[Progressive pulmonary fibrosis during combination chemotherapy with BCNU (author's transl)]. In two patients with acute leukaemia, the development of progressive interstitial pulmonary fibrosis was observed following chemotherapy with BCNU, Cytoxan and Ara-C. The x-ray changes were accompanied by restrictive changes of pulmonary function and, later on, by severe hypoxia. Serologic tests did not reveal infection with cytomegaly virus or mycoplasma pneumoniae. These findings, together with reports in the literature, suggest a toxic effect of BCNU on the lung. The combination with Cyclophosphamide may contribute to this toxic reaction.


Studies on combined effects of organophosphates or carbamates and morsodren in birds. II. Plasma and cholinesterase in quail fed morsodren and orally dosed with parathion or carbofuran. The degree of interaction between mercury and cholinesterase inhibiting pesticides was determined by comparing enzyme responses to sublethal dosages of parathion or carbofuran in quail fed 0.05, 0.5, or 5.0 ppm morsodren for 18 weeks. A statistically significant interaction was defined as greater brain cholinesterase inhibition in morsodren-fed than in clean-fed birds following pesticide dosage. The tissue residues of mercury that accumulated before significant mercury-parathion interactions occurred were higher than levels that might be expected in natural populations, but significant mercury-carbofuran interactions occurred in birds that had only accumulated 1.0 ppm liver mercury. The results indicate that indiscriminate usage of cholinesterase inhibiting pesticides are dangerous, since natural populations of fish-eating birds oftentimes contain this magnitude of mercury.


Departmental libraries: curse or blessing? Communication patterns and working relationships between large health sciences libraries and departmental libraries are examined and discussed. The results of a telephone survey to obtain information on the experiences of twenty-one large New York metropolitan area health sciences libraries with their departmental libraries are reported. Discussion includes the experiences of Columbia University's Augustus Long Health Sciences Library with departmental libraries within the Columbia/Presbyterian Medical Center (C/PMC). A mediated survey of C/PMC departmental libraries and over thirty years of cooperation with some of these departments are reported. The potential detrimental effects of departmental libraries are acknowledged, but the substantial positive benefits of cooperation and ways to achieve this cooperation are emphasized.


A health sciences libraries consortium in a rural setting. The coming of the East Tennessee State University College of Medicine and its effect on the health sciences institutions and practitioners in upper east Tennessee (southern Appalachia) required increased and improved information resources and arrangements for delivery and for use. The Tri-Cities Health Sciences Libraries Consortium was organized to facilitate collection development and to improve services and staff qualifications. The progress of the consortium during the initial two and one-half years of its existence is delineated. Data reflecting the dramatic growth in collection development and staff are given.


Evaluation of a library program in a Carnegie model area health education center. The evaluation strategy of a medical library program within an Area Health Education Center is described. One of about thirty programs in the AHEC project, this library program was singled out as the first to be evaluated both because it was considered a key part of the total program and because a fair amount of quantitative data were available for measurement. Eleven hospitals of the thirty-nine in the area were selected for the study. Two specific and measurable objectives, the evaluation method, instruments, and results are presented. Finally, several important issues raised in conjunction with the evaluation are discussed in terms of the implications of evaluation and policy making.


The information needs of practicing physicians in northeastern New York State. The information needs of practicing physicians in seventeen counties of upstate New York were surveyed by questionnaire. A 45.6% response, or 258 usable replies, was obtained. Computer-aided market analysis indicated that the areas of greatest need for improved information were new developments in specialties and government regulations relating to health care. Sources most frequently used were journal papers, colleagues, and books, in that order. Specialty-related differences occurred with both specific information needs and source use. Degree date, geographical location, and type of practice (hospital, nonhospital, private, and so on), and involvement in research or education were also analyzed in relation to information needs and sources. Implications for library service are discussed.


LATCH at the Washington Hospital Center, 1967-1975. Immediate access to needed information is essential if medical personnel are to provide quality health care. At the Washington Hospital Center, Literature Attached to Charts, LATCH, was created in 1967 to provide the required information quickly. As a collection of a few relevant articles attached to the patient's chart, it supplies current literature on some aspect of the patient's illness. Following an account of the program's inception, an analysis of 1,935 LATCH requests for the years 1968--1975 reveals that new physicians, that is, interns and first-year residents, requested LATCHes most often. Requests in areas of internal medicine were the most common. The data also show that the program has been well received by its users. LATCH has affected the medical library in several ways. The program has been partially responsible for increases in staff, in the number of journal subscriptions, and in the number of literature searches requested. The program has also brought about greater access to the collection via the card catalog. An important effect has been the tremendous development of professional expertise in the staff preparing the LATCH.


Are health science faculty interested in medical history? An evaluative case study. This paper deals with the efforts of a medical library to stimulate interest in the history of medicine by utilizing its historical resources. It is based on a survey designed to evaluate the monthly publication of the library, the Bookman, and to determine the response of health science faculty to historical essays as well as to other sections of the publication. The results show that a large percentage of the faculty reads historical essays either regularly or occasionally, and reveal a trend contrary to the common belief that the teaching staff in health science centers is not interested in medical history. The authors suggest that a library with historical resources can contribute to the educational process in a medical community by actively publicizing its collections and providing opportunities for informal and self-initiated reading.


Microforms: uses and potential.

Microforms: uses and potential. A general overview of microform usage in libraries is provided, emphasizing the impact of conversion of print materials to microforms on library patrons and library staff members. Diagnostic techniques are analyzed to determine the adaptability of both collections and clientele. Problems concerning the standardization of hardware, selection of the proper microform formats, and the use of silver halide, diazo, or vesicular films are discussed.


Perioperative care: preoperative care.

Perioperative care: preoperative care. With a subject as vast as preoperative care its is impossible in an article of this length to do more than sketch in the broad outlines of assessment and preparation, using a few examples to illustrate certain aspects. Unfortunately the pressure of work in most hospitals is such that the standard of preoperative care is not as high as it might be. Many authors have stressed its values not only in making anaesthesia safer but especially in reducing the incidence of postoperative morbidity--a field that has received too little attention for too long.


Perioperative care: emergency anaesthesia. An attempt has been made to indicate some of the problems that may be encountered in emergency anaesthesia. Every case is unique, so it is important to assess each one on its merits and choose appropiate techniques. Experience, adaptability, and vigilance are the keys to patient safety.


Perioperative care: intraoperative fluid balance. Rational intraoperative fluid therapy is based on an understanding of the pathophysiology of severe trauma and surgery. Fluids of suitable compositions are administered in sufficient quantities to form part of the daily maintenance requirement and also to replace blood and ECF lost during surgery.


Outpatient problems: intermenstrual bleeding. Intermenstrual bleeding in young girls is frequently a symptom that disappears spontaneously, but in adults it is best regarded as a symptom of intrauterine pathology. In patients in the late reproductive phase of life it may be the first symptom of uterine carcinoma and should therefore be treated with the same respect as postmenopausal bleeding. Treatment usually presents lille problem in patients who are properly investigated (Table 1).


Time courses of the anti-anaphylactic and anti-inflammatory effects of dexamethasone in the rat and mouse. 1 The time course of the activity of dexamethasone has been studied in a variety of anaphylactic and inflammatory reactions in the rat and the mouse. 2 The times of peak activity of dexamethasone, expressed as time between oral dosage and induction of response, and the approximate ED50 values (mg/kg) found were: anaphylactic bronchoconstriction in rats, 12-24 h, ED50 1.8; passive cutaneous anaphylaxis in rats, 6 h, ED50 0.04; cutaneous reactions to histamine in rats, 4 h, ED50 0.01; carrageenin-induced paw oedema in rats, 4 h, ED50 0.03; pinnal anaphylaxis in mice, 6 h, ED50 0.82; histamine-induced pinnal reactions in mice, 6 h, ED50 0.05. 3 In rats, the characteristics of the inhibitory effects of dexamethasone indicate a differential activity against anaphylactic and inflammatory reactions and between different types of inflammatory reactions. Possible reasons for these differences are discussed. 4 In mice there was little difference between the inhibition by dexamethasone of cutaneous allergic and histamine-induced reactions. 5 Pinnal anaphylaxis in mice was potentiated by dexamethasone given 1-2 h before challenge.


Differential depletion of cytoplasmic high affinity oestrogen receptors after the in vivo administration of the antioestrogens, clomiphene, MER-25 and tamoxifen. 1 The in vivo actions of the oestrogen antagonists, MER-25 and tamoxifen upon the cytosol oestrogen receptors prepared from amygdala, hypothalamus, pituitary and uterus of rats were studied 24 h after drug administration. 2 There was a dose-related depletion of cytosol oestrogen receptors. However, the uterine and pituitary receptors were consistently affected at a lower dose than were those from the brain. 3 The ratios of the combined central ED50 to the combined peripheral ED50 were clomiphene 169 greater than MER-25 19.2 greater than tamoxifen 2.13. 4 The receptor changes were not related to biological activity monitored by serum luteinizing hormone levels and uterotrophic response. 5 The possible role of these drug effects in the induction of ovulation and future developments are discussed.


A study of the interactions between glutamate and aspartate at the lobster neuromuscular junction. The depolarization produced by bath-applied or iontophoretically applied glutamate and aspartate were recorded from lobster muscle fibres by means of intracellular microelectrodes. 2 Bath-applied glutamate or aspartate evoked reversible, membrane depolarizations; however, responses to repeated applications of aspartate decreased progressively in amplitude until a plateau level was attained. Repeated applications of glutamate, kainate, domoate or quisqualate did not produce a similar effect. 3 After a dose of glutamate, responses to bath-applied aspartate were enhanced. Responses to other depolarizing agonists were little affected by previous administration of glutamate. Aspartate dose-depolarization curves were therefore constructed after initial aspartate responses had stabilized. The log-log transforms of the aspartate and glutamate curves had limiting slopes of 0.8 and 2.1 respectively. 4 Iontophoretic application of aspartate to single glutamate-sensitive sites produced small depolarizations with slow time course, compared with the glutamate potentials. When aspartate and glutamate were pulsed simultaneously from a twin-barrelled pipette, the resultant glutamate potential was enhanced. It is suggested that this potentiation was due to summation of agonist concentrations in the receptor region interacting with a second-order dose-response relationship. 5 Bath-applied aspartate increased the amplitude and prolonged the half-decay time of the glutamate potential. This effect was particularly noticeable when the glutamate potential was of slow time course. 6 It is proposed that bath-applied aspartate has an agonist effect whose magnitude is possibly exaggerated by concomitant release of glutamate and/or inhibition by glutamate of aspartate uptake. This agonist action of aspartate is thought to be exerted mainly on extrajunctional areas of the glutamate-sensitive sites.


