Mustard operation for transposition of the great arteries in a 3-day-old infant, complicated by acute renal failure

A successful operative treatment of a three day old girl with transposition of the great arteries is described. Post-operative course was complicated by furosemide resistant anuria which was treated by peritoneal dialysis. At the age of eight months, she is a pink, active baby, developing normally. This case report demonstrates the importance of aggressive treatment of severe congenital heart lesions in the first few days of life. The importance of post-operative care is emphasized.

Synthesis of 5-chloro-3'-nitro-4'-substituted salicylanilides, a new series of anthelmintic and antimicrobial agents

A number of 5-chloro-3'-nitro-4'-substituted salicylanilides (6--23) have been synthesized by treating 4',5-dichloro-3'-nitrosalicylanilide (5) with various sodium aryl oxides, alkoxides, or amines. These compounds have been tested against Hymenolepis nana infection in rats and have also been evaluated for their in vitro antimicrobial activity against various strains of bacteria and fungi. In the former test 17 was the most active cestodicidal agent showing activity at 30 mg/kg. In the antimicrobial screening, 22 inhibited the growth of all the bacteria and fungi used while 6 was active against the penicillin resistant Staphylococcus aureus at a minimum inhibitory concentration of 0.00609 microgram/mL.

Preoperative intra-aortic balloon assist in high risk revascularization patients

Sixty-five high risk myocardial revascularization patients had preoperative IABP with two operative deaths. Only six patients needed rapid institution of cardiopulmonary bypass after anesthesia induction despite marked blood pressure drop in half the patients. There were only two instances of postpump power failure. Preoperative IABP is a valid method of limiting morbidity associated with coronary surgery in high risk patients.

Respiratory characteristics of a microporous membrane oxygenator

A microporous membrane oxygenator has been used in 258 clinical perfusions for cardiac surgery. In 132 perfusions the oxygenator was ventilated with 100% O2, and in 126 perfusions 98% O2-2%CO2 was used. Patients' BSA was 0.4-2.3 M2. Bypass duration was up to 563 min. In the group ventilated with 100% O2, average PaCO2 was 30 mmHg, with arterial pH of 7.48. 98% O2-2% ventilation resulted in an average PaCO2 of 36 mmHg, with arterial pH of 7.41. CO2 transfer is influenced by gas flow rate, and data from selected cases demonstrate that increasing gas flow results in decreasing PaCO2, while decreasing gas flow increases PaCO2. The thickness of the blood film is decreased by increasing the "shim" pressure, so that increasing the "shim" presure results in higher PaO2. Oxygen saturation averaged 99% for the entire series. Addition of CO2 to the oxygen and appropriate changes in gas flow and "shim" pressure permit changes to be made in the ventilation of the device during perfusion to achieve desired levels of PaO2 and PaCO2 under widely disparate conditions of temperature and flow.

Effect of methallibure on gonadotrophic content, ovarian 32P uptake and gonadosomatic index in the freshwater catfish, Heteropneustes fossilis (Bloch)

Gonadotrophin content in the pituitary gland and blood serum as well as ovarian 32P uptake were studied in response to methallibure treatment in H. fossilis. There was a marked reduction in the gonadotrophic activity of the pituitary gland and blood serum within 3 weeks of methallibure treatment (100 microng/g). A simultaneous significant reduction was also recorded in the ovarian activity of these fish. The fall in ovarian activity caused by methallibure could not be prevented by the administration of LH, FSH or LH+FSH. After cessation of methallibure treatment, LH+FSH (50 microng each) administration restored ovarian activity. It is evident from these results that methallibure alters the secretion of gonadotrophin, and also prevents its action on the ovary.

Preoperative intra-aortic balloon support in surgery for left main coronary stenosis

Twenty-six patients with left main coronary (LMC) stenosis were operated upon with preoperative intra aortic balloon pump (IABP) support. There was no mortality, and no morbidity attributable to the balloon catheter. The most delicate facet of revascularization surgery in this entity is the pre-cardiopulmonary bypass phase including anesthesia induction during which blood pressure fluctuation may further diminish severely compromised coronary flow. Although systolic pressure dropped to below 100 mm Hg in 50% of patients during induction, there were only two patients with electrocardiographic evidence of perioperative myocardial infarction, and only one who needed rantic institution of cardiopulmonary bypass just after induction. Perioperative logistics were quite trouble free in all 26 patients, in marked contrast to 5 LMC patients operated upon prior to our preoperative IABP concent; 3 of these deteriorated upon induction, with two deaths resulting. Preoperative IABP is a reasonable supportive adjunct in surgery for LMC stenosis.

