Homeless women in London: the hostel perspective

This is a service-related study of the prevalence of mental illness in 43 women referred to a visiting psychiatrist at a hostel for single homeless women in south-east London. Over 80% of those referred were mentally ill, and 21% of the total were diagnosed as suffering from schizophrenia. Despite the dedication and versatility of the care staff, the hostel was ill-equipped to meet the needs of the chronic mentally ill. The adequacy of community care provision is further brought into doubt.

Sex differences in the hyperkinetic syndrome of childhood

Among a clinic sample of 6525 subjects, 61 males and 18 females with an ICD-9 diagnosis of the hyperkinetic syndrome of childhood were identified. Hyperactive girls had a lower IQ and significantly higher rates of language disorders and neurological disorders, suggesting a possible neurological basis for hyperactivity in females. In contrast, there was a population of male hyperactives with less evidence of brain dysfunction and a normal IQ, evidence compatible with the model of greater male constitutional variability. There was little evidence for the polygenetic multiple threshold model of sex inheritance.

Comparison of chest radiograph reading methods for assessing progress of pneumoconiosis over 10 years in Wittenoom crocidolite workers

Thirty three pairs of chest radiographs taken up to 10 years apart were obtained for 33 subjects suffering from asbestosis who had applied for compensation to the Pneumoconiosis Medical Board of Western Australia. Multiple films from the period before the first radiograph in each pair, from the intervening period between the two, and from the period subsequent to the second radiograph were also available and all films were read by two independent readers according to the 1980 ILO classification of pneumoconiosis. Films were read twice as side by side pairs ten years apart, twice as two separate randomly ordered films ten years apart, and once as part of the full series of all available chest radiographs on each subject to assess which method provided the best consistency (between reader variation) and repeatability (within reader variation). Judging by consistency, the full series method performed as well as either of the other methods when assessing radiographic changes and significantly better when assessing the level of profusion of small opacities. There was little to choose between the other two methods either judging by consistency or repeatability, which could not be estimated for the full series method. Use of all available films for a subject is recommended for assessing single films, as in a prevalence study, as well as for documenting change in a longitudinal study.

Staging of carcinoma of the breast using a hand-held gamma detecting probe and monoclonal antibody B72.3

Radioimmunoguided Surgery (RIGS) uses a hand-held gamma detecting probe to identify radiolabeled monoclonal antibodies (Mab). Fourteen patients with carcinoma of the breast proved at biopsy received Mab B72.3 (5 millicuries of 125I per 1 milligram, Iodo-Gen method) intravenously six to 26 days before exploration. Probe counts were measured intraoperatively in mammary tissue and axillary lymph nodes. In the mammary tissue, the RIGS system identified tumor that was histologically confirmed in seven of eight patients and confirmed the absence in four of six patients. Probe counts were suspicious for tumor that was not proved histologically in two of 14 patients. Unsuspected tumor was identified in three of 14 patients. In axillary tissue, probe counts identified one of two tumors that were confirmed histologically and verified the absence of tumor in eight of 12 patients. Probe counts in axillary tissue were suspicious for tumor that could not be documented histologically in four of 14 patients. RIGS appears to be able to identify residual, subclinical and multicentric carcinoma of the breast and accurately delineate the pattern of antigenic drainage of tumor into adjacent lymph nodes.

Bronchoalveolar lavage sampling of airway and alveolar cells

Bronchoalveolar lavage (BAL) cell counts are used to assess 'alveolitis' in patients with interstitial lung diseases (ILD) but inflammatory cells from airways can contribute to the differential cell count. To determine what BAL volume samples airway cells in patients with ILD we measured the proportion of bronchial epithelial cells (BECs) in four successive 25 ml aliquots in a single lung subsegment in 23 patients with ILD (cryptogenic fibrosing alveolitis (CFA) four, rheumatoid lung (RL) three, asbestosis (ASB) 11, sarcoidosis (SARC) five). Cells recovered from the first two 25 ml lavages exhibited higher proportions of BECs (15 +/- 4% and 9 +/- 2% respectively) than those from the remaining two aliquots (3 +/- 1%, 3 +/- 1%, each P less than 0.01), suggesting that the first 50 ml BAL preferentially samples airway cells compared to the second 50 ml BAL. To evaluate airway and alveolar inflammatory cell proportions in ILD we performed two separate 50 ml BALs (samples I and II) in a single subsegment in 38 patients with ILD (CFA seven, RL five, ASB 19, SARC seven) and measured the proportions of recovered cells in each sample separately and combined. Seven control individuals were also studied. Sample I contained 1-67% (mean 26 +/- 3%) of the total recovered cells. Neutrophil (PMN) proportions were higher in sample I compared to sample II in CFA (20 +/- 6 vs 8 +/- 2%), RL (30 +/- 9 vs 8 +/- 2%) and ASB (12 +/- 2 vs 7 +/- 1%), P less than 0.05 for each, but were similar in samples I and II in patients with SARC (3 +/- 1 vs 2 +/- 1%) and controls (2 +/- 1 vs 2 +/- 1%). In combined samples (I + II), absolute PMN proportions were up to 8% higher than in sample II alone whereas absolute lymphocyte proportions were up to 8% less than in sample II alone. These data suggest that separate processing of the fluid recovered from the first 50 ml BAL in ILD patients provides information on the location of inflammatory cells and improves the accuracy of BAL cell counts.

