Loss of resistance technique for locating the epidural space: evaluation of glass and plastic syringes

Location of the epidural space in epidural anaesthesia usually involves the measurement of loss of resistance using glass or plastic syringes. In the present study two varieties of glass syringe and one plastic type were evaluated to determine the resistive forces associated with plunger movement. The mean static (fs) and dynamic (fd) forces for polished glass syringes having a ground plunger only were fs = 0.47 X 10(-3) +/- 0.22 X 10(-3) N and fd = 0.37 X 10(-3) +/- 0.19 X 10(-3) N and for polished glass syringes having a ground barrel and plunger were fs = 0.43 X 10(-3) +/- 0.16 X 10(-3) N and fd = 0.38 X 10(-3) +/- 0.15 X 10(-3) N. Each of these values was significantly lower (P less than 0.5) than those for plastic syringes fs = 2.22 X 10(-3) +/- 0.48 X 10(-3) N and fd = 1.46 X 10(-3) +/- 0.37 X 10(-3) N. It is concluded that glass syringes are favoured over plastic for locating the epidural space because frictional forces developed with glass syringes were significantly lower than with plastic.

Haemodynamic and neurohumoral responses in elderly patients with postural hypotension

Haemodynamic and neurohumoral responses to head-up tilt were measured in 28 elderly patients with postural hypotension (EPPH) and 12 healthy elderly subjects (HE). There were no differences in catecholamines between the groups and only noradrenaline increased on tilt (P less than 0.001). Plasma renin activity and aldosterone were similar in HE and EPPH in the supine and tilt positions. In both groups vasopressin increases (P = 0.032), and plasma volume decreases were the same (P = 0.673). Supine EPPH had higher heart rates (P = 0.019) but similar cardiac indices (P = 0.621). Both had similar changes on tilting (P = 0.975 and P = 0.341). Stroke volume decrease was higher in HE (35%) than EPPH (23%; P less than 0.001). HE showed an increase in peripheral resistance on tilting with no change in EPPH (P = 0.005). EPPH had larger coefficients of variation for all variables. The differences in haemodynamic responses and the similarity of neurohumoral responses during tilting suggest end-organ failure in EPPH with individual variations. Postural hypotension in old age is not a single entity.

The ageing hypothalamo-neurohypophysial system. An analysis of the neurohypophysis in normal hydration, osmotic loading and rehydration

Age-associated changes in the structure and function of the neurohypophysis may contribute to the decreased ability to conserve water in older animals. We investigated the neurohypophyses of 6 and 28-month-old male mice using radioimmunoassay and quantitative morphological techniques. The dry-weight and volume of the neurohypophysis increased significantly with age but the quantity of vasopressin in the gland remained constant. Oxytocin levels decreased with age. A quantitative morphological analysis was performed on the compartments of the neurohypophysis from male mice of 6 and 28 months of age which were either normally hydrated, osmotically loaded, or osmotically loaded and rehydrated. The absolute volumes of the axon endings, swellings, their constituent organelles and the axon terminals containing degenerating subcellular components were determined. The design of the analysis allowed us to examine both age-related changes and statistical interactions between the age of the animal and the behaviour of a variable during the osmotic loading/rehydration phase of the experiment. There was a significant age-related reduction in the volume of the neurohypophysis occupied by the endings and swellings. The diameters of the neurosecretory granules found in the endings were significantly smaller than those in the swellings in both age groups but the size difference was greater in the young animals. Dehydration and subsequent rehydration of old male mice leads to extensive re-modelling of the neurohypophysial compartments and subcellular organelles to the configuration found in the adult animal.

