanical heart assistance, and long-term electrocardiographic monitoring operated at a reasonable cost over five years. Much of the work was entrusted to trained nurses, and there was close consultation with cardiac surgeons over those patients who needed catheterisation or surgery. New procedures greatly reduced the numbers of early deaths from cardiac arrest and cardiac failure but had less influence on late mortality. Hospital mortality for all 3353 patients was 6-8%, and for patients under 65 with definite infarction, who were admitted direct it was 5-7%.


Referred itch (Mitempfindungen).

Referred itch (Mitempfindungen). About one person in four or five is conscious that scratching an irritation may produce an itch elsewhere. The sensation is well localised, comes and goes quickly, and recurs when scratching is repeated a short while later. Scratch and referred itch are ipsilateral; scratching the site of the referred itch does not cause the original spot to itch. Scatching face, palms, or soles does not produce referred itching. Different people stimulated in the same region do not necessarily feel referred itch in the same place. The mechanism of the phenomenon is unknown, though it may be thalamic.


Continuous fetal monitoring in the ambulant patient in labour. Fetal heart rate was monitored continuously in 30 ambulant women in labour by radiotelemetry. The procedure was practicable and, since contractions were less uncomfortable with the patient standing or walking about, reduced the need for analgesia. It also resulted in a more natural labour. Use of the procedure may lessen the risk of thromboembolism.


Genetic susceptibility in diabetes mellitus: analysis of the HLA association. Two hundred and eighty-eight patients with insulin-dependent diabetes w,o were aged 30 or under at onset and 150 patients with late-onset diabetes, 50 of them dependent on insulin and 100 not dependent on insulin, were HLA-typed. There was a significant positive association between the young-onset insulin-dependent patients and HLA-B8, BW15, and B18 and a significant negative association with B7. These data were combined with those from two other centres. There was a significant concordance for the distribution of all the HLA antigens among these three series, producing evidence in favour of an HLA-linked diabetogenic gene (or genes) having a major role in all cases of juvenile-onset insulin-dependent diabetes. There was a positive association between late-onset insulin-dependent diabetes and B8, but no association between non-insulin-dependent diabetes and the HLA system. This provides further evidence for the existence of different pathogenetic mechanisms in the two major clinical forms of diabetes mellitus.


Screening for breast cancer.

Screening for breast cancer. The feasibility of mass population screening for breast cancer by clinical examination and x-ray mammography was studied. The results indicate that such a programme could be conducted effectively by non-medical staff and be safe from the dangers of irradiation. The response rate of women invited for screening suggests that such a service is acceptable to the general public. The additional work load produced by screening would not overburden the existing surgical services.


Further experience with amoxycillin in typhoid fever in children. A study of 155 children with typhoid fever proved by blood culture showed that amoxycillin was superior to chloramphenical with regard to clinical and temperature response and relapse and carrier rates. This confirmed the findings of a randomised clinical trial on 200 children with typhoid fever and lends support to the value of amoxycillin in this disease.


Amoxycillin in treatment of typhoid fever in patients with haematological contraindications to chloramphenicol. Thirty adults with proved typhoid fever were treated with amoxycillin 1 g six-hourly by mouth for an average of 14 days because of haematological contraindications to chloramphenicol. Eighteen patients were Egyptian men with the Mediterranean variety of glucose-6-phosphate dehydrogenase deficiency and an enzyme activity in the red cells fanging from 0 to 3%, and 12 patients had a history of severe but reversible myelosuppression after eight to 12 days' treatment with chloramphenicol 1-5-2 g daily. The clinical and bacteriological responses in this group of patients were compared with those of 30 haematologically normal patients of comparable age and sex treated with chloramphenicol. The results showed that amoxycillin is an effective alternative to chloramphenicol for treating typhoid fever in patients with haematological contraindications to chloramphenicol.


Mode of referral to hospital of patients with heart attacks: relevance to home care and special ambulance services. Out of 1250 consecutive patients brought to hospital with heart attacks 956 (76%) were at home when their symptoms began. Of these, 587 (61%) called their general practitioner, and for the remainder an ambulance was summoned by a member of the public. Of the 294 patients who were away from home when the attack occurred 291 were brought to hospital by ambulance. Of these, only 70 (24%) were attended by a general practitioner. Patients for whom ambulances were called by a general practitioner had had their symptoms significantly longer and had significantly lower prehospital and hospital mortalities than those for whom ambulances were summoned by members of the public. Special "cardiac" ambulances appear to be inappropriate for patients who have been seen by a general practitioner, and for this group home care may well be as effective as hospital admission.


