[Experimental study of the immunotherapy of burns]. Experiments were conducted on rats. The influence of the serum of a burn convalescent on the toxic properties, the level of proteolytic enzymes activity, and morphological changes following burn were studied. After the burn the blood serum and the extracts of the organs acquired toxic properties; there was an increase in the activity of proteolytic enzymes, and marked morphological changes developed Administration of the serum of aburn convalescent promoted detoxication, diminished the activity of proteolytic enzymes distinctly, and decreased the morphological disturbances.


[Alteration of systemic hemodynamics in dogs with adrenal hypertension]. Arterial hypertension was reproduced in 20 dogs by suturing the adrenal glands with ligature. Arterial pressure showed a significant fall in 2 weeks; cardiac output diminished, and the general peripheral resistance displayed a sharp elevation. The phasic syndrome of hypodynamia, a reduction of the contractility index, of the volumetric rate of cardiac output, of the cardiac index, and of the rate of increase of the intraventricular pressure pointed to reduction  of the myocardial contractility. Three months after the suturing there was an even greater elevation of arterial pressure, and hemodynamic shifts were analogous to the two-week hypertension period.


[Relationship between the phospholipid metabolism of different portions of rat brain and the degree of circulatory disruption in them (following carotid artery ligation)]. Bilateral ligation of common carotid arteries in rats caused a considerable reduction of the blood supply and also a marked fall of phospholipids (PL) metabolism in the hemispheres; in the diencephalon and the midbrain it occurred to a lesser degree; there were no alterations in the blood supply or the PL metabolism in the medulla oblongata and the cerebellum. Dependence of the extent of depression of the PL metabolism on the degree of blood supply disturbances varied in different brain regions. Even 5 hours after the ligation of both carotid arteries there was no restoration of blood supply.


[Development of febrile and leukocytic responses in diabetic rabbits with aseptic inflammation]. Diabetic rabbits displayed a statistically significant reduction of the pyretic index in comparison with control. There was some delay in the development of leukocytic reaction, although no difference in leukocytosis was observed in the diabetic and control rabbits. Leukopenia, most pronounced in control animals 18 to 20 hours after the beginning of observation, was absent in some of the rabbits with diabetes. There were seen no significant differences in the intensity of leukocytic infiltration of the inflammatory focus in the diabetic and control rabbits. A diminished pyretic reaction during aseptic inflammation in rabbits with diabetes was apparently associated with the reduced capacity of leukocytes of the inflammatory focus to release pyrogens, determining the fever.


[Micro- and macroscale electrophoretic study of the constituent proteins of cerebral structures]. A comparative study of the protein composition of the brain structures of rats (premotor area of the cortex, the CA3 region of the hyppocampus, the caudate nucleus, the frontal area of the cerebellum) was carried out by the method of disc electrophoresis in the micro- and macroscale. Protein zones were identified by their relative electrophoretic mobility calculated according to the mobility of the "marker" protein (trypsin inhibitor from soya beans). Both methods revealed no significant differences in the composition of the electrophoretic separation of the brain proteins pointed to the greater resolving capacity of the micromethod.


[Energy potential of the cerebral cortex in the pre-agonal and post-resuscitation period after acute blood loss]. In experiments on dogs it was revealed that during the preagonal period, after a four-hour hypovolemic hypotension, the content of ATP was reduced in the gray matter of the brain by 38 percent, and of ADP and AMP increased by 121 percent and 875 percent, respectively. Reflecting these shifts the energy charge potential decreased from 0.931 to 0.733 (P less than 0.05). At the early and remote postrescucitation period the content of metabolites and of energy charge potential failed to differ from the initial level.


[Effect of disseminated necrotic heart lesions on incorporation of radioactive precursors into the RNA of the inner membranes of rat myocardial mitochondria]. The authors studied the role played by the internal membranes of the myocardial mitochondria of rats as the site of radioactive precursors incorporation into the mitochondrial RNA. As revealed, kinetics of the changes of the specific RNA activity of the internal membranes of the myocardial mitochondrial in vivo and in vitro differed. Necrosis of the myocardium induced both in vivo and in vitro significant changes in the specific activity of the RNA of the mitochondrial membranes.


[Effect of short-term microcirculatory disorders on indices of myocardial energy metabolism]. Disturbance of the microcirculation produced by the combined injection of the high molecular weight dextran and vasopressin led as soon as the first minutes (5 min) to the intensification of glycolysis. This was testified to by the reduction of glycogen concentration by 19.4 percent, elevation of the phosphorylase "A" activity by 30-36 percent and of the pyruvic acid by 36.9 percent. The ATP, ADP, AMP, and the KP concentration remained unchanged. The observed glycolysis changes can be regarded as the initial metabolic reactions resulting from hypoxia originating in microcirculation disturbances.


[Biophysics of thermal lesions].

[Biophysics of thermal lesions]. Experiments on rats showed that thermal irradiation caused a more marked elevation of subcutaneous temperature at the area of the skin separated from the underlying tissues by a felt plate than at the skin area separated from the surrounding and underlying tissues and immediately sutured to its place or the area of the uninjured skin. The authors believe that the data obtained indicated that the blood flow played no significant role in leading the heat from the skin in the action of the radial heat on it. Of much greater significance is the capacity of the underlying tissues to lead off and to accumulate heat.


[Effect of psychotropic substances on orienting-exploratory behavior after startling caused by acoustic stimulation]. Frightening sound stimulation induced alarm and alertness which resulted in weakening of attention to novel environment and increasing of orienting response to the source of the frightening sound. Defense motivation occurring under these conditions failed to alter with the increase of sound loudness. Tranquilizers (diazepam, chlordiazepoxide, benatyzine), antidepressants (amytriptiline, imipramine) and some neuroleptics (trifluoperazine, haloperidol) in a low doze prevented these disturbances. High doses of pentobarbital, chlorpromazine, as well as trifluoperazine and haloperidol did not prevent the mentioned consequences of emotional excitation.


[Opsonins and erythrophagocytosis].

[Opsonins and erythrophagocytosis]. The author studied the capacity of granulocytes and reticular cells of rat bone marrow to phagocytize mouse red blood cells in the action of opsonins against them. A comparative assessment of phagocytosis of fresh and formaldehyde-treated mouse red blood cells was conducted. A moderate phagocytosis observed with the use of fresh erythrocytes and immune noninactivated rat serum was less pronounced when inactivated serum was used. No phagocytosis occurred with rat nonimmune serum. On the contrary, when formaldehyde-treated erythrocytes were used with the same sera phagocytosis was much stronger.


[Modeling experimental pollinosis].

[Modeling experimental pollinosis]. Experimental pollinosis was modelled on guinea pigs. The animals were placed in a cell in which an allergen-water-dialyzed extract of ambrosia pollen was dispersed by means of coaxial pulveriser. Homocytotropic antibodies serving as indices of animal sensitization to the specific allergen formed in guinea pigs as a result of aerosol sensitization. Sensitization of the animals to the ambrosia allergen was accompanied by an increase of sensitivity of the broncho-pulmonary apparatus and was characterized by the bronchospastic reaction in resolving inhalation or inrtavenous injection of a specific allergen.


[Cytostatic effect of cyclophosphane on esophageal tumors and epithelium of mice]. Investigation of cytostatic activity of cyclophosphamide in sarcoma 37 and esophagus epithelium in albino mice with respect to the diurnal rhythm of mitotic activity and the number of labeled nuclei was performed. Apparently the tumour cells in the G1-phase and at the beginning of the S-phase of the mitotic cycle were the most sensitive to the inhibitory effect of this drug. During the completion of the DNA-synthesis period the cell resistance to the action of the cytostatic increased. Cells at the G1-phase of the mitotic cycle were sensitive to the inhibitory action of cyclophosphane in the esophageal epithelium.


[Effect of sarcolysine on glutathione peroxidase and glutathione reductase activity in sarcoma C-45]. A drop of glutathione peroxidase and glutathione reductase activity was revealed in sarcoma C-45 at the period of its most intensive growth. Repeated sarcolysine injections (1.2 mg/kg, intraperitoneally) caused a sharp fall in the activity of both enzymes with a simultaneous reduction of the ratio of glutathione reductase and glutathione peroxidase activities. The important role of the glutathione enzyme redox system in the realization of antitumour action of the chemotherapeutic drugs is supposed.


[Age and biorhythms of the histophysiologic indices of the thyroid gland]. Rhythmic changes of several histophysiological parameters of the thyroid gland was studied in 144 A/He mice of three age groups: young immature, mature adults and ageing animals. The multicomponent nature of the rhythmic changes was found for each index; it included the circadian component, as well as infradian oscillations. The leading role of the circadian component in the establishment of the biorhythms of the organ functioning was shown, whereas ontogenetic changes were chiefly associated with the ultradian components' attenuation.


[Effect of nociceptive stimulation on the mitotic activity of cutaneous epithelial cells surrounding a wound at different age periods]. Wounds, 1 cm in length, reaching the cutaneous muscle were inflicted to rats, aged 11 days, 2 and 2 1/2 months, under the right scapula. In 48 hours the animals were subjected to pain irritation with electric current. Mitotic activity was determined in the cells of the basal layer of cutaneous epithelium. Pain stimulation decreased the mitotic index of the cutaneous epithelium cells in animals of all the age groups under study considerably (several times). There was an increase of mitotic index from the early to later periods of postnatal ontogenesis.


[Patterns in the structural homeostasis of cardiomyocytes]. Results of quantitative analysis of the ultrastructura organization (UO) of animal (rabbit, rat, dog) and human cardiomyocytes carried out by means of the point method are presented. A number of stereometric constants which provide structural cardiomyocyte homeostasis (SCH) were revealed: the sum total mitochondrial (MT) and myofibril (MF) volume is a constant value- a "cardiomyocytic constant" (Vmt + Vmf=Kcm); the total growth of MT and MF volumes in different functional states is equal to "0" (dVmt + dVmf=0); adaptational MT and MF rearrangement takes place during an interval of 11% of the volume (deltaVmt=deltaVmf=11 percent; the SCH is maintained by the changes of the UO within the limits of the law of "constancy of volume interrelations" (80; 10; 10), according to which 80 percent of the volume falls on Kcm, 10 percent of the remaining organellae and cell inclusions (Vi) and 10 percent on the plasma cell (Vpl). The assumption on a possibility of universality of the stereometric constants is suggested.


