Methadone disposition during the perinatal period in humans.

To determine clinical and analytical feasibility of studies of narcotic disposition in the perinatal period, an initial prospective study of methadone disposition in one female, in chronic methadone treatment for heroin addiction, throughout pregnancy and in her neonate have been carried out. Two additional methadone-maintained patients were studied to determine the levels of methadone in simultaneously obtained specimens of plasma and breast milk. A progressive lowering of plasma levels of methadone during late pregnancy was observed. Measurable amounts of methadone were found in amniotic fluid, but without evidence of significant accumulation in this fluid. The apparent excretory half-life of methadone in the neonate was 32.5 hr. Amounts of methadone in breast milk were very small; the ratio of milk to plasma concentrations ranged from 0.05 to 1.2 over multiple time points following a daily oral dose of methadone. The total amounts of methadone which could be delivered to a neonate during the first month of life in breast milk from a mother maintained on moderate doses of methadone (e.g., 50 mg) are very small (less than 60 micrograms/d).


The prostaglandin antagonist polyphloretin phosphate behaves as a nonspecific inhibitor of rat hepatic adenylate cyclase.

The mechanism of the nonspecific inhibitory effects of the prostaglandin antagonist polyphloretin phosphate (PPP) was studied on a partially purified adenylate cyclase preparation from rat livers, PPP in concentrations above 100 micrograms/ml reduced the enzyme activity below basal values regardless of the stimulator used. The activity of adenylate cyclase in a persistent active state due to enzyme preincubation with guanylylimidodiphosphate (Gpp(NH)p) was inhibited 5-10 times more weakly. Kinetic studies indicate that PPP does not influence directly the catalytic site for ATP. PPP seems to produce permanent enzyme inhibition which is not antagonized by repeated washing ot the enzyme preparation. The reduced catalytic activity of adenylate cyclase retains after treatment with PPP the character of its responsiveness to the stimulators, which depends on the state of the enzyme before exposure to the inhibitor.


Alteration of specific binding of prostaglandin F2 alpha by hyperproliferative skin membrane fractions from essential fatty acid-deficient rats.

Specific binding of [3H] PGE2 and [3H] PGF2 alpha to smooth endoplasmic reticulum (SER) membranes prepared from rat skin at various stages of the development of essential fatty acid (EFA)-deficiency syndrome was demonstrated in these studies. The normal SER-binding capacity for [3H] PGE2 per mg of membrane protein was approximately two-fold that for [3H] PGF2 alpha in control rats fed a diet rich in essential fatty acids (EFA). Two weeks following the feeding of the animals with the EFA-deficient diet: histological evaluation revealed hyperplasia and acanthosis of the epidermal layer; a two-fold increase in labeling index (a marker for DNA synthesis) and no alteration in the SER-binding capacity for [3H] PGE2 or [3H] PGF2 alpha. By the 12th week however, labeling index had increased six-fold, accompanied by a five-fold increase in SER-binding capacity for [3H] PGF2 alpha. SER-binding for [3H] PGE2 was relatively unaltered. These results have demonstrated a relationship between marked alteration of skin SER-binding capacity for PGF2 alpha and the increase in epidermal hyperplasia and proliferation characteristic of the skin of the EFA-deficient rat. Refeeding of the animals with EFA-rich diet restored the epidermal proliferation and the SER-binding capacity to PGF2 alpha to normal conditions.


Opposite and mutually antagonistic effects on uterine contractility of two epimeric forms of a synthetic prostaglandin analog.

Comparisons were made of the ability of intravenous infusions of prostalene and PGF2 alpha to stimulate increases in uterine contractility in vivo in the 14 day pregnant hamster. Whereas PGF2 alpha gave a linear dose response over the range 0.25 to 6.25 microgram/min., to achieve 5 fold increase in uterine activity, prostalene induced a multiphasic dose response curve. Inhibition was observed at 0.01 microgram per min. followed by a shallow stimulatory dose response to 0.25 microgram/min. plateauing at 1.8 fold stimulation to at least 1.25 microgram per min. When the epimeric mixture was separated and the two 15 position epimers studied separately the reason for this atypical dose response curve became clear. The 15 alpha OH epimer induced a linear stimulatory dose response from 0.05 to 6.25 microgram per min. infusion rates to a 5 fold increase in uterine contractility. The 15 beta OH epimer, however, induced a linear inhibitory dose response over the range 0.4 to 50 ng/min. It was, therefore, apparent that the atypical dose response curve observed from the mixture was the resultant of two opposite and mutually antagonistic activities. The data suggests also that the inhibitory epimer is capable of antagonizing both endogenous and exogenous prostaglandin, probably by a mechanism of competitive inhibition.


Dissociation between prostaglandin and malondialdehyde formation in exudate and increased levels of malondialdehyde in plasma and liver during granulomatous inflammation in the rat.

During kaolin-induced granuloma pouch inflammation in the rat the concentration of malondialdehyde (MDA) in the exudate, measured by the 2-thiobarbiturate method, steadily increased and this increase was correlated with the increase in granuloma weight. There was a complete lack of correlation between the concentrations of MDA and prostaglandin (PG)-like material in the inflammatory exudate. Whereas the concentration of PGs reached a maximum 1 day after the induction of inflammation and returned to control levels on day 4, the MDA concentration continuously increased from the initiation of inflammation up to day 16. During granuloma development the concentration of MDA in the plasma reached a maximum on day 2 in parallel with the concentration in the liver, then both plasma and liver MDA decreased to levels observed in control rats. Between day 2 and 8 of the inflammatory process homogenates of livers from inflamed rats showed an increased formation of MDA on incubation, the amount formed being maximal on day 4. The results of the present study are discussed in view of a possible involvement of lipid peroxidation in inflammation.


Effect of prostaglandin E2 on vascular reactivity to norepinephrine in isolated rat mesenteric artery, hind limb and splenic artery.

The effects of prostaglandin E2 (PGE2) and indomethacin on the vascular reactivity to norepinephrine were tested in three different isolated rat vascular beds (mesenteric artery, hind limb and splenic artery) perfused with the Krebs bicarbonate solution. In these vascular beds PGE2 (0.1-64 ng/ml) or indomethacin (09.1-96 microgram/ml) in the perfusate did not change the basal pressure. In the mesenteric vascular bed and the hind limb, PGE2 dose-dependently potentiated the vascular response to norephinephrine, whereas PGE2 dose-dependently inhibited the vascular response to norepinephrine in the splenic artery. In these three vascular beds indomethacin in the perfusate dose-dependently attenuated the vascular response to norepinephrine. In the mesenteric artery and the hind limb PGE2 restored the effect of indomethacin, but in the splenic artery PGE2 did not restore the inhibitory effect of indomethacin. These results indicate that the modulating effect of exogenously administrated PGE2 on the vascular action to norepinephrine varies in different vascular beds. It is also suggested that the contribution of endogenous PGE2 synthesized in the vascular wall to the vascular reactivity to norepinephrine is, as well as the effect of exogenous PGE2, different in different vascular beds.


Inhibition of prostaglandin (PG) synthesis in sheep vesicular gland microsomes (SVGM) by nitroblue tetrazolium (NBT) and vitamin E (VE).

Previous studies have shown that NBT and VE together are potent inhibitors of platelet aggregation, secretion and PG synthesis. In this study, we evaluated the capacity of NBT to detect PG synthesis by SVGM. Aspirin pretreatment of SVGM decreased the amount of NBT reduced after addition of arachidonic acid, demonstrating that products generated by the cyclo-oxygenase were involved in NBT reduction. The influence of NBT and VE on PG synthesis by SVGM was then evaluated by measuring malondialdehyde (MDA) production. NBT or VE alone had no significant effect, but together these agents were as effective as aspirin in preventing MDA formation. The effect of NBT and VE on 14C-arachidonic acid conversion was followed by thin layer chromatography and radioscanning. Again, NBT or VE alone were ineffective, whereas the combination was as effective as aspirin in preventing conversion of arachidonic acid. We speculate NBT and VE together inhibit pg synthesis by scavenging a free radical species of arachidonic acid generated in the initial step of fatty acid peroxidation.


Renal prostaglandins and sodium balance in normal man.

We investigated the relationship between urinary prostaglandin E (PGE) excretion and sodium and water balance. PGE excretion was measured in thirteen healthy male volunteers on the metabolic ward during conditions of high sodium (200 mmols/day) and low sodium diets (40 mmols/day) and during intravenous administration of saline and of dextrose and water, using each subject as his own control. PGE excretion was higher on the high sodium than on the low sodium diet (191 +/- 37 SE versus 98 +/- 41 ng/6h, p less than 0.01). Saline and dextrose and water infusions significantly increased PGE excretion while subjects were on low sodium diets (to 314 +/- 74 and 443 +/- 152 ng/6h, respectively, p less than 0.01). While on high sodium diets the increase in PGE excretion during infusions was not significant. To further evaluate the role of prostaglandin in sodium excretion the study was repeated with simultaneous administration of indomethacin or ibuprofen to inhibit prostaglandin synthesis. Sodium excretion from saline and dextrose and water infusions were unaltered. The data suggest that dietary content of sodium may alter PGE excretion, but that acute changes in PGE excretion during saline administration reflect water balance rather than sodium load.


Studies on the effects of altered timing of parturition in the rat.

Manipulation of the length of gestation with two different agents has been compared and contrasted in the rat. Single subcutaneous injection of 1 mg/rat of PGF 2 alpha on day 19 of gestation caused premature parturition of at least 24 hours in 55% of treated rats. Premature parturition was associated with perinatal death and cannibalism of delivered pups. Subcutaneous implantation of pellets of naproxen over days 20-23 of gestation prolonged gestation to 24 days and synchronized onset of parturition compared to placebo-treated controls. Post-mature onset of delivery, in contrast, was associated with increased birth weight of pups and a survival rate of 90%. Post-mature pup deaths were restricted to the last pups delivered, i.e. longest gestation. The potential utility of naproxen for manipulation of time of parturition in domestic animals is suggested.


Progesterone interferes with the actions of prostaglandin (PG) E1 but not those of PGE2 or PGF2 alpha in a rat vascular preparation.