Diffuse myelitis associated with rubella vaccination. Two patients who had received live rubella vaccine developed diffuse myelitis shortly afterwards. Neither patient fully recovered her motor function. In one patients the time between vaccination and development of neurological signs was rather too short to indicate definitely a causal relation. Nevertheless, the chronological association is suggestive, and other observations of such an association may strengthen the suspicion that rubella vaccination may occasionally cause severe neurological damage.


The clinical estimation of liver size: a comparison of techniques and an analysis of the source of error. The clinical estimation of liver size using radioisotope scintiscans as a standard of reference has been shown to be very inaccurate. The main source of error is in the location of the upper border of the liver. Physical characteristics of the patients influence this measurement.


Experiment in managing sociopathic behaviour disorders. A ward catering for both sexes admitted patients with aggressive suicidal, or otherwise disturbed behaviour for observation and treatment until decisions could be made about their long-term needs. Patients were referred from the police, special hospitals, and the courts and some were transferred from other wards in the hospital. A third of the first 100 patients were admitted for forensic reasons. Twelve inmates were discharged to long-term accommodation for disturbed patients. The ward was intended to provide fairly short-term accommodation, though no time limits were set, and it was run as a medium secure unit. The ward was run by 16-18 nurses with support from medical teams, occupational therapists, and clinical psychologists. It has secured its status as a special unit within the hospital and will continue with the active support of the hospital staff.


Clinical judgement and antibiotic use in general practice. Illustrated booklets that contained standard physical but variable social and psychological information relating to 16 patients with sore throats were posted to 1000 general practitioners. The doctors were asked whether they would prescribed antibiotics in each of the cases presented. Replies were received from 634 doctors and it was found that the variations in social and psychological history provided had significantly affected the doctor's responses.


Respiratory syncytial virus infection in north-east England. During a period covering four winter epidemics 987 respiratory syncytial (RS) virus infections were identified in the children's wards that served a total population of about 875 000 in north-east England. The incidence of admission to hospital with RS virus infection tended to be twice as high among children in Tyneside as that among children from the rest of the catchment area. The risk of hospital admission with RS virus infection in the first year of life for city children was about 1 in 50. The risk tended to be increased when there was a high proportion of children in the population, overcrowded housing, and unemployment. There was no clear relation between climatic changes and the onset or progress of epidemics. Thirteen deaths associated with RS virus infection were identified, four of them sudden and unexpected at home, and nine of them in children with congenital or acquired abnormalities. Twelve children were admitted twice with distinct RS virus infections; the relative severity of their two illnesses depended on age. Hospital cross-infection accounted for 60 of the 987 illnesses. Large families and overcrowding among poorer families seem to lead to a higher incidence of RS virus infection, and measures to reduce overcrowding and improve housing should help to reduce the spread of infection. Breast-feeding also protects infants from infection, but further information is needed to pinpoint the infants at greater risk and how they may best be protected.


Reversal of narcotic depression in the neonate by nalozone. Naloxone 40 mug was administered intravenously one minute after birth to 20 out of 44 neonates whose mother had been given pethidine in labour. These neonates were compared with 20 others whose mothers had had only lumbar epidural block. Alveolar PCO2, alveolar ventilation, and ventilatory rate were measured 10 and 30 minutes after birth. The untreated neonates of mothers who had had pethidine showed significant ventilatory depression compared with infants in the epidural and naloxone-treated groups. The naloxone-treated neonates were comparable with the epidural group, although the effects of naloxone were diminishing at 30 minutes. Naloxone is an effective narcotic antagonist which should be considered to be the drug of choice for treating narcotic depression in the neonate.


Writing and speaking in medicine. How I read. Not all who look at a journal are going to read even one of the articles in it. Writers must know, therefore, what turns a looker into a reader.


