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SUMMARY1. A study of nodal and terminal sprouting in fast and slow muscles of the mouse hind limb has been made using the zinc iodide and osmium tetroxide stain.2. The terminal sprouting normally elicited by botulinum toxin injection can be prevented by regular and frequent direct electrical stimulation of the muscle fibres. But the number of end-plates innervated by nodal sprouts in partly denervated spinal preparations was not reduced by direct muscle stimulation.3. In leg muscles given varying doses of botulinum toxin the amount of terminal sprouting was linearly related to the degree of paralysis. In partly denervated muscles neither the amount of terminal sprouting nor the amount of nodal sprouting was correlated with the degree of denervation.4. Partial denervation causes relatively more nodal sprouting in the fast muscles peroneus tertius and extensor digitorum longus than in the slower soleus muscle, which itself has considerably more terminal sprouting than the others. The fast muscles can develop as much terminal sprouting as the soleus only in response to full paralysis with botulinum toxin.

One of the oldest known forms of neuronal plasticity is the ability of peripheral nerves to grow and form functional connections after damage to neighbouring axons. Yet the source of the signal which elicits this "sprouting" remains unknown. In mammalian muscles, paralysis-which gives rise to many of the changes which occur in denervated muscles-causes motor nerve terminals to sprout. Could the inactive muscle fibres (rather than nerve degeneration products, another likely source) be responsible for some of the sprouting found in partial denervation? We confirm in this paper that direct stimulation of a partially denervated muscle inhibits sprouting and show that stimulation does so by activating the denervated fibres. Consequently after partial denervation the same signal as that which causes terminal sprouting in a paralysed muscle is able to spread from the denervated muscle fibres to the nerves on the innervated fibres and initiate terminal sprouting.

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We developed and introduced into clinical practice a leaflet to improve the delivery of information to patients before obtaining their consent to anaesthesia. The amount of information needs to be what a "reasonable" patient thinks appropriate; therefore we tested patients' responses to three levels of information: "full" disclosure, "standard" disclosure (as contained in our leaflet) and "minimal" disclosure.Forty-five patients scheduled to undergo cardiac surgery were enrolled in the study. None of the information sheets caused a significant change in state anxiety score and only the "full" disclosure significantly increased knowledge about anaesthesia (P=0.016). All leaflets were easy to understand. When only one leaflet was provided 64-73% of patients thought the content was "just right", whereas when all three leaflets were viewed together, 63% of patients thought the "minimal" leaflet withheld too much information.