1039 medium to anaerobic organisms that quickly invade the uterine cavity in the early puerperium.3 When a patient known to have fibroids develops symptoms and signs of endometritis after delivery she should be treated initially with antibiotics appropriate to anaerobic organisms. In some cases, such as in our case 1, specimens for culture cannot be obtained. Treatment should then be started on suspicion of anaerobic infection alone.We thank Professor W Gavin for allowing us to report case 1.

1.The heart-rate response during sustained hand grip was studied in four normal subjects before and after intravenous atropine, propranolol and combined cardiac autonomic blockade with both drugs. The results suggest that the increase in heart rate during the first 30 s is due to parasympathetic withdrawal, whereas the further increase between 30 s and 180 s is probably mediated by a combination of parasympathetic withdrawal and sympathetic stimulation.2. The increases in heart rate during each minute of sustained hand grip were compared in 26 normal subjects, 37 diabetic subjects without and 24 diabetic subjects with proven autonomic neuropathy. In the diabetic subjects with autonomic neuropathy the increase in heart rate during the first minute was impaired, whereas the increases during the second and third minutes were similar in all three groups.3. The initial increase in heart rate over the first 30 s of hand grip and the later increase between 30 's and 180 s were compared in nine normal subjects, ten diabetic subjects without and six diabetic subjects with autonomic neuropathy. The increase during thc first 30 s was impaired in the diabetic subjects with autonomic neuropathy, whereas the later phase of the response was similar in all three groups.

Abstract. 1. Praecordial acceleration was measured by a “pixie” strain gauge transducer in 14 dogs in whom an electromagnetic flow probe and pacing electrodes had been implanted. Peak acceleration of blood from the left ventricle (aortic max. dv/dt) was derived from the flow signal by differentiation. – 2. The amplitude of the major systolic complex (DE) of the praecordial accelerogram and aortic max. dv/dt were measured during stimulation of the heart with calcium gluconate and isoprenaline and depression of the heart with propranolol and halothane inhalation. – 3. Close linear correlations were found between the percentage change in the DE complex and the percentage change in aortic max. dv/dt during stimulation and depression of the heart. – 4. The amplitude of the DE complex was found to be sensitive to changes in left ventricular end‐diastolic pressure, systemic vascular resistance and increase in heart rate up to 150 beats per minute. – 5. It is concluded that changes in the amplitude of the DE complex of the praecordial accelerogram may be a useful index for non‐invasive assessment of changes in left ventricular function in the dog.

The effects of isometric exercise on the maximum amplitude of the praecordial accelerocardiogram (as represented by the DE deflection) have been compared in 6 normal subjects (group i), I2 Animal work has shown that peak acceleration of blood flow in the ascending aorta is highly sensitive to small changes in left ventricular contractility which are insufficient to cause changes in stroke volume or systemic blood pressure (Chung, Chamberlain, and Seed, I974; Noble, Trenchard, and Guz, I966a; Reuben and Littler, I973; Winter et al., I967). It has also been shown in the dog that changes in the maximum amplitude of the praecordial accelerocardiogram correlate closely with changes in peak aortic acceleration in response to a wide range of manoeuvres (Reuben and Littler, I973). Furthermore, it appears that both are relatively independent of heart rate and ventricular loading, at least in the intact organism (Noble et al., 1972; Noble, Trenchard, and Guz, I966a, b; Reuben and Littler, I973).

1 The metabolic, hormonal and haemodynamic effects of oral pirbuterol, a new 132-adrenoceptor agonist, were studied acutely (n = 19) and after 3 months treatment (n = 11) in patients with severe heart failure receiving chronic frusemide therapy. 2 In the acute study fasted patients (n = 10) showed reductions in plasma K+ (P < 0.005) and cortisol (P < 0.01) and increases in plasma glucose (P < 0.005), insulin (P < 0.01), lactate (P < 0.005) and pyruvate (P < 0.0025). These acute changes were less in unfasted subjects (n = 9). 3 Maximal increase in stroke volume occurred at approximately half the plasma pirbuterol concentration required for maximal effect on plasma insulin. 4 Treatment with pirbuterol for 3 months was associated with sustained increases in stroke volume and fasting plasma glucose and insulin, but there was loss of all other acute metabolic effects. 5 Despite concurrent frusemide and digoxin therapy acute hypokalaemia caused no adverse effects. Hypokalaemia did not occur with chronic pirbuterol administration.