Statistical analysis of individually matched case-control studies in epidemiology: factor under study a discrete variable taking multiple values. It is now well established in case-control studies with individual matching that the statistical analysis must take the fact of individual matching into account. The problems of so doing have been thoroughly dealt with for the situation of the factor of interest being a two-level factor (all-or-none response) and with one or more matched controls per patient. These results are extended in this paper to the situation where the factor can assume multiple levels in studies where each patient is matched with a single control.


Value systems and delinquency: parental and generational discrepancies in value systems for delinquent and non-delinquent boys. A sample of 82 delinquent boys in two institutions and a matched sample of 82 nondelinquent boys from three secondary schools ranked values from the Rokeach Value Survey in their order of importance for self, mother and father. Order of rankings was counter-balanced. Results indicated that the sets of rankings (value systems) were more discrepant between boys and their parents and between the parents themselves in the delinquent sample than in the non-delinquent sample, but only in regard to the set of terminal values. Marked differences in the relative importance of particular values occurred between the two groups both in relation to rankings for self and for parents, and (for both groups) between the boys and their parents (generational) and between mother and father (parental). Favourability towards father correlated positively with degree of value similarity between sons and fathers but only for the terminal values.


Reward allocation between high and low test anxious boys. Dyads composed of same and opposite type test anxious boys (TASC) were constituted and one randomly determined member in each pair passed an arithmetic test which made toys available for play. Results indicated that (a) high test anxious passing and failing children preferred an equal allocation solution; (b) allocation based on productivity was most acceptable among the pairs of low test anxious children; (c) low test anxious failers rated favourable allocations more acceptable than equalitarian and unfavourable ones when their partner was a high test anxious passer. The findings are discussed in terms of differences between high and low test anxious boys in their response to evaluation.


Personality and value orientations in early adolescence. An analysis of the Psychoticism, Extraversion, Neuroticism and Lie scores of 674 13-year-old pupils in comprehensive schools revealed that they held specific relationships to six value orientations: Family Loyalty, Intolerance, Complacency, Passivity, Cynicism and Educational Primacy. These relationships are seen as pointing to an area which, by systematic investigation, would permit the psychology of personality and the sociology of values to be more closely integrated. The existence of three basic 'life orientations', 'Asocial', 'Unsocial' and 'Hypersocial', is suggested.


Some effects of anxiety and cognitive style upon pursuit rotor learning. The present study sought to investigate the interrelationships between anxiety level and cognitive style upon pursuit rotor learning under conditions of relatively massed practice. The empirical specifications of anxiety were chosen so as to render the study comparable to previous investigations executed within the general framework of Spence's (1956, 1958) developments of Hull's (1943) notions concerning the relationship to drive level and learning task performance. The results were also related to Eysenck's (1956, 1964, 1965) elaborations of Hullian theory as related to motor learning phenomena. The cognitive style variable was assessed by a single measuring instrument, the Stroop Test. The variables tapped by this instrument were expressed within the framework of neo-Hullian theory, and predictions made from an expanded version of the theory. Subjects were constituted into four groups: Cognitive High-anxiety, Cognitive Low-anxiety, Perceptual-motor High-anxiety, and Perceptual-motor Low-anxiety. When the pursuit rotor task was administered, Perceptual-motor subjects excelled, as expected, as compared to Cognitive subjects. High-anxious Perceptual-motor subjects exhibited greater amounts of reminiscence than did Low-anxious Perceptual-motor subjects; unexpectedly, the reverse effect obtained within the Cognitive group, with the Low-anxious subjects showing more reminiscence. It is suggested that conditioned inhibitory effects might have appeared differentially within the groups.


Reversing the process of thought disorder: a serial validation experiment. Previous personal construct theory studies of thought disorder suggest that it can be viewed as a state of grossly loosened construing (a weak and unstable network of links between ideas) and that it can fairly be measured by grid method. Later studies in the series indicated that it is people not things which bewilder the thought-disordered patient--it is his role as a 'psychologist' that is specifically damaged. The serial invalidation hypothesis argued that thought disorder is the long-term consequence of a repeated failure to predict accurately the behaviour of others and self, resulting in the disintegration of any organized, personal 'theory' about relationships. The present experiment attempt to reverse the process of thought disorder by first identifying whatever weak, remaining system of expectations the thought-disordered patient manifests and then fulfilling these expectations. Such a process of serial validation might lead to a strengthening of the 'theory' which generated these expectations--a tightening of the construct system. Experimental and control group were closely studied over a two-year period. Results-while tending in the predicted direction--yield a not proven verdict though they leave the argument viable and the experiment worth modified replication.


The accuracy and correlates of psychiatric patients' self-assessment of their work behaviour. A preliminary study demonstrated that psychiatric patients' evaluation of their work behaviour was unrelated to assessments made by experienced supervisors. Patients involved in clerical work were shown to be more accurate in self-assessment than patients in the manual assembly section of a rehabilitation unit; clerical patients underestimated, and manual patients overestimated their performance. These findings were confirmed in a second study, which also identified some of the differences between the 'clerical' and 'manual' groups, and showed that underestimation was associated with higher intelligence, a general tendency to admit to undesirable behaviours, and a relatively long period of contact with psychiatric services. Neuroticism was also related to underestimation, and schizophrenic patients overestimated their performance. Work satisfaction was found to be unrelated to work performance.


Recognition memory in dementia.

Recognition memory in dementia. The experiment was designed to look at the effects of two parameters on the recognition memory of dementing subjects. These were a forced-choice compared with a free format; and verbal compared with pictorial material. For the entire sample, neither of the comparisons gave significant differences; when those subjects with the best recognition scores were considered separately, the forced-choice condition  was found to give significantly better scores; but there was still no significant tendency in favour of the pictorial material.


Thermography in breast carcinoma: results of a blind reading trial. This paper presents the results of a blind reading trial of thermographic detection of breast cancer. Thermograms from women with no known breast disease, those with benign disease and those with carcinoma have been analysed using a previously described method for examination and assessment. Each record was read blind by three observers and the resulting scores compared for the three groups of women. It was found that, using the scoring system devised, 69 per cent of carcinomas gave scores in the range considered to indicate a high risk of breast disease but that 33 per cent of the scores for the normals also fell into this range. No differentiation between benign and malignant groups could be achieved. A significant number of the carcinomas were also found to show few detectable signs on thermography, resulting in an appreciable false negative rate.


Echography in the diagnosis and management of retinal detachment. Sixty patients presenting with retinal detachment have been examined using a Nuclear Enterprises Diasonograph 4102; 25 with no identifiable cause (primary), the remainder due to causes such as vitreous haemorrhage, trauma, inflammatory eye disease, aphakia and neoplasm. In the diagnosis and management of retinal detachment echography has a definite but limited application, particularly in patients who have cloudy or opaque media and in whom detachment secondary to a malignant melanoma is suspected. In patients with trauma or vitreous haemorrhage important therapeutic considerations depend upon a precise knowledge of the structure of the globe and complicating features such as vitreous fibrosis or retinal detachment. In such patients the value of echo amplitude measurements in combination with B-scan echography is described. In primary retinal detachment because of vitreous haziness, the extent, size and degree of displacement of the retinal detachment may be more precisely demonstrated echographically than by conventional ophthalmoscopy, facilitating surgical management.


Villous adenoma of the large bowel; benign and malignant. The radiological appearances on double contrast barium enema examination of 14 cases of villous adenoma are described and illustrated. Problems of diagnosis and detection of malignancy are discussed. It is concluded that in the majority of cases a confident radiological assessment of benignancy or malignancy cannot be made. The importance of villous adenoma as a pre-cancerous condition and the high incidence of associated large bowel carcinoma are emphasized.


The extent of the inferior border of the thymus: a report of two cases in infants. Two cases of air insufflation of the mediastinum are reported to define the extent of previously unreported prolongation of the right thymic lobe occasionally seen in the normal infant chest radiograph.


An interactive data preparation procedure for three-dimensional interstitial and intracavitary dose calculation programs. A computer system has been developed to assist in preparing data for interstitial and intracavitary calculations. This approach used graphic and interactive techniques, and removes all the format problems which led to errors in data preparation. The program reconstructs the implant and rotates it about X, Y and Z axes to allow close examination of the positions of the radiation sources. The site of the dose calculation can be selected by positioning a frame representing the calculation plane in the reconstructed implant. The output of the program is the three-dimensional data of the source and plane co-ordinates, together with the co-ordinates to define the area on the plane where the calculation is to be performed.


Radioisotope measurements of regional lung function in bronchogenic carcinoma. Five out of 300 patients with bronchogenic carcinoma referred for pre-operative radioisotope imaging showed perfusion losses markedly in excess of regional ventilation impairment, a finding previously reported as being typical for pulmonary thrombeembolism.


Clinical radiobiology of low dose-rate radiotherapy. Investigative irradiations of human skin have shown that the total dose required to obtain a dry desquamation does not increase with the duration of the irradiation as rapidly as it would be expected from the kinetics of repair of the sublethal injuries. This suggests that an additional mechanism, probably accumulation of the cells in a sensitive phase, occurs during a continuous irradiation with dose-rate higher than 150 rads/hour. This effect seems to vanish at smaller dose-rates.


A new design policy for protective barriers in departments of x-ray diagnosis. In order to calculate the thicknesses of protective barriers requried in departments of radiodiagnosis for walls, floors, ceilings, protective screens, etc., it is necessary to make an assessment of work load and occupancy factor in each direction. In order to ensure that barriers are safe, it is customary to assume that all the radiological procedures are carried out at the greatest kVp value used in the room in question, and to look up the necessary thicknesses from prepared tables. In fact, only a small fraction of work load is carried out at the highest kilovoltage, and also it is found that a considerable fraction of the total work load is directed downwards. A computer program has been written to use data available from comprehensive analyses of work load broken down into suitable kVp intervals. As the cost of providing the necessary protective barriers can be anything from a few hundred pounds to several thousand pounds, the use of exact values for work load separated into kVp ranges for each direction can lead to substantial savings in cost amounting to hundreds of pounds per room whilst still satisfying the requirements of the Code of Practice for the Protection of Persons against Ionizing Radiations arising from Medical and Dental Use (HMSO, 1972). Departmental surveys were carried out to establish the distribution of work load in kVp and direction, and also to ascertain dosage levels to the staff and within existing rooms. The results show that in practice the doses are such that the reduced barriers found by the method described would be entirely satisfactory.


