An unusual finding on routine dental pan-oral tomography

Radio-opaque foreign bodies are commonly seen in dental pan-oral tomographs. A case is described of the presentation of a patient with a signet ring lodged in the left nasal cavity discovered by routine pan-oral tomography in dental practice, and of its subsequent removal by an otorhinolaryngologist.

Family medicine residency programs. Evaluating the need for different third-year programs

We asked hospital chief executive officers (CEOs) and District Health Council executive directors (DHCs) to compare third-year family medicine residency programs and judge which are more needed in their communities. Care for the elderly and emergency medicine ranked highest among CEOs, while DHCs ranked care for the elderly and mental health highest. Academic family medicine and northern programs ranked lowest for both groups.

The effect of serum and colostrum immunoglobulins from buffaloes infected with Toxocara vitulorum on T. vitulorum larvae in vitro and in vivo in mice

Serum and colostrum were collected from adult buffalo cows naturally infected with Toxocara vitulorum. When injected into mice, the colostrum reduced the number of larvae of T. vitulorum that migrated in the mice. Injection of particularly the IgG-containing fraction but also the IgM-containing fraction of Sephadex G200-chromatographed colostrum also passively protected mice. When incubated for 6 h in buffalo serum or colostrum or fractions of these from Sephadex G200 and diethylaminoethanol Sephadex, T. vitulorum larvae had their activity in vitro curtailed. When the larvae were then fed to mice, their ability to migrate was markedly inhibited as compared with that of larvae that had been incubated in fetal calf serum or in helminth-free sheep colostrum. Fractions of serum and colostrum containing IgG1 had greater inhibitory effects both on the larvae in vitro and on their subsequent migration in mice than did IgG2-containing fractions. IgM also inhibited the larvae as 2-mercaptoethanol reduction of IgM in the IgM-containing peak eluted from Sephadex G200 reduced the inhibitory activity of this peak, although the activity was not completely abrogated.

Development of the emergency physician job satisfaction measurement instrument

The objective of this study was to develop a valid and reliable instrument to measure the job satisfaction of physicians practicing emergency medicine. A prospective survey involving four separate stages (an item evaluation and reduction stage, a factor analysis stage, a construct validity stage, and a reliability stage) was distributed in Canada to full-time emergency physicians. Three separate survey instruments were administered (an initial draft instrument with 228 items, a pilot instrument with 142 items, and the final instrument with 79 items). Construct validity of the final instrument was tested by evaluating the correlation between physician scores on the instrument, and scores on two instruments measuring the same construct, and three measuring different but related constructs. A draft instrument with 228 items and six hypothetical domains was tested on 61 physicians. Evaluation for frequency endorsement, redundancy, and homogeneity reduced the item pool to 157. The remaining 157 items were used as a pilot instrument and tested on 223 physicians. Factor analysis eliminated 66 items from the pilot instrument, creating a final instrument with 79 items, 11 factors, and six domains. Cronbach's coefficient alpha for the final instrument domains is 0.81, and all domain-total correlations are greater than 0.4. All correlations between the final instrument and the construct validity instruments were statistically significant (P < .001), but not so high that they appeared to be measuring the same thing. Correlations between instruments measuring the same construct were higher than those measuring related but different constructs. Correlations between the final instrument and the CES-D scale, emotional exhaustion, and depersonalization subscales of the Maslach Burnout Inventory were negative. A test-retest reliability study on 42 physicians showed Pearson's correlation coefficients for individual domains were all greater than 0.7 and greater than 0.8 for the final instrument. This study has produced a valid and reliable instrument for measuring emergency physician job satisfaction, which is both internally consistent and stable.