[Effect of Kupffer cell blockade at different periods following partial hepatectomy on regeneration of hepatocytes]. In male Wistar rats, weighing 140-160 g, the block of the liver mononuclear phagocyte system (MPS) was carried out by means of "carbonyl iron" (type R-100F, particle size 1-1.5 micron). It was induced 2 hours before or 3 and 18 hours after partial hepatectomy. Iron injection previously or at the early prereplicative regeneration period led to a significant delay of the hepatocyte nucleus labeling and mitotic indices peaks against the background of an overall depression of hepatocyte proliferation. The MPS block during the intensive DNA synthesis by regenerating liver hepatocytes was less effective. The facts testify to the importance of Kupffer's cells in the regulation of the reparative liver regeneration.


[DNA synthesis in connective tissue elements of regenerating skin under the influence of thyrocalcitonin and hypoxia]. The influence of TCT on the proliferation activity of the connective tissue elements of the regenerating skin in normal and lowered partial oxygen tension was studied by means of H3-thymidin autoradiography. Continuous saturation of the organism with exogenous TCT is characterized by an increase in the count of cells during the S-period of mitotic cycle, the DNA synthesis intensification, and a considerable decrease in the number of silver grains over the nuclei in the course of the 24-hour observation period; this can testify to the acceleration of the cell passage of mitotic cycle stages in normal and low partial oxygen tension in hypoxia.


[Significance of the statistical characteristics of the sinus rhythm of the heart]. Statistical analysis of prolonged continuous recordings of the ECG RR intervals was carried out in 64 patients with purulent surgical infection. The following indices were considered: the mean value of the RR intervals, the mean quadratic deviation (delta), the variation amplitude, the 1st and the 3rd correlation coefficients, the excess, asymmetry, the RR/delta ratio. Besides, the size and the shape of the autoregression could was analyzed. Statistically significant differences of the RR/delta ratio, of the mean quadratic deviation, and of the variation amplitude were revealed in 3 groups of patients differing by the severity of condition. These differences were reflected in the size and shape of the autoregression cloud. The results obtained suggest that statistical characteristics of prolonged recordings of the cardiac rhythm could be used for objective assessment of the severity of the patient's condition and of the therapeutic effect in the patients with a purulent surgical infection.


[Determination of the inequality of ventilation by the helium mixing time in a spirograph--lung system]. The dependence of the time of He mixing in the lung-spyrograph system upon the factors influencing its value was taken into consideration. Cases of equal lung ventilation of the lungs were graphically illustrated; the "ideal" mixing time was determined with the aid of these diagrams. It is suggested that the inequality of the lung ventilation can be judged by the value by which the mixing time obtained in the examination of the patient's respiration exceeded the "ideal" one found by the diagram in the same patient.


[Methods of determining renin activity in individual renal glomeruli and their fragments]. The author suggests a modification of the method for determination of renin activity in a single glomerulus and its fragments, based on the use of cold EDTA-treated plasma of nephrectomized animals as renin substrate source, instead of a complicated method of substrate obtaining from plasma. The renin bioassay method was somewhat simplified. All the procedures were conducted with the use of home-produced equipment. The principle of this modification can be used for clinical purposes.


[The human pineal gland. Study performed on 747 glands]. The study of 747 human pineal glands shows that the weight of this organ is extremely variable. This weight shows seasonal variations. The weight of the pineal is identical in cancerous and non cancerous patients. It is lower (the difference being statistically highly significative) in a great majority of hepatic diseases. Microscopic study of 54 of these pineal glands (those obtained 2 to 6 hours after death) shows that the pineal concretions may have a variable origin: the vessel walls, the interlobular connective tissue, and certain pinealocytes that can then be colored by alcian blue.


[Interspecies study of statistical correlations existing between the pineal gland size and weight and brain and body weight in two groups of mammals. Interspecies study of correlations between the pineal gland and brain in the rat and in man]. Network analysis procedures have been applied to study the cell patterns on the dorso medial and ventral lateral formation of the inferior colliculus of different species, i-e: Cat, Tat and Monkey. The results suggests the existence of important interspecific differences, more particularly in the primates. These differences are more obvious in the dorso medial formation. The functionnal implications of these results are discussed.


[Interkinetic migration of the auditory placode in the chick embryo]. Interkinetic nuclear migration was studied in cells forming the auditory placode of chick embryos with thymidine H3 and autoradiography. Our results show, that the nuclei in the auditory placode, synthesize D.N.A. in the outer zone, then migrate toward the inner zone to undergo division and subsequently return to the outer zone.


[Typology of the cells of the bulbopontine reticular formation]. The network analysis methods have been applied to study the neurons of the medial bulbo pontine reticular formation in the cat. The bifurcation ratio allows isolation of two different cellular patterns: collateral branched cells or CB type, and at random pendant vertices dichotomously branched cells or DA type. The morphologic features of CB cells lead to the assumption that these cells have an integrative function. The topographic distribution of the two cells types seems to vary in the different parts of the reticular formation and should argue for the fact that the reticular formation represents an aggregation of several discrete anatomical units.


[Scanning electron microscope study of the secondary palate during embryonic formation in the rat]. Normal fetuses 14 to 17 days old were obtained from female Wistar rats. The palates have been studied, after dissection, by scanning electron microscopy. Palatal closure is achieved, in the median and posterior region, by the elevation of the lateral palatine processus from a ventro-medial to a horizontal position; immediately after the horizontalization, they adhere to each other. Rostrally naso-palatine canal closure takes place later; it results from an epithelial and mesenchymal outgrowth under the nasal septum. The mutual adhesivity of the free edges of the lateral processes is noticeable. The pattern of the fusion surface has been considered, elements such as exfoliated cells, filopodes and microvilli are present. Their contribution to the adherence phenomenon is discussed.


[Palatine clefts following puncture of the amniotic sac in the rat]. 1) Amniotic sac puncture is a reliable procedure for induction of a cleft palate in rat foetuses 15 days old. 2) This possibility persists during the first hours of day 16. 3) When applied to rats after 16 days 12 hours of pregnancy, amniocentesis does't induce a cleft palate. 4) Treatment during this critical stage of pregnancy with substances able to reduce the amniotic fluid volume, such as acetazolamide and hydrocortisone, doesn't produce cleft palate.


[Conditions affecting the application of the method of determining blood volume by the injection of labeled (iodine 131) serum albumin to small animals (chick embryo)]. The isotopic dilution method is really suitable for the determination of blood volume in small animals. The main purpose of this study is to find the limits of measuring errors made during the injection procedures (injected volumes about one microliter) and the sampling of blood (blood samples less than one milliliter). After evaluation of the extravascular rate of diffusion of the radioactive iodinated human serum-albumin, the blood volume of the 17 days incubated chick embryo is measured by this method for control purposes.


Stereospecificity in toxicity of the optical isomers of EPN. While the optical isomers of EPN were equally toxic to mice, (+)-EPN was 2.9 fold and 4.0 fold more toxic to houseflies and rice stem borer larvae, respectively, than the (-)-isomer. In addition, (-)-EPN produced paralysis of the legs in hens about 10 to 14 days after dosing, whereas (+)-EPN caused no paralytic effects. Thus, (+)-EPN appears to be a more appropriate insecticide than the racemic compound, since it combines high toxicity to insects and no delayed neruotoxicity in hens.


Influence of a pulp and paper mill effluent on aspects of distribution, survival and feeding of Nipigon Bay, Lake Superior, larval fish. Surface distribution of Nipigon Bay larval fish was characterized by high abundance, between 500 and 2100 larval fish/10,000 m3 near shore, particularly in proximity to the pulp and paper mill effluent discharge, and low abundance, less than 100/10,000 m3 away from shore. Static bioassay indicated that approximately 60% effluent concentration was intolerable to the natural mixed larval fish community. No wood fibre was found among stomach contents and no difference was apparent in stomach contents of fish caught in influenced and uninfluenced areas. Data therefore suggest that larval fish either were not greatly influenced by plume conditions or were transients.


Effect of dieldrin on the stability of lysosomes in the rat liver. The effect of dieldrin on the bound and free activity of cathepsin, acid ribonuclease, acid phosphatase and aryl sulphatase has been investigated. Administration of dieldrin increased the activity of free cathepsin, acid ribonuclease, and acid phosphatase in rat liver whereas it did not affect the activity of aryl sulphatase. This indicates that dieldrin labilizes the lysosomes.


A rib-containing free flap to reconstruct mandibular defects. A composite free flap based on intercostal vessels may be used to reconstruct in one stage defects around the mandible in which skin, soft tissue and bone are missing. A delay procedure is recommended one week prior to transfer.


Bizarre implants for augmentation mammaplasty: long term human reaction to polyethylene strips. Two patients are described where a mass of polyethylene strips had been used for augmentation mammaplasty. The reaction to this plastic was different in each case.


The versatile palatal island flap: its use in soft palate reconstruction and nasopharyngeal and choanal atresia. The mucoperiosteal island flap, first designed to provide nasal lining during pushback lengthening of a short cleft palate, has been used to assist in reconstruction of large soft palate defects following resection for cancer, to create and maintain patency of the velopharyngeal aperture after stenosis and to maintain patency of the nasal airway after resection of bony choanal atresia.


