Reliability of plasma cortisol determination by a simple competitive protein binding method.

The method investigated used (3H) cortisol as the ligand, diluted human plasma as the binding protein, and florisil to separate free and bound cortisol. The precision and specificity were found to be adequate for routine use. The effects of such factors as delay in separation of plasma, storage of plasma, provenance of the binding protein, venepuncture, and venous occlusion have been studied. The extent and significance of short term, inter-daily, and longer term variation in plasma cortisol level are discussed.


Accurate measurement of lecithin and sphingomyelin after ultra-rapid chromatographic separation.

The use of small sandwich chambers containing silica-gel-impregnated glass fibre sheets allows chromatographic separation of lecithin and sphingomyelin in 3 minutes, compared with 45 minutes on conventional silica gel media. Quantitation by measuring the areas of the phospholipid spots after staining with a molybdate stain or 8-anilino-1-naphthylamino sulphonic acid was found to be accurate and more convenient than densitometry. Although slight inaccuracies may be caused by lack of resolution from certain phospholipids, this was not found to be a problem in amniotic fluid analyses as they are either absent or present only in trace quantities. The speed of the technique makes it particularly useful for clinical purposes.


An evaluation of the "CentrifiChem" parallel fast analyser.

The operating principles of the CentrifiChem are briefly described and the results of the evaluation are summarised. The pipettor, the temperature control unit, and the photometer were tested separately, but the remainder of the instrument is interdependent. Up to 10 different tests were used to measure within-batch and between-day precision, and accuracy. Carryover was found to be small, and for the six tests investigated the linearity was good. Estimates are given of the running costs, and also included are sections on the reliability and safety of the instrument. Since it requires only a small volume of serum, it is ideally suited to paediatric requirements. When used as an enzyme analyser it can work at about 200 specimens per hour.


How to pass examinations: a personal view on good technique in Clinical Biochemistry examinations.

Elementary faults in examination technique are commonly displayed by candidates who have worked hard for the examination. Advice is offered on answering multiple-choice questions and "essay" questions and on how to tackle oral and practical examinations. A candidate's preparation for an examination should include the submission of written work and the taking of a mock oral examination for critical assessment by a supervisor. Careful writing up of practical work in the home laboratory is important, so that faulty technique can be corrected early in training. Above all, stress is laid on the importance of mastering the technique of effective communication for success both in examinations and in later professional life.


Comparison of a gas chromatographic and colorimetric method for the determination of plasma paracetamol.

Plasma paracetamol levels have generally been determined either by gas chromatography (Stewart and Willis, 1975), which relies on complex equipment, or by spectrophotometry (Knepil, 1974), which can be time-consuming. The introduction by Glynn and Kendal (1975) of a simple colorimetric method based on the reaction of paracetamol with nitrous acid to give 2-nitro-4-acetamidophenol appears to have overcome these disadvantages, thereby providing a suitable procedure for the rapid measurement of plasma paracetamol in cases of overdose. The method was reported to be specific for paracetamol, no interference being caused either by the sulphate and glucuronide conjugates of paracetamol or by a large number of other commonly found drugs. This communication presents the results of a study in which plasma paracetamol levels determined by the colorimetric method were compared with those determined by an established gas chromatographic technique.


A study of factors influencing continuous flow kinetics: the use of serum calcium estimation as a model.

Previous studies of continuous flow kinetics have described an "AutoAnalyzer" peak in terms of two time constants, lag constant "a" and exponential constant "b". Further investigations described here define some of the factors which affect these constants and hence peak shape and analytical performance. This communication outlines the application of this information to the development of an automated method for the determination of serum calcium, having a carry-over of less than 1% and an analytical rate greater than 100/hour. The instaneous colour reaction, simple hydraulics, removal of the dialysis step, and the use of an integral debubbling flow cell have enabled small kinetic constants to be achieved. Over a period of three months' routine use between-batch co-efficient of variation (C.V.) was 1.4%.


Evaluation of a serum/plasma separator: suitability of samples for radioimmunoassay and competitive protein binding techniques.

A new method of separating serum or plasma from whole blood (Sure-Sep, W.R. Warner) has been evaluated with particular regard to the suitability of the serum/plasma samples for radioimmunoassay (R.I.A.) and competitive protein binding (C.P.B.) techniques. Sure-Sep did not affect the results obtained for the following assays: cortisol, thyroxine, triidothyronine, insulin, and growth hormone. In addition it was also found that contact of the serum or plasma samples with Sure-Sep for 24 hours at 4 degrees C was without effect on the results obtained.


The peak of the likelihood curve in linkage testing.

It is often suggested that when z-scores are used for linkage estimation, a maximum z-score of 3 (or maximum antilod score, M = 1000) is good evidence for the presence of linkage. It is pointed out that a better formula, applicable if nothing more is known about the loci concerned, would be that the probability that linkage is present is roughly 1--4/Msigma, whereas sigma is the standard error, i.e. square root(2-3 X downward curvature of z curve at peak). A consideration of typical cases suggests that a value M = 1000 would imply something like a 90% chance of linkage. It would seem simpler to use the formula, probability of linkage approximately to 1--H/20, where H is the average height of the antilod curve.


On the estimation of parental age effects on mutation.

The detection and estimation of the effects of paternal and maternal age and birth rank on mutation rate are considered. Smith's (1972) method and discriminant function techniques are compared using data on Apert's acrocephalosyndactyly and achondroplasia.


A note on the arrival probability, first arrival time and age of a mutant gene in a finite population.

It is pointed out that the arrival or fixation probability of a mutant gene can be easily inferred analytically. The mean first arrival time for a single overdominant mutation to reach frequency y attains its maximum when x is close to but still slightly less than y/2, where x is the equilibrium frequency of the mutant gene in an infinitely large population. For an advantageous mutation, the mean first arrival time decreases with an increasing degree of dominance if selection is strong, but it first increases, after reaching a maximum, then decreases as the degree of dominance increases, if selection is weak. Contrary to our intuition, the mean age of an advantageous mutant gene increases with increasing degree of dominance, except when selection is very strong. A simple explanation is given in terms of the sojourn time at a particular gene frequency.


Growth of deleterious mutant genes in a large population.

Formulae for the arrival probability and first arrival time for a single mutant gene to reach a certain number have been obtained by using a continuous branching process. If the mean of the progeny number of heterozygotes is less than one the arrival probability increases with increasing variance of the progeny distribution whereas if the mean is greater than one the contrary is true. Since most human populations are growing at fairly high rates, the result indicates that the probability for a single mutation to grow to a large number is quite high. Numerical computations show that the mean first arrival time decreases with increasing variance of the progeny distribution of the mutant carriers. The results have been applied to investigate the case of the acheiropodia gene in Brazil. The hypothesis that all acheiropodia genes in Brazil were derived from a single mutation seems to be tenable.


Dominance variance in Fisher's model of assortative mating.

It is argued that there is some confusion in the literature concerning the effect of assortative mating on dominance variance. It is shown that in Fisher's model of assortative mating additive deviations of one factor are correlated with additive deviations of another and that this correlation is responsible for the increase in genetic variance. The dominance deviations of one factor are independent of the dominance, as well as of the additive deviations of a second factor. It is shown that in Fisher's model of assortative mating and to the approximation used by him, the dominance variance does not change under assortative mating.


A model for assortative mating.

It is shown that a generalization of the Hardy-Weinberg law of the proportions of genotypes of the kind given by Wright (1922) is maintained in equilibrium by a pattern of assortative mating suggested by Fisher (1918) and elaborated by Malécot (1939, 1948).


On the method of Penrose of estimating the number of effective factors contributing to a character.

Penrose (1969) presented a method of estimating the number of effective factors contributing to a quantitative character. The method uses samples of parent-child and sib-sib phenotypic values. More detailed mathematical analysis shows that his assertions regarding the method are correct under the assumptions which he made, provided that his phrase 'the same quantitative effect' is interpreted to mean 'makes an equal contribution to the variance'.


A genetic study on the length of tibia.

The length of tibia was studied in 1364 males and 1791 females over 10 years of age in an agricultural district of Wakayama Prefecture, Japan. (1) The length markedly increased from 10 to 17 years of age in males, and 10 to 15 in females, but it remained comparatively unchanged from 20 to 79 years in both sexes. The following regressions of tibial length covering 20 to 79 years were obtained: Y male = 0-0183x+34-7892, Y female = -0-0269x + 32-5329. The modified data proved to be a normal distribution on skewness and kurtosis test; they were analysed on a quantitative genetic basis. (2) No significant contribution of X-linked and Y-linked genes to tibial length was found in an analysis of parent-child combinations. (3) There was no indication of maternal effect, since the difference between father-child (r = 0-36 +/- 0-05) and mother-child (r = 0-42 +/- 0-04) correlations was not significant. (4) Correlation coefficients between sibs were significant, the values being 0-57 +/- 0-09 for brother-brother, 0-32 +/- 0-22 for sister-sister, and 0-27 +/- 0-13 for brother-sister. Correlation coeffiecients between parent and child were also significant, the values being 0-36 +/- 0-06 for father-son, 0-35 +/- 0-09 for father-daughter, 0-44 +/- 0-04 for mother-son, 0-35 +/- 0-07 for mother-daughter. The regression coefficients of child on midparent were calculated to be 0-77 +/- 0-12. Thus, the heritability for the length of tibia may be estimated to be 0-77 approximately 0-80. Contribution of dominance variance to total variance was very small (VD = 0-01), in contrast to a far greater additive genetic variance (VA = 0-80).


Extensions to pedigree analysis. III. Variance components by the scoring method.

The classic variance components for simple polygenic traits - additive, dominance, and environmental variance - have traditionally been estimated from sample covariances between first-degree relatives. If data is gathered on pedigrees, this statistical procedure wastes information. Recently Elston & Stewart suggested an alternative likelihood procedure that uses all the information in a set of pedigrees. A refinement of their method based on the scoring technique gives rapidly converging maximum likelihood estimates of the variance components and of the male and female means. Tests of statistical hypotheses about the various parameters can then be made by the likelihood ratio method. Furthermore, using classical regression analysis, the estimated parameter values allow prediction of unknown trait values from known trait values within a pedigree. These methods should apply to traits like total finger ridge count and to quantitative measurements associated with disease traits. Since the model postulates independent environmental effects and no assortative mating, its utility in human behaviour genetics seems limited.