In the mammary gland some actions of prolactin seem mediated by PGs. Progesterone blocks several of the mammary effects of prolactin. We therefore investigated the effects of 100 ng/ml progesterone (within the normal human plasma concentration in pregnancy) on the vascular effects of PGE2, PGEF2 alpha and PGE1. Progesterone had no effects on the responses to PGE2 and PGF2 alpha but significantly (p less than 0.01) attenuated the actions of low concentrations of PGE1. It may have enhanced the actions of high PGE1 concentrations. Progesterone appears able to block some effects of PGE1 and to imitate others.


Prostaglandins and drug induced agranulocytosis, aplastic anaemia and leukemia.

Drug like aspirin, indomethacin, phenylbutazone, chloroquine and quinine have been reported to induce agranulocytosis, aplastic anaemia and leukemia. These drugs are also known to interfere with the prostaglandin system at one point or another. Since prostaglandins are known to be involved in the maturation and differentiation of macrophage-granulocyte progenitor cells, in erythropoietin mediated erythropoiesis and in the functional capabilities of leukocytes, it is proposed here that these haematological abnormalities by these drugs could be due to their affect on the prostaglandin system.


Effects of naproxen on uterine contractility in vivo.

An in vivo technique for monitoring uterine contractility has been developed and used to assess the effects of naproxen on both spontaneous motility and that due to exogenous PGF2 alpha in the hamster and the rat. Naproxen has been shown to suppress uterine motility in both situations, in both species, whether administered by parenteral or oral routes. The hamster was shown to be approximately 10 X less sensitive to naproxen than is the rat (625 mg/kg vs 62.5 mg/kg) but conversely was 100 X more sensitive than rat to uterine contractive effects of PGF 2 alpha (10 ng vs 1000 ng).


Platelet hyporesponsiveness to epinephrine in carriers of Bartter's syndrome.

Platelet aggregation was investigated in the parents of 4 patients with Bartter's syndrome. Aggregation induced by ADP and ristocetin was normal. However, there was some depression of aggregation induced by collagen. All obligatory heterozygotes showed depressed aggregation in response to epinephrine.


Prolongation of gestation in the rat and hamster by naproxen.

Administration of naproxen by once or twice daily subcutaneous injection, or orally in the drinking water, was found not to routinely prevent parturition in either the rat or the hamster. However, the duration of labor was prolonged and associated with poor pup viability. The prolonged labor and fetal mortality were thought to be due to suppression of myometrial activity after onset of labor and caused by the episodic administration regimens. Thus fetal deaths could result from asphysia due to suppression of uterine contractions, after partial or total placental separation had occurred. Naproxen was, therefore, administered on a more continuous basis by subcutaneous implantation of pellets in rat and hamster, or orally every four hours in the rat. Either of these regimens was then able to postpone parturition beyond the range of deliveries in control animals. In such naproxen treated rats there was no sign of placetal detachment, even out to day 25 of pregnancy. Fetal viability was preserved and fetuses continued to gain weight. These observations are consistent with a true prolongation of gestation by naproxen rather than merely an interference with the process of labor.


Effect of indoprofen on prostaglandin and thromboxane A2 synthesis in the guinea pig lung.

Indoprofen has been studied in vitro as a possible selective inhibitor of thromboxane-synthetase in guinea pig lungs perfused with arachidonic acid. Indoprofen does not show selectivity of action since KB values for prostaglandin and TXA2 synthesis are not significantly different. Indoprofen might therefore act at the cyclooxygenase level as has already been demonstrated for indomethacin.


Termination of pseudopregnancy in rats by silastic-PVP-PGF2 alpha tube.

The efficacy of a one-end or both-end open Silastic-polyvinyl-pyrrolidone (Silastic-PVP) tube containing 600 microgram prostaglandin-F2 alpha (PGF2 alpha) and placed subcutaneously on day-6 of pseudopregnancy (PSP) in the induction of premature termination of PSP was compared. A both-end open Silastic-PVP-PGF2 alpha tube was more efficacious in inducing an early termination of PSP with a mean duration of 7.8 days. By contrast, PSP females receiving a one-end open Silastic-PVP-PGF2 alpha tube showed a mean duration of PSP of 9.9 days. The shortened duration of PSP in both these treatment groups was significantly different from the control value of 13.1 days. The significant drop in progesterone (delta 4P) but rise in 20 alpha-dihydroprogesterone (20 alpha-DHP) occurred 24 hr after treatment in PSP rats treated with both-end open Silastic-PVP-PGF2 alpha tube, whereas similar changes in delta 4P and 20 alpha-DHP took place 48-72 hr after the deposition of a one-end open Silastic-PVP PGF2 alpha tube. It is concluded than an initial larger amount of circulating PGF2 alpha is needed to induce an early premature termination of PSP. The exposure of corpus luteum to a more sustained but lower level of PGF2 alpha leads to a slower response.


The concentrations of the prostaglandins E and F, 13 14-dihydro-15-oxo-prostaglandin F and thromboxane B2. In tissues obtained from women with and without pre-eclampsia.

The concentrations of prostaglandins E (PGE) and F (PGF), 13, 14-dihydro-15-oxo-prostaglandin F (PGFM) and thromboxane B2 (TXB2) were measured by specific radioimmunoassays in tissues obtained from women with and without pre-eclampsia. The concentrations of PGE in the amnion, chorion, decidua and placenta obtained from subjects with pre-eclampsia were significantly lower than those from subjects without pre-eclampsia. The concentration of PGE in these tissues increased significantly with gestational age and correlated with urinary oestrogen excretion. PGF concentrations were lower in the amnion and placenta of the pre-eclamptics compared to those without pre-eclampsia. The concentrations of PGFM in the amnion, decidua, and myometrium were lower in the pre-eclamptics. No significant difference in the TXB2 concentrations between the two groups of subjects were found. It is suggested that the altered tissue concentrations of prostaglandins in pre-eclamptics are due to the effects of gestational age and oestrogens and may or may not be involved in the pathogenesis of pre-eclampsia.


The protective effects of dietary fish oil on focal cerebral infarction.

The protective effect of the (n-3) fatty acids in menhaden fish oil on acute cerebral ischemia was investigated in cats. Cerebral ischemia was produced by ligation of the left middle cerebral artery of cats fed either a basal diet of feline cat chow or the basal diet supplemented with 8% of the calories as menhaden oil for 18-24 days. Fatty acids esters of 20:5 (n-3) were increased and the 18:2 (n-6) decreased in the heart and liver of cats fed supplemental fish oil, but the brain lipid showed no effect of the diet. We found that the neurological deficit and the volume of brain infarction in the group treated with fish oil was less than that of the control group. The present findings suggest that moderate dietary supplements of fish oil may be beneficial in the prophylactic treatment of ischemic cerebral vascular disease.


Indomethacin and uterine evacuation of conceptus in rats: possible mode of action.

Indomethacin at a dose of 2.5 mg/kg from day 18 through day 20 of pregnancy was found to extend the duration of gestation for 2-3 days over the control value. Conversely, prostaglandin F2 alpha (PGF2 alpha) at a dose of 2.0 mg/kg on day 18 of pregnancy induced premature parturition. PGF2 alpha given concurrently with indomethacin resulted in neutralisation of the drug action and the animals delivered viable pups as identically recorded in controls. Failure of indomethacin to extend the length of pseudopregnancy in either bilaterally hysterectomized or bilaterally decidualized pseudopregnant rats revealed that the lengthening of the duration of pregnancy caused by indomethacin is not due to an extension of luteal span, but results from relaxation of the uterine smooth musculature.


Cigarette smoking, prostaglandins and reactive hyperemia.

The hypothesis was investigated that cigarette smoking obstructs the blood flow response that develops as a protection against tissue damage in an organ subjected to ischemia (reactive hyperemia). Forearm blood flow was recorded at rest and following forearm ischemia before and after cigarette smoking in healthy male and female volunteers. The experiments were also repeated after pre-treatment of the subjects with indomethacin, a prostaglandin synthesis inhibitor. Before pre-treatment with indomethacin, ischemia induced a reactive hyperemia amounting to 20 +/- 4 ml/100 ml tissue. This hyperemia was significantly (p less than 0.01) reduced by cigarette smoking, to 12 +/- 3 ml/100 ml tissue. After indomethacin, which in itself lowered the reactive hyperemia to 8 +/- 2 ml/100 ml tissue, smoking did not elicit any effect. It is suggested that smoking counteracts reactive hyperemia in tissues by interfering with the same physiological mechanism as indomethacin, i.e. with the vascular formation of PG. The possible significance of this observation in relation to cigarette smoking and ischemic heart disease is stressed.


Permissive effects on adipose tissue lipolysis of a plasmatic factor which inhibits prostaglandin biosynthesis.

Plasma obtained from fasted rats provoked a dose-dependent stimulation of fat cell glycerol release  and was able to inhibit also generation of prostaglandins E2 and F2 alpha from arachidonate, in vitro, over a very similar range of doses. It is proposed, therefore, that a plasmatic fat-mobilizing factor may act as an endogenous inhibitor of adipose tissue prostaglandin biosynthesis, mediating in the acute (long-term not precluded) regulation of adipose tissue lipolysis. The proposed mechanism of permissive effects of the plasmatic factor in reducing the effects of endogenously-generated inhibitory prostaglandins may be implicated in the development of obesity by reduced availability of the factor and thus reduced ability to utilize fat stores.


The effects of PGF2 alpha on respiratory and cardiovascular variables in pig.

PGF2 alpha was injected into different parts of the circulatory system (intravenously by femoral and jugular veins, into the pulmonary artery, into the ascending or descending aorta and into the internal carotid artery at a level above the sinus and carotid body) of anaesthetized spontaneously breathing pigs. It caused changes in respiratory and cardiovascular variables. In vagosympathectomized animals the changes in pattern of breathing produced by PGF2 alpha were greatly reduced and total lung resistance was increased. This may indicates more than one site of action of PGF2 alpha, lung resistance being influenced by a direct action of PGF2 alpha and by an immediate reflex while the pattern of breathing being modulated by vagal efferents from the lungs.


Effect of some saturated and unsaturated fatty acids on in vitro platelet utilization of arachidonic acid.