Technical note. Evaluation of a new screen/film combination. The Trimax system offers film/screen combinations which reduce the X-ray exposure by factors of about 4. This is achieved without deterioration in image quality.


Multiple lower lumbar spondylolyses.

Multiple lower lumbar spondylolyses. A case is reported in which there was bilateral spondylolysis involving LV3, LV4 and LV5. It is thought that the condition is due to postural stress in a patient having a predisposing genetic weakness of the pars interarticularis.


In vitro studies of subcalyceal upper urinary tract muscle in multicalyceal kidneys. Isolated preparations of porcine renal pelvis and ureter were investigated by an isometric technique. The majority of pelvis muscle preparations exhibited spontaneous activity as did those taken from the upper two-thirds of the ureter, whilst lower-third ureteral specimens remained inactive. By the use of some autonomic drug agonists and antagonists the presence of alpha-adrenoceptors and muscarinic receptors was demonstrated at all sites. Evidence of beta-adrenoceptor activity was noted in pelvis muscle and also in preparations from the upper two-thirds of the ureter. Results of electrical stimulation experiments with similar preparations were shown to be against the concept of any effective innervation of these receptor sites. These findings are compared with earlier studies on the calyx of the same animal, and are discussed in relation to the possibility of the calyx acting as a primary pacemaker site for the upper urinary tract in animals with multicalyceal kidneys.


Conservative management of renal tuberculosis. The conservative management of 60 patients suffering from renal tuberculosis is reported. Following chemotherapy, bacteriological conversion to negative was obtained in all patients. 2 patients (3-3%) relapsed due to failure to take adequate treatment. Evidence of ureteric obstruction was obtained in 30 patients (50%)--23 at the time of diagnosis, 6 during treatment and 1 at the time of relapse. Following corticosteroid treatment relief of obstruction was obtained in 72%. Nephrectomy was carried out in 4 patients (6-7%) but in only 1 of these was the operation carried out for reasons which we now consider valid.


The diagnosis of renal pseudotumours.

The diagnosis of renal pseudotumours. The radiological features of 13 cases of renal pseudotumour due to infolding of the columns of Bertin are presented. 5 of these patients (38%) had partial duplication of the renal pelvis. Pseudotumours show as space-occupying lesions at urography. At angiography they show a clearly defined nephrogram but no abnormal vessels, no pooling of contrast medium and no early venous filling. Radio-isotope scans on 4 cases of pseudotumour showed uptake at the site of the pseudotumour in contrast to cysts and carcinomas which are known to show diminished uptake.


Hypernephroma with polycythaemia: a postoperative complication. A case of acute renal failure following radical nephrectomy for hypernephroma in a 72-year-old man is presented. It is postulated that this was a direct result of vascular weakness from preoperation treatment of the overdistended vessels by repeated venepuncture over too short a period, with resultant loss of vascular tone.


Trans-uretero-ureterostomy: British experience. 158 replies to a questionnaire suggest that many British surgeons remain wary of using trans-uretero-ureterostomy, fearing to risk the opposite ureter and kidney or preferring to use a Boari flap or other operation. 141 (27 personal and 114 reported) cases are surveyed. 56 simple Y-anastomoses performed by 27 surgeons gave very good results, with only 4 exceptions due to wrong indications or techniques. Complications were rare. No damage to any opposite ureter or kidney by the procedure was reported. 10 operations enabling a solitary kidney to drain via the opposite spare ureter were all successful. We recommended that during nephrectomy any spare healthy ureter should be preserved so that, if necessary, it can be used to drain the opposite kidney.


Antireflux ureterocystostomy at the vertex of the bladder. This is the first report on the technique and the results of an antireflux ureterocystostomy in the vault of the bladder. During the last 3 years, a total of 106 antireflux ureterocystostomies at the vertex of the urinary bladder has been performed. In 93 cases without another preceding antireflux operation, only 2 (2-1%) recurrent refluxes were found, whereas in 13 cases where an antireflux operation had been performed previously, 4 cases of recurrent reflux were seen, making a 30% rate of operative failure in this particular group. In all other cases the end result was excellent; the urine has become negative on culture and the dilatation of the ureter has subsided.


Ureteric obstruction due to urine prolapse. 2 cases of ureteric obstruction due to uterine prolapse are reported, one of whom was uraemic. Both were cured by repair of the prolapse.


The effect of chlorhexidine irrigation of the bladder in the rat. Rats' bladders were irrigated with aqueous solutions of chlorhexidine digluconate 1 : 5,000 or 1 : 10,000 for varying periods up to 48 hours. Histologic examination of the bladders showed severe erosive cystitis in a high percentage of cases. It is concluded that chlorhexidine cannot be recommended for prolonged irrigation of the bladder or for instillation during the intermittent catheterisation where chlorhexidine has repeated and prolonged contact with bladder mucosa.


Urinary infection and prostatectomy.

Urinary infection and prostatectomy. The incidence of urinary infection before and after operation for benign prostatic hypertrophy has been reviewed in 140 patients. Repeated screening for bacteriuria was used throughout the hospital admission. Infection was present in 24% before operation and there was a significant correlation between the incidence of infection and the duration of preoperative catheterisation. Postoperative infection developed in 31% and there was no relation between this incidence and the type of prostatectomy; specific antibacterial therapy was significantly more effective in eradicating urinary infection acquired after operation than before. At the time of discharge from the ward, 10% had infected urine, but only 3% of patients had persistent infection at follow-up 6 weeks after operation.


The structure and innervation of smooth muscle in the wall of the bladder neck and proximal urethra. Neurohistochemical and electron microscopic techniques have been employed to compare the structure and autonomic innervation of the bladder detrusor with that of the bladder neck and urethra in male and female cats, rats and guinea-pigs. In all specimens the structure and arrangement of smooth muscle in the detrusor was different from that in the bladder neck and proximal urethra. In male specimens this circular smooth muscle extended into the proximal urethra as far as the entrance of the ejaculatory ducts. A similar muscle coat was less well developed in the female but could be identified along the length of the urethra. Differences in the distribution of autonomic nerves have also been demonstrated. Presumptive cholinergic nerves were frequently encountered amongst the smooth muscle cells of the detrusor whilst noradrenergic nerves were relatively sparse. In contrast, muscle in the bladder neck and urethra was richly innervated by both types of autonomic nerve. In the male these findings are considered to provide support for the concept of a sphincteric mechanism which prevents retrograde ejaculation. In both sexes the possible functional role of the autonomic innervation of the bladder neck and proximal urethra during micturition has also been discussed.


Role of uroflowmetry in the assessment of lower urinary tract obstruction in adult males. A group of 173 prostatic patients were submitted to a prospective study to determine the respective value of symptoms, uroflowmetry, endoscopic and radiological findings in the assessment of the degree of urinary obstruction. Uroflowmetry proved to bring objective evidence of the degree of obstruction with a reasonable degree of accuracy. Maximum urinary flow appears to be more accurate than other flow parameters in the determination of lower urinary tract obstruction.


Measurement of the volume of residual urine using 131I-hippuran and the gamma camera. A modification of the method of determining the volume of residual urine in the bladder using 131I-Hippuran and the gamma camera is described. The method was applied to 26 patients with either normal or impaired renal function and proved to be both reliable and accurate.


The surgery of thyroid cancer.

The surgery of thyroid cancer. Thyroid cancer accounts for just under 1 per cent of malignant disease. The prognosis varies from excellent with papillary carcinoma in young people to very poor in anaplastic carcinoma in the elderly. Modified rather than radical dissection of lymph nodes is indicated with well-differentiated tumours. The level of calcitonin in the blood is a sensitive marker for medullary carcinoma occurring either as sporadic or familial disease. The outcome of management in 7 patients with medullary carcinoma indicates that the prognosis is variable and that thyroidectomy is effective treatment.


The aetiology and diagnosis of malignant tumours of the thyroid gland. Known aetiological factors of thyroid tumours are: genetic, hormonal, irradiation and auto-immune thyroiditis. Some medullary carcinomas are familial. Thyroid-stimulating hormone plays a significant part in the initiation and maintenance of many well-differentiated thyroid carcinomas. Small doses of irradiation in childhood and probably also in adolescence may induce a papillary or follicular carcinoma. Some malignant lymphomas develop in a previous auto-immune thyroiditis. Diagnosis of a malignant thyroid tumour is usually obvious once there has been extrathyroidal spread. Intrathyroidal tumours are suspect if they are hard and irregular. The real diagnostic problem is the clinically solitary nodule which is smooth, firm and mobile in a euthyroid patient. Ultrasound and scanning may increase or decrease the suspicion of malignancy but excisional biopsy is the only certain diagnostic procedure.


Gram-negative septicaemia in surgical practice. Septicaemia in surgical patients usually occurs after operation or a manipulative event. The incidence of bacteraemia in one surgical unit was observed over a 7-year period. Gram-negative infections occurred three times more frequently than bacteraemia caused by Gram-positive bacteria. The clinical features of septicaemia, the portals of entry of the infection and the bacteria isolated from blood cultures are described.