The genotypic distribution of relatives of homozygotes when consanguinity is present.

A correction is made to an expression given by Jacquard (1968, 1972a,b) for the genotypic distribution of a relative of a given homozygote when consanguinity is present. The correction will necessarily be small either if the allele present in the given homozygote has a frequency of near unity, or if the coefficient of inbreeding of the given homozygote is small.


Isonymy in a Bhatia leut.

Isonymy has been described in a North Indian Hindu Community, which shows surname exogamy. A modification is suggested in the formula of Crow and Mange for the estimation of FIS to make it applicable to populations exhibiting clan exogamy. The values of FIS obtained by different methods are compared.


[Assay of the activity of horseradish peroxidase antibodies using ammonium sulfate technique (author's transl)].

The antigen binding capacity (ABC) of mouse and rabbit antisera to horseradish peroxidase (HRP) was measured by the Farr technique, originally introduced for bovine serum albumin. Results obtained by this method are independent of other antibody interactions (precipitation, formation of immune complexes, effect on enzyme activity). Commercially available HRP has variable solubility in ammonium sulfate solutions; almost 40% was precipitated at 50% saturation. Accordingly, the fraction of HRP soluble at 60% saturation was used, and this was labelled with 125I2 using the HRP oxidizing activity. Under these test conditions, accurate and reproducible results were obtained with protein concentrations (as N/ml) of the order to 0.07 mug (antibody) and 0.01 mug (antigen) respectively. This high sensitivity is superior to that achieved by passive hemagglutination, especially when titrating antibody levels in mouse sera.


[The influence of plasmocellular tumours on the humoral immune response in mice (author's transl)].

Syngeneic mice of the C3H/He strain have been inoculated with cells of the plasmocellular tumours X5563 and X5647, producing myeloma proteins of the IgG and IgA class respectively, and were immunized with (1) sheep red blood cells, (2) bovine serum albumin and (3) horseradish peroxydase. The immune responses of the various groups of mice were followed. The antibody activities towards all three antigens were decreased in mice carrying the IgG producing tumour X5563. This effect was correlated with an enhanced catabolism of IgG as well as with a decrease in number of IgG antibody producing cells. A reduced immune response was also observed in mice to which the IgA producing tumour X5647 had been transferred, but the effect was significantly less pronounced. There was no effect at all observed on the IgM response. The avidity which was measured for the various IgG antibodies was not modified by the presence of IgG nor IgA secreting myeloma tumours.


[Delayed-type hypersensitivity induced by digestive immunization and suppression of this induction by antigen-antibody complexes (author's transl)].

BALB/c mice were immunized by intragastric administration of sheep red blood cells or horse red blood cells repeated daily for 4 days. The immunized animals when skin tested with an urea extract of the corresponding antigen showed a delayed-type hypersensitivity reaction. This reaction was observed for 4 weeks after the immunization. This result demonstrates that digestive immunization may induce cellular immunity. When serum from intragastrically immunised mice containing antigen-antibody complexes was administered intraperitoneally 8 hours before the onset of digestive immunization, the subsequent delayed-type hypersensitivity reaction was suppressed or considerably depressed.


[Actinomyces globispororoseus var. granaticus var. nov., a new producer of granaticins].

Actinomycete LIA-0830 was most close by its morphological and cultural features tc Act. globispororoseus. Jet it differed from the latter in the physiological and antibioti properties. Actinomycete LIA-0830 differed from the known granaticin- and granaticin B-producing organisms by its morphological, cultural and physiological properties. On the basis of these data actinomycete LIA-0830 was classified as Actinomyces globispororoseus var. granaticus var. nov. The culture produced 2 antibiotics: granaticin and granaticin B.


[Production of tubular structures from the aerial mycelium of Actinomyces roseoflavus var. roseofungini].

Tubular formations analogous by their structure to those found on the surface of the outer sheath of the hyphae of the aerial mycelium of Actinomyces roseoflavus var. roseofungini were reconstructed in vitro from the mycelium acetone extract on addition of water. A polyenic antibiotic was shown to be present in the composition of the "tubes". A possible role of the antibiotic in the genesis of the secondary structures of the actinomycete is discussed.


Further characterization of milk pyroglobulin.

Milk pyroglobulin was capable of passing through the "Visking" 8/32 cellulose membrane, when dialysed against deionized water but not against saline. Gel filtration analysis of the protein suggested its dissociation into subunit molecules in deionized water. Amino acid composition revealed high contents of proline, glutamic acid, valine and leucine. The protein possessed a biological activity to increase the permeability of skin vessels when injected intradermally. The colostral whey which was experimentally freed from heat-coagulable substances contained as major components proteins which are antigenically related to the pyroglobulin.


[Teichoic acid content in the cell wall of Actinomyces rimosus LST-118 in the process of ontogeny].

Polymeric compounds of the cell walls of Act. rimosus were studied during the actinomycete growth. It was found that the content of teichoic acid decreased 2 times by the end of development of Act. rimosus, while content of glycane polymer remained approximately at the same level. The molar ratios of teichoic acid and glycopeptide glycane were determined.


[Prevalence of markers characteristic for penicillinase plasmids in clinical strains of straphylococci].

Occurrence of the markers of penicillin and erythromycin resistance in the clinical strains of Staph. aureus, as well as their connection with the determinants of resistance to the heavy metal salts and sodium arsenate was studied. 79 per cent of Staph. aureus were resistant to penicillin and 47 per cent to erythromycin. All erythromycin resistant strains were also resistant to penicillin. More than a half of the strains of Staph. aureus of the phage groups I, III and the mixed phage group had a set of markers: pen, asa, cad, mer, ego. The rate of elimination of the above markers with ethidium bromide was high. The presence of the penicillinase plasmid determining a rather low level of resistance to erythromycin (20--50 gamma/ml) was characteristic of the strains belonging to the phage group I. The presence of the plasmid determining a high level of resistance to that drug (500--1000 gamma/ml) was characteristic of the phage group III and the mixed phage group. The erythromycin sensitive strains of Staph. aureus were almost always sensitive to mercuric ions.


[Effect of glucocorticoids on the pharmacokinetics of kanamycin in rabbits].

The effect of hydrocortisone on kanamycin pharmacokinetics in rabbits treated with the drugs administered intramuscularly in two different syringes simultaneously and in one syringe was studied. When the drugs were administered in two different syringes, there were no changes in the antibiotic pharmacokinetics as compared to the control group, while administration of the drugs in one syringe resulted in decreased excretion of the antibiotic with urine and a significant increase of its levels in the blood, liquor and tissues.


[Absorption, distribution and the duration of retention of neomycin in the body of pregnant rabbits and their fetuses].

Neomycin was administered intramuscularly to rabbits in single doses of 50000 gamma/kg 24--25-day gravid rabbits were sacrificed 1.5-2-3-4-6-12-24 hours and 2-3-6 days after the drug administration. 3--4 rabbits were used in every experiment. The antibiotic concentration was determined with the agar-diffusion method. It was found that the drug was present in various bactericidal concentrations in all 55 organs, tissues and fluids of the rabbits and the fetus examined except the crystalline lens in the rabbits and the brain, liver and bile cyst of the fetus. In some material of the rabbits and their fetus, high levels of neomycin were detected during 6 days, i. e. up to the end of the experiment. The highest neomycin levels in the organs, tissues and fluids of the fetus were detected somewhat later than in those of the rabbits. However, their retention time was longer. It is necessary to forbear from using antibiotics, such as neomycin, monomycin and others, which retained for long periods of time in the organism.


[Functional state of the adrenal cortex in the antibiotic therapy of experimental staphylococcal infection].

The functional state of the cortex in experimental animals before and after treatment with tetracycline was studied under conditions of prolonged infection caused by intravenous administration of Staph. aureus. Three staphylococcal strains were used in the study: sensitive, low sensitive and resistant to tetracycline. It was shown that development of the infection in the animals was accompanied by a decrease in the cortex function. Oral administration of tetracycline in a dose of 200 mg/kg resulted in normalization of the glucocorticoid function of the gland after 15 days of its use. Since the same phenomenon was observed when the animals were infected with the antibiotic resistant strains of staphylococci, it was supposed that the therapeutic effect of tetracycline was defined by both the antibacterial action and capacity for increasing the protective-adaptive reactions of the host by stimulation of the cortex function.


[Effect of the prolonged use of streptomycin as well as streptomycin in combination with tubazid on the bioelectrical activity of the brain in experimental tuberculosis].

The effect of streptomycin used alone and in combination with tubazid on the brain electric activity was studied in chronic experiments on rabbits with tuberculosis. The electrocorticographical investigations showed that the antibacterial treatment lowered the spontaneous electric activity and reactive capacity of the cortex. It was evident from a narrow amplitude of the main rythm, coefficient and energy of synchronization on rythmic photostimulation and paroxysmal activity withing the theta range. With the account of the high therapeutic effect of the antibacterial treatment evident from minimum affection of the organs with tuberculosis, the above changes in the electrocorticogrammes should be attributed to the neurotropic effect of the drug and not to tuberculosis intoxication.


[Antiviral activity of a poly A-poly U complex administered by various routes].

Interferon-inducing and antiviral activity of a synthetic polyribonucleotide, polyaenylic and polyuridylic acid complex (poly A--poly U) was studied comparatively on a model of experimental infection of albino mice caused by Venezuela Horse Encephalomyeliti Viruos (VHEV) using oral and intraperitoneal administration of the complex. It was shown that dm-interferon induction and antiviral effect comparatively high doses of poly A--poly U (Reanal) were required (1 mg/mouse). The highest antiviral effect was observed after a two-fold administration of the drug (24 hours and immediately before infection). It was more evident after intraperitoneal administration of the inductor. The interferon titers in the animal blood serum after intraperitoneal or oral administration of poly A--poly U were almost the same 58=60+/- +/- 18.9 IU50/ml).