Hepatic drug metabolism and haem biosynthesis in lead-poisoned rats. 1 Pretreatment of rats with intraperitoneal injections of lead was shown to result in a depression of the microsomal mixed function oxidase system, as assessed by a decrease in hepatic microsomal P-450 and b5 content and by a decrease in the activity of the enzymes aniline hydroxylase and aminopyrine demethylase. Lead had a more marked effect on cytochrome P-450 than b5. 2 The activity of the rate-limiting enzyme of haem biosynthesis, delta-aminolaevulinic acid synthase, was inversely correlated with the microsomal cytochrome P-450 content. 3 The activity of the haem biosynthetic enzymes delta-aminolaevulinic acid dehydratase, coproporphyrinogen oxidase and ferrochelatase were decreased by increasing lead pretreatment. 4 The activity of the haem catabolic enzyme, haem oxygenase, was increased by lead pretreatment.


Blockade of desensitization of nicotinic receptors of the cat adrenal medulla by concanavalin A. 1 The possibility of concanavalin A (Con A) blocking the development of desensitization of nicotinic receptors of the cat adrenal gland has been investigated. 2 During perfusion of the adrenal gland with Krebs-bicarbonate solution containing acetylcholine (ACh), the rate of catecholamine (CA) secretion was very high in the first 2 min; thereafter, as perfusion with ACh was continued the output fell, to reach about 20% of the initial value in 10 minutes. When the adrenal gland was pretreated with Con A, the subsequent desensitization of release during continued infusion of ACh was prevented. 3 When the adrenal gland was perfused with high K+ solution, there was always a large initial secretion of CA, and as perfusion with high K+ continued the output fell, to reach about 15% of the initial rate in 10 minutes. Con A did not affect the rate of CA secretion induced by high K+. 4 It is tentatively suggested that Con A blocks the desensitization of CA secretion evoked by ACh by interaction with the glycoprotein moiety of the nicotinic receptor of adrenal chromaffin cells.


Time course of degeneration of short and long postganglionic sympathetic nerve fibres and effect of pentobarbitone and colchicine on degeneration. 1 The time-course of degeneration of sympathetic nerves was investigated by measurement of the endogenous noradrenaline content of the rat vas deferens, submandibular gland and spleen following sympathectomy.2 Extirpation of the hypogastric plexus, superior cervical ganglion and coeliac plexus under pentobarbitone anaesthesia caused 50% depletion of the noradrenaline content of the vas deferens, submandibular gland and spleen in approximately 16, 19 and 21 h, respectively.3 Under pentobarbitone anaesthesia, proximal sympathectomy (i.e., close to the end organ) produced depletion of the noradrenaline content of the submandibular gland 8 h earlier than that caused by distal sympathectomy. Under ether anaesthesia, the time difference in obtaining the same degree of depletion after the two procedures of sympathectomy was only 2 hours.4 Removal of the superior cervical ganglion under ether anaesthesia resulted in almost complete depletion of noradrenaline content of the submandibular gland in 17 h, whereas when a similar operation was performed under pentobarbitone anaesthesia, nearly 24 h were required for the same degree of depletion. Similarly, the noradrenaline content of the spleen was depleted 4 h earlier if the coeliac plexus was ablated under ether as compared to pentobarbitone anaesthesia.5 Local application of colchicine (10 mg/ml, 30 min) to postganglionic sympathetic nerve axons had no effect on the noradrenaline content of the submandibular gland up to 24 hours. However, removal of the superior ganglion following colchicine application considerably slowed the depletion of the noradrenaline content of the submandibular gland (at 17 and 20 h after ganglionectomy, 10 and 20% depletion, respectively, in the experimental gland, as compared to 70 and 80%, respectively, in the control gland).6 To explain the results, it is proposed that injury to the sympathetic nerves at the site of sectioning triggers a signal (messenger substance) which travels down to the nerve endings to produce degeneration. Thus, the length of the extrinsic nerve fibre influences the time course of degeneration by changing the rate of transport of the messenger substance, whereas pentobarbitone and colchicine alter the synthesis and/or transport of the messenger substance to modify the time-course of degeneration.


The influence of an extraneuronal compartment on the relaxation of the cat nictitating membrane in vivo. 1 Contractions of the cat nictitating membrane were elicited on stimulation of the internal carotid nerve, and the effects were studied of desipramine and two inhibitors of catechol-O-methyltransferase, U-0521 and pyrogallol, on the subsequent relaxation of the muscle. 2 The relaxation of the nictitating membrane occurred in at least two phases. The late phase of relaxation was prolonged after increase in the period of nerve stimulation and the duration of this phase was further prolonged after treatment with pyrogallol. 3 After inhibition of neuronal uptake of noradrenaline with desipramine both the early and late phases of relaxation were increased in duration, and subsequent administration of pyrogallol or U-0521 caused a further increase in the duration of the late phase of relaxation. 4 The results suggest that the late phase of relaxation of the nictitating membrane is influenced by efflux of noradrenaline from an extraneuronal pool.


Structure-activity relationships for the anticholinoceptor action of tricyclic antidepressants. 1 The anticholinoceptor action of 15 tricyclic antidepressants and derivatives has been studied on the guinea-pig ileum. At the muscarinic receptors the compounds were found to exert antagonism which was reversible and apparently competitive up to dose-ratios of around 100 but non-competitive above this level. 2 Log affinity constants were derived from log dose-response curves at dose-ratios less than 100, where parallel curves were obtained. Amitriptyline, the most potent compound, had 214 X the potency of the weakest, hydroxyimipramine, but was itself 20 X weaker than atropine. 3 Structure-activity studies showed that dibenzocycloheptane derivatives were more potent than dibenzazepines and that S or O substitution for C-11 or other major changes in the central ring of the tricyclic nucleus greatly reduced activity. Side-chain N-methylation increased potency markedly. This and other findings indicate that both tricyclic nucleus and side-chain receptor attachments are largely non-polar in type.


The effects of adenine nucleotides on cutaneous afferent nerve activity. 1 The activity produced by the adenine nucleotides adenosine triphosphate (ATP), adenosine diphosphate (ADP) and adenosine monophosphate (AMP) and by potassium, acetylcholine (ACh), 5-hydroxytryptamine (5-HT) and bradykinin when applied to an exposed blister base on the ear of anaesthetized rabbits or intra-arterially to anaesthetized cats was investigated in multiple strands dissected from the auricular-temporal and saphenous nerves of rabbits and cats, respectively. 2 In the rabbit preparation potassium and the adenine nucleotides produced activity in the nerve fibres. The effects of these substances were produced in comparable dose ranges; threshold effects being produced by potassium at a concentration of 13 mM and by ADP at a concentration of 4 mM. ACh, 5-HT and bradykinin were inactive at similar or higher concentrations. 3 In the cat preparation all the substances tested produced activity in the nerve fibres. The adenine nucleotides were comparatively less potent than ACh, 5-HT or bradykinin, but had greater potency than potassium. 4 It was concluded that the adenine nucleotides do possess effects on afferent nerve terminals or fibres and thus resemble other known algogenic substances such as potassium, ACh, 5-HT and bradykinin.


A 5-hydroxytryptamine-like mode of anorectic action for 6-chloro-2-[1-piperazinyl]-pyrazine (MK-212). The mechanism of the reduction in food consumption elicited by 6-chloro-2-[1-piperazinyl]-pyrazine (MK-212) administered systemically was investigated in the rat. (+/-)-Fenfluramine and (+)-amphetamine were included in some studies for comparative purposes. 2 Pretreatment with methergoline, a 5-hydroxytryptamine (5-HT) antagonist, reduced the magnitude of the anorectic effect of 1.5 and 3 mg/kg of MK-212, while the anti-5-HT agents, cyproheptadine and cinanserin, were likewise effective against the 3 mg/kg dose. 3 Xylamidine, an antagonist of 5-HT that penetrates poorly into the central nervous system, completely blocked the decrease in food intake caused by 5-HT administered peripherally, while not antagonizing an equianorectic dose of MK-212. 4 Reduction of brain 5-HT by intraventricular injection of 5,6-dihydroxytryptamine, intraperitoneal administration of p-chloroamphetamine or placement of a lesion in the region of the median raphé nucleus diminished the anorectic response to 3 mg/kg of MK-212. The anorectic effect of amphetamine was reduced by p-chloroamphetamine or lesion in the raphé, but not by 5,6-dihydroxytryptamine. The decrease in food consumption produced by 1.5 mg/kg of MK-212 was antagonized by prior treatment with p-chloroamphetamine, but not by 5,6-dihydroxytryptamine. 5 Haloperidol, which blocks receptors for dopamine, antagonized the anorexigenic effect of amphetamine, but was ineffective in offsetting the action of MK-212, 3 mg/kg. 6 Pretreatment with chlorimipramine to inhibit the 5-hydroxytryptaminergic uptake mechanism did not affect the anorectic response to 3 mg/kg of MK-212, whereas the response to fenfluramine was diminished. 7 The results indicate that the anorectic action of MK-212 involves a 5-HT-like component which is more evident at the higher dose level of the compound. The anorexigenic property of MK-212 may depend, at least partly, upon the integrity of 5-HT-containing neurones in the central nervous system.


