Initiation and evaluation of a pilot scheme for minor surgery in general practice.

This study evaluated minor surgery in seven general practices in Stockport during the last six months of 1988. Information was collected from general practitioners followed by a survey on patient and doctor satisfaction with the scheme. A total of 361 minor surgery procedures were undertaken with no serious consequences of intervention; the post-operative infection rate was less than 1%. Financial implications were identified, including the effect on the District histology services. The results suggest high doctor/patient satisfaction rates, and support the hypothesis that minor surgery in general practice presents a practical alternative to hospital provision.

The economics of mild hypertension programmes.

The recently reported results from several controlled randomised trials of the drug treatment of mild hypertension suggest that such treatment may be expected to exert a small effect toward the primary prevention of stroke disease. In order that the economic implications of these results might be examined, two hypothetical programmes of anticipatory care are considered according to the principles of cost-effectiveness analysis. Each notional 5 year programme is set in a defined population, residents of Stockport, Greater Manchester, aged between 35 and 64 years, and each is addressed toward the detection and treatment of mild hypertension in the community. The programmes differ with respect to their detection processes: one programme is based upon the screening method conducted under the aegis of health visitor staff employed by a District Health Authority, the other upon opportunistic case finding conducted by general practitioners. It is likely that the screening programme would prevent about 13 strokes over a 5 year period; if set in leisure time total programme costs are estimated to be 309,500 pounds at 1986 prices. Discounting future costs and future prevented strokes provides for the development of a present value total cost per prevented stroke of 25,000 pounds. Alternately, the 5 year opportunistic programme, costing 252,650 pounds, would be expected to prevent about 15 strokes at a present value of 17,050 pounds per prevented stroke. The prevention of stroke disease attributable to these programmes can only be achieved in the presence of group compliance to drug treatment. This clearly depends upon the perception of the value of treating hypertension according to each individual subject. The respective merits of the two programmes are examined with particular reference to their sensitivity to this issue, as well as to their likely feasibility and practicability.

Effect of antidepressant drugs on the in-vitro egg-penetrating ability of golden hamster epididymal spermatozoa.

Tricyclic antidepressants appeared to be without effect, except for desipramine which significantly decreased whiplash motility after spermatozoa were added to eggs, and clomipramine which decreased motility and whiplash motility in epididymal sperm suspensions after pretreatment of males. Mianserin and viloxazine were also without effect, but nomifensine significantly decreased sperm motility and whiplash motility and inhibited egg penetration almost completely. After 3 h preincubation with 0.75 mmol nomifensine hydrogen maleate/l, 2/181 and 0/256 eggs were penetrated in two separate series of experiments. Control groups in these series gave medians of 90-100% penetration by 4.5-5.5 h after spermatozoa and eggs were mixed. Maleic acid had a similar effect (1/253 eggs penetrated) whilst nomifensine hydrochloride was inactive, suggesting that the effect was due to the maleate moiety of the original nomifensine hydrogen maleate salt used.

Effect of physostigmine on morphine-induced postoperative pain and somnolence.

The effects of physostigmine 1 mg i.v. were studied on the analgesia, sedation and reduction in respiratory rate induced by morphine 10 mg/60 kg i.v. in 10 patients recovering from surgery. Within 5-10 min, physostigmine abolished the somnolent effect of morphine and restored the respiratory rate to pre-drug values. Analgesia, assessed by an independent observer and by the patient was, if anything, increased by physostigmine. The analeptic effect of physostigmine lasted 40-60 min.

Neuromuscular blocking activity in an extract from the East African wild sisal Sansevieria ehrenbergii.

S. ehrenbergii and A. sisalana extracts (equivalent to 50-250 mg leaf/ml) cause potentiation (ca. 40%) of indirectly elicited contractions of the chick biventer nerve-muscle preparation. The subsequent blockade to direct and indirect stimulation and the sustained but reversible change in baseline tension resemble actions of the depolarizing suxamethonium rather than the nondepolarizing gallamine.