[Comparative characteristics of the serotonin and histamine content in the blood of surgical patients before and after antibiotic administration against a background of droperidol, promedol and atropine premedication].

The effect of intramuscular administration of ceporin and megacillin in single doses of 500 mg and 1000000 Units respectively on serotonin and histamine blood levels in 34 patients against the background of premedication with droperidol, promedol or atropine was studied. The observations showed that after megacillin injection the serotonin blood levels decreased. Ceporin had no effect on serotonin and histamine blood levels.


Sebaceous gland inhibition from combined glucocorticoid-estrogen treatment.

Sebum production in seven hirsute women was found to be markedly inhibited by low-dosage glucocorticoid therapy, usually 5 to 10 mg of prednisone daily, combined with the cyclic administration of ethinyl estradiol, either 80mug or 100mug daily, in the form of oral contraceptive medication. The average reduction of sebum secretion was 85.7%, from a pretreatment mean value of 3.07 mg of sebum to an average treatment level of 0.44 mg.


Hyperpigmented tinea versicolor.

Examination of specimens from lesions of hyperpigmented tinea versicolor and from unaffected skin disclosed that the lesions showed increased stratum corneum turnover (8.2 +/- 0.6 vs 14.8 +/- 0.4 days, respectively), slight to moderate routine histological changes, such as acanthosis and perivascular inflammation, and dramatic electron microscopical changes (larger, singly distributed melanosomes vs small, packaged melanosomes, respectively). Brown hyperpigmentation in tinea versicolor appears to arise from an increase in melanosome size and a change in their epidermal distribution pattern.


Intravenous desensitization to mechlorethamine in patients with psoriasis.

Eight patients with psoriasis who had developed contact allergy to mechlorethamine hydrochloride (nitrogen mustard) were subjected to a regimen of intravenous infusion of small amounts of the drug in an attempt to produce desensitization. Although three of eight developed negative patch tests and were presumed to be desensitized, only one patient was able to use the drug therapeutically, and then only for a period of eight months, after which allergy recurred. The other two patients whose allergic contact dermatitis was abolished by the infusions were unable to use mechlorethamine therapeutically because of pruritus. Seven patients experienced some adverse reaction to the infusion. Intravenous desensitization of psoriatic patients who are allergic to mechlorethamine was not successful enough as a useful clinical procedure to allow them to once again use the drug therapeutically.


Corticosteroid-induced cutaneous atrophy and telangiectasia. Experimental production associated with weight loss in rats.

A bioassay for the evaluation of certain adverse effects of various corticosteroids was performed. Twenty-eight daily topical applications of corticosteroids to young rats produced reduction in body-weight gain, atrophy of the skin as determined by double skin-fold thickness micrometer measurement, and mild to severe telangiectasia. This animal model demonstrates corticosteroid-induced skin atrophy and telangiectasia and the correlation of the degree of atrophy and telangiectasia to body-weight change. Nine corticosteroids were evaluated by this method and are listed in terms of increasing severity of side-effects as follows: 1.0% hydrocortisone cream, 0.1% betamethasone valerate cream, 0.025% betamethasone benzoate cream, 0.05% flurandrenolide cream, 0.05% fluocinonide cream, 0.1% dexamethasone cream, and 0.03% flumethasone pivalate cream. Triamcinolone acetonide cream, 0.5%, and 0.2% fluocinolone acetonide cream resulted in death of the animals prior to completion of 28 days of topical application.


Allergic and photoallergic dermatitis from diphenhydramine.

A 52-year-old man developed contact and photoallergic dermatitis caused by diphenhydramine hydrochloride as well as contact dermatitis from paraphenylenediamine. The diphenhydramine photoallergy was elicited by long-wave ultraviolet light. The action spectrum differs from that noted in a recent report in which wavelengths shorter than 320 nm were responsible for eliciting diphenhydramine photoallergy. To the best of my knowledge, this is the third case of diphenhydramine photosensitivity reported in the English literature. The combination of both contact and photosensitivity to diphenhydramine has not previously been described.


Plaque-type blue nevus.

Blue nevus may rarely appear in plaque form. It seems to be a benign and asymptomatic lesion, but because of its rarity, no definite prognosis can be given. Only through reporting of additional cases and their follow-up will the prognosis become clear.


Arteriovenous fistula. Cutaneous manifestations.

The association between congenital large-vessel arteriovenous (AV) fistulae of the extremities with Kaposiform acroangiomatosis is well established. Based on pathogenetic considerations, it is likely that many benign, cutaneous angiomatoses represent minute or microscopic AV fistulae. Combined large vessel and small vessel congenital AV fistulae of the extremity would result in the previously mentioned syndrome.


Hidradenitis suppurativa following acanthosis nigricans. Report of two cases.

Two overweight male patients developed acanthosis nigrican of the axillae. Seven to nine months later, the patients developed hidradenitis suppurativa deep within the areas of acanthosis nigricans. On examination of biopsy specimens, the hyperkeratosis of acanthosis nigricans was found to extend into the follicles. In previous reports, Fox-Fordyce disease and pityriasis rubra pilaris have preceded the onset of hidradenitis suppurativa.


Circular indurated lymphangitis of the penis.

Circular lymphangitis of the penis has been seen in three of our patients, two of whom complained of mild discomfort. A patient with syphilis was initially misdiagnosed because of similar clinical findings. A serologic test for syphilis should be performed in all patients with this disorder.


Leukonychia striae.

A 19-year-old keypuncher had leukonychia striae. The pattern of striae suggested that they occurred as a result of the mechanical stimulation of keypunching.


Pemphigus foliaceus. Early clinical appearance as dermatitis herpetiformis with eosinophilic spongiosis.

We encountered an unusual case of pemphigus foliaceus in which there were early clinical signs of dermatitis herpetiformis with eosinophilic spongiosis histologically. Numerous authors have appreciated that eosinophilic spongiosis occurs in early pemphigus foliaceus, usually in the preacantholytic stage when the lesions may clinically simulate dermatitis herpetiformis. Recognition of eosinophilic spongiosis may help differentiate early pemphigus from other vesiculobullous disorders.


Sebaceous glands in the esophagus. First case observed grossly.

Minute, pale tan macules of the esophageal mucosa observed at autopsy proved, on microscopical study, to be sebaceous glands unaccompanied by hair follicles. Metaplasia of pluripotent cells is postulated as their origin in this purely endodermal tissue, rather than derivation from islands of misplaced epidermis.


Atypical fibroxanthoma masquerading as pyogenic granuloma.

An atypical fibroxanthoma on the ear of a 82-year-old man appeared clinically as a pyogenic granuloma. Histopathologically, the lesion had been interpreted as a malignant melanoma before its true nature was identified. Familiarity with this cutaneous pseudomalignant growth is essential to prevent radical surgical procedures.


Larva currens. Cutaneous strongyloidiasis.

Strongyloides stercoralis causes a distinctive form of cutaneous larva migrans that is recognized as larva currens. The rapid rate of intracutaneous migration, the cutaneous localization, the chronicity of recurrence, and the frequency of urticarial reaction justify its presentation as a clinically distinguishable form of creeping eruption. This clinical complex should be identified as a cutaneous sign of systemic disease.


Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty.

New charts for height, weight, height velocity, and weight velocity are presented for clinical (as opposed to population survey) use. They are based on longitudinal-type growth curves, using the same data as in the British 1965 growth standards. In the velocity standards centiles are given for children who are early- and late-maturing as well as for those who mature at the average age (thus extending the use of the previous charts). Limits of normality for the age of occurrence of the adolescent growth spurt are given and also for the successive stages of penis, testes, and pubic hair development in boys, and for stages of breast and pubic hair development in girls.


Suspected poisoning in children. Study of the incidence of true poisoning and poisoning scare in a defined population in North East Bristol.

The distinction between true and suspected poisoning in children has not been made clear in previous work on childhood poisoning. A study of suspected poisoning in children under 15 years of age in a defined population of North East Bristol from November 1970 to July 1973 carried out by the Health Education Council Medical Research Division included 53,000 child-years at risk. The number of suspected poisonings was 3-4/1000 population aged under 15 years per year, with a higher incidence in younger age groups. Detailed investigation of the circumstances of the accidents carried out by a multidisciplinary team showed that at least 65%, and possibly as many as 78% were poisoning scares and not true poisoning. The evidence used by the casualty doctor and by the parents to diagnose poisoning was explored, and in many cases was circumstantial. Children with fathers in nonmanual occupations were over-represented. This may reflect differences in patterns of utilization behaviour rather than true differences in incidence.


Pet sensitivities in asthmatic children.

A history of pet contact and/or apparent clinical sensitivity was obtained in 65 (55%) of 118 unselected asthmatic children. These 65 children were skin tested and their sera examined for specific IgE using the radioallergosorbent test. Those children who had apparent clinical sensitivities had larger skin test reactions and were more likely to have positive specific IgE results than those without apparent sensitivities. Positive skin tests were very common (80%), but the larger the skin test reaction (weal diameter greater than 4 mm diameter) the more likely was there to be a positive history or a positive specific IgE result. Hence a large skin test reaction can provide a helpful pointer to animal allergy of clinical importance. Commercially available animal extracts have limitations for diagnostic tests. A questionnaire survey of 150 day schools emphasized the potential opportunities for contact with animal allergens at school.


Cyproterone acetate in treatment of precocious puberty.

Twenty-nine children (23 girls, 6 boys) with precocious puberty were treated with cyproterone acetate for various periods of time ranging from 6 months to 3 years 4 months. They received an oral dose ranging from 70-150 mg/m2 per day, or an intramuscular depot injection once a fortnight or once a month at a dose ranging from 107-230 mg/m2. Both forms of therapy were found to suppress the signs of sexual maturation, but the oral form proved to be superior. Only the younger patients with a bone age under 11 years showed a beneficial effect upon linear growth and bone maturation. No side effects were noted, but additional advantageous effects upon behaviour and sociability were. It is concluded that at present cyproterone acetate by mouth is the drug of choice in the treatment of precocious puberty. The treatment should be initiated as early as possible to attain maximum benefit.


Rifamycin in neonatal flavobacteria meningitis.

