Molluscicidal steroid glycoalkaloids possessing stereoisomeric spirosolane structures

Both the steroidal glycoalkaloid mixture obtained from Solanum mammosum fruits (solasonine 1 and solamargine 2) and the stereoisomeric glycosidic alkaloid tomatine 3 are toxic at 10 and 25 ppm to Lymnaea cubensis and Biomphalaria glabratus, respectively. Their aglycones solasodine 4 and tomatidine 5 obtained by hydrolysis of the glycosides showed no toxicity to either mollusk under the test conditions used. Preliminary structure-activity correlations indicate that the molluscicidal properties depend on the type of aglycones and on the glycoside bond. A common molecular structure in molluscicidal spirosolane and spirostane glycosides is recognized.

Syncope caused by cough-induced complete atrioventricular block

Cough syncope is a well-recognized syndrome in which loss of consciousness follows a bout of prolonged coughing. The pathophysiology of this syndrome has been attributed to lowered cerebral perfusion pressure consequent on an increased intrathoracic pressure, which lowers cardiac output (by a Valsalva mechanism) and impairs cerebral venous return. We report a case of cough-induced syncope in which ECG monitoring showed that coughing produced paroxysmal atrioventricular block with ventricular asystole. Such a case has not previously been documented.

Radiotherapy of lymph node metastases in patients with squamous cell carcinoma of the head and neck region

The results of radiotherapy alone in 233 patients with lymph node metastases of squamous cell carcinoma in the head and neck region were examined. It appeared that the recurrence rate in the neck was mainly related to: localization of the primary tumor; the recurrence of the primary tumor; the radiation dose; and the presence of a residual palpable tumor mass in the neck 6 weeks after radiation. The optimum radiation dose was about 2000 ret. An isoeffect curve was calculated, which differed only slightly with the nominal standard dose (NSD) formula. Elective irradiation of the contralateral neck appeared to diminish the outgrowth of neck node metastases at the side. Changes in the radiation treatment in the last treatment period, such as a higher radiation dose and a larger treatment area, resulted in a lower recurrence rate for the neck node metastases, and also in a higher survival rate.

Syphilis control in populations previously exposed to yaws

Application of an epidemiologic strategy, involving repeated annual screening, public relations activities and treatment to selected groups, for syphilis control in four communities is described. The predictive value of the VDRL screening test was influenced by the titre of the test and the age and location of individuals on whom it was performed. The predictive value of 1:8 VDRL titres (for active syphilis) varied from zero in individuals over 50 years of age, in one community to 0.96 in individuals 10-29 years old in another. Reduction in transmission of infection was closely related to the degree of screening coverage of the community and adjacent communities with which intercourse occurred.

Problems facing aboriginal health workers in a community health service

The length of service and reason for resignation of Aboriginal health workers recruited from 1976 to 1978 are discussed. Resignation rates in the first and second years of employment were 46% and 22.4%, respectively. Resignation was often the final outcome of intolerable personal conflicts with family, community and workmates, compounded by confusion and diversity of opinion over job roles.

Mammary tumorigenicities of three chemically induced mouse kidney cell lines in syngeneic female hosts

Three chemically induced, mammary tumour virus (MMTV) and leukemia virus (MuLV) producing, baby mouse kidney (BMK) cell lines derived from respectively strains BALB/c (-/HeA and -/CrglA) and C57BL/LiA were investigated for their mammary tumour (MT) evoking potentials in syngeneic female hosts. An i.p. inoculated virus-enriched fraction from A3 cells (BALB/c/HeA) had a similar oncogenic effect as i.p. and s.c. inoculated whole A3 cells. The average MT ages were reduced in all 3 groups. Cell lines BBM (BALB/c/CrglA) and BB (C57BL/LiA) were tested as i.p. inoculated whole cells. Again, the average MT age was reduced in thus treated BALB/c/Crgl females. In the case of C57BL/LiA the percentage of animals with MT was strongly increased in the BB cell inoculated group (1 MT in control group). Bioassay results corrected for intercurrent death cases (including leukosis) were statistically significant. It is concluded that the endogenous MMTV variants of the 3 mouse (sub-)strains are virulent MT evoking viruses in autologous hosts when they are induced.