A presynaptic site of action within the mesencephalic reticular formation for (+)-amphetamine-induced electrocortical desynchronization. 1. Changes induced in the electrocorticogram by the bilateral perfusion of (+)-amphetamine into the mesencephalic reticular formation (MRF) have been studied in cat encéphale isolé preparations. 2. (+)-Amphetamine, applied for 5 min in the MRF, mimicked the electrocortical desynchronization induced by the perfusion of (-)-noradrenaline (NA) or (-)-alpha-methylnoradrenaline (AMNA) into the same sites. 3. Perfusion of 6-hydroxydopamine (6-OHDA) also induced desynchronization but, over the 1 h perfusion period, slow wave activity gradually returned to the electrical record. 4. Following the application of 6-OHDA the effect of (+)-amphetamine was abolished or significantly attenuated, whereas the effect of NA or AMNA was not affected. 5. The electrocortical desynchronization induced by (+)-amphetamine could be restored if its application was preceded by perfusion with NA or AMNA. 6. Fluorescence studies using AMNA indicated that 6-OHDA depleted noradrenergic nerve terminals near the cannulae tips. However, the terminals were still capable of taking up exogenously applied AMNA. 7. These results suggest that (+)-amphetamine has a presynaptic action on noradrenergic nerve terminals within the MRF.


The mode of action of tetrabenazine on peripheral noradrenergic nerves. 1. Tetrabenazine (100 mg/kg i.p. in rats) greatly decreased catecholamine-induced histofluorescence in the iris, hepatic portal vein, inferior vena cava and mesenteric blood vessels 4 h after injection. Fluorescence returned to normal by 24 h after injection. 2. The extent of this depletion (4 h after tetrabenazine) was similar to that seen 18 h after reserpine (0.5 mg/kg i.p.). 3. Incubation of tissues taken from rats 4 h after this dose of tetrabenazine with noradrenaline 5 X 10(-6)M restored the intraneuronal fluorescence as well as the electron density of noradrenergic vesicle cores viewed with the electron microscope. No such repletion was seen on incubation of tissues from reserpine-treated rats with noradrenaline under the same conditions. 4. Incubation of tetrabenazine-treated hepatic portal veins with noradrenaline also reinstated the normal response to electrical stimulation of the intramural nerves. This did not occur with reserpine-treated veins. 5. The interpretation that tetrabenazine exerts a reversible depleting effect on the noradrenergic vesicle is supported by the demonstration that it exerts no monoamine oxidase inhibiton.


Comparative evaluation of the in vitro effects of hydralazine and hydralazine acetonide on arterial smooth muscle. 1. Dose-response relationships to K+ were determined in isolated strips of rabbit aorta. 2. K+ contractures were induced by 30 mM K+ in paired strips from individual animals. The effects of hydralazine and hydralazine acetone hydrazone (hydralazine acetonide) on these contractures were studied. 3. Hydralazine and hydralazine acetonide both produced dose-dependent decreases of K+-induced tone. Threshold concentrations for hydralazine were 11.89 +/- 4.5 X 10(-5) M (mean +/- s.d.) and for hydralazine actonide 9.7 +/- 4.6 X 10(-5) M (0.5 less than P less than 0.4). 4. The magnitude of the effect of hydralazine acetonide was greater than that of hydralazine at all concentrations above threshold, as reflected in a significant difference (P less than 0.05) in the slopes of dose-response curves to the two treatments. The vasodilator effects of hydralazine and the acetonide were terminated by washout of the bath. 5. The differences in effect were not due to instability of hydralazine under in vitro conditions. 6. It is concluded that hydralazine acetonide has intrinsic activity on vascular smooth muscle which differs significantly from that of the parent compound and that this may contribute to the hypotensive effects which follow administration of the parent compound.


BRL 13776: a novel antihypertensive agent with interesting monoamine depleting properties. 1. Oral doses of 10-100 mg/kg of BRL 13776 lowered the blood pressure of both deoxycorticosterone acetate (DOCA)/NaCl-treated hypertensive rats and untreated normotensive rats. 2. BRL 13776 (100 mg/kg, orally) also reduced the blood pressure of renal hypertensive cats (cellophane perinephritis model). 3. No tolerance developed to the blood-pressure lowering action of BRL 13776 when an oral daily dose of 100 mg/kg was administered repeatedly for up to 15 days to hypertensive rats and cats. 4. The fall in blood pressure to BRL 13776 in rats was associated with a reduction of tissue catecholamines. 5. The catecholamine depletion occurred in all the peripheral tissues examined but in the brain was restricted to certain regions, these being the hind-brain on single dosing and the hind-brain, hypothalamus and mid-brain on repeated dosing. Catecholamine levels in the cerebral hemispheres were not affected by either single or repeated doses of BRL 13776. 6. BRL 13776 caused some reduction of the 5-hydroxytryptamine content of the heart but not of whole brain or any brain region. 7. Neither single doses (up to 900 mg/kg orally) nor repeated doses (100-300 mg/kg orally) of BRL 13776 produced any significant behavioural effects in animals. 8. BRL 13776 is a new type of agent to display both antihypertensive and monoamine-depleting properties. The reduction of noradrenaline in certain brain regions may be a cause of the antihypertensive response but depletion in the periphery could contribute in a major or minor way. The differential action on noradrenaline in the brain together with the lack of effect on 5-hydroxytryptamine might also explain the apparent absence of behavioural effects.


Circulatory effects of prostaglandin endoperoxide analogues studied in the dog during left ventricular bypass. 1. Intravenous administration of both the 9alpha,11alpha-(epoxymethano) and 11alpha,9alpha-(epoxymethano) analogues of prostaglandin H2 (0.25 microgram/kg) produced a prominent rise in pulmonary arterial pressure and a moderate increase in systemic arterial pressure. 2. Direct administration of the endoperoxide analogues (1.25 microgram/kg) into the bypass reservoir produced a greater rise in systemic arterial pressure and less prominent rise in pulmonary arterial pressure. 3. An intravenous dose of prostaglandin F2alpha that was 20 times larger was needed to produce a comparable rise in pulmonary arterial pressure. 4. The pulmonary and systemic pressor responses produced by the endoperoxide analogues were due to a direct increase in the vascular resistance.


Enkephalins and dorsal horn neurones of the cat: effects on responses to noxious and innocuous skin stimuli. 1. In spinal cats anaesthetized with alpha-chloralose, a study was made of the effects of methionine enkephalin and methionine enkephalin amide on the responses of neurones of spinal laminae IV and V to noxious and innocuous skin stimuli. The enkephalins were ejected from micropipettes either in the region of cell bodies or in the substantia gelatinosa. 2. Administered near cell bodies the enkephalins reduced spontaneous firing and cell responses to both types of skin stimuli. These effects were antagonized by naloxone when administered near cell bodies but not when given intravenously in doses (0.3-0.6 mg/kg) more than adequate to antagonize analgesic doses of morphine. 3. Administered in the substantia gelatinosa the enkephalins were more selective in their action. The predominant effect was a reduction in nociceptive responses with little effect on non-nociceptive responses although spontaneous firing was commonly reduced. Naloxone administered either in the substantia gelatinosa or intravenously (0.1-0.3 mg/kg) reversed these effects of the enkephalins.


Transient changes in plasma digoxin concentration and the development of cardiotoxicity. 1. Eight dogs were given two infusions of digoxin 0.1 mg/kg, one over 9 min and the other one over 90 min in a randomized sequence, allowing at least 12 days between each experiment. 2. Digoxin plasma profiles reflected the rate of digoxin infusion, the peak concentration of drug attained at the end of each infusion being considerably higher but more transient after the 9 min than after the 90 min transfusion. 3. Digoxin reduced the amount of acetylstrophanthidin required to produce electrocardiographic evidence of cardiotoxicity. This increase in cardiac sensitivity at 150 and at 360 min after the start of the digoxin infusion was independent of rate of infusion. 4. These results suggest that the development of cardiotoxicity is dependent upon the quantity of digoxin delivered into the systemic circulation regardless of the plasma concentration. 5. By inference, cardiotoxicity is related solely to the amount and not the rate of absorption from a given dose of digoxin.


Comparison of the discriminative stimulus properties of cocaine and amphetamine in rats. 1. Water-deprived rats were trained to press either the left or the right bar in a test chamber according to whether they were injected with a central nervous system stimulant or 0.9% w/v NaCl solution (saline). Correct responses were reinforced with water. 2. Different groups of rats learned to discriminate amphetamine or cocaine from saline. Dose-response curves and ED50 values were then determined in brief test sessions when no responses were reinforced. 3. In a crossover study, cocaine was tested in the rats trained to discriminate amphetamine from saline, and vice versa. The two drugs were largely interchangeable, but the ED50 values were increased, indicating a possible, subtle difference in their discriminative stimulus properties. 4. The results indicate the importance of complete crossover designs in combination with dose response determinations when attempting to classify drugs according to their discriminable properties.


The effect of uptake by adrenergic nerve terminals on the sensitivity of arterial vessels to topically applied noradrenaline. 1. Direct observations were made of the rat mesenteric vasculature in vivo. They showed a gradual increase in the sensitivity to topically applied noradrenaline from the larger arteries to the precapillary arterioles which was paralleled by a gradual decrease in the density of the adrenergic innervation. 2. Both cocaine and chronic denervation increased the sensitivity to noradrenaline of the innervated arterial vessels, approximately in proportion to the density to their innervation. They did not affect the sensitivity of the non-innervated precapillary arterioles. 3. It is concluded that the sensitivity gradient to topically applied noradrenaline results mainly from the uptake of the applied catecholamine by the perivascular nerve terminals.


Histamine H2-receptors in the brain and sleep produced by clonidine. Sleep was induced in chicks aged 4-7 days by intravenous injection of clonidine hydrochloride 0.04 mumol/kg. Sleep was not prevented or altered by a preceding intramuscular injection of blockers of histamine H2-receptors which were used in doses (as mumol/kg) of up to 800 (metiamide) and 2400 (cimetidine). Clonidine, therefore, does not cause sleep by stimulating H2-receptors in the brain. The highest dose of cimetidine used had a hypnotic action of its own.


