Metabolic activation of cytochrome P-450/P-448 in the yeast Saccharomyces cerevisiae

The strains D6 and JD1 of the yeast Saccharomyces cerevisiae were used to assay the genetic activity of several compounds, benzo[a]pyrene, 15,16-dihydro-11-methyl-cyclopenta[a]phenanthren-17-one, 2-naphthylamine and cyclophosphamide, which require metabolic activation by cytochromes P-450 and P-448 to produce genetically active chemical species. Cells from both strains were harvested from cultures grown in low concentrations of glucose and switched to growth in high glucose containing media. Treatments under these conditions resulted in increased sensitivity of the test systems without the presence of an exogenous S9 mix and the presence of S9 was found not to enhance this sensitivity. The yeasts used under these treatment conditions showed a P-450/P-448 type metabolism.

Early death in acute leukemia in children

Therapy for acute leukemia in children has improved dramatically in recent years so that early death is rare. A subset of patients with extreme elevation of the WBC at diagnosis have been noted to have a higher rate of early death. We reviewed our experience with acute leukemia in children retrospectively over a 10 year period to assess the incidence and outcome of this problem. Nine early deaths occurred in a total of 185 cases (4.9%). One hundred and sixty patients presented with WBC less than 100,000/mm3 at diagnosis and four (2.5%) early deaths occurred. Twenty-five patients presented with WBC greater than 100,000/mm3 at diagnosis and five (20%) early deaths occurred (p less than 0.001). While early death in acute leukemia in children is uncommon (4.9%), patients with extremely elevated WBC at diagnosis have a significantly higher risk of early death.

Increased left ventricular mass in idiopathic mitral valve prolapse

We performed M-mode echocardiography on 100 subjects with idiopathic mitral valve prolapse (IMVP) and on 100 normal control subjects to determine if differences exist between the two groups in cardiac chamber size, left ventricular performance or left ventricular mass. Subjects with IMVP demonstrated significantly greater left ventricular mass than normal control subjects. There were no significant differences in fractional shortening of the left ventricle or left ventricular end-diastolic volume. There was no significant difference in left ventricular mass between asymptomatic subjects with IMVP and those with chest pain, palpitations, syncope or presyncope. Subjects with and without mitral regurgitation showed no significant difference in mass. The results indicate that subjects with IMVP demonstrate subtle left ventricular hypertrophy which does not appear to be caused by underlying organic heart disease, mitral regurgitation or sustained hypercontractility. This suggests that myocardial involvement is an integral part of the IMVP syndrome.

Sensitivity and specificity of M mode echocardiographic signs of mitral valve prolapse

To assess the sensitivity and specificity of previously described M mode echocardiographic signs of mitral valve prolapse, 100 subjects with a mobile mid systolic click and 100 matched normal control subjects were prospectively studied. Late systolic posterior motion and holosystolic hammocking of the mitral leaflets were common, highly specific signs of mitral valve prolapse. When these signs were combined as a single criterion, sensitivity was 85 percent and specificity was 99 percent. Other signs, including systolic echoes in the mid left atrium, systolic anterior motion, early diastolic anterior motion of the posterior mitral leaflet and shaggy or heavy cascading linear diastolic echoes posterior to the mitral valve, were highly specific but uncommon. They occurred only in combination with late systolic posterior motion or holosystolic hammocking. The remaining signs tested did not differentiate subjects with mitral valve prolapse from normal persons.

Contemporary indications for psychosurgery

The initial period of enthusiasm for the surgical treatment of certain psychiatric illnesses, has later given way to increasing rejection of this mode of therapy. But more recently there has been a reappraisal of the therapeutic possibilities of the modern refined operations, which are now receiving more objective assessment.

Effect of acute and chronic alcohol ingestion on the rate of folate catabolism and hepatic enzyme induction in mice

1. Folate deficiency is commonly found in alcoholic subjects although the causative mechanism is uncertain. It has been suggested that microsomal enzyme induction resulting from chronic alcohol ingestion might accelerate the rate of folate catabolism thus causing deficiency. 2. By using an experimental animal model to determine the rate of catabolism of [3H]pteroylglutamate (folic acid) by the quantitative estimation of the two urinary catabolites p-[3H]aminobenzoylglutamate and [3H]acetamidobenzoylglumate, we have measured both the rate of folate catabolism and the extent of microsomal-enzyme induction in mice after acute and chronic alcohol ingestion. 3. Despite significant evidence of enzyme induction in the chronic alcohol group, there was no difference in the rate of folate catabolism after acute or chronic alcohol ingestion when compared with that of the controls.

