Patients'' reactions to a two-way mirror in general practice

From a survey of 200 patients in two general practices it would appear that the patients' reaction to the use of a two-way mirror is on the whole not unfavourable. The results suggest, however, that in the very personal setting expected of general practice people suffering from psychiatric problems (especially depression) should be given every opportunity to decline consultation in front of the mirror and if any patient becomes upset, then the mirror should be 'turned off' immediately. Internal examinations should not take place when the mirror is in use.     

Antibodies to native DNA in discoid lupus erythematosus

The electrophoretic patterns of skin washings from the calf, sheep, goat, pig, horse and man have been compared. It was concluded that protein in these washings was derived mainly from sweat. The amounts of protein lost and the nature of the proteins in the sweat differed markedly between species. The horse had relatively the highest protein loss during active sweating and man the lowest. The potential biological role of these sweat proteins is discussed, including the possibility that they may provide the animal with an outer defence, on the skin surface, against invasion by foreign organisms.     

Incidence and Predictors of Late Complete Heart Block After Alcohol Septal Ablation Treatment of Hypertrophic Obstructive Cardiomyopathy

Objectives

This study was designed to identify the incidence of late complete heart block (CHB) first identified at least 48 hours post alcohol septal ablation (ASA).

Background

Septal reduction with ASA is a therapeutic option for patients with symptomatic hypertrophic obstructive cardiomyopathy (HCM). CHB, resulting from the septal infarct, is a known complication with a reported incidence of 9–22%. The incidence of CHB more than 48 hours post‐procedure is unknown.

Methods

Consecutive patients who underwent ASA were analyzed and clinical characteristics associated with late CHB were assessed. Late CHB was defined as first identification of CHB more than 48 hours after ASA.

Results

From 2002–2013, 145 subjects underwent 168 ASA procedures and were followed for a mean of 3.2 +/? 2.3 years. The incidence of late CHB was 8.9% (15/168 ASA procedures). Heart block occurred from 48 hours to 3‐years post‐procedure. In a multivariable model, patients with any CHB were more likely to have had multiple ASA procedures (OR 4.14; 95% CI: 1.24, 13.9; P < 0.05) and high resting and provoked left ventricular outflow tract (LVOT) gradient assessed by catheterization (OR per 10 mmHg gradient 1.14; 95% CI: 1.0, 1.20; P < 0.05). After multivariable adjustment, only a high provokable LVOT gradient remained an independent predictor of late CHB (OR per 10 mmHg gradient 1.14 [95% CI 1.02–1.29]).

Conclusions

Late CHB is a common complication of ASA for treatment of symptomatic HCM. Post‐discharge electrocardiographic surveillance for atrioventricular conduction disease should be considered after ASA, especially for those with a high provokable LVOT gradient. (J Interven Cardiol 2015;28:90–97)

     

Potent in vivo inhibitors of rat renin: Analogues of human and rat angiotensinogen sequences containing different classes of pseudodipeptides at the scissile site*

Using solid-phase methodology we have synthesised peptides based on the 8–14 or 6–14 human and rat angiotensinogen sequences, containing the following different isosteric units at the P₁-P₁’cleavage site: Leu-Ψ[CH₂NH]Leu; Leu-[CH(OH)CH₂]Val; Leu-Ψ[CH(OH)CH₂]Leu and Leu-Ψ[CH(NH₂)CH₂]Val. In vitro, peptide Piv-His-Pro-Phe-His-Leu-Ψ[CH(OH)CH₂]Leu-Tyr-Tyr-Ser-NH₂( XXI ) is the most potent inhibitor of rat plasma renin reported having an IC₅₀ of 0.21 nM; it is a much weaker inhibitor of human renin (IC₅₀ 45 nM). Peptide Boc-His-Pro-Phe-His-Leu-Ψ[CH(OH)CH₂] Leu-Val-Ile-His-NH₂ ( XX ) was a highly effective inhibitor of rat renin in vivo. When infused (1 mg/kg/h) into two-kidney, one-clip chronic renal hypertensive rats, it lowered blood pressure and suppressed both plasma renin and angiotensin II. When given as a bolus (1 mg/kg) there was a divergence between the rapid rebound of renin levels and blood pressure, which remained suppressed. These results indicate that potent in vivo inhibitors of rat renin could be useful not only in examining the role of circulating renin but also in elucidating the equally important involvement of extracirculatory renin pools.     

Developmental Toxicity of Bromoxynil in Mice and Rats

Developmental Toxicity of Bromoxynil in Mice and Rats. ROGERS,J. M., FRANCIS, B. M., BARBEE B. D., AND CHERNOFF, N. (1991).Fundam. Appl. Toxicol 17, 442–447. The developmental toxicityof the wide-spectrum herbicide bromoxynil (bromoxynil phenol;3,5-dibromo-4-hydroxyphenyl cyanide) was evaluated in Sprague-Dawleyrats and Swiss-Webster mice, and the developmental toxicityof its octanoate ester (2,6-dibromo-4-cyanophenyl octanoate)was evaluated in Sprague-Dawley rats. Animals were treated fromDay 6 to Day 15 of gestation [presence of sperm or semen plug= 0 of gestation]. The doses administered were as follows: bromoxynilphenol in the mouse, 342, 114, and 38 µmol/kg/day; bromoxynilphenol and bromoxynil octanoate in the rat, 54, 18, and 6 µmol/kg/day.Some animals were killed on selected days during treatment formeasurement of organ weights sensitive to stress. In mice treatedwith bromoxynil phenol, maternal mortality was noted at 114and 342 µmol/kg/day, but surviving females gained weightnormally. Liver to body weight ratios increased with increasingdose, but no consistent effect was seen on adrenal, thymus,or spleen weights. Fetuses of mice treated with the highestdose of bromoxynil phenol were of lower weight and had a higherincidence of supernumerary ribs than controls. In rats, bromoxynilphenol and its octanoate ester at the highest doses used causedno mortality but resulted in only transient decreases in maternalweight gain and significantly increased the liver to body weightratio, but did not significantly alter adrenal, thymus, or spleenweight in the dams. No significant maternal effects were seenat lower doses. The highest doses of both compounds increasedthe incidence of supernumerary ribs in fetuses of treated rats,but did not induce other anomalies. Fetal weight was reducedin rats at the highest dose of bromoxynil octanoate, but noeffects on fetal weight were seen with bromoxynil phenol. Bromoxynilexposure produced a high incidence of supernumerary ribs atmaternally toxic doses in both rats and mice, although no evidenceof maternal stress per se was found. The mechanism and significanceof this effect require further study.     