Motor neurone disease and multiple sclerosis among immigrants to Britain. Hospital discharge rates for various immigrant groups resident in Greater London and the West Midlands were studied to compare the incidence of two diseases of the nervous system-motor neurone disease (MND) and multiple sclerosis (MS). For both these conditions immigrants from Europe, Ireland, America and from the old commonwealth countries of Canada, Australia, and New Zealand had discharge rates that were similar to those for people born in the United Kingdom. In contrast, immigrants from the new commonwealth countries of Asia, Africa, America (including the West Indies), and Europe (Gibraltar, Malta, and Gozo) had a greatly reduced risk of MS but a very similar risk of MND compared with those born in the United Kingdom. MS but not MND was rare among immigrants of Asian or African ethnic origin and uncommon among immigrants from the West Indies. Deaths attributed to MS and MND have also been studied. During a three-year period there were no deaths reported for MS among immigrants of Asian and African ethnic origin and 14 were expected. There were two deaths from MND among these immigrants and five were expected. Among the immigrants from the West Indies two deaths were attributed to MS and 13 were expected, and there were three deaths attributed to MND and four were expected. The contrast between MND and MS in hospital morbidity and mortality confirms that MS among immigrants to Britain is rare in those of Asian and African ethnic origin.


A case control study of carcinoma of the ovary. There is increased concern over the apparent rise in incidence of patients with carcinoma of the ovary, particularly in older women. In an attempt to identify aetiological factors 300 women with cancer of the ovary diagnosed at laparatomy were studied. A questionnaire was administered to these women (Group A) and to two control groups matched by age. The first control group (Group B) comprised patients in a gynaecological ward and the second (Group C) comprised were shown in the obstetric history of the three groups. Fewer of the women in Group A had married and fewer had ever been pregnant and the family size was smaller. Significantly fewer of them recollected an attack of mumps, measles, or rubella. In all, only 81 of the whole series of 900 had used oral contraceptives, 19 of Group A and 31 in each of the control groups, a statistically significant deficiency. These findings support those of other investigations and suggest lines of further inquiry.


Defects of the central nervous system in Finland: I. Variations in time and space, sex distribution, and parental age. Data from the Finnish Register of Congenital Malformations for the years 1965-73 were used in a search for associations between environmental influences and defects of the central nervous system (CNS). The material consisted of 710 cases of CNS defects and their matched-pair controls. Moreover, and 'internal' control group of 259 cases of polydactyly and their matched-pair controls were used. The first report gives information on variations in time and space, sex distribution, and parental age. A higher incidence of anencephaly was noted in the eastern part of the country, but no significant secular or seasonal variations were found. The sex ratio (M/F) was lower than expected in the groups of anencephaly and CNS defects as a whole. High parental age turned out to be a risk factor in the group of all CNS defects, mainly owing to the subgroup of hydrocephaly. The dangers of observational studies due to confounding factors are discussed.


Suicide mortality in Greater London: changes during the past 25 years. Suicide mortality in the area now administered by the Greater London Council was assessed for three five-year periods 1949-1953, 1959-63, and 1969-73. For each of the periods the standard mortality ratio (SMR) for suicide in various boroughs was calculated for men and women separately. The boroughs with high SMRs for men were constant. There was a pronounced change in the geographical distribution of high mortality among women. These findings support the hypothesis that the determinants of suicide differ between the sexes.


Mortality and the concentration of elements in tap water in county boroughs in England and Wales. To explain the associations of water hardness and air temperature with area differences in ischaemic heart disease mortality, samples of tap water were obtained from homes in 61 county boroughs in England and Wales, and the concentration of calcium and 12 other elements was estimated. Multiple regressions were calculated with the death rates from various causes as dependent variables and with the concentration of the elements in the tap water, mean annual temperature, mean annual rainfall, and a socioeconomic index as independent variables. The well known negative association between water hardness and ischaemic heart disease was shown to be due to calcium, and none of 12 other elements examined appeared to contribute significantly to the association. Area differences in other causes of death also showed an association with calcium. There was little association between temperature and ischaemic heart disease.


Housing conditions, respiratory illness, and lung function in children in South Wales. The hypothesis was tested that respiratory illness in children occurs more commonly in old housing than in housing built to modern standards. Three areas of housing were chosen in a South Wales valley: a recently constructed council estate with district central heating; a modern council estate heated with open coal fires; and an area of much older, traditional valley housing. Mothers reported the greatest proportion of children free of colds and sore throats during the previous 12 months in the area of traditional valley housing; mothers of children in the centrally heated estate reported the least proportion of children free of colds. Children's lung function was best in the area of traditional valley housing and worst in the centrally heated council estate. Data on demographic indices and respiratory morbidity suggest that the inhabitants of the two council estates have comparable characteristics. Another hypothesis which may explain the findings is proposed.


Marital status and hospital use.

Marital status and hospital use. Published data from the Hospital In-Patient Enquiry (1973) are used to examine the relationship between hospital use and marital state. Non-married men and women are shown to have higher discharge rates and longer mean durations of stay than married patients in the corresponding age groups, and to account, on average, for about 24 000 additional beds each day in non-psychiatric hospitals. Hospital Activity Analysis data from one region suggest that the higher rates of bed use by non-married patients as a whole are maintained for both single and widowed patients separately, and the differences are also observed in all types of non-psychiatric hospitals. Two possible modes of explanation are discussed: that the incidence and possibly the severity of conditions that are normally treated in hospital may be differentially distributed among marital status groups; and that non-clinical factors in decisions about admission and discharge may be associated more commonly with non-married than married patients. The results carry no normative implications for the uses to which hospital resources should be put.


Social area analysis in community medicine. There is an acknowledged need for better information to guide resource allocation and service planning in the health services. Despite the recognition of the important role of socioeconomic factors, difficulties with the appropriate presentation of daya have so far proved insuperable. Social area analysis (SAA), which is a generic name for a number of methods employing census and other data to classify small areas into similar socioeconomic groups, is an approach which quantifies data in a useful fashion and has important applications in medical, epidemiological and health services research. Most previous British exercises in SAA have been in the field of town planning. The potentialities of the approach for community medicine are evaluated, by the use of information from two existing studies. This is shown to discriminate more effectively than does existing health information between hypotheses concerning geographical variations in mortality, and it provides adequate explanations for urban area differentials in infant mortality, the uptake of vaccination, and the incidence of infectious disease. Specific applications of SAA in health planning and research are discussed.


Peripheral outpatient clinics: use, costs, and benefits. A census was taken of outpatient bookings at all hospitals and health centres in Oxfordshire for the main medical and surgical specialities. Nine per cent of all bookings were to peripheral clinics (that is, those outsie the two main medical centres at Oxford and Banbury). About half of all bookings in the area were made to clinics within three of four miles of the patients' homes. The work load at peripheral clinics was mainly local: 75% of all patients at these clinics lived in the town or parishes adjacent to the town where the clinic was held. Peripheral clinics were associated with a lower work load at central clinics, but a higher overall work load from the town in which they were sited.


Evaluation of patients' assessment of day hospital care. The method of linear analogue self-assessment (LASA) was used to quantify the views concerning day care which were held by patients attending a geriatric day hospital. The results suggest that day hospitals are an acceptable form of care for the elderly.


Handedness in psychiatric patients.

Handedness in psychiatric patients. Eight hundred psychiatric patients and eight hundred controls completed a handedness preference questionnaire. There was no significant difference in handedness between the two samples, but, contrary to some previous reports, excess of sinistrality was not associated with male sex. The distribution of handedness was similar in neurotics and controls, but among psychotics in general there was a higher proportion of fully right-handed subjects. Among schizophrenics there was a significantly higher proportion of left-handed writers among males than females. There were relatively few left-handed writers of either sex among patients with affective psychosis. Female patients with personality disorders had a significantly higher proportion of mixed handedness than controls. The findings are considered in relation to suggestions that functional psychoses may be associated with asymmetrical cerebral dysfunction, and that poorly lateralized function may be related to anomalous psychological development.


Effects of lithium salts on memory.

Effects of lithium salts on memory. Thirteen patients diagnosed as having affective disorders, and who were taking lithium, were compared with drug-free controls on short-term and long-term memory tasks. There was some indication that patients on lithium may show an impairment of short-term memory at fifteen-second delay intervals, and possibly enhanced long-term recall of difficult material. Further comparison with results obtained from six patients on tricyclic antidepressants seemed to reduce the possibility that the lithium group's scores were a function of their psychiatric status. As the group sizes were small, all the findings need to be replicated.


XYY males. Some clinical and psychiatric aspects deriving from a survey of 1,811 males in hospitals for the mentally handicapped. A survey of 1,811 mentally handicapped males in eighteen hospitals is described. Males discovered with supernumerary Y chromosomes numbered 15, of whom 12 were 47,XYY. Some of the physical, social, psychological and psychiatric findings are described and compared with groups matched for IQ and height. The main psychiatric findings are diminished intelligence, retardation in development of secondary sexual characteristics, and poor emotional control leading to inadequate social adaptive patters which are described and discussed.


Genetical analysis of unipolar and bipolar endogenous affective psychoses. The mode of inheritance of affective psychoses was studied in 800 first degree and 582 second degree relatives of 122 probands. Morbidity risk for unipolar depression was 12.0+/-3.2 and 11.4+/-2.7 per cent respectively for parents and siblings of probands suffering from unipolar depression. Morbidity risk for manic-depressive psychosis for the respective groups of first degree relatives of manic-depressive probands was 15.1+/-3.2 and 16.9+/-3.2 per cent. In second degree relatives the morbidity risk was 3.4+/-1.0 and 5.3+/-1.4 per cent for unipolar depression and manic-depressive psychosis respectively. The results indicate the role of genetical factors in the etiology of both types of affective disorder and show that unipolar depression and manic-depressive psychosis are distinct entities. The hypothesis of X-linked dominant transmission was not confirmed in either of these affective disorders. By means of the computational model of Slater, no results compatible with a polygenic inheritance of unipolar depression or manic-depressive psychosis were found.


