Alcoholic ketosis

We prospectively studied 23 episodes of suspected alcoholic ketosis in order to learn whether there was objective evidence of the patients having stopped drinking ethanol a few days before admission, and of being starved. Eight patients had moderate ketosis (plasma 3-hydroxybutyrate 4.1-7.8 mmol/liter); seven patients had mild ketosis (2-4 mmol/liter); and eight had little or no ketosis (less than 2 mmol/liter). The latter eight patients had mainly lactic acidosis (plasma lactate 2.0-13.3 mmol/liter). Most of the ketotic patients did not have ethanol detected in their blood. The presence of starvation was supported by the finding of subnormal plasma triiodothyronine levels (less than 90 micrograms/dl) in six of seven ketotic patients (average 60 micrograms/dl for all seven). The ketotic patients usually had low-normal plasma insulin levels (3- 16 microU/ml), as is common in starvation. Our findings support the previously undocumented belief that most patients with alcoholic ketosis did stop drinking ethanol some time before admission, and that starvation is a major pathogenetic factor in the disorder.

Plasma lactate and 3-hydroxybutyrate levels in patients with acute ethanol intoxication

In order to assess the frequency and severity of lactic acidosis and 3-hydroxybutyric acidosis in ethanol abusers, 29 patients who presented to an emergency room with acute intoxication were tested. Most were also chronic ethanol abusers but were not otherwise seriously ill. Their serum ethanol concentrations averaged 226.5 +/- 94.8 mg/dl (range 98 to 426 mg/dl). In 20 patients, the plasma lactate level was elevated only mildly or not at all (1.1 to 3.0 mmol/liter). Seven patients had plasma lactate levels between 3.5 and 4.3 mmol/liter, and only two patients had moderately elevated levels, 5.1 and 8.7 mmol/liter. Thus, severe lactic acidosis was uncommon in these ethanol-intoxicated patients. Only two patients had even trivially elevated plasma levels of 3-hydroxybutyrate, 1.0 and 1.2 mmol/liter. Thus, these patients did not have unrecognized "alcoholic ketosis" manifested mainly as 3-hydroxybutyric acidosis. An unexpected and unexplained finding was the presence of hyperchloremia in 10 of the 29 patients, with serum chloride levels of more than 110 mmol/liter.

Pregnancy following kidney transplantation

Following kidney transplantation, 20 women gave birth to 24 infants after the 28th gestational week. All babies were singletons, alive, and free from malformations. The mean weight was 2,595 g (range 1,420-3,200 g) and the mean gestational age was 37.8 weeks (range 32-40 weeks). The cesarean section rate was 75%. On dividing the patients into low- and high-risk groups, the rate of pre-eclampsia, prematurity, and intra-uterine growth retardation was 2-3 times as high in the high-risk as in the low-risk group. No patients experienced graft rejection during the pregnancy but, within 3 months after delivery, two rejection episodes occurred. Later, a further 5 patients experienced graft rejection. All infants developed normally. We conclude that pregnancy following renal transplantation generally has a normal outcome and that the function of the transplanted kidney is unaffected by the pregnancy.

Bilateral malignant Brenner tumor. A light and electron microscopic study

A case of bilateral malignant Brenner tumor of the ovary in a 43-year-old woman was studied by light- and electron microscopy. The morphologic criteria of this rare lesion are discussed and the pertinent literature reviewed.

Serum morphine levels in cats during dorsal horn neuron suppression by spinally administered morphine

The degree of serum uptake of morphine following spinal morphine administration was measured in cats. Total serum morphine levels (free plus conjugated) were determined during suppression of noxiously evoked wide dynamic range neuron activity by spinally administered morphine and compared with total serum morphine levels following i.v. administration of similar doses. The serum levels at 30 minutes after spinal application of morphine (a time at which there was significant suppression of noxiously evoked neuronal activity) were low; after 0.1 and 0.25 mg the levels were 6.5 (n=6) and 12.5 (n=5) ng/ml respectively. In contrast, intravenous administration of the same doses (0.1 and 0.25 mg) produced levels at 30 minutes of 24 and 36 ng/ml respectively, while an intravenous dose commonly used in earlier neurophysiologic studies (2 mg/kg) produced serum levels in excess of 400 ng/ml. These results indicate that although there is systemic uptake following spinal administration of morphine, the serum levels achieved are much lower than those following intravenous administration of a comparable dose, and are insufficient to explain the resultant suppression of wide dynamic range neurons.

Major adverse reactions during desipramine treatment: relationship to plasma drug concentrations, concomitant antipsychotic treatment, and patient characteristics

Major adverse reactions interrupting drug therapy during treatment of 84 patients with desipramine hydrochloride were studied to determine their relationship to desipramine plasma concentrations and other clinical variables. The frequency of adverse reactions was higher in patients over 60 years old (39%), and in patients also receiving antipsychotic medications (32%), but low in patients under 60 years old (7%). Desipramine plasma concentrations in patients having side effects did not differ significantly from those in patients without side effects. Steady state desipramine plasma concentrations did not increase with age. Symptomatic orthostatic hypotension, the most common side effect encountered, occurred early in treatment at low desipramine plasma concentrations. Other side effects, usually described as anticholinergic, occurred exclusively in the 34 patients receiving both desipramine and antipsychotic drugs. The concentration of 2-hydroxy-desipramine, the total concentration of 2-hydroxy-desipramine and desipramine, and the ratio of 2-hydroxy-desipramine to desipramine were not higher in 11 patients having side effects than in a comparison group without side effects.