The B cell dependence of Haemonchus contortus antigen-induced lymphocyte proliferation

The proliferative responses of ovine lymphocytes to soluble antigens of third-stage larvae of Haemonchus contortus (HcAg) were examined in vitro. Lymphocytes in mononuclear cell cultures responded consistently to HcAg even if the lambs were naive to H. contortus. Lymphocytes from sheep that were immune to reinfection with H. contortus also consistently responded to HcAg with a response significantly greater than that recorded from naive lambs. When the responses of T cell or B cell enriched fractions were examined, neither enriched cell population responded to HcAg, even though the T cell populations were shown to contain monocytes by histochemistry. Studies using the accessory cell dependent T cell mitogen Con A demonstrated that such T cell enriched populations had normal Con A-induced responses compared to unfractionated mononuclear cells. In addition, neither the T cell nor B cell fractions responded to HcAg in the presence of autologous mononuclear cells which contained monocytes and dendritic cells. Responses to HcAg in the T cell enriched population were restored, however, by the presence of mononuclear cells that were cultured with HcAg for 48 hours and then irradiated before the addition of the T cells. These results were seen with cells from both H. contortus naive lambs and immune sheep. This provides evidence that B cells and not dendritic cells or monocytes are acting as antigen presenting cells in Haemonchus antigen-induced lymphocyte responses in both naive lambs and immune sheep.

A Potentially Realizable Quantum Computer

Arrays of weakly coupled quantum systems might compute if subjected to a sequence of electromagnetic pulses of well-defined frequency and length. Such pulsed arrays are true quantum computers: Bits can be placed in superpositionsof 0 and 1, logical operations take place coherently, and dissipation is required only for error correction. Operated with frequent error correction, such a system functions as a parallel digital computer. Operated in a quantum-mechanically coherent manner, such a device functions as a generalpurpose quantum-mechanical micromanipulator, capable of both creating any desired quantum state of the array and transforming that state in any desired way.

Advanced prostate cancer. The role of high priced hormone therapy

OBJECTIVE

To compare the costs of the various options presently available in Australia for treatment of advanced prostatic carcinoma by androgen deprivation.

DESIGN

Forty patients underwent a bilateral orchidectomy for prostatic carcinoma during the 1990/91 financial year at the Princess Alexandra Hospital, Brisbane. The Yale Cost Model, as adapted for use in Australian case-mix projects, was used to derive a diagnosis related group (DRG) cost for this procedure. This was compared with the projected cost that would be incurred in treating patients with the various medical alternatives. To enable comparison, expenses were calculated assuming a mean duration of survival of two years.

RESULTS

The average cost of a bilateral orchidectomy was $2869. This compared to $11,253 for goserelin and $12,329 for cyproterone acetate when used alone in treating a single patient. Flutamide is presently only approved for combination therapy with a luteinising hormone-releasing hormone agonist, and when used with goserelin an average cost of $16,148 per patient was projected.

CONCLUSIONS

Bilateral orchidectomy is clearly the cheapest means of hormone manipulation for prostatic carcinoma. Unless the costs of alternative therapies are drastically reduced in Australia, their use is difficult to justify in other than exceptional circumstances. We believe their use should be restricted presently to patients who would otherwise require a bilateral orchidectomy and have an anticipated survival of less than six months.

Demographic characteristics of full-time emergency physicians in Canada

The objective of this study was to describe individual and practice characteristics of Canadian emergency physicians, and to determine if these characteristics varied with geographic region, type of certification, or method of reimbursement. The study took place in emergency departments across Canada, and all full-time physicians with certification in emergency medicine, and a random sample of Canadian Association of Emergency Physician members without certification were surveyed with a 23-item questionnaire. Descriptive statistics on individual and practice characteristics were outcome measures. Comparative statistics evaluating demographic characteristics by region, type of certification, and method of reimbursement were used. There were significant differences between responders and nonresponders based on certification (P < .001) and region of residence (P < .005). Most physicians are male (87.3%), married (83.3%), reimbursed on a fee for service basis (61%), work in teaching hospitals (65.8%), and participate in medical education (82.3%). On average physicians are 38 years of age, work of 14 shifts/month, 9 hours/shift, 11 nonclinical emergency related hours/week, and have 5 vacation weeks/year. More physicians with FRCP(EM) certification work in teaching hospitals (P < .00001), do nonclinical emergency related work (P < .0001), participate in medical education (P < .0001), and are involved in research (P < .001). There are significant differences by geographic region in gross annual salary (P < .00001), method of reimbursement (P < .00001), and independent hospital emergency department status (P < .00001). Fee-for-service reimbursement for clinical service provides a higher gross annual income than other methods (P = .028). Emergency medicine is an emerging clinical discipline with a strong academic focus.(ABSTRACT TRUNCATED AT 250 WORDS)

The same fractions of Haemonchus contortus soluble antigen induce lymphocyte responses in naive lambs and immune sheep

Soluble antigen extracted from third stage larvae of Haemonchus contortus was divided into fractions based on molecular weight by sodium dodecyl sulphate polyacrylamide gel electrophoresis and electrotransferred to nitrocellulose. Infection immunised adult sheep and H contortus naive lambs were used to examine the lymphocyte responses to these fractions in vitro. The results demonstrate that the same two fractions induced the strongest responses in both groups of animals.

