A randomised trial to investigate X-prep, oral mannitol and colonic washout for double-contrast barium enema

Three methods of bowel preparation used prior to double contrast barium enemas were compared by a randomised trial in 60 patients. Evaluation was by radiological review and from a patient questionnaire. The preparations included X-Prep liquid with colonic washout, oral mannitol alone and oral mannitol with colonic washout. Adequacy of preparation as judged by faecal residue was significantly better after X-Prep than in either group receiving mannitol. The more severe purgation with mannitol did not result in better clearance of the large bowel and the addition of a colonic washout to mannitol did not reduce faecal residue. Side-effects and adverse comments were more common after mannitol. Diarrhoea was significantly less after X-Prep than after mannitol.

Peroperative frozen section and cytology to assess proximal invasion in gastro-oesophageal carcinoma

Peroperative frozen sections and cytological material have been obtained in 39 consecutive gastro-oesophageal resections between October 1978 and February 1980. Material from the proximal edge of the resected specimen was unreliable because of 3 false positive cytology results and 1 false positive frozen section report. Frozen section (no errors) was shown to be significantly more accurate than cytology (6 errors) when material was obtained from the distal oesophagus. Fatal anastomotic dehiscence occurred in only 1 of 30 resections when the excision was adequate. Where the results of frozen section were acted upon, in 5 of 9 patients with an inadequate excision, only 1 fatal dehiscence occurred compared with fatal dehiscence in all 4 patients where a second excision was not performed. These results indicate that frozen section of the distal oesophagus should be used to determine the extent of oesophageal resection in operations for gastro-oesophageal cancer.

The radiological diagnosis of posttraumatic effusion of the elbow joint and its clinical significance: the 'displaced fat pad' sign

Alterations occur in the radiological appearance of the soft tissues after injury to the elbow joint. These are due to displacement of the intra-articular fat pads by capsular distension when an effusion is present. A prospective study of 89 consecutive elbow injuries was undertaken in an attempt to assess the usefulness and reliability of these changes in the diagnosis of minor elbow injuries and the assessment of their clinical progress. In 61 elbows (69 per cent) there was no radiological evidence of an effusion and no evidence of bony injury. All quickly returned to normal. In 28 elbows (31 per cent) radiological evidence of an effusion was present. Twenty-three (80 per cent) of these were also found to have a fracture in, or adjacent to the elbow joint. In 9 elbows the fracture could not be seen on the initial radiographs. Because of the presence of an effusion, repeat radiographs were taken and a fracture discovered. The presence of an effusion was associated with an increase in the time required for full recovery.

Adenocarcinoma of the stomach: review of 1,497 cases

The records of 1,497 patients with histologically proven adenocarcinoma of the stomach were reviewed from Charity Hospital over the 25-year period, 1948 to 1973. The operability rate was 82% and the resectability rate was 48%. In this series gastric carcinoma predominated in males and Negroes. Necropsy studies indicate a similar frequency of involvement of various organs in patients not operated upon as well as those subjected to a prior operation, which suggests the need for some therapeutic endeavors aimed at a wider base than the primary organ. The five-year survival rate, 7.4 overall, varied from 2.0% after esophagogastrectomy to 22.1% after radical subtotal gastrectomy, and to 30.3% for those with localized disease. One hundred one patients survived five years or more, and 5.4% survived ten years or more after the diagnosis of gastric cancer. Radical subtotal gastrectomy gave the best results in this series, whether measured in terms of median survival, five-year survival, or operative mortality. Esophagogastrectomy and by-pass procedures had high mortality and low survival rates, and should be reserved for special conditions.

Intraocular lens implantation in combination with keratoplasty

Intraocular lenses were implanted in combination with penetrating keratoplasty in a series of patients followed for up to 2 years. During this period of observation there was little or no evidence that the simultaneous implantation of an intraocular implant adversely affected the corneal graft. Technique and results are described.

Effects of morphine on brain histamine, antinociception and activity in mice

1. The effect of morphine on the histamine content of the mouse brain has been investigated. The changes in the brain histamine level have been related to morphine-induced analgesia and morphine-induced changes in locomotor activity. 2. With doses of morphine between 1 and 5 mg/kg there was a significant increase in histamine levels. The time required to produce a maximal rise in the brain histamine level with 5 mg/kg of morphine was 15 min. 3. There was a significant decrease in brain histamine levels with doses of morphine between 7-5 and 100 mg/kg. The time at which the greatest decrease was produced with 50 mg/kg was 30 min. 4. The time couse of the alteration of brain histamine by morphine did not correlate with its antinociceptive activity. Both the 5 and 50 mg/kg doses of morphine produced analgesia in mice whereas brain histamine levels were increased and decreased, respectively. 5. Pretreating mice with compounds which modify histaminergic function did not modify the antinociceptive action of morphine. 6. Morphine produced a biphasic effect on locomotor activity when the dose was increased from 0-5 through to 100 mg/kg. Doses up to 2-5 mg/kg caused a reduction of activity and doses above this produced significant increases. 7. There appears to be an inverse relationship between the morphine-induced changes of brain histamine and the morphine-induced changes in locomotor activity.