The effect of some saturated and unsaturated fatty acids pre-incubated with human washed platelets was examined on the platelet utilization of (1-14C) arachidonic acid. The platelets were incubated with the radioactive arachidonic acid for periods of either 10 min or 30 sec. The following results were obtained. Conversion of arachidonic acid to thromboxane B2 was increased during 10 min in the presence of oleic, alpha-linolenic and lauric acids. Increased conversion of 14C-arachidonic acid to hydroxy fatty acids (HHT and HETE) was observed in the presence of stearic acid (10 min incubation) and lauric acid (30 sec incubation). Their synthesis, however, was decreased in presence of gamma-linolenic acid (10 min incubation). Endoperoxide generation from arachidonate was reduced by alpha-linolenic acid but increased by stearic acid. The conversion to PGE2 was not altered by these acids during 10 min incubation with arachidonic acid. However, in presence of gamma-linolenic, lauric and stearic acids conversion of arachidonic acid into PGE2 during 30 sec incubation was increased. Under these conditions, production of PGF2 alpha and PGD2 remained unchanged.


Qualitative study of prostaglandins in pregnant uterine tissues: effects of estradiol- 17 beta and betamethasone.

The presence of prostaglandins (PGs) E1 and F2 alpha in extracts of endometrial, myometrial and placental samples from 19 pregnant women at term, was investigated. The tissue samples were obtained from the following group of patients: untreated, A) with onset of labor, B) without onset of labor; pre-treated (without onset of labor); C) with betamethasone, D) with estradiol-17 beta. Thin-layer chromatography determinations demonstrated PGE1 presence in all tissue  samples from the four groups. On the other hand, PGF2 alpha was consistently found in placenta and endometrial samples from groups A, C, and D, but it was absent in those from group B. The results suggest a physiological role of PGF2 alpha in human parturition, and a possible influence of estrogens and corticosteroids on  the appearance of this prostaglandin.


Increased sensitivity to prostaglandin E2 in old people.

Prostaglandin E2 acts as a feedback inhibitor on the actions of many hormones and other stimuli. For example, mitogens will cause leukocytes to produce prostaglandin E2, and the prostaglandin E2 inhibits the proliferative response of the leukocytes to the mitogen. We have shown that lymphocytes from healthy subjects over age 70 are much more sensitive to inhibition by prostaglandin E2 than are lymphocytes from younger individuals. In this paper, I hypothesize that there is a generalized increase in sensitivity in all tissues in aging humans, and that this increased sensitivity accounts for many of the physiologic changes of aging.


The psychotherapy of the psychosomatic patient.

On the basis of a relatively restricted definition of psychotherapy, the authors describe some of the reasons why psychotherapy is rather seldom used for psychosomatic patients, on an individual or a group basis. Some details are then given about two other kinds of treatment which contain some elements of psychotherapy, and which have been developed in Lausanne as a consequence of the analysis of the early transactions between the psychosomatic patient and his attendants: (1) a bio-feedback method, whose technical aspect is used as a tool towards a more global approach, through encouraging insight and verbalization on the part of the patient; (2) an interdisciplinary approach by physiotherapists, psychiatrists and somaticians, working together in different modalities, adapted to the different cases.


Comments on theory and therapy of psychosomatic patients with a follow-up study.

Given the specific problems of the physically sick, the psychoanalytic therapy of psychosomatic patients normally calls for modification of treatment concepts that have proved viable for patients with mental disorders (neuroses) alone. The patients' difficulty in experiencing and expressing the experience of feelings as well as the fixation on one kind of physical complaint make it essential that the patient be unconditionally 'accepted' and offered translation aids so that within the patient-doctor relationship the 'mute' physical complaints can be assisted towards verbalisation and new emotional experiencing. The kind of special treatment forms indicated is determined by the extent of healthy personality elements. Here, in addition to nonverbal procedures, such techniques as combined inpatient--outpatient group psychotherapy, the subject of the present follow-up study, have proved to be helpful.


Family dynamics and family psychotherapy of psychosomatic.

Family therapy of psychosomatic disorders is oftern difficult and comparable to the therapy of psychotic patients. Nonetheless, the results published today by authors such as Minuchin and Selvini and our own experiences are promising indeed. We have found that what seemed to be a deep-rooted psychic structure changed rapidly and enduringly if the relationship field changed. Amelioration of symptoms is in many cases easily attained if they are understood in their function within a relational system. Also, we regard the system or family approach as a chance for medical practice. The general practioner who usually deals with family systems has, in our view, an ideal position to bring about change if he uses his authority and trust properly. He has to obtain a positive, not pathology-oriented view and should use family and social resources in spite of engaging in an often fruitless and endless contact with the designated patient, which only serves to maintain and even to increase the homeostatic lock of the family system.


Open-heart surgery from the psychological point of view and resulting therapeutic considerations.

A total of 168 patients underwent thorough psychological investigation before and after open-heart surgery. The pre-operative psychological status and the psychosocial situation of the patients were studied by means of questionnaires and semi-standardized interviews. The post-operative psychic status was documented daily on the first four post-operative days and once after discharge from the intensive care unit, by means of a slightly modified version of the AMP rating scale. We found significant correlations between psychosocial problems, the patients' ability to cope with their illness, the surgical stress and the environmental stress of the intense care unit, and post-operative psychic disturbances. The results lead to deliberations on therapeutic consequences.


Growth.

Freud's concepts on the innate and the experiential, applied as they were essentially to the psychic structure, are discussed because, as Winnicott (1952) indicates, 'the psyche grows out of the soma almost from birth' (see also Bion, 1962). The maternal function is basic to the growth in the first months and, to a lesser extent, is basic all through the growing process, which is particularly fast and demanding during the first three years. The fact tha the 'maternal function', essential for growth in the early stage, is comprised of events which the baby either experiences or is lacking, such as bodily early contacts, being held in the arms and the quality of holding, eye to eye communication on which baby's apperception develops is underlined. The quality of early physical care is to be seen, in the author's view, as the food on which basic individual growth takes place. Deviations and distortions of growth, where no genetic and/or organic explanation may be found, have to be studied in this light. This is particularly true with young babies, where maternal deprivation is a frequent cause of malnutrition.


Liaison psychiatry: a service for averting dehumanization of medicine. Recent psychosocial changes in medicine.

Recent technical advances of medical science have become responsible for the altered role of the physician and changes in the practice of medicine. As the practice has become hospital-centered, the importance of the individual physician and the prestige of the medical profession have markedly decreased. Dehumanization of medicine has been a natural outcome of these changes, for as the scientific approach to patient care increased the psychosocial support of the physician and significant others decreased. Liaison psychiatry, the therapeutic arm of psychosomatic medicine, utilizes the holistic principle which incorporates the psychosocial nuances of human behavior into the medical model. It is felt that this service must be utilized with increased frequency if further dehumanization of medical practice is to be prevented.


Body awareness and personality.

The relation between personality characteristics and body awareness, defined as the attention paid to different body zones and measured by means of the Fisher Body Focus Questionnaire, is examined in two ways in groups of medical and dental students: (1) Our results replicate fairly well the relation, reported by Fisher, between back and head awareness and anal characteristics. (2) Exploration of the relations between body awareness and descriptive personality characteristics (neuroticism, extraversion, etc.) reveals differences between sexes: in women back awareness correlates positively with neuroticism and negatively with extraversion; in men higher awareness of the right side of the body is related to lower neuroticism but also to higher scores for test-taking attitude and social desirability. Some implications for our understanding of the position of the body and for psychosomatic research are briefly discussed.


Alexithymia: concept and measurement.

Alexithymia is a concept in need of validation and measurement. The paper summarizes alexithymia as it is understood clinically and describes questionnaires used to elicit information helpful in making the assessment of alexithymia characteristics. Problems in use and the need for further work on comparative clinical experience are discussed.


Alexithymic feature in digestive diseases.

A comparative study was conducted on the psychological features of chronic pancreatitis, peptic ulcer, ulcerative colitis and the irritable colon syndrome by means of psychological tests and interviews. The patients with irritable colon syndrome were found to be the most neurotic of all, whereas those with the definite type of chronic pancreatitis and ulcerative colitis presented prominent alexithymic characteristics. About one half of the patients having peptic ulcer showed alexithymic features. Despite their neurotic tendencies shown on the psychological tests, the patients with the suspicious type of chronic pancreatitis were socially better adjusted than those with irritable colon syndrome. It was also noted that the concept of alexithymia needs to be elucidated by including such factors as over-adaptation to the environment, certain distorted life habits and lack of bodily sensations.


The potential use of videotape in teaching psychosomatics.

Psychosomatists should admit that so far they have largely failed in communicating their knowledge and skills to those outside a limited circle. As a result many sick people suffer more than they need. Students of animal behaviour have made better use of sound and videotape to illustrate the normal and abnormal than students of human behaviour. Some of the reasons for this are examined. In teaching and learning psychosomatics the potential of videotape has yet to be realised. The article presents some such possibilities and is illustrated by edited versions of the author's experience over four years in a busy outpatient clinic of (1) characteristic life situations and attitudes in three disorders: Multiple Sclerosis, Migraine and auto immune disease, (2) the psychological management of an intractable case of Asthma over two years (approx. 32h of therapy).


The teaching of psychotherapy to medical students. An aspect of training in psychosomatic medicine.

Since so many patients have mingled with their illness psychological factors which require psychological help, the teaching of psychodynamic understanding of illness is very important. However, little (if any) systematic teaching of psychotherapeutic methods in the treatment of illness is given to medical students in most universities of Europe. This study is a joint ongoing project between the Psychosomatic Clinic of the University of Heidelberg and the Department of Psychological Medicine, University College Hospital, London. It looks at the establishment of psychotherapy supervision for medical students which has existed for several years at University College Hospital. However, many important local and national differences have become apparent, including the type of patient selected, the mode of selection, the way in which supervision groups are used by supervisors and students, and the status of such a scheme within the general curriculum of medical education. Many of the problems which have emerged during the course of this project, and some ways of solving them, are discussed. It is hoped that this project will be of use to other Centres which may be considering such a scheme as part of their own medical curriculum.


Anorexia nervosa--two cases in discordant MZ twins.

Two female monozygous twin pairs discordant for anorexia nervosa are reported, and literature reports on 18 other monozygous pairs are reviewed. Four of the reported pairs are inadequately described and there is doubt about the diagnosis. When the 2 pairs reported here are included, 16 pairs remain: l (38%) were concordant and 10 discordant. Only 3 pairs fulfilled rigorous criteria for anorexia nervosa and zygosity and one of the pairs was concordant. The population prevalence is probably about 2 promille for hospitalized cases, and there is a 6% risk for female sibs of anorectic probands. Hence, if about 1/3 of monozygotic pairs are in fact concordant, a role of genetic factors in the etiology may be suggested.