Screening to control infectious diseases: evaluation of control programs for gonorrhea and syphilis

Gonorrhea and syphilis serve as models for the definition of criteria for the evaluation of screening programs for detection of disease. Mass screening and selective screening are distinguished from individual screening (case finding). Important characteristics of screening tests are sensitivity, specificity, efficiency, precision, accuracy, and acceptability. Program evaluation includes process evaluation and outcome evaluation. Major criteria to consider in the evaluation of mass screening programs are prevalence and incidence of disease, predictive value of tests used, yield, available screening tests, acceptance, follow-up services, costs and benefits, and control over the spread of infection. All forms of screening programs should be evaluated by available methods so that they will operate with maximal efficiency and so that nonproductive programs can be discarded.

Maternal attitudes in prepared and unprepared cesarean deliveries

Cesarean preparation classes were instituted in an Eastern hospital and are described here briefly. One hundred and forty-three prepared and unprepared women delivering vaginally and by cesarean during a six-week period at that hospital were tested with the Maternal Attitude to Pregnancy Instrumemt. Prepared cesarean women had a significantly greater desire for active participation in the delivery than women unprepared for cesarean delivery. Multiparous cesarean-delivery mothers with previous vaginal deliveries had a significantly more positive attitude than those who had never delivered vaginally.

The hard sell for savings. Interview by Sally Burningham

The NHS might seem to present an opportunity to purchase, store and distribute on a national basis but it is, in reality, a series of largely autonomous local services. According to Graham Hart, DHSS controller of supply, in most parts of the country supplies are held in 'a variety of small, local stores unsuited to their purpose'.

Weight and skeletal maturation - a study of radiological and chronological age in an anorexia nervosa population

The carpal bones of 18 anorexia nervosa patients were radiographed and the X-ray age assessed by 2 different standard methods. The study demonstrates that skeletal development in anorexia nervosa patients is delayed such that there is no association between radiological assessment of age and chronological age. It is strongly suggested that bony development actually ceases when body weight falls sufficiently to stop menstruation. There was a highly significant (P = 0.001) linear relationship between radiological age and the sum of the age of onset of the illness plus any period(s) of re-feeding. Weight gain seems to re-kindle the bone maturing mechanisms: the role of weight thresholds and associated hormone activity being discussed. The findings of this study strongly support the existing evidence that the anorexia nervosa patient is biologically and psychologically immature.

Schizophrenia and albinism

A female albino with squamous cell carcinoma and schizophrenia is reported. The association of schizophrenia and albinism is exceptionally rare; the observation that schizophrenia is characterised by hypermelanosis is questioned.

The syndrome of inappropriate antidiuretic hormone secretion associated with acute myocardial infarction

A 72-year-old man developed the syndrome of inappropriate antidiuretic hormone secretion after sustaining an acute myocardial infarction. Other documented causes of this syndrome were excluded, and this case is therefore reported as a new association.

Suppression of basal insulin secretion by adrenalin in normal man and in patients with insulinomas

Basal insulin secretion has been thought to be via a different mechanism from stimulated insulin secretion, partly because it is not similarly suppressed by adrenalin. However, adrenalin normally causes hyperglycaemia, but if it is infused while the plasma glucose is kept constant there is marked suppression of insulin secretion. Sympathetic stimulation modulates basal insulin secretion, and alpha adrenergic blockade impaired the suppression of insulin secretion in response to hypoglycaemia. Four of five benign insulinomas had marked suppression of insulin secretion by adrenalin, but one malignant and one benign insulionoma had little suppression. Both had a raised proportion of their basal plasma insulin as proinsulin, and the impaired suppression of secretion by adrenalin probably signified an undifferentiated tumour.

Epidemiologic treatment of syphilis

Epidemiologic treatment refers to antibiotics administered when a diagnosis is considered likely on clinical, laboratory, or epidemiologic grounds, but before the results of confirmatory laboratory tests are known. This treatment is justified on the grounds that the potenial benefits of treating the patient outweigh the potential harm of not treating. This potential harm may affect the individual or the community. Individual sequelae are most significnat when congenital syphilis is allowed to develop due to delays in treating the pregnant woman or newborn child. Community sequelae occur when an infected patient disseminates disease during the interval between initial presentation and final diagnosis. Unless qualified by time limitation and the behavioral and disease characteristics of a given population, exposure to syphilis is a poor criterion for epidemiologic treatment. The risk of infection of certain groups (defined by epidemiologic, clinical, or serologic criteria) should be determined empirically so that epidemiologic treatment is only provided to groups in which this risk has been estimated.

Venereal disease in a war environment: incidence and management

The improved control over most infectious disease does not extend to venereal infections, and these now provide the major medical problem encountered in wartime. This factor should be recognized when staff and facilities are being provided for wartime medical services. Unique problems of management of both physical and psychological illness may result from promiscuity in a foreign land during war, and specialist venereologists are as necessary as surgeons and physicians.