The acute effects of nicotine, tobacco smoke and carbon monoxide on myocardial oxygen tension in the anaesthetized cat. 1 The acute effects of nicotine, tobacco smoke, and carbon monoxide on myocardial oxygen tension (MPo(2)) were estimated amperometrically in 33 anaesthetized open-chest cats with a glass-insulated 25 mum platinum cathode within a 22-gauge needle implanted in the left ventricular wall.2 MPo(2) was 1.6-60 mmHg (mean 23.5 mmHg) when arterial Po(2) was >80 mmHg. Sequential intravenous infusions of nicotine (2-3 mug/kg every 45 s) or intracheal puffs (3-5 ml) of tobacco smoke commonly produced transitory increases (25-35 mmHg) of arterial pressure and 4-6 mmHg increments of MPo(2). Intratracheal puffs (5 ml) of 5% carbon monoxide sufficient to increase carboxyhaemoglobin from 0.8 to 1.5% to 4-7% had no effect on arterial Po(2) or blood pressure but typically decreased MPo(2) by approximately 1-4 mmHg. Augmentation of MPo(2) often succeeded carbon monoxide administration.3 Arterial hypoxia (arterial Po(2) < 60 mmHg) reduced mean MPo(2) to 14.4 mmHg but anoxic levels were not observed. Pressor responses to nicotine and tobacco smoke were accompanied by small increases (usually 1-3 mmHg) of MPo(2). Puffs of 5% carbon monoxide had less effect than during normoxia. Locations of low MPo(2) (<10 mmHg) were unaffected as carboxyhaemoglobin was raised to 7-11% during hypoxaemia.4 It is concluded that nicotine and tobacco smoke cause augmentation of myocardial oxygen supply, even during moderate hypoxaemia. By contrast, smoking dosages of carbon monoxide have the potential of producing a small reduction of MPo(2) during normoxia, but the effect is negligible during moderate hypoxaemia.


Incidence of depressive symptoms in users of the oral contraceptive. Evidence is presented that the incidence of depression among users of oral contraceptives is no higher than that among matched controls not taking such medication. There is an association between high depression scores and high neuroticism scores, more marked in controls than takers. Intensity of depression is related more to age, personality and occupation than to the use of oral contraceptives. A higher proportion of users than of controls experience sexual satisfaction. Past takers include a large number of individuals with a high neuroticism score. The incidence of depression symptoms in women increases with age. A higher proportion of housewives than of women going out to full-time work show depressive symptoms.


Management of the demented elderly patient in the community. Eighty-three consecutive patients with organic mental disorder were studied on their first admission to a psychiatric day hospital assessment unit in a general hospital. They were evaluated medically, psychiatrically and by social work, re-evaluated after 3 months, and again after 12 months or at death. The types of care, and the number of days in each setting, were recorded. Nearly three-quarters were dead or in institutions by 12 months: those initially living with spouses did worst, and those with their children did best, while those on their own became long-stay residents in institutions. Family support seeemed the most important factor determining continued life in the community, and increased help to families from social services appeared to be needed. The value of earlier psychiatric diagnostic and earlier treatment of physical ills is also discussed.


Residential needs in hospital and the community for mentally handicapped people. Using successive analyses of hospitalized mentally handicapped people from a geographically defined Welsh catchment area, this article attempts to evaluate changes in cohorts of such patients. It suggests the likelihood that the level of hospital accommodation predicted in the White Paper "Better Services for the Mentally Handicapped" will be sufficient.


Social deviance in a day hospital.

Social deviance in a day hospital. A search was made of records available for 65 nonpsychotic patients referred to a psychiatric day hospital. Assessments were made of whether they had shown various specified types of deviant social conduct, such detailed objective surveys of social conduct being regarded as superior to the use of concepts such as "psychopathic personality". The correlational structures of the areas of deviance produced four factors, i.e. deviant family roles, poor social integration, violence, and a more heterogeneous antisocial behaviour factor. The relationship was examined between areas of deviance and indices of the course and outcome of day hospital admission. The prognostic significance of social deviance was different for men and women; for example, only men showed a correlation between the number of areas of social deviance and the outcome of day hospital admissions. Violence and poor social integration showed no relation to outcome at all. It is suggested that there is no basis for excluding such patients from day hospitals on the assumption that they are less likely to be helped than other non-psychotic patients.


Social bonds in the epidemiology of neurosis: a preliminary communication. In a random sample of the general population (N = 142) a strong inverse relationship was found between social bonds and the presence of neurotic symptoms. This association was strongest in the case of close affectional ties. Together, measures of social bonds accounted for 47 per cent of the variance in neurotic symptoms. While there is likely to be contamination between the two sets of variables, and while the data do not indicate the direction of causality, these findings constitute an aetiological lead which should be pursued.


Distribution of drug-related problems among London casualty departments. A survey of patients with drug-related problems seen in London casualty departments during the course of one month revealed 1,706 separate incidents. In 477 cases the patients were dependent on drugs, and more than 40 per cent were dealt with by only five hospitals, all in the West End of London. The remaining 1,229 incidents involved nondependent patients who had taken a drug overdose, and these cases were distributed more evenly between hospitals all over the Greater London area. The implications of this study for service planning and for further monitoring of the patterns of drug misuse are discussed.


The effects of methadone maintenance with opioid takers. A review and some findings from one British city. Various benefits claimed for methadone maintenance in the treatment of opioid drug takers are reviewed. It is said to stop illicit drug use, maintain treatment contact, reduce morbidity, mortality and crime, and improve social adjustment. Little firm evidence is found to support these claims. Results are reported comparing 26 drug takers on methadone prescriptions with 16 illicit opioid takers. The measures used are Stimson's (1972) 'Patterns of Behaviour' questionnaire and direct behavioural measures of social functioning. The groups are found not to differ in terms of treatment contact, work status and involvement with other drug takers. There is some evidence that the methadone group is involved in less criminal activity. However, no association is found between amounts of drugs prescribed and numbers of local pharmacy thefts. It is concluded that the benefits of methadone maintenance have been exaggerated.


Some psychological correlates of long-term heavy cannabis users. Fifty persons who had all been heavy cannabis users for a long time were given psychological tests measuring psychomotor, perceptual and other variables. Half of these persons were "Charas" smokers, half "Bhang" drinkers. The duration of cannabis use was 4--10 years, with an average daily dose of 150 mg tetrahydrocannabinol. A matched control group of twenty-five persons were given the same tests. Compared with this group, the cannabis users were found to react more slowly, to be poorer in concentration and time estimation, to have higher neuroticism and greater perceptuo-motor disturbance. The higher neuroticism and greater perceptuo-motor disturbance. The Charas smokers were the poorest performers and also showed poor memory, lowered psychomotor activity, and poor size estimation.


The relationship between duration of treatment in a therapeutic community for drug abusers and subsequent criminality. The conviction rates for the first 61 admissions to a therapeutic community for drug dependence were obtained for a period two years prior to admission and two years after discharge, by searching in the Criminal Records Office at Scotland Yards. A long-stay group (n = 20) which had remained in residence more than six months was compared with a medium-stay group (n = 20) which had remained from one to six months and a short stay group (n = 21) which had remained less than one month. The long-stay group had a pre-admission conviction rate of 60 per cent, which was significantly reduced to 10 per cent during the follow-up period. The conviction rate of the medium-stay group was reduced from 70 per cent before treatment to 45 percent after treatment; that of the short stay group remained constant at 57 per cent before and after treatment. It is suggested that periods of more than six months treatment in the community are effective in reducing subsequent criminality.


School phobia: classification and treatment. Ninety-nine cases of school phobia seen at a child guidance clinic over a period of twelve years were divided into acute and chronic groups and investigated in several ways. The results indicate that the children of both groups are more likely to be the eldest or youngest in the family. Acute school phobia is more likely to occur in youngest children with two or fewer siblings, and mothers tend to be older. It is most common in adolescence and seems often to be precipitated by stress. Chronic school phobia is likely to occur in a child from a larger family and with a younger mother. It is more common in social class V and in children of mentally ill parents. Implications for treatment are discussed.


An evaluation of hospital in-patient treatment in adolescent school phobia. Thirty-two school-phobic youngsters of mean age 13 years were randomly allocated to two treatment groups after stratifying for sex. Length of in-patient management in a psychiatric hospital unit for young adolescents was evaluated. One group was admitted for three months and the other for six. Care was taken to ensure that cases had been fairly distributed between the groups by comparing them on a variety of clinical features. Follow-up assessments were carried out in a reliable fashion at six months, one year and two years after discharge. Outcome, overall, was similar to that found in a previous follow-up study for the same unit, in that symptoms of emotional disturbance and social impairment tended to persist in a considerable proportion of cases over the period of review. Length of stay in hospital did not affect outcome as far as the boys were concerned; the findings in relation to the girls was less certain and it seems likely that longer in-patient treatment improves outcome in school-phobic girls.


Attempted suicide and suicide among Oxford University students. A lower incidence of attempted suicide was found for Oxford University students than for other persons of the same age in Oxford City. This may be due to social class differences. Characteristics of the student attempters are reported. On the other hand, the rates for completed suicides of students, over a recent ten-year period, were in excess of those for the rest of their age group.


Epileptic homocide: a case report.

Epileptic homocide: a case report. This case report augments a paper published in 1971 (Gunn and Fenton) in which it was indicated that automatic behaviour is a rare explanation for the crimes of epileptic patients. It was claimed that although two possible "automatic" crimes were committed by two epileptic patients among the 46 male epileptics at Broadmoor there were no such crimes committed by any of the 158 male epileptic prisoners who came into a national sample. Since then it has become clear that one man serving life imprisonment, exluded from the epileptic prisoner sample in 1967 because of a doubt about his diagnosis, is definitely epileptic and probably killed his wife during an epileptic attack or its immediate sequela.


Platelet and plasma amine oxidase activity in alcoholic individuals. Platelet and plasma amine oxidase activity was determined in a group of 99 healthy male (active duty military) alcoholics referred for hospital treatment who had been abstinent from alcohol for 2-10 days, and compared with that of a control military group. Platelet MAO activity was slightly but significantly lower in the alcoholic group. Both groups were significantly lower in MAO activity compared to a group of 42 non-military controls. In the alcoholic group there was no correlation between platelet MAO and severity or chronicity of drinking, nor was there evidence of iron deficiency to account for the lowered MAO activity. When the alcoholic and military control groups were split at the median, the first degree relatives of both the 'low' MAO alcoholics and the 'low' MAO military controls had a higher incidence of alcoholism than did the relatives of both 'high' MAO subgroups. No personal or family history data of alcohol-related problems were available on the non-military control group.


