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.