Ethics of drug studies in infants: how many samples are required for accurate estimation of pharmacokinetic parameters in neonates?

Our study aimed to determine the least number of samples that are required to obtain accurate pharmacokinetic parameters in neonates. Patients treated with either netilmicin or ceftazidime had between five and eight samples drawn for drug concentration measurement after the first or the last dose of the drug. Pharmacokinetic parameters were calculated using all the available points as a reference and then recalculated with 2, 3, or 4 points. Systemic clearance and volume of distribution were significantly different from the reference value when 2 points were used for netilmicin after the first dose and ceftazidime after the last dose. Had parameters obtained from 2 points been used, mean dosage would have been underestimated by 15% for ceftazidime and 11% for netilmicin, and some patients would have received only 65% of the dose calculated from all available points. When 3 points were used, dosage would have been underestimated by a mean of only 1% for ceftazidime and 5% for netilmicin when compared with the dosage estimated from the reference parameters. We conclude that 3 concentration time points may be all that are required for estimation of pharmacokinetic parameters sufficiently accurate for practical purposes in neonates.

Vancomycin pharmacokinetics and dose recommendations for preterm infants

The pharmacokinetics of intravenous vancomycin was studied in 20 preterm infants (gestational age, 26.5 weeks +/- 2.6 weeks [standard deviation]; birthweight, 880 +/- 340 g). At the time of the studies their postconceptional age was 36.4 +/- 4.5 weeks. The drug was infused over 30 min in a dose between 9.2 and 18 mg/kg. A highly significant correlation existed between postconceptional age or body weight and vancomycin t1/2 and clearance. Serum creatinine concentrations correlated with vancomycin t1/2 and clearance. Serum creatinine tended to decrease with increasing postconceptional age. Based on the excellent correlation between age (or weight) and vancomycin pharmacokinetics, dose and dose-interval recommendations are presented.

Polar solvents in the chemoprevention of dimethylbenzanthracene-induced rat mammary cancer

Differentiating agents have been used experimentally and clinically as an adjuvant in the treatment of cancer, but their role in chemoprevention is limited. We used 5% dimethylsulfoxide (DMSO), 1% and 4% methylsulfonylmethane (MSM), 0.3% N-methylformamide (NMF), and retinol acetate (RA) in the chemoprevention of rat mammary breast cancer. One hundred fifty 42-day-old Sprague-Dawley rats were randomized into six groups (control, RA, DMSO, 1% MSM, NMF, and 4% MSM) and received chemopreventive agents along with standard rat chow ad libitum. Eight days later, 15 mg of 7,12-dimethylbenzanthracene was given by oral gastric intubation. The animals were examined weekly for tumor incidence and size (biplanar analysis). Animals were followed up for 240 to 300 days. Tumor incidence was not statistically affected. Time to appearance (latency period) of both tumors and cancers were prolonged by NMF, DMSO, and 4% MSM. Doubling times of all cancers produced were prolonged by DMSO and RA. No group exhibited toxic reactions or significant weight loss. Polar solvents and differentiating agents, specifically NMF, DMSO, and 4% MSM, were effective in the chemoprevention of dimethylbenzanthracene-induced mammary cancers.

Alveolitis of pulmonary asbestosis. Bronchoalveolar lavage studies in crocidolite- and chrysotile-exposed individuals

Bronchoalveolar lavage (BAL) findings in 27 individuals with crocidolite- or chrysotile-induced asbestosis were compared to BAL findings in 29 unexposed control subjects. Alveolitis, defined as an increase in the proportions and/or absolute numbers of inflammatory cells present in BAL fluid compared to values in control subjects, was present in 26 (96 percent) subjects with asbestosis. Most exhibited a neutrophil-eosinophil alveolitis, with neutrophil proportions increased to 7.4 +/- 0.7 percent and eosinophil proportions increased to 2.2 +/- 0.4 percent, compared to 2 +/- 0.5 percent and 0.4 +/- 0.01 percent, respectively, in control subjects (p less than 0.01 for both neutrophils and eosinophils). An increase in the total number of neutrophils and eosinophils per ml of lavage fluid was also seen (neutrophils 23 +/- 5 and eosinophils 13 +/- 4 per ml; p less than 0.05 compared to control subjects). Severity of the alveolitis, defined by the neutrophil or eosinophil proportions, was independent of a history of exposure to cigarette smoke. The pattern and severity of alveolitis in crocidolite- and chrysotile-induced asbestosis were similar. There was a significant correlation between duration of exposure to asbestos and neutrophil proportions (p less than 0.01). No significant difference in the severity of the alveolitis was observed between individuals with radiologic and physiologic evidence of asbestosis compared to those with asbestos exposure and crackles alone, suggesting that, in asbestosis as in other chronic interstitial lung diseases, radiologic and physiologic parameters do not reflect the severity of the alveolitis. This study demonstrates that a neutrophil-eosinophil alveolitis is present in individuals with crocidolite- and chrysotile-induced asbestosis, that this alveolitis is independent of cigarette smoking, and that the severity of the BAL changes is not reflected in radiologic and physiologic changes.