Depression and hemispheric functions: changes associated with unilateral ECT. Nine depressed patients received ECT to the dominant (left) side along with nine matched depressed patients who received ECT to the non-dominant (right) side. Neuropsychological tests showed that the right hemispheric functions were more frequently abnormal as compared to left hemispheric (dominant) functions in the pre-ECT tests. ECTs delivered to either the right or left side improved right hemispheric functions when the depression was ameliorated. This study indicates that in depression right hemispheric functions are initially disturbed and ECT, instead of being deleterious to these functions, tends to improve them.


Dysmorphophobia--a long-term study.

Dysmorphophobia--a long-term study. This study examines the mental health of 187 patients who had a rhinoplasty fifteen years earlier. Of 101 who had the operation following disease or injury 9 are now severely neurotic and one schizophrenic; of 86 who had the operation for aesthetic reasons 32 are now severely neurotic and 6 schizophrenic. The differences between the two groups are significant, and show that dysmorphophobia is an ominous symptom.


The usefulness of first-rank symptoms in the diagnosis of schizophrenia in a Saudi Arabian population. Ninety-two schizophrenic patients of both sexes admitted to hospital at Taif, Saudi Arabia were examined to discover the incidence of Schneider's first-rand symptoms and their usefulness in diagnosing schizophrenia in this country. Fifty-two patients (56.5 per cent) were found to have these symptoms, most frequently 'made' phenomena and 'somatic passivity'. The role of possible socio-cultural factors and the need for serious studies on transcultural psychiatry are discussed.


Early parent death and the clinical scales of the MMPI. There is growing evidence that early parent death can affect the severity of adult depressive illness. It was anticipated, therefore, that early-bereaved depressed patients might score higher on certain MMPI clinical scales than non-bereaved, depressed controls matched for age and sex. This is shown to be the case, the most affected scales being Hypochondriasis and Paranoia. Hypochondriasis is shown to be more strongly associated with early father death, while Paranoia is associated equally with mother and father death. There is some suggestion that early mother death is also associated with elevation of the F score. Early parent death is shown to have no effect upon the MMPI scores of non-depressed patients.


A common language for the psychotherapies? The account of mental processes emerging from the work of cognitive psychologists is briefly reviewed, and aspects of the theoretical basis of the work of psychoanalytic and behaviourist psychotherapists are considered in the light of this. It is argued that in both traditions increasing attention is being paid to cognitive processes. A restatement of psychoanalytic theory in cognitive terms could free it from its present confusion of metaphors, and an extension of behaviourist theory in this direction could free it from reductionism. The advantages of the adoption of a common language, based on the models of cognitive psychology, to theory, practice and research are briefly considered.


How should we measure outcome in psychotherapy? The problem of assessing outcome in psychotherapy is considered by examining the experiment conducted by Bloch et al (1977). The experimental design and statistical considerations in investigating psychotherapy outcome are briefly examined. Tt is argued that attention should be directed towards assessing the severity of patients' problems rather than improvement after treatment.


Insanity in bar of trial in Scotland: a State Hospital study. Legal findings of unfitness to stand trial are returned ten times more frequently in Scotland than in England and Wales. Sixty-five patients in the State Hospital who had been found insane in bar of trial were compared with a control group of 64 offender patients. They showed a significantly greater incidence of homicidal crimes and diagnoses of psychotic disorders, 19 per cent of which later proved to be unstable. They had also been detained longer at the State Hospital. These findings are discussed and particular reference is made to the tendency for psychotic offenders to be almost automatically regarded as unfit to plead. A brief comparison is made with the situation in England, and some modifications in forensic psychiatric procedure are suggested.


Impulsivity/sociability and reinforcement in verbal operant conditioning. The present investigation was designed to study the relationship between impulsivity/sociability and modes of reinforcement in verbal operant conditioning. Two 2x3 randomized block designs, one each for impulsivity and sociability, were replicated ten times. One hundred and twenty undergraduate female students (60 for impulsivity and 60 for sociability) were individually subjected to Taffel's verbal conditioning procedure. When the conditioning scores of high and low scorers on the impulsivity and sociability scales were compared, it was found that under rewarding conditions ('good' and 'buzzer' in respect of sociability and 'good' in respect of impulsivity) the high scorers' score and under punishing conditions ('electric shock') the low scorers' score was the higher of the two. The study also revealed that the high scorers (on the impulsivity scale) conditioned more under rewarding conditions while the low scorers (both on the impulsivity and sociability scales) conditioned more under punishing ones.


A note on the development of recall of spatial location. Recall of spatial location was studied with 5, 8, 12--13, and 17--18 year old subjects. Pictures of objects were shown one at a time in one of the four quadrants of a projection screen which was either blank (NF) or divided by a cross into four quadrants (F). The presence of the frame (F) did not affect item recall, but facilitated location recall more, the younger the subjects. Intentional learning of location was superior to incidental learning in the youngest but not in older children. The results are in agreement with Bryant's (1974) analysis of perceptual development which emphasizes the use of external spatial frames of reference in the encoding of attributes of visual objects in young children.


Role of symmetry in pattern reproduction. The role of enantiomorphs (mirror images) as units of coding of symmetrical patterns was investigated. Simple symmetrical matrices were presented tachistoscopically for 0.3 sec and were immediately followed by 0.3 sec presentation of the same matrix but with half of its cells occluded. The subjects were required to reproduce the first matrix. Five patterns of occlusion were used: random, lateral, skew, vertical and horizontal. It was found that lateral occlusion (which leads to a display of an enantiomorph) did not differ in its effectiveness from horizontal and vertical occlusions, although it conveyed twice as much information. Lateral, horizontal and vertical occlusions all differed significantly from the other two types which gave inferior results. In another experiment the effects of random and symmetrical occlusions were investigated; it was found that random occlusion was more effective than symmetrical occlusion. The results of the experiments, it is argued, show that information theory and gestalt approaches to the problem of symmetry are to some extent complementary.


The subliminal perception of movement and the course of autokinesis. The course of autokinesis is shown to be sensitive to the real movement of a surrounding stimulus. With the supraliminal presentation of this stimulus, apparent movement in a direction opposite to that of the real movement is induced. With the subliminal presentation of the same stimulus the real movement serves to inhibit autokinesis by inducing brief periods of stationarity between the phases of upward and downward apparent movement. The results confirm previous findings that the movement of a stimulus may be discriminated without there being any perceptual (phenomenal) adjunct.


An intra-cultural investigation of susceptibility to 'perspective' and 'non-perspective' spatial illusions. Conventional Müller-Lyer and modified Müller-Lyer (without 'perspective' cues) illusions were presented to two samples of children aged between eight and 19, matched in education, but living in 'carpentered' and 'uncarpentered' environments in Zambia. Traditional differences in susceptibility have been obtained with both the variations of the Müller-Lyer illusion. In view of the lack of perspective cues in one of these, it is concluded that the perspective theory as presented within the 'carpentered world hypothesis' is inadequate. Since these differences are intra-cultural, they also do not support the hypothesis which suggests that cross-cultural variations in illusion susceptibility are due to genetic factors--such as macular (or retinal) pigmentation.


Chlorpromazine and serial reaction performance. The effect of 25 mg or 75 mg of chlorpromazine on the serial reaction performance of 12 male human subjects was studied. Speed or number of correct responses was reduced by the high dose of chlorpromazine and errors of commission and omission were increased. The adverse effect of the drug upon speed appeared only at the end of the half-hour test. By contrast the adverse effect upon gaps and errors was apparent throughout the test and there was no interaction with test duration.


The misplaced caecum and the root of the mesentery. Five cases presenting in late infancy and childhood with symptoms and signs referable to malrotation of the midgut are described. The condition may present with jaundice, malabsorption or the signs and symptoms of intestinal obstruction due to internal hernia or volvulus. It may also result in volvulus and gangrene of the midgut. A short root of the mesentery predisposing to this event will be seen on a barium meal and follow through examination and will warn of its impending occurrence.


Transcatheter embolisation of bone tumour arteriovenous malformations. Arteriovenous malformations complicating benign bone tumours may not be amenable to surgical treatment either because of their extensive size and likelihood of recurrence or because of their location. Transcatheter embolisation may then be used either as the definitive treatment or as a prelude to safe surgical intervention. Patients presenting with arteriovenous malformations in association with polyostotic fibrous dysplasia and vertebral haemangioma are presented who were treated by transcatheter embolisation, using Oxycel and Gelfoam. A haemodynamically significant shunt was obliterated in one patient and in the other an excellent clinical response was obtained facilitating subsequent surgical management.


Limitations of fibre-optic bronchoscopy under fluoroscopy in the investigation of peripheral lung lesions. Transbronchial lung biopsy under fluoroscopic guidance was attempted in 14 patients with discrete peripheral lesions and histological evidence of pathology was obtained in five (37.7%). The difficulties and limitations of the procedure are discussed. The radiation hazard to both patient and bronchoscope are assessed. From this study it is concluded that aspiration needle biopsy is preferred in the investigation of patients with peripheral lung lesions.


The determination of anatomical cross-sections using a radiotherapy simulator. A system for obtaining anatomical cross-sections for treatment planning using a radiotherapy simulator is described. A fluorescent screen is viewed by a low light level Isocon television camera and the video signal is digitized and stored. Many projections of the phantom are obtained by rotating the simulator gantry. A convolution algorithm has been used to reconstruct chest sections in which skin and lung outlines are visible. The technique could also be used to make corrections to radiotherapy dose distributions where irradiation of lung tissue is involved.


Topograhic relation between the myocardial uptake of radiothallium and left ventricular kinetics in myocardial infarction. Myocardial images with thallium 201 are recorded on a computer with the ECG tracing and the cardiac cycle divided into 16 consecutive images. The patients then recieve 99Tcm albumin for first pass and a subsequent ECG gated series for comparison with the myocardial studies. These images can be superimposed and allow the topographic relationships of thallium uptake and ventricular contractility as reflected by the blood pool, to be seen. Quantitative parameters such as ejection fraction and stroke volume are also obtained. Examples in clinical practice are given.


