The effect of pre-anaesthetic fasting on blood glucose level in children undergoing surgery

Blood glucose concentrations were measured in 104 children aged 6 months- 10 years (mean 3.1 years) undergoing inpatient anaesthesia. The mean fasting period was 10.87 +/- 2.68 hours. Mean preanaesthetic and 1/2 hour post-anaesthetic blood glucose levels were 4.8 +/- 0.8 and 6.1 +/- 1.9 mmoles/L respectively. Pre- anaesthetic low blood glucose level (2.7-3.3 mmoles/L) could only be detected in 3.8% cases. Post-anaesthetic increase in blood glucose level was the same as reported in adults.

Laser action from 2,6,8-position trisubstituted 1,3,5,7-tetramethylpyrromethene-BF(2) complexes: part 1

Of the four new pyrromethene derivatives studied, 1,3,5,7,8-pentamethyl-2,6-diethylpyrromethene-BF(2) complex lased ~3 times more efficiently than rhodamine 560 under flashlamp excitation.

Immediate exposed skin grafting in children's burns

The technique of immediate exposed skin grafting following early tangential excision of burns in children overcomes the difficulties of applying dressings with the attendant risk of graft loss from shearing forces. We report on 36 patients treated by this method. Wound healing was achieved in all patients without the need for further surgery.

Chronic postoperative endophthalmitis from Staphylococcus aureus

We recently treated a patient with chronic postoperative endophthalmitis caused by Staphylococcus aureus, which usually presents with a fulminant clinical course. Because of the chronic course, the initial treatment was high dose steroids followed by lensectomy and vitrectomy. However, this was not effective, and intravitreal antibiotics and steroids were ultimately required. We now recommend that in patients with chronic postoperative inflammation unresponsive to high dose steroids, intraocular cultures followed by injection of intraocular antibiotics be considered.

Polyethylene glycol-electrolyte solution for rectal sunflower seed bezoar

We describe the successful use of polyethylene glycoelectrolyte solution (Golytely) in the management of a child who developed a rectal phytobezoar after ingestion of unshelled sunflower seeds. A brief review of the literature regarding the management of rectal phytobezoar is discussed.

Relationship between socio-demographic and behaviour variables, and body mass index in a population with high-normal blood pressure: Hypertension Prevention Trial

The relationship between socio-demographic and behaviour variables and body mass index (BMI: weight/height2) adjusted for age were studied in a population with high-normal blood pressure who participated in the Hypertension Prevention Trial. The BMI of the participants ranged from 19.1 to 35.1 kg/m2 in men and from 16.0 to 35.1 kg/m2 in women. The prevalence of obesity (BMI greater than or equal to 25.0 kg/m2) was 77 per cent in men and 61 per cent in women, with prevalence of severe obesity (BMI greater than or equal to 30.0 kg/m2) being 23 per cent and 19 per cent respectively. Stepwise regression was carried out to identify the most important correlates of BMI. In men, they were family income (+), occupation (-), leisure time exercise frequency (-), number of meals eaten out (-), alcohol intake (-), smoking (-), caffeinated drink intake (+), and meal planner. Men who planned meals with their partners had a higher BMI than men who planned their own meals or had someone else plan their meals. Correlates of little importance were marital status, race, education, number of members in household, energy intake, percentage of total calories from fat, occupation activity level, and vitamin/mineral supplement intake. In women the most important correlates of BMI were alcohol intake (-), caffeinated drink intake (+), and race. Black women had a higher mean BMI than white women. The important socio-demographic and behaviour variables in both men and women accounted for about 20 per cent of the variance in BMI which leaves about 80 per cent of the variation unexplained. This indicates the presence of other factor(s) which may be determining body weight.

Focal xanthogranulomatous pyelonephritis simulating a renal tumor: CT characteristics

Xanthogranulomatous pyelonephritis is the replacement of renal parenchyma by large lipid-filled macrophages clinically associated with an enlarged, nonfunctioning kidney containing a calculus in the diffuse form or tissue destruction in one pole of a duplicated kidney associated with a calculus in the focal form. We report a case where a focal mass in a functioning kidney with no evidence of calculus, duplication, or fat density simulated a primary renal tumor.

