Urinary excretion of cortisol after immunisation

Urinary cortisol excretion and rectal temperature were measured in 66 infants before and after immunisation against diphtheria, tetanus, pertussis, and Haemophilus influenzae type b. Immunisation produced a significant increase of rectal temperature the next night at all ages. Infants without an adult-like night time body temperature pattern had a significant increase in urinary cortisol excretion night and morning after immunisation. Once an adult-like night time body temperature pattern developed immunisation no longer significantly raised urinary cortisol output.

Quantitative endoluminal measurements during angioscopy: an innovative technique

AIM

To evaluate angioscopy in this Unit with respect to its application in lower limb vascular reconstructions. By providing magnified, colour images of the luminal surfaces of vein grafts, anastomoses and native arteries, angioscopy allows direct visualisation of imperfections and is sensitive in diagnosing technical problems. However, assessment is qualitative and magnification of the image can distort the operator's impression of true size. Angioscopy would be more versatile if it were possible to quantify the observed images.

METHOD

A new technique has been developed to measure intra-luminal diameter from the angioscopic images. A linear displacement transducer is attached to the angioscope and accurately monitors its axial shift. Signals from the transducer are received by a personal computer equipped with a video frame grabber and analogue digital converter, together with appropriate software. The computer generates calculated dimensions based on geometrical principles, once each angioscope has been appropriately calibrated at the outset.

RESULTS

Laboratory studies examining tubes of known dimensions have confirmed the reproducibility and accuracy of the technique. Simultaneous angioscopic and Duplex ultrasound measurements of the internal diameters of segments of vein suspended in a water bath were then carried out. Using the Duplex results as the 'gold standard', there was a strong correlation between the measurements obtained with the two techniques (Rs = 0.92).

CONCLUSIONS

In the clinical context, this system has the capability to generate accurate endoluminal measurements during angioscopy. This has application for quality control in the selection of veins and inspection of run-off vessels during bypass grafting and in completion studies, following both operative and percutaneous procedures.

Diagnosis of Bloom's syndrome by sister chromatid exchange evaluation in chorionic villus cultures

Cultures of a chorion biopsy taken from a pregnancy at risk of Bloom's syndrome revealed the high sister chromatid exchange frequency diagnostic of this rare disorder. To obtain the result, cultures were grown under standard conditions, with the addition of 10 microM 5'-bromodeoxyuridine for the final 48 h of incubation. This result demonstrates the feasibility of early prenatal diagnosis of Bloom's syndrome.

Staging of gastrulating mouse embryos by morphological landmarks in the dissecting microscope

We describe and illustrate a set of morphological landmarks for classifying mouse embryos by gross morphology from before gastrulation to the beginning of organogenesis. These landmarks are visible at the resolution of the dissecting microscope in embryos that are intact except for reflexion of Reichert's membrane. Adoption of these criteria should facilitate interpretation of both the expression patterns of genes and the consequences of experimental manipulation of embryos during early postimplantation development.

Complex mosaicism associated with trisomy 9

Fetal karyotypes can be routinely obtained by chorionic villus biopsy, amniocentesis, or fetal blood sampling. Interpretation of results and subsequent counselling can be complicated by pseudomosaicism or mosaicism confined to the placenta or other tissues. We illustrate this by reporting a case of an abnormal fetus with a total of three karyotypically different cell lines (46,XX; 47,XX, +9; and 47,XX, +del(9) (q11) in different tissues (placenta, lung, gonad, and skin).

The Hough transform for locating cell nuclei

A method of cytologic image segmentation that works purely on the basis of geometric information is described. Cell nuclei are assumed to be circular or elliptical. The latest ellipse-finding Hough transform is then used to locate the nuclei. The results are encouraging.

Oral poliovirus vaccine in the United States: molecular characterization of Sabin type 3 after replication in the gut of vaccinees

Derivatives of Sabin 3 shed from recipients of oral poliovirus vaccine in the United States (U.S.) were examined for genetic changes identified in strains excreted by vaccinees in the United Kingdom [U.K.; Evans et al., 1985; Cammack et al., 1988, Macadam et al., 1989]. Among the eight primary vaccinees studied, the duration of excretion and molecular evolution of type 3 strains varied greatly. The period of virus excretion after vaccination ranged from as few as 2 days to as many as 36 days. Nucleotide sequence analysis of viral RNAs extracted from shed virus indicated that only fifty percent of the vaccinees exclusively excreted strains in which the attenuating mutation at nucleotide 472 in the 5' noncoding region of the genome had reverted from uracil (U) to cytosine (C), the nucleotide found in neurovirulent strains. Compared to the wild-type Leon strain, the low activity of stool isolate KW4 in a complete monkey neurovirulence test demonstrated that presence of C at 472 does not render a type 3 strain pathogenic. Conversely, an isolate was identified which efficiently replicated in monkey nervous tissue and maintained the attenuated U at 472. Oligonucleotide fingerprinting and sequence analysis of viral RNAs from stool isolates indicated that one vaccinee (KW) eventually excreted intertypic recombinant strains consistent with those reported in the U.K. studies. Unique to this study, one vaccinee (KS) excreted nonrecombinant virus possessing U at 472 for up to 21 days. The significance of the KS strain profile in relation to differences in the U.S. vaccine compared to the vaccine distributed in the U.K. and other countries is discussed.

