Organizational behavior of the premature infant.

The ability of the premature infant to organize behavior was described in relation to auditory, kinesthetic, and vestibular stimulation. Twenty infants from 31--36 weeks gestation were shown to have heart rate responses to auditory stimuli. The 31 week infant showed deceleration, while 32--36 week infants showed comparable patterns of acceleration followed by deceleration.


Influence of varied stimuli on development of motor patterns in the premature infant.

The premature infant is at risk for both mortality and morbidity. His writhing contributes to weight loss, and his extrauterine environment does not contain the multi-modality patterned afferent stimuli that impinge upon the developing brain in utero. Sound is the most effective modality to achieve concurrent decrement in motility along with enhancement of cortical activity. It was anticipated that subjects exposed to 5 minutes of patterned sound 6 times a day would, by 36 weeks gestation, evidence: (a) less gross motor activity, (b) the normal predominance of upper over lower limb activity, and (c) beginning laterality. The sample consisted of 80 males and 73 females whose gestational age at birth was 26--33 weeks. By random assignment 52 subjects were exposed to the routine ambient noise of the isolette and nursery, 50 to a tape recording of their mother's voice, and 51 to an orchestral arrangement of Brahm's Lullaby. Limb activity was measured just prior to discharge by accelerometers worn unilaterally for a 24-hour period on the ankle and wrist prior to transfer to the alternate side for an additional 24 hours. No statistically significant differences were demonstrated among the limb patterns of the 3 groups. Large intragroup variation in gross activity precluded demonstration of between-group differences. The majority of subjects evidenced predominance of upper limb activity and laterality.


The effects of the Rice infant sensorimotor stimulation treatment on the development of high-risk infants.

The Rice Infant Sensorimotor Stimulation (RISS) treatment was given to 15 premature infants to determine effects on neurophysiological development. The mothers of the infants were trained to administer the treatment for 15 minutes, 4 times a day, for 1 month, beginning the day the infant arrived home from the hospital. When each infant in the study (15 experimental and 14 control) was 4 months postnatal age, he/she was examined by a pediatrician, a psychologist, and a pediatric nurse who had no knowledge of which infant was experimental or control. The results indicated the experimental infants made significant gains in neurological development (p less than .001), weight gain (p less than .04), and mental development (p less than .05). The findings of this research indicate that early and systematic stimulation of the nerve pathways of the skin and of the vestibular nerve cells can accelerate growth and development of premature infants.


The congenitally methadone-addicted infant.

A review of research concerning the effects of methadone on infants born to mothers who received the drug during their pregnancy is presented. The goal was to provide a base for establishing that the infant born of a heroin addicted mother who is in a methadone maintenance program needs the help of health professionals to develop to maximum potential. Factors which should be considered in studying infants born to methadone maintained mothers are delineated. Tools for predicting later development as an area of study are discussed. The sense of inadequacy and low self-esteem of the parents, particularly the mother, is presented as an area in need of study. Theoretical considerations are discussed. The literature review indicates the effect of methadone on the overall development of the infant is debatable. However, evidence is mounting that infants born to heroin-addicted mothers receiving methadone maintenance treatment are high-risk. Consequently, health professionals are alerted to the importance of providing appropriate stimulation during sensitive periods of infant readiness.


Scanning electron microscopy (SEM) of cranial neural crest migration in chick embryos.

This study describes migrating cranial neural crest cells and the microenvironment through which they migrate in chick embryos. Just prior to and during cell migration, an extensive fibrillar meshwork is observed, particularly on the outer surface of the neural tube and the inner surface of the ectoderm. This meshwork in general had a random orientation. This suggested to us that the meshwork does not provide a directive vector for cell migration but rather a substratum to promote or enhance crest cell filopodial attachment as the cells migrate. Much remains to be done in characterizing the composition of this meshwork. Based on other studies in which a smiliar meshwork has been observed, it is not unreasonable to consider it to be partly collagenous. Another major component in the relatively cell-free space through which avian crest cells migrate is hyaluronic acid. The migrating crest cells are characteristically bipolar and are generally oriented in the direction of migration, although little is known about the actual mechanism of motility. Alterations in the migrating cell or in the environment through which it migrates may interfere with normal craniofacial morphogenesis, as discussed elsewhere in this volume by Johnston and Sulik.


Speculations regarding the influence of the major histocompatibility complex (H-2) upon congenital craniofacial malformations in inbred and congenic strains of mice.

Investigations in different mammalian species have demonstrated a remarkable degree of analogy between distant mammalian species. All mammals possess a major histocompatilibity complex. The identified and postulated functions for the MHC appear to be similar among all mammalian species [14, 25]. One fascinating, but still unconfirmed possibility is that the MHC functions to regulate the immunobiology of normal pregnancy. It should be stressed at this point that much more knowledge is necessary to elucidate the mechanism of H-2-disease associations in mice and HLA-disease associations in man [25]. One explanation of the observed H-2 and HLA-disease associations is linkage disequilibrium. Data are available suggesting a tenuous HLA--cleft lip and/or palate association [34, 35] but the data are equivocal. The available data from congenic mice studies are considerably less equivocal and strongly suggest several important future approaches. Identification of the H-2a haplotype susceptibility and the H-2b resistance to steroid-induced clefting is a major advance in this complex field [36]. Available methods are sensitive, and newer, more precise methods are now in the offing. The renaissance in the field of congenital craniofacial malformations is rather exciting, especially the renewed awareness of interdisciplinary research toward ultimate prevention. Understandably, many physicians, dentists, nurses, and pharmacists, as well as allied biomedical health professionals investigating the heredity of congenital craniofacial malformations, are deeply interested in immunogenetics. In tandem, the biomedical scientific community (eg developmental biologists, molecular biologists, immunologists) wish to learn more about the complicated and often overlapping relationships between various clinical features of the diseases concerned. All are aware that our knowledge of this fascinating subject will not stand still; many are busy changing it.


[Analysis of the mechanism of amplitude change in Pacinian corpuscle receptor potential in a solution with a decreased calcium ion concentration].

The effect of Ca2+-free solution on the amplitude increase in the receptor potential (RP) of Pacinian corpuscles was studied using external perfusion technique. The RP amplitude increased in Ca2+-free solution. It was blocked after addition of 10-20 mM of tetraethylamonium. A temporary increase in the RP amplitude is seen in the solution with 0.2 mM of 2.4-dinitrophenol. Sensitivity of the receptor membrane to mechanical stimuli does not change in Ca2+-free solution. It is suggested that near the mechanosensitive ionic canal of Pacinian corpuscle receptor membrane the fixed negative charges which could influence the "gate" system state of the mechanosensitive canal are absent.


[Functional dependence of single muscle receptors on muscle activity].

In experiments on chloraloso-urethane anesthetized cats changes in spontaneous and induced spike activity of single muscle spindles and Golgi's receptors following a direct and/or indirect electrical stimulation of the muscle were studied. It was found that contractile activity of the plantar (phase) and heel (tonic) muscles decreased the spike activity of both muscle spindle and Golgi's receptors, the decrease in the phase muscle spindle activity being more considerable than in the tonic one.


[Systemic circulatory reaction in the initial period of Cannon's traumatic shock].

In experiments on dogs it was shown that on the basis of the dynamics of circulatory parameters it is possible to divide the erectile phase of traumatic shock into two periods. The first period, similar to "defence reactions" in dangerous situations and under the action of potent non-specific stimuli, is characterized by an increased blood inflow to the myocardium, rise in the cardiac output and reduction of the tonus in peripheral vessels. The second period is characterized by the beginning of decompensation of the cardiovascular system. It is completed by the development of the torpid phase of shock.


[Dynamics of DNA synthesis in the gastric mucosa in ulcer].

Anomalous DNA synthesis  was seen in the stomach mucosa of mice with experimental stomach ulcer during different phases of the ulcerous process, using histoautoradiography. At the early stage of ulcer formation a decrease in the label index (LI) is seen. Formation of the ulcer, morphologically similar to the shronic one, is accompanied by growth of the number of DNA-synthesizing cells in its margins. Over a period of ulcer healing proliferative activity of epithelium decreases approximately to an initial level. Histoautoradiographic studies of bioptates of the stomach mucosa obtained under spot gastroscopy in patients suffering from the ulcerous disease allowed to reveal intensifying proliferative activity of epithelium in the ulcer margins. Similar changes in LI were found in gastritis, followed by the gland affection, and in atrophic gastritis.


[Effect of cold stress on the postnatal formation of the carbohydrate hydrolysis and transport mechanisms in the rat small intestine].

In acute experiments on rats using accumulating mucosa preparation (AMP) method it was shown that cold training (daily 2-hour exposure to 6-7 degress C) exerts stable inhibitng effect to postnatal formation of maltase- and gamma-amilase transport digestive-absorbtive system and does not change the dynamics of its own transport. The same training program significantly accelerates the rate of hydrolytic-transport conveyor on the cell membrane external surface in rats aged from 10 to 17 days.


[Interrelationship of the platelet and plasma coagulating components of the hemostatic system normally and in pathology].

The adhesive-aggregative activity of blood platelets and the blood coagulation rate were compared in 125 healthy humans in the reaction of prompt adaptation (circadian rhythm, emotional stress, ACTH load) and 157 patients with cardiovascular diseases over the period of crisis and under acute pharmacological effects. The discovery of differently directed shifts of the blood platelets and plasma coagulative components of hemostasis suggested about the hemostatic function of blood platelets.


[Protein biosynthesis in the rat liver in natural fluctuations of the steroid background].

The results of the study of protein and RNA biosynthesis and inducation of glucose-6-phosphatase activity in the rat liver at natural (seasonal) fluctuations of the steroid background are presented. It is shown that the adrenal gland seasonal activation increases incorporation of precursors labeled (l14C-leucine and l14C-orotic acid) into total liver proteins and RNA and enhances glucose-6-phosphatase activity in the rat liver. The conclusion is drawn that the changes in the endogenous corticosteroid level have regulative significance for protein biosynthesis in the rat liver.


[Gylcine-14C incorporation into the plasma membrane proteins of normal and regenerating liver].