Reduced survival with increasing plasma osmolality in elderly continuing-care patients

The results reported here are from a 2-year follow-up study of 58 elderly patients in a continuing-care unit. Most of these patients were in a hyperosmolar state at the time of entry (mean plasma osmolality 304 +/- 8 mOsmol/kg). The survival of those patients with the highest osmolality (greater than 308 mOsmol/kg) was significantly reduced (p = 0.025), with an increased mortality at 2 years (15/20 patients, p = 0.053). There was no correlation between age and plasma osmolality (r = 0.02) and the effect of osmolality on survival was independent of age. Hyperosmolality was either a marker for, or a cause of, increased mortality in this group of frail elderly patients.

Oxygen-dependent desulphation of monomethyl sulphate by Agrobacterium sp. M3C

Agrobacterium sp. M3C, previously isolated from canal-water for its ability to grow on monomethyl sulphate, degraded this ester with stoichiometric liberation of inorganic sulphate. In contrast with the biodegradation of monomethyl sulphate in Hyphomicrobium sp., and of other longer-chain alkyl sulphates in Pseudomonas spp., the pathway in Agrobacterium appeared not to involve a sulphatase enzyme capable of catalysing ester-bond hydrolysis. No such sulphatase was detectable under a range of conditions of bacterial culture, or using various methods for preparing cell-extracts, or different assay conditions. There was no incorporation of 18O-label from H2(18O) into the liberated inorganic sulphate. No methanol was detectable during biodegradation, and the organism was incapable of growth on methanol, and did not produce methanol dehydrogenase activity when grown on monomethyl sulphate. Tracer studies using mono[14C]-methyl sulphate indicated that formate serine and glycine were produced during the biodegradation. The presence of these amino acids, together with high activity of hydroxypyruvate reductase, indicated the operation of the serine pathway common in methylotrophs. Use of an oxygen electrode in conjunction with monomethyl[35S]sulphate showed that release of 35SO2(-4) was dependent on availability of O2, and that there was equimolar stoichiometry among monomethyl sulphate degraded, O2 consumed and 35SO2(-4) released. A proposed pathway for the degradation involved an initial mono-oxygenation to methanediol monosulphate with subsequent elimination of SO2(-4) and concomitant formation of formaldehyde. The pathway was compared with degradation mechanisms for other C1 compounds and for other sulphate esters.

Effect of lysophosphatidylcholine on the filtration coefficient in intact dog lungs

Lysophosphatidylcholine (lyso-Pc) is a lysophospholipid normally found in low concentrations in the lung. At high concentrations lyso-Pc, instilled into the airways, causes pulmonary edema. We tested the hypothesis that the edema caused by lyso-Pc was due to an increase in pulmonary microvascular membrane permeability. In 11 anesthetized dogs we continuously weighed the left lower lobes (LLL) while instilling lyso-Pc (20 mM) into the LLL airways. After 30 min we determined the microvascular membrane fluid filtration coefficient (Kf) from the relationship between the rate of LLL weight gain and the pulmonary microvascular pressure. Kf was not significantly different between the lyso-Pc-treated lobes (0.048 +/- 0.018 ml.min-1.mmHg-1) vs. control lobes (0.067 +/- 0.031 ml.min-1.mmHg-1). Our data do not support the hypothesis that lyso-Pc, instilled into the airways, causes an increase in pulmonary microvascular permeability.

Age-associated changes in the kidney of the laboratory mouse

This paper describes a qualitative and quantitative morphological investigation of the kidneys of male laboratory mice without macroscopic pathology at 6, 12, 24 and 34 months of age. In the 6- and 12-month old adults there were no signs of microscopic pathological changes in either the kidney cortex or medulla. However, at 24 and 34 months of age minor pathology, such as focal interstitial inflammation, was detected. In both these age groups there were a few glomeruli with sclerotic changes. There were no significant differences in the total volume of the kidneys, cortex, medulla or other structures with age. There was a significant increase in the diameter of the glomeruli with age but no change in the total numbers of glomeruli. The increase in volume of the glomerulus appears to be due to cellular components rather than changes in the blood vessels. It is concluded that in animals without macroscopic pathological changes there are only minor alterations in kidney structure with age, and that any alterations which do take place occur very late in the life span.