Optimal fluoridation--The concept and its application to municipal water fluoridation

Optimal fluoridation has been defined as that fluoride exposure which confers maximal cariostasis with minimal toxicity and its values have been previously determined to be 0.5 to 1 mg per day for infants and 1 to 1.5 mg per day for an average child. Total fluoride ingestion and urine excretion were studied in Marin County, California, children in 1973 before municipal water fluoridation. Results showed fluoride exposure to be higher than anticipated and fulfilled previously accepted criteria for optimal fluoridation. Present and future water fluoridation plans need to be reevaluated in light of total environmental fluoride exposure.

The effects of raising alveolar PCO2 and ventilation separately and together on the sensitivity and setting of the baroreceptor cardiodepressor reflex in man

1. The effects of changes in ventilation and/or alveolar P(CO2) on the baroreflex control of heart rate have been studied in seven experiments on six young men and women who had been trained to control tidal volume and respiratory frequency at various levels independent of alveolar P(CO2), during hyperoxia.2. Intravenous phenylephrine provoked transient rises of directly measured arterial pressure during which individual systolic pressures (P) were linearly related to the following pulse interval (I). Baroreflex sensitivity was expressed as the slope of the regression of I on P, and reflex setting (I(ref)) as I at a single reference arterial pressure (= mean P for the experiment).3. Voluntary control of breathing had little effect on heart rate and arterial pressure (baroreflex setting), but diminished reflex sensitivity.4. Hypercapnia regularly caused tachycardia at the reference pressure (i.e. baroreflex setting lowered). The response was completely or partly reproduced by change of P(A, CO2) at constant ventilation in four subjects but not in two others; in them change of ventilation at constant P(A, CO2) completely mimicked the effect of free-breathing hypercapnia.5. Values of baroreflex sensitivity were relatively scattered. Hypercapnia caused a fall in baroreflex sensitivity in three subjects whether ventilation was fixed or free to rise. After separating the effect of voluntarily controlling ventilation, ventilation per se was without effect on reflex sensitivity.6. It is concluded that hypercapnia and hyperpnoea have separate effects on the baroreflex, the relative magnitudes of which differ from one subject to another. Baroreflex setting and sensitivity vary independently in response to change of ventilation and of P(A, CO2).

Effects of acid etchants on dentin

The ability of acid etchants to penetrate dentin was tested under simulated clinical conditions. No penetration of the dentinal tubules by acid was detected by use of two different test methods, although pronounced roughening of the treated surfaces was observed.

Comparison of the dose-response effects of morphine on brain amines, analgesia and activity in mice

1. Noradrenaline, dopamine, 5-hydroxytryptamine and 5-hydroxyindoleacetic acid concentrations in the mouse brain were measured 30 min after subcutaneous injection of doses of morphine ranging from 0.1 to 100 mg/kg: motor activity was also measured.2. The noradrenaline concentration in the mouse brain was reduced by moderate (2 to 20 mg/kg) but not by high (above 20 mg/kg) and low (below 2 mg/kg) doses of morphine.3. The dopamine concentration in the mouse brain was reduced by moderate (1 to 20 mg/kg) doses but was raised by high doses (above 20 mg/kg) of morphine.4. The 5-hydroxytryptamine concentration in the mouse brain was reduced by moderate (1 to 20 mg/kg) doses of morphine but not by high (above 20 mg/kg) and low (below 1 mg/kg) doses of morphine.5. The 5-hydroxyindoleacetic acid concentration was not affected by low doses (0.1 to 2 mg/kg), raised by a dose of 5 mg/kg, lowered by doses of 10-50 mg/kg and not affected by 100 mg/kg of morphine.6. These results are discussed with reference to the possible implication of changes in monoamines for the analgesic and behavioural effects of morphine.

How does the striate cortex begin the reconstruction of the visual world?

The striate cortex transforms the topographic representation of visual space in the lateral geniculate body into a Fourier transform or frequency representation at the complex cell level via the intermediary simple cell stage of "strip integration." Each of these three stages contains essentially the same amount of information, which expresses a conservation of information principle; however, the form of the information is changed. In the transform domain, invariant descriptions of visual objects can be derived to serve as the basic sets required for pattern recognition and memory. We believe that our experimental and theoretical findings are fundamental for understanding the functional organization of the striate cortex.

Modification of morphine analgesia by drugs affecting adrenergic and tryptaminergic mechanisms

The effects of drugs that modify adrenergic or tryptaminergic mechanisms were tested on the analgesic action of morphine in mice. Analgesia was assessed by the hot plate method and phenylquinonewrithing method. Reserpine antagonized the analgesic action of morphine in both tests, the maximal effects occurring 6–8 h after the administration of reserpine. p-Chlorophenylalanine antagonized the analgesic action of morphine as assessed by the writhing method but not by the hot plate method. The analgesic action of morphine was not modified in either test by pretreatment with α-methyl-p-tyrosine, propranolol, phentolamine or methysergide. These results suggest that the analgesic action of morphine, as measured in the writhing test, may be mediated by 5-hydroxytryptamine but that other mechanisms may be involved in the hot plate test.