36 patients aged 65 and over who were admitted to hospital after suffering a fall were examined soon after admission and followed for 4 months. 10 patients developed a severe tendency to clutch and grab and were unable to walk unsupported; 9 of these died or were still in hospital 4 months later. 16 patients showed similar signs but were able to walk independently; 5 of these died or were still in hospital after 4 months. 10 patients had no features of the post-fall syndrome; only 1 of these died within 4 months, and one of the survivors remained in hospital. The syndrome may represent the end result of a positive feed-back relationship between disturbed balance and falls.

The presence of immunoreactive (IR) endothelin, endothelin mRNA, and endothelin receptors in human brain and pituitary gland has been studied by RIA, Northern blot hybridization, and receptor assay. IR endothelin was detected in all five brain regions examined (cerebral cortex, cerebellum, brain stem, basal ganglia, and hypothalamus) (6-10 fmol/g wet wt) and spinal cord (22 +/- 6 fmol/g wet wt, n = 7, mean +/- SEM). Higher concentrations of IR endothelin were found in the pituitary gland (147 +/- 30 fmol/g wet wt). Fast protein liquid chromatographic analysis of the IR endothelin in pituitary gland showed a large IR peak in the position of endothelin-3 and a smaller peak in the position of endothelin-1, whereas IR endothelin in the hypothalamus and brain stem was mainly endothelin-1. Endothelin messenger RNA was detected by Northern blot hybridization in the pituitary but not in hypothalamus. The receptor assay showed that 125I-endothelin-1 binding sites were present in large numbers in all five brain regions but were much less abundant in the pituitary gland. Binding capacity and dissociation constant were 5052 +/- 740 fmol/mg protein and 0.045 +/- 0.007 nM in brain stem and 963 +/- 181 fmol/mg protein and 0.034 +/- 0.009 nM in hypothalamus. In the pituitary gland, there were two classes of binding sites for endothelin with dissociation constants of 0.059 +/- 0.002 nM (binding capacity = 418 +/- 63 fmol/mg protein) and 0.652 +/- 0.103 nM (binding capacity = 1717 +/- 200 fmol/mg protein). Endothelin-1, -2 and -3 were almost equipotent in displacing the binding (IC50 approximately 0.04 nM). These findings are in accord with the possibility that endothelin acts as a neurotransmitter, neuromodulator or neurohormone in man.

Aims: To evaluate the use and effectiveness of fungal stains in a dermatopathology service of a district general hospital. Methods: A retrospective analysis of skin biopsies submitted over three years, where fungal stains were used; the results were correlated with clinical history and case notes. Results: In total, 99 cases were studied for fungi with the periodic acid Schiff stain with diastase. Fungi were present in seven cases; fungi had been suggested in the differential diagnosis of three of these cases but were an unexpected finding in four cases. Conclusion: Non-specific clinical details should prompt early fungal staining and non-specific microscopic findings or inappropriate well recognised skin reaction patterns should warrant the exclusion of fungal infection. The finding of at least one case of unexpected fungal infection is justified financially and for patient best management where clinical and microscopic findings are non-specific or inappropriate. F ilamentous fungi, dermatophytes, which invade and colonise the keratinised layers of the skin, are the main cause of skin fungal infection. Fungal infection is the reason for about 3-4% of dermatological consultations.

We report five cases of human orf complicated by bullous pemphigoid. This is a previously unrecorded complication of orf. Knowledge of the association allows for better management in the affected patient.

Pituitary adenylate cyclase-activating polypeptide (PACAP) is a novel peptide of hypothalamic origin which increases adenylate cyclase activity in rat anterior pituitary cell cultures. The 38-amino acid peptide shows a close sequence homology to vasoactive intestinal peptide (VIP). Binding sites for PACAP in membranes from postmortem human brain tissue were studied using [125I]PACAP27 as the radioligand. High specific binding sites (amount of specific binding measured at 0.25 nM [125I]PACAP27 in femtomoles per mg protein +/- SEM; n = 4) were present in hypothalamus (344.5 +/- 13.0), brain stem (343.0 +/- 29.3), cerebellum (292.0 +/- 21.1), cortex (259.6 +/- 19.8), and basal ganglia (259.2 +/- 50.3). Specific binding sites in pituitary, although present, were less abundant (35.0 +/- 8.9). Binding of [125I]PACAP27 was reversible and time, pH, and temperature dependent. Despite the homology with VIP, VIP was a poor inhibitor of [125I]PACAP27 binding (IC50, greater than 1 microM) compared with PACAP27 (IC50, 0.5-1.3 nM) and PACAP38 (IC50, 0.2-1.3 nM). Scatchard plots of [125I]PACAP27 binding showed the presence of both high and lower affinity sites. Chemical cross-linking of PACAP-binding sites revealed that [125I]PACAP27 was bound to polypeptide chains of 67,000 and 48,000 mol wt. Thus, we have demonstrated the presence of PACAP-specific receptors in human brain which are not VIP receptors. This opens the possibility of PACAP functioning as a novel neurotransmitter/neuromodulator in human brain.

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