The Brighton resuscitation ambulances: a continuing experiment in prehospital care by ambulance staff. Two ambulances from the existing fleet in Brighton and one in Hove are equipped with portable defibrillator-oscilloscope units. Selected attendants have been trained not only to defibrillate patients but also to perform endotracheal intubation and administer intravenous atropine and lignocaine for carefully defined indications. In the two years up to December 1975 the ambulances responded to 2253 calls which were considered possible emergencies. Retrospective analysis showed that half of these had been for patients with myocardial infarction, coronary insufficiency, or angina. The ambulances took a median time of five minutes to reach a patient. Attempts at resuscitation were made in 207 patients with circulatory arrest, of whom 160 had ventricular fibrillation. Coordinated rhythm was restored at least transiently in 66 patients, and 27 of them survived to leave hospital. Sixteen of the survivors had been in ventricular fibrillation before the arrival of the ambulance. The delay before admission to hospital was reduced: over 50% of patients carried in the ambulances were admitted within two hours of the onset of major symptoms. No extra ambulance staff have been employed for the scheme. The increased load on hospital services has been limited by encouraging a rational admission policy and also by early discharge.


Association of HLA-A9 and HLA-B5 with Buerger's disease. Eighteen patients who satisfied stringent criteria for the diagnosis of Buerger's disease, healthy controls, and patients with atherosclerosis were tested for various HLA antigens. The incidence of HLA-A9 and HLA-B5 was significantly greater among those with Buerger's disease. This finding supports the concept that Buerger's disease is a distinct clinicopathological condition.


Teesside coronary survey: an epidemiological study of acute attacks of myocardial infarction. A 12-month epidemiological survey of attacks of acute myocardial infarction was carried out in a large urban population. The incidence and mortality at all ages and in both sexes were examined. Altogether, 1938 attacks were diagnosed--an overall incidence of 4-89 per 1000 population. The 28-day fatality rate was 50-5%. A third of the patients were treated at home and these patients had a lower fatality rate than those in hospital, a difference that could not be attributed to age, sex, or severity of attack. Half of the deaths that were witnessed occurred suddenly and a further 21% occurred within the next two hours. The median time to patients coming under care was about three hours. As used at present, coronary care units are unlikely to improve fatality rates. Future advances in treatment must take place outside hospital and will require re-education of the public and the general practitioner.


Use of cardiac pacemakers in Britain.

Use of cardiac pacemakers in Britain. In Britain during 1975 cardiac pacemakers were implanted at the rate of 56 new patients per million population. This is about one-third the rate for other Western countries but still represents an increase of 150% since 1972. Six-thousand generators were used, and apparatus worth about 2m pounds was implanted. Over 90% of the initial implantations were by the transvenous route, and the mortality from this operation was only 0-3%. Electrode repositioning was needed in 10% of cases. The average age of patients at the time of first implantation was 70. Most patients with pacemakers were able to obtain driving licenses and insurance; only 10% had to pay an additional premium. There is no evidence from insurance comparnies that such patients have an increased risk of accidents. Patients who wished to undertake paid employment almost always did so, often in their previous job. About 80% of the patients were able to increase or maintain their leisure activities at the same level of effort as before pacing became necessary. The number of implantations may be expected to increase by about three times over the next five years.


Small intestinal transit in diabetics.

Small intestinal transit in diabetics. Small intestinal transit was assessed in diabetic patients and healthy controls by measuring the breath hydrogen appearance time after the ingestion of lactulose. Transit in diabetics with autonomic neuropathy was significantly slower than in diabetics without neuropathy and controls. Delayed transit is probably due to vagal denervation. These slower transit times would allow bacteria to proliferate, which might explain why some diabetics have diarrhoea. The test cannot be used in patients with bacteria in the small bowel because these may metabolise lactulose and release hydrogen prematurely.


Drug-induced haemolysis in glucose-6-phosphate dehydrogenase deficiency. People with the variants of glucose-6-phosphate dehydrogenase (GPD) deficiency common in the southern Chinese (Canton, B(-)Chinese, and Hong Kong-Pokfulam) have a moderate shortening of red-cell survival but no anaemia when they are in the steady state. With a cross-transfusion technique, primaquine, nitrofurantoin, and large doses of aspirin were found to aggravate the haemolysis while sulphamethoxazole did so only in some people. Individual differences in drug metabolism may be the reason for this. Many commonly used drugs reported to accentuate haemolysis in GPD deficiency did not shorten red-cell survival.


