Simultaneous reading with the two hands: reply to Bertelson and Mousty

Bertelson and Mousty's criticisms of Millar's (1987) analyses rest on a misapprehension of the nature and purpose of the measures that were used. Millar (1987) used two measures to test a prediction from the hypothesis that fast braillists use the two hands to read different portions of text simultaneously. The study was not about scanning. Bertelson and Mousty's criticism and reanalysis of Millar's (1987) data is shown to be based on unsupported assumptions, and a misunderstanding of the first measure. Details about the first measure are given. It is shown that the findings from the two measures agree and are in the opposite direction to that predicted by the hypothesis. There could be a number of reasons for the difference between Bertelson et al. (1985) and Millar's (1987) data. They need further study.     

Endoscopic sphincterotomy for bile duct stones in patients with intact gallbladders

Endoscopic sphincterotomy was performed in 121 patients (age ranged 34-92 years; median 80 years) with intact gallbladders and bile duct stones. Clearance of the duct by basket or balloon extraction was attempted in 97 patients (80 per cent) and achieved in 93 of these patients (96 per cent). In 24 patients the duct was left to empty spontaneously and this occurred in 22 patients. Immediate complications due to endoscopic sphincterotomy occurred in five patients (two haemorrhage, two perforation, one haemorrhage and perforation). Of the 101 patients reviewed 12-72 months (median 24 months) after endoscopic sphincterotomy, 76 (75 per cent) have remained asymptomatic throughout the follow-up period. Eighteen patients (18 per cent) required cholecystectomy for recurrent gallbladder symptoms 1-24 months after endoscopic sphincterotomy. One of the asymptomatic patients underwent cholecystectomy on the advice of his consultant. A further seven had recurrent biliary colic or cholangitis necessitating enlargement of the sphincterotomy and further stone retrieval in three of these patients. Endoscopic sphincterotomy is an effective treatment for bile duct stones in high risk patients, but subsequent cholecystectomy is required in a significant number of patients owing to continuing gallbladder symptoms.     

Transaxillary sympathectomy for primary hyperhidrosis palmaris in children

Although primary palmar hyperhidrosis is uncommon in the paediatric age group, it is unpleasant and disturbing for the affected child. Both local and medical treatment often fail and only sympathetic denervation can be permanently effective. We have performed seven bilateral transaxillary preganglionic dorsal sympathectomies removing T2, T3 and T4 ganglia. More recently, the surgical technique has been changed to a preganglionic sympathectomy of T4, T3 and T2 with lateral displacement of the sympathetic chain. Four children presented from birth with excessive palmar sweating. The average age at sympathectomy was 9 years. No serious complications were encountered, but one patient developed a mild Horner syndrome, where a composite first and second dorsal ganglia was encountered at surgery, and another child had localised, compensatory, thermally induced hyperhidrosis. Pilocarpine sweat tests before and after surgery showed an 80% reduction in sweat production on stimulation, which correlated well with clinical improvement. The transaxillary approach has certain advantages since it allows for excellent exposure of the sympathetic chain, adequate denervation and minimal morbidity as well as being cosmetically acceptable. It is recommended that transaxillary sympathectomy be performed for primary palmar hyperhidrosis in children after medical treatment has failed. Offprint requests to: S. Cywes at the above address     

Antibody to Hepatitis C Is Common among Patients with Alcoholic Liver Disease with and without Risk Factors

Thirty-seven patients with clinically suspected alcoholic liver disease were retrospectively studied for the prevalence of antibody to hepatitis C virus (HCV) by enzyme-linked immunosorbent assay (ELISA) and immunoblot assay. Twenty-four had biopsy-proven cirrhosis. Nineteen had identifiable risk factors for non-A, non-B viral hepatitis, and 18 did not. Five of 19 high-risk (26%) and 6 of 18 low-risk (33%) patients had positive antibody, compared with two of 179 healthy blood donors (p less than 0.01 for either group of alcoholics compared with blood donors). Nine of 11 ELISA-positive patients were also either positive or indeterminable by immunoblot testing. Histologic scores for parameters commonly associated with chronic viral hepatitis were numerically worse among anti-HCV-positive patients, but none reached statistical significance. Clinically, seven of 11 (64%) of anti-HCV-positive patients versus 14 of 26 (54%) anti-HCV-negative patients were Child's class C. Among the 21 Child's class C patients, seven (33%) were anti-HCV-positive versus four of 16 (25%) of Child's class A/B patients. A weak correlation between IgG and ELISA optical density was observed (r = 0.52). We conclude that antibody to hepatitis C by ELISA and immunoblot is common among alcoholics with liver disease even in the absence of known or suspected risk factors for viral hepatitis. Although hepatitis C-positive patients tended to have more severe histologic disease, neither histologic parameters nor clinical findings were adequate to predict antibody seropositivity.     