Computerisation of primary care in Wales

OBJECTIVE

To obtain information about the computerisation of general practice in Wales, and to enable more effective planning of educational provision for doctors and other primary health care workers.

DESIGN

Postal questionnaire sent to all general practices in Wales.

SUBJECTS

553 general practices, of which 401 (73% replied).

RESULTS

The level of computerisation varied from 11 (85%) of practices in Powys Family Health Services Authority to 22 (40%) in Mid Glamorgan. Less than half of practices had a computer in only two authorities. The commonest uses of the computer were for patient registration (208 practices), repeat prescribing (180), call and recall of patients (165), and partial clinical records (122). The main suppliers were VAMP (78 practices), AAH Meditel (46), and AMC (23). 102 of 226 practices with a computer had a terminal on each doctor's desk. Just 33 practices had full patient notes on computer and 51 had modems for electronic communication.

CONCLUSION

Mechanisms to encourage greater and more sophisticated use of computers and information technology need to be explored.

Peroxisomes in pigment epithelium and Müller cells of amphibian retina possess D-amino acid oxidase as well as catalase

In this paper we identify peroxisomes in Müller cells and retinal pigment epithelial cells of Rana pipiens and Xenopus laevis by virtue of their content of cytochemically stainable catalase. These organelles have the form of an extensive, branched system of tubules in the retinal pigment epithelium and appear as discrete ovoid structures in the Müller cells. In both the pigment epithelium and the Müller cells a second peroxisomal enzyme, D-amino acid oxidase, can be detected in the same structures as catalase by means of a cerium-based cytochemical staining procedure. This oxidase is active only against nonpolar and polar, uncharged D-amino acids.

Nuclear medicine studies of aging--III. Radial bone mineral content by single and dual photon absorptiometry

Measurement of bone mineral content of the radius has been possible by single photon absorptiometry. Recently, dual photon devices have become widely used for measuring the quantity of lumbar vertebral bone mineral. Therefore, we studied the utility of a dual beam machine for quantifying the bone mineral content of the radius, and compared results with those obtained by single photon absorptiometry in the same patient on the same day. There was an excellent correlation between single and dual beam measurements of the radius. The present study indicates that a dual photon machine can be used for assessing not only vertebral, but radial bone mineral content as well. This may facilitate studies of the two sites by use of one machine.

Nuclear medicine studies of aging--VI. Dual photon absorptiometry and bone scans in "at risk" women with back pain

We studied 20 women who were at risk for osteoporosis (postmenopausal, or on dialysis, or on steroids), who presented with severe back pain. Patients underwent a dual photon (153Gd) densitometry study of the L2-L4 vertebrae, as well as an emission bone scan (99mTc-MDP). The dual photon method revealed abnormal results (20% or more below the mean expected value) in 13/20 patients (65%), and below the "fracture threshold" in 15/20 (75%). The emission bone scan delineated abnormal foci of uptake in 15/19 (79%). We conclude that women at risk for osteoporosis, who present with severe back pain, are likely to have a positive bone scan due to compression fracture or other derangements related to bone demineralization.

Anterior pituitary response to thyrotrophin releasing hormone in senile dementia (Alzheimer type) and elderly normals

Sixteen patients with senile dementia of the Alzheimer type (SDAT) were compared with 11 age-matched normal subjects with respect to their responses of thyrotrophin (TSH) and prolactin (PRL) to thyrotrophin releasing hormone (TRH) challenge. Both groups showed a continuing rise in TSH response at 60 min, and no difference was found between the groups. A significantly exaggerated PRL response at 20 min was found in the SDAT group. There was no difference between sexes with respect to either the TSH or PRL response. These findings, albeit preliminary, may have implications for dopaminergic impairment in SDAT.

Accident department or general practice?

Ninety two patients, who were registered with one general practice partnership that has a tradition of providing minor trauma services and who had attended a hospital accident and emergency department, completed a questionnaire giving their reasons for not first attending their general practitioners with their ailments. Most had not tried to contact their general practitioner, and of these, only a few were unsuitable for treatment first by the general practitioner. More than half had attended the accident and emergency department because they did not want to bother their own general practitioner or thought that their problem was unsuitable for his attention. A higher proportion had attended for reasons of perceived speed or convenience. In the light of the need to cut costs in the hospital service and of government interest in promoting a wider range of services in general practice further study of such problems is needed. Patients' perceptions of the role of the accident department need to be changed if present behaviour is to be altered.

Group Training Associations

For many employers training is purchased from the in‐house Training Centre, Skill Centre, College of Further Education or Management Consultant. However, throughout England, Scotland and Wales there is a network of Training Centres and expertise — Group Training Associations — providing high quality courses and services at fees generally well below those charged by the traditional providers.