Incorporation of 14C-glycine in plasmatic membrane proteins of the intact and regenerating liver was studied at the beginning of G1 period of the cell cycle. The electrophoretic study of 0.05 M Na2CO3 soluble plasmatic membrane proteins of the regenerating liver showed that maximal incorporation of 14C-glycine was associated with the proteins having molecular weight of about 60 000. The pattern of incorporation of 14C-glycine in different fractions of 0.05 M Na2CO3 insoluble proteins of the plasmatic membranes of the intact and regenrating liver did not differ essentially.


[Effect of hypobaric hypoxia on the acetate-1-14C incorporation rate in hydrophilic and hydrophobic brain phospholipid components].

Rats were kept in barochamber for 2 hours at the pressure of 240 mm Hg after subcutaneous administration of (1)14C-acetate. Hypobaric hypoxia caused depression in the incorporation of labeled acetate similar in both phospholipid (PL) components. But the dependence of depression in the metabolic rate upon hypothermia which accompanied hypoxia was more pronounced for hydrophobic portion of PB (carbon skeleton of fatty acids) than for hydrophilic one. Similarity in the degree of the hypoxia induced depression of incorporation of the precursors containing labeled phosphorus and carbon allows one to suggest that the carbon-containing parts of PL hydrophilic components (glycerol and nitrogen bases) and residues of ortho-phosphoric acid respond to hypoxia as a whole.


[Change in the activity of DNAse I inhibitor in the mouse spleen on the administration of a synthetic polyanion].

Synthetic polyanion pyran (copolimer of divinyl ether and maleic anhydride) injected to mice increases the titre of antibody to sheep red blood cells as well as the activity of serum DNAase I and DNAase I splenic inhibitor. Simultaneously a growth of the spleen weight takes place. A possible role of the DNAase I inhibitor system in the mechanism of the adjuvant action of synthetic polyanion is discussed.


[Conformational changes in the heat-denatured nucleotide complex of human lymphocytes on subsequent cooling].

The microfluorometric technique allowed an assay of the chromatin state from binding of acridine orange in studies on the kinetics of conformational changes in the nucleoprotein complex (NP) of human peripheral blood lymphocytes. Extraction of F1 histone fraction with 0.01 N HCl (pH 2) substantially altered (decelerated) conformational changes in the NP complex. Extraction of F1, F2 and F3 histone fractions with 0.25N HCl (pH 0.6) led to a more pronounced deceleration of the kinetics of conformational changes. The latter ones were decelerated as well when the process was run in a more viscous medium (e. g. in a 70% glycerin solution). No conformational changes in the NP complex deproteinized with 0.25N HCl were revealed in a vicsous medium. In such a case the NP complex showed low F530 values and elevated values of the alpha coefficient that seems likely to suggest the nonreversible denaturation of the NP complex.


[Bradykinin, morphine and naloxone interaction on the sensorimotor cortical neuron level].

In experiments on awake rabbits the effect of bradykinin, morphine and naloxone (applied by means of microiontophoresis) on sensomotor cortical neurons was studied. Bradykinin increased the discharge frequency in the majority of neurons. Morphine inhibited the neuronal activity. Bradykinin had no activating effect in the presence of morphine. Naloxone eliminated morphine depressing effect and restored the neuronal reaction to bradykinin. According to the data obtained it is suggested that bradykinin interacts with opiate receptors in the brain.


[Rosette formation in a cell population syngeneic transfer system from donors with an altered serotinin level].

The formation of primary immune response has been studied during transplantation to sublethally irradiated recipients of cells from different immunocompetent organs of non-immune intact donors as well as of those from animals injected serotonin. Considerable variations in the development of the immune reaction have been mainly discovered due to IgM-forming cells, both during the transfer of spleen cells alone and in combined injection of these cells with bone marrow and thymus cells from the same donors. The results obtained suggest a possible serotonine influence on variations in the ratio and migration of T and B cells in different organs and on T and B suppressor cells.


[Correlation between the immunological responsiveness to haptens and an increase in stem cell migration on immunization with hapten-carrier conjugates].

CBA and C57BL mice were immunized intraperitoneally with the conjugates 2,4-dinitrophenyl-bovine gamma-globulin, 2,4,6-trinitrophenyl-bovine serum albumin, diasotated p-aminobenzoic acid-bovine serum albumin, and sulfanylic acid-bovine serum albumin, whereupon migration of hemopoietic stem cells to the spleen was investigated. Immunization with the conjugates haptene--protein was shown in most cases to provoke an intensified migration of hemopoietic stem cells in mice highly responsive to the specific haptene, and at the same time to reduce, as a rule, the intensity of migration in mice of the poorly responsive genotype. It is concluded that the migration ability of stem cells seems likely to be connected with genetic determination of the immune response in mice of different genotypes.


[Hematopoietic and lymphoid cell adhesion to stromal mechanocytes in vitro].

In vitro adhesion of guinea pig bone marrow and spleen cells to cultured fibroblasts of bone marrow, spleen, thymus and peritoneal fluid origin was studied. Much better binding of myeloid cells to fibroblasts than to macrophages was observed, but no difference in adhesion to stromal fibroblasts of different origin was focund. The number of adhereing cells per one stromal mechanocyte depends on the number of adhesion sites on the surface of target cells. According to our data, adhesion sites for myeloid cells are much more numerous, than adhesion sites for lymphoid cells.


[Tumor and body interrelationships in 14C-thiamine utilization].

Variations in the content of 14C-thiamine, thiamine-dependent enzyme transketolase (TK), and thiamine diphosphate (TDP) in mouse tissues were studied during Ehrlich's ascites tumour growth. The concentration of TDP in the liver of tumour-bearing animals continuously drops during 10 days after inoculation, TDP level in the tumour itself decreases more abruptly by the terminal period of tumour growth (the 10th day). At the same time the tumour demonstrates sharp deficiency of the coenzyme and redundance of apoenzymatic forms of TK. The growing deficiency of thiamine in the tumour favours greater tension of thiamine metabolism and appearance of competitive tumour-host interrelationships that are most pronounced in the presence of hypovitaminosis.


[Hematopoietic stem cell migration study in dogs].

The migration rate of stem hemopoietic cells (SHC) of the bone marrow was studied by two methods in experiments on 54 dogs. In the first case the dogs were irradiated with an absolute lethal dose (550 R) subtotally, shielding two knee-joints. Seven days after the first irradiation under inactivation of shielded parts with 2000 R dose the survival rate was 12.5% and after 14-day inactivation all the dogs survived. In the second case firstly both knee-joints were irradiated with 2000 R dose. All the animals died following subsequent subtotal irradiation of the areas previously irradiated with 550 R dose if the second irradiation was performed 7 days after the first one. Prolongation of the time intervals between irradiations up to 31 days lead to 20% survival of the animals. It was concluded that SHC migration in dogs is much lower than in mice.


[Growth-stimulating action of nitroso compounds on organ cultures of mouse and rat embryonic liver].

Transplacental and direct effects of nitroso-methylurea (NMU) on the organ cultures of the liver of 18-20-day embryos of CBA and C57BL mice and the action of diethylnitroso-amine on the embryo liver cultures of noninbred rats were studied. Nitroso-compounds acclerated explant adaptation, enhanced the culture survival as compared with the normal and induced hyperplastic proliferation of small basophilic cells, whose survival in the experiment and under normal conditions was higher than that in the normal embryonal hepatocytes. The growth-stimulating effect depended on the animal species and strain and on the carcinogen, as weel as on the route of administration.


[Effect of cytidine and uridine on liver regeneration in rats poisoned by carbon tetrachloride].

The effect of cytidine and uridine on the reparative processes in the rat liver in experimental hepatitis induced by CCl was studied. Combined administration of uridine or cytidine with CCl4 during 7 days does not prevent the liver affection. The subsequent nucleoside treatment (up to 15 and 20 days) accelerates to a different degree the reparative processes after CCl4 withdrawal. Thus, cytidine provokes marked hypertrophy of regenerated hepatocytes accompanied by proliferation of the mesenchymal elements, not followed, however, by recovery of the conjugative and excretory liver functions. Uridine, in contrast to cytidine, promotes more rapid normalization of these functions though the organ structure regeneration is not complete.


[Cellular ultrastructure of the hepatic sinusoid in partially hepatectomized rats].

In male Wistar rats weighing 160-200 g 2/3 of the liver tissue was removed. As a result the phase modifications of lysosome structures in Kupffer's cells have been observed. 2.5 hours after operation the number of primary lysosomal granules increased, 9 hours later an augmentation in size and polymorphism of lysosomes was revealed. At the moment of hepatocyte mitotic peak, i. e. 30 hours after partial liver removal mainly secondary lysosomes were detected in Kupffer's cells. On the contrary, 48 hours following operation the number of new wave of accumulation of primary lysosomal granules was seen. In endothelial cells the lipid infiltration was prevalent especially at the hepatocyte mitotic peak period. The data obtained indicate specific relationship of ultrastructural modifications in sinusoidal cells and phases of the liver reparative regeneration.


[Proliferative activity of the surface foveolar gastric epithelium in acetysalicylic acid injury].

The proliferative activity of gastric mucous cells (GMC) was studied in white mice following the administration of acetylsalicylic acid (200 mg/kg). One hour before sacrifice all the animals received intraperitoneal injection of 3H-thymidine. The mitotic index and index of labeling nuclei were calculated by means of radioautographers 3, 10 and 20 days after administering the drug. Following 3-day exposure to acetylsalicylic acid the proliferative activity of GMC remained unchanged as compared to controls. Long-term administration (10 and 20 days) of the drug produced no increase in the number of erosions, but there was a statistically significant rise in the proliferative activity of GMC. This rise was accounted for by increased number of proliferating cells in the foveated and cervical divisions of the glands as well as due to the extension of the zone of distribution of precursor cells in the gastric glands as far as the basal divisions. These changes may be considered as manifestation of the protective-adaptive reaction of the gastric mucosa in response to the damaging effect of acetylsalicylic acid.


[4-Aminopyridine induced spontaneous synchronism of acetylcholine release in the neuro-muscular junction].