Three newborn infants with meningitis due to Flavobacterium meningosepticum were treated with rifamycin administered parenterally and directly into the cerebral ventricles. Antibiotic concentrations of blood and cerebrospinal fluid (CSF) were monitored during treatment. There was rapid sterilization of the CSF after this antibiotic. Jaundice was the only toxicity noted. All 3 infants developed hydrocephalus and are shunt dependent. Two of them are otherwise free of neurological complications and are developing normally. Rifamycin is a safe and effective antibiotic in this form of neonatal meningitis.


Reversible intestinal mucosal abnormality in acrodermatitis enteropathica.

In 3 cases of acrodermatitis enteropathica duodenal biopsy performed at the outset of treatment showed a similar abnormality of the intestinal mucosa. Further biopsies taken during treatment showed progressive improvement of the intestinal mucosa with subsequent complete restoration of the normal cellular and villous pattern. The initial treatment was with expressed human breast milk and oral di-iodohydroxyquinoline. The latter was continued alone and later replaced by zinc sulphate. Changes in the intestinal epithelial cells and inflammatory cell infiltration of the lamina propria still detectable on di-iodohydroxyquinoline therapy reverted to normal with oral zinc.


Medullary carcinoma of thyroid gland in a girl aged 10 years.

A healthy girl of 10 years presented with lumps on her tongue, shown on biopsy to be neuromas. She had had operations to her feet for pes cavus and was relatively long-limbed but had no other 'Marfanoid' features. She had a high plasma calcitonin level. At operation a normal sized thyroid gland was totally removed. It contained two discrete masses of malignant C-cells and diffuse foci elsewhere. The plasma calcitonin fell slowly to normal on follow-up but was noted to be rising 2 1/2 years later. We stress the importance of making this diagnosis as early as possible and mention briefly another child aged 15 months, similarly diagnosed and operated upon.


Peritoneal dialysis and exchange transfusion in a neonate with argininosuccinic aciduria.

Peritoneal dialysis rapidly reduced blood ammonia concentration in this child with arginino-succinic acid-lyase deficiency, whereas exchange transfusion did not. Yet this reduction in plasma ammonia level did not produce clinical improvement. We speculate that the effects of ammonia intoxication on the highly susceptible neonatal metabolism are due to an accumulation of toxic products and to an altered energy metabolism. Both aspects must be considered in any attempt to treat congenital hyperammonaemia.


Decreased antihaemophilic globulin and leucocyte response to epinephrine in preterm infants.

Twenty-one preterm and 23 term neonates, 13 splenectomized children and one with congenital asplenia, and 20 normal children were examined for plasma antihaemophilic activity and for blood leucocyte levels before and 30 minutes after a subcutaneous injection of epinephrine 0-01 mg/kg. The basal values for antihaemophilic activity were similar for the 4 groups. The response to epinephrine was a trivial rise in antihaemophilic activity in the preterm group, while the rise in the term newborns was comparable to that of the normal children. The asplenic children all showed a trivial rise. The leucocyte response was also negligible in both the preterm neonates and asplenic groups, while in the term infants it was comparable to that seen in the normal children. These results may indicate an incapacity of the preterm newborn infant's reticuloendothelial system and spleen to react to other challenges, such as bacterial infection.


Manpower goals in American surgery. Implications for residency training. Future surgical manpower in the framework of total United States physicians.

Constraints on manpower are intrinsic in the establishment of standards of excellence. When such constraints are exerted by individual Boards, Societies, Colleges or Academies they should act to improve the quality of care; their weakness lies in their lack of control over non-members, or those who have failed to pass the examinations. Such manpower constraints become specific objectives or goals when the number of accredited specialists is specifically related to the size of the population served. Any such manpower planning must recognize the many uncertainties in the future of American medicine, and maintain wide elasticity in the planning process. Social and economic pressures render the consideration of specific manpower goals essential at this time. Data from the national surgical study (SOSSUS) make it possible to consider such goals. Manpower objectives for surgery or any other branch of medicine should be considered as a part of the total medical manpower outlook for the United States. Pressures to reduce the number of surgeons entering practice are notable at this time. These should be evaluated against other pressures to maintain or increase the number of hospital-based specialists in all fields as the total number of practitioners undergoes a major expansion over the next 25 years, and the pressure for specialty care is thereby increased. A reasonable balance between these two pressures would be a manpower goal for surgery that allowed a modest growth rate over the next 25-50 years. An example of such is the goal of limiting surgical practitioner growth to a 1% increase in the ratio to population, every 5 years. This would be in sharp contrast to the continuous explosive growth of numbers of surgeons, since World War II.


Acute cholecystitis as a postoperative complication.

The clinical course and management of 40 patients who underwent operation for acute cholecystitis developing as a postoperative complication were reviewed. Of note was the mortality of 47%, the high incidence of gangrene, perforation, empyema, and cholangitis, and the atypical clinical presentation of acute cholecystitis under these conditions. Awareness of this possible complication, knowledge of its clinical features, and early surgical intervention are important facets of successful management.


Leiomyosarcoma of the inferior vena cava: report of a case and review of the literature.

Leiomyosarcoma of the inferior vena cava is a rare and usually fatal disease. Only 45 cases have been reported in the world literature. The authors add one case and review all previous reports. The disease is one primarily of elderly women, arising from the middle third of the inferior vena cava with a wide range of symptomatology, varying form the Budd-Chiari syndrome to a few asymptomatic cases. The tumor may grow very slowly or occasionally very rapidly, shows extensive local invasion, and metastasizes more frequently than previously believed. While radiotherapy and chemotherapy have not been adequately studied, aggresive surgical intervention using the recent advances in vascular surgery appears to offer long term palliation and hopefully cures of this disease in the future.


Anastomotic aneurysms following arterial grafting: A 10-year experience.

A multi-faceted pathogenesis of vascular anastomotic aneurysms encompassing both the earlier and modern eras of vascular surgery has been proposed. A review of the clinical records of patients with such aneurysms suggests that while silk sutures were an important causative factor in the earlier era, this complication continues to occur with the more recent use of synthetic suture material. Future examination of the data suggests that the location of the anastomosis remains important in the development of these aneurysms. Moreover, operative findings suggest that graft tension, shearing and vibration forces along the suture line and degeneration of the host vessel are the more important causative factors today.


Physical properties of surgical suture materials: Stress-strain relationship, stress-relaxation and irreversible elongation.

The stress-strain relationship, the stress-relaxation and the irreversible elongation of different suture materials were investigated. It was found that the distensibility of the fibers varied greatly. Most fibers were found to be chiefly elastic but some fibers were elastic when a moderate load was applied and plastic when the load increased. Some fibers, especially Prolene, were plastic also when moderate load was applied. The importance of information concerning these and other physical properties of surgical suture material is pointed out. In the future, surgeons will not have to accept suture materials with unknown physical properties but will demand fibers with defined properties for every purpose.


The effect of vagotomy antrectomy or vagotomy pyloroplasty on the response of the antrum to meat extract in duodenal ulcer patients.

In 9 normal and 42 duodenal ulcer patients, acid and gastrin studies were performed. Basal, Oxo and Histalog stimulated acid secretion was conducted on each patient. In 24 patients post vagotomy pyloroplasty or vagotomy antrectomy, these studies were repeated within three months after surgery. Two groups of duodenal ulcer patients were identified; those who did respond and those who did not respond to Oxo stimulation. In the "responders," Oxo stimulated acid output and gastrin secretion increased significantly over basal values. Both vagotomy pyloroplasty and vagotomy antrectomy caused a similar significant decrease in Oxo and Histalog stimulated acid output. In two patients with incomplete vagotomy, antrectomy, but not pyloroplasty abolished the Oxo stimulated acid response. These data suggest that OXO stimulation test can select patients with a significant antral component in whom vagotomy and antrectomy would be the appropriate procedure. Our results also indicate that antrectomy will protect against recurrent ulceration in patients with incomplete vagotomy and may explain the lower incidence of stomal ulceration in patients with vagotomy antrectomy, compared to vagotomy pyloroplasty.


Comparison of ancrod and heparin as anticoagulants following endarterectomy in the dog.

An experimental model of surgically-induced arterial thrombosis was devised using the femoral arteries of dogs. Within 7 days, 67% of the arteries became completely thrombosed and only 12% remained compeletly patent. In the group of dogs that received low-dose heparin, 69% of the vessels were completely thrombosed and 6% remained completely patent. In the group of dogs treated with low-dose Ancrod to induce partial defibrination, 75% remained completely patent while only 19% of their femoral arteries were completely thrombosed. Although the ancrod was effective in preventing arterial thrombosis, 88% of the wounds showed moderate to severe separations. Most likely the absence of a fibrin lattice, necessary for the securement and growth of fibroblasts as the wound heals, explains this latter effect. Thus while Ancrod may become useful as an anticoagulant in certain clinical situations, it should not be used in proximity to surgery. Finally, in these studies of acute arterial thromboses, low-dose heparin therapy offered no protective effect.


Reduction of early occlusions in the high risk peripheral saphenous vein graft.

Early thrombosis of saphenous vein grafts can only reduce long-term patency. There exists a high risk category of patients who can be identified preoperatively where early failure is increased above the 10-20% which is attributed to technical errors. A venous side-arm indwelling catheter offers a safe means of reducing early thrombosis, promptly diagnosing the occlusion when it does occur, and more clearly delineating a course of corrective action. The venous side-arm catheter provides a means by which the vascular bed at highest risk may be regionally anticoagulated while allowing systemic clotting times to remain near normal. In addition, vasoactive drugs may be infused directly into the arterial tree and perhaps most importantly, rapid and atraumatic arteriograms can be obtained postoperatively at the bedside for evaluation of questionable perfusion. Regional heparinization and postoperative arterigraphy by means to the side-branch catheter technique was used in twelve patients who otherwise had an expected occlusion rate of 75% or more with an actual early occlusion incidence of zero.


Gastrocolic fistulae in benign peptic ulcer disease.

