Medroxyprogesterone on corneal ulceration. Its effects after alkali burns on rabbits

The effect of medroxyprogesterone acetate treatment in preventing or retarding corneal ulceration after alkali burns was studied in rabbits in an attempt to correlate dose and response. The eyes were treated for 21 days with a 0.01% or 1% suspension administered topically four times a day or medroxyprogesterone acetate, 4 mg or 30 mg, given subconjunctivally on alternate days. None of these regimens was noticeably effective, although at times there was a trend toward retarding ulceration. Thus, it was not possible to confirm earlier reports of substantial efficacy of medroxyprogesterone. Corneal stroma with epithelial defects and/or ulcers persistently showed infiltration with neutrophils in the superficial stroma within the epithelial defect, implicating the tears as the source of the inflammatory cells.

Heart rate response of fetal and adult sheep to hemorrhage stress

The responses of heart rate and blood pressure to hemorrhage of 15% of estimated blood volume were studied in 24 chronically instrumented fetal lambs of gestational ages 81-144 days (0.55-0.98 gestation) and 6 conscious adult nonpregnant ewes. A transient tachycardia of 25 +/- 3 beats/min (+ 15 +/- 2%) was noted in the fetuses after removal of about 5% blood volume and reduction of mean arterial pressure of 2 +/- 1 mmHg (8 +/- 2%). With 15% reduction of blood volume fetal mean arterial pressure fell 12 +/- 1 mmHg (27 +/- 2%), venous pressure fell from 3.5 +/- 0.5 to 2.0 +/- 0.5 mmHg, and heart rate dropped by 39 +/- 8 beats/min (22 +/- 4%). The fetal bradycardia during the hemorrhage period was reversed by atropine administration. In adult ewes, mean arterial pressure decreased 12 +/- 3 mmHg, venous pressure was unchanged but heart rate increased by 25 +/- 6 beats/min (29 +/- 8%). These studies indicate the presence of a functional baroreflex by 81 days (0.55 gestation).

A parents' group in the management of anorexia nervosa

Recent reports have suggested that family therapy is useful in the treatment of anorexia nervosa. There are, however, recognized contraindications to family therapy. As we were seeing patients with anorexia nervosa for whom family therapy was not possible, we predicted that the formation of a group for the parents would provide benefit through education, support and insight. The present study was designed to develop and evaluate such a group. We selected parents of ten anorectic patients for whom family therapy was contraindicated. There were two therapists, the unit social worker and a former patient who had successfully overcome the symptoms of anorexia nervosa. After an 18-month period, the ten couples were sent anonymous questionnaires assessing the group's value. Six indicated positive feelings about the group and felt they had benefited. One couple reported dissatisfaction. Most perceived the group as an important part of the overall treatment.

Diagnosis of haemobilia by duodenoscopy

A case of haemobilia due to liver abscess presenting as haematemesis and melaena is described. Duodenoscopy in the acute phase can distinguish haemobilia from other causes of upper gastrointestinal bleeding and is the first step towards accurate localization of the lesion by hepatic arteriography.

Prevention of stromal ulceration in the alkali-burned rabbit cornea by glued-on contact lens. Evidence for the role of polymorphonuclear leukocytes in collagen degradation

Stromal ulceration of the alkali-burned rabbit cornea was found to be associated invariably with phagocytically active polymorphonuclear leukocytes (PMNs). A glued-on methylmethacrylate lens applied to corneas soon after burning, however, prevented re-epithelialization and also prevented PMN infiltration of the stroma and stromal ulceration. Subsequent partial detachment or complete removal of the lens resulted in epithelial resurfacing of the stroma, PMN infiltration, and stromal ulceration. Glued-on lenses applied to already ulcerating corneas arrested further ulceration by prohibiting additional PMN infiltration. Either surface debridement or glued-on methylmethacrylate rings also prevented re-epithelialization and ulceration in stromas not infiltrated by PMNs, but neither treatment was sufficient to prevent ulceration in corneas already containing numerous PMNs. The data suggest the possibility that the epithelium stimulates infiltration of the stroma by PMNs which then participate in stromal matrix degradation. Although no claim is made that only PMNs mediate matrix destruction in corneal ulceration, the efficacy of the lens would seem to be due to exclusion of the epithelium and the consequent prevention of stromal infiltration by PMNs.