Photon absorptiometry for non-invasive measurement of bone mineral content

Bone mineral content of the distal radius was determined in 106 patients by single photon absorptiometry using iodine-125 monochromatic source. The technique provided a reliable means to assess the degree of mineral loss in conditions such as osteoporosis, renal osteodystrophy in patients on chronic maintenance dialysis, subjects on long-term steroid therapy, and those with diabetes mellitus. It is more sensitive than conventional radiography and completely noninvasive compared to bone biopsy. It is suggested that photon absorptiometry is a simple, sensitive, and reliable technique for assessment and follow-up of the bone mineral content in a host of disorders associated with bone demineralization.

Volatile products from acetylcholine as markers in the rapid urine test using head-space gas-liquid chromatography

Head-space gas--liquid chromatographic analyses of cultures of all Proteus spp. showed that the production of trimethylamine from acetylcholine could be the marker for the detection in 3.5 h of significant numbers of P. mirabilis, P. vulgaris, P. rettgeri and P. inconstans A in the rapid test for Escherichia and Klebsiella spp. in urine specimens. Trimethylamine was not detected in cultures of five other urinary pathogens. Six of fifteen strains of K. aerogenes produced trimethylamine from acetylcholine but were distinguished from Proteus spp. by ethanol production from arabinose. Ethyl acetate was produced from acetylcholine by P. mirabilis, P. vulgaris, P. rettgeri, P. inconstans A, P. inconstans B, E. coli, K. aerogenes and Streptococcus faecalis.

Translocation of c-ab1 oncogene correlates with the presence of a Philadelphia chromosome in chronic myelocytic leukaemia

The localization of cellular oncogenes near the break points of tumour-specific chromosomal aberrations suggests an involvement of these genes in the generation of neoplasms. Recently, we demonstrated the translocation of the human cellular homologue (c-ab1) of the transforming sequence of Abelson murine leukaemia virus (A-MuLV) from chromosome 9 to the Philadelphia chromosome (Ph1) in chronic myelocytic leukaemia (CML). In an attempt to investigate the significance of this translocation in the pathogenesis of CML, we have now studied two CML patients with complex translocations, t(9; 11; 22) and t(1; 9; 22), and two CML Ph1-negative patients with apparently normal karyotypes. In addition to using blot hybridization with human c-ab1 probes and DNA from rodent: CML cell hybrids as before, we have used in situ hybridization of these probes directly to metaphase chromosomes of CML patients. These studies show that the c-ab1 gene is translocated in Ph1-positive but not in Ph1-negative CML patients. CML without the Ph1 chromosome seems to be a distinct entity with a different origin, and this view is supported by clinical observations including correlations which reveal a poorer prognosis.

The estimation of fetal haemoglobin in healthy adults by radioimmunoassay

A radioimmunoassay (RIA) for the measurement of fetal haemoglobin (HbF) was established and used to determine the distribution of HbF in 2463 British adults between the ages of 18 and 65 years. Although a range in HbF values was similar in both genders a shift towards higher values is seen in females and the mean HbF% is higher, in females, at all ages between 18 and 55. A significant and different fall in HbF over the age range studied was noted between females (47%) and males (23%). The difference in mean HbF between the genders was less marked after age 40 years and a small rise in HbF production was measured in females between ages 50 and 54 years.

Gas-Liquid Chromatographic Determination of Terbuthylazine Technical and Its Formulations: Collaborative Study

Terbuthylazine technical and its 80% wettable powder were analyzed in a CIPAC collaborative study. The content and the identity were determined by gas-liquid chromatography on a column of 3% Carbowax K20M on Gas-Chrom Q, using di-n-pentylphthalate as the internal standard. Results obtained from 27 government, university, and industrial collaborators showed within-laboratory repeatability of 1.3% for the technical and 1.0% for the wettable powder. Reproducibility was 2.1% for both samples. The method has been adopted official first action

Thyroid stimulating antibodies and metastatic thyroid carcinoma

A patient with previously treated follicular carcinoma of the thyroid developed Graves' disease with a high titre of thyroid-stimulating antibodies (TSAb). He developed functioning pulmonary metastases leading to hyperthyroidism. Levels of TSAb paralleled the functional status of the metastases suggesting that hyperfunction of the neoplastic tissues was caused by TSAb.

The effects of therapy with oestriol succinate and ethinyl oestradiol on the haemostatic mechanism in post-menopausal women

The effects on the haemostatic mechanism of oestrogen therapy, given to prevent bone loss in post-menopausal women, have been investigated. Oestriol succinate was given orally to 10 women at a level of 2 mg/day for 1 month and for a further 3 months with incremental increase of 2 mg each month. 6 of the 10 women were subsequently treated with 25 mug/day orally of ethinyl oestradiol. Oestriol succinate therapy resulted in a small increase in the level of factor VII, a decrease in factor VIII concentration and increased sensitivity of platelets to aggregating agents. Ethinyl oestradiol treatment resulted in much more widespread changes with marked increases in coagulation factors VII, VIII, IX and X, decreased levels of antithrombin and dramatic increases in circulating plasminogen levels and euglobulin lysis activity. The data suggested that the nature of oestrogens employed therapeutically is important in determining the qualitative and quantitative effect of oestrogen therapy on components of the haemostatic mechanism.