Psychophysiological study on fasting therapy.

The Tohoku University method of fasting therapy was performed on 380 patients. The clinical results revealed an efficacy rate of 87%. With regard to psychosomatic diseases, irritable colon syndrome, neurocirculatory asthenia, mild diabetes mellitus, obesity and borderline hypertension were good indications for this therapy. In order to clarify the therapeutic mechanism, several clinical examinations were administered before, during and after therapy. EEG data was analysed according to the power spectral method. The peak frequency decreased as fasting progressed, while it increased as re-fed continued. Percent energy of alpha waves after fasting therapy was significantly higher than that of the pre-fasting stage. The dexamethasone suppression rate of urine 17-OHCS after fasting therapy was significantly lower than that of the pre-fasting stage. It seems that ketone nutrition may work as a strong stressor in the brain cell, temporarily placing all biological mechanisms in a stress state and then activating the natural healing power inherent to the human body, thereby bringing about homeostasis.


Psychodynamic approach to the most common psychiatric disorders in the elderly.

It should be emphasized that it was difficult for the author, if not impossible, to sort out any specific dynamic factor(s) or unconscious motive that could explain fully and appropriately the protean psychopathology of the patients seen and followed-up in his series. A multifactorial pathogenesis should be taken into consideration in such or similar cases. On the other hand, to make any attempt at an overall or generalized dynamic formulation in the elderly should, in the author's opinion, be out of the question.


Ill health in two contrasting societies, particularly non-psychiatric morbidity among those with a psychiatric diagnosis.

An epidemiological study in two culturally contrasting north-norwegian societies indicates that persons with a psychiatric diagnosis are more prone to non-psychiatric illnesses than those without such diagnosis. The onset of the non-psychiatric ailments of these persons come mostly before the onset of their psychiatric conditions. These are cross-cultural findings.


Symptom changes during the psychotherapy of patients with myasthenia gravis.

Four patients with myasthenia gravis were treated psychotherapeutically: two who suffered from generalized myasthenia gravis were treated without additional medical treatment. During the course of the therapy a clear correspondence of the patients' behavior and the severity of symptoms could be observed. The symptoms would improve, or even disappear, depending on the developed 'ego-strength' and the possibility of being aggressive and creative during therapy and also depending on the degree to which the 'meaning' of the symptoms could be understood. There seems to be a possibility of influencing decisively the course of myasthenia gravis by psychotherapy.


Peptic ulcer in childhood. Psychological factors.

Thirty children (20 girls and 10 boys, aged 6-16 years) with primary peptic ulcers, matched in paris for age, sex and socio-economic standard to a group of 30 ulcer-free controls, were submitted to a structured psychiatric interview, a structured 'present psychiatric state' examination and to personality and intelligence tests. With one exception all patients suffered from duodenal ulcer; 3 male patients had personalities with psychopathic elements, 7 patients had nicknames, 5 suffered from psychiatric disorders, 3 had attempted suicide in the past, and 3 had had homosexual experiences. These parameters were negative in all controls. The patients had lower mean IQ, worse scholastic adaptation, more anxious and overprotective parents, higher frequency of faddiness in food and lower frequency of nail-biting than the controls. Psychotraumatic events had preceded the onset of ulcer symptomatology in 11 cases. The findings are discussed and the contribution of psychological factors in the pathogenesis of childhood peptic ulcer is stressed.


The theory and therapy of hyperkineses (torticollis).

The paper presents the interaction approach in psychosomatics, as developed by the author. In this context the physical proceedings, which are oversome by the categories of the structure of space, differ from the psychic ones which are not of space but of time. The psyche itself is understood as an intentional experience, wherein the affects and unconscious proceedings are essential. Language has an important function. The psychosomatic disease is understood as a presentative symbolic event and as compensation for the loss of the cognitive ability to symbolize in the field of language. The problem of symbolization is illustrated by a case of spasmodic torticollis. The results of an examination of 81 patients are given, 23 of whom were treated psychoanalytically. The object relation, the regression to the pregenital level, the ego-regression in the form of the omnipotence of motion, and the inability for developing an own self are presented. An alternative technique of treatment is pointed out. Finally, the results of an examination of 26 cases of tic, including a case of generalized tic, are described.


The relationship between somatic growth and psychological development in Turkish adolescents.

The relationship between somatic and psychological development, such as intellectual capacity, introversion--extroversion, neuroticism and anxiety, has been investigated with the aid of 148 Turkish adolescents and preadolescents from a middle-level school in Istanbul. The results revealed no relationship between the rate of somatic growth and psychological development. The level of parental cultural environment seemed to have a certain influence upon the degree of intellectual capacity to the disadvantage of those originating from lower levels. The present findings obtained from this study lead to the conclusion that the variations of psychological characteristics in adolescents may not be accepted as only due to factors within the organism, such as the tempo and degree of somatic development independent of cultural, environmental effects, but that a more intensive investigation of also the external, social-environmental factors is necessary.


Aspects of therapy in psychosomatic medicine.

An inquiry into the selection of patients at the Heidelberg Psychosomatic Clinic confirmed that in the process from diagnosis to psychotherapy the selection had the tendency to exclude more those patients without higher education, those aged over 30 years, and those transferred from other clinics. Patients with psychosomatic disorders or physical ailments are not subjected to this negative selection. However, they come less often to the clinic of their own accord, are usually less well-educated, have vague ideas about therapy or expect to have medicines prescribed, and generally are less aware than neurotics of having contact problems with others. After combined verbal and pre-verbal inpatient therapy and two years of outpatient group therapy, personality changes are apparent both in neurotics and psychosomatic patients. Studies with Giessen Tests show that changes are even greater in the psychosomatic group.


The work physiology of fishing.

Circulatory strain, energy output and urinary catecholamine excretion were determined in 24 coastal, 6 trawler, 5 bank and 3 capelin fishermen. From these studies it is evident that fishing may represent hard physical work. However, if properly organized with job rotation and adequate creq numbers, it may, in some respects, be comparable with many occupations ashore. The introduction of mechanization and automation has led to increased tempo and greater stress. Consequently, the older fishermen, due to declining physical work capacity, may find it difficult to keep up with their younger colleagues. Yet, the official Norwegian statistics show that the percentage of older fishermen is increasing.


Milieu and mental health in a Norwegian fishing community.

During 1970-1973 a comprehensive epidemiological investigation was carried out on the island of Vaerøy and Røst in Northern Norway; 1,700 people live in the area and fishing provides the main employment. The paper contains mainly a morbidity study, with special reference to factors in the local milieu influencing the morbidity pattern. A few of the major results concerning living conditions and mental health in this fishing population are presented.


The psychiatrist's role at a local hospital in the northern part of Norway and his cooperation with the primary health service in the area.

This paper describes a practical working situation for a psychiatrist situated in the northern part of Norway. The psychiatrist is attached to the local hospital on a part time basis and takes care of the psychiatric cases in the medical ward together with somatic cases. In addition, he works in a polyclinical setting in town, in close contact with several health and social services, and tries to be close to where the problems originate. The psychiatrist deals mainly with crisis interventions and has a social psychiatric approach.


[Chronic eosinophilic pneumonia (author's transl)].

The clinical and radiologic findings of the chronic eosinophilic pneumonia are presented. A personal observation of one case is reported. This should be the first in the Italian roentgenologic literature. The importance of radiology in the diagnosis and in the evolution of the disease is stressed.


[Farmer's lung: comparison of the teleradiographic images and computerized tomographic (CT) images].

A critical and comparative analysis between chest radiograms and CT pictures in pulmonary fibrosis of various degree, occurring in farmer's lung, reveal that the latter are apt to give a somewhat more diversified informations about pulmonary changes as simple radiography. This would prove useful in evaluating the extension and distribution of anatomical changes due to fibrotic process, although as far not able to allow an earlier diagnosis.


[Spontaneous pneumothorax: an uncommon clinical first sign of the bronchial carcinoma (author's transl)].

Seldom the bronchial carcinoma begins with spontaneous pneumothorax. About 20 cases are reported in the literature. A personal observation is described concerning a 63 year old patient with clinical symptoms of spontaneous pneumothorax. The histologic diagnosis was bronchial spinocellular carcinoma.


[Intraosseus lipoma (author's transl)].

A case of intraosseus lipoma of the rib is presented, when showed bone expansion and endothoracic tumour. Emphasis is put upon the arteriographic findings ("angiolipoma"). This case is perhaps the 31st in the literature, but sometimes these tumours are not diagnosed or not histologically classified.


[Incidence and evolution of soft tissues calcifications in patients in periodic hemodialysis (author's transl)].

In a series of 92 patients' in hemodialysis the evolution of periarticular and vascular calcifications has been studied. A correlation exists between the incidence of arterial calcifications and the patients' age, while no direct correlation has been proved to exist with the duration of dialysis. In fact their annual average increase (8.4%) is similar to that of periarticular calcifications (12.2%).


[Scar cancer and rib fractures. Causality or coincidence?].

On consulting our archives in order to give a casuistic contribution to the scar-cancer theory, we have met with a new datum: in 60 patients affected with a lung carcinoma, 13 of these, i.e. 21.6%, had suffered with a previous thoracic trauma with or without rib fractures.


[Fissures in biliary calculi. Personal contribution (author's transl)].

In a series of 70 patients suffering from biliary lithiasis, the roentgenologic findings of fissures in the calculi was observed in 5 cases examined by means of cholecystography and in 7 cases who underwent cholangiocholecystography. Fissures were demonstrated 11 times in calculi after surgery. The "Mercedes-Benz" sign was never observed at the abdominal examination without contrast medium. The presence of fissures may be an additional sign in the radiologic diagnosis of biliary calculi, but its value is not determinant.


[Calcified meningiomas: anatomo-radiographic correlations and description of some clinical cases (author's transl)].

A review has been carried out of the literature concerning the frequency of calcifications in  meningiomas. Four cases of meningiomas with calcifications are presented with the description of the anatomo-radiologic findings. The preoperative diagnostic value of the calcifications is stressed. The mechanisms of calcium deposition in the neoplastic tissues are discussed.


