The Specific Gravity of the Brains of Alcoholic and Control Patients: a pathological study

In recent pathological studies the authors have shown that the brain shrinkage seen in alcoholics is due to a loss of tissue from the white matter and not the cortical grey matter. In order to address the question of the pathogenesis of this shrinkage the Specific Gravity (SG) of the frontal, parietal and occipital grey and white matter of alcoholics and age- and sex-matched controls was measured. The alcoholics were found to have a consistent, but not significant, reduction in SG. Alcoholics with Wernicke's encephalopathy (WE) showed similar changes. The decrease in SG in alcoholics with cirrhosis was significant. This pattern of change, in the absence of a large variation in brain water content, suggests that the loss of tissue is probably balanced so that protein/lipid/ carbohydrate ratios are not appreciably different in controls and alcoholics.     

CARERS' KNOWLEDGE OF DEMENTIA AND THEIR EXPRESSED CONCERNS

Objective. The authors wished to determine how much carers from different settings caring for patients with dementia knew about the disorder and elicit their main concerns about the disease. Design. A survey questionnaire was administered to 136 carers. Setting. Two old age psychiatric services and an Alzheimer's support group in urban areas of the UK. Participants. The carers came from one of three categories: (1) carers with no prior contact with elderly mental health services (preassessment group); (2) carers who had been in contact with mental health care professionals (postassessment group); (3) carers in contact with an Alzheimer's Disease Society support group. Measures. A questionnaire on the subject of dementia. Carers' worries about the disorder were also recorded. Results. Carers in contact with an Alzheimer's support group were the most knowledgeable and carers in the preassessment group were the least knowledgeable on the subject of dementia. While carers in the postassessment group had a level of knowledge above that of the preassessment group, this difference failed to reach statistical significance. Conclusion. The study highlights the need for elderly mental health teams to evaluate their methods of dissemination of knowledge to carers, develop educational packages for carers and evaluate their effectiveness. © 1997 by John Wiley & Sons, Ltd.     

The Effect of Surfactant and Solid Phase Concentration on Drug Aggregates in Model Aerosol Propellent Suspensions

The effect of increasing solid phase concentration on the morphology and flocculation rate of model aerosol suspensions has been investigated. Suspensions of micronized salbutamol sulphate and lactose in trichlorotrifluoroethane (P113) were studied under conditions of increasing shear stress. By use of image analysis techniques, measurement of aggregate size, fractal dimension and rate of aggregation was performed. The effect of the surfactant sorbitan monooleate on morphology and flocculation rate was also studied. Increased solid phase concentration caused an increase in the rate of aggregation and average aggregate size at a given value of shear stress. Surfactant addition retarded the aggregation rate, and caused a shift from a diffusion-limited cluster aggregation to a reaction-limited cluster aggregation mechanism. The aggregate profiles showed a corresponding change from rugged and crenellated without surfactant, to increasingly smooth and Euclidian with increasing surfactant concentration. The morphological changes were characterized by a decrease in the average boundary fractal dimension which also correlated well with the corresponding reduction in aggregation rate.     

Dantrolene and suxamethonium

A single oral dose of dantrolene (100--150 mg) given at least 2 hr pre-operatively has been found to reduce significantly the strength of muscular fasciculations, the hyperkalaemia and the incidence of muscle pains following suxamethonium (from 56 to 4%) in a series of forty-eight patients compared with controls. The biceps EMG of the fasciculations was unchanged by dantrolene; the incidence of troublesome side effects was low (9%) and there did not appear to be any alteration in the duration of action of suxamethonium.     

Limited Wegener's Granulomatosis

6 cases of limited Wegener's Granulomatosis are presented. There were 4 males and 2 females, with a mean age of 48 years. Predominant organ systems involved were the upper and lower respiratory tracts, eyes and ears, with isolated involvement of the joints, gall bladder and adrenals. Chest Radiographic features included large rounded masses, widespread airspace consolidation, thin-walled cystic lesions and lobar atelectasis.     