The value of the radio-isotope hepatogram in the jaundiced patient. The distinction between 'medical' and 'surgical' jaundice is often difficult due to the lack of specificity of biochemical liver function tests, and the difficulty in assessing hepatocellular function and biliary tract patency in the jaundiced patient. We present a noninvasive isotopic technique which gives reliable information on these parameters, resulting in a high degree of accuracy in the classification of jaundice. 131I Rose Bengal, which is handled by the liver like bromsulphthalein, is administered intravenously and count rates during hepatic uptake and biliary excretion are recorded over the liver, biliary tract and duodenum using a gamma camera/computer system, into which is built an electronic light pen, so that particular areas of interest can be studied. Blood clearance of the iostope is simultaneously measured, and from these data the T 1/2 of uptake, the plasma retention and the excretion quotient are determined. The results of the first 80 examinations show that by qualitative assessment of the uptake and excretory phases of the 'hepatogram' and by determination of the T 1/2 and excretion quotient, jaundice has been classified with an 86 per cent accuracy in cases where the diagnosis is not apparent from clinical and biochemical data. The T 1/2 of uptake correlates well with bromsulphthalein retention in the non-jaundiced patient, and when applied to patients with obstructive jaundice enables the progress of hepatocellular impairment with time to be studied, and its recovery after relief of the obstruction. Preliminary results suggest that the technique may also have applications in the study of biliary tract dynamics in patients with post-cholecystectomy syndromes and relapsing acute pancreatitis.


Observations of gastric mucosal blood flow using 99Tcm in rat and man. The 99Tcm clearance technique is shown to be a useful method of assessing gastric function. It is easily carried out and is relatively non-toxic--the dose of isotope could be reduced to 100 muCi or less without sacrificing the accuracy of the investigation. Although the results are preliminary and the number of cases investigated so far is small, they suggest that the measurement of pertechnetate clearance is directly related to gastric mucosal blood flow; it is a useful parameter of gastric function and may well prove to be a more accurate discriminant in cases of peptic ulceration than the conventional measurement of gastric acid secretion.


Feasibility of screening for breast cancer. The feasibility of screening for breast cancer by clinical examination and X-ray mammography has been studied. The results suggest that a breast screening programme is safe from dangers of irradiation and can be conducted by non-medical staff. The response of women at risk suggests that the service is acceptable to the general public. The hospital service could deal with the additional surgical work.


Sex hormones in breast disease.

Sex hormones in breast disease. Serum concentrations of oestradiol 17beta and progesterone were measured daily throughout one menstrual cycle in 32 normal women, 32 women with benign disease of the breast and 10 women with cancer of the breast. In normal women concentrations varied with age. Women with cysts had concentrations of oestradiol 17beta which were significantly higher than normal. In women with cancer the concentrations of oestradiol 17beta and progesterone were significantly higher than normal, but the difference was very small and much larger numbers of patients need to be studied. Concentrations of oestradiol 17beta and progesterone in postmenopausal women were consistently very low.


Measurement of cell production rates in human gastro-intestinal cancer--a guide to treatment? Cell production rates were measured in 19 cases of rectal carcinoma and in 11 cases of gastric carcinoma using a stathmokinetic technique. These measurements were compared with results from normal rectal and gastric mucosa. It was found that most of the cases of rectal cancer were proliferating more slowly than morphologically normal rectal mucosa. This was true for the majority of gastric cancers, but a small proportion appeared to be proliferating more rapidly. These results are discussed with their relevance to appropriate therapy.


Serum alpha-1-acid glycoprotein as an index of dissemination in breast cancer. Assay of the serum alpha-1-acid glycoprotein (SAGP) produced by the liver in response to many disease states is shown to reflect prognosis and monitor progress in patients with early, recurrent and disseminated breast cancer. Eighteen of 26 patients with localized breast cancer and positive bone scans had elevated SAGP when first seen, but within 5 months of treatment 5 further patients with positive bone scans developed an elevated SAGP. Furthermore, an initially abnormal SAGP level became normal within 5 months in 5 of 6 patients with negative bone scans. While elevated SAGP in breast cancer correlates with positive bone scans, a series of normal values may indicate patients without early haematogenous dissemination of their disease.


The immune reaction to human breast cancer: a comparison of skin and leucocyte migration tests. In vivo and in vitro tests of cellular immunity using autologous tumour antigen have been performed in patients after mastectomy for cancer and in a control group with benign tumours of the breast. Overall, the incidence of positive immune reactions in both groups was 45 per cent. Poor correlation was found between the results of in vivo and in vitro tests, which could not be explained in terms of serum factors. The specificity of the reaction is questioned but the clinical relevance will be determined by long term follow-up.


The internal sphincter and Lord's procedure for haemorrhoids. Anal pressure and motility have been measured in 56 patients with haemorrhoids and 40 asymptomatic subjects. The anal pressure of patients with haemorrhoids (93-6 cm H2O) was very significantly higher than that of the controls (66-8 cm H2O; P less than 0-001). Ultra-slow pressure waves (amplitude 25-100 cm H2O, frequency 0-9-1-6/min) were present in 39 per cent of patients with haemorrhoids, but in only 7-5 per cent of the controls (P less than 0-001). Ultra-slow waves are present under anaesthesia with the voluntary muscles paralysed and are associated with the highest anal pressure, and so, represent abnormal activity of the internal anal sphincter. Measurements after anal dilatation showed complete abolition of ultra-slow wave activity and a very significant drop in pressure. One year after dilatation 19 patients had a mean anal pressure of 62 cm H2O. Very good results were obtained unless the haemorrhoids were so large that they prolapsed at times other than defaecation. Lord's procedure is a rational treatment since it corrects an underlying overactivity of the internal sphincter.


Prolonged symptomatic and radiological remission of colonic gas cysts after oxygen therapy. Colonic gas cysts invariably shrink and disappear and symptoms associated with them resolve if an adequate concentration of oxygen is inhaled over a sufficient period of time. Careful monitoring of inhaled oxygen levels and arterial oxygen tension is necessary to ensure effective therapy. Plain X-ray of the abdomen is the best method of assessing the size and response of the cysts to treatment and for following the patients subsequently. Six consecutive patients managed in this way are discussed and their subsequent progress is documented.


The place of frozen section in the practical management of melanoma. A selective policy is proposed for the use of frozen section in suspected melanoma which provides maximal help while minimizing false frozen section diagnosis. It is based on the fact that suspected melanomas fall into two broad groups which present different problems in diagnosis and management. A raised lesion is likely to be a highly malignant melanoma or a lesion of non-naevoid cells. Differentiation is readily made on frozen section and allows immediate radical excision. A flat pigmented lesion is usually of obvious naevoid origin, and the problem is whether early malignant change has occurred. It is better managed by urgent paraffin section to avoid sampling error. Frozen section has a place in the management of a single doubtful node in a patient being managed by a 'watch' policy.


Recurrence of gastric ulcer after selective vagotomy and pyloroplasty for chronic uncomplicated gastric ulcer: a 5-10 year follow-up. Selective vagotomy and pyloroplasty were used in the surgical treatment of 73 patients with benign gastric ulcer between July 1964 and February 1970. Over the long period of observation recurrence of the gastric ulcer was found in 13 patients (19-1 per cent). This complication occurred equally commonly after treatment of primary and secondary gastric ulcers and was twice as frequent in women as in men. Possible reasons for these recurrences are discussed. It is concluded that vagotomy and pyloroplasty cure benign gastric ulcer in about 80 per cent of patients, and this should be taken into account in the choice of surgical treatment, especially in patients in whom a gastrectomy might put the patient's life at risk. However, because of the high recurrence rate, it is doubtful whether this operation should be considered the treatment of choice for all cases of gastric ulcer.


The effect of the size of the gastric outlet on gastric emptying after vagotomy for duodenal ulcer. Gastric emptying of isotopically labelled solid meals was studied in normal human subjects and in 30 patients who had had an operation for chronic duodenal ulcer. Each patient had a vagotomy of the whole stomach combined with either a Finney pyloroplasty to produce a large gastric outlet or a Heineke-Mikulicz pyloroplasty to produce a relatively small outlet. At 10-22 days after operation gastric emptying was equally and significantly slowed in both groups when compared with the normal controls. This delay occurred regardless of whether the vagotomy was complete or incomplete. At 4-6 months after operation emptying had returned to normal in the patients who had had a Finney pyloroplasty but remained significantly slowed after Heineke-Mikulicz pyloroplasty. Mild symptoms of gastric stasis frequently occurred in both groups in the early postoperative period, but were rare 4-6 months after operation. There was no correlation between the incidence of these early symptoms of stasis and the size of the gastric outlet constructed.


Intrabiliary rupture of hydatid cyst of the liver. In a series of 136 cases of hydatid disease affecting various tissues and organs admitted to one surgical unit in the Medical City Hospital, Baghdad, and personally studied and treated by the author, the liver was involved in 94 cases (69-1 per cent) and intrabiliary rupture occurred in 15. Pain in the right upper abdominal quadrant associated with tenderness and rigidity, radiating to the back and right, shoulder, was the presenting feature in almost all the patients. Hectic fever was present in 14. Obstructive jaundice developed in all the patients at some stage of the illness, but was complete with clay-coloured stools in only half. Chills and rigors were present in 67 per cent, eosinophilia in 40 per cent, a positive Casoni's test in 87 per cent, itching with urticaria and weal formation in 20 per cent and a palpable mass in the liver in 67 per cent of cases. Operative treatment is mandatory in order to clean the mother cyst of hydatid membranes, debris and daughter cysts, to explore and clear the common bile duct and to ensure free biliary passage to the duodenum. Sphincterotomy is neither necessary nor advisable, and when the gallbladder is not invaded by the cyst it should be preserved.


A rare complication of hydrocele.

A rare complication of hydrocele. A case of multiple stones complicating a hydrocele is presented. Review of the relevant literature has failed to show a similar case. The aetiology of stone formation appears to be obscure.


Experience with 26 reservoir ileostomies. A personal experience of 26 reservoir ileostomies is reviewed. There were no operative deaths, but 3 patients developed non-fatal faecal fistula and 6 patients eventually had their reservoir removed for a variety of reasons. No patient given a reservoir without an intussusception valve was fully continent, but of 15 patients with a reservoir incorporating such a valve who were followed up, 9 enjoyed complete continence, though 2 experienced periodic difficulty with stomal intubation. The indications for this operation are discussed.