[Hydrocephalus and craniodiaphyseal dysplasia (author's transl)].

One case is reported of dilatation of the lateral ventricles in a patient suffering from craniodiaphyseal dysplasia, with follow up of one year. The pathogenic hypothesis personally proposed are: a) partial and intermittent compression of the aqueduct by a dolico-mega basilar artery; b) "cisternal hypofunction".


[Perspectives and limits of holographic applications in radiology (author's transl)].

Some holographic techniques such as composite holograms, Fresnel's plate, holographic filters, may be employed in radiology in order to obtain three dimensional images. The basic elements of holography are summarized and the possible applications are discussed. A practical method is presented to prepare the Fresnel's plate.


[Introduction to the use of 125 iodine in interstitial radiotherapy (author's transl)].

The 125-iodine is employed for definitive implantation in the treatment of some apical and non apical lung tumors, and in pancreas and prostate tumors. The results obtained by the  authors are not evaluable and the results of north-american literature are reported. The 125-iodine properties are original and allows a very important progress above all of the protection problems.


Rheological and biochemical changes in open heart surgery with extracorporeal circulation and moderate hypothermia.

The plasma enzymes, glucose, urea nitrogen, total and conjugated bilirubin, osmolality, acid--base balance and rheological data have been studied in a group of patients who underwent open heart surgery to replace the stenotic or insufficient aortic valve. The aim of this study was to assess our operative conditions and to compare results with those obtained by other authors.


Energy utilization and changes in some intermediates of glucose metabolism in normal and hypoxic rat brain after decapitation.

Energy metabolism was studied in the cerebral cortex of rats during and after hypoxia induced by breathing a gas mixture of 7% O2 in N2 for 2 h. Cortical energy stores (2ATP + ADP + phosphocreatine) remained unchanged after hypoxic treatment. Lactate rose over four-fold. Pyruvate, glucose and glucose 6-phosphate concentrations also increased significantly. Metabolic activity in the cortex expressed as the utilization of high-energy phosphates 5, 10 and 30 s after decapitation was decreased by 30% after hypoxia and remained lowered for 3 h during recovery. This was accompanied by elevated glucose consumption and lactate production, suggesting that the maintenance of the energy balance after hypoxia was partly due to activation of the glycolytic pathway. During the recovery period, these metabolic abnormalities returned towards control values, but, after 6 h of recovery the high-energy phosphate utilization increased transitorily above the control values.


The significane of measurement of osmolality in critically ill patients.

The plasma and urine osmolality and their ratios were measured in 774 patients in critical care. We found that changes in osmolality were related to the alterations of ratios of sodium ion, glucose, blood urea nitrogen and unknown metabolites, and this knowledge may be of therapeutic and prognostic value.


Distribution of free amino acids in coma due to acute barbiturate poisoning in guinea pigs.

The cerebral protein and amino acid concentrations in guinea pigs coma due to barbiturate poisoning have been studies. Some significant alterations in systemic and central amino acid patterns have been found, giving rise to a hypothesis about the biochemical pathways involved in the coma. An attempt to correlate the amino acid changes and cerebral energetic 'need' is also reported.


Total hypothermic blood exchange in acute endotoxin shock.

It has been reported that total hypothermic blood exchange holds promise for the treatment of septic shock in animals. Since this procedure does not carry any mortality in out laboratory, we studied its effect in an acute septic shock model. After the intravenous injection of endotoxin (10 mg/kg) and blood transfusions into 33 dogs, severe haemoconcentration, tachypnoea, tachycardia, low cardiac output, metabolic acidosis and hyperpyrexia led uniformly to death within 5 h. All of these symptoms were prevented in five dogs by total hypothermic blood exchange, instituted 5 min after the endotoxin injection. Nevertheless, all of these treated animals died a delayed death. Since the endotoxin particles are rapidly phagocytosed by the reticulo-endothelial system, even very early total blood exchange cannot dislodge them from their intracellular site.


Blood pressure changes in severely injured patients.

Sixty-five severely injured patients with hypertension on arrival at the Accident and Emergency Department were studied. Forty-eight had head injuries. In children there were significantly higher diastolic blood pressures in those admitted unconscious than in those conscious on admission. The possible cause of this is discussed. There was a fall in both the systolic and diastolic blood pressures of all patients after treatment and rest for some hours.


[Effect of bromocriptine on secretion of the enzyme dopamine-B-hydroxylase (DBH) in patients with Parkinson's disease].

The activity of DBH enzyme was measured in plasma of 7 non treated patients suffering from Parkinson's disease; a 10 mg dose of Bromocryptine was administered per os to these patients. Attained results were compared to the enzyme activity in a group of control of 7 healthy individuals. It was pointed out that in patients suffering from Parkinson's disease the decrease  of DBH level in plasma after the administration of Bromocryptine was of 32.6% +/- SE 4.4% while in the group of control the decrease was only of 15% +/- SE 4.9%. This decrease in the plasmatic level of the enzyme after the administration of Bromocryptine should be due to the marked antagonistic activity of Bromocryptine on pre-synaptic dopaminergic receptors. This should mean that peripheric pre-synaptic dopaminergic receptors are involved in the physiopathology of Parkinson's disease.


[The repetitive stimulation test in the diagnosis of neuromuscular fatigue syndromes. Critical review of the results in 62 cases].

The usefulness of the method of the repetitive stimulation of the peripheral nerves has been widely accepted since the original observations of Desmedt on patients with Myasthenia Gravis, and this test is now routinely performed in many EMG laboratories. On the other hand the technical difficulties and the variability of the results in the various syndromes of neuromuscular fatigability have put some criticism on the value of the test as a routine examination. The AA. make a critical review of the clinical history and of the EMG pattern of 62 patients, who underwent one or more tests of repetitive stimulation during a period of four years, under the suspicion of Myasthenia Gravis or myasthenic syndrome. The AA. give full details of the employed technique and analyze the results either of the 27 cases with Myasthenia Gravis, either of the 15 cases of Myasthenia Gravis with ocular involvement, either of the 16 cases with myasthenic syndrome and of the 4 cases of psychogenic fatigability. The only typical changes of the motor response are its post-tetanic decrease in the not-treated cases of diffuse form of Myasthenia Gravis and its facilitation in the myasthenic syndromes associated with bronchial carcinoma.


Pancreatic pleural effusion with endoscopic retrograde cholangiopancreatography: A case report.

A case is discussed of a 30-year-old Black woman who developed a massive pseudocyst of the pancreas while under investigation in hospital for a left pleural effusion. An internal pancreatic fistula to the pleural space was demonstrated at endoscopic retrograde cholangiopancreatography. The patient recovered completely after distal pancreatectomy with splenectomy.


Effects of ascorbate on leucocytes: Part III. In vitro and in vivo stimulation of abnormal neutrophil motility by ascorbate.

Abnormal in vitro neutrophil motility was found in 10 patients with recurrent bacterial infection. The defect appeared to be primary in 3 patients, secondary to hyperimmunoglobulinaemia E in 2 patients and secondary to bacterial infection in 5 patients. In 7 patients impaired polymorphonuclear leucocyte (PMN) motility was the only detectable abnormality; defective lymphocyte function was found in 2 patients and 1 had a total IgA deficiency. Increased random motility and migration to endotoxin-activated serum (EAS) and partially purified C5a was observed when patients' neutrophils were incubated with 5 x 10(-2)M calcium ascorbate or 10(-1)M sodium ascorbate in the presence of 5% autologous serum in vitro. Six of the patients, 4 children and 2 adults, were given oral ascorbate, 1 g daily for children and 3 g daily for adults, and tests of neutrophil migration were performed at monthly intervals thereafter. Improved neutrophil motility was observed in all patients and this correlated with clinical improvement in 5 of the 6.


Bone disease in patients on maintenance haemodialysis using softened or de-ionized water.

A clinical, biochemical and radiological study was carried out in 28 patients on maintenance haemodialysis in order to assess the prevalence of bone disease, particularly with regard to osteomalacia and/or osteopenia. The patients were selected from dialysis units using softened or deionized water, and the aluminium levels measured in the different water supplies. The results showed that symptomatic osteomalacia/osteopenia occurs more frequently in the units using softened water, which has a higher aluminium content, than in the de-ionized water unit. The patients dialysed on softened water also have significantly higher serum calcium and phosphorus levels. It is suggested that in Johannesburg, water softening alone is inadequate, and that the high aluminium levels in our water may be responsible for accelerated osteomalacia/osteopenia.


Chronic middle ear effusions (secretory otitis media).

Middle ear effusions are common in childhood and are a serious cause of disability and learning difficulty. The symptoms and signs tend to be obscure, but a high index of suspicion should be cultivated with primary care physicians, paediatricians, schoolteachers, and parents. Treatment is medical in the early stages, but a high proportion of patients require the surgical insertion of pressure equalization tubes. The condition tends to run a protracted course, but the eventual outlook is favourable.


The elective period in the undergraduate medical curriculum.

Electric periods allow students in their clinical years a welcome opportunity to extend their medical experience in the field of their own choice. As a result of the experience with electives over the past few years, the Medical Faculty of the University of Cape Town believes that this is an exercise which is valuable to both the student and the faculty.


Leucodystrophy of late onset in two members of a family.

We report 2 cases of demyelinating disease of unusually late onset in a mother and her son. The late onset of symptoms, at the age of 63 years in the mother's case, is rare. The onset in the son was at the age of 35 years. The relatively few adult cases previously reported range in age from 25 to 65 years, but only 2 cases in persons over the age of 60 could be found in the literature. The clinical and neuropathological findings are described.


Effects of ascorbate on leucocytes: Part IV. Increased neutrophil function and clinical improvement after oral ascorbate in 2 patients with chronic granulomatous disease.

A brother and sister with chronic granulomatous disease (CGD) of the autosomal recessive type, and with markedly defective neutrophil motility and elevated serum IgE levels, were treated with a single oral daily dose of 1 g ascorbate for 6 months. Neutrophil function and serum IgE levels were measured repeatedly at approximately monthly intervals. Both children also received prophylactic antibiotics which were always stopped 1 week prior to testing of immune function. Ascorbate treatment was accompanied by significantly increased neutrophil motility and post-phagocytic metabolic activity, and a reduction in serum IgE levels. Enhanced neutrophil function correlated with clinical improvement. Both children have remained free of infection since ascorbate was added to their regimen and have gained weight.