Energy-dependent volume regulation in primary cultured cerebral astrocytes

Cell volume regulation and energy metabolism were studied in primary cultured cerebral astrocytes during exposure to media of altered osmolarity. Cells suspended in medium containing 1/2 the normal concentration of NaCl (hypoosmotic) swell immediately to a volume 40-50% larger than cells suspended in isoosmotic medium. The cell volume in hypoosmotic medium then decreases over 30 min to a volume approximately 25% larger than cells in isoosmotic medium. In hyperosmotic medium (containing twice the normal concentration of NaCl), astrocytes shrink by 29%. Little volume change occurs following this initial shrinkage. Cells resuspended in isoosmotic medium after a 30 min incubation in hypoosmotic medium shrink immediately to a volume 10% less than the volume of cells incubated continuously in isoosmotic medium. Thus, the regulatory volume decrease (RVD) in hypoosmotic medium involves a net reduction of intracellular osmoles. The RVD is partially blocked by inhibitors of mitochondrial electron transport but is unaffected by an inhibitor of glycolysis or by an uncoupler of oxidative phosphorylation. Inhibition of RVD by these metabolic agents is correlated with decreased cellular ATP levels. Ouabain, added immediately after hypoosmotic induced swelling, completely inhibits RVD, but does not alter cell volume if added after RVD has taken place. Ouabain also inhibits cell respiration 27% more in hypoosmotic medium than in isoosmotic medium indicating that the (Na,K)-ATPase-coupled ion pump is more active in the hypoosmotic medium. These data suggest that the cell volume response of astrocytes in hypoosmotic medium involves the net movement of osmoles by a mechanism dependent on cellular energy and tightly coupled to the (Na,K)-ATPase ion pump. This process may be important in the energy-dependent osmoregulation in the brain, a critical role attributed to the astrocyte in vivo.

A simple method for the estimation of glomerular filtration rate by gentamicin pharmacokinetics during routine drug monitoring in the newborn

Assessment of the glomerular filtration rate (GFR) in the newborn is often imprecise because of difficulties in urine collection and because the plasma creatinine level, the traditional marker of renal function, is influenced by many factors in this age group. Gentamicin is given to most preterm infants for suspected or proved sepsis. This drug is eliminated almost entirely by the kidney and its rate of elimination parallels the GFR. We calculated gentamicin pharmacokinetic parameters (t1/2, volume of distribution, and clearance) from three consecutive concentration-time points (trough, peak, and next trough levels) in 38 newborn infants. Creatinine clearance was measured by the conventional method. Both t1/2 (r = 0.74; P less than 0.001) and gentamicin clearance (r = 0.77; P less than 0.001) correlated well with measured creatinine clearance. There was no correlation between these variables and urine output. Gentamicin elimination t1/2 and clearance are useful indices of GFR in the newborn infant and can be easily calculated during routine therapeutic drug monitoring.

Clinical and pathologic correlations in disease metastatic to the thyroid gland

Findings in our series of patients and a review of the literature seem to suggest that metastatic cancer to the thyroid is much more common that is clinically evident. The clinical presentation of an asymptomatic mass, normal thyroid functions, and a cold nodule on thyroid scan can occur months to years after treatment of a primary cancer and thus often produces a clinical dilemma. Workup should include ruling out other metastatic cancer and fine-needle aspiration of the thyroid mass. If isolated metastatic cancer to the thyroid is found, surgical resection should be performed, usually by lobectomy and isthmusectomy. Unfortunately, the prognosis is poor, but surgery often prolongs the disease-free interval and occasionally will be curative.

The validity of 'biorhythmic' theory questioned

The study was of the relation between three categorical independent variables (cases in the critical, positive or regenerative phase of their 'biorhythmic' cycle) and two numerical independent variables, academic performance and factor scores on the psychoneurotic component of the University College London Study Questionnaire. The sample comprised 368 Open University students. A subset was used to study the relation between cases at the peaks and troughs of their cycles. If 'biorhythms' had any effect then it would be expected that the mean scores of the three subgroups would differ significantly. Results for 18 ANOVAs showed that none of the observed relations was greater than would be expected by chance.