The effect of 4-aminopyridine (4-AP) on acetylcholine release was investigated on the rat phrenic diaphragmatic preparations by means of intracellular recording of spontaneous synaptic activity. 4-AP in concentrations of 1.10(-6) to 1910(-3) M did not cause significant shifts in the mean value of frequency and amplitude of miniature end-plate potentials (MEPP). At the same time 4-AP induced appearance of large spontaneous EPP capable of generating distribution of action potentials. 4-AP transformed the character of MEPP amplitude distribution into the polimodal one, the main node being shifted in several cases to the range of lower values. It was concluded that 4-AP can modify the character of acetylcholine release that intensifies the spontaneous synchronism manifestation.


[Electrogenesis of muscular fibers in the rat masseter muscle proper].

It was established by the method of intracellular lead of membrane rest potentials (MRP) and action potentials (AP) that fibers with high MRP and little overshot are mainly located in superficial layers of the rat masseter muscle proper whereas those with low MRP and high overshot principally in deep layers. Excitability of the cytoplasmic membrane of muscular fibers of both types proved to be related in electrical properties (critical level of depolarization, current threshold). It is suggested that the rat masseter muscle contains a great number of rapid phasic fibers in superficial layers and slow ones in deep layers.


[Mechanism of regulation of steroidogenesis in the adrenals by blood serum lipoproteins].

It has been shown that high density lipoproteins obtained by ultracentrifugation and loaded with cholesterol and pregnenolone exert a stimulant effect on in vitro production of glucocorticoids by rat adrenals. Low density native lipoproteins possess an inhibitory effect connected with the protein component. The action of various blood serum lipoproteins on steroidogenesis in rat adrenals has significantly different mechanisms.


[Do specialized cutaneous cold receptors exist?].

The relative quantity of the cutaneous nerve unmyelinated fibers that conduct the excitation impulses from mechanoreceptors under contraction of pilomotors without and during cooling of the skin by 10 degrees C at a rate of 1 degree C per second was measured by the integrating method of colliding impulses. The same mechanoreceptors are shown to be excited by pilomotors both under skin deformation and cooling. A conclusion is made about absence of specific cold receptors in the cat skin.


[Experimental studies of parmidin (pyridinolcarbamate) effect on microvascular permeability of the lungs, skin and mesentery].

The effect of parmidin (pyridinolcarbamate) on microvascular permeability of several organs has been studied on experimental mice and rats using different models of increased vascular permeability, returned to normal by the drug due to its antibradykinine properties. The experimental results correlate with the clinical data on parmidin applied in therapy of a number of diseases associated with abnormal microcirculation.


[Analysis of analgesia induced by the generator of excitation in the dorsal raphe nucleus].

In experiments on white rats the generator of excitation was created in the dorsal raphe nucleus by microinjection of tetanus toxin. After formation of the excitation generator electrical activity in this nucleus was changed as the following: the first negative component (N1) was strongly increased, general EP configuration changed and the spontaneous paroxysmal activity became more frequent. The time of the generator formation correlated with the appearance of intense and prolonged analgesia. Naloxone did not reverse the effects of analgesia described.


[Analysis of hemodynamic reactions induced by stimulation of the hypothalamus in alert animals].

Electrical stimulation on the hypothalamus in alert cats increases the blood pressure and inhibits the baroceptor reflexes. In animals with extirpated sinocarotid and aortic nerves the pressor reactions are perversed to depressor ones at threshold stimulation of the hypothalamus. Meanwhile suprathreshold stimulation of this organ leads to emergence of depressor-pressor responses. It is suggested that inhibition of the baroceptor reflexes is one of the mechanisms of the hypertensive reaction emergence at stimulation of the hypothalamus.


[Comparative study of intravital microcirculation and hemorheological changes following burn injury of different severity in rats].

It was shown in experiments on rats that burn injury is followed by microcirculatory disturbances, hemoconcentration and increasing blood viscosity that is especially pronounced in the vessels with low blood pressure. The microcirculatory changes in the mesentery correlated with the in vitro investigated dynamic viscosity and blood composition. The disturbances were more pronounced after severe burn followed by a mortal shock than after moderate burn without fatal consequences. This investigation confirms great importance of hemorheological changes and microcirculatory disturbances in the early period of burn disease.


[Permeability of histohematic barriers of the small intestine during perfusion with some preserving solutions].

The permeability changes in histohematic barriers of the isolated small intestine loops of laboratory white rats whose vessels were perfused with 0.85% sodium chloride, Ringer-Lock, Hanks and Collins-2 solutions as well as with hemodez and aminopeptide were studied. The amount of the fluid flowing off the vessels, perfusate penetration into the intestinal lumen and its transudation through the serous membrane were determined. It was concluded that the slightest disturbance in the small intestine histohematic barrier was observed during perfusion of the vessels with Collins-2 solution. The above method is recommended for testing the comparative characteristics of the preserving solution.


[Cholinergic regulation of transcription in the liver].

The rate of the RNA synthesis in the rat liver was enhanced 6 hours after intramuscular administration to rats of acetylcholine, carbamylcholine or chlorosil at doses of 20, 1 and 2 mg/kg, respectively. At a dose of 0.025 mg/kg chlorosil failed to influence the transcription rate, but partially blocked its stimulation by carbamylcholine. Chlorosil and carbamylcholine did not change the RNA synthesis rate in isolated hepatocytic nuclei. It is suggested that the effect is mediated by their interaction with the cholinoreceptor or with the cell plasmatic membrane sites structurally associated with it.


[Regulation of oxidative phosphorylation by adrenaline and insulin, effect of the insulin-dependent cytoplasmic factor].

The insulin-dependent cytoplasmic factor-regulator (IDR) was shown to inhibit pyruvate and succinate oxidation by the rat liver mitochondria. In view of the fact that insulin increases and adrenaline decreases IDR activity in the liver cytoplasm it is suggested that oxidation of the substrate in mitochondria in vivo is regulated by changes in IDR content in cytoplasm. It was shown that adrenaline-activated oxidation apart from decreased activity of IDR in cytoplasm is induced by a different mechanism not related to IDR content.


[Ultraweak luminescence of blood plasma in experimental embolism of the main arteries of the limbs].

The changes in the level of blood plasma chemiluminescence initiated by hydrogen peroxide and divalent iron were studied in experiments on 15 dogs with aorta bifurcation embolism. After occlusion of the arteries the level of iron-initiated chemiluminescence decreases. The level of hydrogen peroxide-initiated luminiscence increases simultaneously, reaches the maximum after 6-hour occlusion and subsequently tends to decrease. Hydrogen peroxide-initiated statistically significant increase in luminescence allows one to form a judgement about duration of the disease. After blood flow recovery in the limbs there take place a rise in the level of hydrogen-peroxide initiated hemiluminescence and subsequent iron-initiated hemiluminescence level drop.


[Variations in prostaglandin E content in the arterial blood and cerebrospinal fluid under conditions of hypo- and hypercapnia].

A marked increase in the prostaglandin E (PGE) content in the cerebrospinal fluid (CSF) and the arterial blood of cats was observed under conditions of 3-minute hypocapnia. During 30-minute hypocapnia a restoration of the initial PGE level was seen. The PGE content in CSF increased while in the arterial blood it decreased comparatively to the control under conditions of 3-minute hypercapnia. In 30-minute hypercapnia the PGE amount in the CSF and the blood dropped in comparison with 3-minute hypercapnia being below the basal level in the blood. It is suggested that in hypocapnia PGE should limit its constrictive effect on the cerebral vessels while under conditions of hypercapnia they are to promote the realization of the cerebral vessel reaction to CO2.


[Inhibition of phytohemagglutinin-stimulated lymphocyte transformation by neutral SH-dependent proteinase of the spleen].

The effect of neutral SH-dependent proteinase of the spleen on transformation of human peripheral blood lymphocytes has been studied. Proteinase (1--10 micrograms/ml) inhibits phytohemagglutinin-stimulated (PHA) lymphocyte transformation and has no effect on spontaneous transformation. Proteinase does not alter the mitogenic properties of PHA and possesses no cytotoxicity. Therefore, inhibition of stimulated lymphocyte transformation is either resultant of proteinase direct action on the cell or associated with the inhibitor factor formation.


[Immune response of (C57BL/6xA/Sn)F1 mice in mycoplasm-virus infection].

Mixed Rauscher leukemia virus (RLV) and M. arthritidis infection of (C57BL/6xA/Sn)f1 mice-hybrids, highly resistant to RLV, was accompanied by a progressive inhibition of rosette-forming cells (RFC) and plaque-forming cells (PFC), resulting in the induction of malignant erythroblastosis identical by cytology to Rauscher leukemia. The mice-hybrids infected with A. laidlawii and RLV developed significant splenomegaly on the 21st day of the infection, and their immune response was almost entirely suppressed, but both RFC and PFC populations as well as the spleen weight returned to the initial level by the 62d day the infection. A possible role of mycoplasm in the induction and development of Rauscher leukemia is discussed.


[Allergenic activity of some kinds of plant pollen].

Allergenic active fractions of ragweed, wormwood, goosefoot and sunflower pollen with a molecular weight of 37 000, 19 000, 35 000 and 14 000, respectively, were isolated by chromatography on Sephadex. All studied allergens had similar properties: affinity to Sephadex which was more pronounced to Sephadex G-75 than to G-100; absorbing components had no activity; allergenic and antigenic activities were determined only in fractions eluted in the bed volume of the column. Affinity of the allergans to Sephadex did not depend on the eluent type, but decreased in potentiation of the buffer ionic strength.


[Effect of some stressors on the mitotic regimen of the corneal epithelium and on the level of aneuploid bone marrow cells of adrenalectomized albino rats].

It has been shown that pyrogenal administration or one-hour hyporthermia at 28--30 degrees C did not induce development of reactive inhibition in adrenalectomized rats but produced a significant increase in the level of pathological mitoses in the cornea of intact (from 4.3% to 6.3%) and adrenalectomized (from 10.6% to 12.5%) rats subjected to stress. The karyotypic analysis of the bone marrow cells under such conditions showed a significant rise in the number of aneuploid (hupo- and hyperdiploid) cells.


[Circadian rhythms of the parameters of the mouse esophagus epithelial cell kinetics].