Schizophrenia in Hawaii: analysis of cohort mortality risk in a multi-ethnic population. Schizophrenic patients in treatment with the Hawaii state system have been followed from 1962 to 1972. This cohort includes 1,689 persons: out-patients as well as in-patients; of Japanese, Caucasian, part-Hawaiian, Filipino, Chinese and other ancestries. After ten years, 60 per cent remain registered with the Hawaii Mental Health Division; 14 per cent are found living in the state; 12 per cent are lost to follow-up; and 14 per cent have died. Mortality is analysed for all causes by comparison with similar ethnic and sex sub-groups of the general population.


Three weeks in isolation with two chronic schizophrenic patients. An account is given of impressions and observations collected during three weeks in November 1975 which the writer spent with two of his chronic schizophrenic patients in a purpose-built isolation unit inside which it was impossible to have any idea of the real time. This experience gave the observer an unusually close view of schizophrenic and institutional behaviour and some insight into the natural outcome of staff-patient interaction.


The children of psychiatric patients: clinical findings. Findings are presented on 42 children of school age, the offspring of 26 adult psychiatric patients. Psychiatric disorder was found in 19 (45 per cent) of the children, compared with 12 (26 per cent) of 47 children from a control group of families. Families with disturbed children differed from the remaining families in the following ways: presence of frank marital discord, the diagnosis of personality disorder in the parents, the inability of the father to tolerate angry situations, and the presence of siblings of under 9 years of age. Six months later 9 of the 19 children had improved considerably. In almost every family this was associated with improvement in the condition of the parents. It is suggested that the psychiatric disorder of these children is reactive to the presence of emotional turmoil in the families.


Behaviour problems in pre-school children: family and social factors. In a group of 99 three-year-old children with behaviour problems identified in an epidemiological survey, family and social factors were compared with those in a group of controls. Behaviour problems were significantly associated with a strained marital relationship between parents, with social stresses and with type of housing. There was a high rate of maternal depression in both problem and control groups. The interaction between a behaviour problem in a young child, maternal mental health and social factors is discussed.


Do newspaper reports of coroners' inquests incite people to commit suicide? A statistical association has been found between reports of suicide inquests in a local paper and the subsequent suicide of men under 45 years.


The gaslight phenomenon--an institutional variant. A case of paranoid psychosis in an elderly female is reported in which recurrent episodes were apparently induced by the staff of the institution where the patient was a resident. The issues raised by this case are discussed.


Familial sinistrality and degree of left-handedness. Hécaen & Sauguet (1970) reported that, according to a handedness inventory measure, familial sinistrality among left-handers (brain-damaged patients) was associated with weak left-handedness. We assessed the relationship of familial sinistrality and degree of left-handedness among 71 normal left-and 80 right-handed subjects. No general relationship of degree of left-handedness, defined by four handedness tasks, to familial sinistrality obtained. Only one of the tasks (finger tapping speed) significantly differed between familial and non-familial left-handers, the familial left-handers being more strongly left-handed on the task.


Absolute pitch: a case study.

Absolute pitch: a case study. The auditory skill known as 'absolute pitch' is discussed, and it is shown that this differs greatly in accuracy of identification or reproduction of musical tones from ordinary discrimination of 'tonal height' which is to some extent trainable. The present writer possessed absolute pitch for almost any tone or chord over the normal musical range, from about the age of 17 to 52. He then started to hear all music one semitone too high, and now at the age of 71 it is heard a full tone above the true pitch. Tests were carried out under controlled conditions, in which 68 to 95 per cent of notes were identified as one semitone or one tone higher than they should be. Changes with ageing seem more likely to occur in the elasticity of the basilar membrane mechanisms than in the long-term memory which is used for aural analysis of complex sounds. Thus this experience supports the view that some resolution of complex sounds takes place at the peripheral sense organ, and this provides information which can be incorrect, for interpretation by the cortical centres.


Characteristics of items in the Eysenck Personality Inventory which affect responses when students simulate. A large sample of students completed Form A of the Eysenck Personality Inventory, and four subgroups were later asked to simulate extraversion, introversion, neuroticism or stability. It was found that subjects could simulate these four personalities successfully. The changes in individual item responses were correlated with the items' factor loadings, validity, response bias, and detectability. The different scales and types of item were considered separately. In some cases the changes in item responses when simulating introversion and extraversion were related to the extraversion validities and factor loadings of the items. More often, however, the behaviour of items under simulation was correlated with aspects of the items that made them more like an item from another scale and thus lessened their susceptibility to a particular type of simulation.


Effects of phase-of-respiration on GSR detection. Previous studies of visual and auditory signal detection (Flexman & Demaree, 1972; Flexman, 1974; Flexman, Demaree & Simpson, 1974) have found that signals occurring during exhalation are detected with greater sensitivity than are signals occuring during inhalation. The purpose of the present study was to make use of a use of a signal detection paradigm (Green & Swets, 1966) in extending these phase-of-respiration findings to internal event detection, specifically, to the detection of spontaneous galvanic skin responses (GSRs). A secondary purpose of the study was to re-examine Stern's (1972) finding that high magnitude GSRs were better detected than were low magnitude GSRs. It was found that the phase of respiration during which the GRS reached its peak significantly influenced GSR detection, but that unlike studies of external signal detection, detection was greater for GSRs peaking during the inhalation than for GSRs peaking during exhalation. Some possible artifactual sources of this finding are discussed. No significant effect of GSR magnitude on GSR detection was observed although differences were in the expected direction.


Cross-modality transfer of spatial information. First, second, and fourth grade boys and girls were tested on a spatial task requiring perception of the location of a group of three geometrical objects. The initial sensory input was either visual or tactual/kinaesthetic, and the choice stimuli, which were presented either simultaneously with the objects, or after the objects were removed (successively) were photographs of different configurations of the objects. There was no performance difference between th intramodal and cross-modal conditions, although older children performed better than younger ones, and performance was better under the simultaneous than successive conditions. It was concluded that in making complex visual spatial judgements, visual perceptual representations mediate performance under both tactual/kinaesthetic and visual sensory inputs.


Affiliation before and after child delivery as a function of repression-sensitization. A group of 177 women were asked, before and after child delivery, to state their preference for being alone or with other women. They were also asked to rank their level of anxiety. After delivery they filled out the Repression-Sensitization Scale of Byrne, Barry & Nelson (1963). Results show sensitizers to be more anxious than repressors before but not after delivery. Before delivery repressors preferred to be alone, while sensitizers wanted to stay with others. After delivery both groups show a significant preference for being with others. There is no significant correlation between anxiety and affiliation.


Smokers, non-smokers and the attribution of addiction. Questionnaries concerned with attitudes towards cigarette smoking were completed by 368 respondents who were taking part in a survey of audience reactions to one week's television programmes. Cigarette smokers were asked how difficult it would be for them to give up cigarettes, whether they would like to do so, whether they felt they were addicted to cigarettes, and how often a cigarette gave them real pleasure. Non-smokers were asked parallel questions to determine their perceptions of the average cigarette smoker. In comparison to how smokers saw themselves, non smokers saw the average smoker as more addicted, and as deriving less pleasure from cigarettes. Smokers who saw themselves as more addicted felt it would be more difficult for them to give up, smoked more cigarettes per day, said they would like to give up more, and derived somewhat more pleasure from cigarettes. Among those who had never smoked cigarettes, the attribution of addiction to the average smoker was related only to perceived difficulty of giving up. Lesser self-attributed addiction was also relevant to the prediction of which smokers claimed to be trying to reduce or give up smoking. Implications of these data for attribution theory, and for health education, are discussed.


The influence of context on language perception in schizophrenia. The present experiment employed the 'Cloze' procedure to investigate language perception in schizophrenia. The stimulus immediacy hypothesis of Salzinger, Portnoy & Feldman (1966) predicts that with increasing context, schizophrenic performance, unlike that of normals, will fail to improve. A comparison of groups of schizophrenics and normals on such a task, with varying levels of context, not only showed that schizophrenics failed to improve with greater context but that their performance deteriorated. A comparison of acute and chronic schizophrenics indicated that deterioration was most prominent in acute patients, the performance of chronics remaining relatively stable. An interpretation of the data in terms of narrowed the performance of chronics remaining relatively stable. An interpretation of the data in terms of narrowed attention in chronic schizophrenia appears plausible, and consistent with Broen's (1968) theory. Such an interpretation may be 'tested by an extension of the range of context conditions.


Factorial invariance across gender for the primary symptom dimensions of the SCL-90. The present study was focused on an evaluation of factorial invariance across gender for the primary symptom dimensions of the SCL-90-a multidimensional self-report symptom inventory. The argument is advanced that evidence of invariance across relevant subject parameters is an essential component of reliability for dimensional constructs. Findings indicated subtantial levels of invariance across gender for eight of the nine primary symptom dimensions of the SCL-90 with moderate levels for the ninth. The implications of invariance, for the SCL-90 in particular, and clinical measurement in general are related and discussed.


Visual interaction and speech patterning in remitted and acute schizophrenic patients. Previous research has suggested that schizophrenic patients sometimes show abnormal patterns of visual interaction and speech. Several important questions remain, however, and the present study was designed for two purposes; to examine the behaviour of remitted patients; and to follow up a suggestion that acute patients show abnormalities only in personal encounters. Three groups of subjects, remitted schizophrenic patients, acute schizophrenic patients and a control group of psychiatrically normal chest patients, took part, and each subject held two conversations with a nurse, one about a 'personal' topic and one about a 'neutral' topic. Unexpectedly, the remitted and acute groups were both found to behave normally, in both conversations. Taken together with previous evidence, the findings thus confirmed that acute schizophrenic patients respond situation-specifically and sometimes behave normally, but no further interpretation of the data was possible since the manipulation of topic did not have the expected effects.