The effectiveness of salbutamol as a suppressant of established labour.

The effectiveness of beta 2-adrenergic stimulants as suppressants of active labour is well known. This study examines the effects of salbutamol upon established labour in 32 patients undergoing emergency caesarean section. Twenty-five (78,1%) of the patients studied showed a sustained and effective suppression of labour after a bolus intravenous injection of 250 micrograms salbutamol. In 6 of the 7 remaining patients the parameters of uterine activity were also dramatically decreased, but because uterine activity recurred, it had to be further suppressed with an intravenous infusion. There was only 1 refractory case. No serious maternal or fetal side-effects were noted, and patient acceptance was good.


Chronic salpingo-oöphoritis with hydrosalpinx formation and ureteric obstruction: A case report.

An association between gynaecological lesions and dilatation of the upper urinary tract has frequently been described. Hydronephrosis as a result of pelvic inflammatory disease has, however, rarely been reported in the literature. The case presented here illustrates the importance of investigation by means of excretory urography in patients with pelvic inflammatory disease presenting with renal symptoms and signs.


Therapeutic use of zoster-immune plasma: A report of 8 cases.

Varicella and herpes zoster can be serious or even fatal diseases in immunocompromised patients. However, they can be prevented or markedly attenuated by the administration of zoster-immune globulin (ZIG) or zoster-immune plasma (ZIP), but there is no established treatment once these disorders have occurred. Eight such patients were treated with ZIP, with promising results.


Effects of ascorbate on leucocytes: Part V. Effects of ascorbate and calcium and sodium ascorbate on certain functions of human blood lymphocytes in vitro.

The effects of ascorbate and calcium and sodium ascorbate at concentrations of 10(-8)M--10(-2)M on the following functions of human blood lymphocytes were investigated: mitogen-induced DNA synthesis and secreted and intracellular protein synthesis; migration towards a stimulus of endotoxin-activated serum; active E-rosette formation and lymphokine production. The mitogens used were concanavalin A (con A) and phytohaemagglutinin (PHA). No significant effects of ascorbate or its salts on lymphocyte mitogen-induced transformation, intracellular protein synthesis, motility and numbers of active E rosettes were found. However, increased incorporation of radiolabelled amino acids into secreted protein and increased production of leucocyte inhibitory factor (LIF) were observed at calcium and sodium ascorbate concentrations of 10(-6)M--10(-4)M.


Multiple endocrine neoplasia: Part II. Sipple's syndrome.

Multiple endocrine neoplasia (MEN) type II is a genetically inherited disorder characterized by a combination of medullary carcinoma of the thyroid, phaeochromocytomas and, more rarely, hyperparathyroidism. A subgroup of patients who do not have the same genetic inheritance pattern have in addition a Marfanoid habitus and multiple mucosal neuromas. The phaeochromocytomas cause paroxysmal hypertensive crises due to catecholamine surges, and are diagnosed most easily by elevated levels of urinary vanillylmandelic acid. Medullary carcinoma presents as a thyroid nodule and is often associated with flushing or diarrhoea. Measurement of plasma thyrocalcitonin levels permits diagnosis and detection of affected members of the family. It is unusual for hyperparathyroidism to be asymptomatic or to require treatment. Bilateral adrenalectomy should always be performed since both adrenals are involved, even if an overt tumour is only apparent in one. Total thyroidectomy for medullary carcinoma is indicated once the phaeochromocytomas have been removed. Affected families should be regularly screened to detect overt cases.


Cervical spine fusion and the effects of injury.

Congenital or acquired cervical vertebral fusion is sometimes an incidental radiological finding. Such fusions decrease the normal range of spinal movement and predispose to trauma. An analysis of 200 patients with acute cervical spinal cord trauma has been made with reference to pre-existing vertebral fusion and the circumstances of injury. The analysis showed the patients to be particularly predisposed to hyperextension injury and the risk of spinal cord damage from minor trauma. Precautions which should be taken by these patients to avoid spinal injury are suggested.


Photosensitizers and radiosensitizers in dermatology and oncology.

Two therapeutic modalities are currently of great interest, namely photo- and radiosensitization. Whereas photosensitizers only function in combination with ultraviolet (UV) light, radiosensitizers act only in combination with ionizing radiation. Because of the small UV penetration, up to a maximum of 0,5 mm, photosensitization can take place only at the surface of the body, ie. the skin. Photosensitizers are applied in dermatology in order to optimize and improve the UV therapy of certain diseases (mainly psoriasis, mycosis fungoides and vitiligo). Radiosensitizers lead to an increase in sensitivity of the hypoxic and therefore radioresistant parts of tumours against X- and gamma-radiation. With sufficient concentration within the tumour, they can act where the radiation can reach, even in the deeper parts of the body. They represent a modern and useful aid to radiation oncology. Because of neurotoxic effects, however, their practical use is limited. A short review of the history, mechanisms of action, application and side-effects of these photo- and radiosensitizers is presented.


Psychological factors in the health of South African blacks.

Aspects of mental disorder in developing communities are considered. The effects of changes precipitated by modern living conditions are expounded and these are related to the nature of, and impediments to, effective treatment strategies. An explosion in the need for treatment is predicted, and suggestions are made to handle the phenomenon.


Trends in maternal mortality in Cape Town, 1953-1977.

In the period 1953 - 1977 there were 223 maternal deaths among 291 800 patients delivered in hospitals under the aegis of the Department of Obstetrics and Gynaecology of the University of Cape Town. A sudden decrease in the maternal mortality rate to below 100/100,000 deliveries occurred in 1956, largely due to the greater use of the obstetric 'flying squad'. Since 1975 maternal mortality rates have been available for the various ethnic groups. For the period 1975 - 1977 the rates were 69/100,000 for Blacks, 40/100,000 for Coloureds and 27/100000 for Whites. Of the deaths, 48% occurred in women aged 21 - 30 years and 29% in those aged 35 years or more. While 28% of deaths were associated with the first pregnancy, grand multiparity (parity 5 or more) accounted for 39%. Nearly half of the patients who died were unbooked. The 7 commonest causes (grouped) of maternal deaths (obstetric as well as non-obstetric) were, in rank order: proteinuric hypertension, haemorrhage, cardiac disease, pulmonary embolism, sepsis, trauma and anaesthetic complications. Proteinuric hypertension is the most important obstetric problem in Cape Town, in terms of numbers of patients, maternal and perinatal deaths, and socio-economic implications for the community. Slightly more than 33% of the infants whose mothers died also succumbed. Major avoidable factors associated with maternal deaths were booking status, grand multiparity, cardiac disease and late or incorrect use of the 'flying squad'.


Deaths in gynaecological wards at Groote Schuur Hospital, Cape Town, 1957 - 1977.

During the period 1957 - 1977 there were 421 deaths recorded in the gynaecological wards of Groote Schuur Hospital, Cape Town. Nearly 50% of the patients were Coloureds, 25% were Whites, and 14% were Blacks; in 14% the ethnic group was not stated. Seventy-four per cent were more than 40 years and 25% were more than 70 years of age. The causes of death in order of frequency were: malignant disease of the cervix (30%), malignant disease of the ovary (17%), incomplete abortion (15%), non-gynaecological conditions (11%), malignant disease of the corpus uteri (8%), intra-abdominal malignancy (6%), pulmonary embolism (3%), sepsis not associated with abortion (3%), malignant disease of the vulva (2%), and other conditions (5%). The six commonest causes of death varied in the three ethnic groups.


Puerperal tubal ligation in Cape Town.

Major changes have occurred in the nature of the obstetric population under the care of the Department of Obstetrics and Gynaecology in Cape Town between 1974 and 1978. In the Coloured group, a settled population, these changes were: a decrease in the number of teenage deliveries, a shift from the very young to the older teenage patient, and a decrease in the number of elderly obstetric patients and of grand multiparas. Puerperal sterilization virtually doubled during this period. Similar trends in Black and White patients must be interpreted with caution since the former constitutes a shifting population and the latter are not representative of White obstetric practice in Cape Town. Family planning education and the greater acceptance of voluntary sterilization have contributed to the declining numbers of socially and obstetrically disadvantaged patients.


Maternal size and fetal growth.

In a population characterized by short and underweight mothers, weight gain during the third trimester and post-delivery weight were found to be more important determinants of birth weight than was maternal height. These findings suggest that maternal energy stores during pregnancy, rather than genetic factors or childhood nutrition as reflected by height, influence fetal growth in undernourished communities.


Sperm antibodies in men with oligozoospermia and azoospermia.

Spermatozoal antibodies found in the sera of oligozoospermic and azoospermic men are often related to infertility or subfertility. In this study the sera of 36 such men were examined for the presence of sperm antibodies. During the routine analysis of the semen, note was taken of the type and degree of agglutination in the ejaculates. The semen and serum of 15 normozoospermic men were used as controls. The gelatin agglutination, micro-agglutination and tube-slide agglutination tests were compared. A correlation between the state of fertility and the presence of sperm antibodies was found. The presence of sperm antibodies is more likely to be a corollary than a cause of oligozoospermia or azoospermia.


Ovarian dysgerminoma with embryonal carcinoma: A case report.

The association of an ovarian dysgerminoma with embryonal carcinoma in a 19-year-old woman is described. This is a highly malignant combination resulting in very rapid tumour growth and dissemination. A case report is presented and the aetiology, malignant potential and subsequent management of this most unusual tumour are discussed.


Advanced extra-uterine pregnancy: A case report.

In most cases of advanced extra-uterine pregnancy the fetus is surrounded by fetal membranes and varying quantities of amniotic fluid. It is, however, possible that the fetus may survive outside the amniotic sac intra-abdominally for varying periods of time. A case of extra-uterine pregnancy is presented where a normal infant was delivered 65 hours after rupture of the membranes.


Upper gastro-intestinal endoscopy in chidren.