The complications of synchronous combined excision for adenocarcinoma of the rectum at St Mark's Hospital. The complications of synchronous combined excision of the rectum for adenocarcinoma in 227 patients were analysed. Urinary retention with infection occurred in 78 patients (34-4 per cent) and was the commonest complication. There was a significant correlation between tumours involving the anterior quadrants of the rectum and urinary complications. Primary suture of the perineal wound with closed drainage was associated with a higher incidence of complications than open drainage. The cumulative risk of a paracolostomy hernia in the sixth postoperative year was approximately 33 per cent. Extraperitoneal colostomy gave some protection against paracolostomy herniation.


An assessment of the value of the white cell count in the management of suspected acute appendicitis. A prospective study of 100 consecutive patients was carried out to determine if a knowledge of the white cell count was a useful factor in determining the correct management of patients presenting with suspected acute appendicitis. A retrospective study of the differential white cell count and neutrophil morphology was performed to see if these investigations would provide more specific aids to diagnosis. These studies show that such haematological information is only of limited supportive value in the total assessment of these patients. Where the clinical findings are at variance with the white cell count, the clinical findings should take precedence.


Comparison of impedance and strain gauge plethysmography in the measurement of blood flow in the lower limb. Simultaneous measurement of the flow of blood in the calf in 24 normal volunteers by impedance and mercury strain gauge plethysmography has revealed a systematic difference in the results from the two methods. Possible reasons for this discrepancy are discussed.


The surgical cure of primary varicose veins. A prime requisite of successful varicose vein surgery is a detailed clinical examination. This reveals a new test for short saphenous incompetence and shows that 14 per cent of varices stem from a saphenopopliteal reflux. The intimate details of juxtafemoral and juxtapopliteal ligation are emphasized and the common causes of failure pointed out. The technique of 'scarless' varicose vein surgery is described. A 6-10-year follow-up of some 2000 patients reveals an overall recurrence rate of 7 per cent.


Bilateral simultaneous rupture of the quadriceps tendons. A case of bilateral simultaneous rupture of the quadriceps tendons associated with intra-tendon diabetic arteriolosclerosis is described.


Loose bodies in the elbow.

Loose bodies in the elbow. This is a retrospective study of 52 patients with loose bodies in the elbow joint. The major cause was osteoarthrosis, accounting for 37 per cent of the cases, and the commonest site was the anterior compartment of the joint. Restriction of elbow extension by 10 degrees or more was the most constant clinical finding. Thirty-three patients were subjected to arthrotomy, with a low complication rate.


Serum thyrotrophin concentration: an unreliable test for detection of early hypothyroidism after thyroidectomy. Three groups of patients who had undergone subtotal thyroidectomy for Graves's disease, toxic multinodular goitre, or euthyroid multinodular goitre 12 to 15 years before and in whom a normal serum thyroxine (T-4) level was found were each divided into two subgroups on the basis of a normal or a raised serum thyrotrophin concentration. There was no difference in mean serum T-4 concentration between patients with normal and those with raised serum thyrotrophin concentrations, and the values were similar to the mean T-4 values of the normal population. The mean serum triiodothyronine values of all groups were higher than normal, but the mean values of the groups with a normal and a raised serum thyrotrophin were similar. After thyroidectomy a mildly raised serum thyrotrophin does not in itself indicate the presence of hypothyroidism.


Silicone foam sponge for pilonidal sinus: a new technique for dressing open granulating wounds. A silicone foam sponge has been used to replace the daily packing of deep granulating wounds with moist sterile gauze. In the treatment of pilonidal sinus use of the sponge demands less nursing time and is more comfortable for the patient than the excision and open granulation technique. Patients can usually return to work soon after operation. The method has many applications in surgery, and widespread application of the technique to the management of granulating wounds could result in considerable savings to the NHS in money and skilled nursing time.


Megaloblastic erythropoiesis and macrocytosis in patients on anticonvulsants. The results of deoxyuridine suppression tests on the bone marrow cells of 14 patients on anticonvulsant drugs, 11 of whom had evidence of megaloblastic erythropoiesis, indicated that the megaloblastic changes and macrocytosis encountered in treated epileptics are often not caused either by folate deficiency or by drug-induced impairment of the 5, 10-methylenetetrahydrofolate-dependent methylation of deoxyuridylate to thymidylate. A folate-related abnormality in the methylation of deoxyuridylate was found in only two of the 11 patients with megaloblastic erythropoiesis.


Survey of general practitioners' attitudes to management of patients with heart attacks. Out of 305 general practitioners sent a questionnaire asking how they would treat three hypothetical patients with heart attacks 231 (76%) replied. Of these, only 179 were prepared to make an unqualified choice of home or hospital treatment for a middle-aged man with an uncomplicated attack, 70 (39%) saying that they would keep the patient at home. Practitioners qualifying before 1960 were more likely to do this than those qualifying in 1960 or later. If a patient declined hospital treatment 161 (70%) of the practitioners would keep him in bed for a week or less, but the date of the practitioners' qualification significantly affected the time they would advise him to remain off work. Faced with a patient acutely ill after a heart attack, 162 (70%) of the practitioners would arrange his immediate admission to hospital and 51 (22%) would send him to hospital after initial treatment at home. The numbers of partners in the practice, the nature of the premises, and the location of the practice in urban or rural areas affected the practitioners' attitude to the management of severely ill patients but not to the management of patients with uncomplicated attacks.


Programmed investigation bed.

Programmed investigation bed. A single programmed investigation bed has become a useful addition to a busy male medical ward. Patients had to wait only a short time before being admitted and their stay was shorter than it would have been before the bed was introduced. The use of the bed requires careful planning and the full co-operation of all medical and nursing staff.


Enhanced antiplasmin activity in acute renal failure. Plasmatic slow plasmin-inhibitor activity was assessed in 20 patients with acute renal failure and 12 controls with the fibrin plate method. The area of fibrinolysis was 250-5 +/- 5 mm2 in the patients and 289 +/- 6mm2 in the controls (P less than 0.001) and was negatively correlated with antiplasmin activity. Thirteen patients had areas of lysis equal to or inferior to the minimal lysis observed in the controls. No correlation was found between antiplasmin activity and serum fibrin-fibrinogen related antigen titres, the presence or absence of disseminated intravascular coagulation, or the causative disease.


Secretion of immunoreactive calcitonin by human breast carcinomas. Twenty-three out of 28 patients with metastatic breast carcinoma and one out of 13 patients with localised disease had raised levels of plasma immunoreactive calcitonin. Monolayer cultures of breast carcinomas maintained for up to 10 weeks released immunoreactive calcitonin, and a primary breast carcinoma passaged in "nude" mice for over a year contained material immunologically and chromatographically resembling the monomeric form of human calcitonin. These studies indicate that breast carcinomas can produce calcitonin and that plasma calcitonin measurements may be useful in staging patients with breast carcinomas.


Observations on the systemic effect of topical clobetasol propionate (Dermovate). Topical application of clobetasol propionate in a strength of 0-05% in cream or ointment (Dermovate) suppressed the hypothalamic-pituitary-adrenal axis in both normal people and patients with diseased skin. In normal people the 9 am serum cortisol level was suppressed when between 45 and 90 g was applied weekly. Insulin stress test results in patients with diseased skin showed an abnormally small response after long-term application of similar amounts. We conclude that long-term administration should be restricted to less than 50 g a week.


Cerebral function before and after carotid endarterectomy. Twenty men had their cerebral function measured preoperatively and three months after carotid endarterectomy using the Halstead-Reitan neuropsychological test battery. Thirteen patients were cerebrally impaired preoperatively, but 12 of them improved appreciably after surgery. Changes in internal carotid arterial blood flow measured preoperatively showed no significant correlation with the improvement in neuropsychological status. We think that carotid endarterectomy carries an even better prophylaxis for the brain as a whole than had been thought.


Contraceptive practice and unplanned pregnancy among single university students. The sexual behaviour and contraceptive practices of a random sample of unmarried university students were compared with those of a group attending the student health service with an unplanned pregnancy. The immediate cause of most pregnancies in this series was incorrect use of a rhythm method. Irregularity of the menstrual cycle may have been a contributing factor in many cases. Psychological factors influencing the desire for pregnancy, while present, were not major contributing causes in many pregnancies.


Access by general practitioners to physiotherapy department of a district general hospital. There has been much opposition, voiced most notably in the Tunbridge Report, to general-practitioner access to hospital rehabilitation services. Co-operation between general practitioners, physiotherapists, and the consultant with responsibility for the physiotherapy department at a general district hospital has provided an efficient open-access service. This service has been welcomed by the general practitioners because it supplies prompt treatment for their patients and by the physiotherapists because it enables them to minimise disability by treating musculoskeletal problems at an early stage.


e Antigen-antibody system as indicator of liver damage in patients with hepatitis-B antigen. The clinical relevance of the e antigen-antibody system was investigated in 61 people persistently positive for hepatitis-B surface antigen, including 22 healthy carriers. The e antigen was not detectable in any of the healthy carriers, whereas it was found in 15 out of 28 patients with chronic aggressive hepatitis and two out of 11 with chronic persistent hepatitis. Its presence therefore indicates chronic liver disease but its absence does not exclude it. It may prove to be a particularly useful prognostic aid in chronic persistent hepatitis, since one of the two patients in whom it was found later developed aggressive hepatitis. In contrast, e antibody is of little diagnostic help, for, though it was found mostly in healthy carriers (18;82%), it was also detectable in 9 (23%) of the patients with chronic hepatitis. In 13 (76%) of the patients positive for e antigen Dane particles were seen on electron microscopy, but these were also present in 5 (19%) of the patients positive for e antibody. These findings are consistent with other evidence suggesting that e antigen is not a surface component of the Dane particle, but rather an independent soluble protein manufactured by the host in response to infection with the hepatitis-B virus.


Does anaemia increase the risks to the fetus caused by smoking in pregnancy? A significantly greater rise in carboxyhaemoglobin concentration in response to smoking a single cigarette was shown in pregnant (3-9% increase) as opposed to non-pregnant (2-1% increase) women. This was more pronounced when anaemia was present (5-0% increase) and appeared to be inversely related to the haemoglobin concentration. We suggest that the risks to the fetus may be particularly increased when anaemia complicates pregnancy in women who smoke cigarettes.