Thyroid uptake measurements: the influence of gland depth, gland mass and lobe separation. Phantom measurements were carried out to define the dependence of standard thyroid uptake measurements on gland depth, gland mass and lobe separation. In the case of 99Tcm and 131I, depth can cause a variation of up to a factor of two in the apparent uptake, while in the case of 125I the variation due to depth is a factor of about four. By contrast, gland mass and lobe separation cause only small errors, of the order of 2 and 10% respectively for medium energy isotopes. These errors are particularly important when the uptake value is used to guide prescription of 131I for therapy of thyrotoxicosis.


A study of technetium-labelled sulphide colloid uptake by regional lymph nodes draining a tumour-bearing area. With appropriate controls, experimental groups of inbred C3H mice bearing a syngeneic mammary carcinoma challenge in their right rear footpads were injected in both rear footpads with 99TcmASC. Mice were sacrificed 15 and 90 min after the labelled colloid injection. Popliteal and sacral lymph nodes were weighed and counted in a well scintillation counter. A marked inhibition of labelled colloid uptake was demonstrated in regional lymph nodes draining a tumour-bearing area. Rabbits bearing VX2 carcinoma in a forelimb received 99TcmASC into each front footpad. Depression of labelled colloid uptake by regional lymph nodes draining tumour was evident on gamma-camera scanning.


Diagnosis of malignant breast disease by axillary lymphoscintigraphy: a preliminary report. The ability of regional lymph nodes to take up 99Tcm-labelled antimony sulphide colloid from the breast tissue was studied in 50 patients with mammary symptoms by gamma-camera scanning. Thirteen out of 14 patients with histologically confirmed carcinoma of the breast had a depressed uptake of labelled colloid in ipsilateral nodes, i.e. a positive scan. Twenty-nine out of 32 patients with benign breast disease had a negative scan. The method promises to aid both the precise diagnosis of breast disease and the definition of the extent of mammary cancer.


The effect of hepatic interposition on insulin-stimulated gastric secretion after proximal gastric vagotomy. The peak acid output to insulin 10-14 days after proximal gastric vagotomy (PGV) for uncomplicated duodenal ulcer in a control group of 11 men was 1.5 mmol/h, and this rose significantly (P less than 0.01) after a mean interval of 26.1 months to 5.3 mmol/h. The rise in the PAOI in 7 male patients undergoing PGV and hepatic interposition for duodenal ulcer was from 1.0 mmol/h to 4.5 mmol/h (P less than 0.05) over a mean interval of 13.1 months. No significant difference between the changes in the PAOI in the two groups of patients could be detected. It is concluded that separation of the lesser curve of the stomach from the cut edge of the lesser omentum by the left lobe of the liver after PGV in an attempt to block vagal regeneration does not alter the postoperative rise in acid secretion.


Abdominal tuberculosis in the 1970s: a continuing problem. Eight cases of abdominal tuberculosis (5 indigenous and 3 immigrants) treated in Cardiff in the 5-year period 1972-6 were studied to determine clinical presentation, errors in diagnosis and usefulness of investigations. The heterogeneous presentation is reflected in the 7 types of lesion seen in the 8 cases. Anorexia and weight loss were present in all cases and abdominal colic and post-prandial discomfort were common. No patient had diarrhoea, constipation or intestinal obstruction. The clinical diagnosis was wrong 7 out of 8 times. Investigations were unhelpful in the diagnosis and where a lesion was found on barium studies, a diagnosis of Crohn's disease or carcinoma was made. The same was true of the findings at laparotomy. The examinations most useful in the diagnosis were histopathological examination for caseation and demonstration of acid-fast bacilli by alcohol and acid-fast tissue stains, or by a culture technique. The need for a greater awareness of abdominal tuberculosis, not only in immigrants but also in the indigenous population of Britain, is apparent.


A microsurgical technique for the creation of arteriovenous fistulas. A new method for creating arteriovenous fistulas employing microvascular techniques is described. It is proposed that this method should be used in problem cases where conventional means have failed or as a first procedure in cases in which technical problems are envisaged. A two-stage microvascular procedure has been used to create adequate fistulas in these difficult cases. Satisfactory fistulas have been formed in 15 out of 16 patients in whom these techniques have been used.


Arterial reconstruction extending below the popliteal bifurcation. Results are reported for 172 anastomoses below the popliteal artery in patients almost exclusively suffering from severe distal ischaemia with an in-hospital mortality of 7.6 per cent. The patency rate in survivors was 83 per cent on discharge and 39 per cent at 3 years. There were 37 major amputations following 172 operations and 15 following 47 operations on diabetics. As most of the patients would have lost their limbs if arterial repair was not undertaken this constitutes a considerable salvage rate. Diabetes mellitus does not appear to influence the results infavourably, so patients suffering from this disease should be considered for operation.


Amylase thermolability as a screening test for pancreatic pseudocysts. Amylase thermolability was determined by heating sera from control patients and patients with acute pancreatitis and pancreatic pseudocysts at 65 degrees C for 15 min. Normal serum amylase was 44 per cent thermolabile, but increased to 84 per cent thermolability during the hyperamylasaemia of acute pancreatitis, and returned to normal on resolution of the pancreatitis. In 9 patients with a pancreatic pseudocyst, although the total amylase level had almost returned to normal limits, 79 per cent of the amylase remained thermolabile. Amylase thermolability appears to be a simple screening test for pancreatic pseudocyst formation secondary to acute pancreatitis.


Pneumoperitoneum following hernia repair. In a small series of 20 consecutive patients it proved impossible, using conventional radiography, to detect free intraperitoneal air following herniorrhaphy.


A method of treating post-irradiation rectovaginal fistulas. A sphincter-saving operative method of treating post-irradiation rectovaginal fistulas is presented. The technique involves the peranal anastomosis of healthy colon to the mid-anal canal using a 'sleeve' anastomosis. Four patients have been treated with cure of the fistula and a return to normal bowel habit. A fifth, with an irradiation ulcer causing intractable pain, also obtained complete relief of symptoms.


Unusual small intestinal obstruction in adolescent girls: the abdominal cocoon. Ten cases of small intestinal obstruction seen over a period of 6 years (1971-6) in young girls within the narrow age range of 13-18 years are described. The patients were all within 2 years of menarche. In all these cases the obstruction was due to a membrane encasing the small intestine in the manner of a cocoon. There was no previous history of abdominal operation, peritonitis or prolonged drug intake. The clinical features, operative findings and management of the cases are presented. Possible causes of the condition are discussed. In view of the similar clinical presentation in all these patients, their conditions can be grouped as a clinical entity--'the abdominal cocoon'.


Strangulating adhesive small bowel obstruction with normal radiographs. A review of patients having laparotomy for adhesive small bowel obstruction has revealed that many patients have normal radiographs on admission and that this group of patients, who are predominantly women, have delayed laparotomies and are at a significantly increased risk of developing strangulating obstruction while in hospital. The clinical and laboratory data which may distinguish strangulating from non-strangulating obstruction were examined and found to be non-discriminatory in this series.


The role of IgA in the prevention of bacterial colonization of the jejunum in the vagotomized subject. The efficacy of three mechanisms of defence against jejunal bacterial colonization (i.e. gastric acid, vagal and pyloric integrity and intestinal IgA) has been investigated. Only in subjects with disturbance of all three mechanisms did significant jejunal colonization occur, and this was invariably associated with severe diarrhoea. Clearly normal intestinal IgA is of critical importance in the prevention of jejunal bacterial colonization in the vagotomized subject.


Endoscopic appearances and histological changes in ulcer-associated duodenitis. A simple system of grading the endoscopic appearances of duodenitis is described. There was a good association between the degree of duodenitis recorded using this method and that obtained from a histological grading system in a group of duodenal ulcer patients and a group of dyspeptic patients with no endoscopic evidence of duodenitis. Endoscopic assessment is recommended as a reliable guide to the presence of duodenitis. After 1 month of treatment with cimetidine there was a significant improvement in the endoscopic duodenitis scores of a group of 17 duodenal ulcer patients. In 16 of these patients there was complete ulcer healing. Duodenitis can be a manifestation of chronic duodenal ulcer disease. In the absence of ulceration, the endoscopic diagnosis  of duodenitis is of value in the recognition of patients with this condition.


Graft avulsion: an unreported complication of axillofemoral bypass grafts. A case of avulsion of a unilateral axillofemoral Dacron bypass graft 3 weeks after insertion is reported. Surface measurements on healthy volunteers suggest that when the thoracolumbar spine is in full lateral flexion the length of the graft may increase by up to 21 per cent. Such movements should be restricted during the early postoperative period.


Thermography in screening postoperative deep vein thrombosis: a comparison with the 125I-fibrinogen test. The value of thermography as a screening method for postoperative deep vein thrombosis has been evaluated in 308 patients (616 legs). Comparison was made with the 125I-fibrinogen test. The overall diagnostic agreement was 81.0 per cent; the sensitivity was 62.1 per cent and the specificity 90.3 per cent. The agreement increased with proximal extension of the thrombi. Thermography became positive 0.26 days after the 125I-fibrinogen test but in 19.8 per cent thermography was positive before a positive fibrinogen test.


Resistance to chenodeoxycholic acid (CDCA) treatment in obese patients with gall stones. In most patients with radiolucent gall stones who were given chenodeoxycholic acid (CDCA) in doses of 13-15 mg/kg body weight/day the bile became unsaturated in cholesterol, and their gall stones dissolved. The patients whose stones did not dissolve were significantly heavier and fatter than the responders, which suggested that obese patients might be "resistant" to the effects of CDCA. To test this hypothesis, 32 consecutive patients presenting for medical treatment of gall stones had their ideal body weight (IBW) and estimated body fat mass calculated. The eight most obese and the eight least obese patients were then selected, and their fasting bile lipid responses to CDCA 13-15 mg/kg/day were measured. The very obese patients were also given larger doses, and any changes in bile lipid composition were studied in relation to subsequent gall-stone dissolution.Before treatment the obese patients had a higher mean biliary cholesterol saturation index than the non-obese patients, and this difference was maintained during treatment with the normal dose of CDCA: the bile in the obese patients remained supersaturated while that in the non-obese became unsaturated with cholesterol. When the obese patients were given larger doses of CDCA their bile ultimately became unsaturated in cholesterol. Gall stones dissolved partially or completely in five of the eight non-obese patients after 6-18 months of 13-15 mg CDCA/kg/day, but none of the obese patients showed any response after comparable periods of treatment with this standard dose. With increased doses and unsaturated bile, however, three of the obese patients showed partial gall-stone dissolution after 3-12 months' treatment and one showed complete gall-stone dissolution after three years' treatment.These results suggest that when giving CDCA to patients with gall stones, larger than normal doses (some 18-20 mg/kg/day) should be prescribed. Alternatively the lipid composition of the patients' bile should be monitored by duodenal intubation and the CDCA dose increased until the bile becomes unsaturated in cholesterol.


