Intestinal obstruction following previous myomectomy and the use of beta-sympathomimetics in pregnancy

Two cases of intestinal obstruction in pregnancy following previous myomectomy are reported. The use of tocolytic agents to suppress premature uterine contractions may be a predisposing factor and probably intensifies the obstruction. As the symptoms mimic the normal side-effects of pregnancy, the diagnosis is often delayed. Laparotomy was done, as initial conservative treatment was unsuccessful in both instances. A live baby was delivered in the first case, whilst the second case ended in an abortion.

Intraperitoneal haemorrhage from a ruptured corpus luteum. A cause of "acute abdomen" in women

During the 10-year period 1974-1983, 68 patients with intraperitoneal haemorrhage as a result of the rupture of a corpus luteum were managed at the University Hospital, Kuala Lumpur, Malaysia. Most of the patients were aged between 18 and 35 years. In 63% of the patients the rupture occurred between the 14th and the 35th day of the menstrual cycle, and 10 patients had intraperitoneal bleeding severe enough (450-1500 mL) to require blood transfusion. The condition is often confused with other surgical emergencies such as appendicitis and ectopic pregnancy. An increased awareness of the problem in women of reproductive age and the use of laparoscopy, when indicated, will allow a more conservative approach to be adopted for those patients with minimal bleeding. The performance of an appendicectomy in the presence of blood in the peritoneal cavity did not appear to increase morbidity in those patients with a preoperative diagnosis of "appendicitis".

Diffuse nonsecretory osteosclerotic myeloma with extensive erythrophagocytosis

A 51-year-old, black man presented with severe anemia and weakness. X-ray studies showed diffuse osteosclerosis involving most of his skeleton. He was documented to have similar bone changes on x-ray 5 years previously. Peripheral blood findings were suggestive of a myelophthisic anemia. Open biopsy of the iliac bone showed osteosclerotic myeloma. Secretion of abnormal protein could not be demonstrated through many examination of serum or urine. A unique finding at the autopsy was the presence of extensive erythrophagocytosis by the neoplastic plasma cells and macrophages.

Steroid modulation of response of plasma bicarbonate concentration to NH4Cl loading: gamma distribution analysis

Studies have been carried out in awake chronically cannulated adrenalectomized rats subjected to steroid replacement protocols. Our objective was to determine the effects of mineralocorticoid or glucocorticoid or combined replacement on acid-base composition of the extracellular fluid compartment in response to an acute ammonium chloride acid load. We obtained six blood samples from each animal over a 26-h period and, with the help of a specially derived mathematical model, we were able to obtain a continuous dynamic assessment of changes of plasma bicarbonate concentration during induction and recovery of the metabolic acidosis. Assessment of minimum values for plasma bicarbonate concentration, time to reach the minima, and time for 90% recovery showed that dexamethasone did not exert as much protection as aldosterone. The approach we have used, in a sense being a continuous display of plasma bicarbonate concentration, should be useful in further exploring the nature of the interrelations between acid production, net acid excretion, and the resultant plasma acid-base composition.

The brief alcoholism rating scale: a new test for diagnosing

A new scale, comprising 100 criteria based on medical history, physical examination and routine laboratory data, independent of a drinking history, can help physicians in the detection, diagnosis and early treatment of alcoholism. The scale also permits objective classification of alcoholism into mild, moderate and severe categories and overcomes the patient's denial-a major obstacle to early diagnosis. Results suggest that the instrument is accurate: 94% of patients were classified correctly by the scale. Further validation studies in clinical practice are necessary.

Influence of alcohol and tobacco use on sodium thiopental requirements in general anesthesia: a retrospective study of 700 patients

Hospital charts of 700 patients who had undergone upper gastrointestinal surgery were reviewed to examine the relationship between alcohol abuse and dose of intravenous sodium thiopental (Pentothal) required to induce general anesthesia. Patients who required a high sodium thiopental dose (greater than 6.08 mg/kg) exhibited a higher incidence of alcoholism, heavy drinking, and heavy smoking, compared to patients who required low sodium thiopental dose (greater than 3.42 mg/kg and less than 4.75 mg/kg). Alcoholics and heavy drinkers, the majority of whom were heavy smokers, required a greater mean sodium thiopental dose than heavy smokers who were neither alcoholics nor heavy drinkers. Possible future research into the apparent cross tolerance between alcohol and sodium thiopental is discussed, particularly the possibility that the family physician may be able to use sodium thiopental dose requirement as a marker for early detection and diagnosis of alcoholism.

Loop of Henle bicarbonate accumulation in vivo in the rat

We have carried out perfusion studies on hydropenic and bicarbonate-loaded rats to provide direct in vivo observations on bicarbonate accumulation in the short loops of Henle. Analysis of early distal tubular fluid was made during bicarbonate-free saline perfusion from the end proximal to the early distal site, documenting accumulation of "new" bicarbonate. During perfusion in hydropenic rats, steady-state bicarbonate concentrations were suggested by early distal values of approximately equal to mM, which were independent of perfusion rate and virtually indistinguishable from bicarbonate concentration measured during free flow when filtered bicarbonate was allowed to enter the loop. Thus, loop bicarconate accumulation was apparently sufficient to allow new bicarbonate to enter at a rate comparable to that delivered to the early distal site during free flow, recognizing of course that free-flow delivery rates are the result of complex components of filtration and bidirectional fluxes. In bicarbonate-loaded rats, however, bicarbonate accumulation rates although higher than in hydropenia, were much lower than free-flow delivery rates. Furthermore, early distal bicarbonate concentrations during bicarbonate loading fell as perfusion rate increased, presumably because of a limitation to increasing ionic bicarbonate entry.

Statistical models for renal micropuncture studies

Statistical issues relating to data analysis of re-collection micropuncture experiments are presented. In the presence of significant animal-treatment interaction, namely, differential response of each animal at different levels of the treatment, the conventional paired or unpaired t testing would not be entirely appropriate. Accordingly, two analysis of variance (ANOVA) models have been derived for the appropriate paired and unpaired designs of micropuncture experiments. Interactive computer programs have been written for both these analyses, and the results are illustrated with experimental data. An example is presented in which the results are statistically significant with paired t testing and by analysis of variance for unequal number of tubules but not when the animal-treatment interaction is included in the analysis of variance model. To investigate linkage in renal transport mechanisms, we propose the use of partial correlation analysis. Experimental results from our laboratory are used to illustrate these techniques.

Specific active immunochemotherapy in lung cancer: a survival study

A radomized clinical trial of chemotherapy, immunization and immunochemotherapy among 55 patients with stages I and II carcinoma of the lung is reported. The survival rate in the immunized groups was significantly better (P = 0.001) than that in the nonimmunized groups. The results are discussed in the light of the reactivity of the patients to the specific cancer antigen.