Occurence of gastroenteric fistulae in non-surgically treated peptic ulcer disease is rare as suggested by only 26 cases published in the literature so far. We had the opportunity to care for 3 patients with this problem in a period of one year. At our institution, a search of the medical records dating back to 1955 yielded one additional case. Most of our patients had a history of salicylate or corticosteroid intake. We present here the details of these cases and discuss the possible role of the location of the ulcer and ulcerogenic anti-inflammatory drug ingestion in the causation of gastroenteric fistula. We believe the incidence of this uncommon entity may rise significantly with the more common use of salicylates and corticosteroids.


Pyogenic liver abscess secondary to asymptomatic sigmoid diverticulitis.

A patient with multiple pyogenic abscesses in both lobes of the liver secondary to asymptomatic sigmoid diverticulitis is presented. The rarity of this illness is noted. It is suggested that barium enema be performed in patients who present with pyogenic liver abscess of unknown etiology because of the association with asymptomatic sigmoid diverticulitis.


Disposition kinetics of ketamine in the domestic cat.

The disposition kinetics and systemic availability of ketamine, a dissociative anaesthetic agent, was studied in normal domestic cats. A similar dose (25 mg/kg) of ketamine hydrochloride was administered by the i.v. and i.m. routes; drug concentrations in plasma were measured by a gas-liquid chromatographic procedure. A rapid distribution phase (t1/2 (alpha) = 3 min) was followed by a slower first-order elimination phase. The half-life of the drug (66.9 +/- 24.1 min) was independent of the route of parenteral administration. Absorption from i.m. site of administration was rapid, with peak plasma level at 10 min, and ca. 92 per cent of the dose was available systemically. Extent of plasma protein binding, measured in vitro at 5 and 20 mug/ml by equilibrium dialysis technique, was 53 per cent and independent of ketamine concentration. Simulated plasma and tissue level curves, which were generated by an analogue computer programmed with the individual rate constants of the two-compartment open model, showed that 10 and 15 per cent of the dose were present in the central and peripheral compartments, respectively, at 90 min after i.v. administration of the drug. Peak tissue level of 42 per cent of the dose was reached at 12 to 15 min. Parenteral administration of ketamine, at the dosage rate studied, quickly produced an immobilizing effect of variable duration (0.75 to 1.75 hr) in normal cats.


Carbamazepine pharmacokinetics in young, adult and pregnant rats. Relation to pharmacological effects.

Adult, male, female and pregnant rats were treated with single and repeated doses of carbamazepine (CBZ). The time course of the drug concentrations in plasma and tissues was followed. In all cases, data on plasma levels were subjected to pharmacokinetic analyses. Attempts were made to relate pharmacokinetic properties of carbamazepine to its effect on pentobarbital sleeping time and on protection against electroshock, after acute and repeated administration: --it was found that male rats eliminate carbamazepine faster than females: the total body clearance (TBC) was 16 ml/min/kg and 9.4 ml/min/kg, respectively. Two dose levels (25 and 50 mg/kg) had the same pharmacokinetic properties in young rats. Pregnant rats clear CBZ to a lesser extent than controls. --CBZ was found to accelerate its own elimination after repeated administration in both adult and young rats as revealed by the shortening of its half-life and an increase of 50% in clearance. Moreover, the protection against electroshock was significantly reduced after repeated administration, compared with a single-dose administration. Repeated administration of CBZ in rats shortens pentobarbital sleeping time and decreases the pentobarbital brain level significantly.


Hexachlorophene metabolism in rats: the hepatic route.

The terminal elimination rate of radioactivity from the bile of bile-duct cannulated rats, that had received hexachlorophene-14C via the hepatic portal vein, had an apparent first-order half-life of about 10 hr. Tissue distribution studies in these rats indicated that 35-47% of the carbon-14 of the dose was eliminated through the bile within 24 hr. Significant amounts of radioactivity were also found in the liver and carcass at that time; the brain was the only tissue that did not consistently have much higher concentrations of carbon-14 than the blood. The rate limiting step in the disposition of hexachlorophene may be excretion into the bile. A bile-feeding technique demonstrated enterohepatic circulation.


[Interaction of tricyclic antidepressants with noradrenaline and 5-hydroxytryptamine in peripheral preparations of the rat].

The potentiation of the noradrenaline (NA) actions by antidepressant drugs was studied in vitro on the rat vas deferens and in vivo on the rat blood pressure. A new dibenzazepine compound, LM 208, and two antiparkinsonian drugs, orphenadrine and its demethylated derivative, were compared to well known antidepressants. The modification by all these agents of the rat uterus response to 5-hydroxytryptamine (5-HT) was also investigated. The possible use of these interactions as models for NA and 5-HT uptake inhibition is discussed.


The influence of meprobamate on heart rate in the conscious dog.

The effects of meprobamate on heart rate in the unanesthetized dog were compared under two experimental conditions: (1) In the animal equipped with a telemetry device, in which the heart rate was on average 70/min over a 24 hour period, i.v. injection of 20 mg/kg of meprobamate tended to increase heart rate, a dose of 50 mg/kg provoking a significant tachycardia; (2) In the untrained dog restrained on a table, in which the heart rate ranged from 100 to 110/min, i.v. doses of 20 and 30 mg/kg of meprobamate did not lower heart rate, notwithstanding a significant sedative effect whereas a dose of 50 mg/kg provoked tachycardia; atropine-induced cardio-acceleration was not influenced by these doses of meprobamate.


Release and receptor stimulating properties of p-tyramine in rat brain.

Radiolabeled p-tyramine could be released from rat striatal slices, which were previously allowed to accumulate this amine, upon depolarization with media containing 40 mM potassium. This depolarization-induced release did not occur in the absence of calcium ions in the medium and over 75% of the labeled material released was identified chromatographically as tyramine. The possible existence of a direct receptor-stimulating activity of p-tyramine was examined by injecting this amine intraventricularly into rats, after pretreatment with various drugs, which inhibit catecholaminergic function, and measuring their motor activity. If injected into rats, which were pretreated with reserpine or alpha-methyl-p-tyrosine, p-tyramine induced a marked increase in the motor activity, which was not accompanied by a significant decrease in brain catecholamines, ruling out the possibility of indirect receptor stimulation. Since the presence of endogenous p-tyramine in the brain has been reported, these data may indicate a specific synaptic role for this amine, perhaps as a neurotransmitter.


Intravenous pharmacokinetic profile in rats of etomidate, a short-acting hypnotic drug.

Etomidate is a novel short-acting drug, whose pharmacokinetic profile was studied in 14 organs and tissues after i.v. administration to rats. Four dose levels, ranging from 224 to 1800 mug, were assayed between 1.75 and 112 min after administration. A three-compartment open linear model has been fitted to the plasma concentrations, assuming a central, peripheral and deep compartment. The fast component of the plasma curve, has a half-life of 1.19 min. Brain tissue rapidly enters in equilibrium with plasma and shows the highest concentration. Muscle, subcutaneous fat and possibly skin and connective tissues contribute most to the total amount of drug in the body. Many tissues are heterogeneous and exhibit combinations of central, peripheral and deep compartments. Elimination of etomidate occurs by ester-hydrolysis in plasma and in the liver with approximately equal rate constants. Metabolization of etomidate in the liver is a capacity-limited Michaelis-Menten process.


The mechanism of contraction of rat aorta to various agonists.

To elucidate the mechanism of contraction of the smooth muscle of the rat's aorta, its response to norepinephrine (NE), 5-hydroxytrypatamine (5-HT) and potassium chloride (KCI) was determined before and after pretreatment with reserpine and beta-diethylamionethyl 2-2-diphenylpropyl acetate (SKF 525-A). Unlike the rabbit's aorta, contraction of the rat's aorta induced by NE was inhibited by SKF 525-A. After the induction of maximal contraction, SKF 525-A induced a graded rapid relaxation after KCl, less so after 5-HT, and least after NE. Pretreatment with reserpine failed to induce supersensitivity to NE. After incubation in a Ca++-free or Na+ and Ca++-free Krebs solution, the rat's aorta failed to contract even on the addition of Ca++ or NE.


The effect of temperature upon the positive inotropic and chronotropic responses of isolated cardiac preparations to isoprenaline and its modification by experimental variables.

The effects of various experimental variables upon the optimum temperatures for positive inotropic and chronotropic responses to isoprenaline in isolated cardiac preparations were examined. Perfusion rate and animal (heart) size affected the satisfactory determination of rate and tension optima of guinea-pig and rabbit perfused hearts. Isolated spontaneous atria were assumed to have the same temperature optima as perfused hearts and these were independent of the animal size/age. Paced atria, in which spontaneous rate changes were absent, revealed a sharper tension optimum at an unaltered temperature. The inotropic optimum in all preparations varied with the method of expressing the response; however, since the increase tension remained independent of resting developed tension in pacing experiments, this measure was adopted. The resulting inotropic and chronotropic optima, having minimized these variables, were 25 and 35, and 30 and 37.5 degrees C for guinea-pigs and rabbits respectively. This confirms the separation of these responses by temperature.


Characteristics of responses of isolated human fallopian tube to transmural stimulation and to sympathomimetic amines.

The responses of circular and longitudinal muscle of human fallopian tube to transmural stimulation and sympathomimetic amines have been investigated. It was found that tissues from the earlier part of the menstrual cycle (i.e., estrogen dominant) were less responsive to all stimuli than those from the middle or late phase of the cycle. Although excitatory alpha responses of ampulla and isthmus could be observed, the predominant response of ampulla and isthmus, in all phases of the menstrual cycle, to (--)-noradrenaline and transmural stimulation was inhibition of spontaneous activity. The inhibitory response to transmural stimulation, was abolished by tetrodotoxin and guanethidine. The inhibitory responses to transmural stimulation and (--)-noradrenaline were reversed by propranolol. These findings show that the response of tissues to transmural stimulation resulted from release of noradrenaline from adrenergic nerves, and subsequent action on inhibitory beta adrenergic receptors.


The actions of ketamine on vascular smooth muscle.

