A COMPARISON OF NEPHROGENOUS CYCLIC AMP, TOTAL URINARY CYCLIC AMP AND THE RENAL TUBULAR MAXIMUM REABSORPTIVE CAPACITY FOR PHOSPHATE IN THE DIAGNOSIS OF PRIMARY HYPERPARATHYROIDISM

A determination was made of total urinary adenosine 3′-5′cyclic monophosphate (UcAMP), nephrogenous cyclic AMP (NcAMP) excretion and also of the renal tubular maximum reabsorptive capacity for phosphate T_mPO₄/GFR (all expressed as a function of the glomerular filtrate) in fourteen patients with primary hypercalcaemic hyperparathyroidism and twelve control normal subjects. The hyperparathyroid patients gave a mean excretion of UcAMP (7·0 ± 45·68 nmol/100 ml GF; mean ± SEM), NcAMP (6·19 ± 0·64 nmol/100 ml GF) which were significantly greater (P < 0·001) than those of normal controls, (2′45 ± 0·15nmol/100 ml GF and 1·25 ± 0·12nmol/100 ml GF) respectively. The difference between the patients and controls for the maximum renal tubular reabsorptive capacity for phosphate (T_mPO₄/GFR) (patients 0·55 ± 0·04, controls 1·05 ± 0·05 mmol/l GFR) was also highly significant (P<0·001). Statistical evaluation of the results obtained from the patients with primary hyperparathyroidism revealed that there was a positive correlation between the level of plasma calcium and immunoreactive parathyroid hormone (PTH) (r=+0·46), NcAMP(r=+0·337), UcAMP (r=+0·36), and an inverse correlation with the T_mPO₄/GFR (r=?0·62). There was also a positive correlation between plasma immunoreactive PTH and NcAMP(r=+0·31), and UcAMP(r=+0·35), and an inverse correlation with the T_mPO₄/GFR (r=?0–39). Successful removal of a single parathyroid adenoma in six patients was associated with a highly significant fall in the excretion of UcAMP, NcAMP, and a rise in the T_mPO₄/GFR (P<0·005). The combination of a low T_mPO₄/GFR and a high excretion of UcAMP or NcAMP in the presence of hypercalcaemia is highly suggestive of primary hyperparathyroidism in the absence of clinical evidence of malignant disease.     

SPINAL ANAESTHESIA WITH 0.5% BUPIVACAINE 3 ML: COMPARISON OF PLAIN AND HYPERBARIC SOLUTIONS ADMINISTERED TO SEATED PATIENTS

In a double-blind study, 0.5% bupivacaine 3 ml in plain (n=10)or hyperbaric (n=10) solution was injected intrathecally to20 patients who were in the sitting position, to produce spinalanaesthesia for transurethral resection of prostate. No statisticallysignificant differences were found in time to maximum cephaladspread of analgesia nor in the level reached. However, the plainsolution produced a smaller scatter around the mean level thanthe hyperbaric solution. The duration of analgesia was not significantlydifferent between two groups. There was no difference in theincidence of complete motor block, but a longer duration oflesser degrees of motor block was found with the plain solution(P<0.05). The plain solution produced a more predictablelevel of blockade.     

VARIATION WITH AGE IN THE VOLUMES OF GREY AND WHITE MATTER IN THE CEREBRAL HEMISPHERES OF MAN: MEASUREMENTS WITH AN IMAGE ANALYSER

Miller A. K. H., Alston R. L. & Corsellis J. A. N. 1980 Neuropathology and Applied Neurology 6, 119–132
Variation with age in the volumes of grey and white matter in the cerebral hemispheres of man: measurements with an image analyser
The total volumes and relative quantities of grey and white matter have been measured in sixty-five normal male and sixty-five normal female cerebral hemispheres. Fixed hemisphere volume was found to fall linearly at 35% per decade for men from 641 ml at the age of 20 to 463 ml at the age of 100. For women the decrease was 1–9% per decade from 531 ml at 20 years to 462 ml at 100 years. After correction for the effects of fixation and for the secular increase in brain size, it was concluded that mean hemisphere volume remained roughly constant between the ages of 20 and 50 years (558 ml for men, 474 ml for women). After the age of 50 the mean volume in both sexes fell at about 2% per decade. The ratio of the volumes of grey to white matter was the same for the two sexes at all ages. Its mean value was 1–3 at the age of 20, falling to 11 at the age of 50, then rising steadily to over 1–5 at 100 years. It is impossible in practice to correct these measurements for the effects of fixation or secular change. Fourteen hemispheres from thirteen elderly female dements were also measured. The total volume was 18% lower than for an age-matched group of normals, but the ratio of grey to white matter was identical.     

SPINAL ANAESTHESIA WITH HYPERBARIC BUPIVACAINE: EFFECTS OF CONCENTRATION AND VOLUME WHEN ADMINISTERED IN THE SITTING POSITION

In a double blind study, solutions of 0.5% or 0.75% bupivacainecontaining 8% dextrose were compared with regard to the effectof varying concentration and volume when administered intrathecallyto patients in the sitting position. Ten patients received 3or 4 ml of 0.5% bupivacaine or 2 or 3 mi of 0.75% bupivacaine.Nine patients received 0.5% bupivacaine 2 ml and another ninereceived 0.75% bupivacaine 1.3ml. The use of the 10-mg doseof both solutions was abandoned after nine patients in eachgroup becafse of insufficient cephalad spread. With both solutions,the smallest volumes (bupivacaine 10 mg) had significantly shorterdurations of action than both the larger ones (15–20/22.5mg), between which there were no significant differences.     

A method for the simultaneous determination of serum and cell-bound IgE

A method for determining the amount of total IgE bound to leucocytes has been devised by measuring that released on incubating various cell number dilutions in acetate buffer pH 4.0. A linear relationship between IgE released and cell number was obtained over a limited concentration range. The method seemed to work satisfactorily with 50 ml of whole blood for those subjects with very high serum levels of total IgE. However, with subjects having a slightly elevated or normal serum IgE level it may be necessary to use twice the amount of blood.