The induction of ovulation

A treatment plan utilizing placebo, cyclical steroid therapy, clomiphene citrate, and human pituitary gonadotropin is outlined for the induction of ovulation in carefully selected potentially fertile women. Such a plan minimizes any risk with the potentially hazardous ovulatory stimulants. A total of 220 patients with secondary amenorrhea were studied and an etiologic basis for the condition was found in 98 (45 per cent). Of the 220, 190 were found suitable for the induction of ovulation, and together with 145 patients with oligomenorrhea and 17 patients with anovulation, entered the treatment plan. Ovulation was successfully induced in 351 of the 352 (99.5 per cent) and pregnancy in 218 (61.9 per cent). The success rates for the agents in the various conditions are presented and discussed.

Cytoplasmic receptor levels and glucocorticoid response in human lymphoblastoid cell lines

The cytolethal response to treatment with prednisolone was investigated in vitro in eight human lymphoblastoid cell lines containing varying concentrations of specific cytoplasmic glucocorticoid receptors. A similar response was observed in seven of the lines irrespective of their concentration of cytoplasmic receptors and pharmacological doses of steroid, well above those required to saturate receptors in cell-free extracts, were required for a massive lethal response. One cell line derived from Burkitt's lymphoma was refractory to lethal effects even with pharmacological doses of steroid. A similar unresponsiveness to the cytolethal effect of prednisolone in vitro was observed in fresh lymphoblasts derived from patients with acute lymphoblastic leukaemia despite evidence of a satisfactory clinical response to therapy which included steroid. The resistance of human lymphoblastoid cells to treatment with glucocorticoids in vitro may result from a defect in activation subsequent to the binding of steroid to cytoplasmic receptors.

Haemangioma with coagulopathy: sustained response to prednisone

Two cases of giant haemangioma with thrombocytopenia are described. A satisfactory and sustained response to prednisone was achieved in respect of both coagulation abnormalities and tumour size. It is proposed that prednisone is effective by enhancement of thrombosis and reduction of fibrinolysis within the tumour, thus promoting a natural form of resolution. It is suggested that prednisone therapy should be first-choice treatment of complicated haemangiomas.

Glutaraldehyde and human T cell rosettes

Blood mononuclear cells from ten healthy donors and cells from fifty cultured human lymphoblastoid lines were tested for the capacity to form rosettes with sheep erythrocytes. The effect of adding glutaralhehyde before scoring rosettes and the effect of substituting glutaraldehyde-fixed for fresh sheep cells were both examined. The results suggest that glutaraldehyde increases the apparent proportion of rosette-forming cells by altering the sheep erythrocytes in such a way that they will adhere to some B lymphocytes. Although a small number of cells carry both surface immunoglobulins and receptors for fresh sheep erythrocytes, the rosette test with fresh sheep cells identifies T lymphocytes more accurately in the absence of glutaraldehyde than in its presence.

Population studies on Gilbert's syndrome

Total serum bilirubin concentration was measured by an Autoanalyzer technique in 197 normal males and 102 normal females. The mean bilirubin concentration was significantly lower in the females than in the males. Total bilirubin concentration in the males showed a bimodal distribution with an antimode at 24 mumol/1 (1.4 mg/100ml). Individuals with bilirubin concentration above this value had unconjugated hyperbilirubinaemia and probable Gilbert's syndrome. Total bilirubin concentration in the females again showed a bimodal distribution with an antimode at 12 mumol/1 (0.7 mg/100ml). It is conceivable that females with bilirubin levels above this also have Gilbert's syndrome. This suggests that the population incidence of Gilbert's syndrome could be as high as 6% and that the sex incidence is approximately equal.

Monoparesis. Complication of constant positive airways pressure

Erb's palsy has been observed in 2 infants who had been treated with constant positive airways pressure for idiopathic respiratory distress syndrome. Both infants made complete neurological recovery from what was thought to be an acquired injury from the neck seal.