Collection of eggs and hatching and culturing second-stage larvae of Toxocara vitulorum in vitro

Eggs of Toxocara vitulorum were harvested from the feces of infected buffalo calves and embryonated in vitro. Optimum conditions for hatch and culture of the second-stage larvae were determined. Maximum hatch of larvae occurred from eggs that were decoated by treatment with saturated Ca(OCl)2 for 16-24 min followed by treatment with CO2 and incubation at 37 C. Larvae could be cultured in RPMI-1640 medium for up to 3 mo but survived for only 3 wk in Eagle's minimum essential medium.

Efficacy of a drug combination of praziquantel, pyrantel embonate, and febantel against helminth infections in dogs

Tablets containing praziquantel, pyrantel embonate, and febantel were tested for efficacy against helminths in dogs. A single treatment with this drug combination gave 100% reductions in Toxocara canis and Taenia hydatigena in experimentally induced infections in dogs. In dogs with naturally acquired infections, treatment gave > 97 to 98% reductions in fecal egg counts attributable to Toxascaris leonina, T canis, and Uncinaria stenocephala. Efficacy against Trichuris vulpis was > 92%.

Matching-to-sample deficits in patients with senile dementias of the Alzheimer and Lewy body types

Using a computerized matching-to-sample task, nonverbal visual recognition memory was studied in two groups of patients suffering from senile dementia of the Alzheimer type or the recently described senile dementia of the Lewy body type. The patients' cognitive abilities had been shown to be similar according to a number of standard psychometric tests. The two groups did not differ with respect to simultaneous matching-to-sample performance, although both were impaired relative to control. The group with senile dementia of the Lewy body type was severely impaired, relative to the group with senile dementia of the Alzheimer type, when delays (delayed matching to sample) were introduced. The findings suggest that short-term mnemonic processes, mediated by temporal lobe structures, could be more severely affected in senile dementia of the Lewy body type.

Lymphocyte reactivity to antigens of Haemonchus contortus in antigen-inoculated and H contortus-naive lambs

Lambs were inoculated during either fetal or early neonatal life with antigens of Haemonchus contortus (HcAg) third-stage larvae, or ovalbumin (OVA), or were left untreated. By the time lambs were 4 weeks old, blood lymphocytes from all of them responded to HcAg. This was evident in all lambs, regardless of the previous inoculation regimen, although higher response was seen in HcAg-inoculated lambs, compared with naive lambs. Only lambs inoculated with OVA had OVA-specific lymphocyte activity. In HcAg-naive lambs, the maximal HcAg lymphocyte response was observed between the ages of 5 and 25 weeks, with gradual decrease thereafter. In vitro detection of HcAg-reactive lymphocytes was affected by antigen concentration and presence of plasma. Plasma inhibited HcAg-reactive lymphocytes from all lambs at high in vitro antigen concentration and completely abrogated the response in H contortus antigen-naive lambs.

Cytosolic calcium and insulin resistance in elderly patients with essential hypertension

We evaluated insulin sensitivity in normotensive (blood pressure, BP, less than 135/85 mm Hg) and hypertensive (BP greater than 160/90 mm Hg) elderly subjects over 65 years old who were stratified as normal weight (body mass index, BMI, less than 27) and obese (BMI greater than 27). Obese hypertensive individuals demonstrated marked hyperinsulinemia (P less than .01) and significantly reduced (P less than .05) submaximally stimulated adipocyte 2-deoxyglucose (2-DOG) uptake (abdominal wall fat biopsy). Normal weight hypertensive subjects also demonstrated higher levels of insulinemia and lower insulin-stimulated 2-DOG uptake than nonobese controls. Adipocyte [Ca2+]i levels were elevated in all elderly subjects compared to young individuals (P less than .01). Basal and maximally stimulated 2-DOG uptake were similar in all groups. One month of therapy with a calcium channel blocker, 10 mg nitrendipine twice daily, reduced blood pressure in the hypertensive subjects, reduced plasma insulin to control values during an oral glucose tolerance test in obese hypertensive individuals (P less than .01), and restored adipocyte 2-DOG uptake at submaximally effective insulin concentration to control values in normal weight and obese hypertensive subjects. In summary, older hypertensive, and particularly older obese hypertensive, patients manifest significant insulin resistance accompanied by elevated levels of [Ca2+]i in their adipocytes.

