A study of cochlear innervation patterns in cats and rats with the Golgi method and Nomarkski Optics.

Cochlear innervation patterns were studied in infant cats and rats with the rapid Golgi method. Examination of thick serial sections and surface preparations with the differential interference contrast microscope (Nomarski optics) allowed direct visualization of individually impregnated spiral ganglion cells, complete with their peripheral processes and endings in the organ of Corti. Individually impregnated efferent fibers could be recognized as heavily varicose axons that project radially to endings beneath inner and outer hair cells after taking a tangential course in the intraganglionic spiral bundle. It was often possible to visualize unimpregnated hair cells in contact with the impregnated endings of both types of fibers. There are at least two types of spiral ganglion cells in the cochlea of the infant cat and rat. One type innervates only inner hair cells by means of radial fibers. These ganglion cells constitute the overwhelming majority of ganglion cells impregnated in our preparations, and each cell typically innervates two inner hair cells. Hence, these ganglion cells establish nearly "point-to-point" connections between the auditory nerve and the organ of Corti. The other type of ganglion cell innervates outer hair cells by means of long spiral fibers; each cell typically innervates many outer hair cells through the numerous angular enlargements and short end branches of its spiral fiber. In addition, a few of these spiral fibers also send branches to inner hair cells by means of short collaterals; it remains to be seen if such fibers also occur in mature cochleas. Efferent fibers have been traced to inner and outer hair cell regions. The simplest pattern is formed by fine beaded axons with only a few branches ending mainly beneath inner hair cells. More complex patterns are formed by larger axons with many branches ending beneath inner or outer hair cells. Many efferent fibers send branches to both inner and outer hair cells. Electrophysiological studies so far have not demonstrated different populations of units that clearly correspond to the spiral and radial fibers. Therefore, the physilogical differences between inner and outer hair cell innervation remain undefined.

Neuronal morphology of the rabbit cochlear nucleus.

The cytoarchitecture of the cochlear nucleus in young adult albino rabbits (Cuniculus oryctolagus) has been examined in Nissl- and Golgi-impregnated material to compare rabbit cochlear nucleus with other mammalian species. Cochlear nucleus was subdivided into anteroventral (AVCN), posteroventral (PVCN), and dorsal (DCN) regions, as in other mammals. AVCN was characterized by bushy cells and stellate cells. The "bushy" dendritic trees of adjacent bushy cells often overlapped. PVCN was characterized by octopus, elongate, and stellate cells. The dendritic trees of adjacent octopus cells extended in a parallel array across the auditory nerve fibers. DCN had molecular, fusiform and polymorphic layers. The fusiform cell layer was especially prominent, with the fusiform cells appearing visually to be the organizing elements in DCN. The large cells in DCN were the fusiform and giant neurons; the medium cells were the stellate and elongate neurons; the small cells were the cartwheel, small stellate, and granule cells. The cochlear nucleus of rabbit is essentially similar in cytoarchitectural organization to other mammalian species which have been studied. The detailed morphology of the various cell types seen in Golgi preparations is quite similar to that of cat (Brawer et al., '74), although some differences do exist.

Electromyographic analysis of the "baccinator mechanism" in human beings.

Electromyography of the muscles of the "buccinator mechanism" was undertaken, utilizing indwelling fine-wire electrodes. Electromyograms were made of 14 subjects with normal occlusion during various oral activities. Several activities elicited simultaneous contraction of all muscles. Simultaneous activity represents a potential restraining force of this muscular band on the dentition.

Group counselling for relatives of hospitalized presenile dementia patients: a controlled study.

A controlled study is reported in which the effects of time-limited group counselling for the relatives of hospitalized presenile dementia patients is evaluated. The results indicate that such group counselling was effective in increasing relatives' morale, increasing their knowledge about dementia, and increasing the number of activities performed with the patient during visits, but had no effect upon the frequency or duration of visits or the amount of verbal and non-verbal communication between patient and relative. All changes achieved were maintained at three month follow-up.

Identity and coping with mental illness in long-stay psychiatric rehabilitation.

