Lateral release for recurrent dislocation of the patella

We reviewed 41 knees after arthroscopic lateral release for recurrent dislocation of the patella at a mean follow-up of four years, and graded the results according to the criteria of Crosby and Insall (1976). There were no dislocations after operation in 28 knees (68%); the less satisfactory results were in patients with subluxation of the patella on extension of the knee and those with generalised ligamentous laxity. There were no complications. A characteristic and previously unreported lesion of the patellar surface was seen in eight of the 41 knees. The results of lateral release are better than those reported for other techniques. This treatment, by either open or arthroscopic methods, is recommended.

Three cases of aberrant right subclavian artery in the dog

In the normal dog only 2 arteries leave the ascending aorta–the brachiocephalic trunk and the left subclavian artery. This communication describes 3 dogs, a labrador, a poodle and a german shepherd, in which 3 large arteries left the ascending aorta–firstly a trunk for both common carotid arteries, then a left subclavian artery and finally a right subclavian artery.

Melatonin reduces the production and secretion of prolactin and growth hormone from rat pituitary cells in culture

A culture of clonal tumour cells from rat pituitary gland that secrete both prolactin and growth hormone were used to investigate whether the pineal hormone melatonin can act directly on the pituitary gland to control prolactin production. Melatonin inhibition of prolactin and growth hormone production was significant but mild. Concentrations of between 10(-8) M and 10(-6) M reduced both prolactin and growth hormone production and prolactin secretion by 10-50%. 17 beta-oestradiol (OE) and thyrotrophin-releasing hormone (TRH) stimulated prolactin production but had no significant effect on growth hormone production. Melatonin reduced the effects of both of these compounds. Both TRH and vasoactive intestinal peptide (VIP) stimulated secretion of prolactin, and TRH also of growth hormone. Melatonin reduced these effects significantly. TRH and VIP increased cAMP production two- and 12-fold, respectively. Melatonin had no effect on basal or stimulated cAMP production. The melatonin-induced changes in prolactin and growth hormone production and secretion seen here do not approach the magnitude of the fluctuations seen in plasma in vivo. It is concluded that while melatonin does have a direct effect on the lactotroph in the regulation of prolactin production, its main physiological target must be elsewhere.

Study of DTH and resistance in Mycobacterium lepraemurium infection using a T-cell line isolated from mice infected with Mycobacterium bovis (BCG)

A T-cell line of mixed phenotype (60% L3T4+, 40% Lyt-2+) was isolated from mice infected with Mycobacterium bovis (BCG). This line responded to M. lepraemurium and BCG but not to M. leprae and produced TCGF spontaneously. It also produced factors which stimulated macrophages to secrete hydrogen peroxide and superoxide anion. In vivo studies showed that only L3T4+ cells were required to transfer DTH responses and that Lyt-2+ cells suppressed this response. Both L3T4+ and Lyt-2+ cells were required to inhibit M. lepraemurium multiplication in vivo.

Familial occurrence of testicular neoplasia: case report of testicular embryonal carcinoma in 2 brothers and a first cousin

Testicular tumors of a similar histological type have been reported rarely in families. We report on 2 nontwin brothers and a first cousin who presented with embryonal carcinoma.

Anatomical and physiological observations on supraspinal control of bladder and urethral sphincter muscles in the cat

In 15 cats injections of 3H-leucine were made in the pontine tegmentum. Injections in the medial part of the dorsolateral pontine tegmentum (M-region) resulted in specific projections to the sacral intermediomedial and intermediolateral cell groups. The intermediolateral cell group contains preganglionic parasympathetic neurons that form the motor supply of the detrusor muscle of the bladder. Injections in the lateral part of the pontine tegmental field (L-region) produced labeled fibers in the nucleus of Onuf, which contains motoneurons innervating the pelvic floor including the anal and urethral sphincters. L-region projections to the sacral preganglionic parasympathetic neurons and M-region projections to the nucleus of Onuf were very limited or absent. In 12 cats physiological experiments were performed. Electrical stimulation in the L-region elicited a prompt increase in the pelvic floor EMG and urethral pressure but had little influence on the intravesical pressure. Stimulation in the M-region elicited a prompt decrease in the pelvic floor EMG and urethral pressure followed, after a delay of 2 seconds, by an increase in the intravesical pressure, so simulating normal micturition.

