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Fifty-one patients admitted to hospital with severe exacerbations of chronic bronchitis entered a double-blind trial of treatment with cefaclor (500 mg tds) compared with amoxycillin (500 mg tds) for 7 days. Twenty-six patients received cefaclor and 25 amoxycillin. Sputum and throat swabs were collected on admission, after 7 days of therapy and at outpatient follow-up, 3 weeks after treatment had finished. Clinical status and spirometry were assessed on admission and at the third, seventh and 28th day. There was no significant difference between the two regimes for clinical outcome, spirometry or numbers of infecting pathogens. Opportunistic colonization with resistant Gram-negative organisms and Candida species was highly prevalent on admission (56%) in both groups, perhaps because of previous antibiotic administration and general debility of the majority of patients. The high prevalence of opportunistic colonizing organisms persisted at follow-up (48%) with a significant excess of new organisms (Enterobacter cloacae, Klebsiella species and Candida species) present in sputum in the amoxycillin-treated patients. Cefaclor may be less damaging to normal flora than amoxycillin with a consequently reduced risk of colonization and superinfection of the respiratory tract with resistant Gram-negative organisms and yeasts.

Sensory nerves innervating rat distal limb skin were labeled by axonal transport of an enzyme-lectin conjugate injected into lumbar dorsal root ganglia (DRG), with emphasis on tracing the course of the thin axons. Selective neonatal neurotoxin destruction of most unmyelinated sensory or sympathetic axons was achieved by treatment with capsaicin (CAP) and 6-hydroxydopamine (6-OHDA), respectively. The relationship of substance P-immunoreactive (SPI) axons to the patterns of axonal transport-labeled thin axons was compared in normal and neurotoxin-treated animals. SPI is restricted to a limited population of unmyelinated axons, and electron-microscopic observation reveals its total absence in myelinated axons. SPI fibers of sensory origin, as determined by CAP susceptibility, can be traced into the epidermal stratum spinosum, in relation to guard hair follicles, mast cells, and a specific class of small blood vessels. These morphological features are not eliminated by neurotoxin sympathectomy, and some are inferred to contribute to the initial events associated with the neurogenic vasodilation and plasma extravasation associated with the inflammatory response. A re-evaluation of the concept of "free nerve endings" is suggested in the context of the variety of afferent and efferent patterns displayed by sensory peptidergic unmyelinated axons, their putative nociceptive role, and the functional diversity of sensory C fibers.

Financial and other constraints, such as operative risk, may prevent older patients being considered for coronary arterial bypass grafting. Grafting was performed in 315 elderly patients (244 males, 71 females, age 65-79, mean 69 years) between 1981-1986. All patients had limiting angina, 38% had rest pain, 90% were housebound and 80% had triple-vessel disease. Impairment of left ventricular function was absent in 46%, mild in 20%, moderate in 23% and severe in 10% of patients. Grafts (saphenous vein or internal mammary artery) were inserted into 3 vessels (52%), 4 vessels (42%), 5 vessels (6%), 6 vessels (0.5%). Death during surgery occurred in 1.6% and a further 3.5% of patients died later during the same admission (70% of deaths were among the 33% with preoperative moderate or severe left ventricular impairment). Surgical complications included myocardial infarction (8%), cerebrovascular accident (1%), transient cerebral vascular ischaemia (5%), chest infection (10%) and wound infection (4%). Median stay on the intensive care unit was 1 day and median total hospital stay 12 days. 299 patients therefore survived to leave hospital and follow-up data are available for 217 (72%) of these. 96% were subjectively improved by surgery, 88% being free of angina on no antianginal drugs a median of 72 weeks (range 8-307) and a further 8% not limited by angina on medical therapy a median of 85 weeks (range 9-302) after surgery. We conclude that coronary arterial surgery is an effective treatment for angina in the elderly. This will have consequences for future resource allocation if the elderly are not to be denied effective therapy because of financial rather than clinical restraints.

Calcitonin gene-related peptide (CGRP)-like immunoreactivity was localized in neuronal processes and somata of the rat gastrointestinal tract. Varicose processes were observed in the myenteric and submucosal plexuses, smooth muscles, submucosa, mucosa and around blood vessels. Immunoreactive somata were visualized in the myenteric and submucosal ganglia of the intestine in colchicine-treated rats. These observations, together with previous neuroanatomical and pharmacological studies, suggest that CGRP may be involved in regulatory functions of the gastrointestinal tract.

New radiocarbon dates and plant macrofossil data establish that parts of the Queen Charlotte Islands, British Columbia, were ice-free during and subsequent to the late Wisconsin glacial maximum on the Pacific coast of Canada. A paleoecological investigation of dated sediments at Cape Ball has indicated that a varied flora consisting of terrestrial and aquatic plants was present there about 16,000 years ago. This finding provides support for the existence of a heretofore questioned biotic refugium on the Queen Charlotte Islands during the last glaciation. These results shed new light on problems of glacial chronology, climatic change, biogeography, and archeology along the western margin of North America.