Pulmonary artery banding for truncus arteriosus in the first year of life

Results of pulmonary artery banding (PAB) for truncus arteriosus (TA) in infancy are reviewed in 15 children between 1957 and 1974. There were ten hospital and one late deaths (73%). A policy of early correction of severely symptomatic infants with TA was adopted in 1974. Since October, 1974, four infants with TA and one with hemitruncus had a complete correction. Three of these are surviving 22, 17, and 9 months after the operation. Their weight at operation was 4.7, 6.0, and 3.5 kg.

Left ventricle to pulmonary artery conduit in treatment of transposition of great arteries, restrictive ventricular septal defect, and acquired pulmonary atresia

Progressive cyanosis after banding of the pulmonary artery in infancy occurred in a child with transposition of the great arteries and a ventricular septal defect, and a Blalock-Taussig shunt operation had to be performed. At the time of correction a segment of pulmonary artery between the left ventricle and the band was found to be completely occluded so that continuity between the left ventricle and the pulmonary artery could not be restored. A Rastelli type of operation was not feasible as the ventricular septal defect was sited low in the muscular septum. Therefore, in addition to Mustard's operation, a Dacron conduit was inserted from the left ventricle to the main pulmonary artery to relieve the obstruction. Postoperative cardiac catheterization with angiocardiography indicated a satisfactory haemodynamic result. The patient remains well 11 months after the operation. This operation, a left ventricle to pulmonary artery conduit, may be used as an alternative procedure in patients with transposition of the great arteries, intact interventricular septum, and obstruction to the left ventricular outflow, if the obstruction cannot be adequately relieved.

Chemical constituents of genianaceae XX: natural occurrence of (-)-loliolide in Canscora decussata

Loliolide was isolated as a native compound from Canscora decussata Schult (Gentianaceae). Physical and spectral (UV, IR, PMR, CMR, and mass spectra) properties of the compound and its acetate derivative established its identity. The significance of the cooccurrence of loliolide with a number of carotenoids in C. decussata and the facile transformation of violaxanthin into loliolide and violoxin are discussed in the light of the biogenesis of the degraded carotenoid.

Chemical constituents of Gentianaceae XIX: CNS-depressant effects of swertiamarin

CNS activity of swertiamarin, a secoiridoid glucoside from Swertia chirata, was evaluated. An apparent anomaly, associated with the unanticipated finding that the alcoholic extracts (excluding mangiferin) of S. chirata significantly reversed the mangiferin-induced CNS-stimulating effects in albino mice and rats, was resolved. The results indicate that swertiamarin and mangiferin antagonize each other in vivo and thereby reverse their CNS effects.

Tracheoesophageal and aortoesophageal fistulae complicating corrosive esophagitis

A 51-year-old man suffered third-degree caustic burns of the esophagus and proximal two-thirds of the stomach. A tracheoesophageal fistula developed, and surgery was performed to exclude the esophagus from gastrointestinal reflux and to divert the oral secretions. An uneventful postoperative course was interrupted on the 27th day after the burn by massive hemoptysis and sudden death. Autopsy revealed an aortoesophageal fistula in addition to a tracheoesophageal fistula.

Lithium protection against oxygen toxicity in rats: ammonia and amino acid metabolism

1. The use of Li pre-treatment in rats before high pressure oxygen exposure has been reported effective in controlling convulsions. This is an effect which is better demonstrated if exposure to oxygen follows shortly after Li injection than exposure following several hours later. 2. This study has investigated the hypothesis that the protective action of Li may be exerted, in the short term, by its removing ammonia from the blood and alleviating the latter's known toxic action. 3. A normal Li distribution time profile in unstressed rat brain and blood following intraperitoneal injection has been established. Brain and blood ammonia, amino acids and Li concentrations were also measured in Li-treated animals exposed and convulsed by oxygen. These measurements were made both shortly (15 min) and also several hours after (24 hr) Li treatment. Ammonia and amino acid values in Li-protected groups were compared to normal unstressed animal values and also to values in animals convulsed by oxygen unprotected by Li pre-treatment. 4. In rat brain abd blood significant (P less than 0-001) elevation of ammonia and glutamine and depression of gamma-amino butyric acid (brain only) and glutamate was noted following oxygen treatment in unprotected animals. Prior injection of Li 15 min before high pressure oxygen exposure delayed convulsions twice as long. Additionally if these animals were only exposed to oxygen for a period of time equal to that which would normally produce convulsions in unprotected animals, brain and blood ammonia and amino acids were maintained near to unstressed animal levels. Concomitantly, blood Li concentrations were considerably depressed below the values one would expect from the previously determined Li distribution time profile. 5. In rats exposed to high pressure oxygen 24 hr after Li treatment there was no protective action against high pressure oxygen convulsion, rather a potentiating effect for convulsion was seen. 6. These data present compelling evidence for the controlling effect of Li in rats, on rising blood ammonia concentration which occurs in high pressure oxygen exposure. The effect might well be due to the known chelating properties of Li with ammonia.