Antigen-induced protection against infection with Toxocara vitulorum larvae in mice

Larvae of Toxocara vitulorum hatched and migrated in the tissues of normal mice. Larvae survived in reasonable numbers, particularly in the liver and, to a lesser extent, in the lungs and kidneys, for at least 4-7 days and in muscles, albeit only in low numbers, for at least 3 weeks. Oral infection of mice on three or more occasions with T. vitulorum eggs induced protection against a challenge infection with eggs of T. vitulorum. Prior parenteral immunization of mice with a variety of T. vitulorum soluble antigens (extracts, excretions/secretions, or perienteric fluid and their fractions) from adult parasites and/or infective larvae induced statistically significant protection against infection. The most effective protective immunogens were three or more injections with perienteric fluid from adults (100% protection) and excretions/secretions from infective larvae of T. vitulorum (> 92% protection).

Casemix and costing hospital information program, Brisbane South Regional Health Authority: a preliminary study to determine the emergency department component of DRG costs

The issue of costs incurred for patients in the Emergency Department who are subsequently admitted was investigated by the authors to determine the significance of costs and to identify which DRGs and clinical specialties are likely to be affected. A theoretical costing study was performed in collaboration with the staff in the Emergency Department for patients admitted through this Department. The Study was a preliminary one with a number of methodological limitations. This paper describes how the costing exercise was performed. The DRGs most likely to be admitted via this route are identified and recommendations for further study are made. The study results identify a number of issues that require resolution prior to the introduction of casemix based funding.

The effects of sleep posture and sleep stage on apnea frequency

The Apnea Plus Hypopnea Index (A + HI) of 60 male positional sleep apneics was analyzed by sleep stage to determine if positional differences are limited to NREM sleep. Differences in apnea severity by sleep position were found to persist in REM sleep and to be of equal extent to those differences found in NREM sleep, despite the fact that there is also a significant increase in the frequency of apneic events associated with REM sleep. The positional effect persists in REM sleep, making treatments to control sleep posture a viable option.

Use of sentinel lambs for early monitoring of the South Powys Hydatidosis Control Scheme: prevalence of Echinococcus granulosus and some other helminths

Sentinel lambs were used to identify young Echinococcus granulosus infections in sheep, to provide an early indication of the progress of the South Powys Hydatidosis Control Scheme. Four sentinel lambs were purchased on each of 60 farms, from inside and outside the control area; they were examined when approximately six, 10 and 15 months of age. Gross examination, thin slicing of organs and histological examination of the lesions in the viscera revealed no E granulosus hydatid cysts in lambs born within the control area, whereas 25 per cent of the 15-month-old lambs from outside the area harboured E granulosus cysts (less than 1 to 2 mm in diameter). Lambs from E granulosus infected farms had significantly higher anti-E granulosus ELISA antibody titres than lambs from uninfected farms. It was concluded that within one year of beginning to treat dogs with praziquantel every six weeks the transmission of E granulosus to sheep had ceased. In contrast, this treatment did not prevent infections with Taenia hydatigena or T ovis; an examination of the 240 lambs revealed T hydatigena in 33.3 per cent of them, Tovis in 4.2 per cent, Dictyocaulus filaria in 12.1 per cent and Meullerius capillaris in 49.2 per cent.