The literature on coping with mental illness is reviewed. A study is reported which was designed to operationalize and measure the responses to chronic psychiatric illness of denial or adoption of a sick role outlined by Wing & Morris (1981) and Shepherd (1984) and to investigate their correlates and relationship to identity as measured by Thompson (1988). On the basis of existing literature, it was anticipated that subjects who identified themselves as 'community members' would tend to cope by denial of psychiatric problems whilst those seeing themselves as a 'typical psychiatric patient' would exaggerate their disabilities. Although both types of response and identity were found within the group studied, this prediction was not confirmed: responses of patients to their illness were independent of identity, and had different sets of correlates. As compared with 'exaggerators', 'deniers', tended to have social networks within the hospital, and showed higher self-esteem and less subjective distress. Community identity, on the other hand, was related to actually going into the community, better overall functioning (especially in the areas of social activities and community skills), and poorer compliance with medication. The theoretical and practical implications of these findings are discussed.

Cognitive and affective aspects of boredom.

It is argued that previous research may have been mistaken in assuming that monotony in sensory stimulation is a necessary and sufficient cause of boredom. Five investigations are reported which used personal construct theory and repertory grid techniques to investigate three hypotheses: that boredom is associated with subjective monotony, that boredom is associated with a high degree of frustration and that boredom arises when stimulation lacks meaning for the individual. Results supported hypotheses (1) and (2) but no evidence was found to support hypothesis (3).

Towards a model of boredom.

On the basis of the authors' own research it is suggested boredom may be viewed as having cognitive and affective components. The cognitive component is subjective monotony and the affective component is a high level of frustration. An attempt is made to integrate the evidence supporting this view of boredom with other evidence from the literature to present an integrated model of boredom in which the roles of personality, situational and task characteristics influencing boredom are outlined. Psychophysiological changes occurring during the performance of boring tasks are examined. It is argued that the nature and extent of changes in heart rate and heart-rate variability are not a consequence of boredom but of a task feature (mental load). It is concluded that no clear psychophysiological component of boredom can be detected at present.

Sex differences in service usage in long-term psychiatric care are women adequately served?

There is a paucity of research concerning service usage and needs of female long-term psychiatric patients. A series of studies comparing the provisions for chronically mentally ill men and women in a south London community-focused rehabilitation and continuing care service indicate marked differences in the services received by men and women, and raise questions concerning whether the needs of female patients are adequately served. As a group the women had been in contact with services for longer, had received less intensive input from services, and it appeared that the services had been less responsive to their changing needs. Among those in high contact with the services, the functioning of men and women did not differ, yet women were over-represented in workshops designed for those functioning at a lower level. Women over 45 years of age seemed to be particularly badly served by the organised activities offered.

Routes to psychiatric inpatient care in an Inner London Borough.

A study is reported in which pathways to psychiatric inpatient care were investigated in an Inner London Borough. Data were collected on a series of 52 consecutive admissions of adults to the psychiatric wards serving the area. The most striking feature of the results was the variety of routes taken to inpatient care, combined with a high level of police involvement (23.1% of admissions) and low level of referral from General Practitioners (15.4% of admissions). Significant age differences in routes to care were found: those under 30 years were usually brought to hospital by the police or presented directly to psychiatric emergency services; those over 30 typically came via medical/surgical hospital services, domiciliary psychiatric services or psychiatric outpatients. There were no differences in the routes taken by Afro-Caribbean and white people or by men and women. Higher proportions of Afro-Caribbeans received a diagnosis of schizophrenia, considered themselves to have nothing wrong with them and were compulsorily detained. Higher proportions of whites were diagnosed as depressed and considered themselves to have physical problems rather than psychiatric ones. However, results clearly indicated that it was ethnic status rather than diagnostic category that accounted for the higher rates of compulsory detention of Afro-Caribbean people. The implications of the findings for service development and delivery are considered.

Secondary tensor and supinator muscles of the human proximal radio-ulnar joint.

A gross anatomical study was made of the human elbow. Three very small muscles were found that are not described in contemporary anatomical publications. A lateral tensor muscle of the annular ligament was observed in seven of every ten cadavers; its action is to tense or pull the annular ligament laterally during supination. A medial tensor muscle of the annular ligament was found in two of every ten cadavers; its action is to tense the annular ligament, pulling it medially and distally, and to assist in supination. An accessory supinator muscle was found in four of ten cadavers; its action is to assist in supination. These muscles would be synergistic to the primary supinator muscles of the radio-ulnar joint.

Perception of problems in psychiatric inpatients: denial, race and service usage.