Eosinophilic granuloma of the palatal mucosa in a nine-week-old infant

Histiocytosis commonly presents as a disseminated disease in children under one year of age and is rare in infants less than three months of age. This case describes a nine-week-old infant with unifocal eosinophilic granuloma without bone involvement. One year after surgical excision the child is free of disease by roentgenographic and laboratory studies and is growing and developing normally. Thus our patient demonstrates several unique features, which include a young age at presentation without disease dissemination and an unusual site of tissue involvement without bone extension.

Clinical review of beta-blockers in anxiety

Anxiety has three essential elements: the subjective experience, autonomic symptoms and avoidance behaviour. Various theories are considered which highlight the psychic and somatic aspects of anxiety. Beta-adrenergic receptor blocking drugs have been used with advantage to treat everyday stresses. These include the anxiety produced by the civil disturbances in Northern Ireland, performing surgery, dentistry, musical instruments or speaking in public, as well as examination nerves. The profile of symptoms such as tachycardia, palpitations and tremor which are most likely to respond to beta-blockers are discussed as well as their side-effects. Their mode of action is different from other anxiolytics, with which they can be combined.

Sinus histiocytosis with massive lymphadenopathy

A 22-month-old child presented with massive cervical adenopathy accompanied by a retropharyngeal mass that caused stridor and dysphagia. Biopsy from both sides was consistent with sinus histiocytosis with massive lymphadenopathy (SHML). SHML is an unusual benign lesion that characteristically presents with painless, massive cervical adenopathy. Extranodal sites such as orbit, nose and skin are usually affected in association with cervical adenopathy. The pharyngeal involvement in this and several other recently reported cases adds to the heterogeneity of presentation of this unusual disease. The etiology remains unknown. No treatment is required, nor is any treatment known to be consistently effective. Gradual resolution of adenopathy over six months to several years is the expected outcome.

Effect of anticonvulsant drugs on the rate of folate catabolism in mice

An increase in folate catabolism has been suggested as the cause of the folate deficiency observed in many clinical conditions, including chronic anticonvulsant therapy. Previous studies have shown that the radioactive catabolites, excreted after an equilibration period of 3 d, consisted exclusively of folates that had been cleaved to produce pteridines and p-aminobenzoylglutamate, most of which was excreted as acetamidobenzoylglutamate. We have developed an experimental animal model using mice to determine the rate of catabolism of [3H]pteroylglutamate (folic acid) by the quantitative estimation of [3H]p-aminobenzoylglutamate and [3H]acetamidobenzoylglutamate in urine. Administration of diphenylhydantoin at three different doses (0.5, 20, and 50 mg/kg) significantly increased the rate of catabolism as measured by an increase in both the mean daily excretion and the cumulative excretion of these catabolites. Administration of intramuscular phenobarbitone on the other hand, did not affect the rate of catabolism, when compared with controls.

Regional cerebral blood flow measured by 133Xe inhalation in tracheostomized and laryngectomized men and women

The question of contamination of cerebral clearance curves utilized for measuring regional cerebral blood flow by radioactivity derived from the nasopharyngeal air passages following inhalation of 133Xe was tested in patients with chronic tracheostomy. The peak counts for head curves were 5--9% higher when 133Xe was inhaled via a face mask than when inhaled via the tracheal stoma. Calculated flow values using standard recommended start-fit-times were not significantly different between these two different methods. Present results indicate that neither overestimation of fast flow values due to contamination from rapid 133Xe washout recorded from the air passages nor the underestimation of slow flow due to contamination from 133Xe trapped in the air sinuses produced significant measurement errors. However, if earlier start-fit-times were used, flow values were artificially high, particularly for brain stem/cerebellar probes because of an initial rapid decline in the head desaturation curves due to an arterial peak believed to be derived from the basilar artery.