The community hospital: a three-year study. In a three-year period a community hospital of 40 beds discharged 2086 patients, their mean length of stay being 14.8 days. Some 68% of the patients treated were over 65, and 8.9% died in hospital. While the most common diagnosis on admission was disease of the respiratory tract, this does not indicate the actual cause of admission. For 142 patients from one practice this was acute illness in 44% of the cases, assessment in 20%, and a need for nursing care in 36%. If the community hospital had not been available about half these patients would have been admitted to the general hospital.


The erythrocyte sedimentation rate in syphilis. The erythrocyte sedimentation rate was studied in 520 men and 202 women with syphilis. It was raised in 66-6 per cent. of sero-negative primary cases, 80 per cent. of sero-positive cases, 100 per cent. of secondary cases, 80 per cent. of early latent cases, and 73-9 per cent. of late latent cases. It was also raised in sixteen out of seventeen cases of neurosyphilis and in all eleven cases of cardiovascular syphilis. It was concluded that the ESR had little place in the management of syphilis in general, but could be helpful in the post-treatment follow-up of late syphilis.


Diagnosis of gonorrhoea in women.

Diagnosis of gonorrhoea in women. 250 consecutive female contacts of men with gonorrhoea were examined in Lydia Department of Genito-urinary Medicine, St Thomas' Hospital, London, and 165 (66 per cent.) were found to be positive for gonorrhoea. Over 99 per cent. of the positive results were found by the first two sets of genital investigations. These results are compared with earlier and more recent results from our own and other centres and it is postulated that the higher early diagnosis rate is due to the introduction of a highly selective but non-inhibitory culture medium (VCNT), combined with a new incubator which accurately regulates temperature, humidity, and CO2 content. Reasons for the negative findings in 35 per cent. of the female gonorrhoea contacts are discussed.


Drug misuse in a special clinic patient population in Glasgow. During the period October, 1970, to October, 1972, a sample of 295 patients attending Special Clinics in the City of Glasgow participated in an investigation into drug misuse. Results show that, of the 136 males and 159 females who took part--all within an age range of 16 to 24 years, 43 per cent. of the males and 36 per cent. of the females admitted to having experimented with drugs. These percentage figures on the prevalence of drug misuse compare with 36 per cent. of males and 24 per cent. of females obtained from other Glasgow-domiciled target groups, comprising a sample of 2,514 individuals. The principal drug of misuse is shown to be cannabis, followed by LSD and sleeping pills. Data on drug availability suggest that little difficulty is experienced in obtaining drugs illicitly from a variety of sources. Comparison between drug misusers and non-misusers on domestic, educational, and social variables revealed no very distinctive patterns. Results of screening for personality characteristics, using Eysenck's Psychoticism, Extraversion and Neuroticism Inventory generally confirmed previous findings related to atypical scores on the P, E, and N parameters. Even so, results obtained by means of the PEN Inventory and IPAT Anxiety Scale revealed a pattern in which drug misuse is shown to be related to even higher scores of psychoticism, neuroticism, and anxiety. The results of the investigation are discussed with particular reference to the nature of the appeal of drugs to the sexually permissive and promiscuous.


Response of ventilation and of intracranial pressure during rebreathing of carbon dioxide in patients with acute brain damage. A study of the ventilatory response to rising CO2 in 43 patients with acute brain damage, using a rebreathing method, has revealed several instances of abnormally low responsiveness. The increased responsiveness previously reported in chronic brain damage was not observed in these patients by this method. The incidence of a very low response to CO2 tended to be associated with hyperventilation and brain-stem damage, but the numbers were insufficient to define a statistical relationship. There was no association between responsiveness to CO2 and either bilateral forebrain damage or periodic breathing. Studies of changes in intracranial pressure with rising CO2 suggest that such a rebreathing test might provide a simple means of confirming the presence or absence of cerebrovascular response to changing CO2.