Fibre-optic endoscopy of the upper gastro-intestinal tract has been successfully performed in 55 patients (60 examinations) with one complication related to general anaesthesia. Fifty-six of these examinations were performed under general anaesthesia in children ranging from 1 to 14 years. Four examinations were done without an anaesthetic. The instruments used were the Olympus GIF-K (forward oblique gastroscope) in the older children and the GIF-P2 (end-viewing paediatric gastroscope) in the younger patients. Indications for examination included gastro-intestinal bleeding, confirmation or exclusion of peptic ulceration as suspected on barium studies, persistent and recurrent vomiting, chronic abdominal pain, and the evaluation of gastro-oesophageal reflux. The need for careful selection of patients is emphasized since general anaesthesia is considered essential in the majority of chidren.


Ascaris lumbricoides and allergic asthma: A new perspective.

Infestation of humans with the parasite Ascaris lumbricoides may induce high total serum IgE levels, but the influence of this immunogenic response on allergic asthma has not been defined. In this study, the specific antiparasitic IgE-mediated response as determined by skin-prick testing was related to the incidence of allergic asthma in Ascaris-infested patients. A limited number--17% of the non-allergic controls and 51% of the allergic asthmatics--had a clinically detectable immunogenic response to the parasite. The predicted incidence of asthma was significantly higher than the observed incidence in the subjects in whom the Ascaris skin test was positive. This was not found in subjects in whom the Ascaris skin test was negative. Inhalation of Ascaris antigen induced asthmatic reactions in 7 of 8 patients who were Ascaris-positive on skin testing, but not in the negative controls. The groups of patients who respond immunogenically to parasite infestation need to be defined, as they may be predisposed to allergic diseases such as asthma.


A simple method of screening for multiple myeloma of the IgG-3 type.

A simple method for distinguishing IgG-3 myelomas from IgG myelomas of the other subclasses is described. The method relies on the increased molecular size of the IgG-3 molecule, and is far quicker than previously described chemical methods of subclass typing.


Acid secretion in the bile duct-ligated pig.

Bile duct ligation is associated with severe gastric ulceration in the pig, but the pathogenesis is unknown. Gastric acid secretion was therefore studied before and after bile duct ligation in pigs with Heidenhain pouches. Basal pouch secretion and the response to submaximal pentagastrin stimulation incresed significantly 6--14 days after ligation of the common bile duct (P < 0,05). Bile duct ligation was not followed by gastric ulceration in the pigs in this study which had had, in effect, a 50--70% gastric resection in the course of fashioning the Heidenhain pouch. These observations suggest that oesophagogastric junction ulceration in pigs is associated with gastric acid hypersecretion.


Self-medication in a developing country.

An interracial study on self-medication, including over-the-counter medication, as assessed by medications kept in the home, was carried out among a group of White, Indian and Black patients of differing sociocultural backgrounds. Whites had the most medications in their homes followed by urban Blacks, Indians and rural Blacks. The White section of the population appears to be as 'drug-dependent' as their counterparts elsewhere; the chain of events leading to this situation appears to be: sophistication + drug availability + social pressures = drug-dependence.


The 'riding' ulcer: A report of 3 cases.

Hiatal hernia with ulceration at the level of the diaphragm is a well-recognized and not uncommon condition. These ulcers may be simple gastric ulcers in patients who coincidentally have a hiatal hernia, or they may be related to trauma of the stomach against the diaphragm. They are not always readily detected on barium study. The clinical and radiological features in 3 recent cases are described, together with a brief review of the literature.


The use of metrizamide for myelography.

Metrizamide (Amipaque; Winthrop) has provided consistently reliable diagnostic results in a small series of 150 myelograms. It is an acceptable diagnostic alternative to Dimer-X for myelography of the lumbar, thoracic and cervical segments. It is also safer but expensive, and its use requires modification of technique. The distressing headache which often follows lumbar puncture appears to be unavoidable.


Serum and salivary digoxin concentrations in children.

Serum and salivary digoxin concentrations were measured in 53 children and correlated with ECG variables and serum potassium, calcium and magnesium concentrations. In 73% of patients cardiac failure was controlled, while only 7,5% of patients had serum digoxin concentrations within the 'therapeutic range'. It is proposed that the adult therapeutic range of 1-2 ng/ml is not applicable to children, who can be controlled at lower concentrations and/or that a significant proportion of the children studied no longer required maintenance digoxin therapy.


Application of perfusion pressure measurement to problems of upper urinary tract dilatation in children.

A simplified technique of measuring perfusion pressure in the equivocally obstructed upper urinary tract of children is described. Twelve patients with dilated renal pelves or ureters encountered in an 18-month period have been investigated. The findings in the majority of cases were contrary to those anticipated from the radiological appearances. This test of obstruction has wide application in the management of paediatric urological problems.


A critical look at geriatrics in a teaching hospital: Part I. The situation.

A survey of the admission and discharge patterns of geriatric patients admitted to Groote Schuur Hospital, Cape Town, during July and August 1978 was conducted. The findings highlight a lack of methodology in the economic use of beds, a lack of rehabilitation services and of follow-up services on discharge, and poor liaison regarding facilities outside the hospital setting.


Peri-umbilical cutaneous schistosomiasis: A case report.

A case of peri-umbilical cutaneous schistosomiasis is described. The patient exhibited the typical clinical features. Diagnosis as confirmed by simple examination of the skin scrapings.


Evaluation of driving skills after brief exposure to nitrous oxide.

The driving skills of 10 dental students were evaluated on three occasions on a driving simulator after exposure to air and 50% and 70% nitrous oxide in oxygen. Errors increased after exposure to nitrous oxide and were statistically significant during the middle of the test period. Driving after short exposure to nitrous oxide appears inadvisable.


A case for the traditional healer in South Africa.

It is argued that the traditional form of health care delivered by the traditional healers meets some important community-felt needs which modern or Western medicine does not meet. An attempt is made to demonstrate that some shortcomings in the available health care delivery system may be amenable to the use of indigenous healers as health assistants. A plea is made to recognize the 'cultural communication gap' as one of the most important constraining factors in health care delivery, and one which indicates a need for research into the concept of disease and health in both the rural and urban sectors, as well as for epidemiological studies into the determinant factors of disease causation and distribution, with special emphasis on cultural and social factors.


Haemoglobin Miwate in Cape Town: A report of 2 cases.

Two siblings had suffered from cyanosis since birth owing to the presence of Hb MIwate. The diagnosis was confirmed by electrophoresis, spectroscopy and peptide analysis. The benign nature of this unusual condition is stressed.


The action of tetanus toxin: a case report.

A case of neonatal tetanus in an infant with myelomeningocele is described, and the possible action of tetanus toxin is discussed.


Clinical diagnostic criteria for primary anorexia nervosa: An analysis of 54 consecutive admissions.

Clinical data on 54 consecutive patients presenting with primary anorexia nervosa were analysed under three main headings--demographic and family composition, patient personality and attitudes, and quality of family interaction. Eleven characteristic features were determined. It is suggested that a definitive diagnosis of anorexia nervosa can be made on purely clinical grounds, and without recourse to expensive and time-consuming investigations, if these features are considered. These features are also valuable in predicting whether a stringently dieting girl is in the early stages of anorexia nervosa or is merely conforming to the current adolescent fad for thinness.


Lengthening of the Achilles tendon in cerebral paresis: Basic principles and follow-up study.

The treatment of children suffering from cerebral paresis differs widely from that of children with poliomyelitis, since we deal with active spastic muscles which are influenced by many factors. We discuss these factors and present the results in a series of patients who were operated on with these factors borne in mind.


Glycosaminoglycan synthesis by human chondrosarcoma.

Human chondrosarcoma of low-grade malignancy was cultured in the presence of 35S-sulphate and 3H-glucosamine. The glycosaminoglycans isolated were fractionated on Ecteola cellulose and electrophoresed on cellulose acetate membranes before and after treatment with chondroitinase AC or Streptomyces hyaluronidase. The results demonstrated the in vitro synthesis of hyaluronate, chondroitin sulphate and keratan sulphate. The presence of keratan sulphate of large average chain length (congruent to 15 monosaccharides) supports the contention that chain length of keratan sulphate is inversely proportional to the degree of malignancy.


Mortality from cardiovascular diseases in the various population groups in the Republic of South Africa.

Cardiovascular mortality rates (MRs) for 1970 were calculated from Department of Statistics reports for the various populations of the RSA and showed that the MRs for chronic rheumatic heart disease were highest in Coloureds and lowest in Whites, the rates for Asians and Blacks being intermediate, and that a relatively high proportion of all cardiovascular deaths in the 15- 24-year group were due to this disease. It was also found that the pattern of cardiovascular diseases differed in the various population groups as follows: in White males the MRs for ischaemic heart disease (IHD) were high (4 times the rate for cerebrovascular disease (CVD). In White females the MRs for IHD and CVD were similar and accounted for most deaths from cardiovascular disease. The MRs for hypertensive disease were low in Whites. Asians in the older age groups had the highest MRs for IHD, CVD and hypertensive disease of all the population groups. The MRs for IHD of Asians in general exceeded those of Whites. Coloureds had high MRs for CVD, relatively high MRs for hypertensive disease and other forms of heart disease (mainly ill-defined heart disease) and relatively low MRs for IHD (compared with Asians and Whites). Blacks had high MRs for CVD and other forms of heart disease (mainly ill-defined heart disease), relatively high MRs for hypertensive disease and very low MRs for IHD. The MRs for cardiovascular diseases in Blacks are not reliable.


Augmentation mammoplasty - a hazardous procedure.

A few of the early and late complications of augmentation mammoplasty are described. Although it is classified as a simple technical procedure, the long-term hazards should be taken into consideration before operating on a patient.


A specific cardiac glycoside for cardiac failure and another for atrial fibrillation?

Ouabain produces a greater degree of prolongation of the P-R interval than digitoxin in rats when dosages which produce similar inotropic responses are used. When digitoxin is administered after pretreatment with propranolol, it produces prolongation of the P-R interval comparable to that produced by ouabain. Indications in the literature that these findings may apply to human beings suggest that in some situations atrial fibrillation may be better controlled with a hydrophilic digitalis preparation (e.g. ouabain), whereas cardiac failure with a tendency to atrioventricular block may be better controlled with a lipophilic preparation (e.g. digitoxin).


Carcinoma of the oesophagus.

A survey of carcinoma of the oesophagus at Kalafong Hospital revealed a greater incidence of the disease in males, being highest in the age group 50 - 59 years, with the middle third of the oesophagus the most prevalent site and with oesophagotracheal or oesophagobronchial fistulae a common complication.