The pressure within a collapsed tube, with special reference to urethral pressure

A definition is proposed for tube pressure (the pressure within a collapsible tube in the collapsed state, e.g. the urethral pressure or the pressure in the anal or oesophageal sphincter) which conforms to the common sense view that it is a measure of the ability of the tube to prevent leakage. It is not dependent on the orientation of a measuring probe in the tube. The orientation effects which have previously been reported are due to attempted bending of a stiff measuring catheter by internally and externally applied forces. A satisfactory way of measuring the tube pressure, by slow perfusion through a thin, flexible catheter with an end hole, and of testing whether it is a meaningful concept in a given case, is proposed. It is illustrated by measurements of urethral pressure in 42 continent and incontinent females. No cases of urinary incontinence due to poor urethral sealing ability are observed, indicating that tube pressure is a meaningful concept. The theory of viscosity-limited flow through a compressive zone in a collapsible tube, on which the perfusion method of measuring tube pressure is based, is developed.

Reversibility of cyclosporin nephrotoxicity after three months' treatment

86 renal allograft recipients were randomly assigned to cyclosporin (Cy) for 90 days followed by azathioprine and prednisolone (Aza and P), or to Aza and P from day 0, as part of the second Oxford trial of short-term Cy use. All 62 patients whose grafts functioned for at least 120 days were included in this study. Serum creatinine was significantly higher in Cy-treated patients than in control patients from day 28 to day 90. Serum uric acid was also significantly higher in Cy-treated patients over the same period. Both creatinine and uric acid fell to the level of the control group after conversion to Aza and P. Serum uric acid was significantly higher for a given level of creatinine during Cy treatment than in either the control patients or the Cy-treated patients after their treatment had been changed to Aza and P. These data imply that Cy affects both the glomerular filtration rate and renal tubular function but that these effects are largely reversible.

Rathke-cleft cyst

A patient is reported who presented with signs of hypopituitarism. On surgical exploration, she was found to have an intrasellar cyst containing creamy mucoid substance resembling pus. Microscopic examination revealed the lesion to be a Rathke-cleft cyst. These rare lesions are associated with a better prognosis than the typical craniopharyngioma. The distinguishing features between a Rathke-cleft cyst and a craniopharyngioma are discussed.

Neurosecretory cells of the lamina propria of the appendix and their possible relationship to carcinoids

Carcinoid tumours of the appendix are generally thought to be derived from enterochromaffin cells; in-situ abnormalities of these cells are, however, rarely observed in the mucosal epithelium. One hundred appendices, removed consecutively at surgery, were stained with an alcian blue-PAS diastase-lead haematoxylin sequence and, in 69, cells were found in the lamina propria with a cellular and architectural morphology identical to those of an archetypal appendiceal carcinoid tumour. These cells appeared to contain neurosecretory granules, were diazo-positive and showed argentaffinity. They were further characterized by the localization of cytoplasmic neurone specific enolase and the presence of neurosecretory granules was confirmed by electron microscopy. These cells are designated subepithelial neurosecretory cells (SNC). It is suggested they are an integral component of the subepithelial nervous plexus and are in progenitors of appendiceal carcinoid tumours. A neuroectodermal origin of the SNC-and hence appendiceal carcinoid tumours-is proposed.

[Function of the lower urinary tract. 3. Report on terminology standardization: studies on urination analysis, pressure-flow functions and residual urine]

The third report continues with recommendations on procedures related to the evaluation of micturition. It covers pressure-flow relationships and residual urine. These recommendations were subject to discussion during the Seventh Annual Meeting of the International Continence Society in Portoroz, Yugoslavia, September 1977.

A factor VII concentrate for therapeutic use

A concentrate of factor VII suitable for therapeutic use has been prepared from human plasma by a method forming part of a comprehensive scheme of large-scale plasma fractionation. Factor VIII was separated as cryoprecipitate and factors II, IX and X were adsorbed on DEAE-cellulose. Most of the factor VII remained in the supernatant. By batch adsorption on DEAE-Sepharose, followed by elution on a chromatographic column, factor VII was concentrated about 25-fold, and purified about 50-fold compared with original plasma, without the need for further dialysis or concentration steps. Data are presented from 10 batches, each from 80-120 kg plasma. Following doses of factor VII to six congenitally deficient patients, the mean rise in plasma factor VII was 95-100% of theoretical; the half-disappearance time was about 4 h. The treatment of four patients with acquired deficiency of factor VII is also described. No untoward side effects were observed.