Intestinal changes in puppies infected with Toxocara canis

Small intestinal histopathology and absorption were examined in Beagle puppies infected with either a moderate or a low burden of Toxocara canis. Infection with T. canis significantly reduced absorption of xylose, but only slightly delayed absorption of para-aminobenzoic acid. Fat assimilation was reduced and faecal proteolytic activity was increased. A significant reduction in villous height occurred and was inversely related to the extent of the infection. Villous goblet cell numbers, particularly those in the luminal third of the villus, were lowest and crypt goblet cell numbers were highest in the most heavily infected of the puppies. Villous goblet cell numbers increased rapidly after treatment of the puppies with piperazine or after the spontaneous elimination of the T. canis infection while crypt goblet cell numbers were less affected by elimination of the parasites. Intra-epithelial lymphocyte numbers were lowest in 33- to 37-day-old puppies infected with greater than 127 T. canis and highest in 44- to 46-day-old puppies losing their infection. Infection with T. canis had no apparent effect on mast cell numbers or pyroninophilic cell numbers in the lamina propria.

Nonpharmacologic treatment of periodic leg movements in sleep

The effects of a 30-minute stimulation of the dorsiflexors of the feet and toes before bedtime were investigated in eight patients with periodic leg movements in sleep (PLMS). None were taking medications at the time of the investigation. All subjects were treated with the EMS-250 Neuromuscular Stimulator, which has a maximum output per channel of 1.5mA and a frequency of 47Hz. Stimuli were delivered via a pulse train (on for 1.5sec and off for 1.8sec). A single all-night polysomnogram after this stimulation showed that all patients responded to stimulation, with reduction of leg movements from an average pretreatment PLMS index of 44.6 per hour to a posttreatment PLMS index of 14 per hour (p less than .01). Nocturnal leg movements were primarily reduced during the non-REM sleep. Multiple indices of sleep continuity did not change significantly, although there was a trend toward better sleep consolidation.

Memory following cholinergic (NBM) and noradrenergic (DNAB) lesions made singly or in combination: potentiation of disruption by scopolamine

Groups of rats were trained on either delayed matching or nonmatching to position tasks, then divided into four subgroups and given the following bilateral lesions: (a) SHAM [vehicle injection into the nucleus basalis magnocellularis (NBM) and dorsal noradrenergic bundle (DNAB)], (b) DNAB (6-hydroxydopamine lesion of the DNAB, vehicle into the NBM), (c) NBM (quisqualic acid lesion of the NBM, vehicle into the DNAB) and (d) DUAL (neurotoxin lesions of both DNAB and NBM). Following postoperative recovery, the DUAL lesion subjects were slightly impaired, but by the seventh day of testing all groups were performing at similar levels. This strongly suggests that quisqualate lesions of the NBM are not sufficient to produce severe and lasting mnemonic disorders resembling those seen in Alzheimer's disease (AD). These data also indicate that the noradrenergic system may not be of critical importance with respect to cognition. It was reasoned that an additional anticholinergic treatment might exacerbate an underlying deficiency. All groups were injected, peripherally, with the cholinergic antagonist scopolamine (0-0.5 mg/kg). This drug dose-dependently disrupted performance in all groups. Moreover, the highest dose had a marked effect in the DUAL group, impairing performance even when no mnemonic burden was present (at zero delay). The results suggest that cholinergic NBM and noradrenergic DNAB lesions produce only transient mnemonic deficiencies. A combination of the two can be disruptive, but longer term task (or reference) memory is the primary process affected, and only under certain conditions. The implication of these findings to research concerning animal models relating to Alzheimer's disease is discussed.

Effects of nicotine, oxotremorine and 9-amino 1,2,3,4- tetrahydroacridine (tacrine) on matching and non matching to position in rats: no evidence for mnemonic enhancement

Groups of rats were trained on one of two variants of an operant memory task which allows strength of memory (accuracy), bias and response rates to be measured directly. In matching to position (MTP), one of two retractable response levers appeared at random as the sample. A response caused the lever to retract and this was followed by a delay (0-64 s) interval, during which the rat had to approach, and respond at, the magazine tray. Both levers were then presented and the rat had to respond to the lever which had most recently appeared as the sample, for food reward. A second group of rats learned non-matching to position (NMTP). In this task, rats had to respond to the lever which had not appeared as the sample.The subjects were then divided into subgroups and injected, peripherally and prior to test, with one of three cholinergic drugs. These were nicotine (NIC: 0-0.3 mg/kg), oxotremorine (OXO: 0-0.3 mg/kg) and 9-amino 1,2,3,4-tetrahydroacridine (tacrine, THA: 0-3.0 mg/kg). NIC had a delay-independent disruptive effect on accuracy, but only in the non-matching version, and it did not affect rate of responding. OXO and THA had no effect on accuracy, but adversely affected response latencies and rates.The results suggest that these drugs do not affect memory mechanisms; instead, and at the doses used, certain types of bias may be induced (NIC) and general responsiveness altered (OXO and THA).