Studies on Protein Fractions Isolated from Human Plasma

S ummary . Fractions of human plasma separated by precipitation with cold ether and ethanol were examined for a number of protease and esterase activities. Plasminogen, kallikrein, increased vascular permeability, thrombin and TAMe esterase were concentrated in fraction G 2 / i R, a lipo-protein fraction containing a mixture of alpha and beta globulins and a gamma-M globulin, which also contained activated coagulation contact factors. ATEe esterase was concentrated in G 2 / i R and fibrinogen. Kinin-ase and TAMe esterase were also found in G 2 / 2 a mixture of alpha, beta and gamma globulins.
Tests of fractions of G 2 / i R separated by chromatography confirmed the findings of Kagen et al , (1963) and showed that kallikrein was a gamma-M globulin. Vascular permeability activity, but not kininogenase activity was removed by high-speed centrifugation from this fraction.
Fractions G 2 / i R, G 2 / 2 and to a lesser extent G 3 contained a substance which induced kininogenase activation in intact plasma, but was not identified as PF, plasmin or activated contact factor and had no esterase activity.
Kininogenase activity was associated with contaminants of fibrinogen and gamma globulin concentrates and absent from albumin. In fractions prepared by large-scale methods, only those made from G 2 are likely to contain sufficient kininogenase to cause a clinical reaction. Kininogenase was not adsorbed by Al(OH)³ gel or C^a3(PO⁴)² and would not contaminate clotting factors prepared from G².     

Differentiation of the dopamine mechanisms mediating stereotyped behaviour and hyperactivity in the nucleus accumbens and caudate-putamen

A number of dopamine agonists were applied intracerebrally to the nucleus accumbens and caudate-putamen of rat in an attempt to differentiate the dopamine mechanisms in these nuclei which mediate hyperactivity and stereotyped behaviour. The major effect of dopamine was to induce hyperactivity from the nucleus accumbens and stereotypy from the caudate-putamen; N-n-propyl-norapomorphine induced hyperactivity and stereotypy from the nucleus accumbens whilst apomorphine induced a marked stereotypy from the caudate-putamen, modest stereotypy from the nucleus accumbens and no hyperactivity. In contrast to apomorphine, 2-(NN-dipropyl)amino-5,6-dihydroxy TN? induced a more marked stereotypy from the nucleus accumbens and, again, no hyperactivity. The major effect of 2-(NN-diethyl)amino-5,6-dihydroxy TN was to cause an intense hyperactivity from the nucleus accumbens and marked stereotypy from the caudate-putamen whilst the primary amine, 2-amino-5,6-dihydroxy TN induced hyperactivity and stereotypy from both areas. The marked hyperactivity and stereotyped responses were inhibited by haloperidol, but not by α- or β-blockers. These data would indicate that there may be different dopamine mechanisms in the nucleus accumbens and caudate-putamen for the mediation of hyperactivity and stereotyped behaviour.     

Catecholamine Induced Double Tachycardia: Case Report in a Child

A six-year-old girl with syncope in association with atrial flutter-fibrillation and ventricular tachycardia produced by exercise or emotion is presented. The tachycardias could be reproduced by low-dose isoproterenol infusion and were blocked by high dose propranolol therapy. Catecholamine-induced tachyarrhythmias should be suspected in children with unexplained syncope in association with exercise or emotion.     

The South Manchester family worker scheme

This paper reports on our experiences in setting up and runninga health promotion initiative in the south of Manchester, UK.The project was modelled on the work of the travailleuses familialesin France, and consisted of a team of "family workers" who wereemployed to provide social, practical and psycho logical supportto women in pregnancy. The aim of the scheme was to improvethe health and well-being of the women and their eventual offspringby reducing stress during pregnancy. The intervention was evaluatedin the form of a randomised controlled trial. Those eligiblefor the trial were women identified as being at above-averagerisk of giving birth to a low birth weight baby. In this article we present details of the intervention itselfrather than of the trial. Aspects of the scheme covered relateto certain issues raised in the course of carrying out the project–forexample, the difficulties of introducing a service which useslay workers and adopts a client-centred approach, ethical dilemmasposed by preventive work, difficulties of cooperation amongstaff and of coordinating the care offered through various servicesto women in pregnancy. Following the work of Schwartz, we describe our trial as pragmatic,in an attempt to encompass the additional variables, as describedabove, which must be taken into account when assessing the impactof any intervention. The research therefore addresses not onlythe theoretical question of whether social support is effective,but also the pragmatic question of whether social support canbe delivered effectively in a "real life" situation.