Circadian rhythms of the mitotic activity, DNA synthesis and the parameters of the mitotic cells of the mouse esophagus epithelium were studied during the periods of maximum and minimum proliferation. The number of mitoses and DNA-synthetizing cells increases rhythmically at 1--7 a. m. from 22 p. m. to 4 a. m., respectively. When 3H-thymidine was injected to the mice at 2 a. m., tG2min was 1h; tG2+1/2 M was 2h; tS was 7.1; tG1+1/2 M was 2h; tS was 7.1; tG1+1/2 M was 15.9h. When 3H-thymidine was injected at 2 p. m., tS rose up to 8.2 and tG1+1/2 M up to 14.8h. The mitotic cycle in both series of experiments totalled 25 h. Thus, the duration of various phases of the mitotic cycle depends on the time of the day and correlates with circadian rhythms of the mitotic activity and the number of DNA-synthetizing cells. Duration of the mitotic cycle of the cells passing through it at varying time of the day is the same and approximates the period of the circadian rhythm of mitoses and DNA synthesis in esophagus epithelium.


[Effect of some drugs on colchicine uptake by colchicine-sensitive and resistant cells].

The effect of several agents on 3H-colchicine, uptake by L cells and resistant to colcemide and colchicine L-53 cells was studied. Vinblastin to which L-53 cells are cross-resistant increases labeled colchicine uptake by L and L-53 cells 3- and 8-fold, respectively. The substances which decrease ATP level in the cells (olygomycin, etc.) enhance colchicine uptake by L and L-53 cells 2--4-fold. In the presence of these substances colchicine uptake by resistant cells is more intensive than by sensitive L cells. The structural analogue of colchicine, lumicolchicine, inactive in binding the microtubular protein tubulin enhances colchicine uptake by L and L-53 cells to about equal degree.


[Effect of sodium hydroxybutyrate on the ultrastructure of cross-striated muscle tissue myocytes during physical exercise].

The ultrastructure of myocytes of the rat myocardium and skeletal muscles was studied in the control during physical exercise and under conditions of two-week sodium hydroxybutyrate pretreatment. It was shown that single maximum physical exercise caused significant changes in the fine structure of cardiomyocytes and somewhat less changes in a pronounced intermyofibrillar edema, the swelling of mitochondria and an acute fall of the glycogen level. A two-week sodium hydroxybutyrate pretreatment prevented the changes in the myocytes. The observed structure normalization induced by the drug is likely to be due to the specific nature of its metabolic transformation and to the effect on the energy exchange.


[Ultrastructure of parietal cells in summer and in the period of hibernation].

The parietal cells of active and hibernating citellus erythkogenus Br. were studied by electron microscopy and morphometric analysis. It was shown that there are clear-cut changes in the ultrastructure of parietal cells during hibernation, which reflect the absence of secretory activity of the cells. No pronounced dystrophic changes in morphology of the parietal cells were found. Structural differences due to the life stages of the cells were preserved.


Influence of levamisole on the capacity of neutrophil granulocytes for ingestion and for the reduction of nitrobluetetrazolium.

With the aid of a modification of the NBT test it has been shown in in vitro and in vivo studies that levamisole does not affect the NBT reduction capacity of neutrophil granulocytes. The increased NBT positivity of these cells under the influence of levamisol is due to stimulation of ingestion.


[A contribution to the cytostatic long-term chemotherapy of polycythemia vera (author's transl)].

From 1967 to 1978 38 patients with polycythemia vera received a long term cytostatic chemotherapy. The results of 14 patients who were given Procarbacin (Natulan) during a mean treatment time of 9 1/2 years are communicated. Two patients showed secondary tumors after 9 or 11 years respectively. The advantages and disadvantages of the various therapeutic approaches in the management of polycythemia in the literature are discussed together with our own experiences.


Trials with the auditory response cradle. 1--Neonatal responses to auditory stimuli.

The Auditory Response Cradle enables physiological response measures to be recorded from the neonate. Auditory responses are detected in the form of head rotation, startle, body activity and respiration changes. This paper reports the results of trials with 203 neonates using 250 and 1000 Hz pure tone and broad band noise stimuli. Response criteria are determined and spontaneous control 'responses' compared with those resulting from stimulus presentation. The response rate is correlated with the measured intra-meatal sound pressure level. Clear response thresholds are determined for all three stimuli. The sharpness of these motor thresholds is discussed and found to have significant implications for cost-effective neonatal auditory screening.


A forced-choice procedure to detect feigned or exaggerated hearing loss.

A forced-choice technique which may be used to confirm the existence of a non-organic hearing loss is described. Evidence is presented which shows that although this technique is not infallible it can in many cases unmask attempts to simulate or exaggerate a hearing loss. Supplementary tests using conventional audiometry demonstrated that persons with normal hearing can consistently feign a bilateral hearing loss.


Auditory fusion: a critical interval test with implications in differential diagnosis.

Pulses of white noise each of uniform duration but adjustable in interpulse spacing were presented to subjects at a comfortable loudness level. Reduction of pulse spacing below a critical interval resulted in a subjective impression of continuous noise. Eighty-four per cent of patients with sensori-neural hearing loss had a longer critical interval than normal subjects. Tentative explanations for this phenomenon are put forward in terms of desynchronisation or impaired interaction between inner and outer hair cells. Longer critical intervals found predominately in neural cases are explicable in terms of a reduction in neural conduction velocities. Interesting similarities in respect of end organ and nerve fibre lesions are apparent between critical intervals and reported electrocochleographic responses.


Transtympanic electrocochleography in Ménière's disease: variation in the amplitude of the summating potential related to clinical status.

A patient with Ménière's disease is presented in whom several transtympanic electrocochleographic recordings were made during the course of the disease. Variations in the amplitude of the Summating Potential are related to clinical status. These findings lend support to the theory that the enhanced negative SP in Ménière's disease is produced by endolymphatic hydrops. The scientific evidence for this theory is discussed.


A preliminary evaluation of remote medical manipulators.

This paper traces the development of teleoperators and associated control technology leading to the development of remote manipulators for medical application. The implications of various design approaches are elaborated in a general review of the UCLA Biotechnology Laboratory's preliminary evaluation of medical manipulators. The manipulators were made available through the auspices of the Veterans Administration, and included some early models which have since been improved. Conclusions from our preliminary evaluation, and suggestions for further development, are discussed.


The infrared light transmission hearing aid.

Recognizing the inherent weakness of the conventional hearing aid, we have developed a totally new design for hearing aids utilizing infrared (IR) light transmission. The hearing aid transmits the auditory message not as an acoustic wave, but as an infrared light beam. The invisible light beam carries the signal directly from a microphone near the speaker to the listener without any appreciable loss of level or fidelity, thereby providing true suppression of room noise. In preliminary tests, the IR aid has been shown to deliver intelligible sound under many noisy conditions where the conventional personal hearing aid is of little value. In this report, progress is reported in two related areas: (i) measurement of the hearing handicap of potential candidates for the IR aid, and (ii) engineering development of IR systems for personal and group hearing situations.


End-bearing characteristics of patellar-tendon-bearing prosthesis--a preliminary report.

The present work was aimed at investigating the degree of participation of the stump end in the weightbearing process in PTB prostheses. Despite the belief that the stump end is not capable of withstanding high loads, it was revealed that most patients can bear from 15 percent up to 45 percent and more of their weight on the stump end. The limited number of patients studied diminishes the statistical significance, but the results of this work do suggest that the weightbearing mechanism of a PTB prosthesis can be further improved by transferring more load through the stump end. It is suggested that a nondestructive technique for assessing the end-bearing efficiency of the prosthesis be developed. Also, the criteria for design of the socket end in order to produce the desired load-bearing features needs further investigation.


The Spartacus telethesis: manipulator control studies.

This paper describes a method and an experimental system permitting a severely handicapped operator, such as a quadriplegic, to control a telemanipulator. These developments form the first phase in the design of the Spartacus "telethesis". This is a manipulator system specifically developed for a quadriplegic person. Manipulator control experiments which are discussed concern four quadriplegics who have used the experimental system for significant periods of time. The present system is a laboratory simulation of a telethesis, consisting of an industrial manipulator controlled by a mini-computer. A flexible semi-sequential control and a variety of transducers permit the system to be adapted to the individual user. Thus far, the experiments performed have shown the feasibility for the four quadriplegics to effectively control a telemanipulator, using head movements and some remaining arm movements in various modes of end-point control. In particular, a position control and a "piloting" type of velocity control, both with the addition of some force limitation, have given promising results.


Incorporation and metabolism of [14C]-arachidonic acid in guinea-pig lungs.

1 Following infusion of [(14)C]-arachidonic acid into guinea-pig isolated lungs more than half the administered radioactivity was retained by the lung.2 The majority of the retained radioactivity was present in the phospholipid fraction with lesser amounts in the neutral lipid and free fatty acid fractions. When fatty acid methyl esters of the phospholipid fraction were prepared, 80% of the radioactivity co-chromatographed with methyl arachidonate.3 Transformation to cyclo-oxygenase products and subsequent emergence in lung effluent accounted for approximately 20% of infused radioactivity.4 After pretreatment of lungs with [(14)C]-arachidonic acid, stimulation of arachidonic acid metabolism with injections of partially purified slow-reacting substance of anaphylaxis (SRS-A), bradykinin or antigen challenge released rabbit aorta contracting substance (RCS) and prostaglandin-like substances (PGLS) but little radioactivity. Furthermore, repeated injections of SRS-A or bradykinin released similar amounts of RCS and PGLS but diminishing amounts of radioactivity.5 These data indicated that exogenous arachidonic acid was taken up by the lung and incorporated into phospholipids. However, this newly incorporated arachidonic acid had not equilibrated with the pool activated by SRS-A, bradykinin and antigen challenge for conversion to cyclo-oxygenase products.


Prostaglandins and the contractile action of bradykinin on the longitudinal muscle of rat isolated ileum.