Changes in plasma urate concentration immediately after acute myocardial infarction. The plasma urate concentration of 70 patients with acute myocardial infarction increased progressively up to the seventh day and was significantly higher than in a group of 23 patients with ischaemic changes only. Diuretic treatment might have accounted for an early rise in urate levels but the persistent increase seen at seven days could not be so explained.


Student views on continuous assessment at Birmingham University Medical School. Student opinion on the system of continuous assessment used at Birmingham Medical School was sampled by distributing questionnaires to 621 students in the first four years of the course; 482 questionnaires (78%) were returned. Many comments and criticisms of the system were received but the vast majority of students (92%) said they preferred the present style of assessment to conventional final examinations. These criticisms are discussed and recommendations are made to improve the existing scheme.


Inflicted burns and scalds in children.

Inflicted burns and scalds in children. Ten children who had been burnt and six who had been scalded by parents or those caring for them were seen over three years. In no case did the thermal injury affect more than 5% of the body surface and there were no deaths. In seven the perineum or buttocks were in the burnt area. In 12 children there was evidence of other inflicted injury including six recent fractures. Staff caring for burnt children should be aware of this type of inflicted injury. X-ray skeletal surveys should be carried out in doubtful cases and a case conference initiated with the appropriate social work services to consider supervising the family after the child's discharge or taking legal care proceedings.


Changing status of doctors in Finland.

Changing status of doctors in Finland. This short sociological study discusses the changing status of doctors, in regard to both non-medical administrators and the public. Though based on observations in Finland I also see similar trends in other countries, trends which are associated with rapid social change in the West generally. These developments will lead to changes in the esteem in which a community holds its doctors.


Effects of influx of holidaymakers on an acute medical unit in Cornwall. This paper illustrates the effect of a large influx of holidaymakers on a medical unit in Cornwall. Increasing numbers of visitors are coming to Cornwall and, unless adequate resources are allocated for their efficient medical care, the medical facilities available to the residents will suffer greatly.


Absorption and metabolism of nicotine from cigarettes. Eight men volunteers each smoked a single cirgarette containing 14C-nicotine and gave arterial blood samples during and for 50 minutes after smoking. The maximum concentration of nicotine in the arterial blood ranged from 31 to 41 mug/l in four regular cigarette smokers who inhaled. Two non-smokers achieved maximum levels of 2 and 4 mug/l. On a separate occasion two of the inhalers received 1 mg. 14C-nicotine in 10 divided doses injected intravenously. In both cases the peak arterial nicotine concentrations bore a similar relationship to the intravenous dose, as did the peak nicotine concentrations to the retained doses during smoking.


Plasma renin activity and aldosterone concentration in children. Using semi-micro methods, plasma renin activity (PRA) and plasma aldosterone concentration (PA) were measured concurrently in 79 healthy children aged 1 month to 15 years to establish a reference range. PRA and PA varied inversely with age. Eleven children with renal hypertension had higher PRA and PA than age-matched controls. In contrast, PRA was much greater in 38 saline-depleted children. PA was not uniformly increased in this group and was within the normal range in children with adrenal diseases compared with the high values seen in other salt-wasting states. The findings emphasise the need to relate data from patients to age-matched control values before attempting interpretation and suggest that sodium depletion is a more potent stimulator of renin-aldosterone release than renovascular disease or renal scarring in children. Plasma renin-aldosterone profiles were also valuable in discriminating between renal and adrenal causes of salt loss in childhood.


Idiopathic heart block: association with vitiligo, thyroid disease, pernicious anaemia, and diabetes mellitus. Out of 100 patients with chronic heart block 16 had one or more autoimmune disorders-namely, vitiligo (5,) hypothyroidism (4), Graves's disease (1), pernicious anaemia (2), and diabetes mellitus (9). All these disorders occurred with greater frequency than normal and were more prevalent than in a group of hospital inpatients of comparable age. Autoantibodies were not increased. We suggest that among patients with idiopathic heart block there is a subgroup with multiple autoimmune disorders.


Free erythrocyte protoporphyrin level and nerve conduction velocity in end-stage renal disease. Increased free erythrocyte protoporphyrin concentrations and depressed motor nerve conduction velocities (MNCV) were observed in 45 patients on maintenance haemodialysis. Neither of these findings could be correlated with age, duration or frequency of dialysis, or the degree of uraemia present. A strong negative correlation (r=--0-53; P less than 0-001), however, existed between the free erythrocyte protoporphyrin level and the MNCV, which suggested either (a) a direct effect of iron status on nerve function, or (b) a toxic factor in "uraemia" that depresses both nerve conduction and haemsynthetase activity.


Mortality study of pathologists and medical laboratory technicians. Membership lists of professional bodies were used to establish study populations of British pathologists (1955-73) and medical laboratory technicians (1963-73). The standardised mortality ratio (SMR) for pathologists was 60 and for medical laboratory technicians 67. Twenty-seven of the 310 deaths were due to suicide. These numbers gave SMRs of 250 for pathologists and 243 for medical laboratory technicians. Suicide was the commonest cause of death in female technicians. Access to lethal chemicals at work is a possible factor explaining the high proportion of suicide by poisoning compared with the general population. Suicide rates for pathologists exceed those of all medical practitioners; similary medical laboratory have higher rates than all laboratory technicians. Excess deaths from lymphatic and haemopoietic neoplasms were noted in English male pathologists (observed 8, expected 3-3; P less than 0-01). This difference is not due to Hodgkin's disease or leukaemia and remains unexplained. No other neoplastic diseases were noted as causing excess mortality in either occupational group but a small, possibly spurious, excess number of deaths was noted for aortic aneurysm in male pathologists (observed 4, expected 1-8).


200 injuries caused by playground equipment. Two-hundred children with injuries caused by playground equipment were studied. Whereas only about 9% of the total casualty attendances are for fractures, 26-5% (53) of these children had fractures. The climbing frame and the slide seemed to be associated with more severe injuries than the swing or other equipment, but more cases need to be studied to confirm this. The youngest children were at particular risk on equipment such as the wooden rocking horse or roundabout, when the speed of operation could be controlled by older children. Many of the injuries to the very youngest children occurred when they were walking behind a moving swing. Faulty equipment did not seem to be a major factor in causing accidents, but the use by older children of apparatus designed for young ones led to accidents. There was supervision, either at home, in a school playground, or in a park, in 62% of the cases. Many of the accidents were the result of the normal desire of children for experimentation and adventure.


Recurrent sigmoid volvulus in young people: a missed diagnosis. In nine young patients with recurrent attacks of sigmoid volvulus there was a long delay before a correct diagnosis was made, yet volvulus was indicated in most of them by a well-taken history. All were treated successfully by excision of the redundant colon. This condition is not as uncommon in young people as was thought.


Metal sensitivity in patients with joint replacement arthroplasties. A high incidence of unexpected metal sensitivity was found in patients with metal-to-metal (McKee) hip arthroplasties. Patients with metal-to-plastic (Charnley) prostheses had no greater incidence of metal sensitivity than a control group awaiting operation. If metal sensitivity does occur loosening of the prosthesis may be a complication.


Incidence of metal sensitivity in patients with total joint replacements. Sensitivity to chromium, cobalt, nickel, molybdenum, vanadium, and titanium was studied by patch tests in 50 patients who had received total joint replacements. Nineteen (38%) were sensitive to one or more of the metals. In 23 patients non-traumatic failure of the prosthesis had occurred, and 15 of these patients were sensitive to metal. Out of 27 patients with no evidence of prosthesis loosening, four were sensitive to nickel and cobalt or nickel only. Dermatological reactions occurred in 13 patients after surgery; in only eight, however, was there evidence of metal sensitivity. These findings indicate that metal-on-metal total joint replacements may sensitise the patient to metals contained in the prosthesis. Although there is a high incidence of prosthesis failure among metal-sensitive patients it remains uncertain whether the loosening causes the sensitisation or vice versa.


Acute cardiomyopathy with rhabdomyolysis in chronic alcoholism. Of five chronic alcoholics with acute skeletal muscle necrosis (rhabdomyolysis) three developed acute heart failure with disturbances of rhythm and conduction. Symptoms came on abruptly after a period of intensified drinking. Myocardial infarction, thiamine deficiency, and cobalt intoxication were excluded. Probably the whole spectrum of muscle disease in chronic alcoholism may be commoner than has been suspected.


Peripheral paediatric clinics: survey and medical audit. The work of the paediatric clinics in nine general-practitioner hospitals in country towns in the Bath Health District during 1972 was analysed with respect to the pattern of referrals and methods of management. It is concluded that no child suffered harm from being seen in a clinic without full laboratory and x-ray facilities. Nearly 98% of the consultations were deemed, even with a long period of hindsight, to have been completely satisfactory. The tremendous benefit to the patients and their families of being seen in a hospital near their home is not bought at the cost of a second-rate medical service.


Problems in distinguishing tuberculosis of bowel from Crohn's disease in Asians. The cases of five immigrants with definite or almost certain intestinal tuberculosis are described. Because of the clinical, pathological, and radiological features all were thought as some time, often for long periods, to have Crohn's disease. Recommendations are made for medical and surgical treatment.


Prevalence of gall stones in Dundee: a necropsy study. Necropsy records from two large general hospitals in Dundee showed short-term fluctuations in the prevalence of gall stones that had not previously been described. There was no evidence of a rise in the standardised prevalence rate between 1902-9 and 1953-73. A spurious increase was apparent from the crude prevalence rates for these periods, which resulted simply from the increased age of the patients in the later period. Since there was no real increase in prevalence no conclusions can be drawn about dietary or other changes. Patients with stones in the common bile duct were likely to die from an associated cause. This related mainly to a high mortality rate in women. In patients with established epilepsy the prevalence of gall stones was greater than expected, which suggests that phenobarbitone does not diminish the likelihood of gall stones.