Health issues related to customary consanguineous marriage among British Pakistanis

Social, medical and genetic factors related to the practiceof consanguineous marriage are reviewed with particular respectto the British Pakistani population and recent media coverageof topic is also considered. The present study is based on asample of 78 first- and second-generation Pakistanis livingin Britain. The subjects were asked to give their views on consanguineousmarriages and to demonstrate their knowledge of possible healthproblems related to the practice. Sources of information andpersonal experiences of health education on the subject werealso determined. The popularity of consanguineous marriageswas attributed to social rather than religious or economic influencesby the majority of respondents, and television and magazineswere the major sources of health information, rather than schools,family or health workers, emphasising the need for accurateand unbiased information through these channels. Second-generationsubjects, in particular, stressed the desirability of consanguineouscouples receiving health information on potential risks, beforemarriage. Knowledge of genetic disorders associated with consanguineousmarriage was limited with only four subjects identifying beta-thalassemia,despite its high incidence in British Pakistanis (>18 perthousand). A majority of subjects emphasised the need to educateother population groups, including health workers, on the advantagesof consanguineous marriages to counter a perceived widespreadprejudice against the practice. Prenatal screening, with theoption of termination of pregnancy for serious fetal abnormalities,was favoured by a majority of both generations. The need fora considered and rational view of consanguineous marriage onthe part of health professionals is emphasised.     

Changes in cardiovascular risk factors by combined pharmacological and nonpharmacological strategies: the main results of the CELL Study

Objective. The objectives of the Cost Effectiveness of Lipid Lowering (CELL) study were twofold: (i) to evaluate the effect on overall cardiovascular risk of two types of health care advice (‘usual’ and ‘intensive’) given in primary care, with or without pharmacological medication, with the target being to attain a moderate decrease in cholesterol; (ii) to evaluate the ritual of daily medication on compliance with the health care advice. Design. A prospective, double-blind, randomized, controlled trial of 18 months' duration. Setting. The study was carried out in 32 health centres (out of a total of approximately 850) in Sweden. Subjects. In all, 681 subjects, aged 30–59 years, were randomized. They had at least two cardiovascular risk factors in addition to moderate primary hyperlipidaemia (total cholesterol of at least 6.50 mmol L^-1 on three occasions measured by Reflotron, triglycerides less than 4.0 mmol L^-1 and an LDL:HDL cholesterol ratio of more than 4.0). Most (87%) of the subjects were males; 626 subjects (92%) completed the 18-month follow-up. Intervention: Half the subjects were randomized to ‘intensive advice’ given in group sessions led by doctors and nurses in primary care. The other half received ‘usual advice’. In each of the two advice groups, one-third received an active lipid-lowering drug (pravastatin), one-third placebo, and one-third no drug at all. The tablets were titrated to achieve a 15% reduction in cholesterol. Main outcome measures. Changes in the overall Framingham risk score, and the development of adverse events in each group. Results. The change in Framingham risk score was significantly reduced only in subjects taking lipid-lowering medication (together with intensive advice-0.13; 95% CI -0.20,-0.06, and together with usual advice -0.16; 95% CI -0.23,-0.09). The other subjects receiving intensive advice tended to fare better than those on usual advice. Lifestyle was not influenced significantly over the study period. The ritual of daily medication did not affect the outcome. Conclusion. As expected, lipid-lowering medication reduced serum cholesterol as well as overall cardiovascular risk in subjects with several risk factors for cardiovascular disease. There was no additive effect of intensive advice to these subjects. However, there was a meagre but significant effect of intensive advice in subjects not receiving active lipid-lowering drugs. One explanation for this difference may be that those on active lipid-lowering medication who had substantial drops in cholesterol might have felt less inclined to change their lifestyle compared with those on other treatment regimens who had less successful drops in cholesterol. There was no benefit from the ritual of taking daily medication.     

Atrial Natriuretic Peptide and Cardiac Electrophysiology: Autonomic and Direct Effects

ANP and Cardiac Electrophysiology. Atrial natriuretic peptide (ANP) has varied effects on cardiac electrophysiologic parameters including heart rate, intraatrial conduction time, and refractory period. ANP's vagoexcitatory and sympathoinhibitory actions as well as its direct actions on cardiac ion currents may be responsible for some of these effects. This review discusses the role of ANP in cardiac electrophysiology, its interactions with the autonomic nervous system and baroreceptor reflex, and its effects on cardiac ion currents.