Serum lipid concentrations and blood pressure in obese women. In 70 obese women no correlation was found between body weight and serum cholesterol or triglyceride concentrations, but there was a significant correlation between weight and blood pressure. Weight reduction by diet or jejunoileal shunt was not accompanied by any significant change in serum lipid concentrations other than the decrease in serum cholesterol expected after intestinal bypass. Twelve months after bypass surgery was carried out on 14 patients, however, both systolic and diastolic blood pressures were significantly reduced and at levels appropriate to the patients' new weights. These results suggest that obesity in women cannot be taken to indicate the presence of hyperlipidaemia and that sustained weight loss may lower blood pressure.


Early deaths in Jamaican children with sickle cell disease. In Jamaican children with homozygous sickle cell (SS) disease diagnosed at birth two-year survival was 87%, compared with 95% in children with sickle cell-haemoglobin C (CS) disease, and 99% in normal controls. Death among those with SS disease occurred most often between the ages of 6 and 12 months. Principal causes were acute splenic sequestration and pneumococcal infection. Neonatal diagnosis of haemoglobinopathies must be followed by close observation if mortality is to be reduced by early diagnosis and treatment of these complications.


Maternal and fetal nutrition in south India. The relation between the nutrition of the mother and that of her baby was assessed in a south Indian community where malnutrition is common and women do not smoke. Unselected mothers and their infants of over 37 weeks' gestation were studied in two groups: those who paid for their care (150) and a poorer group who did not (172). There were significnat differences between the paying and non-paying groups in maternal triceps skinfold thickness, infant weight, and infant length. Overall there was a significant positive correlation between maternal triceps thickness and infant weight, length, and triceps and subscapular skinfold thickness. The correlation with the infant head circumference was less significant. These findings are further evidence that the nutrition of the mother has an important effect on the nutrition of her baby and that malnutrition is an important reason why Indian babies are lighter than European ones.


Management of intracranial metastases.

Management of intracranial metastases. Of 223 patients with intracranial metastases, 161 underwent removal of a presumed solitary lesion and 29 were treated by burr-hole biopsy. Results of radical surgery were better than those of biopsy alone in terms of survival. Quality and duration of survival were poorer in patients who had infratentorial metastases removed than in those who underwent surgery for supratentorial metastases. In this second group only patients with breast cancer benefited from surgery, though a few women with bronchial carcinoma also did well. The interval removal of a primary tumour and development of intracranial symptoms did not influence outcome. Evidence of a previous primary tumour should not lead to the assumption that intracranial symptoms are caused by a metastasis.


Developmental surveillance in general practice. During a two-year study of a developmental surveillance programme covering all children under 5 in a large general practice in the south of England, 2157 children were examined, including 382 newborn babies seen at home. Suspected disorders--excluding those found during non-routine consultations--were discovered in 232 children (15% of boys and 11% of girls), of whom 171 (104 boys and 67 girls) were referred to specialist agencies. The number and nature of the disorders show that routine surveillance on the lines proposed by the Court Committee is worth while. Nevertheless, such programmes could not be started on a national scale without increased resources for the specialist services to which more children would need to be referred.


Relations between bleeding pattern, endometrial histology, and oestrogen treatment in menopausal women. Vacuum curettage was performed on 348 women who had received various regimens of oestrogen treatment for an average of 9.7 months for climacteric symptoms. In 62 cases (18%) the specimens were unsatisfactory for histological assessment; among the remainder, however, they showed a normal endometrium in 257 cases (90%), cystic hyperplasia in 21 (7%), adenomatous hyperplasia in 7 (2%), and endometrial adenocarcinoma in one. Cyclical unopposed oral oestrogen treatment (98 cases) was associated with a 12% incidence of endometrial hyperplasia, but among those given an additional five-day course of progestogen in each cycle (37 cases) the incidence was only 8%. No case of hyperplasia occurred among 102 women taking regimens including 10 or 13 days of progestogen. Among women treated with subcutaneous oestradiol implants and monthly five-day courses of oral progestogen (50 cases) there was a 28% incidence of hyperplasia including the one case of carcinoma, though some of those with hyperplasia may not have taken the full course of progestogen. Regular withdrawal bleeding during treatment was associated with a lower incidence of endometrial hyperplasia (6%) than unscheduled breakthrough bleeding (28%), but the one patient with carcinoma had experienced regular bleeding only.The risk of developing endometrial carcinoma from oestrogen treatment may be reduced by avoiding the use of unopposed oestrogen regimens, the addition of more than five days' treatment with a progestogen, and recognising that a regular bleeding response to oestrogen is no guarantee of a healthy endometrium.


Relevance of duration of transient ischaemic attacks in carotid territory. A retrospective review of the clinical and angiographic features of 116 patients who had had one or more transient ischaemic attacks in the carotid territory showed that stenosis of ther cervical portion of the internal carotid artery was significantly more prevalent among patients whose attacks had been brief, with full recovery in under one hour. This information may be helpful in selecting patients for angiography.


Anticonvulsants and thyroid function.

Anticonvulsants and thyroid function. Serum total and free thyroid hormone concentrations were estimated in 42 patients with epilepsy taking anticonvulsants (phenytoin, phenobarbitone, and carbamazepine either singly or in combination). There was a significant reduction in total thyroxine (TT4), free thyroxine (FT4), and free triiodothyronine (FT3) in the treated group compared with controls. Free hormone concentrations were lower than total hormone concentrations, suggesting that increased clearance of thyroid hormones occurs in patients receiving anticonvulsants. Detailed analysis indicated that phenytoin had a significant depressant effect on TT4, FT4, FT3, and reverse T3 (rT3). Phenobarbitone and carbamazepine had no significant main effects, but there were significant interactions between phenytoin and carbamazepine for TT4 and FT4. phenobarbitone and carbamazepine for FT3, and phenytoin and phenobarbitone for rT3.


Effect of paracetamol on gastric mucosa. The effect of paracetamol on the gastric mucosa was examined in seven healthy volunteers. The dose used (2 g instilled in 100 ml isotonic saline) was equivalent to about six tablets taken with water. Biopsy specimens were taken before and 10 and 60 minutes after instillation. The mean incidence of damaged surface cells in the control period was 1.7%. Ten minutes after instillation 3.5% of the surface cells were damaged. This increase was not significant. Light microscopy showed focal cell disruption and infiltration of red blood cells. Scanning electronmicroscopy showed minimal loss of normal cell apices. No erosions were seen on microscopy. Biopsy specimens taken 60 minutes after paracetamol showed similar changes. These findings differ appreciably from the extensive cell damage and microscopic erosions caused by therapeutic doses of 600 mg (two tablets) of aspirin. We conclude that large "analgesic" doses of paracetamol cause minimal ultrastructural changes in normal human gastric mucosa. The continued use of paracetamol in place of aspirin appears to be justified when there is a possibility of gastric mucosal injury.


Stilboestrol and vaginal clear-cell adenocarcinoma syndrome. A vaginal clear-cell adenocarcinoma developed in a young woman who had been exposed in utero to maternal stilboestrol treatment. During 1940-71 in the UK some 7500 women were given stilboestrol during pregnancy. Thus more cases are likely to appear and clinicians caring for young women should be alert to this possibility.


Bites by foreign venomous snakes in Britain. In 1970-7 17 people in Britain were the victims of 32 bites by foreign venomous snakes. Crotalus atrox caused eight of these bites, Bitis arietans five, and the remaining 19 bites were caused by 12 different species. All the victims were bitten while handling the snake, and 24 bites were incurred by private individuals in their own homes. Poisoning was negligible in 17 of the 32 bites but life-threatening in at least two cases. Thus in the early stages snake bite may be unpredictable as a clinical problem. All victims of snake bite should be observed for at least 12 hours to assess the severity of poisoning and to ensure rational treatment. Local necrosis developed in six cases and resulted in prolonged illness in five of these cases; local incision was carried out and many have been a casual factor. Comprehensive stocks of antivenoms for treating bites by foreign venomous snakes are held by the National Health Services in Liverpool and London. Antivenom is indicated (a) for potentially serious systemic poisoning, as evidenced by hypotension, electrocardiographic changes, neurtrophilia, and acidosis (after viper or elapid bites), abnormal bleeding or non-clotting blood after viper bites; and ptosis or glossopharyngeal palsy after elapid bites; and (b) for bites from snakes whose venom causes local necrosis, to prevent or minimise this unpleasant complication. For effective antivenom treatment intravenous infusion is mandatory.


Radiological prevalence of Paget's disease of bone in British migrants to Australia. The radiological prevalence of Paget's disease among migrants from the United Kingdom to Australia was higher than in a comparable Australian resident population but lower than in a British resident population. A probable explanation is that the migrants carry with them the higher UK risk of developing the disease.


Norethisterone oenanthate as an injectable contraceptive: use of a modified dose schedule. Norethisterone oenanthate (NET-OEN) was given as an injectable contraceptive to 295 healthy women over 1606 woman-months. A modified injection schedule was used. There were no pregnancies, and the 12-month, life-table, use-related discontinuation rate was 39.1/100 users. Menstrual disturbance (10.8/100 women), minor side effects (13.5/100 women), and personal reasons (12.0/100 women) were the main causes of use-related discontinuation. There was no difference in use-related discontinuation rates between women receiving their first injection during a normal menstrual period and those receiving it immediately after a pregnancy. There were no serious side effects. The use of NET-OEN in certain groups of women is recommended, particularly in those in need of highly effective contraception, who cannot or do not wish to take oral contraceptives, who are lactating, or who are awaiting hospital admission for sterilisation.