Hospital discharge reports: content and design. The information required by family doctors on initial and final discharge reports from hospitals was specified and 546 such reports from hospitals in Aylesbury, Amersham, Banbury, Oxford, and High Wycombe were reviewed for the availability and accessibility of important information. Several items could have been recorded better, including the name of the hospital, the specialty (or department) concerned, and the name of the consultant in charge of the case. Drug reactions seemed to be under-reported in the initial discharge reports and information about treatment on discharge was inadequate. The recording of the prognosis and information given to the patient was deficient and communication on follow-up needs to be improved. The use of obscure abbreviations was widespread. There is room for improvement in the ease of access to important information, especially the diagnostic assessment, and the time taken for final reports to reach the general practitioner.


Surgical instruments and dressings: an information service. A regional information service on surgical equipment, instruments, and dressings is proposed that would be staffed by information scientists. It would appreciably reduce the time spent on administration and make the buying of equipment more efficient. Such a service could be extended to all health service staff.


Changes in breast volume during normal menstrual cycle and after oral contraceptives. The volume of the left and right breasts was measured daily in four nulliparous women during normal menstrual cycles and after the use of oral contraceptives. Breast volume increased significantly in the second half of both normal and contraceptive-controlled cycles. The mean total change in volume throughout the cycle was 100 ml under natural conditions and 66 ml on oral contraceptives.


Role of pelvimetry in active management of labour. All cases referred for pelvimetry in 1970-1 and all breech presentations referred for pelvimetry in 1972-4 were reviewed. Indications for pelvimetry fell into four main categories: high head in the antenatal clinic (47-8%); high head in labour (13-9%); breech presentation (20-9%); and previous caesarean section (14-8%). In the first two categories pelvimetry rarely if ever influenced management, and it should not be performed routinely. In breech presentation and cases of caesarean section pelvimetry seemed to be of value, but in the latter group it should be performed puerperally to avoid the known radiation hazard to the fetus. A fairly close correlation between obstetric conjugate and pelvic capacity was shown, which suggested that a 3400-g baby might pass through a pelvis of obstetric conjugate of 10 cm as a cephalic trial of labour, but would need an obstetric conjugate of 11-7 cm for safe vaginal breech delivery.


Histories obtained by two-stage questionnaire with automated transcript in specialist gynaecological practice. A two-stage questionnaire which the patient completes at home has been developed for use by gynaecological outpatients. The first stage (root) identifies the patient's problem and obtains general background information. The second stage (branch) deals with the presenting problem in depth. The system has proved highly acceptable to patients. At the clinic a non-medical assistant uses a programmed typewriter to transcribe the data into a typewritten history which is handed to the doctor before he examines the patient. The transcript compares favourably with the conventional hand-written history in content, ease of assimilation, and cost. While the questionnaire itself is an excellent means of collecting information it becomes an efficient means of transmitting information to the clinician only when combined with the transcript facility. There is no storage of confidential information and no scope for unethical disclosure.


The clinical psychologist in a health centre: one year's work. The Livingston integrated health services project is an attempt to provide a fully integrated area health service with special emphasis on developing multidisciplinary community health teams. As part of this experiment a clinical psychologist was appointed to work in general practice. Ninety-four patients with behavioural, emotional, and cognitive problems were referred in the first year (1% of the 10 000 patients registered at the practice). The psychologist thus provided treatment for some patients who would otherwise have been seen by a general practitioner with neither the time nor the training to deal adequately with their problems.


Laminar thermocoagulation of the visual cortex of the rat. I. Interlaminar connections. Lesions were made in the visual cortex of hooded rats by laminar thermocoagulation and later examined using modifications of the Fink-Heimer method. Following lesions limited to supragranular layers a dense, descending projection to layer V was identified, as well as a probable projection to deep layer III, callosal and cortico-cortical projections, but no subcortical projections. The morphological changes in the degenerating systems were examined as a function of survival time. The anatomical basis of functional derangement related to superficial lesions of visual cortex was discussed.


Laminar thermocoagulation of the visual cortex in the rat. II. Visual pattern discrimination. Hooded rats were trained on a series of four visual discrimination tasks in a Y-maze, and subjected to a variety of posterior cortical lesions. In 17 animals this consisted of an extensive aspiration lesion contralateral to a more superficial lesion made by laminar thermocoagulation and centered over the striate area. After operation the animals were tested on the same problem series. The behavioral deficit in this group varied with the extent and depth of the thermal lesion, and six animals with very superficial thermal lesions displayed an isolated difficulty in solving an encircled triangle problem. This deficit seemed to be referable to widespread involvement of supragranular cortex, and specifically of layer I of area striata which receives an input from the nonspecific thalamocortical afferents. The possible influence of various interlaminar projections upon underlying vertically-oriented cell columns as a mechanism for the mediation of 'selective attention' was discussed.


Projections of the trapezoid body and the superior olivary complex of the Kangaroo rat (Dipodomys merriami). Glass micropipettes filled with 2 M sodium cyanide were used to physiologically locate and iontophoretically damage the nucleus of the trapezoid body (NTB), the medial superior olive (MSO), and the lateral superior olive (LSO). Mechanical lesions were made in the trapezoid body as it leaves the cochlear nuclei. After a 3- to 10-day survival time the projections and terminal degeneration were traced with the Fink-Heimer and Nauta-Gygax stains. The ventral cochlear nucleus (VCN) projects via the trapezoid body to ipsilateral LSO, ipsilateral preolivary nuclei, ipsilateral lateral and a contralateral medial dendritic fields of MSO, and contralateral NTB; there is also a small ipsilateral projection to the ventral nucleus of the lateral lemniscus (VNLL) and the central nucleus of the inferior colliculus (CNIC). Some trapezoid body fibers ascend via the contralateral lateral lemniscus to VNLL, DNLL (dorsal nucleus of the lateral lemniscus), and CNIC. There is no projection from the ventral cochlear nucleus to the ipsilateral NTB and contralateral preolivary nuclei. All portions of NTB project ipsilaterally to LSO (ventral NTB to dorsomedial LSO, dorsal NTB to ventral LSO) and to the retro-olivary nucleus. In two animals with NTB lesions there is also degeneration in the ventromedial portion of the ipsilateral facial nucleus. NTB projects contralaterally by way of the stria of Monakow to the pyramidal and molecular cell layers of the dorsal cochlear nucleus (DCN). The NTB does not project ipsilaterally to MSO, preolivary nuclei, VNLL, DNLL and CNIC. Contralaterally there are no projections to any of the nuclei of the auditory pathway except the DCN. Most MSO projections are ipsilateral. The densest goes by way of the lateral lemniscus to the lateral aspect of the ipsilateral CNIC, terminating throughout its dorsoventral axis. MSO also projects bilaterally to the pyramidal and molecular cell layers of dorsal cochlear nucleus (DCN), and ipsilaterally to the ventral portion of the motor nucleus of V and to the facial nucleus. MSO does not project ipsilaterally to the LSO, NTB, preolivary, VCN and retro-olivary nuclei. On the contralateral side, all structures except the DCN are free of projection patterns from axons originating in the MSO. LSO projects bilaterally to the central and ventral portions of CNIC and to the nuclei of the lateral lemnisci, and ipsilaterally to the large and small spherical cell areas of anterior ventral cochlear nucleus (AVCN) and to all portions of DCN. The LSO does not project ipsilaterally to the NTB, MSO, preolivary and retro-olivary nuclei. On the side opposite, this nucleus does not project to NTB, MSO, retro-olive, VCN, preolivary and LSO. For all lesions regardless of the site, there is no degeneration found rostral to the CNIC. The medial geniculate body or other structures in the diencephalon or cortex are free of any fields of terminal degeneration.


Repetitive vocalizations evoked by electrical stimulation of avian brains. IV. Evoked and spontaneous activity in expiratory and inspiratory nerves and muscles of the chicken (Gallus gallus). The activity in respiratory nerves and muscles in response to electrical stimulation of vocal substrates in the brain and to CO2 stimulation of the respiratory centers was studied in 28 adult chickens. It was found that the same nerves and muscles were active during both vocalization and respiration. Stimulation of vocal substrates resulted in short latency bursting in the expiratory nerves and muscles. As stimulation intensity increased, progressively longer duration bursts composed of numerous subbursts were produced. By relating muscle activity with sound production , such bursting was shown to underlie evoked vocalizations. Background activity in inspiratory nerves and muscles continued uninterruptedly past stimulus onset only stopping when expiratory activity began. Thereafter inspiratory bursting reciprocated with expiratory bursting and was shown to underlie the intervals between vocalizations. The pattern of activity which was evoked by stimulating vocal substrates was found to strongly interact with the pattern of activity evoked by CO2 stimulation of the respiratory system. Simultaneous records of respiratory and tracheal muscles demonstrated that the same information was sent to both groups of muscles during evoked vocalization. Activity in the respiratory muscles was recorded during spontaneous vocalization of a free-moving bird and was found to resemble that recorded from anesthetized birds. Finally the activity of single units in the obex region of the medulla was recorded during electrical stimulation of vocal substrates and during CO2 stimulation of the respiratory system. Rhythmically active units were found only in the medulla. Unit activity paralleled that found in the nerves and muscles. On the basis on the data accumulated, two models of the chicken vocal system are presented. The first is a model of the sound-producing structures of the chicken. The second is a model of the neural machinery which controls the sound-producing structures. The two models are used as a basis for an explanation of the production of voclizations by the chick of the same species.


Bilateral sensory neglect following midsagittal reticular formation lesions in cats. We have observed that midsagittal reticular formation lesions in cats produce bilateral deficits in attention to and localization of various sensory modalities. To correlate these changes with previously reported changes following lesions in other areas of the brain, we propose the existence of two interdependent inhibitory pathways which originate in the frontal lobes.


Nerve-impulse patterns: a quantitative display technique for three neurons. A scatter diagram is described that displays the relative timings of nerve impulses in 3 simultaneously monitored neurons. The technique is a generalization of the cross-correlation histogram for two impulse trains. The time intervals between impulses in different neurons are plotted on triangular coordinates to yield a Joint Impulse Configuration Scatter Diagram. The resulting 'snowflake' plot shows a pattern of spots and lines, which is interpretable in terms of the functional circuitry among teh neurons. Illustrations are given of the snowflakes produced by a variety of three-neuron circuits, which may serve as a preliminary catalog of snowflake types for interpretation of experimental data.


