1. Uromodulin, an immunosuppressive glycoprotein found in urine, is a high-affinity binding ligand for certain cytokines, including tumour necrosis factor. 2. Its occurrence in urine was monitored after renal transplantation to investigate whether this simple urine test might differentiate common early causes of graft failure: acute immune rejection and acute tubular necrosis. 3. Diluted urine was assayed for uromodulin using a sandwich enzyme-linked immunosorbent assay. When graft function failed due to acute tubular necrosis, urinary uromodulin levels were significantly depressed compared with levels in urine produced during biopsy-proven acute immune rejection episodes (P < 0.01) or during periods of stable graft function (P < 0.02). This suggests that urinary levels of uromodulin may reflect tubular damage rather than other causes of graft functional failure. 4. The cytokine tumour necrosis factor, which binds with high affinity to uromodulin, was found in 30% of urine samples in association with immune rejection episodes, but not during acute tubular necrosis. However, the presence of urinary tumour necrosis factor was not related to levels of uromodulin in the same sample.

The development of the m = 0 instability in a Z pinch was followed and the measured growth rates compared with 2D MHD simulations. Where MHD is valid, the measured growth rates agree well with simulation. Where the ions are magnetized, i.e., where the ion-cyclotron frequency is smaller than the ion-collision frequency and the ratio of the ion Larmor radius to pinch radius is of the order of 0.1, the growth rate was smaller than expected by a factor of 2.5. This is as predicted by finite-Larmor-radius theory. The product of the wave number and the pinch radius was ka approximately 2pi and was the same for all conditions. Perturbations as large as 30% of the pinch radius were observed; no nonlinear saturation was evident.

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Section for an opinion as to the best method of treatment of severe symptoms pointing to pressure on the right brachial plexus. A description of the patient's appearance and disabilities will be found in both the reports referred to.Her work as a dressmaker had been interfered with by severe shooting pains down the inner side of the arm and over the front of the chest. There was marked loss of power in the right hand, and much circulatory disturbance. When the shoulder was depressed the right pulse was diminished in volume, a sign which assisted in the exclusion of syringomyelia, a condition which has been described in association with this form of dysostosis.Mr. Davies removed the outer fragment of the clavicle, and when the patient left the hospital there was already improvement. She has been completely free of the severe neuralgic pains, her hand has recovered power, and she has resumed her occupation. The only complaint now is of a dull ache in both shoulders, brought on by the long hours during which she sits in a position sewing over her work that tends to make the shoulders " over-stoop." This is relieved by sitting up with the shoulders braced back, and is of an entirely different nature to the former trouble, which was. caused by the inner end of the outer fragment of the right clavicle pressing back on the nerves. I Lancet, 1907I Lancet, , ii, p. 1599

Surgical collapse of the lung has won an honoured place in the treatment of pulmonary tuberculosis and, in the form of thoracoplasty, is widely used. We are, however, very conscious of the drawbacks of this operation. No matter what the individual technique or aftercare, in a certain proportion of cases the collapse of the apex of the lung, which had seemed so perfect a week after operation, is found a few weeks later to be less complete, and cavities which had closed to have reopened in the re-expanding lung. The ordeal of multiple stages and the inevitable permanent deformity are, moreover, distasteful to the surgeon and to the patient alike, being acceptable only as a life-saving necessity.In the past, efforts have been made to overcome these defects by the use of plombage. The experience at that time of one of us (Morriston Davies, 1933, 1944 was not encouraging. Paraffin plombs had a tendency to lead to ulceration from surface cavities, or to produce tissue reaction leading to abscess formation necessitating the subsequent extraction of the foreign body. Living tissue grafts of breast and muscle failed because they were difficult to pack into the extrapleural space and, even when the immediate result was good, later shrank. Plombage, with fat from other parts of the body and lipomata, was equally unsatisfactory owing to the tendency to liquefy and disintegrate. Later extrapleural pneumothorax was tried and still has its advocates, as has the substitution of the air in the extrapleural space by oil.Since 1937 Semb has been advocating the extrafascial stripping of the lung from the mediastinum when doing a thoracoplasty. For a time this was hailed by some as a solution of the problem of re-expansion of the lung but not of the deformity. Still later Semb (1950) tried air refills of the " Semb space," and he and others (Edwards, 1949) have attempted many varieties of bone graft and suture to assist in maintaining the collapse of the lung and cavity. The quest for a solution of the two problems, the prevention of re-expansion and of deformity associated with a thoracoplasty, continues.In 1946 Wilson published his paper on the use of polymethyl methacrylate or lucite balls as an extrapleural plomb. This interested us as there was evidence that the balls did not irritate the tissues, and it seemed evident that they could be made to accommodate any size and shape of space. When, however, we obtained samples of these lucite balls we decided against their use. The very hardness and unresilient qualities of lucite, at any rate as spheres, seemed to us to constitute a danger. The insertion of an unyielding substance extrapleurally in apposition to the lung, with p on 11 May 2018 by guest. Protected by copyright.