Opposing effects of vasopressin on matching versus non-matching to position: further evidence for response, not memory, modulation

Rats were trained on either of two related variants of an operant memory task. In the matching to position (MTP) task, one of two retractable response levers appeared, at random, as the sample. A response caused the lever to retract and this was followed by a delay (0-32 s) interval, during which the subjects had to approach and respond at the magazine tray. Both levers were then presented and the rat had to respond, for food reward, to the one which had appeared as the sample. A second group of rats learned non-matching to position (NMTP). This task was very similar to MTP, with one crucial difference: here, the subject had to respond to the lever which had not appeared as the sample. Both groups of rats learned their respective tasks rapidly, performance depending on the delay interval as expected. They were then injected, peripherally, with different doses of arginine-vasopressin (AVP: 0-25 micrograms/kg), a peptide which others have argued improves mnemonic performance. There was evidence to suggest that MTP performance was improved by AVP; on the other hand, NMTP performance appeared to be disrupted. It is suggested that AVP induces a bias towards responding on one side of the two lever test chamber. In other words, it affects motor or motivational, not mnemonic mechanisms.

Postprandial changes in cytosolic free calcium and glucose uptake in adipocytes in obesity and non-insulin-dependent diabetes mellitus

We evaluated the possible relationship between [Ca2+]i and glucose uptake in the postabsorptive state and postprandially in adipocytes obtained from normal and obese subjects, as well as from patients with non-insulin-dependent diabetes mellitus (NIDDM). Adipocytes isolated from overnight-fasted obese and NIDDM patients revealed high levels of [Ca2+]i (p less than 0.05 vs. control) in association with a decreased insulin-stimulated glucose uptake (p less than 0.05 vs. controls). In obese and NIDDM patients treated with oral hypoglycemic agents, the overnight fasting levels of [Ca2+]i were increased postprandially (p less than 0.05), concomitantly with a further decrease in insulin-stimulated 2-deoxyglucose uptake. Although the precise nature of the relationship between [Ca2+]i in specific insulin target tissues and diminished insulin action remains unknown, it is clear that high levels of [Ca2+]i may contribute to the development of insulin resistance.

Intestinal infection with Nematospiroides dubius selectively increases lactase expression by mouse jejunal enterocytes

1. Intestinal structure, lactase (beta-galactosidase; EC 3.2.1.23) activity and alkaline phosphatase activity have been determined in mouse jejunal and ileal tissues before and during infection with the intestinal parasite Nematospiroides dubius. 2. Oral infection with small numbers of N. dubius larvae caused villus height, crypt depth and enterocyte migration rate to increase in the mouse jejunum. None of these effects occurred in ileal tissue. 3. Lactase activity also increased in jejunal, but not ileal, tissue of infected mice. This increase was associated with a doubling of the rate at which activity appeared in the brush-border membrane of enterocytes during migration over the basal regions of jejunal villi. Alkaline phosphatase activity in jejunal tissue remained unchanged in infected mice. 4. Attention is drawn to the fact that this is the first occasion when crypt cell hyperplasia has been found to be positively correlated with an increase in lactase activity and a decrease in cytotoxic/suppressor T-cells. Further work is needed to establish the primary cause of these effects.