Actions of dopamine antagonists on stimulated striatal and limbic dopamine release: an in vivo voltammetric study.

1. Fast cyclic voltammetry at carbon fibre microelectrodes was used to study the effects of several dopamine antagonists upon stimulated dopamine release in the rat striatum and nucleus accumbens. 2. In both nuclei, stimulated dopamine release was increased by D2-receptor-selective and mixed D1/D2-receptor antagonists. The D1-selective antagonist SCH 23390 had no effect. 3. Striatal and limbic dopamine release were elevated by cis- but not trans-flupenthixol. 4. The 'atypical' neuroleptics (clozapine and thioridazine) did not cause a selective elevation of dopamine release in the limbic terminal region, whereas the non-antipsychotic drug metoclopramide increased dopamine release more in striatum than nucleus accumbens. 5. We conclude from this study that striatal and limbic dopamine release are under the control of a stereoselective dopamine D2-autoreceptor on the nerve terminal and that atypical neuroleptics do not show a limbic-selective effect at this receptor after acute administration.     

A comparative study of the effectiveness of metronidazole and penicillin V in eliminating anaerobes from postextraction bacteremias

Recent reports have indicated the serious nature of anaerobic endocarditis and septicemia. As anaerobes can be isolated from postextraction bacteremias, this study was undertaken to evaluate the effectiveness of metronidazole and penicillin V in eliminating anaerobes from postextraction bacteremias. Twenty-five patients were randomly assigned to each of three groups--a placebo group, a metronidazole group, and a penicillin V group--for a total of seventy-five patients. Although penicillin V reduced the occurrence of anaerobes to a greater degree than did metronidazole, it was noted that gram-negative anaerobes were still detected in the blood of four patients in the penicillin V group. In the metronidazole group no gram-negative anaerobes were cultured. Because of the marked effectiveness of metronidazole against gram-negative anaerobes, the use of penicillin V and metronidazole in combination might be effective in the prevention of the sequelae of postextraction bacteremias. However, further studies, using a larger sample size, to investigate specifically gram-negative anaerobes are required.     

Human immunity to rat antigens.

A test has been devised with the object of assaying immune responsiveness in normal and immunodepressed persons. It has been based on the graft-versus-host model of Ford et al. (Transplantation 10: 258, 1970) and employs rat antigens as the immunological stimuli. Peripheral blood lymphocytes were injected into the hind feet of young Wistar rats, and 7 days later the popliteal lymph nodes were removed and weighed. It was found that the unwanted host-versus-graft activity could be suppressed in the rats by total body irradiation. Inactivated lymphocytes were injected into the right hind foot as a control and the result was expressed as a ratio: weight of left node to weight of right node. Lymphocytes from 45 healthy individuals were examined in this way. The response was readily suppressed by administering daily injections of steroid or antilymphocyte globulin to the rats, but was not influenced by the presence or absence of antirat antibodies in these individuals.     

Non-adherence to HIV antiretroviral medications: 'The drugs are working and I'm a continuing success story'.

Non-adherence to antiretroviral (ARV) regimens has been associated with HIV drug resistance. Anecdotal evidence in our client group, people living with HIV/AIDS infection in Central Sydney Area Health Service (CSAHS), suggested that non-adherence was an issue. Eighty three participants completed an anonymous questionnaire; with a 98% response rate. The mean age of respondents was 44 years with 68% over age 40 years. 68% of respondents missed doses of ARV, 54% because they forgot. 54% stated they did not report the non-adherence to their doctor. They were more likely to miss the lunch time dosage (n=49, p<0.05). The results demonstrate that non-adherence with medications is a significant issue and further research into strategies for interventions to aid adherence is required.