Effect of topical corticosteroids on ulceration in alkali-burned corneas

Dexamethasone sodium phosphate was administered topically to one eye of rabbits with bilateral alkali corneal burns, and saline solution was administered to the contralateral eye. Topical steroids were also administered in animals with moderate corneal ulcers and were found to enhance the severity of ulceration when given during the second and third weeks following the burn. If the corticosteroids were given daily in the first six days or in the fourth and fifth weeks following the burn, they did not have an adverse effect on the cornea. Corticosteroids can be used intensively during the first week following an alkali burn, without increasing the risk of corneal melting. The mechanism for the enhancement of corneal ulceration is not a direct augmentation of collagenase activity, but probably involves the inhibition of repair processes.

Trisomy 8 mosaicism syndrome. Report of monozygotic twins

Monozygotic twins were born with the phenotypical appearance of the trisomy 8 syndrome. The first twin, a stillborn, had autopsy findings suggestive of trisomy 8 syndrome. Cultured lymphocytes and skin fibroblasts of the second, liveborn twin, showed trisomy 8. While the lymphocyte culture showed 46/47, +8 mosaicism, with normal cells predominating, skin fibroblasts yielded only cells with trisomy 8. Bone marrow preparation showed only normal cells, 46,XY. Repeat lymphocyte culture at age 14 months, showed a reduced number of trisomy 8 cells. We would like to emphasize the importance of cytogenetic studies in early infancy, using both peripheral lymphocyte and skin fibroblast cultures, to increase the chance of detecting chromosomal abnormalities.

Ultrasonography of adrenal masses: usual features

Gray-scale B-scan was successful in delineating adrenal masses in 40 patients, all confirmed pathologically. Two patients with extra-adrenal pheochromocytomas, two calcified cysts, and two patients with bilateral adrenal hyperplasia are demonstrated. The usual ultrasonographic features are presented in this paper; they correlated well with urographic, angiographic, CT, and pathological findings. The smallest mass demonstrated was an aldosteronoma (1.3 cm in size).

Ultrasonography of adrenal masses: unusual manifestations

Forty patients with pathologically-proved adrenal masses, and two patients with extra-adrenal pheochromocytomas, were examined with gray scale B-scan. The authors describe unusual echo patterns of adrenal masses due to necrosis or hemorrhage, variations in the effects of large adrenal masses on surrounding organs and vessels, and the differential diagnosis. The complementary role of computed tomography is also discussed.

An evaluation of the role of the Doppler stethoscope and the testicular scan in the diagnosis of torsion of the spermatic cord

The spermatic cord of five dogs were twisted 720 degrees. The animals then underwent both Doppler and isotope evaluations of their scrotums. Both modalities proved highly accurate in diagnosing acute testicular ischemia.

Avoidable factors contributing to death after head injury

We reviewed 116 patients, known to have talked before dying after head injury, to discover factors which had contributed to death but which might have been avoided. All the patients were admitted to a neurosurgical unit and had a neuropathological post-mortem examination. One or more avoidable factors were identified in 86 patients (74%); an avoidable factor was judged certainly to have contributed to death in 63 patients (54%). The most common avoidable factor was delay in the treatment of an intracranial haematoma; others included poorly controlled epilepsy, meningitis, hypoxia, and hypotension. Changes in the management of patients with head injuries which reduce the incidence of avoidable factors should decrease mortality from this condition.

Regional categorization and quality of care in major trauma

A statewide evaluation of major inpatient trauma treatment was completed demonstrating the relationship of emergency medical service categorization and quality of trauma care. Demographic and organ injury data provided guidelines for preventive and medical education emphasizing the need for more practical sessions. The differences between the review process of primary care physicians and specialists was also discussed.

Long-term prognosis of mitral-valve prolapse

We examined the natural history of mitral-valve prolapse in 53 patients who had had a midsystolic click or late systolic murmur (or both) documented phonocardiographically a mean of 13.7 years earlier. Thirty-eight patients were alive without serious complications, and seven had died of unrelated causes. In two patients prolapse was implicated in the cause of death. Other complications were ventricular fibrillation in one patient and bacterial endocarditis in three. Progressive mitral regurgitation developed in five patients, requiring valve replacement in two. These complications occurred in a total of eight patients (15 per cent), and were significantly (P = 0.15) associated with a late systolic murmur rather than an isolated midsystolic click. Thus it appears that the diagnosis of mitral-valve prolapse should not be regarded as ominous; however, patients in whom this diagnosis is associated with a late systolic murmur should be followed carefully.

A double-blind comparison of meptazinol with placebo in postoperative pain

In a double-blind clinical trial, meptazinol (400-mg capsules) was shown to be significantly better than placebo in relieving postoperative pain in patients who had under gone total abdominal hysterectomy operations. Analgesic activity was assessed by patients rating their pain before and 1 hour after the administration of each treatment, by sequential analysis of patient and investigator preference for treatment, and by calculating the time interval between doses of the two treatments.