Doctor effectiveness: Transactional analysis as a means of assisting movement towards a holistic approach to medicine.

Transactional analysis (TA) is offered as one solution to the problems faced by doctors attempting to move away from the traditional Cartesian approach towards the holistic approach to medical practice. It can help to increase the doctor's understanding of, and insight into, the emotional and interactional components of his patients' problems.


Sclerosing glomerulonephritis and malignant hypertension in a patient with congenital renal dysplasia: A case report.

A patient with a single functioning kidney presented with the nephrotic syndrome. On the basis of highly selective proteinuria, a diagnosis was made of lipoid nephrosis. Steroid therapy over a 2-year period did not control the disease. The patient eventually developed end-stage renal failure and malignant hypertension. Nephrectomy was performed to control the hypertension. Histological examination showed congenital dysplasia in one kidney and sclerosing glomerulonephritis, malignant nephrosclerosis, as well as dysplastic changes in the other.


Incidence of preterm delivery in patients with previous preterm delivery and/or abortion.

Patients with a history of two or more pregnancies which ended spontaneously before 37 weeks' gestation had an increased risk of spontaneous labour and delivery in subsequent pregnancies. This risk was correlated with previous second trimester abortion and spontaneous preterm delivery but not with previous first trimester abortions. Patients with one or more pregnancies ending in spontaneous second trimester abortion or with preterm labour and delivery had a 38--43% risk of again delivering before term.


The significance of meconium staining of the liquor amnii during labour.

Labour, labour outcome and fetal outcome were compared in 200 patients with meconium-stained amniotic fluid and in 200 matched controls with clear liquor amnii. All patients were subjected to a standardized form of management. The caesarean section rate was higher in the meconium group because of a higher incidence of cephalopelvic disproportion and fetal distress. In distinguishing between thick and thin meconium, no differences in labour or fetal outcome were found. The finding of meconium in the latent phase of labour seemed to be more ominous than during the active phase of labour.


The incomplete cone in carcinoma in situ of the cervix: A prospective study in a developing country.

The diagnostic procedures and treatment of carcinoma in situ and severe dysplasia of the cervix are becoming more conservative. In a developing country special problems make such an approach more hazardous. During a 15-month period the diagnosis in 25 of 206 patients (12,1%) with a smear positive for carcinoma in situ could not be confirmed histologically at Tygerberg Hospital. A prospective study of 147 cases (71,4%) in which the diagnosis was confirmed revealed that they were mostly young patients of relatively high gravidity. The difficulty of assessing the completeness of a cervical cone and of evaluating a postconization smear is confirmed. The danger of a too conservative approach in our patients is confirmed by the fact that only 8,2% of patients came for regular follow-up examinations and that 34,7% did not return for follow-up smears. The high incidence of total hysterectomy (51,7%) as the definitive form of treatment is defended, and a more conservative future approach of confirming the diagnosis and reducing the incidence of cervical conization is suggested.


Contraction pattern variations in oesophagography.

In recent literature a pattern of transient transverse folds seen in oesophagography has been described as a new variant. It is suggested, however, that the pattern is part of a spectrum of oesophageal contractions that occurs with or without specific lesions, and that it is created by contraction of the transverse oblique muscles of the oesophagus.


Medical student training in doctor-patient communication.

Basic theories on doctor-patient communication as taught in the course on human behaviour to third-year medical students at the University of Cape Town are outlined, and it is shown how these are understood and used by medical students early in their clinical training. It is on these foundations that the later training in psychiatric interviewing and therapeutic intervention is based. The goal is to train the doctors of tomorrow to care for patients with physical and psychological distress equally effectively.


[Trancutaneous measurement of arterial oxygen tension during anesthesia].

The transcutaneous oxygen tension was measured in 29 anaesthetized patients by means of a TCM1 TC Oxygen Monitor (radiometer). The correlation coefficient between these transcutaneously determined values and the true PaO2 values was 0,81 as compared with 0,93 in a previous trial in which a Servomed Oxymonitor (Hellige) was used. The effect of diathermy on the TCM1 TC Oxygen Monitor was much less than that on the Hellige apparatus.


Follow-up study of children admitted to a psychiatric day centre.

A follow-up study of the first 20 children admitted to the Red Cross War Memorial Children's Hospital Day Centre for emotionally disturbed children is described. The psychiatric status of the children and their families was evaluated at admission, discharge and follow-up. The results indicate that younger children benefit more than older ones from day hospital treatment, and that more attention must be paid to the psychiatric needs of the family as a whole.


An evaluation of the Ramco kit for serum ferritin assay.

The determination of serum ferritin levels may be of diagnostic importance in medicine. To establish whether values obtained using a commercially available kit (Ramco) were adequate for this purpose, a comparison was undertaken using a two-site immunoradiometric assay that had been developed and standardized in our laboratories. Over the range 6 micrograms/l to greater than 2 000 micrograms/l there was a correlation coefficient between the two methods of 0,8284 (P less than 0.001). It is concluded that the Ramco kit is suitable for use in clinical practice.


The effect of portal arterialization on hyperglucagonaemia in the portacaval-shunted pig.

Hyperglucagonaemia after portacaval shunt may be the result of liver dysfunction because of devascularization, or portal diversion. In order to investigate the effects of devascularization, a comparison was made between a group of young pigs which had undergone a portacaval shunt (PCS) alone and a group in which the portal stump had been revascularized from the splenic artery (PCS-R). Plasma glucagon levels were elevated threefold within 4 days of the operation in PCS pigs and after 8 days in PCS-R pigs. Plasma insulin levels were higher in PCS animals on day 3, but thereafter there was no difference. These studies suggest that plasma glucagon levels rose, despite the improvement of liver function by portal arterialization, confirming the hypothesis that the hyperglucagonaemia which follows portacaval shunt is caused by hypersecretion.


Postmenopausal endometriosis: A case report.

A case of postmenopausal endometriosis is presented. Symptoms started 14 years after total abdominal hysterectomy and bilateral salpingo-oöphorectomy for endometriosis following oestrogen administration. The disease had a protracted course and eventually responded well to radiotherapy. Certain aspects of postmenopausal endometriosis are discussed.


Prognostic significance of ventricular ectopic beats in chronic ischaemic heart disease.

Holter studies were performed periodically over a period of up to 7 years (mean 33 months) in 175 post-myocardial infarction patients. According to the number of ventricular ectopic beats (VEBs), the patients were classified into two main groups: those with few VEBs, i.e. less than 8 per hour, and those with many, i.e. 8 or more per hour. By comparing the number of ectopic beats during the different monitoring sessions, it was found that individual patients tended to remain in their originally allocated groups. Patients with frequent VEBs were more likely to die suddenly, the difference being significant (P < 0,001). No association could be demonstrated between recurrent non-fatal myocardial infarction and ectopic beat frequency (P > 0,10).


Mitochondrial function and free fatty acid levels in rats after portacaval shunt.

The effects of portacaval shunting on the oxidative phosphorylation process of mitochondria isolated from rat liver and skeletal muscle were evaluated and correlated with mitochondria free fatty acid (FFA) contents. ADP/O ratios, respiratory control index and QO2 values were significantly depressed in liver mitochondria from portacaval-shunted rats; these changes were associated with decreased mitochondrial FFA contents. The mitochondrial function of skeletal muscle was unaltered.


Drug-induced hyperpyrexia. A case report.

A patient who developed hyperpyrexia and heat stroke after taking overdoses of a monoamine oxidase inhibitor, benzodiazepines and a beta-adrenergic receptor blocking agent is described. The possible mechanisms involved in drug-induced hyperpyrexia are briefly discussed.


Asymptomatic arsine nephrotoxicity. A case report.

A completely asymptomatic patient with arsine nephrotoxicity is described. The light and electron microscopic appearances of the kidney biopsy specimen are documented. The pathogenesis of the lesions, the usual manifestations of arsine exposure, and how these differed from those seen in our patient, are discussed.


Some aspects of aminoglycoside antibiotic measurement.

More than 2 years of experience in assaying aminoglycoside antibiotic levels have proved that the appropriate acetyltransferase employed in conjunction with 14C-acetyl co-enzyme A provides rapid, reproducible results (CV = 4+). These results are available before the next administration is due, enabling the clinician to adjust the dose. This is especially indicated if there is impairment of renal function.


The role of the occupational health nurse in South Africa.

The improvement of the quality and quantity of occupational health care is a major issue in South Africa. The role of the nurse in the delivery of this care was examined at a workshop conference on 'The role of the occupational health nurse in South Africa'. In this article, the conclusions of the conference are reported, and the problems identified in developing the role of the nurse in this field are discussed.


An opinion survey of tuberculosis case-finding procedures.

The number of new cases of tuberculosis officially reported each year does not necessarily reflect the true position in the Republic of South Africa. One of the factors contributing to this is defective case-finding, an area giving rise to great diversity of opinion. A survey of opinions on various means of case-finding and diagnosis reveals disagreement among tuberculosis physicians in South Africa.


[An epidemiological study of peripheral blood studies].

A statistical random sample of 600 patients from the population referred to Tygerberg Hospital for peripheral blood investigations was analysed statistically with an IBM 370/158 computer. Suitable transformations were used for normalization of the data. The results of Coulter Model S investigations, platelet counts (coulter F), erythrocyte sedimentation rates, differential counts (with regard to neutrophil, lymphocyte, monocyte and eosinophil counts), age, race and sex of the patients, as well as possible associations between the day of the week and the haematological tests were investigated independently for each of the four race and sex groups, i.e. White men, White women, non-White men and non-White women. Machine sorting was used to obtain graphs representing the mean values of 12 haematological variables versus age in the four race and sex groups. Regression analysis between the different variables was done, and mean values are reported. Normal haematological limits (+/- 2 standard deviations) for the different age groups were used, and with machine processing the results were evaluated as low, normal or high in order to obtain a table for the visualization of a normal or abnormal distribution, skewness to the right or left, and percentages of abnormal values for each variable for each of the different age groups in the four race and sex groups. In this study we investigated a selected group of patients. No conclusions with regard to 'normal' values can be made, but, with the use of statistical computing of routine numerical data, an approach to epidemiology is demonstrated.