1. The effect of the prostaglandin synthesis inhibitors aspirin and indomethacin (Ind) was investigated upon contractions of the perfused isolated terminal ileum of the rat to bradykinin (Bk) or potassium chloride (KCl). The release of a prostaglandin-like substance (PGLS) from the ileum was simultaneously assayed on the rat fundus strip (RFS). 2. Aspirin (610 micro M) or Ind (28 micro M) reduced contractions of the ileum to Bk perfused over the mucosal surface but not to Bk perfused over the serosal surface. 3. After perfusion of either ileal surface the effluent potentiated the contractions of the RFS to Bk. No potentiation was observed in the presence of either Ind or aspirin. 4. Contractions of the RFS to Bk were potentiated by prostaglandin E2 (PGE2) (0.7 X 10(-12) M and 1.4 X 10(-12) M) but not by either a higher (2.8 x 10(-12) M) or a lower (0.35 X 10(-12) M) concentration of PGE2. No potentiation was observed with prostaglandin F2 alpha (PGF2 alpha) at the concentrations studied. 5. Only the contractile action of Bk acting on the mucosal surface of the rat isolated perfused ileum seems to involve prostaglandin synthesis.


Effects of uptake inhibitors on responses of sheep coronary arteries to catecholamines and sympathetic nerve stimulation.

1. Transmural stimulation of intrinsic sympathetic nerves and exogenous catecholamines produce beta 1-adrenoceptor mediated relaxant responses in strips of contracted sheep coronary artery. 2. The neuronal uptake inhibitors, metaraminol, cocaine and desipramine and the extraneuronal uptake inhibitor, cortisol, failed to potentiate responses to noradrenaline or sympathetic stimulation; responses to isoprenaline were enhanced by cortisol. 3. Oxytetracycline, which inhibits binding to connective tissue fibres, did not affect responses to noradrenaline or nerve stimulation. 4. 17 beta-Oestradiol, caffeine and U0521 proved to be unsuitable compounds for studying catecholamine inactivation since they non-selectively potentiated responses to noradrenaline and isoprenaline. 5. It is concluded that catecholamine inactivation processes do not modify transmitter function in sheep coronary arteries.


Hydroxy analogues of oxytocin and of lysine-vasopressin.

1 Synthetic analogues of oxytocin and of lysine-vasopressin with an hydroxyl group in either the L ro D configuration replacing the primary amino group have been tested for biological activity.2 [1-(L-2-Hydroxy-3-mercaptopropanoic acid)] oxytocin ([L-Hmp(1)]oxytocin) was 1.5 to 2 times more potent than oxytocin on the rat uterus in situ, the rat mammary strip and the rat mammary gland in situ and 3 times more potent on the rat isolated uterus.3 The pressor activity of [1-(L-2-hydroxy-3-mercaptopropanoic acid)-8-lysine]vasopressin ([L-Hmp(1), Lys(8)] vasopressin) was 2.2 and the antidiuretic activity 2.1 times that of lysine-vasopressin.4 The [D-Hmp(1)] analogues of oxytocin and vasopressin were much less potent than the [L-Hmp(1)] analogues.5 The responses to oxytocin and its hydroxy analogues in vivo were qualitatively indistinguishable but the pressor and antidiuretic responses to the hydroxy analogues of lysine-vasopressin were prolonged compared with those to the parent hormone.6 The hydroxy analogues of oxytocin and lysine-vasopressin were not inactivated by pregnancy plasma oxytocinase.7 The results are discussed in relation to the importance of the primary amino group for the biological activity and metabolism of the neurohypophysial hormones.


Evidence for an endogenous dopamine-mediated hypothermia in the rat.

1 Unilateral intrahypothalamic injection of either dopamine (10 mug) or amphetamine (10 mug) caused a fall in core temperature in the rat. Pimozide (0.5 mg/kg, i.p.) significantly reduced the hypothermic response, whereas pretreatment with phentolamine (1 mg/kg, i.p.) or methysergide (5 mg/kg, i.p.) was ineffective.2 Systemic pretreatment with cocaine (20 mg/kg) abolished the hypothermic effect of amphetamine, but slightly enhanced the hypothermic response to dopamine.3 Systemic pretreatment with tranylcypromine (10 mg/kg) had no significant effect on the fall in core temperature induced by either amphetamine or dopamine.4 Intraperitoneal injection of cocaine and tranylcypromine, on their own, caused a fall in core temperature in the rat, which was significantly antagonized by either systemic or central pretreatment with pimozide. Phentolamine and methysergide failed to block the hypothermia.5 Unilateral intrahypothalamic injection of cocaine (20 mug) or tranylcypromine (10 mug) also caused a significant fall in core temperature, which was reduced by intrahypothalamic pretreatment with pimozide (0.5 mug), but not significantly changed by pretreatment with phentolamine (25 mug) or methysergide (5 mug).6 These results provide evidence for the presence of a dopaminergic system within the preoptic region, which mediates a lowering of core temperature in the rat.


Pharmacological effects of phosphatidylserine liposomes: the role of lysophosphatidylserine.

1. Unique among the phospholipids, phosphatidylserine depresses brain energy metabolism when injected intravenously into mice in the form of sonicated liposomes. The possibility that this effect results from a metabolic transformation of phosphatidylserine is examined in this paper. 2. A strong enhancement of the phosphatidylserine effect is induced by the incubation of liposomes with rat serum. Similar phosphatidylserine activation is observed after the incubation of the phospholipid with purified phospholipase A2 from pancreas. In both cases phosphatidylserine is split into the deacylated derivative, lysophosphatidylserine. 3. Lysophosphatidylserine reproduces with greater efficacy the effect of phosphatidylserine on brain energy metabolism. Other lysophospholipids are not effective. 4. It is concluded that the pharmacological effects of phosphatidylserine liposomes is due to the generation of lysophosphatidylserine.


Gnerations of maltreated children and multiagency care in one kindred.

Rigorously collated information on 40 members of one kindred (not previously studied) and on their spouses and cohabitees, revealed that massive multiagency support had failed fully to ascertain and prevent extensive child abuse over at least three generations. Furthermore, five other large battering families have been closely associated (by cohabitation) with this kindred. Severe behaviour disorder (starting with hyperactivity and uncontrollability) occurred in at least three-quarters of the children, and usually progressed to adult criminality. The second most common disorder was subnormal intelligence, which crucially incapacitated the rearing abilities of young mothers who were associated with antisocial cohabitees. Seven children died in infancy. The Welfare State has done little to help the plight of surviving children in this kindred.


Psychiatric aspects of sterilization: a prospective survey.

Patients consecutively referred for sterilization were examined at the time of referral, two months and one year after operation. Twenty-five per cent of the sample were identified as psychiatric cases at the time of referral, and rates of disturbance were even higher in some subgroups of women. The rate of disturbance fell in all these groups by one year after operation. New psychiatric disturbance following sterilization was similar in amount to that found in the community and was not related to any groups of women said in the literature to be at risk apart from those divorced or separated at the time of referral. Many experienced improvement in their marital and sexual relationships and only 3 per cent expressed feelings of regret.


Sexual and marital problems in a psychiatric out-patient population.

The study aimed to identify those patients referred to a psychiatric out-patient clinic who had sexual or marital difficulties and who could be offered help with these problems, although none of the patients had been referred primarily for sexual or marital therapy. The methods of assessment formed a series of filtering devices for screening the sample, and possible reasons for discrepancies in the results are discussed. Twelve per cent of the sample had sexual or marital problems and were offered treatment, and it is suggested that this proportion may be an underestimate of the 'true' frequency of such problems in the sample. Implications of this finding for the provision of treatment resources in the psychiatric out-patient setting are considered.


Sheltered accommodation in the community mental health service in the 13th Arrondissement of Paris.

The well-developed community psychiatric services in the 13th Arrondissement use a large number of places in sheltered accommodation. Reasons for this are explored. It may be that there are areas in the U.K. where the need for such accommodation is greater than the Department of Health and Social Security has estimated.


Nurse therapists in psychiatry: developments, controversies and implications.

This paper concerns a new clinical role for psychiatric nurses--as case managers for selected adult neurotics with behaviour problems. The role involves unusual autonomy. The selection and training procedures are unusually rigorous and focus on general case-management as much as behavioural skills. The number of service posts offered these therapists is rising. These developments have wide implications for other personnel, particularly in respect of authority and responsibility boundaries, selection and training procedures, and team structure.


Statistical errors in papers in the British Journal of Psychiatry.

In the 12 months from July 1977 to June 1978, out of 168 papers in the British Journal of Psychiatry, 139 (83 per cent) presented numerical results. A total of 63 papers contained statistical errors and at least one drew unsupportable conclusions. In many cases the errors were not considered to be severe, but they were often sufficient to raise doubts about some inferences. It is suggested that more consultation of investigators with medical statisticians, a basic training in statistical methods in the preclinical years, and more extensive statistical refereeing are needed.


A better outlook for schizophrenics living in extended families.

Cases of schizophrenia and schizophreniform attacks living in extended families have been compared to cases with similar diagnoses in nuclear families. Both diagnostic groups living in extended families presented earlier: they had lower rates of withdrawal symptoms and higher rates of behavioural disturbances and subjective suffering. Inter-generational conflict was a significantly more common precipitating factor in patients living in extended families; this was therapeutically utilized to induce family support. Patients from extended families had a lower tendency to deteriorate into with drawn, affectively blunted residual states.


Schneider's First Rank Symptoms: their prevalence and diagnostic implications in an Asian population.

In an in-patient population in Sri Lanka, only those receiving a diagnosis of schizophrenia had Schneider's First Rank Symptoms. Amond 65 males and 104 females, the prevalence of FRS was 25.4 per cent. Those patients with FRS in the first episode are likely to develop more during subsequent episodes. An attempt is made to explain the findings on a cultural basis.


Clinical significance of plasma drug and prolactin levels during acute chlorpromazine treatment: a replication study.

Nineteen patients with acute psychoses, the majority schizophrenics, were studied in the course of chlorpromazine (CPZ) treatment. Plasma levels of the drug, plasma prolactin (PRL), extrapyramidal side-effects (EPS) and changes in mental state were monitored weekly, as in our earlier study. The results confirm some of our previous findings: (a) plasma CPZ levels vary widely among patients and correlate poorly with daily doses of CPZ; (b) increased plasma PRL is associated with higher plasma CPZ levels and is more common among the patients who develop EPS; and (c) none of these three variables differ between groups of patients with good and poor treatment outcome. However we did not confirm our previous finding of a significant association between EPS and higher plasma CPZ, nor did we find that the ratio of CPZ-sulphoxide to CPZ differed between the improved patients and the rest.


Hypercalcaemia-induced psychopathology in malignant diseases.