Mucin histochemistry of the lower gastrointestinal tract

Variations in the mucin secretion pattern in the mucosal lining of the colon and rectum have been studied. Mucins have been differentiated histochemically as neutral mucins, sialomucins and sulphomucins, using alcian blue/PAS and HID/alcian blue techniques. In the normal colonic mucosa, the goblet cells secrete predominantly sulphomucins with small amounts of sialomucins. Twenty one cases with benign lesions showed varying patterns of mucin secretion. In the 35 cases with adenocarcinoma studied, the transitional mucosa adjacent to the lesion showed a reversal of mucin secretion pattern, with an increase in sialomucins and a marked decrease in sulphomucins, suggesting a reaction to neoplasia.

Mucin histochemistry of the upper gastrointestinal tract

Histochemically differentiated mucins have been studied in the mucosal lining of the esophagus and the stomach. Acid mucin was differentiated from neutral mucin by the alcian blue/PAS technique and sulphomucin by the high iron diamine/alcian blue technique. Neutral mucin secreted normally by the stomach mucosa was replaced by acid mucin in 17 of the 19 mucin secreting adenocarcinomas involving the lower third of the esophagus, and in 24 of the 28 mucin secreting gastric adenocarcinomas studied. The intestinal metaplasia (IM) seen in the gastric mucosa associated with adenocarcinoma, chronic gastric ulcer and chronic gastritis was classified according to the type of mucin secreted by the goblet cells. IM secreting sulphomucins was seen to be associated with gastric adenocarcinoma.

Acute inflammatory demyelinating polyradiculoneuropathy presenting as complete heart block and Stoke-Adams attacks

A patient with acute inflammatory demyelinating polyradiculoneuropathy (AIDP, Guillain-Barré syndrome) whose presenting complaints were related to autonomic dysfunction in the form of parasympathetic and sympathetic overactivity is reported. Parasympathetic overactivity was severe enough to cause complete atrioventricular block (atropine-responsive) and Stoke-Adams attacks, for which a demand pacemaker was required. Limb weakness was apparent 48 hours later. To our knowledge no such presentation of AIDP has been previously recorded.

Lectin binding in colorectal mucosa

Lectin binding of goblet cell mucin in human colonic mucosa was studied in patients with irritable bowel syndrome, colorectal malignancy and ulcerative colitis using plant lectins, Dolichos biflorus agglutinin (DBA) and peanut agglutinin (PNA). Normal colonic mucosa demonstrated a strong binding with DBA (100%) but did not bind to PNA at all. Colonic carcinomas showed strong PNA binding (7 of 15 biopsies) while DBA binding was absent in 14 of 15 biopsies. The transitional mucosa showed reduced or absent DBA binding in 6 and positive PNA binding in 2 of 15 biopsies. During the active phase of ulcerative colitis, there was a loss of DBA binding in 10 of 15 biopsies, which was restored during remission in all. One biopsy with severe dysplasia showed PNA binding. It is concluded that normal colorectal mucosa binds DBA strongly but not PNA. Malignant tissue and transitional mucosa reveal PNA binding often, with decreased DBA binding. In ulcerative colitis DBA binding decreases during phases of activity.

Lower metabolic rates of post-obese versus lean women: thermogenesis, basal metabolic rate and genetics

Components of daily metabolic rate (thermogenesis, BMR and net exercise) were compared between 16 women predisposed to obesity (post-obese) and 16 naturally lean controls of matching age, weight and height, at three levels of activity, in a whole-body respirometer. At all levels of activity, the mean metabolic rate of the post-obese was 15 per cent lower than that of the lean controls. Expenditure on net exercise showed the same relationship, but BMR was only 10 per cent lower, while thermogenesis was 50 per cent lower. The latter was partly due to the smaller food intake of the post-obese and also to a lower thermogenic response. In absolute terms BMR accounted for less than half of the difference in total energy expenditure between the post-obese and the lean (45 per cent). Thermogenesis accounted for approximately 40 per cent of the difference, and 15 per cent after adjusting for the different energy intakes. Significantly more post-obese subjects had a family history of obesity (88 per cent) than lean subjects (38 per cent). Within the post-obese and lean groups there was a consistent trend at each level of activity for those with a family history to have lower metabolic rates, indicating that family history of obesity has an influence on energy expenditure over and above personal history of obesity.

Development of human palmar and digital flexion creases

To determine the timing of the development of the various palmar and digital creases, we examined the hands of 100 human fetuses obtained after therapeutic abortion. The fetuses ranged in age from 7 to 19 fetal weeks, with age being established by menstrual period dates and ultrasound examination before termination. Our observations show that palmar and digital creases develop between 8 and 13 fetal weeks. Digital creases are well defined by 10 weeks; palmar creases are consistently seen by 13 weeks of gestation. The volar pads are present from 8 to 14 fetal weeks. A hand malformation or specific insult that occurs before the time of crease development and that alters the form or function of the fetal hand can cause secondary alterations increase patterns of the hand.