Elderly female patients in continuing care: why are they hyperosmolar?

We have shown that the majority of elderly female patients in continuing care are in a hyperosmolar state. Thirty-two out of thirty-nine subjects had an osmolality greater than 295 mosm/kg and the mean osmolality was 302 +/- 8 mosm/kg (range 280-317 mosm/kg). No significant relationship was found with the degree of confusion (rs = 0.31; p greater than 0.05). In the second part of the study neither the measured degree of hydration, or any acute, small increases in fluid input influenced the plasma osmolality.

Age-related changes in the stomach of the laboratory mouse: a quantitative morphological study

This report is of a quantitative morphological investigation of the gastric wall in the aged laboratory mouse. Male mice of 6, 9, 18, 28 and 34 months of age were killed and the mid-greater curvature of the stomach examined qualitatively and quantitatively for age-related changes. There was no evidence of superficial or atrophic gastritis in any of the mice investigated. There were significant decreases in the relative volumes of parietal and chief cell components with age, and a significant increase in other components in the lamina propria. The relative volume of the mucous cell compartment did not change with age. In all cases where a significant change was observed it took place in the 34-month-old age group when compared with 6-, 9- or 18-month-old animals. There was a progressive change in the components after 18 months of age but this only achieved significance at 34 months. It was concluded that alterations in the gastric wall take place later in the life-span and appear to be a physiological, rather than a pathological change.

A new urethral catheter

A new balloon catheter for women with a flexible urethral portion that conforms to the shape of the closed urethra was tested. In sheep control catheters caused epithelial destruction, which was absent with the conformable catheter. A 12 week crossover trial compared control catheters in 52 long stay geriatric patients. Eighty two out of 91 conformable catheters were rated as comfortable compared with 68 of 87 control (p = 0.006). The average length of time in situ was 15.9 days for the conformable catheter compared with 12.9 days for the control (p = 0.001). The average number of bypasses a week with the conformable catheter was 1.1 compared with 1.3 for the control; this difference was not significant. Examination of 249 used catheters showed significantly fewer with intraluminal obstruction with struvite among the conformable than control catheters (1 (0.8%) versus 15 (11.5%); p less than 0.001). This new catheter for women is a substantial improvement over the Foley catheter and (except in urethral stricture) is suitable for all forms of drainage.

Age changes in the human female urethra: a morphometric study

Aging in the human female urethra can contribute towards urinary problems. To our knowledge the effect of age on urethral tissues has not been quantified previously. Histological sections were prepared from 8 regions along the length of the urethra from 26 women between 19 and 88 years old. Using quantitative morphological techniques the relative volume fractions of various tissue components were determined. As age increased there was a decrease in the relative volume of striated muscle and blood vessels, and an increase in the relative volume of connective tissue. There was no change in the smooth muscle components. These age changes in the human female urethra may lead to impairment of urethral function.

Renal vasopressin receptors in ageing C57BL/Icrfat mice

The mechanism of water conservation is impaired in ageing mammals. An age-related defect in the release of vasopressin has been implicated but, more recently, attention has moved to the renal component of the water conservation mechanism. Previous studies using renal cells prepared from mice of different ages have shown that the threshold dose of vasopressin required to elicit a significant rise in cyclic AMP (cAMP) was greater in older animals. The dose-response curve was moved to the right in 35-month-old mice, i.e. the concentration of vasopressin required to give maximum cAMP output was increased. To investigate this further we examined the binding of vasopressin to renal medullary cells maintained in short-term culture, to determine whether the decreased response of cAMP levels to vasopressin is due to changes in hormone-receptor interaction. In 6-month-old male mice the dissociation constant (Kd) was 2.38 nmol/l and the maximum binding of the hormone (Bmax) was 47.6 fmol/10(6) cells, and at 30 months of age Kd was 2.37 nmol/l and Bmax was 47.0 fmol/10(6) cells. In female mice the changes were more complicated because the data for the 6-month-old mice could be split into two groups. It is concluded that there are no age-related differences in the numbers of receptors or their affinity for vasopressin, and that the decreased cAMP response is probably associated with post-receptor mechanisms in this species.