Seven out of twelve patients with malignancy and hypercalcaemia had associated psychiatric symptoms. The mental aberrations disappeared when the calcium levels returned to normal after treatment.


Personality and extinction of a conditioned electrodermal response.

This study investigated personality differences in extinction of a conditioned EDR. The subjects were selected on the basis of EPI neuroticism and impulsivity scores. Subjects with scores on, or near, the sample means were excluded. Fifty-one subjects underwent an aversive discrimination conditioning procedure. The reinforcement was 75 per cent, the UCS was 100 dB white noise for 1 sec, while the CS was one of five different coloured lights of 2 sec duration. The UCS was presented at CS termination. Subjects were informed of the CS--UCS contingency before the acquisition phase and informed of the onset of the extinction phase. Subjects high on impulsivity showed significantly (P less than 0.01) greater extinction of the discrimination than subjects low on impulsivity.


Psychopathy and personality: the dimensionality of self-report and behaviour rating data in abnormal offenders.

Factor analyses of personality test data in two samples of offenders admitted to psychiatric security hospitals yielded two higher order factors identified as psychopathy or antisocial aggression versus conformity, and social withdrawal versus sociability. One sample was also rated for ward behaviour by nursing staff, and similar factors emerged from the behaviour rating data. The self-report dimension of psychopathy correlated significantly with the corresponding rating dimension at the time of admission and, for medicated subjects only, with ratings obtained 2 years later. Cross-media convergence of the withdrawal dimension was not found at the time of admission, but for unmedicated subjects, initial self-reports correlated significantly with the equivalent rating dimension as assessed 2 years later. The two dimensions therefore appear to measure meaningful behavioural dispositions. While they define the same dimensional space as neuroticism and introversion--extraversion, they appear to provide a more appropriate framework for classification within this population of offenders.


Shyness as a dimension of personality.

Examination of a number of major studies of personality questionnaires reveals the existence of a shyness factor which is related to but separable from both introversion and neuroticism, and which loads on items referring to feeling uncomfortable and self-conscious, and keeping in the background in certain kinds of social situations. The fears that are generally expressed about social situations--of being negatively evaluated and of being socially inadequate--are reflected in subjects' descriptions of the causes of shyness, and these findings suggest a model of shyness in terms of individual differences in susceptibility to threat.


The effects of social reinforcement on dominant and dependent mildly intellectually handicapped school-leavers.

The aim of this study was to replicate Exline & Messick's (1967) study of eye-contact interview behaviour with college students on a group of mildly intellectually handicapped students. Twenty subjects (mean CA 14.02 years, SD 0.45 years, mean IQ 72.0, SD 7.6) attending a metropolitan school for the mildly mentally handicapped were classified as dominant or dependent by teacher ratings and sociogram analysis. They were given large or small amounts of reinforcement for eye-contact when interviewed by their teacher. Although the study failed to replicate some of Exline & Messick's findings, results indicated a feedback rather than reward model in explaining the effects of social reinforcement on eye-contact in interviews. Implications for communication training for such intellectually handicapped students is discussed.


Orienting responses and locus of control.

Few studies have attempted to relate the locus of control (Rotter, 1966) variable to physiological activity. This paper describes the heart-rate and skin conductance responses of 40 subjects exposed to a series of auditory stimuli, in relation to their locus of control scores. It was found that those scoring relatively 'externally' on the locus of control scale gave less decelerative and more accelerative heart-rate responses and tended to give larger skin conductance responses when there was a change in stimulus characteristics, than those scoring 'internally'. These results may be interpreted to support Lazarus' (1966) suggestions that control over a situation lessens the threat perceived in that situation. They also indicate that internal subjects tend to seek information to increase their control.


Hypnosis as obedience behaviour.

Obedience to authority has been implicated in hypnotic behaviour from the earliest theories. However, no exact formulation of a model of obedience was available until Milgram's experiments in the 1960s. Milgram's model can usefully be applied to hypnotic behaviour in terms of antecedent and immediate antecedent variables, binding and strain factors and the resolution of conflict. An experiment was carried out to test the hypothesis that the presence of a 'disobedient' hypnotic subject in the same room as another hypnotic subject would lower the susceptibility to hypnosis of the second subject. Results showed that when one subject disobeyed by leaving the hypnotic situation, susceptibility was significantly less than that of control subjects. It is suggested that hypnosis can be viewed as an 'agentic state' whereby the subject gives up autonomy and relinquishes responsibility for his actions to the hypnotist, whilst remaining responsible to the hypnotist for his performance as an hypnotic subject.


The long-term consequences of head injury: a discussion of the evidence with special reference to the preparation of legal reports.

An outline is presented of the longer term consequences of severe closed head injury (i.e. those exceeding the period of PTA). It is shown that head injury can have very serious consequences for the victim. Despite the fact that measures of IQ have been claimed to show considerable recovery it is likely that severe head injury invariably results in some degree of permanent functional impairment. The vexatious issue of the 'post-concussional syndrome' is discussed and the conclusion is reached that it is unlikely that this syndrome is solely produced by the possibility of compensation.


The effect of cues of quantity visible and preference on drinking by alcoholic and non-alcoholic subjects.

When a glass (150 ml) of a preferred/non-preferred orange drink was visible alcoholic subjects drank less than non-alcoholics. When a glass+jug (900 ml) was visible the alcoholics drank significantly more than the non-alcoholics. The cues of quantity visible and preference had an additive effect on the alcoholics' consumption. The experiment was modelled on a study by Nisbett (1968 a) concerned with cues controlling food intake in obese and non-obese subjects. An analogy was drawn between overeating by the obese and overdrinking by alcoholics.


The structure of delinquent values: a repertory grid investigation.

Two experiments are reported, employing repertory grid technique and designed to test predictions derived from Matza & Sykes' (1961) account of the relationship between delinquent and conventional values. These predictions were confirmed. In addition, following the demonstration of equivalence in the structure and content of value systems in delinquents and non-delinquents, certain differences between the groups were observed, which were eventually attributed to delinquency rather than socio-economic status. On the basis of the results, a two-component structural hypothesis of delinquent values is advanced. Implications for theories of delinquency are discussed and directions for further research suggested.


Two non-reactive field experiments on stealing from a 'lost' letter.

Two non-reactive field experiments were conducted to study factors influencing stealing. The subjects were people in the streets of London who picked up a stamped, addressed, unsealed, apparently lost letter, containing a handwritten note and in most cases also a sum of money. Experiment 1 employed a 2 x 2 x 2 between-subjects factorial design, varying the amount of money (20p or 1 pound), the form of the money (cash or postal order) and the apparent victim (an old lady or a higher class male). Ten letters were dropped in each of the eight conditions, and a further 10 in each of two control (no money) conditions. Stealing was greatest with cash and the higher class male victim, but did not vary significantly with amount of money. In Expt 2, larger amounts of money were used, and the apparent victim in each case was the old lady. Twenty letters were dropped in each of three conditions, control (no money), 1 pound and 5 pounds in cash, and stealing did vary significantly with amount of money. In both experiments, younger people were more likely to steal, as were those who put the letter in pockets or handbags after picking it up.


Some conceptual difficulties with the term 'schizophrenia': an alternative model.

The term 'schizophrenic' is used in two distinct ways: namely to describe a particular type of illness and also as a label for the person suffering from this illness. If we concentrate on the 'illness' conception of schizophrenia it readily becomes apparent that its definition and nature varies somewhat from one proponent to another. Added to this is the problem that the major conceptions of schizophrenia are based on disjunctive concepts. The basic argument of this paper is that while all clinical conceptions of schizophrenia have assumed the existence of a disease-entity syndrome, no attempt has ever been made to test its logical alternative: namely a random-symptom model. Some data will be presented which are at least compatible with this alternative and some of the theoretical implications spelt out.


Mental imagery, human memory, and the effects of closed head injury.

Several recent experiments suggest that mental imagery is relevant to an explanation of memory impairment resulting from neurological damage. This study compared a group of patients with recent closed head injuries with a control group of orthopaedic patients in their recall of concrete and abstract words. The head-injured subjects demonstrated a specific deficit in the recall of concrete material, which was interpreted as an impairment in the use of mental imagery as a form of elaborative encoding in long-term memory. It is suggested that the understanding of clinical conditions would be assisted by the application of the procedures and theoretical interests of experimental psychology.


The Revised Kendrick Battery: clinical studies.

The former Kendrick Battery--the Synonym Learning Test (SLT) and the Digit Copying Test (DCT)--has been revised. The new version comprises the Object Learning Test (OLT) and the DCT. The discrepancy between Mill Hill and WAIS Verbasl IQs as a diagnostic sign has been eliminated. The Revised Battery has been shown to discriminate between elderly dementing and non-dementing subjects, and also between normal, depressed, and dementing elderly subjects. Utilizing test-retest data it has been found possible to discriminate absolutely between dementing and non-dementing subjects. The reliabilities and validities of the Battery have been ascertained by examining a broad spectrum of elderly subjects: normal, depressed, dementing and institutionalized.


Angiographic appearance of post-operative aortic valvar stenosis. Angiographic and haemodynamic correlation.

The classic angiographic appearance of a stenotic aortic valve is that of "dooming". Adequate relief of the obstruction can be obtained with an aortic valvotomy. It should be stressed, however, that even in the absence of an haemodynamically significant gradient, "dooming" of the aortic valve persists over many years and is explained by the presence of an anatomically bicuspid valve.


The left atrial notch: a sign of persistent left superior vena cava draining to the right atrium.

A notch in the inferior border of the left atrium has been observed in patients with a persistent left superior vena cava draining via the coronary sinus into the right atrium. It is suggested that the notch is due to the dilated coronary sinus.


Age related gross changes of the liver and right diaphragm, with special reference to partial eventration.

A total of 38937 6 X 6 cm chest films, made in three series of check-up programmes for local residents above the age for nursery school, were examined for partial eventration of the right dome of the diaphragm in relation to age. It was found that after nursery school age, eventration and irregularity of the right dome increased with age, particularly among women over the age of 60. In a series observed in a rural region, marked eventration was found in more than 1% of the women above 60 years. In another study on 1 332 liver scans in patients without intrinsic liver disease, a prominent, dome-like elevation of the right lobe of the liver was also very frequent among older women. It is concluded that the majority of right-sided eventrations are acquired and may be attributable to dietary and dressing habits.