Dimensionality of the perceived self: the Tennessee Self Concept Scale. The 12 indices of self-perception in the Tennessee Self Concept Scale, together with the Eysenck Personality Inventory, were factor analysed using data obtained from psychiatric day-care patients (n = 131). Separate item- and scale-level factor analyses revealed that: (1) the five external and three internal domains of self-concept, hypothesized as distinct, may be accurately viewed as lying in one-dimensional space; (2) the conflict, variability and distribution scores are unrelated to subtype of self-esteem; (3) extraversion and neuroticism form a bipolar factor that is orthogonal to self-concept; and (4) the emergence of 30 item-factors with a 30 per cent factorial overlap implies a good deal of spuriously shared variance, low inter-scale homogeneity and sizable redundancy in the TSCS scales. Owing to these results, the construct and factorial validity of the TSCS is seriously questioned. It is suggested that future researchers develop more sensitive, treatment-oriented (or idiographic) measures to compare man's less conspicuous and more private 'self-image feelings and cognitions' against his public self-disclosure in the interests of facilitating more rapid behavioural change.


Psychological implications of mastectomy. The adjustment of a group of mastectomy patients to their operation was assessed at an interval of between 18 months and 5 years after surgery. They were found to be significantly more depressed and anxious than a control group of cholecystectomy patients; they tended to have lower self-esteem; and they described themselves as being more introverted in their behaviour. These differences were attributed to concern about both the loss of the breast and the possibility of recurrence of the cancer.


Encoding in senile dementia and elderly depressives: a preliminary study.. Forty-seven subjects (19 elderly dements, 18 elderly depressives, 10 elderly physically ill) were given a continuous false recognition technique (FRT) in a test battery including a measure of short-term memory and the Kendrick Synonym Learning Test. Results were analysed according to signal detection theory and interpreted in terms of an encoding breakdown. Depressives were found to be characterized by conservative error-free performance whereas the demented made more errors, partly because of their more liberal criterion and partly because of their greater loss of encoding characteristics. From these results, an optimal cut-off score was chosen for differential diagnosis using the FRT. This was shown to hold more promise than the SLT in discriminating between dementia and depression.


The HDHQ results of long-term prisoners: relationships with criminal and institutional behaviour. The HDHQ (Foulds, Caine & Creasy, 1960) was administered to 100 long-term prisoners as part of routine psychological assessment prior to their allocation to training prisons. The questionnaire results were analyzed in terms of the prisoners' past and present criminal and institutional behaviour. Additionally they were used to test Megargee's (1966) hypothesis that extremely assaultive individuals are generally overcontrolled and will thus express less hostility than moderately assaultive individuals. The results showed that the sample of long-term prisoners had a significantly higher total hostility score than normals but did not differ significantly in the direction of their hostility. Violent offenders were significantly more extrapunitive than non-violent offenders, and prisoners who had attempted suicide were more extrapunitive than those with no history of attempted suicide. Apart from these findings no significant relations were found between the HDHQ results and criminal and institutional behaviour, whether violent or non-violent. Megargee's (1966) over- and under-controlled hypothesis failed to receive support. The results suggest that the HDHQ would be of little value in making predictions about future violent or criminal behaviour.


The removal of retained biliary tract stones: report of 105 cases. The removal of retained biliary stones by the use of the steerable catheter and wire basket after removal of the T-tube has proven itself to be valuable and safe technique. A success rate of 90% or better can be achieved by a radiologist quite quickly. The reduction in morbidity and absence of mortality makes non-operative removal of stones a very desirable service in any hospital doing a significant amount of biliary surgery.


Bronchial walls in the radiological diagnosis of asthma. Although bronchial wall thickening is known to occur in asthma, its radiological visibility and significance are matters of dispute. The present study shows that thickening can be detected in the plain chest radiographs of patients with severe asthma, but it cannot be reliably detected in patients with mild asthma. Measurements of bronchi made on lung tomograms showed that the lumen-wall ratio more clearly separated the asthma and normal groups than did observation of bronchial wall thickness alone.


The left aortic arch and right descending aorta. Three patients with a left arch and a right descending aorta are described, all presenting in infancy. In one patient the abnormality was acquired, yet the radiological appearances were very similar. The place of the barium swallow in the diagnosis is discussed, and it is concluded that aortography is required for a definitive diagnosis.


Spontaneous urinary extravasation in non-acute ureteric obstruction: a report of four cases. Four new cases of spontaneous extravasation of contrast medium during intravenous urography have been described. All were due to non-acute obstruction of the ureter. This is relatively uncommon as most of the cases previously described have been due to passage of a ureteric calculus. Two of the patients improved after relief of the obstruction. In one a nephrectomy was carried out, and one patient died of an unrelated cause before the obstruction could be relieved.


Distribution of calcification within the pineal gland. The distribution of calcification in the normal pineal gland was investigated by a macroradiographic in vitro technique. The centre of calcification in 72 out of 73 glands studied was within 2 mm of the mid-line of the gland. In one gland it lay 2.6 mm from the mid-line. These findings explain the accepted normal limits for pineal calcification on the standard semi-axial projection of the skull of up to 2 mm to either side of the mid-line and the occasional measurement in excess of this in normal subjects.


Measurement of serum TSH and thyroid hormones in the management of treatment of thyroid carcinoma with radioiodine. 1. Serum levels of TSH, thyroxine (T4) and triiodothyronine (T3) have been measured during treatment and follow-up of patients with thyroid carcinoma. 2. Serum TSH and thyroid hormone levels were initially normal. Three weeks after total thyroidectomy, TSH was elevated in about 50% of patients and after a subsequent therapy dose of 131I it exceeded 30 mU/l in 90% of patients. Occasionally, TSH did not rise until after the second dose of 131I. Low serum T4 and T3 concentrations were associated with the increase of TSH. 3. Withdrawal of l-thyroxine replacement treatment in athyreotic patients for four weeks before test doses of 131I, led to falls of serum T4 and T3 concentration and a progressive rise of serum TSH after the first weeks but there was considerable variation in the final level reached. In the majority, values greater than 30 mU/l were attained despite some patients having received l-thyroxine for many years. A few patients on prolonged thyroxine maintenance had little or no increase in TSH despite considerable reduction in serum T4 and T3 concentrations. 4. The 131I concentration (muCi/g) developed in tumour tissue was also examined in relation to the serum TSH level. In general a tumour should not be considered as incapable of concentrating 131I adequately until serum TSH levels have exceeded 30 mU/l.


The design of the detector and collimators for a hybrid scanner. The hybrid scanner is a scanning device in which a long crystal with two or more photomultiplier (PM) tubes acts as a gamma camera along the crystal axis; the device acts as a linear scanner in a direction perpendicular to the crystal axis. A detailed analysis of the intrinsic resolution and uniformity is given for a two-PM-tube hybrid scanner (with one PM tube at each end) and the expressions derived should help the designer to choose the best crystal system. Collimation theory is discussed for the general hybrid scanner. Expressions and graphs are given to help in the design of a collimator with the best balance between the conflicting requirements of resolution, sensitivity, depth independence and freedom from artifacts (collimator holes may be seen in the image at high energy). Examples of practical collimators are given for energies of 80-140,364,511,662 and 840 keV.


Epoxy resin based tissue substitutes.

Epoxy resin based tissue substitutes. A series of epoxy resin based tissue substitutes, simulating adipose tissue, bone, breast, lung, muscle and skin is described. Details of the physical radiation characteristics of the formulated systems are given, together with the manufacturing procedures. The versatility of the range of substitutes is discussed in terms of both investigated and projected applications in experimental radiation studies.


Comparison of ultrasound and computer-assisted tomography in pancreatic diagnosis. In a series of patients suspected of having pancreatic disease both ultrasound and computerized tomography (CT) were performed. The diagnosis has been confirmed in 50 patients. Computerized tomography visualized the pancreas in all 50 (100%) whereas ultrasound was successful in 40 patients (80%). The ultrasound failures were due to bowel gas anterior to the pancreas. The overall diagnostic accuracy was 84% for computerized tomography and 64% for ultrasound; however, in those cases where ultrasound successfully detected the pancreas the diagnostic accuracy was 80%.


A lymphographic study of chyluria.

A lymphographic study of chyluria. Ninety patients with chyluria were studied by bilateral pedal lymphography. The retroperitoneal lymphatic vessels were dilated, tortuous and increased in number in 61% of cases while the appearance of the lymph nodes was abnormal in 67% of cases. Renal lymphatic reflux, either bilateral or unilateral, was seen in 93% of patients. A correlation (P greater than 0.007) was observed between the site of origin of the cisterna chyli and side of unilateral renal lymphatic reflux. There was no evidence of thoracic duct obstruction although the thoracic duct was more than 3 mm in calibre in seven cases. Lymphography was also performed on 22 patients who had undergone stripping of the lymphatics along the renal pedicle to determine if surgical disconnection was complete. The pathogenesis of chyluria is briefly discussed.


Unusual arteriovenous communications presenting as cardiac murmurs in infancy. Report of three cases. Three cases are decribed of infants presenting with murmurs in, or adjacent to, the thorax and considered to be cardiac. Later full investigations established that the murmurs were due to aorto-azygos fistula, vertebral arterio-venous fistula and intercostal angioma, respectively. While such lesions are extremely rare, the possibility of systemic arteriovenous communication should be considered in infants with atypical murmurs.


Myxofibrosarcoma: a pathologico-anatomical, microangiographic and angiographic correlative study of eight cases. A correlated angiographic, microangiographic and histological study of eight myxofibrosarcomas is presented. Myxofibrosarcoma is a very recently described type of malignant soft tissue tumour characterized by a mucoid and nodular appearance, predominantly arising superficially in the extremities and trunk in elderly people. Microscopically, the lobulated and myxoid tumours in the present series showed a characteristic plexiform network of fine capillary-like vessels and occasional wide, sinusoidal, angulated vessels. On plain radiographs they were all dense and well demarcated. Angiographically the tumours appeared highly vascular, with irregular tumour vessels often arranged in a patchy or nodular fashion. All revealed signs of a rapid circulation. The microscopic and angiographic appearances were correlated, in two cases utilizing microangiography. In the presence of a superficially located tumour with high density on plain radiographs, marked vascularity, patchy or nodular opacities, and signs of rapid circulation on angiogram one should suspect this diagnosis.


