Diagnostic yield of fibre-optic endoscopy in the operated stomach

Fibre-optic instruments have been used on 212 occasions to examine 177 patients who were symptomatic after peptic ulcer surgery. A diagnosis other than gastritis was reached in 83 patients, including 46 ulcers. Five ulcers were not seen–4 as a result of using inadequate equipment early in the series. Radiology detected only 60 per cent of the ulcers and raised many false-positive diagnoses. Expert review of the radiographs corrected many originally mistaken interpretations. Retained suture materials were seen by endoscopy and removed using biopsy forceps. Gastric mucosal congestion and gastritis were common in the operated stomach, but the clinical significance of these changes remains obscure in the absence of a control series. Fibre-optic endoscopy is now an essential part of the investigation of patients who are symptomatic following ulcer surgery.

A lexical approach to the remediation of final sound omissions

The hypothesis presented and the training method arising from that hypothesis suggest that a language training (vocabulary building) or lexical approach to the remediation of final sound omissions may for some children be an effective method of therapy. A six-year-old trainable mentally retarded boy with a vocabulary of five understandable words, all of which contained final consonant omissions, was taught by a lexical method. He was required to use the final consonant to differentiate between word alternatives not previously present in his vocabulary. This method of training brought obvious improvement in the use of final consonants, and should offer an alternative to the traditional approach to therapy for some children who omit final consonant sounds.

A reinvestigation of a possible route to 1,2-Benzisothiazoles: The reaction between N-benzyl-substituted sulphonamides and trichloromethanesulphenyl chloride in the presence of base

The reaction between N-benzyl-substituted sulphonamides (1) and trichloromethanesulphenyl chloride in the presence of base afforded the expected N-trichloromethanesulphenyl derivatives (4); the previously reported 1,2-benzisothiazolines (2) were not obtained. Treatment of the derivatives (4) with base under various conditions gave no indication of cyclization to 1,2-benzisothiazolines (2).

The Anrep effect reconsidered

Evidence is presented supporting the hypothesis that the positive inotropic effect after an abrupt increase in systolic pressure (Anrep effect) is the recovery from subendocardial ischemia induced by the increase and subsequently corrected by vascular autoregulation of the coronary bed. Major evidence consists of data obtained from an isolated heart preparation showing that the Anrep effect can be abolished with coronary vasodilation, and that with an abrupt increase in systolic pressure there is a significant reduction in the distribution of coronary flow to subendocardial layers of the ventricle. Furthermore, the intracardiac electrocardiogram shows S-T segment and T wave changes after an abrupt increase in ventricular pressure similar to that noted after coronary constriction. Major implications are that normally there may be ischemia of the subendocardial layers tending to reduce myocardial contractility which may account, in part, for the positive inotropic effect of various coronary vasodilators; that with an abrupt increase in ventricular pressure the subendocardium is rendered temporarily ischemic, placing the heart in jeopardy from arrhythmias until this is corrected; and that end-diastolic pressure and the intracardiac electrocardiogram may provide a means of evaluating the adequacy of circulation to subendocardial layers in diseased ventricles when systolic pressure is abruptly increased.