Ocular motor abnormalities in hereditary cerebellar ataxia. Twelve members of a family with hereditary cerebellar ataxia of late onset were examined and, in 5, quantitative recording of eye movements were obtained. The initial and most severe symptom in all patients was ataxia of gait, followed by dysarthria and later by dysmetria of the limbs. Clinical examination did not reveal involvement of structures other than the cerebellum. Ocular motor examination showed: (1) inability to hold eccentric gaze resulting in gaze-paretic nystagmus; (2) downward beating nystagmus, accentuated on lateral gaze; (3) defective smooth pursuit, with relative preservation of optokinetic nystagmus induced by full-field stimulation; (4) rebound nystagmus; (5) enhanced gain (eye velocity/head velocity) of the vestibulo-ocular reflex during rotation in darkness; (6) decreased ability to suppress the vestibulo-ocular reflex during fixation of an object rotating with the patient; (7) saccadic dysmetria, especially downward overshoot; and (8) square wave-jerks. Although each of these signs can probably occur with lesions elsewhere in the brain, in combination they are highly suggestive of cerebellar involvement. With the reservation that we do not yet have pathological confirmation of the location of our patients' lesions, our results support the suggestion that the cerebellum specifically: (1) helps maintain eccentric gaze; (2) produces smooth pursuit eye movements; and (3) modulates the amplitude of saccadic eye movements. Many of the characteristics of the altered vestibulo-ocular responses and rebound nystagmus could be explained by the underlying anomaly in the smooth pursuit system.


Impaired temporal resolution of vision after acute retrobulbar neuritis. Following retrobulbar neuritis patients need a greater interval between two flashes of light in order to see them as double. The abnormality is large and easily detectable; the values lie well outside the normal 99 per cent tolerance limits. The abnormality sometimes occurs in localized retinal areas but can cover the whole visual field. The abnormality is a persistent one, remaining up to five years after visual acuity has returned to normal. It can occur in the absence of optic atrophy and with normal visual fields. There is also a delay in visual perception following retrobulbar neuritis but when this and double flash discrimination are both measured at the same retinal sites, the areas of abnormality do not correlate for the two tests. This indicates that the two tests monitor different aspects of visual damage. Double flash threshold can be a more sensitive indication of visual damage due to demyelination than conventional clinical tests including critical flicker fusion frequency. It provides an absolute measurement of local damage in the visual field and has advantages over the recording of perceptual delay and of evoked potentials.


Visual "closed-loop" and "open-loop" characteristics of voluntary movement in patients with Parkinsonism and intention tremor. Normal voluntary movements are considered to be of two kinds, or to involve two components, (i) a ballistic or "open-loop" type, which are preprogrammed and executed without reference to current sensory information and (ii) a corrective or "closed-loop" type, whose course or termination are regulated by such information. In a previous paper it was suggested that Parkinsonism disrupted the first kind of movement, but intention tremor did not. In the present paper three experiments designed to test this hypothesis are described. Subjects were tested on an acquisition-tracking task using an oscilloscope display and joystick control, and measurements were made of the duration, velocity and error of their initial movements to acquire the target. Parkinsonian movements were found to be considerably different from normal in that (a) most movements by this group lasted longer than the reaction time for their initiation, as if including some secondary correction in their execution, (b) the rate of movement was not varied for different amplitudes (so keeping the duration fairly constant) as in normal subjects, but rather movements of all amplitudes were made at a constant slow rate, so that duration increased markedly with the larger steps, (c) error increased disproportionately as the velocity of movement increased; in particular any movements completed in one reaction time or less tended to be wildly inaccurate, (d) removing either the target or the response marker from the screen at the beginning of a movement had a significant effect, making it shorter in duration and smaller in amplitude than those usually produced with both markers visible all the time. Parkinsonian subjects showed no improvement in performance with repeated attempts at one movement over a whole sequence, so their deficit appears to be stable even after practice on a known fixed task. These results are interpreted as supporting the hypothesis that Parkinsonism interferes with the generation of accurate ballistic action which are characteristic of normal skilled movement. Tremor subjects in general resembled normal control subjects in their initial acquistion movements, but their accuracy was less with the larger steps.


