Autokinesis and some conditions of fatigue

Effects of physical, mental, and vigilance fatigue on the autokinetic reports of 48 undergraduate students are described. Eight response measures were taken of the subjects with an apparatus that permitted recording of the apparent motion of the autokinetic stimulus in the same plane as the light source. Presence of the fatigue states was verified by independent measurements. Fatigue conditions facilitated quick and continuous perception of the autokinetic movements. The most perceptual complexity in the patterns of apparent motion was observed under mental fatigue followed by physical and vigilance fatigue, with least in the neutral condition.

Operant conditioning for management of a noncompliant rehabilitation case after stroke

An operant conditioning model was used to design and implement a multidisciplinary intervention with a 53-year-old woman who was a difficult rehabilitation client after a cerebrovascular accident. She was depressed, noncompliant in learning ADL's refused to eat, and except for physical therapy (PT), was frequently absent from therapies or unmotivated if present. In a unified program, good performances in ADL's were rewarded with small privileges, increased eating was rewarded with extra PT, and attendance and good performance in therapies were rewarded with tokens exchangeable for weekend passes. Immediately after initiation of the program, there was a dramatic increase in appropriate behaviors.

D-penicillamine treatment improves survival in primary biliary cirrhosis

The copper-chelating, immunological, and antifibrotic effects of D-penicillamine indicated that it might be suitable for the treatment of primary biliary cirrhosis (PBC). In a randomised clinical trail, 55 PBC patients received penicillamine (600 mg daily), and 32 received a placebo. Drug reactions developed in 16 patients on penicillamine. All deaths occurred in patients with stage 3 or 4 (late stage) liver histology on entry to the study. 5 (14%) of 37 penicillamine-treated patients and 10 (43%) of 23 placebo patients have died (p less than 0.01). Improvement in survival only became evident after 18 months. Survivors in the penicillamine group demonstrated a significant fall in serum aspartate transaminase, serum immunoglobulins, and liver copper concentrations. On follow-up liver biopsy 12-72 months (median 33) after joining the study, 21% of penicillamine-treated patients had less pronounced inflammation and piecemeal necrosis, whereas there had been no improvement in patients on placebo (p less than 0.02). Penicillamine did not retard the histological evolution of the liver disease from the early prefibrotic stages to the late fibrotic or cirrhotic stages. Both the copper-chelating and immunological effects of penicillamine are probably important in improving survival. The excellent prognosis of patients with PBC in its early histological stages, and the failure of penicillamine to prevent histological progression from early to late stages, suggests that penicillamine treatment should not be given to patients with PBC in the early (stage 1 or 2) histological phase of the disease. Penicillamine treatment is recommended in patients once liver biopsy has demonstrated histological results typical of late stage 3 or 4 PBC.

Creation of caverno-glandular shunt for treatment of priapism

Caverno-glandular shunt was performed in 8 patients with priapism during the past 3 years. Complete and sustained detumescence was achieved immediately in all patients. Only one case developed a complication, viz. cavernositis which responded to antibiotic administration systemically as well as locally. This procedure was performed under local anaesthesia in 5 patients. The technical details and advantages of this procedure over conventional operations for priapism are discussed.

The effect of small and moderate doses of d-amphetamine on hunger, mood, and arousal in man

In rats, low doses of d-amphetamine (d-amp) increase rather than decrease food intake. A double-blind study was carried out in nine healthy female subjects to compare the effects of a low (1 mg) and a moderate (10 mg) dose of d-amp and placebo on hunger, mood and arousal. Each subject participated in three experimental sessions, 1 week apart, when they received either 1 mg d-amp, 10 mg d-amp or placebo, according to a random double-blind design. Visual analogue rating scales for hunger, mood and arousal were completed prior to drug administration and at 30-min intervals for 4 h. A questionnaire relating to sleep pattern and side effects was completed the morning after each experimental session. d-Amp (10 mg) produced a significant reduction in hunger ratings as compared with placebo at 2 h and 2.5 h after administration, while 1 mg d-amp had no significant effect on hunger. Mood and arousal were only slightly elevated by 10 mg d-amp, and not at all by 1 mg.