Levamisole and other diamine oxidase inhibitors as inhibitors of sperm motility.

Levamisole, an anthelmintic drug and inhibitor of sperm motility, is a potent inhibitor of seminal diamine oxidase. Many other diamine oxidase inhibitors also inhibit sperm motility. The most active class of these sperm motility inhibitors is the group for isothiuronium compounds, some of which are much more potent than many other metabolic inhibitors tested. They also possess the property of inducing sperm to be motile in closed circles becoming immotile with a characteristically curled shape, and are active against mouse epididymal, rabbit, and human spermatozoa.

In vitro fertilization of hamster eggs as a test system for drug effect on spermatozoa--lack of clomipramine effect.

Clomipramine may affect reproduction in male rats and dogs, while other psychotropic drugs can affect sperm motility in vitro. This study investigates the motility of hamster sperm and the fertilization of hamster eggs in vitro with epididymal sperm from alpha-chlorohydrin-pretreated males, and after preincubation with clomipramine. Alpha-chlorohydrin, a compound with a predicted antifertility action, decreased sperm motility and prevented in vitro fertilization. In contrast, clomipramine had no effect on sperm motility, including activated motility, on the acrosome reaction, or on egg penetration in vitro. Clomipramine can, however, influence prolactin levels in man, and follicle-stimulating and luteinizing hormone levels in male rats.

Characterization of receptors on postganglionic cholinergic neurons in the guinea-pig isolated ileum.

Dopamine, apomorphine, noradrenaline and isoprenaline reduced the response of the isolated guinea-pig ileum to exogenous acetylcholine by a maximum of 40%. Propranolol reversed this inhibition whilst phentolamine and pimozide were ineffective, suggesting that the drugs were acting on a post-synaptic beta-adrenoceptor. The same agonists were more effective as inhibitors of the response to transmural electrical stimulation of the ileum, lower doses producing almost complete inhibition. This inhibition was partially antagonized by phentolamine, pimozide and propranolol. Clonidine proved to be the most potent inhibitor of the response to transmural electrical stimulation, whilst phenylephrine was ineffective. pA2 determinations showed that phentolamine was a potent antagonist of clonidine but a weak antagonist of apomorphine whilst for pimozide the opposite was true. The results suggest that there are two populations of prejunctional receptors on the cholinergic nerves innervating the smooth muscle of the guinea-pig ileum. One receptor is similar to a classical prejunctional alpha-adrenoceptor and the other resembles a central dopamine receptor.

Pharmacology and toxicology.

PIP: Increasing concern over the dangers of oral contraceptive therapy in women aged 35 and over (Beral and Kay, 1977) has focused attention to the possibility of an orally acting compound which can inhibit male fertility. Criteria for a male oral contraceptive include: 1) rapid onset of action; 2) predictable duration; 3) completely reversible; 4) no effect on libido; 5) nontoxic to recipient and nonmutagenic; and 6) stable. The compound alpha-chlorohydrin satisfies many of these requirements. In addition, it is reversible and there is as yet no known mutagenicity in animal tests. It has been found however to produce bone marrow damage in primates (Kirton et al, 1970) and thus has not been used in human trials. Studies by Jackson (1977) suggest that further research should be done on the toxicity of the compound to determine the possibility of removing impurities through distillation. The commercial preparation of a-chlorohydrin is a racaemic (50:50) mixture. 2 isomers have recently been separated by Jackson et al, one showing antifertility in rats and several times less toxic than the biologically inactive isomer. If this isomer can be found to be less toxic in other species, then the possibility of a male contraceptive is much improved.^ieng

Variations in sperm count in oligozoospermic or asthenozoospermic patients.

Using a Coulter Counter, sperm density and total sperm population per ejaculate has been measured repeatedly in a series of oligozoospermic and asthenozoospermic patients. Marked variations in these parameters were found with repeated sampling from the same patient. The implications of such findings are discussed.