Variation in rates of hospital admission for appendicitis in Wales. In a study designed to investigate the variations in rates of admission to hospital for appendicitis in Wales Hospital Activity Analysis listings were analysed according to the sex and age of the patients and the month and day of the week of admission. The incidence of hospitalisation was greatest among boys aged 10-14 and girls aged 15-19. The number of admissions was higher on weekdays than at weekends, but there were no seasonal variations. Durations of stay differed between the 17 health districts. We conclude that admission rates vary mainly because of differing hospital admission policies. Admission is not wholly governed by the sudden onset of abdominal pain; other factors include the threshold of consultation of each patient, the referral habits of general practitioners, the availability of hospital beds, and the degree to which doctors and patients expect admission.


No news is bad news: patients' views about communication in hospital. One hundred patients on four general surgical wards in a large teaching hospital were interviewed about the information they had received about their illness and what they had been told about the investigations they had undergone. Fifty-five of them expressed some dissatisfaction and 14 were strongly dissatisfied. The way in which ward rounds were conducted was heavily criticised, but most patients did not object to the teaching of medical students at the bedside. Twenty-four patients would have liked more explanation about why investigations were performed, and 38 though that they had not been told enough about the results of their investigations. This lack of information led to anxiety and fear. The findings suggest that more effort is needed to improve communication between doctors and patients.


When and why are babies weaned?

When and why are babies weaned? A prospective study was designed to investigate the weaning practices of 50 primiparous mothers whose babies were born between September 1976 and March 1978. The question whether the age of weaning influenced growth from birth to 6 months was also considered. The mothers and babies were seen in hospital and then at a follow-up clinic at 1, 2, 3, and 6 months. Details were taken of feeding practices, and measurements made of the babies' weight, length, and subscapular and triceps skinfold thicknesses. Seventeen infants who were breastfed received their first solid food at a mean age of 13.8 weeks, compared with 8.3 weeks for the 33 bottle-fed infants. Most (38) mothers weaned because they though their babies were hungry (crying after a feed or demanding more frequent feeds, or both). The age of weaning did not influence weight gain, growth in length, or change in skinfold thicknesses. The results suggest that the "4-month rule" for weaning is unrealistic. The decision to wean should be based more on the mother's interpretation of her baby's needs than on age alone.


Improved management in the diagnosis of gonorrhoea in women. In this paper an evaluation is made of the endeavours to improve diagnosis in women named as contacts of gonorrhoea. The problem was approached in three ways. (a) The number of sites sampled was increased. (b) The results of microscopical examination of smears made by clinical staff were regularly evaluated. (c) Cultural examinations by the supporting laboratory were dealt with more efficiently and speedily. It is concluded that the number of tests currently used to establish or exclude a diagnosis of gonorrhoea in women can safely be reduced to two, and that the methods currently in use allow a more cost-effective management of an increasing case load.


The efficacy of cefuroxime for the treatment of acute gonorrhoea in men. This is a report on a clinical trial in which cefuroxime was used for treating 110 men with uncomplicated urethral gonorrhoea. Twenty-three men were given 1 g cefuroxime intramuscularly and 1 g probenecid orally, and 87 were treated with 1.5 g cefuroxime intramuscularly with 1 g probenecid orally. All 18 patients treated with 1 g cefuroxime and 1 g probenecid and seen at least once after treatment, were cured. Sixty-six (98.5%) of 67 patients treated with 1.5 g cefuroxime and 1 g probenecid and seen at least once after treatment, were cured. No side effects were reported. The high cure rates compared favourably with other antibiotics now in regular use and cefuroxime should be of great value especially for patients infected with beta-lactamase producing gonococci.


Clotrimazole (Canesten) in the treatment of candidal balanitis in men. With incidental observations on diabetic candidal balanoposthitis. Clotrimazole 1% (Canesten) cream was used in a trial comprising 138 men with candidal balanitis. Eighty-six (91%) out of 94 men were asymptomatic after seven days and 57 (98%) of 58 men were asymptomatic after three weeks' treatment. After seven days, Candida albicans could no longer be cultured from 86 (90%) of 96 men, nor from 55 (95%) of 58 men three weeks after treatment. Microscopical examination gave varying results. Fifteen (10.9%) of 138 men were found to have diabetes mellitus; this group was significantly older than the non-diabetics. It is concluded that treatment with clotrimazole for seven days is effective in the treatment of candidal balanitis.


Measuring the outcome of contact tracing. 1. A description of the patient and contact populations studied. A standard system for health workers to record and handle information on patients and contacts was introduced to five clinics. Information on all the patients interviewed during the first quarter of 1975 was collected and analysed. An analysis of the characteristics of these patients showed variation between the clinics. However, regardless of what was being measured, there were always differences between men and women. It was found that not all infected patients were interviewed about their contacts. Unless or until contact tracing includes all infected patients, the effect of contact tracing on the control of the sexually transmitted diseases will be of limited value and difficult to assess.


Measuring the outcome of contact tracing. 2. The responsibilities of the health worker and the outcome of contact investigations. The previous paper (Satin and Mills, 1978) concerned information on patients who were interviewed by health workers in five selected clinics; information on the contacts named by these patients was similarly analysed. This paper describes and evaluates the activities of the health workers and the outcome of contact investigations. At all stages of the contact tracing process, differences were observed between men and women. It was found that more than half of the male contacts and half the female contacts were known to have been examined. Of those contacts examined, at least two-thirds of them attended the same clinic as the patient who had named them, and 85% of these contacts were found to have a treatable condition. It will be seen that the concept of success or effectiveness of contact tracing is complex in definition and measurement.


A survey of attitudes of patients in a department of genitourinary medicine. A questionnaire concerning clinic organisation was completed by 415 patients attending a department of genitourinary medicine. Most (62.9%) patients preferred to be identified by number rather than by name, and about half (52.7%) did not like mixed waiting rooms. An appointment system as well as having an open clinic was liked by twice as many (44.9%) as those patients (23.6%) against such a system. More information about sexually transmitted diseases in the form of leaflets, etc. at the clinic was requested by most (79.1%) patients and a similar number (82.0%) felt the department itself should be more widely advertised.


Cellular and field potential properties of epileptogenic hippocampal slices. Epileptogenic activity was induced in hippocampal slices by addition of penicillin (2.0mM) to the bathing medium. Field potential epileptiform events were recorded and single cell bursts studied with intracellular electrodes. Epileptogenic activity was seen in areas CA1 and CA3 of the slice, with bursts in CA3 always leading CA1 bursts; a cut between CA1 and CA3 abolished spontaneous bursting in CA1 but not in CA3. Increased (Mg2+) and decreased (Ca2+) abolished epileptiform discharge, thus demonstrating its dependence on synaptic activity; burst occurrence was also sensitive to (K+). Measurements of single cell resting potentials, resistance, and time constant in CA1 cells revealed no difference between cells in normal medium and cells made epileptogenic by penicillin. Depolarization shifts in CA1 neurons during epileptogenesis did not behave like 'giant EPSPs' but rather were complexes to which depolarizing spike after-potentials, fast prepotentials, and underlying slow depolarizing events all contributed.


Experimental lead encephalopathy in the suckling rat: concentration of lead in cellular fractions enriched in brain capillaries. Five-day old rats subjected to short-term (2-day) lead exposure by gastric gavage of aqueous lead acetate at the highest non-lethal dosage (1mgPb/g body weight/day) developed a hemorrhagic encephalopathy. Capillaries and microvessels isolated from brains of these rats showed abnormal morphology consisting of an increased number of irregularly dispersed endothelial nuclei and swollen, vacuolated endothelial cells. Lead was concentrated in isolated brain capillary-microvessel fractions, as demonstrated by both atomic absorption and 210Pb tracer methods. When lead exposure was continued for 20 days (at the maximal dosage regime compatible with a 60% survival rate), the rats recovered from the initial encephalopathy and capillaries and microvessels isolated from brains of these rats appeared morphologically normal. This recovery occurred despite continued high levels of lead in the blood and in the isolated capillary-microvessel fractions, suggesting that, as capillary endothelial cells mature, they are able to adapt to the presence of large amounts of lead.


A quantitative electron microscope study of cerebellar axon terminals on the magnocellular red nucleus neurons in the cat. In the red nucleus (RN) of the cat, the bouton covering ratio (BCR: the ratio of whole somatic surface length and that covered with axon terminals) and the density of axon terminals in contact with somatic profiles (DAST: the number of axosomatic terminals per micron of somatic surface membrane) were calculated in each neuronal somatic profile over 60 micron in diameter. The mean BCR was 61.4 +/- 1.43 (S.E. M.)%. The mean DAST of axosomatic terminals filled with spherical synaptic vesicles (S-terminals) was 27.7 +/- 0.95, and that of terminals with pleomorphic and/or flattened vesicles (F-terminals) was 10.3 +/- 1.12. Subsequently, sequential changes of the BCR and DAST of intact terminals were examined in the RN deafferented from the cerebellorubral fibers. The mean BCR and DAST were decreased most markedly during the survival period of 4-7 days; thus decrease was chiefly due to degeneration of S-terminals (BCR: 16.7 +/- 1.17 %, DAST of S-terminals: 7.1 +/- 1.12, DAST of F-terminals: 5.8 +/- 1.22). In the RN 11-63 days after the operation, both the BCR and DAST tended to re-increase slightly and the majority of the re-increased terminals appeared to be F-terminals. Possible meanings of this re-increase of axosomatic terminals are discussed.