Late results of the Royal Free Hospital prospective controlled trial of prednisolone therapy in hepatitis B surface antigen negative chronic active hepatitis

A long-term follow-up of at least 10 years or until death of 44 patients taking part in a controlled prospective trial of prednisolone therapy in hepatitis B antigen negative chronic active hepatitis (lupoid hepatitis) has been performed at the Royal Free Hospital, London. Patients presenting between 1963 and 1967 were randomly allocated into control and treatment groups. Ten year life table survival curves showed a significantly improved survival in the treatment group where 63% of patients were alive at 10 years compared with only 27% in the control group (log rank test, P = 0.03). The median survival in the treatment group was 12.2 years compared with 3.3 years in the control group. The mean duration of treatment was 4.5 years. Age, presence of antinuclear factor, cirrhosis, or level of serum transaminases at presentation did not appear to affect survival. Male patients if untreated had a poorer prognosis than females (P = 0.02). The natural history of chronic active hepatitis appeared from clinical, biochemical, and histological findings to be from an active hepatitis or cirrhosis to inactive macronodular cirrhosis. Prednisolone therapy significantly improved survival by reducing mortality in the early active phase of the disease.

Levamisole therapy for HBsAg-positive chronic liver disease

Eight subjects with HBsAg-positive chronic liver disease received levamisole therapy continuously for 6 to 8 weeks. Depressed T-lymphocyte concentrations, found in all patients before therapy, transiently returned towards normal. All of the three patients who had normal delayed hypersensitivity responses before treatment showed an acute hepatitic reaction manifested by elevation of serum aspartate transaminase (AsT) and HBsAg levels, with transient cell-mediated immunity to HBsAg. This was interpreted as indicating increased lysis of infected hepatocytes. All of the five anergic patients showed no change in AsT or HBsAg levels. The clinical features and hepatic histology were unchanged. In patients with the capacity to mount normal delayed hypersensitivity responses, levamisole enhanced the cell-mediated response to HBsAg, and there was increased lysis of infected cells. Nevertheless, this treatment failed to eradicate the virus, as all patients remained HBsAg-positive.

[Phonomechanocardiographic study of congestive myocardiopathy]

There were studied 14 patients with congestive myocardiopathy demonstrated by cardiac catheterism at nine, echocardiogramme at five and/or necropsy at four. There were registered mytral insufficiency blowings at thirteen and tricusp insufficiency blowings at five. Of them, there were 11 that presented pathologic noises III and IV. Right apexcardiogramme showed growth of such cavity at the twelve patients that were studied. "a" index of the same precordiogramme had qualitative correlation with systolic pulmonary pression. Apexcardiogramme showed ventricular growth at twelve from thirteen patients and "a" index was also qualitatively correlated with direct deermination of the left ventricule's telediastolic pression. Chronocardiometry was anormal at all of them. Short expulsive period, long pre-expulsive period, expulsion's fraction diminution reckoned by this method and systolic quotient, all of them diminished, translated the cardiac expense fall by "pump" fail. Elongation of pre-isosystolic phase, isosystolic phase, true isosystolic phase, and diminution of ventricular pression's elevation middle velocity and contractility index were consequences of myocardic contraction's bad quality. Decrement of ventricular pression's elevation velocity, added to the important elevation of left ventricle's final diastolic pression determined the "pseudonormality" of IIa-0 interval, and of the integrated isovolumetric pression. Shortening of fast filled's phase is explained by a minor ventricular filled in order to the volume's increase and diastolic pression's increase (Board VII). By last, shortening of Q-IIa interval, coinciding with the cardiac frecuence's increase is explained by catecolamins' increased secretion like compensating mechanism of chronic cardiac insufficiency. Phonomechanocardiogramme is useful for entity's diagnostic and it informs about ventricular disfunction which characterise the suffering.