Radiation dose to critical organs of staff and patients during neuroradiology.

The doses delivered to some critical organs of patients and staff during cerebral angiography, X-ray computer assisted tomographic scanning and 99Tcm brain scanning have been measured or assessed. The results show that doses received by staff and by the patients' gonads are generally quite low. However, patients having two or more of the investigations could receive skin and orbit doses in excess of 25 rad.


Cytotoxicity of misonidazole in vivo under conditions of prolonged contact of drug with the tumour cells.

A single high dose of misonidazole (greater than or equal to 1 mg/g) given to BALB/c mice bearing EMT6 tumours kills approximately 90% of the tumour cells. No cytotoxicity, however, can be demonstrated at more clinically relevant dose levels (less than 0.3 mg/g). However, Stratford and Adams (1978) have shown that extensive killing of hypoxic cells occurs in vitro with low concentrations of misonidazole provided that the contact time is long, such as would occur in man in whom the plasma half-life of misonidazole is approximately 12 hours. We have attempted to simulate the human situation in the BALB/c mouse by performing bilateral kidney ligations prior to injection of misonidazole. This extends the apparent plasma half-life of misonidazole plus its O-demethylated metabolite after an injection of 0.1 mg/g of misonidazole from approximately one hour to seven hours. This provided a good fit over the first nine hours to the in vitro simulation of the human plasma clearance curve done by Stratford and Adams (1978). However, despite finding extensive killing of tumour cells at the high dose of misonidazole of 1.2 mg/g, no detectable cytotoxicity was observed in the low dose (0.1 mg/g) mice in which the plasma half-life had been extended to seven hours. This suggests that misonidazole will produce little, if any, cytoxocity to human tumours.


Gastric reduction for morbid obesity: technique and indications.

The results of gastric reduction for obesity in 12 patients are described. Emphasis is laid on preoperative weight loss, using jaw wiring in 9 patients. The successful outcome of the operation was found to depend on the formation of a small gastric pouch and a narrow gastro-jejunal anastomosis. A constant-sized pouch was achieved by forming the pouch around a 100-ml silicone balloon devised for the purpose. Postoperative results were good in 7 patients, partial success was achieved in 3 patients and there were 2 failures. It is concluded that the procedure will produce successful results provided that a small proximal pouch with a narrow outlet is fashioned in motivated and psychologically well-balanced patients.


Hepatic resection for trauma, tumour and biliary obstruction.

Hepatic resection was performed in 37 patients. Fifteen emergency procedures were undertaken for blunt trauma and 16 patients had elective resection for hepatic tumour. A further 6 resections were performed for benign biliary tract obstruction. The importance of preoperative assessment and the indications for resection are discussed particularly in relation to resection for biliary obstruction. Operative procedures are outlined and the technique of extended left lobectomy is described in detail.


In vitro dissolution of human gallstones: the efficacy of heparinized solutions.

The use of heparinized solutions to dissolve or fragment stones retained in the biliary tree after surgery is still controversial. In this in vitro study heparin in concentrations of up to 100,000 mu/l did not dissolve or fragment the stones examined, nor did it enhance the dissolution properties of the bile salt, sodium cholate.


Intestinal bacterial metabolism of protein and bile acids: role in pathogenesis of hepatic disease after jejuno-ileal bypass surgery.

Jejunal bacterial colonization and intestinal metabolism of bile acids and protein by bacteria have been investigated in 12 patients with abnormal liver histology following jeujno-ileal bypass surgery for obesity. Aerobic and/or anaerobic colonic flora was present in jejunal aspirates from 8 of 12 bypass patients, but in none of the controls. Intestinal protein metabolism and bile acid deconjugation (measured by urinary indican excretion and 14C-glycocholic acid breath test) was significantly enhanced in bypass patients. Intestinal bacterial overgrowth, with abnormal intestinal metabolism by bacteria of ingested nutrients and bile acids, could contribute to hepatic disease after bypass surgery via the production of endogenous hepatotoxins.


The effect of bile acids on colonic myoelectrical activity.

The effect of different concentrations of sodium cholate, sodium chenodeoxycholate and sodium deoxycholate on colonic myoelectrical activity was studied in 4 dogs. There was no statistically significant difference in percentage motility, motility index, basal pressure or mean slow wave frequency with either cholic or chenodeoxycholic acid (5--15 mM). Deoxycholic acid (15 mM), however, caused a marked increase in percentage motility (median control value 4.1, range 0--23; after installation, median value 27--0, range 20.6--45.0, P less than 0.001). This was accompanied by an increase in spike activity, but no alteration in mean slow wave frequency or basal pressure was seen. Cholestyramine inhibited the motor response. It appears that only deoxycholic acid affects both motility and absorption, presumably by different pathways, and may thus assume importance in disorders of colonic motility.


Chylous ascites and obstructive lymphoedema of the small bowel following abdominal radiotherapy.

The case history of a patient who developed chylous ascites following abdominal irradiation for recurrent carcinoma of the colon is presented. Laparotomy revealed generalized radiation damage of the small bowel with a particularly severely affected segment of jejunum, from the serosal surface of which chyle was seen to be leaking. Mesenteric lymphangiography revealed an obstruction to lymphatic drainage in the mesentery. Resection of the worst affected segment of bowel prevented further development of chylous ascites.


Leucocyte counts in the diagnosis and prognosis of acute appendicitis in children.

Preoperative total and differential leucocyte counts were made in 225 children with acute appendicitis, 50 children with a normal appendix and 100 children with acute abdominal pain which resolved without any therapy. When adjusted to age, neutrophilia in 96 per cent, 30 per cent and 32 per cent and leucocytosis in 41.8 per cent, 4 per cent and 3 per cent was noted in the respective groups, the levels being significantly higher in the acute appendicitis group than in the other two groups. Among children with appendicitis, infections were observed in 62.8 per cent of the group with leucocytosis and in 13.7 per cent of the group with a normal leucocyte count; the difference is statistically significant. It is suggested that in acute appendicitis neutrophilia supports the diagnosis and leucocytosis indicates the prognosis. The rate of infection increases as the total leucocyte count rises above the upper normal limit. The difference of opinions on the significance of leucocyte counts in acute appendicitis is discussed.


Controlled environment therapy in the management of lymphoedema: a case report.

A case of surgically-treated elephantiasis of a lower limb is reported in which preoperative controlled environment therapy (CET) proved to be an effective, rapid method of reducing the oedema.


A new vascularized bone graft transferred by microvascular anastomosis as a free flap.

We describe a new, versatile bone and soft tissue compound free flap which may be transferred quickly and simply and describe its use in the treatment of compound fracture of the tibia and fibula with non-union due to loss of bone. The iliac crest and overlying soft tissue is transferred to the leg in one stage by microvascular anastomosis of the deep circumflex iliac vessels to vessels in the leg.


The presentation of gastrointestinal lymphoma: study of a population.

The clinical presentation and findings in 45 patients with lymphoma of the gastrointestinal tract occurring in an unselected population are described. Nineteen patients presented as emergencies with haemorrhage, perforation, pyloric stenosis or intestinal obstruction. Systemic symptoms, peripheral lymph node enlargement and hepatosplenomegaly were rare, and a preoperative diagnosis of lymphoma was seldom made. Endoscopy was superior to radiology in defining lesions in the stomach and duodenum. Lesions which were multicentric, or of unusual macroscopic appearance, were common in the small bowel, and these should raise the suspicion of lymphoma. Local and systemic recurrence was common, but was not always fatal. Patients with gastric lymphomas survived longer than those with intestinal disease.


Pneumatosis coli and sigmoid volvulus: a report of 4 cases.

Pneumatosis coli is an uncommon disease which is frequently misdiagnosed and inappropriately treated. The condition can usually be managed conservatively but complications requiring surgical treatment are occasionally encountered. We describe 4 patients with pneumatosis coli and associated volvulus of the sigmoid colon. Some of the factors that may have contributed to pneumocyst formation in these 4 patients are discussed with reference to recent advances in our understanding of the pathogenesis of pneumatosis coli.


Multiple intestinal perforation due to Celestin tube.

Two cases of multiple intestinal perforation caused by the nylon from the core of disintegrating oesophageal Celestin tubes migrating down the alimentary tract are described. It is suggested that Celestin tubes should not be used in patients likely to survive for more than a few months.


Postoperative hypoxaemia: oesophagectomy with gastric replacement.

Pre- and postoperative arterial blood samples were analysed for oxygen partial pressure (PaO2) and carbon dioxide partial pressure (PaCO2) in a consecutive series of 21 patients subjected to two- or three-stage oesophagectomy for carcinoma of the oesophagus. The forced vital capacity (FVC) was measured at the same time. On the second postoperative day the PaO2 showed a fall to 65 per cent of the preoperative value followed by a gradual recovery to 78 per cent on the tenth postoperative day. After 13 weeks the PaO2 had recovered to 95 per cent of the preoperative value. The PaCO2 decreased in the early postoperative period but had returned to the preoperative level by the tenth day. The FVC showed a trend similar to the PaO2 with a reduction to 33 per cent of the preoperative value on the second postoperative day, 52 per cent on the tenth day and 85 per cent after 13 weeks.


Salmonellosis associated with late rupture of an aortofemoral bypass graft.

Salmonella infection is a rare cause of rupture of the atherosclerotic abdominal aneurysm. A case never previously reported is presented in which salmonella infection occurred involving an aortofemoral bypass graft which had been inserted 10 years previously. The infection caused a leak in the region of the graft which presented as a haematoma in the thigh.


Haematemesis in infantile hypertrophic pyloric stenosis: the source of the bleeding.

Thirteen infants with haematemesis associated with hypertrophic pyloric stenosis were investigated in order to elucidate the source of bleeding. All 13 patients showed endoscopic evidence of oesophagitis, moderate in 4 and severe in 9. No significant gastric mucosal lesion was found. It was concluded that the site of the haemorrhage was the oesophageal mucosa in all 13 infants. Eleven of the patients experienced troublesome postoperative vomiting.


The concept of disease.