A method of visualizing and documenting pancreatic lesions by diagnostic ultrasound. A reliable method of visualizing and documenting pancreatic lesions by ultrasound is described. This method is valuable for the follow-up of varying types of pathology, and it may be applied to a wider range of lesions than pancreatic. It is simple and saves time and money for the ultrasonographer and is more easily interpreted by the clinician.


Interaction of hyperthermia and radiation: the survival surface. The interaction of hyperthermia and radiation on cell survival is illustrated by the increase in sensitivity to radiation caused by hyperthermia and the increase in sensitivity to hyperthermia caused by radiation. A method of expressing the total response to a combination of these two agents by means of a survival surface in three dimensions is explained and discussed. A simple mathematical model of the suface is formulated in which is a first order interaction term is separated from the two terms representing unperturbed radiation survival and unperturbed hyperthermia survival. An experiment is described in which survival data points were obtained for 77 combinations of radiation and hypertermia doses in the form of a matrix. These data points are plotted as 11 radiation survival curves and seven hyperthermia survival curves. The results are also analysed to give the parameters of the survival surface model. The model with its three components is shown to be a good approximation to the experimental results.


Interaction of hyperthermia and radiation: temperature coefficient of interaction. Cell survival data were collected to determine the survival surface for asynchronous CHO cells X-irradiated at room temperature 100 min prior to a hyperthermic exposure. The survival surface could be approximately described by a survival model comprising three components of cell killing; the unperturbed radiation component, the unperturbed hyperthermia component and the interaction component. The temperature sensitivities of the hyperthermia component and of the interaction component were investigated by using different hyperthermic temperatures, revealing that the interacting component is significantly less sensitive to a change in temperature than the unperturbed hyperthermia component.


Localized giant pseudopolyposis of the colon in granulomatous colitis: a case report and review of the literature. A case of localized giant pseudopolyposis of the colon is presented. The case was proven histologically to be granulomatous colitis. This unusual manifestation of granulomatous colitis may mimic a large bowel carcinoma or less frequently villous adenoma. This is the first proven reported case of granulomatous colitis presenting in this manner.


Selective renal phlebography in the diagnosis of renal pelvic and ureteric varices. 4 cases are presented in order to demonstrate the efficacy of renal phlebography in the diagnosis of renal pelvic and ureteric varices. It is believed that this simple procedure should also be used as a supplement to renal angiography in cases of unexplained gross haematuria and/or persistent renal colic.


The elastic tissue of the adult dilated ureter. Adult dilated ureters have been examined in order to calculate the amount of the elastic tissue. From the histological observations and by the chemical analyses performed on the extracted elastin a decrease of the elastic tissue, as compared to the normal adult ureters has been noted. In fact, in the adult normal ureters, the elastin accounts for 9% of the dry matter, while in the abnormal the elastin represents 6.5%.


Ileal conduit urinary diversion in children. In a review of 113 paediatric patients followed for an average of 5 years, the ileal conduit has been very effective in preventing infection and loss of renal function. The incidence of early and late complications can be minimised by proper patient selection, attention to surgical details and diligent postoperative follow-up.


Sixteen years' experience with the Heitz Boyer-Hovelacque procedure for exstrophy of the bladder. The various methods of managing bladder exstrophy are described. Bladder reconstruction and ureterosigmoidostomy are discussed and evaluated. The satisfactory results obtained with 21 patients treated by the Heitz Boyer-Hovelacque operation are reported and it is concluded that this is the procedure of choice when urinary diversion is needed for the exstrophic bladder.


Rectal vesico-urethroplasty updated with ten years' evaluation. A new operation--rectal vesico-urethroplasty--has been designed to reproduce the normal anatomy and physiology of the lower urinary tract after total cystectomy. This is achieved by using the rectum with its intact nerve supply to replace the bladder and posterior urethra, thereby ensuring the known requirements for normal bladder function, viz, an adequately contractile reservoir with a sphincteric outlet and an intact corticospinal nerve tract. The operation has been carried out on 126 patients, 114 males and 12 females. It has been performed as an immediate sequel to cystectomy in 111 cases and as a secondary reconstruction after previous cystectomy and diversion in 15 cases. The results are greatly superior to colocystoplasty: most patients enjoy practically normal continence and voiding and are not threatened by subsequent complications. The postoperative mortality rate of 17% in the present series is largely due to avoidable factors and has markedly reduced in the last group of cases.


Transurethral removal of bladder stone: the place of litholapaxy. The surgical management of 652 cases of bladder stone, with particular reference to the value of litholapaxy, is discussed. The majority of cases can be treated by closed methods--litholapaxy and transurethral removal. Those cases treated by closed methods have a reduced postoperative complication and morbidity rate, a shorter operating time, and a reduced period of hospitalisation. Provided the necessary skill is acquired, it is concluded that litholapaxy is a safe and efficient method of dealing with bladder stones.


Diathermy to the trigone and urethra in the management of the female urethral syndrome. The effects of diathermy to the trigone and upper urethra in the female urethral syndrome are compared with the effect of cystoscopy alone in the 27 cases. It is shown that the addition of diathermy gives superior results. The effects of such diathermy in the female urethral syndrome in 56 cases were reviewed by questionnaires 3 years later. 45% of the patients had had no further attacks and 90% thought that the treatment had been worth while.


Subcapsular orchidectomy for carcinoma of the prostate. Our results suggest that subcapsular orchidectomy is at least as effective as oestrogen therapy in producing long-lasting suppression of plasma testosterone. It has many advantages over oestrogen therapy, so that, like Huggins, we believe it to be the hormonal treatment of choice for patients who develop symptoms from carcinoma of the prostate.


The role of the bacterial L form in urinary tract infection. The relationship between the bacterial L form and chronic relapsing urinary tract infection was evaluated, using septicaemic cases as the basis of assessment. The results of this study supported the theory that chronic relapsing pyelonephritis is associated with L form infection. The antibiotic treatment of L form infection is discussed.


Tuberose sclerosis and bilateral renal carcinoma. A case report is presented of an 18-year-old girl of normal intellect with tuberose sclerosis and multiple bilateral renal carcinomas. These tumours were successfully treated surgically by right nephrectomy and left partial nephrectomy. The usual renal lesion in these patients is the angiomyolipoma, which is a hamartoma. Renal carcinoma associated with tuberose sclerosis is extremely rare, and the mode of behaviour of these tumours may be unusual.


Renal carcinoma presenting with pulmonary emboli: a review of two cases. Two patients with renal carcinoma presenting with pulmonary emboli are discussed. Pulmonary emboliform renal carcinoma may be more common than previously supposed. Evaulation for such tumours should be done in patients with pulmonary emboli of obscure origin.


Composition of urinary tract calculi in children of different ages. The composition of urinary tract calculi in children in relation to their age has been examined and comparisons have been made with other published series. It is concluded that paediatric stone disease can be divided into two main types: (1) infection stones, composed largely of magnesium ammonium phosphate and occurring mainly in children under 5 years of age, (2) calcium stones, occurring mainly in older children.


Primary obstructed megaureter.

Primary obstructed megaureter. The clinical presentation and management of 57 primary obstructed megaureters in 46 patients, 35 of whom were children, are reported. Indications for operation include pain, infection, progressive pyelo-ureteric dilatation and reduction in the glomerular filtration rate. We have found that affected children cannot be managed successfully without operation. Conservative treatment may be employed effectively in adults in whom the condition is often stable and complications are less frequent. The preferred surgical technique is ureteric narrowing with reimplantation to the bladder by the Politano-Leadbetter method. The results of surgery are less satisfactory in adults than in children. This may be related to the reduced quantity of elastic tissue in the ureteric wall in adult cases.


Hypertension due to Ask-Upmark kidney.

Hypertension due to Ask-Upmark kidney. A young girl in whom severe hypertension was cured by the surgical removal of a unilateral hypoplastic kidney (Ask-Upmark kidney) is described. The clinicopathological features of the Ask-Upmark kidney are described with particular reference to the aetiology of the hypertension as well as the selection of patients for surgery. No abnormality of the renin-angiotensin system was detected.


Ectopia in unduplicated ureters in children. The clinico-pathological features and surgical management of 19 unduplicated ectopic ureters in 15 children are presented with special reference to the problems of recognition and treatment and to the underlying embryological and pathological significance of the wide-ranging associated abnormalities. The high incidence of renal and ureteric malformations, both ipsilateral and contralateral, is emphasised, as is also the frequent co-existence of vesical, bladder neck, urethral, genital and anal abnormalities. These associated anomalies modify the presentation of unduplicated ureteric ectopia and may mask its presence. Late recognition is common, but may be avoided by awareness of the problem. Whereas the degree of kidney involvement seems to dictate the choice and priorities of surgical treatment, the lower urinary tract anomalies have more significance as regards continuing disability and these largely determine the outcome in relation to continence.


The results of urinary diversion in multiple sclerosis. Out of a total of 78 patients with multiple sclerosis who underwent urological assessment, 12 (15%) were treated by ileal loop diversion. The results of surgery were highly satisfactory in spite of a high incidence of postoperative complications. The surgical trauma that occurs from the operation does not necessarily result in neurological deterioration of the patient. The only absolute contra-indication to urinary diversion is decubitus ulceration. Urinary diversion should be considered much earlier in the treatment of incontinence in multiple sclerosis rather than offered as a last resort.


Back-flow from urinary collecting devices into the ileal conduit. The occurrence of back-flow from urinary collecting devices into the ileal conduit was observed in 9 out of 46 patients. In 6 of them back-flow to the upper urinary tract also occurred. Nipple stomas of at least 2 cm height were found to resist back-flow into the conduit better than any flat stoma.


A further assessment of bladder transection in the management of adult enuresis and allied conditions. The use of bladder transection for the management of adult enuresis and allied conditions is reported. The beneficial effects of the operation, assessed by an improvement of symptoms and measured objectively by urodynamic investigation, have been found to be maintained during 4 years' experience of the procedure.