Ward environment in an inpatient drug dependence treatment unit: II. Attempts to improve ward environment

Ward activity and atmosphere in a Drug Dependence Treatment Unit were found to be poor in a previous study. The results of two attempts to improve ward environment are reported. The arrival of an occupational therapist had a very slight and restricted effect on the level of patients' constructive activity, and produced only one significant change on the Ward Atmosphere Scale; patients perceived an increase in Practicality. There was, however, a consistent improvement in patients' Vigor and Friendliness mood scores following the arrival of the occupational therapist. A pilot project using cigarettes as reinforces for patient constructive activity produced little sustained effect. Possible reasons for the difficulties in managing drug-dependent patients are discussed, and suggestions made for improvement.

High performance liquid chromatography of ceramides: application to analysis in human tissues and demonstration of ceramide excess in Farber's disease

Conditions have been determined for the benzoylation of ceramides containing nonhydroxy and hydroxy fatty acids, and a high performance liquid chromatography system for the separation and measurement of these derivatives has been devised that is capable of good resolution and high sensitivity. These methods have been used to determine quantitatively the levels of ceramides in human tissues, and in serum and urine, and to demonstrate elevated amounts of ceramide in Farber's disease urine and tissues.

Adolescents and work difficulties

As the staff in a psychiatric adolescent service become more experienced, they invariably develop hunches and hypotheses about the young people referred to them. These ideas, which are essentially clinical in origin, can often be tested if relevant information is systematically collected; previously unsuspected associations may also be found in such a body of data. For these reasons, the Young People's Unit adopted the routine use of a pre-coded assessment form.

A psychiatric service for the disturbed adolescent

The recognition of the need for psychiatric services for disturbed adolescents led to the opening of the first two adolescent in-patients units in Great Britain in 1949. As a result of community pressures and active encouragement by the Department of Health and Social Security since 1964, an increasing number of units have opened. Although the provision of psychiatric services specially designed to cater for the adolescent has gained momentum only in the past three to five years, the demands of this section of the population is underlined by Rosen et al. (1965) who showed, in an American survey of 750,000 clinic patients seen in 1962, that approximately one-quarter were aged between ten and nineteen years—a number representing 6 · 2 per thousand adolescents of the population served. Similar figures, namely, 6 · 6 per thousand (Kidd et al., 1968), were found in Aberdeen, and 5 · 6 per thousand (Henderson et al., 1967) were found in Edinburgh. Since an adolescent psychiatric service was opened in Edinburgh in 1967, there has been a continual increase in the demand for its services, as follows:

This suggests that the previous figures were an underestimate and that psychiatric disturbance amongst adolescents may be much greater than formerly estimated. Furthermore, such referrals do not indicate the demands for help that Approved Schools and children's homes have made. The authors believe that psychiatric skills are most effectively deployed in these settings if the psychiatrist acts as a consultant to the staff, rather than by assessing and treating individual children (Evans, 1963). Even so, demands have far outstripped the available supply of psychiatric time.

Solutions to axon equations

The solutions to a general class of axon partial differential equations proposed by FitzHugh which includes the Hodgkin-Huxley equations are studied. It is shown that solutions to the partial differential equations are exactly the solutions to a related set of integral equations. An iterative procedure for constructing the solutions based on standard methods for ordinary differential equations is given and each set of initial values is shown to lead to a unique solution. Continuous dependence of the solutions on the initial values is established and solutions with initial values in a restricted (physiological) range are shown to remain in that range for all time. The iterative procedure is not suggested as the basis for numerical integration.

Vancomycin for staphylococcal shunt site infections in patients on regular haemodialysis

Six anuric patients with Scribner shunt site infections were treated by intermittent infusion of vancomycin into the shunt, and a satisfactory clinical response was obtained in five. Serum levels of the antibiotic were estimated frequently. From estimating serum levels and the minimum inhibitory concentrations of vancomycin for a range of hospital staphylococci a dose of 1g. vancomycin every seven days is recommended as a suitable schedule for treating staphylococcal infection in this situation.