The connotations of the term "a disease" were investigated by studying the ways in which both medical and non-medical people used the word. A list of common diagnostic terms was read slowly to groups of non-medical academic staff of a university, secondary-school students, medical academics, and family practitioners, who then indicated whether they thought each word referred to disease.All groups rated illnesses due to infections as diseases, but the doctors, and particularly the general practitioners, were more generous in accepting as diseases the terms for non-infectious conditions. Apart from the nature of the cause, the most influential factor in determining whether or not an illness was considered to be a disease was the importance of the doctor in diagnosis and treatment.These findings provide further evidence that there is ambiguity about the meaning of the term disease. To the layman a disease seems to be a living agency that causes illness. Doctors have obviously accepted more heterogeneous defining characteristics but remain reluctant to adopt unequivocally nominalist ways of thought. The position is not unlike that in the physical sciences, in which there is a good precedent for distinguishing between the formal scientific and the everyday uses of terms such as "force" and "power."


Diet and Crohn's disease: characteristics of the pre-illness diet.

Thirty newly diagnosed patients with Crohn's disease were interviewed about their habitual, pre-illness diet and compared with 30 healthy controls, matched for age, sex, social class, and marital status. The patients ate substantially more refined sugar, slightly less dietary fibre, and considerably less raw fruit and vegetables than the controls. A diet high in refined sugar and low in raw fruit and vegetables precedes and may favour the development of Crohn's disease.


Treatment of Crohn's disease with an unrefined-carbohydrate, fibre-rich diet.

Thirty-two patients with Crohn's disease were treated with a fibre-rich, unrefined-carbohydrate diet in addition to conventional management and followed for a mean of four years and four months. Their clinical course was compared retrospectively with that of 32 matched patients who had received no dietary instruction. Hospital admissions were significantly fewer and shorter in the diet-treated patients, who spent a total of 111 days in hospital compared with 533 days in the non-diet-treated control group. Whereas five of the controls required intestinal operation, only one diet-treated patient needed surgery. This is in strong contrast to general experience with this disease. Treatment with a fibre-rich, unrefined-carbohydrate diet appears to have a favourable effect on the course of Crohn's disease and does not lead to intestinal obstruction.


Fibreoptic injection of oesophageal varices.

A new technique for injecting sclerosant into oesophageal varices uses a flexible gastroscope. Once the gastroscope has been inserted a flexible tube with a window cut into its distal end is pushed down over the gastroscope until a varix protrudes through the window. The varix can then be injected with a needle passed down the biopsy channel of the gastroscope. Once the varices have all been injected in this way the tube is advanced to compress the injection sites and so help control bleeding. This method, using a flexible gastroscope, has proved easier and safer than the traditional method using a rigid gastroscope.


Pregnancy in patients presenting with hyperprolactinaemia.

Ninety-two pregnancies occurred in 76 hyperprolactinaemic patients treated with bromocriptine. Half conceived within three months of attempted conception. There was no evidence of an increased rate of spontaneous abortion, fetal abnormality, or multiple pregnancy; the three twin pregnancies occurred in women who were additionally treated with clomiphene and human chorionic gonadotrophin. Thirty-one patients had radiological evidence of a pituitary tumour; 14 with major radiograph changes in the pituitary fossa or serum prolactin concentrations greater than 100 ng/ml received pituitary irradiation before conception. None of the latter showed evidence of enlargement of the tumour during pregnancy. In contrast two of the four patients with similar tumours but who were not irradiated developed visual field defects, one with gross destruction of the pituitary fossa. Prophylactic treatment to limit subsequent tumour expansion during pregnancy in patients with prolactinomas is indicated, and pituitary irradiation before conception appears to be a safe and effective method to achieve this goal.


Are breast-fed babies still getting a raw deal in hospital?

After preliminary validation of test weighing under ward conditions the fluid intake and weight gain of 39 breast-fed and 25 artificially fed infants were compared. All were fed every four hours for six feeds a day, and the breast-fed infants received dextrose supplements only. The average intake and weight gain of the breast-fed group was significantly less than that of the group fed artificially.When cows'-milk supplements are withheld from breast-fed infants a four-hourly regimen provides insufficient stimulus to lactation for their needs in the first week of life. If more than lip service is to be paid to the mother who desires to breast-feed in hospital, early and more frequent feeding should be practised.


De novo acute infection and reactivation of hepatitis B virus in established cirrhosis.

Five patients with cirrhosis proved by biopsy had clinical, biochemical, and serological evidence of an acute hepatitis B infection. In two the illness was fulminant and led to death. Only one patient completely recovered. Serological markers for the hepatitis B virus were absent before the onset of the acute illness in four patients, which suggested that a de novo infection had been acquired as a result of recent transfusions of blood or blood products. The fifth patient, who had Goodpasture's syndrome, had antibody to the core of hepatitis B virus, indicating previous exposure to the virus; his acute hepatitis may have been related to immunosuppressive drug treatment, which may have reactivated a dormant virus infection. Thus an acute type B viral hepatitis due to either a de novo or a reactivated infection may be superimposed on cirrhosis.


Verification of smoking history in patients after infarction using urinary nicotine and cotinine measurements.

Urinary concentrations of nicotine and its major metabolite cotinine were measured in volunteers whose smoking habits were known to test the reliability of the measurements as indicators of current smoking. In the non-smokers detectable concentrations were always below the confidence limits set for the method, while in smokers the concentrations were always above these limits. After subjects stopped smoking cotinine appeared in the urine for longer than nicotine and was still detectable at least 36 hours after the last cigarette had been smoked. When this method was used to verify the smoking histories given by patients attending an infarction clinic it was estimated that 46-53% of previous smokers had actually stopped smoking compared with the 63% who said that they had done so. It is suggested that simultaneous assays of urinary nicotine and cotinine may be a useful means of verifying patients' current smoking habits.


Improving medication compliance: a randomised clinical trial.

A medical monitor which recorded the date and hour each time a medicine bottle was opened was used to evaluate a programme for improving patients' compliance with their treatment. Eighty-two patients with glaucoma who had been prescribed pilocarpine eye drops three times daily to prevent visual loss were randomised into two groups. Both groups used the medication monitor during two 20-day periods, but before the second period the experimental group were given an education and tailoring programme in an attempt to improve their compliance. Nine patients missed the second treatment period and were excluded from the analysis. The patients in the experimental group showed significantly improved compliance when compared with the control group. The numbers of missed doses were reduced by about half, as was the proportion of time that exceeded the eight-hour dose intervals. Follow-up studies are needed to determine how long the improved compliance persists, but anyone considering setting up an education and tailoring programme should recognise the extent to which therapeutic efforts are wasted because of non-compliance.


Long-term urethral catheter drainage.

Long-term catheter management is best conducted by specially trained community staff, provided there is close liaison with the urologist. Patients, hospital staff, and the primary health care team all benefit. The scheme is cost-effective, more convenient for patients and relatives, and reduces the need for emergency calls to the general practitioner and hospitals. We advocate development of similar schemes in other districts.


Intravenous N-acetylcystine: the treatment of choice for paracetamol poisoning.

One hundred cases of severe paracetamol poisoning were treated with intravenous N-acetylcysteine (acetyl-cysteine). There was virtually complete protection against liver damage in 40 patients treated within eight hours after ingestion (mean maximum serum alanine transaminase activity 27 IU/1). Only one out of 62 patients treated within 10 hours developed severe liver damage compared with 33 out of 57 patients (58%) studied retrospectively who received supportive treatment alone. Early treatment and acetylcysteine also prevented renal impairment and death. The critical ingestion-treatment interval for complete protection against severe liver damage was eight hours. Efficacy diminished progressively thereafter, and treatment after 15 hours was completely ineffective. Intravenous acetylcysteine was more effective than cysteamine and methionine and noticeably free of adverse effects. It is the treatment of choice for paracetamol poisoning.


Haemodynamic effects of salbutamol in patients with acute myocardial infarction and severe left ventricular dysfunction.

The haemodynamic effects of salbutamol infusions at rates of 10,20, and 40 micrograms/min were measured in 11 patients with acute myocardial infarction complicated by left ventricular failure. Four patients also had cardiogenic shock. Consistent increases were observed in cardiac outputs at all doses (up to 56% at 40 micrograms/min), while the mean systemic arterial pressure fell slightly (average 5 mm Hg), implying a reduction in peripheral vascular resistance. Changes in right atrial pressure and indirect left atrial pressure (measured as pulmonary artery end-diastolic pressure) were small and not significant. Analysis of data from individual patients showed that the greatest increment in cardiac output was reached at 10 micrograms/min in two cases, 20 microgram/min in three, and 40 micrograms/min in the remaining six. Heart rate at these doses increased by an average of only 10 beats/min. Salbutamol failed to reduce left ventricular filling pressure and cannot be recommended for the treatment of pulmonary oedema in acute myocardial infarction. The increase in cardiac output, however, was considerable, so that the drug may be important in the management of low-output states. This action is probably a result of peripheral arteriolar dilatation (itself a result of beta 2-adrenoreceptor stimulation) and is achieved with little alteration in the principal determinants of myocardial oxygen requirement.


The Scottish perinatal mortality survey.

Perinatal deaths in single births that occurred in Scotland during 1977 were investigated by case-record analysis. Causes of death were divided into nine categories, an extended version of the Aberdeen classification being used. Out of 1012 single perinatal deaths, 265 were due to fetal abnormality, which in 140 cases was malformation of the central nervous system. Of the 747 normally formed infants, 446 weighed 1500 g or more, of whom 82 died intra partum and 154 were born alive. The largest single cause of death was low birth weight in normally formed babies whose mothers had no complications of pregnancy (302 cases). Of these babies, 103 (34%) were growth-retarded. Rhesus incompatibility (16 deaths) and maternal diabetes (seven deaths) were not major causes of perinatal loss. These results were thought to be valuable in illustrating the main causes of perinatal mortality and directing attention to important issues. Hence a modified version of the study is being continued to see whether yearly audit by regional assessors is a feasible and practical way of monitoring trends in perinatal mortality.


Monitoring of psychotropic drug prescribing in general practice.

Over 1000 repeat prescriptions of psychotropic drugs, which were given without the doctor seeing the patient, were analysed from a population of over 100 000 patients during a two-week period. The analysis showed that the longer repeat prescribing had taken place the older the patient was likely to be and the less closely were they monitored by their general practitioner.