Immunologic and hematologic responses in ponies with experimentally induced Strongylus vulgaris infection

Immunologic and hematologic responses were examined in 4 ponies with experimentally induced Strongylus vulgaris infection and in 5 helminth-free ponies. Two ponies were inoculated with 200 larvae and 2 were inoculated with 700 larvae of S vulgaris and then were reinoculated with the same numbers of larvae 34 weeks later. Initial response of the ponies inoculated with S vulgaris was S vulgaris antigen-induced lymphocyte response that developed 1.5 to 3 weeks after inoculation and did not persist. Development of antigen-reactive lymphocytes was followed sequentially by a biphasic complement-fixing antibody response, then biphasic eosinophilia. Antibody titer to S vulgaris antigen was higher in ponies inoculated with 700 larvae, compared with that in ponies given 200 larvae of S vulgaris. Also, the second peak in antibody titer and in absolute number of eosinophils was observed earlier in ponies inoculated with 700 larvae, compared with ponies inoculated with 200 S vulgaris larvae, and subsided before or from about 24 weeks after inoculation. The prepatent period for S vulgaris infection was 24 to 25 weeks. After reinoculation with S vulgaris, a degree of increased lymphocyte responsiveness was apparent but, by 17 weeks after reinoculation, only the primary peak in the absolute number of eosinophils indicated an anamnestic response. Essentially, antibody was not detectable after reinoculation.

Role of the spleen and rosette-formation response in experimental Eperythrozoon ovis infection

The role of the spleen and rosette-formation responses was investigated in sheep experimentally infected with Eperythrozoon ovis. Phagocytic activity was observed in the spleen 19 days after primary infection. Phagocytosis of E. ovis-parasitised and non-parasitised erythrocytes by cordal reticular cells occurred. E. ovis organisms seemed to be detached from the erythrocytes by pseudopodia extending from macrophages and cordal reticular cells without causing damage to the plasmalemma of the erythrocyte. No phagocytic activity was observed in spleens removed 74 and 146 days after infection. Antigen-specific lymphoid cell responsiveness, assessed by rosette formation, indicated that 2.8, 15.4, 8.0 and 6.0% of lymphoid cells in the spleens of the four E. ovis-infected sheep, respectively, formed antigen-specific rosettes. Rosette formation did not occur when splenic lymphocytes from E. ovis-infected sheep were mixed with non-infected erythrocytes or when splenic lymphocytes from an uninfected sheep were used.

[D-TRP11]-neurotensin, unlike alpha-flupenthixol, may not block amphetamine-induced hyperactivity in rats

Recent reports have suggested that neurotensin (NT) and some of its analogues resemble neuroleptics, for example alpha-flupenthixol (FLU), in their ability to suppress locomotor activity. The results obtained support this conclusion, but only if total photocell counts (the "traditional" index) are considered. An improved method of measuring activity--where subjects have to interrupt photocell beams in sequence before a ("conditional") count is registered--suggested, in direct contrast to the total counts index, that the stable analogue of neurotensin [D-Trp11]-neurotensin (DTNT) increased activity slightly (Sahgal and Keith, 1986). The present report is on the effects of DTNT (0-8 microgram/rat, i.c.v.) and FLU (0-1 mg/kg, i.p.) on hyperactivity induced by D-amphetamine (1.5 mg/kg, i.p.). The usual total counts index of activity suggested that FLU and DTNT blocked the increase. On the other hand, conditional count data suggested that only FLU was effective. Both measures indicated that FLU and amphetamine, administered separately, suppressed and enhanced activity, respectively. In contrast, DTNT at these doses had no significant effect on the conditional counts but markedly suppressed total counts. Subsequent observation of DTNT-treated rats placed in small open fields, suggested that the peptide induced marked circling (ambulatory) behaviour, at the cost of other behavioural categories, especially rearing and grooming. It is argued that (a) DTNT may not resemble neuroleptics in its effects on motor behaviour and (b) conditional activity counts, and also measures relating to brief interruptions of photocell beams, can provide useful additional information concerning motor activity.

Use of clinical and paraclinical data to diagnose appendicitis in a patient with abdominal epilepsy

We report a case of acute appendicitis in a 36-year-old patient with recurrent abdominal pain diagnosed seven years previously as abdominal epilepsy. Prior to his reported presentation, he successfully managed his pain at home by self-administration of phenobarbital, but on three previous occasions the patient required emergency-department treatment for severe pain. Our patient had been symptom free for several months prior to this presentation. This case raises several important questions regarding the approach to the diagnosis of acute appendicitis in the emergency department. The case illustrates the relative value of clinical and paraclinical data in establishing the diagnosis. We evaluate accepted clinical and paraclinical data used to diagnose acute appendicitis and advocate using likelihood ratios to increase diagnostic accuracy.