Ageing in the hypothalamo-neurohypophysial-renal system

Ageing is characterised by a failure in the maintenance of the internal environment (homeostasis) which is regulated by the hypothalamic neuroendocrine system. Of the many systems that undergo age-related degeneration is the control of water metabolism which leads to a variety of complications in the elderly. The magnocellular neurons of the hypothalamus produce the peptide anti-diuretic hormone (vasopressin) which acts on the kidney regulating water loss in the urine. This physiological axis lends itself to both fundamental studies of the cellular and molecular biology of ageing, and to studies of age-related alterations in the functional ability of elderly people. This review summarises some of the recent research into age-related changes in this system. The morphological and functional changes in the hypothalamus, neurohypophysis and kidney are described for the various species examined and the results discussed in terms of ageing in humans.

The epithelium in the female urethra: a quantitative study

Histological sections were prepared from 8 regions along the length of the urethra in 16 women 19 to 82 years old. The epithelium was examined under the light microscope at 4 points in each region and the type of epithelium was classified. Our results indicate that the human female urethra is lined by stratified squamous, pseudostratified columnar and, occasionally, transitional epithelium. There is a gradual change from squamous to columnar epithelium with advancing age. More squamous epithelium is present at the distal end of the urethra.

Long-term study of the immuno-pathological consequences of sympathetic orchiopathia in the rat

Unilateral testicular ischaemia was induced in Wistar rats by ligation and division of the testicular and deferential vessels. Damage (as assessed by a Johnsen count) to the contralateral testis caused significant spermatogenic suppression only at the equator of the testis at 28 days after operation. Cytotoxic antisperm antibody production increased progressively from 7 to 14 days and became maximal at 28 days after infarction, but after 3 and 6 months antibody production was decreasing. The presence of agglutinating antisperm antibody was noted at 28 days, 3 months and 6 months after infarction. Serum immunoglobulin estimations revealed an increase in IgG and IgM levels at 7 days and IgM levels at 14 days, supporting the contention that an immunological reaction had occurred. It is suggested that unilateral testicular ischaemia in the rat, an animal model intended to mimic torsion of the testis in the human, causes a transient immunological phenomenon (sympathetic orchiopathia) which recovers over the course of time. Caution should be exercised before regarding this relatively common surgical emergency as an aetiology of oligospermia or asthenospermia.

The effect of vitamin E deficiency on the induction of age pigment in various tissues of the mouse

The effect of a dietary deficiency of vitamin E on the concentrations of lipofuscin in the hippocampus and the supraoptic nucleus (SON) of the hypothalamus, and in adrenal cortical cells was assessed in male mice. The animals were fed either a control diet or the vitamin E deficient diet after 2 months of age for a period of 6 months. There was no significant difference in the growth curves of the 2 groups of animals over the period studied. Fluorescence microscopy and transmission electron microscopy were used to assess the effect of the diet on lipofuscin in the different tissues. Quantitative morphological techniques were used to determine the relative volumes of lipofuscin in the neurons from the SON and in the adrenal cortical cells. There was no significant difference in the concentration of lipofuscin in the SON neurons after vitamin E deficiency but there was a significant increase in the adrenal cortical cells. There was a clear difference in the effect of the deficiency on mitotic and fixed post-mitotic cells over the period investigated but further studies would be necessary to determine whether or not there was a critical period in the life span where vitamin E deficiency may induce changes in all cell types.