On the role of central program and afferent inflow in the control of scratching movements in the cat. Rhythmical scratching movements of the hindlimb were evoked in decerebrate and decapitate cats by stimulation of C1-C2 segments of the spinal cord. Movements of the limb and electrical activity of its muscles were recorded. All muscles were divided into two groups according to their activity. Muscles of the first group supported the limb in a propriate position; they were active during most of the cycle and relaxed during small intervals when muscles of the second group contracted. A deafferented limb was also capable of rhythmical scratching movements with approximately the same cycle duration. However, after deafferentation, the mean position of the limb changed and the amplitude of oscillations increased. This is due mainly to decreased activity of the first group muscles. In curarized preparations, stimulation of C1-C2 segments evoked a rhythmical process within the lumbosacral spinal cord ('fictive' scratching) with a cycle duration nearly the same as in normal scratching. Electrical activity of the muscle nerves during 'fictive' scratching resembled that of corresponding muscles during normal movements. 'Fictive' scratching could be easily elicited provided that the limb was put in a position similar to that of normal scratching.


Denervation supersensitivity in the cholinergic septo-hippocampal pathway: a microiontophoretic study. The purpose of this study was to determine whether denervation supersensitivity could be produced in an identified cholinergic pathway in the CNS of the rat. The mechanism for the development of this phenomenon was also explored. Cholinergic denervation of the hippocampus was accomplished by lesions of the medial septum. The response of hippocampal pyramidal cells to microiontophoretic application of acetylcholine (ACh) and carbachol in lesioned and unlesioned animals was determined by extracellular recording. There was a marked increase (6 X) in sensitivity to ACh 2-43 days following lesions. However, there was no increase in sensitivity to carbachol or glutamate. Other workers have shown that septal lesions cause a large decrease in hippocampal acetylcholinesterase (AChE) which is located mainly presynaptically. The absence of increase in sensitivity to carbachol, a cholinomimetic resistant to hydrolysis by AChE, suggests that the postlesion increase in sensitivity to ACh results from a decrease in its inactivation by AChE. A time course for the development of ACh supersensitivity was found to be similar to the time course of AChE loss previosly reported. Experiments using physostigmine, an AChE inhibitor, demonstrated that inhibition of AChE can potentiate the effects of ACh in unlesioned preparations, but not in lesioned preparations. We conclude: (1) denervation supersensitivity to ACh occurs in the septo-hippocampal pathway; and (2) the supersensitivity is probably due to decreased inactivation of ACh by AChE. The results suggest that presynaptic AChE plays a significant role in modulating the neurotransmitter function of ACh in the septo-hippocampal pathway.


Topographical study of the distribution of gamma-aminobutyric acid (GABA) in the human substantia nigra. A case study. The topographical distribution of gamma-aminobutyric acid (GABA) in the substantia nigra of a 28-year-old male 4 h after death was investigated. In a preliminary study the entire substantia nigra was dissected from transverse sections. The results showed that there was no correlation between the GABA concentration and the number of melanin-rich nigral cell bodies. This was especially so in the rostral third of the substantia nigra. Using the method of Miyata and Otsuka, transverse sections (150 mum) of the rostral, middle and caudal substantia nigra were cut into 500 mum X 500 mum square blocks which were assayed for GABA by an enzymatic method. In the rostral substantia nigra the GABA distribution was markedly uneven. The highest concentration of GABA was found in the pars reticulata. Within the pars reticulata the highest levels of GABA clearly occurred in two separate regions, a medial and a lateral. In the middle and caudal substantia nigra the GABA distribution was again uneven; however, the highest GABA levels were divided between the pars reticulata and the pars compacta. The results support the view that in the substantia nigra the greatest part of the GABA content is due to the presence of striato-nigral nerve terminals which are known to synapse with the dendrites of the substantia nigra dopamine neurons. In the rostral substantia nigra the concentration of GABA within the pars reticulata is in keeping with the presence of dendrites of such neurons in this region. Presumably on this basis it can be assumed that in the middle and caudal substantia nigra the dendrites are oriented in a more rostro-caudal direction.


Role of neocortex in binsural hearing in the cat. I. Contralateral masking. Cats with earphones were trained with a shock avoidance procedure to detect the occurrence of 1 kHz tone pulses at one ear while continuous noise pulses were simultaneously presented to the opposite ear. For normal cats the presence of the noise produced a mean increase of 5.4 dB in the thresholds for detection of tones at the opposite ears. After large unilateral auditory cortex ablations the same cats exhibited an asymmetry between the ears in the size of the contralateral masking effect. There was a mean increase of 10.9 dB in the detection thresholds for tones at the ear contralateral to the damaged hemisphere when noise was presented to the ear opposite the intact hemisphere. Noise of the same physical intensity when presented to the ear contralateral to the damaged cortex produced no significant changes from the preoperative masking levels. Subsequent ablation of the auditory cortex of the opposite hemisphere resulted in a cancellation of the unilateral lesion effect; the cats exhibited interaurally symmetrical masking levels of the same magnitude as those observed prior to the first operation. Additional control tests indicate that the unilateral lesion effect is a central nervous system phenomenon and is specific to lesions of auditory cortex.


Visual discrimination between spatially separated stimuli by cats with lesions of the superior colliculus-pretectum. (1) This study was designed to test the ability of cats with lesions of the superior colliculus-pretectum to discriminate between stimuli which are widely separated in space. (2) Intact cats and cats learning or relearning after lesions of the superior colliculus-pretectum, were trained on light-dark (LD) and horizontal-vertical stripe (HV) discriminations in a V-maze, where the stimuli were widely separated in space, or in a divided straight maze, where the stimuli were side by side. (3) Two types of errors were scored: door-push errors when the cat pushed open the incorrect door; alley-entrance errors when the cat entered the incorrect alley, but turned and entered the correct alley without having pushed the incorrect door. (4) In the V-maze as well as in the straight maze, cats with lesions of the superior colliculus-pretectum achieved criterional performance by alley-entrance and door-push scoring on LD and HV discriminations. Thus, cats with lesions of the superior colliculus-pretectum can locate or orient to widely separated visual stimuli well enough to discriminate between them from a distant choicepoint. (5) Cats with lesions of the superior colliculus-pretectum generally committed a larger number and higher percentage of alley-entrance errors during learning than unoperated cats in either maze. However, commission of alley-entrance errors was not further increased in the V-maze, where the stimuli were widely separated in space. (6) All unoperated cats committed alley-entrance errors as well as door-push errors suggesting that commission of alley-entrance errors may reflect a normal process in two-choice learning.


Serotonin nerve terminals in adult rat neocortex. Axonal processes which take up and retain exogenous tritiated serotonin ([3H]5-HT) have been demonstrated in the fronto-parietal cortex of adult rats, by means of high resolution radioautography. Prolonged topical superfusion with relatively high concentrations of ([3H]5-HT allowed detection of a maximal number of axonal reactions in the upper 3 layers of cortex. Comparison of results obtained from normal rats and animals pretreated with 6-hydroxydopamine or bearing midbrain raphe lesions established the specificity of this labeling. All reactive axons seemed to arise from the serotonin nerve cell bodies in groups B7 and B8 of Dahlström and Fuxe15. In electron microscope radioautographs, the serotonin fibers appeared as tenuous, naked axonal processes (0.1-0.5 mum in diameter) exhibiting small enlargements (0.7 mum in mean diameter) spaced at frequent intervals (1-3 mum). These boutons contained occasional mitochondria, small, round, agranular 'synaptic' vesicles and large granular vesicles. With axons, [3H]5-HT was concentrated in the boutons, and to a much lesser extent in connecting segments. This reactive pattern resembled that revealed by the fluorescence technique for endogenous serotonin. Preferential accumulations of the tracer by mitochondria and vesicular organelles indicated that these elements could sequester exogenous serotonin. Large granular vesicles were not necessarily visible in random thin sections of the labeled varicosities, and thus could not serve as the unique criterion for electron microscopic identification of 5-HT terminals. Moreover, these organelles are known to be present in other types of nerve endings. Topometric analysis of serial thin sections nevertheless demonstrated that large granular vesicles were potentially detectable in every 5-HT containing bouton, and also enabled extrapolation of their average number at 7 per varicosity. This low number makes it unlikely that large granular vesicles primarily represent storage sites. They could rather serve as a carrier for particle-bound enzymes essential to the local metabolism of serotonin or its precursors. A very small fraction of the serotonin varicosities exhibited the membrane differentiations of typical synaptic terminals. Extensive sampling in serial thin sections revealed junctional complexes in only 5% of labeled boutons, as opposed to 50% of unlabeled nerve endings in the surrounding neuropil. The data do not preclude the possibility that other monoaminergic neurons also share similar characteristics. It is probable that endogenous serotonin can be liberated from all axonal varicosities including those lacking strictu senso synaptic relationships. The overall configuration and ultrastructural features of cortical serotonin fibers suggest intrinsic dynamic properties which could assume particular significance in terms of function, plasticity and regrowth.


Effect of penicillin on an excitatory synapse. When penicillin, an epileptogenic agent, was applied to the neuromuscular junctions of the superficial flexor muscles of crayfish, the excitatory junctional potential (EJP) amplitudes were increased by 50-200%. This effect of the drug was not due to changes in the passive electrical properties of the muscle cell membrane or to an increase in its chemical sensitivity to acetylcholine (ACh), the presumed transmitter at the junction studied. Inactivating the penicillin with the enzyme penicillinase, or substituting acetate for penicillin in the test solutions eliminated the effect on EJPs, showing that the penicillin ion was the active agent. Penicillin ions did decrease the frequency of spontaneous miniature EJPs and increase the amplitude or presynaptic spikes recorded extracellularly, suggesting that augmentation of EJPs may have been due to alterations at the presynaptic nerve terminals.