Stereotactic limbic leucotomy--a follow-up at 16 months

Sixty-six patients were assessed clinically, psychologically and physiologically before operation, at six weeks and at a mean of 16 months following stereotactic limbic leucotomy. Seventy-three per cent were clinically improved at six weeks and 76 per cent at 16 months. In obsessional neurosis, 89 per cent of patients showed definite clinical improvement at 16 months; in chronic anxiety, 66 per cent were improved; in depression, 78 per cent; and in the small number of schizophrenics treated the improvement rate was over 80 per cent. Self-assessment and observer-assessment questionaires and scales measuring Depression, Anxiety, Neuroticism, Hysterical symptoms and Obsessional symptoms and traits all showed highly significant reductions of mean scores at 16 months. There was no fall-off in intelligence, and adverse effects were minimal. Limbic leucotomy, with its enhanced accuracy and safety, compares very favourably with similarly assessed, more extensive 'free-hand' procedures, and in obsessional neurosis and chronic anxiety the results are superior.

Physiological measurements in phobic and obsessional disorders

The various physiological measurements which can be made in obsessional and phobic disorders are described. Useful information can be obtained about the effects of acute stress and the changes that medication can produce in anxious patients and the clinical progress of behaviour therapy can be monitored. When physiological measurements are made it is important to record the emotional state of the patient simultaneously so that the level of physiological arousal is related to the subjective experience of the patient.

Warning Methods for Quality Control in Determinations of Serum Calcium

We have examined quantitative warning methods based on the measurement of controls (reference samples) to signal day-to-day displacements in determinations of serum calcium. A warning procedure that uses the mean of two control values (Method 2) was compared to a procedure that tested the two control values individually (Method 1). A simulated baseline shift was used to approximate the mechanism of day-to-day displacement. The two methods compared were calibrated to signal a warning with equal frequency in the absence of shift; then the method that signaled with highest frequency under baseline shift was judged most effective. Some statistical models were evolved for the distribution of serum calcium control values. Theoretical comparisons based on these models showed Method 2 to be more effective on the average under a broad range of conditions. However, in an empirical comparison based on 253 pairs of control values, Methods 1 and 2 were about equally effective.

Left ventricular function in acute myocardial infarction evaluation by gated scintiphotography

Ten normal volunteers and 38 patients with acute myocardial infarction were evaluated by biplane gated blood pool scanning. The mean left ventricular end-diastolic volume in those with infarction was 125 ± 41 ml/m 2 compared to 82 ± 10 ml/m 2 in the normals. The left ventricular end-systolic volume was 82 ± 35 ml/m 2 compared to 35 ± 4 ml/m 2 , and the left ventricular ejection fraction 36 ± 8% compared to 56 ± 3% in the normals. Thirty-six of the 38 patients with infarction had an area of akinesis which ranged from 15 to 59% of the left ventricular wall. Patients with acute myocardial infarction were found to have a significant increase in left ventricular end-systolic volume and decrease in ejection fraction compared to normals. The end-diastolic volume was, however, increased only in those with an elevated left ventricular filling pressure or decreased cardiac index.

Follow-up studies obtained in 20 patients between one week and three months following infarction showed that in the 14 who improved clinically, left ventricular ejection fraction significantly increased from 38 to 45% ( P < 0.001) while in six who failed to show clinical improvement or worsened, left ventricular ejection fraction remained at 30%.

Left ventricular ejection fraction was significantly greater and the extent of akinesis significantly less in the patients who survived compared to those who died.

Psychosurgery and the limbic system

The limbic system can be considered to consist of a central ‘core’ from which three well-defined circuits emerge. These are the Papez or medial circuit, the basolateral circuit and the defence reaction circuit. The functions of the primitive limbic brain are modulated by a higher order control—the frontal lobe. Emotional responses and physiological changes have been obtained by stimulation of fronto-limbic pathways and limbic circuits and these have been used for location of target sites in psychosurgery. For the relief of intractable depression and anxiety, lesions are generally made in the lower medial quadrant or posteroorbital part of the frontal lobe, where there is a concentration of fronto-limbic connections. In primary obsessional neurosis lesions at this site produce less satisfactory results, but these illnesses may be helped by lesions in the cingulate gyrus, which is part of the Papez circuit. Patients with epilepsy and aggressive outbursts may respond to temporal lobotomy, or to operations, such as amygdalotomy, where lesions are placed in the defence reaction circuit.

