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Background and Purpose The underlying embolic material detected by transcranial Doppler ultrasound in patients with prosthetic heart valves remains unknown. We undertook this study to evaluate the relation between the number of Doppler emboli signals and the activity of the coagulation system.Methods Patients with various types of prosthetic valves (n=120) and patients in atrial fibrillation (n=20) were monitored for 30 minutes using transcranial Doppler with a 2-MHz probe. The plasma concentrations of cross-linked D-dimer, antithrombin-III, and thrombin-antithrombin III complex were measured.Results No correlation between the levels of any of the hematologic parameters and the number of emboli was demonstrated in the studied groups. The D-dimer levels were significantly higher in patients with mechanical prosthetic valves with an international normalized ratio under 2.0 com-

SYNOPSISThe levels of four serum proteins, assayed by a radial immunodiffusion technique, have been measured in healthy women who had been given either the oestrogen or progestogen component of a combined oral contraceptive preparation for three weeks. Raised x2-macroglobulin and transferrin levels were found after oestrogen treatment but albumin and IgG did not significantly alter. In the progestogen-treated group all four proteins remained unchanged. The four proteins have also been assayed at frequent intervals during the normal menstrual cycle. No evidence of cyclical variation was found.In a previous study using a radial immunodiffusion technique (Horne, Howie, Weir, and Goudie, 1970) we demonstrated significant increases in the levels of serum a2-macroglobulin, transferrin, and IgG in normal females who had received combined oestrogen/progestogen oral contraceptives. It therefore seemed of interest to determine whether these changes could be produced by the action of oestrogen or progestogen components administered alone and whether endogenous production of steroid hormones during the normal menstrual cycle caused physiological variation in the serum levels of these proteins. Subjects and MethodsTwo groups of 14 healthy females (mean ages 20-6 and 20-9 years, ranges 17-28 and 17-30) were given respectively either 50 ,ug of the oestrogen mestranol or 1 mg of the progestogen ethynodiol diacetate daily for a period of three weeks beginning on day 5 of a menstrual cycle. Before administration of these preparations serum was obtained on day 3 of the cycle; a further six samples were taken at weekly intervals during treatment and the subsequent three weeks.To determine the effects of endogenous hormones sera were also obtained from a third group of 14 healthy females (mean age 19 9 years, range 19-23) at three-to four-day intervals throughout one complete menstrual cycle.The sera were stored for up to 16 weeks at -20°C before the serum protein levels were measured by a

In a previous study the levels of four serum proteins, assayed by a radial immunodiffusion technique, were measured in nine healthy women before and after taking combined oestrogen/progestogen oral contraceptives. Significant increases in macroglobulin, transferrin, and IgG were found but albumin was unchanged. The purpose of the present experiment was to determine whether the oestrogen or progestogen component was responsible for these changes.Two groups of 14 healthy females were given either 50 mg oestrogen (mestranol) or 1 mg progestogen (ethynodiol diacetate) daily for three weeks. Protein levels were determined, at weekly intervals, before, during, and aftertherapy. Significant increases in c2 macroglobulin and transferrin were found in those subjects taking mestranol. Neither of the two groups showed significant changesin IgG or albumin.Protein levels in 14 healthy females were measured at three-to fourday intervals over one menstrual cycle. No convincing evidence of cyclical variation due to endogenous production of hormones was found but there was some indication that transferrin perhaps showed cyclical variation. Agar gel electrophoresis at pH 5-0 of histamine-stimulated normal gastric juice reveals eight proteolytic zones, not all of which are present in every subject (see Table). Zones 1, 2, 3, 3a, and 5 are caused by different individual pepsins, of which 3 and 5 are the principal pepsins. Zones 4 and 6 arise from a pepsin inhibitor complex and from residual zymogen respectively. Zone 7 is not inactivated at alkaline pH and is better called a gastric proteinase than a pepsin.Pepsin 1 occurs with significantly increased frequency in patients with peptic ulcer (Table). It also occurs in several such patients in greatly increased amounts. Patients with gastric ulcer exhibit these effects to a greater extent than patients with duodenal ulcer.There is no association of hyperchlorhydria with increasing amounts of pepsin 1; in duodenal ulcer the datasuggest the reverse, but are not conclusive. Nor is there any association between the presence of pepsin 1 and the possession of blood group 0; in both sorts of ulcer the data again suggest the reverse.A new aetiological factor in peptic ulcer has thus been revealed, which is operating more frequently in gastric than in duodenal ulceration, and independently of other aetiological factors, such as hyperchlorhydria and the possession of blood group 0. Table Frequency ofoccurrence (Y.) eliminated from the unit. Between 1966 and 1969 there had been a four-fold increase in the amount of ampicillin and cloxacillin prescribed and, in desperation, it was agreed to abandon the use of antibiotics. The dramatic result of this decision was an immediate reduction in the incidence of infections and the disappearance of K. aerogenes from the unit. This improvement has been sustained for six months.Search for Serratia WILLIAM A. BLACK (Glasgow)The search for Serratia was stimulated by the fact that since the paper by Black, Pollock, and Batchelor (1967) there have been no fur...