Metabolic rate during and after aerobic exercise in post-obese and lean women

The effect of aerobic exercise (cycling on bicycle ergometer for four 10-min periods/60-80 per cent max VO2) on energy expenditure following the activity was investigated in 16 post-obese and 16 lean control women over 24 h and shorter periods. In addition, net energy expenditure during aerobic exercise was compared to that during prolonged mild activity (stepping for four 30-min periods at 12 steps/min). The measurements were made in a room respirometer. Aerobic exercise did not significantly stimulate the 24-h resting metabolic rate of either the post-obese (3 per cent, 50 kcal) or lean controls (2 per cent, 30 kcal), nor was there any significant stimulation over shorter periods: during waking hours RMR was non-significantly increased by 5 per cent in both the post-obese and lean controls. Sleeping expenditure remained the same in the post-obese and was decreased by 2 per cent in the lean controls. All subjects found the aerobic exercise to be quite uncomfortable, yet in both groups the net cost was smaller than that of prolonged mild exercise which was found to be acceptable (post-obese: aerobic 180 kcal, mild 250 kcal; lean controls: 220 kcal, 290 kcal). It is suggested that prolonged mild activity (eg, as in walking frequently) is more appropriate in increasing energy expenditure as a means of preventing or controlling obesity. Total expenditure at each level of activity is also expressed as multiples of BMR calculated from FAO/WHO/UNU (1985) prediction equations and from measured sleep values. The results show that the equations overestimated BMR in the post-obese.

The daily metabolic rate of the post-obese and the lean

Daily metabolic rates of 16 post-obese women and 16 matched, lean controls were measured at three different levels of activity in a room respirometer. Both groups had similar height, weight, age, and other anthropometric indices. Results show that the post-obese have metabolic rates approximately 15% lower than their controls at any level of activity. They also eat less. Slimmed-down, obese women have a normal body composition. For both groups, aerobic exercise did not have a prolonged stimulatory effect on metabolic rate after the exercise had finished. Mild exercise was more effective than aerobic exercise in increasing daily metabolic rate because it could be comfortably sustained for a longer time. Implications of these findings are discussed in relation to the etiology and treatment of obesity.

Graft versus host-like illness in a child with phenobarbital hypersensitivity

A child in whom a phenobarbital hypersensitivity drug reaction developed which consisted of fever, a pruritic desquamating erythrodermic rash, alopecia, icterus, protein-losing enteropathy, myositis, and nephritis, is described. Laboratory studies demonstrated eosinophilia, elevated serum IgE, and elevated T suppressor/cytotoxic cells in the peripheral blood. Findings from biopsy specimens of skin and jejunum suggested a cell-mediated pathogenesis, and lymphoproliferative studies of the patient's mononuclear cells revealed a positive response to phenobarbital. The clinical findings and laboratory studies suggested an autoimmune cell-mediated hypersensitivity reaction triggered by phenobarbital.

Effect of premedication with diazepam, morphine or nalbuphine on gastrointestinal motility after surgery

Premedication with nalbuphine and morphine delayed gastric emptying in the period after operation, but oral diazepam did not. All three drugs delayed co-ordinated intestinal motility, although nalbuphine did so for less than half as long as morphine. This property of nalbuphine, if confirmed, could make it a valuable analgesic drug in the period after operation.

Callosal syndrome: implications for understanding the neuropsychology of stroke

A case is presented of callosal syndrome following cerebral hemorrhage and amphetamine abuse in a 26-year-old right-handed man. There were few hemispheric findings but a full callosal syndrome including left apraxia to verbal commands, left tactile anomia, left agraphia, right constructional apraxia, failure of blindfolded side-to-side hand replication and form-board testing showing loss of interhemispheric transmission including intermanual interference. The "draw-a-clock" test showed left inattention when drawn with the right hand but not the left, and perseveration was noted for spatial tasks done with the right hand and symbolic tasks done with the left. The patient recovered functionally almost completely but testing demonstrated continued loss of interhemispheric transmission. The case is considered of most interest for its potential in explaining phenomena observed in severe unilateral hemispheric lesions. Our findings suggest that perseveration is not a dysfunction of the damaged portion of the brain, but a phenomenon associated with intact brain attempting unfamiliar tasks. The persistence of left hemi-inattention is attributed to the inability of the left hemisphere to utilize spatial information to compensate for the phenomenon of inattention. Left-sided dyskinesia following left hemisphere lesions was attributed to the lack of symbolic information necessary to perform some movements. Dysprosody was attributed to lack of tonal information to the left hemisphere. Recovery of function following severe unilateral lesions may be largely due to compensatory learning by the intact hemisphere and assertion of ipsilateral control. As our patient originally assumed an inverted left-handed writing posture, we assume the posture is controlled by the right hemisphere.(ABSTRACT TRUNCATED AT 250 WORDS)