Effects of vagotomy on the distribution of cholinesterases in the cat medulla oblongata. Histochemical study of the distribution of cholinesterases in the cat medulla oblongata reveals that all neurones in the dorsal motor nucleus of the vagus (DMV) contain true cholinesterase (AChE) but, while most contain this enzyme alone, a small proportion of cells contain pseudocholinesterase (BuChE) as well. Cervical vagotomy affects the two types of cell to different degrees of severity. The BuChE-containing neurones lose their enzyme completely within 2-3 weeks and they atrophy and disappear as a result of the operation. On the other hand, the reaction is less severe and is reversible in those cells containing AChE only. Vagotomy also causes reduction of AChE and BuChE staining in the nearby area subpostrema; the depletion here is pronounced at 2-3 weeks and recovery occurs within the year. These findings suggest that some cells in the area subpostrema project peripherally via the vagus and that the area is part of the vagal nuclear complex. Moreover, capilllaries in the area contain AChE and BuChE in the endothelial lining and this is one of the few areas of the cat hindbrain to exhibit such vascular enzyme activity. The ependyma of the area postrema, which overlies the area subpostrema, is heavily stained for BuChE but this is unaffected by vagotomy.


The effects of choline and inositol on hepatic lipid metabolism and the incidence of the fatty liver and kidney syndrome in broilers. 1. Diets high in wheat and low in protein (18%) produced 5 to 6% mortality from fatty liver and kidney syndrome (FLKS) in broiler chicks whereas there were no deaths from FLKS in birds fed on a maize/barley diet containing 20% protein. 2. Supplementation of the wheat-based diets with choline or inositol (2-5 g additive/kg diet) did not affect the incidence of FLKS or liver lipid metabolism. 3. The wheat-based diet did not significantly affect the activities of hepatic lipogenic enzymes suggesting that hepatic lipid biosynthesis is not a cause of the syndrome. 4. The biotin contents of the wheat and maize/barley diets were little different, which may suggest that factors other than this are implicated in FLKS.


The effect of high dietary sodium chloride on renal function in chicks. 1. One-day-old male broiler chicks were fed on diets containing 3-8% or 2-7% added NaCl in two experiments lasting 22 and 42 d respectively. 2. Sodium clearance was increased in treated birds in both experiments. No other changes in renal function were observed but an increase in plasma urate in treated birds of the first experiment may indicate some loss of proximal tubular function. 3. Renal function, relative to body weight, diminished slowly with age in control and treated birds but these changes could not be related to the fact that at about 3 weeks of age testicular cysts no longer develop.


Sampling broiler house litter for coccidial oocysts. 1. A method of sampling the surface litter of commercial broiler houses for laboratory estimation of numbers of coccidial oocysts is described. 2. The resulting estimates can be regarded as indices of the total number of oocysts present in the house at the time of sampling. 3. Using material from a variety of sources it was shown that reliable estimates for many practical purposes can be achieved with few samples, unless the birds are less than 3 weeks old. 4. Oocyst numbers usually reached a peak 4 to 5 weeks after introduction of the birds and then rapidly declined in the next few weeks.


Early body weight of five strains of White Leghorn. 1. The means, standard errors and coefficients of variation for body weight at fortnightly intervals from day 1 to day 90 of five indigenous strains of White Leghorn were estimated. 2. The differences between the strain and body weight were significant at all ages while the differences between sex were significant from day 45. 3. Phenotypic correlations between body weight at day 1 with that of day 30, 60 and 90 were 0-237, -0-007 and -0.07. 4. The heritability by paternal half-sib method ranged from 0-32 to 0-54 for body weights from day 1 to day 90.


Amino acid requirements of the young turkey: leucine, isoleucine and valine. 1. The leucine, isoleucine and valine requirements of the 3-week-old turkey were determined in a factorial experiment and were found to be 1-42, 0-84 and 1-21% respectively in semi-purified diets containing 12-5 MJ ME/kg. 2. It is suggested that the efficiency with which turkeys and chicks utilise isoleucine and valine is similar, and that a daily intake of about 325 mg of valine would sustain a rate of growth of about 23 g/d in both species.


Sexual dimorphism in the weight of chicks. 1. Male chicks hatched from eggs heavier than 60 g weighed more (P less than 0-05) than female chicks from eggs of similar weight. 2. The weight of the residual yolk was similar in both sexes. 3. It is concluded that male embryos are better able to utilise the energy supplies in the egg, particularly after the 18th day of incubation.


The effects on liver metabolism of administering excesses of biotin to immature pullets and laying hens. 1. The administration of a ten-fold excess of biotin to immature chicks and a 25-fold excess to laying hens had no adverse effect on growth rate, liver weight or liver lipid content. 2. There were no marked effects of excess biotin on glutamate-metabolising enzymes but the specific activity of ATP citrate lyase was decreased.


The hydrolysis of some N-acylaspartic and N-acylglutamic monoamides in dilute mineral acid. The release of ammonia by hydrolysis of N-benzoyl-L-asparagine, glycyl-DL-asparagine, L-asparagine, and succinamic acid, and of aniline from N-benzoyl-L-glutamic-alpha-anilide, N-benzoyl-L-aspartic-alpha-anilide, L-aspartic-alpha-anilide, and the monoanilides of succinic and glutaric acids is first-order with respect to substrate in dilute (0.4-0.03 M) aqueous hydrochloric acid at 100 degrees C. The first-order rate constants (kobs) for these reactions can be expressed as kobs = kintra + k2[H+]. The above hydrolyses are used as models for developing a tentative mechanism to account for the selective release of aspartic acid from proteins under these condiditons. The data are also used to suggest reasons why glutamic acid is not released with equal facility.


Charge properties of mitochondrial matrix proteins. Proteins of the rat liver mitochondrial matrix have been separated into anionic (acidic), cationic(basic), and neutral groups by electrophoresis. These groups represent 69, 8, and 23% of the total matrix protein, respectively, compared to 69, 21, and 10% for the cytosol protein. The acidic nature of the mitochondrial matrix proteins has been confirmed by cellulose ion-exhange chromatography, isoelectric focusing in sucrose gradients, and amino acid analysis. The anionic, cationic, and neutral matrix proteins were separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis into 18, 6, and 5 bands, respectively, compared to 22 bands for the total fraction. The significance of the charge properties of these proteins in terms of mitochondrial biogenesis is discussed.


The histones of rainbow trout erythrocytes include an erythrocyte-specific histone. The erythrocyte histones of rainbow trout were compared with those of goose by polyacrylamide gel electrophoresis. A band analogous to goose erythrocyte-specific histone V, but not identical in relative mobility or quantity, was found to be a component of trout erythrocyte histone. A similar component was also found in carp erythrocyte histone, but it was absent from trout liver histone. To reveal this band clearly, it was advantageous to displace the histone III monomer by oxidation. To verify the character of this protein, each of the main erythrocyte histones of trout were purified by chromatography on Amberlite CG-50, eluted with guanidinium chloride, and then further purified by exclusion chromatography on Bio-Gel P-60. Amino acid compositions of corresponding trout and goose histones, including that of the erythrocyte-specific histone, were sufficiently similar to establish their analogous identities. In general, the chromatographic and electrophoretic properties of histones I, IIb1, IIb2, and V from trout differed more from those of goose, than did their gross amino acid compositions. Comprehensive fractionation and characterization is necessary to extablish identities of corresponding histone fractions, An extensive quantitative variability was found among erythrocyte-specific histones of fish. This must be reconciled with hypothetical roles for this histone in erythropoiesis.


Diaglycerol biosynthesis in everted sacs of rat intestinal mucosa. The molecular specificity in the biosynthesis of diacylglycerols by rat intestinal mucosa was examined by means of radioactive markers, thin-layer chromatography with silver nitrate and gas-liquid chromatography with radioactivity monitoring. Bile salt micelles of alternately labeled monoacyglycerols and free fatty acids were incubated with everted sacs of intestinal mucosa for various periods of time and the diacylglycerols were isolated by solvent extraction and thin-layer chromatography. Sterospecific analyses of the X-1,2-diacylglycerols labeled from 2-monoacylglycerols showed that the sn-1,2-isomers (45-55%) were slightly in excess of the sn-2,3-isomers (34-45%) with the X-1,3-diacylglycerols accounting for the rest of the radioactivity (5-10%). This suggests that racemic diacylglycerols may be intermediates in the resynthesis of dietary fat in rat intestinal mucosa. Detailed analyses of the molecular species of the sn-1,2-diacylglycerols labeled from free fatty acids revealed that 10-45% of the total did not contain the acid present in the 2-monoacylglycerol supplied, and therefore had originated from the phosphatidic acid pathway. These findings are at variance with those obtained in isolated microsomes, which have suggested an inhibition of the phosphatidic acid pathway by monoacylglycerols as well as have given evidence of an exclusive synthesis of sn-1,2-diacylglycerols from 2-monoacylglycerols.


Triacylglycerol biosynthesis in everted sacs of rat intestinal mucosa. The molecular specificity of the biosynthesis of triacylglycerols by rat intestinal mucosa was examined by means of radioactive and mass tracers, and thin-layer chromatography with silver nitrate and gas-liquid chromatography with radioactivity monitoring. Bile salt micelles of alternately labeled monoacylglycerols and free fatty acids were incubated with everted sacs of intestinal mucosa for various periods of time and the triacylglycerols isolated by solvent extraction and thin-layer chromatography. Analyses of the molecular species of the triacylglycerols labeled from monoacylglycerols showed that the 2-monoacylglycerol pathway was responsible for the biosynthesis of a maximum of 90% and the X-1-monoacylglycerol pathway for about 10% of the total radioactive triacylglycerols. Detailed analyses of the molecular species of triacylglycerols labeled fro free fatty acids showed that the phosphatidic acid pathway contributed a minimum of 20-30% of the total labeled triacylglycerol formed. There was a preferential utilization in triacylglycerol biosynthesis of the more unsaturated diacylglycerols arising from the monoacylglycerol pathway and of the more saturated diacylglycerols originating from the phosphatidic acid pathway. The above experiments do not allow a demonstration of the utilization of the sn-2,3-diacylglycerols in triacylglycerol biosynthesis but are not inconsistent with it.