Bladder transection for adult enuresis.

Bladder transection for adult enuresis. 45 patients with adult enuresis have been treated by bladder transection between 1969 and 1975 and followed-up from 6 months to 7 years. 24 patients are now asymptomatic. Bladder transection gave very worthwhile results in 53% of cases.


Intermittent catheterisation in congenital neurogenic bladder: a preliminary report. 53 children with congenital neurogenic bladders are currently managed on intermittent catheterisation. The problems of continence, urinary tract infection and upper tract deterioration have to date been controlled reasonably successfully and the need for urinary diversion appears to have been obviated. Complications have been negligible and parents and patients alike prefer this method to the Crédé manoeuvre.


Endoscopic removal of bladder stones in adults. Endoscopic removal of bladder stones of all sizes in adults has been discussed and illustrated by 100 cases. 3 different techniques were used to remove the stones viz. (1) extraction by Dormia basket, (2) cystoscopic lithotrity and (3) electronic lithotripsy by Russian-made "URAT 1". Safety and economic advantages to the patients have been discussed.


Recording of vesical voiding pressure by means of CO2-perfusion. By means of a CO-2-cystometer, carbon dioxide is introduced through a urethral catheter (F5) into the full urinary bladder while the subject is urinating around the catheter. A reproducible pressure curve can be recorded. The pressure values measured by CO2-perfusion correlate very well with those measured simultaneously by a conventional fluid method. It can be statistically demonstrated that the CO2 flowing into the bladder does not influence the vesical voiding pressure. It is concluded that the vesical pressure during micturition can be accurately recorded by CO2-perfusion.


Effect of phentolamine on perineal muscle EMG activity in paraplegia. The effect of the alpha-adrenergic blocking agent, phentolamine, was studied on the perineal muscle EMG in 3 paraplegic patients. The drug reduced the EMG activity in these patients. This suggests that the normal suppression of external sphincter activity during micturition might be related to a reduction in the external sphincter activity supplied by the sympathetic system.


The anatomy of the urethral stricture.

The anatomy of the urethral stricture. A post-mortem study of the urethral anatomy following gonorrhoea is presented. The different specimens examined demonstrated lesions ranging from microscopic submucosal scars to fully developed urethral strictures. In every specimen extensive squamous metaplasia of the surface epithelium was present. It is postulated that overstretching of this unsupported squamous epithelium during voiding causes microscopic epithelial tears and that the accumulation of the subsequent microscopic scars leads to the formation of a urethral stricture. Bacterial infection does not seem to play any part in the genesis of the stricture.


Bacteriuria after out-patient cystoscopy. The presence of bacteriuria 48-72 hours after cystoscopy has been correlated with the sex and previous history of the patient, and with the use of chlorhexidine 1/5,000 and water as alternative irrigant solutions. The infection rate was higher in women than in men. Chlorhexidine in the irrigant solution protected against postoperative bacteriuria in patients who did not have a history of previous urinary infection, but did not do so where there was such history.


Familial abdominal aortic aneurysms.

Familial abdominal aortic aneurysms. The case histories of three brothers, the only siblings of one family, all of whom underwent surgery for the treatment of a previously asymptomatic ruptured abdominal aortic aneurysm, are recorded. The possibility of underlying constitutional and hereditary factors is discussed and the suggestion of a primary familial incidence of atheromatous, nondissecting aortic aneurysm is raised.


Abdominal aortic aneurysms: should they all be resected? A retrospective study has been carried out on 124 consecutive patients with abdominal aortic aneurysms admitted during the period 1960-74. The mortality rate after emergency operation was 56 per cent and after elective operation 15 per cent. As in other vascular centres during these years the mortality rate has decreased among electively operated patients. We have tried to answer two questions: which patients without signs of rupture should undergo operation and which patients with a ruptured aneurysm should not be operated upon?


Haemodynamics of axillofemoral grafting in a case with normal inflow and outflow vessels. Intra-operative haemodynamics were studied in a case of axillofemoral grafting. When the normal axillary artery acted as the donor artery no steal from the arm occurred, even after vasodilatation in the leg. When, conversely, the very poor arterial collaterals to the leg were required to serve as donor arteries because the axillary artery proximal to the anastomosis was occluded by a clamp, a steal from the leg to the arm was observed. The study supports the concept that only if the donor artery has a high resistance to flow can a steal develop.


Distal lower limb arterial reconstruction with modified allograft saphenous veins. Cadaveric donor saphenous veins subjected to proteolytic enzymatic digestion, crossbonding and heparin bonding were used for arterial reconstruction in the legs of 13 patients threatened with amputation and without suitable autogenous saphenous veins. Distal anastomoses were to the tibial and peroneal vessels. Twelve patients (92 per cent) were discharged from hospital with functioning grafts; 9 grafts (69 per cent) continue to function 2-16 (average 8) months after operation. Amputation was avoided in 11 patients (85 per cent). Although early results are encouraging, late results are yet to be determined.


Mesenteric venous thrombosis occurring late after splenectomy. Two patients with mesenteric venous thrombosis which occurred late after splenectomy are reported. In the first case the thrombosis was seen, with preceding thrombocytosis, 3 years after splenectomy. In the second case the thrombosis occurred 2 years and 5 months postoperatively. Platelet counts had not been obtained before the mesenteric thrombosis in this case. In both instances persistent severe anaemia for several weeks preceded the symptoms and signs of mesenteric venous thrombosis. Both patients were treated by extended resection of the affected small bowel. Thus, dangerous thrombocytosis may occur in the presence of persistent severe anaemia even late after splenectomy. Thrombocytosis occurring immediately after splenectomy, which is almost inevitable, should be treated with heparin or other anticoagulants. In the late period the avoidance of persistent severe anaemia seems to be important in the prevention of thrombotic complications due to reactive thrombocytosis in splenectomized patients.


Cosmetic excision of an isolated extracranial arteriovenous malformation using Gelfoam embolization. Surgical excision of extracranial arteriovenous malformations may be indicated for cosmetic or urgent medical reasons, such as haemorrhage or high output cardiac failure. However, serious haemorrhage, incomplete removal and poor cosmetic results are well-known complications encountered after this operation. Preoperative embolization under angiographic control is recommended to reduce the incidence of these problems.


Plasma catecholamine concentrations during operation. Plasma catecholamines have been measured before, during and after operation in 40 patients undergoing elective major abdominal surgery and in 12 patients during open heart surgery. Plasma concentrations did not increase during abdominal surgery and showed only small increases during cardiopulmonary bypass. It appears that it is not possible to assess individual intra-operative sympatho-adrenal responses to surgical trauma by measurement of plasma catecholamine concentrations because of the efficiency of catecholamine uptake mechanisms.


Perforated duodenal ulcer in the black population of Central Johannesburg. The increasing incidence of perforated duodenal ulcer among Black patients admitted to the Johannesburg General Hospital between 1966 and 1976 is described against a background of the different forms of peptic ulcer disease seen in this hospital population. Admission for perforation during the years 1973-6 was as common among Black as among White patients. Perforation occurred principally in young (20-40 years) Black males (sex ratio 14 : 1), with a short history of preceding symptoms, and treatment was usually by simple closure. In the White group the age range was broader (20-70 years) and the male : female ratio only 2.7 : 1. Duodenal ulcer occurred predominantly in males (ratio 6 : 1), and the spectrum of the disease among the Black population in this urban environment resembled that among the White population in Johannesburg and in Western countries in the relative frequency of perforation and haemorrhage, rarity of stenosis and ratio of duodenal to gastric ulceration.


Intrinsic factor secretion after vagotomy. The intrinsic factor (IF) output during basal and Histalog-stimulated gastric secretion has been estimated in two series of patients with chronic duodenal ulcer before and 3 months or more after treatment by either highly selective vagotomy or truncal vagotomy and pyloroplasty. The effects of the two different vagotomy operations appear to be virtually identical and each produced significant reductions in intrinsic factor secretion after Histalog stimulation. This confirms the view expressed by previous workers that it is the vagotomy as such which is responsible, excluding the drainage procedure from any possible role. Furthermore, as these results were demonstrated 3 months after operation, it is likely that the depressed IF secretion is a permanent feature and one which, it is postulated, may become progressively more severe. In both series there is a marked reduction in IFoutput during the second hour of stimulated gastric secretion, indicating an early wash-out of preformed IF. This persists after vagotomy.


Intrathyroid cystic parathyroid adenoma: a rare case of hyperparathyroidism. A case is presented of a 52-year-old man with a swelling in the neck and dysphagia resulting from an intrathyroid cystic parathyroid adenoma. Hypercalcaemia and unusually high parathyroid hormone levels were detected preoperatively. The adenoma was removed by partial hemithyroidectomy. The literature is reviewed.


Epidermal repair in chronic venous ulcers. Certain features of epidermal repair, namely increased mitotic activity, cell migration and cell differentiation, have been investigated in fresh biopsies from 17 patients with chronic venous ulcers, using light and electron microscopy. Increased mitotic activity was present at the edges of most of these lesions whether they were in a grossly recognizable healing or non-healing phase, and some cells with ultrastructural features of migratory cells were invariably seen. The results are discussed in relation to other chronic epithelial lesions and suggest that failure of epithelialization is not due to any lack of epithelial cell production and that some other fundamental defect must be sought.


Occult primary malignant melanoma: factors influencing survival. Seventy-six patients with occult primary malignant melanoma were studied in order to detect features which would help to determine prognosis. It was found that the 5-year survival rate of these patients was: (a) no worse than in patients first presenting with one known primary lesion and metastases; (b) just as poor for women as for men; (c) more favourable if only a single lymph node was involved with secondary deposits; (d) similar whether the manner of spread of the disease was lymphatic or haematogenous; (e) similar whether there was or was not a history of a pre-existing lesion. The prognosis for occult primary malignant melanoma, although bad, is not hopeless.