Stereotactic limbic leucotomy--a follow-up study of thirty patients

This prospective study reports the results of stereotactic limbic leucotomy at a mean of 17 months following surgery. Clinical improvement had occurred in twenty-four (80%) of the patients, fifteen (50%) of them being symptom free or much improved. Fourteen of sixteen patients suffering from obsessional neurosis were improved, as were five of seven with chronic anxiety and the degree of improvement at 17 months was superior to that at 6 weeks. Psychometric scores of anxiety, obsessions and neuroticism were all significantly reduced at 17 months. The mean depression scores were also significantly reduced and this result was superior to that reported in a previous study of ‘free-hand’ operations.

Adverse effects were not a problem following limbic leucotomy. Emotional blunting, disinhibition, post-operative epilepsy and excessive weight gain were not encountered, and intelligence was unaffected by the operation. Limbic leucotomy is a much more limited and precise procedure than older ‘free-hand’ operations which we have studied, but its therapeutic effects are comparable and in obsessional neurosis, superior.

Stereotactic limbic leucotomy: neurophysiological aspects and operative technique

Psychosurgery has always been, and is likely to remain, a controversial subject. Blind operations lack precision and can lead to adverse personality changes or other serious side-effects. Open surgery is becoming less acceptable because of the difficulties of accurately assessing the extent of a lesion and its exact location. The introduction of stereotactic techniques enables far smaller lesions to be placed with a high degree of accuracy, and increased knowledge of the limbic system has contributed to advances in this field.

Stereotactic limbic leucotomy: a preliminary report on forty patients

The neurophysiological aspects and operative technique of stereotactic limbic leucotomy have been described in a previous paper (Kelly, Richardson and Mitchell-Heggs, 1973). The present investigation is a prospective study designed to assess the results of such surgery in a group of 40 severely ill psychiatric patients, who had failed to respond satisfactorily to every other type of treatment. The results have been assessed clinically, psychologically and physiologically, in a very detailed way, at six weeks; a similar follow-up at one year is in progress. A comparison is made between the results of the present series and those of a previous: study (Kelly et al., 1972), in which more extensive leucotomy operations were carried out, and similar means of assessment were employed.

A psychological and physiological evaluation of the effects of intravenous diazepam

Intravenous diazepam is widely used both in general medicine and in psychiatry. It is used to produce sedation in psychiatric emergencies and to enhance systematic desensitization; it is also employed in the treatment of drug-induced dystonic reactions, status epilepticus and tetanus, and as an anaesthetic agent. Its property of relieving severe muscle spasm has been utilized to treat patients suffering from ‘stiff-man syndrome‘.

Phenelzine in phobic anxiety: a controlled trial

A double-blind trial of phenelzine versus placebo in psychiatric outpatients with long-standing phobic anxiety is described. Forty patients with agoraphobia or social phobias entered the trial and 32 of these completed treatment with either phenelzine or placebo (with appropriate dietary restrictions) in flexible dosage for two months. Fourteen pairs of patients were prospectively matched, and analysis of the score differences between these pairs showed a significant improvement for patients on phenelzine compared with placebo on overall assessment (P<0·01) and secondary phobias (P<0·05). These differences were not shown at assessment after one month's treatment, but became marked after two months. The improvement on phenelzine, which was maintained at follow-up, was not related to initial depressive symptoms in the patients. It is suggested that phenelzine is an effective agent in the treatment of phobic anxiety but that treatment needs to be continued for at least two months before full benefit is achieved.

Modified leucotomy assessed clinically, physiologically and psychologically at six weeks and eighteen months

After more than thirty years the operation of leucotomy still remains a controversial treatment, and its value is questioned by many. This scepticism, and the advent of new surgical techniques, have emphasized the need for careful appraisal of the results of psychosurgery. In a previous prospective study 40 patients were assessed six weeks after modified leucotomy, and 75 per cent of these patients were found to be clinically improved (Kelly, Walter and Sargant, 1966). They were less neurotic on the M.P.I., had lower Taylor Manifest Anxiety scores and rated themselves as less anxious; a good clinical outcome was associated with diminution of physiological arousal as measured by forearm blood flow and heart rate. This group has now been followed-up and reassessed 18 months after operation, and a further group of 38 patients has been examined before, and again six weeks after, leucotomy. The data from the two groups have been combined to determine the immediate outcome for various diagnostic categories, and a multiple regression has been performed to elicit which of the pre-operative factors predict a favourable post-operative result.