The use of lisuride, a potent dopamine and serotonin agonist, in the treatment of progressive supranuclear palsy

Seven patients with progressive supranuclear palsy were treated with lisuride. Mean age was 62 years (range, 52 to 68 years), and duration of disease was 4.4 years (range, 1 to 7 years). All seven had been treated with levodopa/carbidopa and three with bromocriptine; four had, at one time, shown a partial response to levodopa. One patient had also shown a partial response to bromocriptine. Lisuride was used alone in four patients, and combined with levodopa/carbidopa in three patients. Mean dose of lisuride was 2.5 mg (range, 1.5 to 5.0 mg). Mean duration of treatment was 4 months (range, 1 to 10 months). While two patients showed a reduction in rigidity, one in tremor and two in bradykinesia, in only one of them was there an overall improvement. It is postulated that the relative lack of response to lisuride may be due to a loss of both the dopaminergic and serotonergic receptors in progressive supranuclear palsy.

Occurrence of the release reaction during preparation and storage of platelet concentrates

To determine the degree of damage occurring during preparation and storage of platelet concentrates, the percent release of B-thromboglobulin (BTG) and percent leakage of the cytosolic protein lactic dehydrogenase was determined sequentially from phlebotomy to the end of storage for 72 h at 20-24 degrees C. The effect of storage temperature, pH, and radiation was also evaluated. The results showed that during preparation of platelet concentrate a large degree of release was found after resuspension of the platelet button formed after the high-speed centrifugation. During storage the percent BTG release increased from 18.1 to 40.2% (p less than 0.05). The percent release seen during storage at 4 degrees C (72 h) was 19.2%, while that seen for platelets subjected to temperature cycling at 4-37 degrees C was 24.9%. Both of these values were significantly less (p less than 0.05) than that seen for concentrates stored at room temperature. A negative correlation between pH and BTG release was found (r = -0.64). Irradiation to 10,000 rad did not induce the release reaction or lactic dehydrogenase leakage. We conclude that the degree of in vitro platelet release is dependent on the preparative manipulations, and gentler protocols for preparation and storage of platelets should be investigated.

Uterine cellular stromal infiltration. A diagnostic problem

Extreme pleomorphic stromal cellular infiltration of the cervix and the corpus uteri was demonstrated by curettage in a 29-year-old woman with menorrhagia. The histological classification was not decisive and a hysterectomy was performed. The histological picture may be compatible with a malignant disease such as a stromal sarcoma or a lymphoma of Hodgkin or non-Hodgkin type, or with an inflammatory or immunologic disease. The clinical course, however, indicates a benign disease.

[Studies on the effect of phosphoric phenyl ester diamide as inhibitor of the rumen urease of dairy cows. 1. Influence on urea hydrolysis, ammonia release and fermentation in the rumen]

An amount of 0, 0.1, 0.5 and 1.0% (related to N) of phosphoric phenyl ester diamide (PPD) effective as urease blocking substance was applied to the surface of urea with oilbitumen and fed to cows with rumen cannulae over a period of 31 resp. 164 ... 167 days. (The ration essentially consisted of 4.5 kg dried roughage and 1.5 kg starch or 1.1 kg starch plus 0.4 kg sugar and contained 50 g urea). By treating the urea with PPD, the activity of urease, the hydrolysis rate of urea and the NH3-concentration in the rumen were significantly diminished 0.5 to 2 hours after feeding (alpha = 0.05). The effect of PPD was greatest in the first days and decreased with the advancing feeding period. In the variant with 0.5% PPD the examined parameters were significantly reduced after 142 to 164 days, too. This effect remained traceable in its diminished form even after the preparation was discontinued over a period of 35 days. The dynamics of the NH3-concentration was not altered by PPD after a longer feeding period. One can conclude that PPD inhibits the hydrolysis of urea but does not retard it. In conclusion one can say that, because of PPD, the toxicity of urea is lower without the utilisation of urea being better. Due to PPD the molar propionate level in volatile fatty acids decreases significantly and the acetate-propionate relation is expanded.

Seizures and intraventricular conduction defect in propranolol poisoning. A report of two cases

We have recently seen two cases of propranolol poisoning. In both instances, plasma propranolol levels were elevated. Both patients experienced generalized seizures and had a transient intraventricular conduction defect on electrocardiogram. The literature on intoxication of propranolol and other beta-adrenoceptor blocking drugs suggests that the effects of massive propranolol intoxication observed in our patients can be explained on the basis of the pharmacologic properties of propranolol. Therapy consisted of gastric lavage and agents to antagonize the beta-adrenoceptor blockade effect. Both patients recovered.

[The suitability of the general evaluation of pupils in their report books for the prediction of their cooperation as orthodontic patients]

The author reports studies in which the ratings in the markbooks prior to orthodontic treatment are compared with the quality of subsequent co-operation. The 145 patients were subdivided into three groups differing in co-operation and rating by the teacher, respectively. It was found that there existed a statistically significant correlation between the prognosis deduced from the general rating and the actual co-operation.