A comparison between open-end (single hole) and closed-end (three lateral holes) epidural catheters. Complications and quality of sensory blockade

A randomised, single-blind study was conducted on 802 parturient women who required epidural analgesia, to compare open-end (single hole) with closed-end (three lateral holes) epidural catheters. The complication rate after catheter insertion was not statistically different between the two groups, but the number of unsatisfactory blocks was significantly higher in the open-end group (p less than 0.001). The closed-end catheters were easier and less painful to place, but gave a higher incidence of bloody taps. The open-end catheters caused sensory blockade to be more frequently unilateral and more frequently missed sensory segments. This resulted in a significantly higher number of open-end catheters that required replacement (p less than 0.001). Open-end catheters despite their theoretical advantages in the detection of intravenous and subarachnoid placement caused an unacceptably high incidence of unsatisfactory sensory blockade.

Absorptive capacity for dietary fat in elderly patients with debilitating disorders

To determine the effectiveness of vigorous realimentation with dietary fat, 17 subjects aged 64.0 +/- 2.1 years (mean +/- 1 SEM) were pump-fed via a nasogastric tube for an average of 22 days. The diet was liquid and nutritionally complete, high in unsaturated fat (67% of energy) and in the caloric density (12.6 kJ/mL or 3 Kcal/mL) [corrected]. Advanced malnutrition was manifested by 74% of the ideal body weight, subnormal anthropometric measurements, and low serum protein levels. At an intake of 17,986 +/- 945 kJ (4068 +/- 225 Kcal [corrected]) and 344 +/- 18 g of fat per day, the rate of nutrient absorption was 93% for energy and fat and 88% for protein. An increase in the daily fecal fat to 23 +/- 6 g was not associated with diarrhea. While serum triglyceride levels remained unchanged, the total cholesterol level decreased, with a relative increase in the high-density lipoprotein level. Effective utilization of nutrients resulted in a positive nitrogen balance and increases in body weight, triceps skinfold, the midarm muscle circumference, total iron binding capacity, and serum urea nitrogen level.

Random urine bile acids in prediction of liver abnormality in asymptomatic alcoholics

We evaluated bile acids for prediction of abnormal serum liver profile in a random sample of urine (URNBA). Seventy-four subjects with excessive alcohol intake, self-referred for outpatient detoxification, had no history or physical findings of liver disease. Surprisingly, in 49% (36/74) of alcoholics, two or more of these were elevated: serum bile acids, aspartate aminotransferase (AST), alanine aminotransferase, alkaline phosphatase (ALP), and/or total bilirubin. All subjects were subdivided into 39 URNBA normal and 35 URNBA abnormal, using 2.6 mumol/g of creatinine as a dividing value. Serum tests confirmed the subgrouping made with URNBA. Compared with alanine aminotransferase, URNBA had better sensitivity, specificity, and overall diagnostic accuracy predicting abnormal serum bile acids, AST, and alkaline phosphatase values. A predictive potential for a multivariate discriminant function of laboratory tests, known to best identify biopsy-documented mild liver disease, was only mildly inferior for URNBA when compared with AST. Multiple abnormalities of liver test results are unexpectedly frequent in asymptomatic alcoholics. The URNBA are helpful in the detection of liver abnormality in its clinically latent phase, because of the convenience of testing a spot sample of urine.

Cytogenetic study of a testicular tumor in a translocation (13;14) carrier

We performed chromosomal analysis of a primary testicular tumor from an individual who, on subsequent analysis of peripheral blood, was found to have a balanced (13q14q) translocation. Histologically, the tumor was a mixed germ cell neoplasm, predominantly embryonal carcinoma, with some teratomatous elements. The modal chromosome count of the tumor cells was 62, with most counts ranging from 54 to 66. In addition to a t(13q14q) chromosome (of constitutional origin), nine nonrandomly acquired chromosomal abnormalities were identified, including an abnormal chromosome #1 and a probable i(12p). These findings are further discussed and compared with cytogenetic data on human testicular neoplasms from the literature. This case is also discussed with regard to the possible association of a constitutional t(13q14q) and various malignancies and related disorders.

Predictive value of random sample urine bile acids corrected by creatinine in liver disease

Bile acids, in a random sample of urine, discriminated normal controls from liver disease, with a probability similar to fasting plasma bile acids (p less than 0.01 and p less than 0.001, depending on the analytical technique). A high degree of correlation between urinary and plasma bile acids (up to r = 0.93) was achieved only when the urine flow was corrected by using a urinary bile acids/creatinine ratio but not with urinary bile acids as simple volume concentration. These findings originated from 10 patients with severe liver disease and 10 with mild liver disease, all biopsy-confirmed, compared with controls. In 24 normal controls and 24 histologically confirmed compensated liver disease, the predictive value of urinary bile acids/creatinine equaled or exceeded fasting plasma bile acids and routine liver tests. In a patient recovering from subacute hepatic necrosis, the urinary bile acids/creatinine closely resembled changes in plasma bile acids and in the routine liver tests. When sulfated urinary bile acids were included, the discrimination between liver disease and controls did not improve. Gallbladder contraction induced by parenteral analogs of cholecystokinin did not change urinary bile acids/creatinine, despite a significant increase in the plasma bile acids. Collection of fasting urine is thus not necessary. Urinary bile acids/creatinine in 12 subjects with renal insufficiency and moderate impairment of creatinine clearance was not different from controls. The weight/height index did not affect this urinary test: there was no significant correlation between the two. Available radioimmunoassays for plasma bile acids can be easily adapted for urine.(ABSTRACT TRUNCATED AT 250 WORDS)

Bile acid levels in diagnosing mild liver disease. Fasting and postcholecystokinetic values

In ten healthy controls and in ten patients with biopsy-proved mild liver disease, we studied fasting and postcholecystokinetic bile acid levels to assess their diagnostic value compared with standard liver tests. Cholecystokinetic bile acid elevation was standardized by evacuating the gallbladder with intramuscular ceruletide diethylamine (cholecystokinin decapeptide) in a double-blind, randomized, placebo-controlled crossover design. Radioimmunoassay of primary conjugated bile acids was adequately sensitive to separate controls from patients even on the basis of fasting serum bile acid levels. In both controls and patients, the 180-minute postcholecystokinetic bile acid time curve was significantly higher after ceruletide than after placebo. Nevertheless, neither this response nor any of the 30-minute postcholecystokinetic interval bile acid levels separated controls from patients better than the fasting bile acid values, which discriminated better than standard liver tests or the indocyanine green clearance at 20 minutes. Alanine aminotransferase separated the two groups with a sensitivity equal to fasting bile acid levels.

Ovulation and pregnancy after pulsatile administration of gonadotropin releasing hormone

Twenty-seven patients with primary or secondary amenorrhea were treated with gonadotropin releasing hormone (GnRH). They were given 20 micrograms of GnRH in 50 microliter solution i.v. every 90 min by means of a peristaltic pump (Zyklomat, Ferring GmbH, Kiel). Two days after a rise in basal body temperature and when a ferning test on cervical mucus was negative the Zyklomat was removed and injections of hCG (2,500 IU) were given on alternate days until three injections had been administered. Ovulation occurred in 32 out of 40 treatment cycles and 11 patients conceived. Three of them miscarried at 6, 8, and 15 weeks of gestation. There were no severe complications of treatment and we did not encounter ovarian hyperstimulation and multiple pregnancy.