The responses of rabbit aortic strips superfused with noradrenaline, adrenaline and 5-HT were studied alone and in combination with ketamine (50 mug/ml). Ketamine caused a slight depression of the isolated aorta but potentiated responses to adrenaline but not to noradrenaline or 5-hydroxytryptamine. Ketamine did not potentiate aortic strips contracted to a stable level by pyrogallol and adrenaline. Experiments carried out with COMT from homogenates of rat liver showed that, in contrast to pyrogallol (10(-5) M), ketamine (10(-3) M) did not inhibit the enzyme. Other experiments with rabbits given 6-hydroxydopamine showed that aortas of these rabbits responded in a similar manner to controls when treated with ketamine and catecholamines. Results obtained with aortas contracted by adrenaline and noradrenaline with ketamine present, followed by oil immersion, showed that ketamine prolonged greatly the relaxation induced by adrenaline and to a lesser extent the relaxation induced by noradrenaline. The results of these studies indicate that ketamine prevented catecholamines from reaching the intracellular site of COMT. In this respect, ketamine can be termed an inhibitor of uptake site 2. If this hypothesis is valid then the action of ketamine on vascular tissue might explain the cardiovascular effects of the drug in man and experimental animals.


Antitussive properties of butorphanol.

Butorphanol (levo-N-cyclobutylmethyl-3, 14-dihydroxy morphinan), a potent analgetic agent of the narcotic antagonist type with a low abuse potential in laboratory animals, was evaluated for antitussive activity in unanesthetized guinea-pigs and dogs. Subcutaneously, it was over 100 times more active than codeine, dextromethorphan and dl-pentazocine and about 20 times more active than morphine in the guinea-pig, while in the dog it was 100, 10 and 4 times more active than codeine, dl-pentazocine and morphine, respectively. Orally, butorphanol was 15-20 times more active than either codeine or dextromethrophan in both species. Naloxone reversed the antitussive effects of butorphanol, codeine, morphine and dl-pentazocine while those of dextromethorphan were not antagonized. The antitussive effect of butorphanol and morphine lasted about 4 hr and both compounds were longer acting than codeine. Butorphanol was also shown to be as effective against cough of pathological origin as against experimentally induced cough in the dog.


A relatively simple differential screening test for GABA or glycine antagonists using rat electroretinography.

Intravitreal injection of GABA- and glycine-antagonists had specific and reversible effects on the ERG of rats. For example, picrotoxin induced characteristic rhythmic potentials. The effect was common to other GABA-antagonists, such as bicuculline, N-methylbicuculline and penicillin G. Strychnine caused the appearance of a- and c-like waves in response to low intensity flash stimuli in addition to the suppression of the b-wave commonly seen with agents such as asparate following higher intensity flash stimuli. The strychnine-like effect was common to other glycine-antagonist tested, such as brucine, morphine and laudanosine. The quanternization of the glycine-antagonists abolished the strychnine-like activity and endowed the ability to induce the rhythmic potentials characteristic of GABA-antagonists. This relatively simple method of observing either rhythmic potentials or a negative deflection (a-like wave) to a low intensity stimulus (about 1.0 log unit above dark threshold) in the ERG should be useful for the rapid screening of the predicted and new GABA--and glycine-antagonists.


Autoradiographic distribution study of 14C-DOPA in cat brain.

The penetration and distribution in various areas of cat brain of 14C-DL-DOPA and/or its derivatives was studied by the autoradiographic technique. The highest activity was found, 1 hr after administration, in the caudate nucleus, putamen and n. accumbens, while hypothalamus, substantia nigra, substantia grisea pericentralis, tuberculum olfactorium, raphe nuclei and nucleus interpeduncolaris showed lower levels of labelling. Very low activity was detected in the cerebral cortex and in the other gray and white matter structures of brain. After pretreatment with a peripheral DOPA-decarboxylase inhibitor or high dosage of cold DOPA, the distribution pattern was not modified but the levels of radioactivity were greatly enhanced. The localization of the drug in dopaminergic structures and other areas of the brain is discussed.


Effects of DOCA on circulation, renal functions, body fluids and tissue electrolytes.

Desoxycorticosterone acetate (DOCA) was administered subcutaneously to 11 normal dogs (2 mg/kg/day) for 4 days. Few changes were observed in cardiovascular and renal functions except that the glomerular filtration rate was significantly increased. Total body water and plasma volume increased with a reduction of red blood cell volume. Hematocrit, plasma osmolality and total protein concentrations were decreased. The plasma K+ levels were lowered despite unchanged plasma concentrations of Na+, Ca++, Mg++, Cl- and phosphorus. The heart showed an increase in Na+ content and a decrease in K+, Ca++, phosphorus and total lipids. The skeletal muscle showed a decrease in Ca++ and an increase in Cl- and water content. The skin revealed a reduction of K+ and an elevation of Cl-. This study showed that a DOCA-induced depletion of K+ from skeletal muscle did not occur in normally fed dogs that did not receive a large sodium load.


Discrimination of narcotic drugs on 3H-fentanyl receptor binding.

Stereospecific opiate receptor binding was measured using specifically labeled fentanyl in the presence of an excess of either dextromoramide or levomoramide, only the former being the analgesic isomer. In a very large series of chemically related drugs, but of different pharmacological activity, it was possible to recognize compounds endowed with a potential morphine-like activity. Attempts were made to localize the opiate receptors within the neuronal cell.


Effect of isoproterenol on urinary function in goats.

Intraventricular administration of small doses (6.3-19-58 ng/kg/min) of isoproterenol (ISO) in non-hydrated goats produced a diuretic response, a decrease in urinary Na+, K+ and Cl- excretion and an increase in free water clearance. The diuretic response of ISO could be blocked by propranolol, but not by phentolamine. The data suggest that hypothalamic beta-adrenoceptors are involved in the inhibition of ADH release.


[Results of Mustard's operation for transposition of the great vessels. Apropos of 81 cases of children who survived the intervention with a follow-up of from 1 to 6 years].

In a series of 81 children who survived to Mustard's operation, with a follow-up varying from 6 months to 6 years, there were 19% of secondary deaths, 19% of bad results, 29% of questionable results and only 33% of good results. The most frequent complications were: disturbances of cardiac rhythm and obstructions to pulmonary or caval venous return.


[Evaluation of gonadotropic and gonadal secretions in primary abnormalities of the gonads and male pseudohermaphrodism before and after the age of puberty].

Blood levels of gonadotropins (FSH and LH) and gonadal steroids (testosterone or estradiol) have been evaluated in 72 children and adolescents with primary gonadal defects (45 agonadal patients, 7 with asymetrical gonadal dysgenesis, 9 with Klinefelter syndrome, 4 with partial testicular dysgenesis and 7 with partial ovarian dysgenesis) and in 17 cases of male pseudohermaphrodism. A LH-RH test has been performed in most cases, and a testicular stimulation test with chorionic gonadotropin in patients with testicular tissue. Agonadal subjects had increased blood and pituitary releasable gonadotropins: very high in infants and young children, much less from 7 to 11 years, a high spurt being observed at 12 years. This diphasic pattern relates to the varying sensitivity of hypothalamic receptors and suggests that adrenal steroids may restrain gonadotropic secretion at 7-8 years. As a diagnostic tool, the increase of gonadotropins may be missing in the 7-11 years group. In the 1-12 years patients with partially defective gonads, blood and pituitary releasable gonadotropins and blood steroids are usually normal, but testosterone response to chorionic gonadotropin may be already blunted. From 13 years the gonadotropic secretion is usually increased, even when testosterone secretion and reserve are within normal range. Most male pseudohermaphrodites showed normal gonadotropic and testicular secretions. But four patients had highly increased responses to LH-RH, suggesting a defect of testicular secretion or of receptors, and demonstrating some heterogeneity in the male pseudohermaphrodism group.


[Pediatric pharmacology. Practical ideas of kinetics and metabolism of drugs].

After administration, a drug does not exert immediately all its actions. Rates of diffusion, fixation and excretion of drugs are depending from their nature as well as from the condition of the body to which they are given. The resultant of these mechanisms control the blood level of a drug, level which varies in function of time. The blood level reflects the pharmacodynamic activity of a drug. Information on kinetics and significance of the status of drug equilibrium are of major importance for rational drug administration.


[Attempts at a nosological classification with two standardized psychiatric rating scales (author's transl)].

Three different procedures for classification of psychiatric patients, a modified form of Q factor analysis, the classical discriminant analysis and a simple procedure based on clinical concepts, were compared empirically. On the basis of the psychopathological state rated by means of the Inpatient Multidimensional Psychiatric Scale (IMPS) and psychopathological and somatic scales of the AMP documentation system (AMP scale), the three procedures were applied in order to reproduce the psychiatric diagnosis. The classification was made by paired comparison of the following four diagnoses: schizophrenia, paranoid form (n = 45), schizophrenia, unspecified form (n = 47), depressive psychosis (n = 44), and depressive neurosis (n = 53). The procedures were evaluated according to their crossvalidation results. The mean percentages of correct classification were the following: 83% for the modified form of Q factor analysis, 77% for the classical discriminant analysis, 73% for the simple procedure based on clinical concepts using the IMPS, and 79% for the same procedure, but using the AMP scale, all three procedures reaching about the same level of validity.


[Multiple sclerosis and personality aspects (author's transl)].

In a sample of 85 multiple sclerosis patients an increase of the objective neurological degree of severity of the illness resulted in a significant decrease of manifold psychometrically recorded functions of intelligence (verbal and non-verbal intelligence). Of the personality characteristics registered by questionnaire only depression proved significant, but numerically slightly positive correlation with the degree of severity of the illness. The correlations between degree of severity and personality characteristics, as aggressiveness, sociability, neuroticism, extraversion were not significant. The personality-psychological results were especially interpreted and discussed with regard to the therapeutic consequences.


[Investigations of fasting blood glucose in endogenous depressive, schizophrenic, and neurotic patients (author's transl)].

Fasting blood glucose was estimated in endogenous depressive, schizophrenic, and neurotic patients. Mean fasting blood glucose levels were found to be significantly increased in endogenous depressive patients as compared with schizophrenics and neurotics. This finding is thought to be a sensitive symptom for a decrease in glucose tolerance in endogenous depression. No correlation could be detected to sex, body weight: body height ratio or age. Several hypothetical explanations of the finding are discussed.


[Investigation of the interraterreliability of the AMP system (author's transl)].