Cardiovascular haemodynamics and the response of vasopressin, aldosterone, plasma renin activity and plasma catecholamines to head-up tilt in young and old healthy subjects

Increasing age impairs the regulation of blood pressure during posture change. The neuro-humoral and cardiovascular responses to head-up tilt were analysed in carefully-screened young and healthy elderly individuals. Mean blood pressure was significantly higher in the elderly but there were no differences in total peripheral resistance, heart rate, stroke volume and cardiac index. Age-related interactions were observed in the control of mean blood pressure, heart rate and stroke volume. Total peripheral resistance increased and cardiac index decreased but there was no difference in their control in the young and old. Noradrenaline, vasopressin, plasma renin activity and aldosterone all increased in response to the tilt. These observations indicate differences in the neuroendocrine responses and cardiovascular haemodynamics of young and old healthy individuals to head-up tilt and are particularly important because of all observations were made simultaneously in the same subject. It is suggested that a similar approach should be adopted in the investigation of patients with postural hypotension.

Contracts to bear children

In the surrogate mother procreation can be divorced both from sex as well as any anticipation of child rearing. Often the risks of surrogate motherhood are presented in terms of alternative family structures and economic exploitation of women. Such possibilities must invite critical reflection in order for there to be legal reform. Of paramount importance is the child's best interest and until the full psychological is the child's best interest and until the full psychological ramifications for the child, adoptive parents and natural mother are determined then the law's role must be ambivalent. In this impasse the minority view of the Warnock Report has much to commend itself.

The effect of age on the control of water conservation in the laboratory mouse--metabolic studies

Age-related changes in the intake of food and water, and the output of faeces and urine were investigated in C57BL/Icrfat mice of 6 and 24 months of age. Animals were singly housed in a metabolic cage for a period of 30 days. 14 days were allowed for acclimatization before the animals were dehydrated for 24 hours. 10 days of rehydration were allowed prior to a hyperosmotic challenge with 3% sodium chloride in the drinking water. The animals were then observed for 5 more days of rehydration. Urine was collected and analysed with regard to sodium, potassium, urea and vasopressin output/24 hours (/100g body weight), and the osmotic pressure of the urine was determined. Data were analysed by a 2 factor analysis of variance with repeated measures on one factor. Significant changes were detected in the control of body weight, potassium, sodium and urea outputs. No age-differences were detected in the intake of food or water, the output of faeces or urine, the urine osmotic pressure or the excretion of vasopressin. However, significant changes in these variables were detected in both age groups on the days of physiological challenge. The conclusion drawn is that in the mouse strain studied, and for the period of the lifespan investigated, there is no age related defect in the secretion of vasopressin. However, there are trends in the data suggesting a decreased responsiveness of the kidney with age.

Effect of ageing on cyclic AMP output by renal medullary cells in response to arginine vasopressin in vitro in C57BL/Icrfat mice

The effect of age on the cyclic AMP (cAMP) response to increases in the concentration of arginine vasopressin in the presence of isobutyl methylxanthine (100 mumol/l) was studied in an in-vitro renal cell suspension prepared from C57BL/Icrfat mice at 6, 12, 18, 24, 29 and 35 months of age. Comparison of the response of the preparation to vasopressin, calcitonin and parathyroid hormone suggested that it was enriched with renal medullary cells. Basal cAMP output was similar throughout but the threshold dose of vasopressin increased from 1 X 10(-11) mol/l (6, 12 and 18 months of age) to 1 X 10(-10) mol/l (24, 29 and 35 months of age). The dose-response curve in 35-month-old mice was shifted to the right with the concentration of vasopressin required to give half maximal cAMP increased from 9.4 +/- 0.37 X 10(-11) mol/l (6 months) to 3.5 +/- 1.6 X 10(-10) mol/l (35 months). Maximum cAMP output at 1 X 10(-9) mol/l was also reduced in the same animals (stimulated:basal ratio, 51.22 +/- 19.12 at 6 months; 11.50 +/- 6.02 at 35 months). The results suggest that the lack of renal response to vasopressin in terms of cAMP metabolism may play a role in the well-documented age-related decline in urine-concentrating ability in experimental animals and elderly people.