Cerebrospinal fluid pressure changes in response to coughing. CSF pressure recordings have been taken from the lumbar region and the cisterna magna of 16 patients during coughing in the sitting position. Isolated coughs of low amplitude have been studied. The lumbar pressure waves occur sooner and lower. Thus there is a phase during which the lumbar pressure exceeds the cisternal, followed by one in which the cisternal exceeds the lumbar. These phenomena may be conveniently displayed on a differential trace. The phase during which the cisternal pressure exceeds the lumbar may be protracted. It is suggested that Froin's syndrome, central subarachnoid pouches and syringobulbia may be associated with upward pressure waves. Cough headache, the filling stages of communicating syringomyelia and tonsillar herniation may be associated with valve-like blockage at the foramen magnum which produces craniospinal pressure dissociation by interfering with downward or rebound pulsation. Decompensation of hydrocephalus after birth may be related to pulsation in association with crying; also after removal of a meningocele sac decompensation may be related to the effects of similar pulsation modified by changes in capacitance following operation. The cord destruction of syringomyelia, and the mechanisms which fill spinal subarachnoid cysts may be related to pressure waves directed both upwards and downwards. The merits and limitations of cough impulse as a clinical test for spinal blockage are discussed, and the suggestion is made that after further evaluation they may provide a more sensitive indication of spinal blockage than Queckenstedt's test.


Depletion of attentional capacity after total commissurotomy in man. The attentional capacity of 6 total commissurotomy patients and 2 partial commissurotomy patients was tested by means of a vigilance task in which signals were flashed to the left or right hemisphere. With complete commissurotomy a gross depletion of attentional capacity was discovered which was absent in the partial commissurotomy patients, whose performance equalled that of normal man. Hemisphere asymmetry was also observed. The left hand was more likely to act in the absence of appropriate signals; the left hemisphere showed none of the expected high level efficiency, displaying, instead, a discontinuous action characterized by gaps and holes in its relation to the stimuli. The results are interpreted to mean that some aspect of consciousness represented by sustained attention is dependent upon hemispheric co-operation and upon the integrity of the cerebral commissures.


The pattern-evoked potential in compression of the anterior visual pathways. Pattern evoked responses have been recorded in 19 patients with compression of the optic nerve, chiasm or tract, verified at operation. These included 4 patients with orbital tumours, 5 with intracranial meningiomas, 2 with craniopharyngiomas and 8 with pituitary tumours. The evoked response was abnormal in all except one of these patients. The pattern of abnormalities in the response, however, differed from that in the earlier series of patients with primary demyelinating disease. The incidence of delayed responses was much lower, and the magnitude of the delays was smaller. Absent responses were particularly characteristic of patients with intracranial meningiomas. Tumours arising in the region of the sella turcica were associated with a high incidence of abnormalities of the waveform of the response, and asymmetry of the field of the occipital evoked potential was especially characteristic of this group. Most, but not all, asymmetric cases were associated with field defects.


Landing from an unexpected fall and a voluntary step. The electromyographic (EMG) response of soleus to a sudden fall has previously been shown to consist of two peaks of activity, the first a response to release, and the second in relation to landing (Greenwood and Hopkins, 1976). We have now examined activity in soleus during falls at various reduced accelerations. The amplitude of the first peak is proportional to acceleration and is not present during falls at accelerations of less than about 2-0 ms-2. The timing of the second peak is related to the timing of landing whether the duration of the fall depends upon the height or upon the acceleration of the fall. Its timing depends upon knowledge of the height of the fall, rather than to ongoing visual information, and upon labyrinthine function. EMG activity in soleus was also examined during voluntary downward steps which could be unexpectedly increased in height. The moment of landing is preceded by an increase of EMG activity and is followed by a number of peaks of activity. These peaks were not seen after the moment of expected landing during unexpectedly lengthened steps and thus probably represent reflex activity due to the mechanical event of landing.


Frontal cortex and response suppression in the rat. Parts of the rat's neocortex were mapped for sites where electrical stimulation, square waves at 10/sec, will suppress a bar-press response for food. Effective sites were found in the frontal pole and over most of the frontal dorsolateral cortex. Within these regions the strongest inhibitory influences were at sites in the frontal pole and adjacent frontal cortex, and at sites along the midline. These data generally agree with results of previous cortical ablation studies, but they suggest that inhibitory processes are more widespread in the dorsolateral cortex than these studies indicated.