The interraterreliability of the AMP system (developed by the Arbeitsgemeinschaft für Methodik und Kokumentation in der Psychiatrie (AMP)) has been studied for the first time concerning the level of scales. The investigation was carried out using 80 ratings from two raters concerning a group of acute schizophrenic patients. The results pointed out the extreme usefulness of the AMP system also with respect to interraterreliability. Furthermore, a comparison between the group studied (ICD 295) and a group of schizophrenic patients (ICD 295) from the literature indicated a special AMP profile for groups of schizophrenic patients, the paranoid subgroup (295.3) being predominant.


[Controlled EEG alpha feedback training in normals and headache patients (author's transl)].

Headache patients and healthy controls underwent alpha-EEG feedback training in 12 sessions. The present study does not support the literature which reports alpha increase by feedback training. The study included a patient group receiving feedback, a patient control group receiving pseudofeedback, and a volunteer group receiving feedback. Increase of alpha EEG was observed under feedback and pseudofeedback. However, there was always more alpha during baseline times than during training times. Alpha increase over time is suggested to be a habituation effect. Headache pain decreased with training (within the boundaries of a placebo effect), and there was no difference in headache decrease between feedback and pseudofeedback patients.


[How alcohol and drug consumers see themselves: a personal and social self-assessment (author's transl)].

In a representative inquiry we found significant differences in the self-assessment of 4082 20-year-old Swiss men, as to whether their consumption of alcohol and drugs is high, low, or zero. The heavy users of alcohol and drugs describe themselves as men with frequent personal difficulties and psychosomatic disturbances. They tend to separate earlier from their family and prefer a less conventional, more consume-orientated, and passive way of life than the remainder.


[On the concept of "situation" in psychopathology (author's transl)].

In continuation of previous work, the present investigation attempts to present the concept of situation from the point of view of an interactional psychopatholgy. Three aspects of situation are emphasized, the impressive, the expressive, and the dynamic. Some kinds of psychopathologically significant situation-changes are described as examples.


[Critical remarks on the symptom of "thought insertion" (author's transl)].

"Thought insertion" is one of Kurt Schneider's first rank symptoms of schizophrenia. Earlier, Karl Jaspers had made a finer distinction, differentiating between "thought insertion in a narrower sense" and "made thoughts." However, most German and English writers have dispensed with the Jasperian criteria for this differentiation and consequently their use of the term "thought insertion" is broader. Such authors, including Kurt Schneider and Weitbrecht, usually speak of "thought insertion", "made thoughts", and "influencing of thoughts" as if they were identical phenomena. In contrast, Jaspers' differentiation offers us the possibility of more clearly distinguishing such symptoms and thus his distinction should not be neglected. Furthermore, the Jasperian criteria can be logically and usefully extended to all "made and passivity experiences" enabling one to recognise four aspects of such phenomena. Some general differential diagnostic considerations with respect to "thought insertion" are then presented.


Electroencephalographic laterality changes during human sexual orgasm.

Left and right parietal EEGs were recorded while seven subjects experienced sexual climax through self-stimulation. EEG data were quantified by continuous cumulated measurements of the integrated areas of EEG recording during successive 1-sec epochs. In eight out of 12 experiments, this measure revealed a statistically significant change in laterality. Controlled replications with two of the original subjects obviated the possibility that two potential sources of artifact (hand used for masturbation and gross body movements) accounted for the changes. While previous research has focused on vasomotor and myotonic indices of sexual response, this study demonstrates the significance of brain phenomena in sexual orgasm.


Polygyny: insufficient father-son contact and son's masculine identity.

In polygynous societies in which the family consists of husband, wives, and children only, if each cowife lives in a separate quarter with her children, males are more likely to be circumcised or segregated at puberty. These customs are interpreted as the measures to rectify boys'  mother-oriented personality development because of limited contact with their fathers due to their mother's separate quarters. Circumcision and segregation can be explained better in terms of the son's insufficient contact with the father rather than a very close relationship with the mother due to the long postpartum sexual taboo.


Autonomic responses of transsexual and homosexual males to erotic film sequences.

Penile volume and galvanic skin responses to nude female and male film sequences were studied in 10 transsexual patients, 44 patients requesting treatment for homosexual impulses, and 60 heterosexual students. Student controls and homosexuals showed significantly greater galvanic skin responses to the preferred than to the nonpreferred sex. Transsexuals tended to show larger galvanic skin responses to females than did male homosexuals. No strong relationships were found between penile volume and galvanic skin response to the preferred sex. It is concluded that transsexual patients differ significantly from homosexual patients in autonomic responsivity, which may have diagnostic usefulness.


Alternative behavioral approaches to the treatment of homosexuality.

Radical changes in attitudes toward homosexuality in American society are integrated into a new perspective for the therapist confronted by a client who engages in homosexual behavior. The traditional mandatory attempt to eradicate homosexual behavior has been expanded into three options, any one of which may be pursued by the therapist at the client's request: (1) modification of homosexual in favor of heterosexual behavior, (2) enhancement of homosexual behavior, and (3) ignoring of homosexual behavior if it is functionally unrelated to the presenting symptoms. Therapists' negative attitudes toward clients who engage in homosexual behavior are such as to abrogate expanded options and may results in therapeutic efforts at modification of homosexual behavior in defiance of the client's expressed wishes. Contrary to current professional belief, careful analysis and the use of appropriate techniques such as systematic desensitization, orgasmic reconditioning, and training in heterosocial skills generally obviate the necessity for aversive procedures in those instances where homosexual behavior is to be modified in favor of heterosexual behavior. Three case histories are presented illustrating the use of each of the expanded options described above.


Atttitudes of the aged toward nontraditional sexual behavior.

Age as a correlate of attitudes toward nontraditional sexual behavior is explored. The data were drawn from a United State national probability sample. Subgroup comparisons were made between two age cohorts--respondents over and under 65. Sexual attitudes were measured toward premarital sexual relations, extramartial sexual relations, and homosexuality. Older respondents held the most conservative sexual attitudes. However, the background variables of sex, social status, church attendance, marital status, and parenthood were predictors of sexual attitudes for both age strata. The findings indicate individual variations among the aged with the likelihood of a greater range of differences in the future.


A law concerning sex reassignment of transsexuals in Sweden.

In 1972, a law regulating surgical and legal measures reguired for sex reassignment came into force in Sweden. The law, its practical application, and the number of transsexual cases dealt with by the National Board of Health and Welfare during the first 2 years of enforcement are described.


Combined intervention for controlling unwanted homosexual behavior: an extended follow-up.

Of 49 patients who were able via previous therapy to control their sexual arousal in the presence of homosexual stimuli, 31 (63%) were contracted for follow-up. The average period since the end of treatment was 4 years. Nineteen subjects (61%) have remained exclusively heterosexual, whereas nine (29%) have had homosexual intercourse. Heterosexual intercourse was reported in 28 (90%), including the previous nine subjects. Three (10%) subjects have had neither homonor heterosexual intercourse.


Effect of modeling on sexual imagery.

Social learning theory was used to examine the effects of a model's sexual imagery on the observer's sexual imagery. In the guise of a creative writing experiment, male and female college students were asked to listen to a tape recording of a same- or opposite-sex model relating a story in response to a sample TAT card. The story described a man and a woman in a physical sex encounter (high sex), a romantic date (medium sex), or a casual study date (low sex). The sample TAT picture and model's story were omitted in the control groups. All subjects wrote stories in response to two other TAT cards. These stories were scored for sexual imagery by a male and a female judge who were blind to experimental conditions and who used a standard sexual imagery scoring manual. The following prediction were based on social learning theory: There would be greater sexual imagery in the stories of subjects who heard the high sex model than in the stories of those who heard the medium or low sex model or no model. Past research implied the prediction that the modeling effects would be greater for males than for females in the high sex model condition and greater for females than for males in the medium sex model condition. The results were analyzed using two factorial analyses of variance. There was greater sexual imagery by subjects who heard the high sex model than by those who heard the low sex model or model. The sexual imagery by subjects who heard the medium sex model was intermediate between that by those who heard the high sex model and that by those who heard the low sex model. The modeling effect was greater in males. The results also confirmed the prediction that sexual imagery would be greater for males in the high sex model condition but did not confirm the prediction that sexual imagery would be greater for females in the medium sex model condition.


Follow-up effects of a medical school course in human sexuality.

The effects of a course in human sexuality for a class of second-year male medical students are described. The course consists of two interacting components: a 2-day seminar and a 2-week didactic presentation. The purpose of the seminar is to develop humanistic understanding and tolerance of one's own and others' sexuality. The didactic presentation focuses on factual information. A variety of evaluation instruments were used, and students were tested precourse, postcourse, and at the end of 6 and 12 months. Results show a significant pre-post increase in tolerance in attitude and amount of knowledge. There appears to be some moderation in level of attitude and knowledge gain at the 6-months point, and significant increases from the precourse level to the 12-months point persist. Participants almost uniformly report personal benefit, with a significant number described greater satisfaction in their own sexual behaviour.


Group treatment format: mixed sexual dysfunctions.

This study reports the rationale and results of a ten-session group composed os six couples with mixed sexual dysfunctions. Dysfunctions included premature ejaculation, primary and situational orgasmic dysfunction, situational impotence, and incompatible sex drives. A variety of pretreatment behavioral and attitudinal measures were administered, including a Life History Questionaire, Sexual Assessment Inventory, Marital Adjustment Scale, and Sexual Interaction, orgasmic attainment, ejaculatory control, and enhanced self-acceptance, particularly for females (SII changes). The consistency between outcome measures was also a noteworthy finding. The results suggest increased use of mixed short-term groups, particularly when cost-effectiveness accountability is important. One contraindication for such groups is, however, severe marital discord, as evidenced by Locke-Wallace mean scores of 80 or less.


Homosexuality: behaviours and attitudes.

To assess the incidence of homosexual experiences, heterosexual experiences, associated attitudes, and related demographic characteristics, a sexual behaviour and attitudes questionaire was administered to 4251 university students. The rate of homosexual experiences was found to be appreciably lower than that commonly reported in the literature and was not significantly related to race, religion, or region of residence. Individuals with homosexual experiences, compared to those without, tended to be more liberal in their views toward socially deviant sexual behavior in general, did not demonstrate fewer heterosexual contacts, and did not report significantly more guilt or anxiety about their sexual behavior.