Acute ankle injuries: clinical/radiologic assessment in diagnosis

Acute ankle injuries represent a large burden of illness in the primary care/emergency setting. Concern has been expressed in the medical literature about the unnecessary use of X-rays in the assessment of these patients. A literature review was conducted to address the question: "Can clinical examination alone accurately diagnose fractures and sprains in patients with acute ankle injuries?" Published reports offer inconsistent conclusions on the value of clinical criteria in the diagnosis of fractures or sprains. These inconsistent conclusions appear to result from numerous biases, different patient populations studied, varied interpretations of normal and abnormal results, and different groups of examiners. The only criteria associated with the diagnosis of fracture in more than one study are age greater than 40 years, inability to bear weight on examination, "point" or "bone" tenderness, and swelling. Until consistent results are available, no change in the rate of X-ray referral should be expected.

Seasonal allergic dermatitis in sheep

The lesions of a seasonal dermatitis in sheep occurred mainly on the ventral surface of the animals, but in other respects they resembled those of 'sweet itch' in horses. They were primarily an immediate hypersensitivity response and the circumstantial evidence indicated that they were due to the bites of Culicoides species, possibly C obsoletus.

Testing the hypothesis that crypt cell hyperplasia inhibits lactase expression by mouse jejunal enterocytes

Lactase activity and crypt cell proliferation both increased significantly in mouse jejunal villi in the presence of the intestinal parasite Nematospiroides dubius. Comparisons are made between this result and others showing lactase activity to decline whenever crypt cell proliferation is increased.

Effect of methionine loading and endogenous hypermethioninaemia on blood mercaptans in man

In five patients with cirrhosis given an oral methionine load, blood mercaptan concentrations were not significantly affected by neomycin and metronidazole therapy. Methanethiol and dimethyl sulphide rose after methionine to levels encountered in hepatic encephalopathy but in stable cirrhotics no neurological abnormalities were evident. In one patient with chronic hepatic encephalopathy there was no significant change in methanethiol, dimethyl sulphide or ammonia concentration 4 h after methionine when conscious state had deteriorated by two stages of encephalopathy. Elevations in blood methanethiol and dimethyl sulphide concentration in children with congenital hypermethioninaemia were not associated with any neurological or electroencephalographic features of hepatic coma. These studies do not support an important role for mercaptans in hepatic encephalopathy although a synergistic effect cannot be excluded. Furthermore, mercaptans appear to arise from endogenous metabolism rather than bacterial action in the gut.

Whole body leucine turnover and nutritional status in continuous ambulatory peritoneal dialysis

1. Nutritional status and leucine turnover has been measured in ten patients with chronic renal failure before the onset of continuous ambulatory peritoneal dialysis (CAPD) and after 3 months treatment, and in five normal subjects. 2. Somatic muscle protein reserves, as judged by anthropometry and measurement of total body potassium, showed no significant changes after 3 months treatment and were not significantly different from normal. 3. Visceral protein reserves, as judged by serum albumin and plasma amino acids, showed a significant fall after 3 months CAPD and were also lower than in normal subjects. 4. Protein turnover was lower in uraemic than in normal subjects, but the balance between synthesis and breakdown was significantly higher and was maintained after 3 months on CAPD.

Short-term studies on the use of amino acids as an osmotic agent in continuous ambulatory peritoneal dialysis

1. A 1% amino acid dialysis solution with a high concentration of the branched-chain amino acids has been compared with 1.36% glucose in short-term studies. 2. The 1% amino acid solution was as effective an agent as 1.36% glucose with respect to ultrafiltration and clearance of creatinine, urea and potassium. 3. Levels of branched-chain amino acids rose to the upper end of the normal range within 1 h and remained at this level over the entire period of the study. Total and non-essential amino acids had returned to baseline by the end of the cycle. 4. Blood glucose rose to significantly greater levels during the 1.36% glucose exchange than during the 1% amino acid exchange. There was an increase in serum insulin levels during both cycles; this was significantly greater with the 1% amino acid solution than the 1.36% glucose. 5. There was no evidence of short-term metabolic complications with the 1% amino acid solution.