Acute renal insufficiency occurring during intravenous desferrioxamine therapy

A patient of 14 years suffering from secondary haemosiderosis and thalassaemia major was treated with i.v. desferrioxamine in doses up to 3 g/d. Urine iron loss ranged from 46-158 mg/d. Despite improvement in cardiac and hepatic status the patient developed acute renal insufficiency of the pre renal type. The possible role of desferrioxamine in this complication is discussed. Desferrioxamine given s.c. or i.v. effects a marked urinary iron loss but its use may not be without significant complications.

Reduction of immune complexes and immunoglobulins induced by D-penicillamine in primary biliary cirrhosis

Penicillamine has an effect on immune complexes and immunoglobulins both in vivo and in vitro. We therefore studied the effect of penicillamine on immune complexes and immunoglobulins in primary biliary cirrhosis. Twenty-eight patients were randomly allocated into a treatment group receiving 600 to 900 mg of penicillamine, or a control group, and followed for a maximum of 24 months. After 12 and 24 months, serum immune complexes had fallen significantly in treated patients as compared to controls (P less than 0.05, P less than 0.01). Treatment reduced IgA, IgG and IgM concentrations, with IgM being significantly different from controls at six, 12 and 24 months (P less than 0.01). Over 24 months, serum aspartate transaminase levels fell in treated patients but rose in controls (P less than 0.01). Bilirubin concentrations increased at a slower rate in treated patients. Penicillamine may favorably influence the course of primary biliary cirrhosis by its immunologic action in addition to its copper-chelating action.

Histological demonstration of copper and copper-associated protein in chronic liver diseases

Liver copper concentrations in percutaneous biopsy specimens were measured by neutron activation analysis and compared with histological staining for copper by rubeanic acid and rhodanine, and with copper-associated protein stained by orcein. Liver copper concentrations were elevated in 31 of 35 biopsies from patients with primary biliary cirrhosis (PBC), and discrimination between normal and elevated liver copper was correct in 32 of the 35 biopsies by staining with rubeanic acid, and 31 of the 35 by staining with rhodanine. Orcein staining of copper-associated protein was positive in 33 of the 35 biopsies. All 17 biopsy specimens from patients with Wilson's disease had high liver copper concentrations, but only nine had positive staining for copper, and six were orcein positive. Similarly, histological stains gave little indication of the liver copper concentrations in tissue from 16 patients with chronic active hepatitis. Staining of liver sections can be useful in detecting elevation of liver copper in PBC, but not in Wilson's disease, where the absolute concentration must be measured. Excess copper appears to accumulate in the liver in different chemical forms in PBC and Wilson's disease.

Immune complexes in acute and chronic liver disease

Anti-complementary (AC) activity and C1q-binding are increased in acute type A and B hepatitis, alcohol-induced hepatitis, HB surface antigen-positive and -negative chronic active hepatitis and primary biliary cirrhosis.

In acute type A hepatitis, a large increase in C1q-binding was demonstrated during the period of elevated transaminases. In type B hepatitis, the initial peak was small, but was followed by a further peak during the period of falling serum HB surface (HBs) antigen titre. In both diseases the C1q-binding was associated with >20S particles. In paracetamol-induced necrosis, C1q-binding remained normal. In type A and B hepatitis and in paracetamol-induced necrosis, C4, C3 and factor B concentrations were depressed in the early phase of the disease. This change may reflect either diminished synthesis or increased catabolism.

In chronic active hepatitis (HBs-positive and -negative) and in alcohol-induced disease there is a significant correlation between C1q-binding and the severity of hepatitis. C1q-binding and AC activity were also increased in primary biliary cirrhosis. Density gradient studies indicate that the C1q-binding activity in these subjects lies in the 8–14S and >19S particle-containing fractions.

These findings suggest the presence of immune complexes in patients with acute and chronic liver disease. In some cases the complexes may contained hepatitis viral antigens, but in alcohol-induced and autoimmune disease other types of complex formation must exist. The accumulation of large and small complexes in subjects with liver disease may be a reflection of an impaired function of the mononuclear phagocytes in these diseases. The potential of these complexes to activate complement will determine their pathological importance, and in this respect those found in primary biliary cirrhosis may have special significance.