Electrophysiological and electron microscopic analysis of the vagus nerve of the pigeon, with particular reference to the cardiac innervation. The compound action potential components and their associated fiber contingents were investigated in the pigeon vagus nerve with a view toward identifying the vagal cardioinhibitory fibers. In the cervical vagus, the compound action potential evoked by electrical stimulation included four major components that conducted at 17.0-30.0 (A-wave), 8.0-14.5 (B2-wave) and 0.8-2.0 (C-wave) m/sec. Cardiac slowing was not elicited until activation of the Bl-wave, and the bradycardic response was maximal when this component was maximized. Electron microscopic analysis of the cervical vagus revealed myelinated fibers 1.1-6.8 micron in diameter and unmyelinated fibers 0.3-1.4 micron in diameter. A contingent of myelinated fibers approximately 2-4 micron in diameter apparently generated the Bl-wave, while the prominent unmyelinated fiber contingent (37%) accounted for the C-wave. Analysis of various vagal branches indicated that approximatley 20% of the cervical vagal fibers exit the main trunk between cervical and mid-thoracic levels, but few of these are the larger myelinated fibers greater than 2 micron in diameter. The upper abdominal vagus consists largely of unmyelinated and small myelinated fibers, and consequently the vast majority of larger myelinated fibers found in the cervical vagus exit between mid-thoracic and upper abdominal levels, presumably in the cardiac branches. Direct examination of the cardiac branches confirmed this. Thus, it is concluded that the Bl-wave of the compound action potential is uniquely associated with cardiac slowing, that this component is generated by myelinated fibers ranging from 2 to 4 micron in diameter, and that almost all such fibers are destined for the cardiac branches of the vagus.


Field potential and single unit analyses of the avian dorsal motor nucleus of the vagus and citeria for identifying vagal cardiac cells of origin. Field potentials evoked by mid-cervical vagal stimulation were systematically mapped in the dorsal motor and solitary nuclei of the pigeon. Since responses varied predictably with microelectrode position, they could be used for localization in the dorsal medulla. By varying stimulus intensity and monitoring the vagal compound action potential, contributions of the different compound action potential waves were then established. Activation of the Bl-wave, which includes cardioinhibitory fiber activity, has its most prominent effect in the intermediate rostrocaudal zone of the dorsal motor nucleus in the region of subnuxleus b. This is where the cells of origin of the vagal cardiac fibers have previously been anatomically localized. Single unit experiments then established that (a) vagal motoneurons with axonal conduction velocities in the cardioinhibitory fiber range (8.0-14.5 m/sec) are primarily localized to the intermediate rostrocaudal zone of the dorsal motor nucleus in the region of subnucleus b, and (b) motoneurons in this zone that conduct at 8.0-14.5 m/sec distribute their axons in the cardiac branches. Furthermore, no error is introduced by identifying such neurons with mid-cervical rather than midthoracic vagal stimulation. Thus, the following criteria establish a neuron as giving rise to a vagal cardioinhibitory fiber: (a) localizing it to the intermediate rostrocaudal zone of the dorsal motor nucleus on the basis of the field potential evoked by mid-cervical vagal stimulation; (b) antidromically activating it with mid-cervical vagal stimulation; and (c) demonstrating that its axon conducts at 8.8-14.5 m/sec.


Distribution of an alpha-bungarotoxin-binding cholinergic nicotinic receptor in rat brain. Cholinergic nicotinic receptors in rat brain were demonstrated by the use of the potent nicotinic antagonist [125I]alpha-bungarotoxin [125I]alpha-Btx). Biochemical studies on binding of [125I]alpha-Btx to rat hippocampal homogenates revealed saturable binding sites which are protected by nicotine, D-tuborcurarine and acetylcholine but not by atropine or oxotremorine. The hippocampus and hypothalamus displayed relatively high [125I]alpha-Btx specific binding whereas the cerebellum was devoid of specific binding. Other regions displayed intermediate binding levels. Analysis of the regional distribution of [125I]alpha-Btx binding by autoradiography of frontal brain sections revealed high labeling in the hippocampus, hypothalamic supraoptic, suprachiasmatic and periventricular nuclei, ventral lateral geniculate and the mesencephalic dorsal tegmental nucleus. It is suggested that the limbic forebrain and midbrain structures as well as sensory nuclei are the main nicotinic cholinoceptive structures in the brain.


Release of dopamine in both caudate nuclei and both substantia nigrae in response to unilateral stimulation of cerebellar nuclei in the cat. The effects of unilateral focal electrical stimulation of the deep cerebellar nuclei on the activity of the nigrostriatal dopaminergic neurons on both sides of the brain were examined in halothane anaesthetized cats. For this purpose, push-pull cannulae were inserted into both caudate nuclei and both substantia nigrae, and the release of [3H] dopamine ([3H]DA) continuously formed from [3,5-3H]L-tyrosine was estimated in superfusates. The unilateral electrical stimulation of the right cerebellar dentate nucleus induced a long-lasting increase in the release of [3H]DA in the left caudate nucleus and a simultaneous decrease in the release of [3H]transmitter in the right caudate nucleus. These changes were associated with opposite fluctuations in the release of [3H]DA from the corresponding substantia nigrae. Thus, the electrical stimulation of the right dentate nucleus induced a pronounced decrease in the release of the [3H]-amine in the [3H]transmitter in the corresponding substantia nigra, whereas the activity of the contralateral substantia nigra, whereas the release in the ipsilateral substantia nigra was simultaneously increased. In contrast, the unilateral electrical stimulation of the right cerebellar fastigial nucleus resulted only in an increased release of [3H]DA in the ipsilateral (right) caudate nucleus, associated with a decreased release of the [3H]transmitter in the corresponding substantia nigra, whereas the activity of the contralateral (left) dopaminergic system was not significantly affected. These results support a direct functional interaction between the cerebellum and the basal ganglia. They also suggest that the release of DA from dopaminergic axonal terminals is inversely correlated to the extent of the transmitter release from dendrites.


Survey of intracellular recording in the cochlear nucleus of the cat. Intracellular recordings were made in the cochlear nucleus of anesthetized cats. In anterior passes, one never obtained sustained depolarizations from 'primary-like' units. For 'chopper' units, however, it was possible to record sustained depolarizations accompaneid by spikes that lasted as long as the tone burst. 'Pauser, 'buildup' and 'on' units also had spike responses that could be accompanied by sustained depolarizations. For 'pauser', 'buildup' and 'on' units, hyperpolarization was not seen during the times when no spike discharges appeared so long as the tone bursts were at the characteristic frequency of the units.


Dual actions of some amino acids on spike discharges in the carp retina. The effects of some amino acids (Glu, Gly and GABA), applied in 3 different manners (electrophoretically, in the superfusate and by pressure-microinjection), were investigated on spontaneous and light-induced spike discharges in the isolated carp retina. When applied electrophoretically or by pressure-microinjection in the inner plexiform layer (IPL), the agents acted directly on spike-generating units. Electrophoretic application of Glu at IPL consistently increased while Gly and GABA always decreased spike discharges regardless of the light-induced response patterns, when the tangential distance between the recording and injection electrodes was 25--100 micron. Increasing the distance up to 400 micron diminished the effects, but did not invert them. When added to the superfusate, the amino acids produced a dual action (two different sequential effects); Glu (5 mM) initially decreased and increased spike discharges, while Gly and GABA (5 mM) produced opposite effects. Gly and GABA tended to suppress selectively off-discharges (of ON--OFF units and certain OFF-center units), leaving on-discharges (of ON--OFF units and certain ON-center units) unaffected. The amino acids produced different effects on some units, when applied by pressure-microinjection into OPL or IPL. When injected in OPL Glu suppressed, while in IPL it activated spike discharges, whereas Gly and GABA caused opposite changes to those observed with Glu. Therefore, the action of the agents when pressure-microinjected in OPL is equivalent to the initial action of the agents applied in the superfusate. The dual actions of the agents are assumed to be mediated by bipolar cells, resulting in disfacilitation (Glu) or in disinhibition (Gly or GABA) of spike-generating units.


An electrophysiological study on the cholinergic system in the carp retina. The effects on spike discharges of acetylcholine chloride (ACh), applied electrophoretically at the inner plexiform layer, were examined in air-exposed and superfused preparations of the isolated carp retina. Most of spike-generating units examined (147 of 204 units; 72%) were sensitive to electrophoretically applied ACh. Among the ACh-sensitive ones, 125 units (85%), including all ON-center, most ON-OFF and two-thirds of OFF-center units, were activated, whereas 22 units (15%), including mainly OFF-center units, were suppressed by the agent. In retinas superfused with a medium containing 20 mM M2+ and 0.5 mM Ca2+, units ceased in their spontaneous and light-induced discharges, but they were activated by electrophoretically applied ACh. The ACh-induced activation was reduced in magnitude or abolished during an exposure of the retina to a medium containing hexamethonium chloride (25 micrometer), whereas the ACh-induced suppression was reduced by atropine sulfate (25 micrometer) more effectively than by hexamethonium. Therefore, the results suggest that nicotinic receptors are involved in the ACh-activation, whereas both, but predominantly muscarinic, receptors may participate in the ACh-suppression of spike discharges in the carp retina.


Separation of cell types from the developing cerebellum. The heterogenous population of perikarya (cells) obtained by dissociating cerebellar tissue of developing postnatal rats was separated by sedimentation at unit gravity. Peak fractions, defined by monitoring the distribution of different size classes with a particle analyzer, were enriched in ultrastructurally well-preserved and metabolically competent specific cell types. These fractions included the peak of rapidly sedimenting cells comprising large neurones, such as Purkinje cells, which accounted for about 50% of the cells (vs. 2% in the initial cell suspension) and for a much greater proportion of the total cell mass (over 80%). More slowly sedimenting peak fractions contained 2-5-fold enrichments in replicating cells (assessed in terms of [3H]thymidine incorporation into DNA or by the frequency of mitotic cells), astroglia-like cells and external and differentiating granule cells, respectively. Separated, replicating cells continued synthesizing DNA in vitro; the [3H]thymidine incorporation rate was about 5-fold greater in the fraction enriched in proliferating cells than in the total cell suspension. Besides their structural integrity, the viability of the cells was also indicated by the finding that the proportion of trypan blue-excluding cells in all fractions exceeded 80%. Moreover, protein synthesis, in terms of incorporation of labelled amino acids, continued in the separated cells at a linear rate for a relatively long time. The rate per cell was highest in the large neuronal fraction, and lowest in the astroglia-like fraction.