The intelligence of rapists.

IQs of rapists were compared to IQs of nonrapist prisoners convicted of violent crimes and nonrapist prisoners convicted of nonviolent crimes. Subjects were 136 male convicted felons in the Kentucky State Penitentiary. Determination of violent vs. nonviolent crimes other than rape was made upon consultation with a Kentucky Commonwealth Attorney. The results revealed significantly lower IQs for rapists compared to nonrapists convicted of violent crimes and compared to heterogeneous nonrapist convicts. The present research supports the findings of Karacan and co-workers, indicating a general tendency for rapists to have lower IQs than other convicted prisoners.


A current appraisal of side effects of oral contraceptives.

Oral contraception, although offering almost 100 per cent protection against pregnancy, is associated with many side effects which have resulted in much unnecessary adverse publicity. Such side effects, the majority of which are of annoying nature only, are due to the synthetic hormones used, and have resulted in many changes in formulation and in the withdrawal of several preparations. The types of preparations available are discussed and the side effects appraised from both the patient's and the physician's viewpoint.


Diabetes in children.

Juvenile diabetics comprise approximately five per cent of the total diabetic population. The sex incidence in children is approximately equal and it can occur at any age. However, it would seem that the peak ages for its onset in childhood are between eight and twelve years.


The need for psychosexual counselling in family planning practice.

In this review article, the case in favour of the need for psychosexual counselling in family planning practice will be presented. Since psychosexual counselling is a multidisciplinary subject, family planning clinics and practices are ideally suited to the task. In presenting the case, liberal illustrative examples are provided in order to depict what the current and suggested extended facilities and techniques involve. The article is also intended to act as a comprehensive guide for students, nurses, medical practitioners and specialists alike, to bring them up to date in new concepts in history taking, physical examination and the sexually explicit aspects of family planning. Traditionally taught concepts may well be out of date in a modern society.


Diabetes mellitus. A report from the Australian General Practitioner Morbidity and Prescribing Survey 1969-1974.

The Royal Australian College of General Practitioners, in association with Intercontinental Medical Statistics conducted a General Practice Morbidity and Prescribing Survey from 1.4.69 to 31.12.74. This gave a baseline study of morbidity as it occurs in Australia plus a breakdown by State, sex, age and season, to give a clearer idea of geographical, personal and epidemiological factors influencing health and sickness.


The nature and use of purified insulins.

The limited availability of highly purified insulin preparations for the treatment of diabetes mellitus in australia since 1975, has prompted a review of their history, clinical use and potential in the treatment of diabetics receiving insulin.


Masturbatory guilt and sexual dysfunction.

Anxiety arising from masturbatory guilt plays a major role in the production of frigidity and impotence. Reduction of this anxiety through greater community awareness of the normality of masturbation is therefore a fertile area for the principles of preventive medicine to be applied.


Women and the doctor-patient relationship.

What little is known about the doctor-patient relationship in Australia has been sought and written from the profession's point of view. This article will concentrate on the consumer; especially women, who have special problems and difficulties not shared with male patients.


The care of diabetes mellitus at a community health centre.

Diabetes mellitus is a chronic disease with a high prevalence of about 2.0 per cent in the australian community. Although hospital diabetic clinics play an important role in the management of diabetic patients, the majority are managed by their local doctor. In this article the possible role of a health centre in the care of diabetics is outlined.


A screening test for thyroid function.

The Achilles tendon reflex half relaxation time measurement (ART) has been used by many physicians both as a diagnostic test and for the assessment of progress in thyroid gland malfunction. Reference is made to some results obtained in Melbourne and in other countries using different methods of measurement of the ART for these purposes. In a series of 2064 patients referred to the Shepherd Foundation Centre, the Achilles tendon reflex half relaxation time was measured by means of the SMI Reflexometer and a comparison was made in each case with a laboratory estimation of the T3 resin uptake and T4 total thyroxine iodine and the Free Thyroxine Index (FTI). Reference is made to a survey conducted among referring doctors where opinions were sought as to the clinical usefulness of different tests including the Achilles tendon reflex time measurement.


Cold adaptation and the anaesthetic requirement for cyclopropane in rats.

The effect of cold adaptation at 4 degrees C on cyclopropane MAC was studied in 10 Wistar rats over a 16-week period. Compared with a similar control group (normally adapted), there was a significant decrease in weight gain and a significant increase in anaesthetic requirement in the cold-adapted rats.


Suxamethonium-induced porcine malignant hyperthermia.

Metabolic, haemodynamic and neuroendocrine responses to suxamethonium (SCh) were measured in five normal swine and five swine susceptible to malignant hyperthermia (MH), to compare the responses with those previously reported for halothane. Following SCh, the onset of MH was sooner and more abrupt than following halothane. The maximal changes in aerobic metabolism and body temperature sere similar, while the changes in lactate, potassium, hydrogen ion and catecholamine concentrations were smaller than those observed following halothane. These results are discussed in terms of the action of chemical depolarizing drugs such as suxamethonium and acetylcholine. The propagated muscle action potentials produce an increase in the free intracellular calcium concentration which may be self-regenerative, but which may become uncontrollable because of the peculiarities of MH that effect the calcium pump or storage areas.


Halothane 0.2-4% analysis by gas chromatography.

The katharometer detector is better suited to the analysis of gaseous halothane (0.2-4%) than is the flame ionization detector, since the peak heights are directly proportional to concentration, and are more reproducible.


Radip induction of ether anaesthesia and controlled maintenacne by a combination of intravenous and inhalation administration without the risk of explosion.

The induction and maintenance of anaesthesia with ether using a combined intravenous infusion and a constant low inspired concentration are discribed. Predictions from a mathematical model were checked against animal experiments. Anaesthesia occurred within 5 min. The mehtod obviates the need for explosive mixtures.


Sequential changes in the fade of tetanic tension after the administration of tubocurarine in anaesthetized man.

Tetanic and single twitch contractions of the adductor pollicis muscle in anaesthetized man were measured continuously following the i.v. injection of tubocurarine 0.2 mg/kg. Tetanic contractions were depressed earlier by tubocurarine and to a greater extent compared with the single twitch. Recovery was also slower for the tetanic contractions. The fade of tetanic tension was also measured throughout the blockade produced by tubocurarine. Fade was expressed in terms of the tetanic tension ratio: the ratio of the magnitude of the muscle tension at the end of 1 s of tetanic contraction compared with its peak height at the beginning of that contraction. Tetanic tension was well maintained during the onset of the neuromuscular block but was less well maintained during the recovery phase. It is suggested that the assessment of tetanic tension fade shoudl be carried out throughout the various stages of curarization.


Effects of Althesin on cerebral blood flow and oxygen consumption in man.

Cerebral circulation and metabolism during Althesin anaesthesia were studied in seven healthy patients. Althesin was given in a single dose of 0.1 ml/kg and thereafter infused at a constant rate of 0.3 ml/kg/h. During Althesin infusion, the cerebral blood flow (CBF), the cerebral metabolic rate for oxygen (CMRo2) were 29 +/- 10 ml/100 g/min and 1.7 +/- 0.4 ml/133 g/min, respectively. These values were significantly different from those obtained in awake subjects in our laboratory (CBF: 46 +/- 7 ml/100 g/min; CMRo2: 3.1 +/- 0.6 ml/100 g/min). During CBF measurement, the mean cerebral perfusion pressure, cerebral vascular resistance (CVR) and arterial carbon dioxide tension (PaCO2) were 89 +/- 16 mm Hg, 3.4 +/- 1.3 mm Hg/ml/100 g/min, and 36 +/- 9 mm Hg, respectively. The relationship between CBF and PaCO2 were studied and it was found that during Althesin anaesthesia reactivity of cerebral vessels to the alteration of PaCO2 was maintained. It is concluded that Althesin caused cerebral metabolic depression which was accompaned by a decrease in CBF and an increase in CVR.


Suxamethonium-induced hyperkalaemia in patients with severe intra-abdominal infections.

In nine patients, undergoing repeat operations because of severe intra-abdominal infection developing after major abdominal surgery, serum potassium concentrations were monitored during induction of anaesthesia. Four patients showed an increase of serum potassium ranging from 2.5 to 3.1 mmol/litre above baseline values within 3-6 min after suxamethonium 100 mg i.v. In five patients there was no change. The four patients demonstrating an increase had suffered from pyrexia and leucocytosis for at least 2 weeks. The other five had signs of infection for no more than 9 days. It is concluded that patients with signs of severe intra-abdominal infection lasting longer than 1 week represent an additional category susceptible to suxamethonium-induced hyperkalaemia. They should receive only non-depolarizing muscle relaxants. When the use of suxamethonium is unavoidable, the injection of a non-depolarizing muscle relaxant before the administration of suxamethonium is recommended.


Pethidine compared with pethidine-naloxone administered during labour. A study of analgesic treatment by a sequential method.

In a restricted sequential trial in healthy parturient women, the pain relief from pethidine 100 mg and pethidine 100 mg combined with naloxone 0.4 mg was compared. Pethidine alone gave better relief. The incidence of minor side-effects was high with both treatments but dizziness was reduced slightly by naloxone. It was concluded that naloxone antagonized the analgesia without abolishing the side-effects of pethidine.


Ergometrine, oxytocin and extradural analgesia.

Blood loss and the incidence of emetic sequelae were assessed in 148 patients undergoing midcavity forceps delivery under continuous lumbar extradural analgesia. Five units of oxytocin i.v. was found to be as effective as ergometrine 0.5 mg i.v. in reducing blood loss at delivery. Nausea, retching or vomiting occurred in 35 (46%) of the mothers who received ergometrine and in none of those who received i.v. oxytocin. The cardiovascular side-effects of ergometrine and oxytocin are reviewed and compared with special reference to patients with hypertension and heart disease. It is suggested that 5 units of oxytocin i.v. should be preferred in these high-risk patients. Because of the absence of an emetic action, i.v. oxytocin is preferable to i.v. ergometrine for patients receiving extradural analgesia.