Nuclear magnetic resonance (NMR) imaging in white matter disease of the brain using spin-echo sequences

Attention is drawn to the use of nuclear magnetic resonance (NMR) spin-echo sequences in the recognition of white matter disease of the brain. In 5 patients with multiple sclerosis, 8 lesions were seen with postcontrast x-ray computed tomography (CT) (37.5 g of iodine), 33 with inversion-recovery (IR) scans, and 47 with spin-echo (SE) scans. Partial volume effects were less of a diagnostic difficulty with SE scans than with IR scans. Extensive areas of abnormal white matter were seen with CT, IR, and SE scans in a patient with leucodystrophy associated with congenital muscular dystrophy. In a patient with adrenoleucodystrophy focal lesions were seen with CT, IR, and SE scans. In addition, loss of gray-white matter contrast was seen in both occipital lobes with IR scans. Extensive areas of white matter involvement were also seen in a case of Binswangers disease.

Experiences with the new oral contraceptive Ovysmen

The contraceptive effect of the new pill Ovysemn has been tested in two groups in a total of thirty-six patients. The preparation was well tolerated and the results failed to reveal fundamental differences in comparison with other trials performed by other investigators. No pregnancies occurred in either group.

Attitudes of medical practitioners to mental illness

The O.M.I. Scale was used to evaluate the attitudes to mental illness of a sample of 50 Australian medical practitioners. Although the scores of the Australian subjects did not differ from those of previously-tested British medical practitioners, they were significantly different to those obtained in a study of Czechoslovakian practitioners. The Australian, British and Czechoslovakian medical practitioners scored similarly on Mental Hygiene Ideology which reflects a medical model of mental illness. It was suggested that there were several disadvantages in supporting the medical model and that, through undergraduate and continuing education programs, medical practitioners should be exposed to alternative models of mental illness.

Discrete length classes of DNA depend on mode of dehydration

The length of double-stranded coliphage lambda DNA, as determined by electron microscopy using the benzyldimethylalkyl ammonium chloride technique, depends on the mode of dehydration. The freeze-dried DNA form is the longest (16.5 micron), whereas dehydration in methanol (15.9 micron) or in ethanol (three forms: 15.2 micron, 13.9 micron, and 12.4 micron) results in progressively shorter molecules. These measured lengths of the freeze-dried, methanol-dehydrated, and shortest ethanol-dehydrated forms correspond to the axial rise per nucleotide pair in the B, C, and A forms of DNA, respectively. The remaining forms of ethanol-dehydrated DNA seem to represent novel intermediary conformations of DNA. In agreement with the predicted increment, DNA exposed to ethidium bromide and freeze-dried is elongated by 39% (22.9 micron). All size classes show the same relative distribution pattern of bound Escherichia coli RNA polymerase molecules (nucleoside triphosphate:RNA nucleotidyltransferase, EC2.7.7.6), used as intramolecular markers, indicating that the dehydration-caused transitions are uniform.

Corneal edema: iris-clip lens implantation and simple intracapsular extraction compared

Corneal edema following intracapsular lens extraction and iris-clip lens implantation was compared by assessing corneal thickness and epithelial edema. In a retrospective study the corneal thickness of twenty patients who had intracapsular lens extraction in one eye only was compared with twenty-six patients with iris-clip lens implants in one eye. There was no significant increase in corneal thickness in the operated eye in either group. In a prospective randomized controlled study, a smaller number of patients, had serial measurements of corneal thickness pre- and postoperatively. There was an increase in thickness in the immediate postoperative period for both groups. However, there was no significant difference between eyes which had simple extraction and those which had implants. The implanted eyes however had greater mean increase endothelial trauma in the initial period, compared to eyes with cataract extraction alone.

HLA matching and corneal grafting

A series of 200 cases of full-thickness corneal allografts have been followed to determine whether HLA and ABO incompatibility influence prognosis of the grafts. 85% of patients with avascular corneas had clear, functioning grafts one year after transplantation. Only 33% of patients with severely vascularised corneas had successful grafts one year after transplantation. A significant association was found between severe vascularisation of the patient's cornea and irreversible graft rejection. In this group of patients, the proportion of grafts functioning was found to be ranked according to the number of HLA antigens shared by graft donor and recipient. Patients receiving grafts matching for 2 HLA antigens showed a failure-rate due to irreversible rejection of 26% at one year, in comparison with 57% and 62% of grafts matching for 1 or 0 HLA antigens respectively. ABO incompatibility or ABO phenotype of the recipient did not influence graft prognosis. The results indicate that patients with severely vascularised corneas should receive HLA-matched corneal grafts. The institution of HLA-typed cornea "banks" for treatment of such patients is advocated.