The importance of the ways in which people with psychiatric problems construe their difficulties is considered in this study. A study of 60 consecutive acute admissions to wards serving an inner city area in London (UK) is reported. The results indicated that 55.8% of the sample did not consider themselves to have psychiatric problems: 15.4% said that they had no problems at all and 40.4% thought they had physical or social problems rather than psychiatric ones. Although more younger people denied that they had problems and none of those who denied having problems sought the help of a general practitioner, there was a significant association between diagnosis and perception of problems, and when this was taken into account these associations disappeared. Of those who denied having any problems, only one person had no police involvement on admission. Significantly more of those who denied problems were compulsorily admitted and there were significant differences in the proportions of whites and African-Caribbeans reporting different types of problems. African-Caribbeans were both more likely to consider that they had no problems at all and to be compulsorily admitted. Although African-Caribbeans were also more likely to be diagnosed as experiencing psychotic disorders, it was their ethnic status rather than their diagnostic category that determined both their status on admission and the way in which they construed their problems. Denial among whites tended to take the form of somatisation or construction of problems in terms of social difficulties.

Comparison of heat shocking and acridine orange treatment in phage typing of nontypable strains of Staphylococcus aureus.

Forty-five percent of 108 nontypable strains of Staphylococcus aureus from clinical and environmental sources were phage typable after heat shock and acridine orange treatment. Although phage patterns were produced by different types of treatment, the same phage groups were present, showing specificity. The newly typable strains appear to be similar in phage group distribution to the primary typable strains typed at the Peter Bent Brigham Hospital during the same time period. Ten of the originally nontypable S. aureus strains that showed lytic patterns after heat shock or acridine orange treatment were subcultured four times from the treated culture and then tested again with bacteriophages. Phage patterns were still present in 8 of the 10 strains without any further treatment. These findings are compatible with the findings of other workers, who have shown that the insensitivity of primary nontypable S. aureus strains to phage is linked to phage-resistant genes in extrachromosomal genetic elements that can be "cured" by both heat shock and acridine treatment.

Resettlement of old long-stay psychiatric patients: the use of the private sector.

A follow-up study of 17 old long-stay psychiatric patients resettled in private facilities for the elderly is reported. Resident satisfaction with the placement and functioning (using the CAPE Behaviour Rating Scale) was assessed, together with the quality of the physical and social environment, and the regime characteristics in the establishments. All residents were satisfied with life and their functioning had improved significantly. The private facilities were more resident-orientated, and had a generally superior social environment to their local authority 'old people's home' counterparts. The physical amenities, safety features, and architectural choice available were of a similar standard to those in local authority old people's homes, but there were fewer prosthetic and orientational aids and on-site recreational amenities.

Antibiotic susceptibilities of AIDS-associated mycoplasmas.

Because mycoplasmas may be a cofactor in the progression of human immunodeficiency virus infection to AIDS, their susceptibilities to antibiotics need to be known in the event that appropriate therapy is required. The mycoplasmas studied were a stock culture strain of Mycoplasma fermentans, two strains of M. fermentans isolated from patients with AIDS, M. fermentans var. incognitus, Mycoplasma penetrans, and Mycoplasma pirum. The antibiotics tested were doxycycline, tetracycline, clindamycin, ofloxacin, erythromycin, azithromycin, and clarithromycin at levels consistent with the attainable levels in serum. By the macrodilution metabolic inhibition method, all six mycoplasma strains were susceptible to doxycycline, tetracycline, clindamycin, ofloxacin, azithromycin, and clarithromycin. M. penetrans was susceptible to erythromycin. The M. fermentans strains and M. pirum were resistant to erythromycin. The macrodilution metabolic inhibition method results showed agreement with the Sensititre Gram Positive MIC Panel results for tetracycline, clindamycin, and erythromycin. MICs of clarithromycin for all six mycoplasma isolates tested were low, indicating susceptibility.

Monitoring steam sterilization of surgical instruments: a dilemma.

The study of two biological indicators in monitoring "flash" sterilization demonstrated that indicator construction often leads to a false interpretation of spore survival.

A case of Ureaplasma urealyticum septic arthritis in a patient with hypogammaglobulinemia.

Patients with hypogammaglobulinemia have an increased susceptibility to certain infections. We describe the case of a patient with common variable hypogammaglobulinemia for whom the diagnosis of destructive monoarticular arthritis caused by Ureaplasma urealyticum was established after two nondiagnostic open biopsies had been performed. Mycoplasmal infection may involve a joint in hypogammaglobulinemic patients without causing macroscopic purulence in the joint. Histological examination of the bone may be helpful in the differentiation of an infectious process from the rheumatoidlike arthritis that occurs in such patients. Culture of involved bone in addition to synovium or synovial fluid may also be helpful in establishing the diagnosis.