Chronic liposome administration in mice: effects on reticuloendothelial function and tissue distribution

Liposomes have a pronounced tendency to localize in the reticuloendothelial (RE) system, a major host defense system. We have examined, in mice, the effect of chronic i.v. administration of low to moderate liposome doses on drug metabolism, phagocytic index and spleen and liver size. Little effect on the rate of pentobarbital metabolism was noted, except when mice received 80 mg/kg of sphingomyelin-containing liposomes in a series of 10 injections over 3.5 weeks. Impairment of RE phagocytic function was found to be related to liposome size and composition, size and frequency of liposome dose and the presence of lipid peroxides. The effects on tissue distribution of liposome-entrapped [14C]sucrose was also determined in mice receiving chronic liposome injections. In RE blockaded mice there was a consistent trend in favor of decreased liver uptake and increased spleen uptake. No significant uptake of liposome contents was seen in non-RE tissues even in mice with severe RE blockade, indicating that the induction of RE blockade by predosing with empty liposomes may not be a successful strategy for increasing liposome uptake to non-RE tissues. Liver to spleen ratios of [14C]sucrose appeared to be a sensitive method for quantitating RE blockade. Sphingomyelin-containing liposomes produced the greatest RE blockade, distearoylphosphatidylcholine-cholesterol liposomes were intermediate and egg phosphatidylcholine-cholesterol liposomes produced the least impairment in RE function. Liposomes which contained 1% vitamin E as an antioxidant had slightly less effect on RE function than liposomes not containing vitamin E.(ABSTRACT TRUNCATED AT 250 WORDS)

The efficacy of face masks

Photographs of smoke particles expelled by coughing showed that the filtration type of face mask effectively prevents them from spreading far from the wearer.

Plasma fibrinopeptide A and beta-thromboglobulin in pre-eclampsia and pregnancy hypertension

Increased plasma levels of beta-thromboglobulin (beta TG) and fibrinopeptide A (FPA), markers of platelet release and thrombin generation respectively, were measured in normal women, women taking oral contraceptives, normal pregnancy and pregnant women with hypertension or pre-eclampsia. No significant increases in beta TG or FPA were found in women taking oral contraceptives. Significantly increased concentrations of beta TG, but not FPA, were found in normal pregnant women in the second and third trimester of pregnancy when compared with non-pregnant age-matched controls. In eleven women with pregnancy hypertension and thirteen women with pre-eclampsia significantly elevated levels of both beta TG and FPA were found when compared with age, parity and gestation-matched pregnant controls. Although the mean value for both beta TG and FPA in the group with pre-eclampsia was higher than the group with pregnancy hypertension, the difference was not statistically significant. These findings provide additional evidence that pre-eclampsia and pregnancy hypertension are associated with activation of the coagulation system and the platelet release reaction.

Clinico-chemical changes in goats given carbon tetrachloride

Six healthy castrated male goats were each given 1.0, 1.25 or 1.5 ml of carbon tetrachloride per 10 kg BW by stomach tube (2 animals at each dose level). Definite signs of dose dependant liver damage were seen, starting about 4 hours after administration of the drug. The clinico-chemical changes included increased total and conjugated plasma bilirubin, decreased blood clotting activity, and increased activities of P-ASAT and P-GT. Further experiments are needed in animals afflicted with liverflukes to establish the lowest possible anthelmintic dose of carbon tetrachloride.

Changing patterns of Staphylococcus aureus bacteremia

Medical records of 134 patients with Staphylococcus aureus bacteremia at the Cincinnati General Hospital during 1975-1977 were reviewed. Bacteremia was community-acquired in 48 patients and hospital-acquired in 73 patients. In addition, 13 patients were on chronic hemodialysis. In 22 patients, bacteremia was associated with an infected intravenous catheter; all except one of these patients acquired the infection in the hospital. Thus 21 of 73 (29%) episodes of hospital-acquired S aureus bacteremia were associated with an infected intravenous catheter. Four of the 22 patients with intravenous catheter-associated bacteremia had endocarditis (18%). The overall incidence of endocarditis in this study was 16% (21 of 134 patients). This contrasted with the much higher incidence of endocarditis (64%) in Staphylococcal bacteremia reported from this same hospital in patients during 1940-1954. Possible reasons for this difference are discussed.

Factor VIII Related Antigen-Activity Differences in Intrauterine Growth Retardation

Haemostatic values, hormone and uric acid levels were determined in women during pregnancies suspected of growth retardation, and compared with normal pregnancies. Nine of the 21 suspect pregnancies resulted in a small baby, below the 10th weight percentile. Platelet count, fibrinogen, soluble fibrin complexes and fibrinogen degradation product values were not significantly different between the normal and growth retarded group. In normal pregnancies. F VIII related antigen (VIII RAg) and clotting activity (VIII C) increased with gestation up to 36 weeks, with antigen about 20% higher than activity. In mothers who delivered growth retarded babies the VIII RAg minus VIII C difference (or VIII RAg/VIII C ratio) was significantly greater. Seven of the nine mothers who delivered small babies had a VIII RAg-VIII C different greater than 125% (VIII RAg/VIIIC ratio greater than 1. 75), while only one of the 12 mothers who delivered normal weight babies had this difference. Serum prolactin, oestriol or uric acid levels provided no further means of distinguishing between the two groups. The VIII RAg/VHI C ratio appears to be the single best test for distinguishing growth retarded babies from normals in a clinically suspect group.

The effects of expiratory positive airway pressure on functional residual capacity in normal subjects

Functional residual capacity (FRC) was determined by constant volume, whole body plethysmography in seven normal subjects under resting conditions and following the addition of increasing levels of expiratory positive airway pressure (EPAP). There was a significant increase in FRC in six of the seven subjects studied. Grouped data showed a progressive increase in FRC with increasing EPAP (p less than 0.01). The highest level of EPAP (15 cm H2O) was associated with a 20% increase in FRC. We have been able to confirm that EPAP provides a simple and effective method of increasing FRC which could be applied to the treatment of conditions characterized by temporary and reversible reduction in lung volume.

Staphylococcus aureus sternal osteomyelitis complicating bone marrow aspiration

This case of S aureus sternal osteomyelitis occurring at the site of bone marrow aspiration in a 24 year-old man illustrates the potential for infection that complicates any clinical procedure, even those considered to have a very minimal risk of infection. The patient recovered uneventfully after antibiotic therapy with nafcillin administered intravenously, followed by dicloxacillin taken orally.

[Classification of intracerebral hematoma (lateral type) on C.T. and its relation to the shift of the lenticulostriate arteries (author's transl)]

Classification of intracerebral hematoma (lateral type) with C.T. was tried. And also, the relationship among the location of the hematoma, the shift of the lenticulostriate arteries and the prognosis of hemiparesis was verified. The results were as follows; 1) The location of the hematoma was classified into four types: 1. anterior type (the hematoma mainly located in the anterior limb of internal capsula). 2. Posterior type (the hematoma mainly located in the posterior limb of internal capsula). 3. lateral type (the hematoma mainly located just below the insula). 4. spread to the all direction type. 2) The lenticulostriate arteries was divided into three portions: L1 portion is the part from the origin at the middle cerebral artery to the knee point, L3 is the part of the distal portion of the lenticulostriate arteries, and L2 portion in the part between L1 and L3 portions. L1 portion was mainly shifted medially in the anterior type of the hematoma. L2 portion was mainly shifted medially in the lateral type of the hematoma. L3 portion was mainly shifted in the posterior type of the hematoma. L1, L2, L3, all portions were shifted medially in the type in which the hematoma spread to all directions 3) The prognosis of the hemiparesis was best in the lateral type of the hematoma, and next in the anterior type. In the posterior type and all spread type, it was worst.

Management of spontaneous pneumothorax using a Heimlich flutter valve

Intrapleural evacuation of air was achieved with a Heimlich flutter (non-return) valve in 16 patients with a total of 18 pneumothoraces, 17 of which were spontaneous. Complete lung expansion occurred in 17 (94·4%) of these episodes by five days, and 12 (66%) showed full expansion within one hour. Valve blockage occurred in one patient whose pneumothorax was associated with exudation through the intrapleural catheter and standard under water drainage is recommended in this situation or where there is effusion.

The flutter valve precludes the need for the cumbersome apparatus of under water seal drainage and therefore avoids the well-known possible dangers of connecting an intrapleural catheter to a water trap. Another advantage is the immediate mobility of the patient.