Treatment of puerperal uterine inversion by the hydrostatic method; reports of five cases

In five patients, puerperal inversion of the uterus was successfully replaced by the hydrostatic technique. This method proved to be effective in acute and subacute uterine inversions. There was no maternal death and in one patient cardiac arrest occurred.

[Malaria in the Djibouti Republic. Results of a serologic survey in Ambouli]

To investigate the importance of malaria as a public health problem in Djibouti, we studied 144 febrile subjects living south of Djibouti-city in the agricultural area of Ambouli. All blood slides examined were negative for parasites. Antibodies against the merozoite stage of Plasmodium falciparum were investigated by an indirect immunofluorescence assay using serial serum dilutions. Only 9 sera reacted negatively at the titer of 50 (the chosen cut-off for positivity). Fourteen sera tested positive at a titer above 1000. Percentages of seropositive subjects and geometric mean titers increased with age. We conclude that inhabitants of Ambouli were heavily exposed to Plasmodium falciparum in the recent past. However, our data do not allow to ascertain if the malaria infections were contracted inside or outside of the national territory, since Djiboutians are frequent and extensive travelers.

Intracellular pH, lactate, and energy metabolism in neonatal brain during partial ischemia measured in vivo by 31P and 1H nuclear magnetic resonance spectroscopy

Sequential 31P and 1H nuclear magnetic resonance spectra were measured for neonatal piglets (n = 7) to determine the relationship between brain intracellular pH (pHi), lactate, and phosphorylated energy metabolites during partial ischemia. Simultaneous determinations of arterial and cerebral venous blood gases, pH, O2 content, and plasma concentrations of glucose and lactate were also made. Ischemia, induced by bilateral carotid artery ligation plus hemorrhagic hypotension for 35 min, resulted in variable reductions in ATP, phosphocreatine, and increases in Pi, H+, and lactate relative to control levels. In four piglets, whose arterial blood glucose rose above control, brain lactate exceeded 20 mumol g-1 with corresponding decreases in pHi of greater than 0.7 units compared to control levels. The extents of brain acidosis and lactosis showed a strong linear correlation with each other (r = 0.94). Maximal changes in brain lactate, pHi, and ATP at the end of ischemia showed significant positive linear correlations with the control levels of arterial blood glucose, but did not correlate with arterial glucose or arterial cerebral-venous glucose difference values during ischemia. The relationship between pHi and buffer base deficit was comparable to results reported for adult animals up to 20 mumol ml-1. However, in contrast to models proposed for adult brain, the continued linear relationship between pH and higher buffer base levels is most consistent with a theoretical model that assumes the presence of weak acid buffers with pKa values from 6.7 to 5.2.

Quantitation of acidosis in neonatal brain tissue using the 31P NMR resonance peak of phosphoethanolamine

31P NMR brain spectra were obtained from piglets over a range of mild hypocarbia to severe hypercarbia (PaCO225 to 198 mm Hg). The chemical shifts of the phosphoethanolamine and inorganic phosphate were used to calculate intracellular brain pH (pHet and pHpi, respectively). Both pHpi and pHet underwent parallel significant decreases during hypercarbia, corresponding to 51 and 53% pHregulation, respectively. We conclude that the chemical shift of the phosphomonoester peak in vivo can be used to measure decreases in intracellular pH in neonatal brain.

Pregnancy and ventriculoperitioneal shunt. Report of a case and literature review

Reported cases of pregnancy occurring in association with an extracranial shunt for hydrocephalus are very few. This report documents two uncomplicated pregnancies in a patient with ventriculoperitoneal shunt. Abdominal pain was the most frequent symptom in our patient.

Auditory brainstem evoked potentials in insulin-dependent diabetics with and without peripheral neuropathy

Auditory Brainstem Evoked Potentials (ABEP) were recorded from 33 insulin-dependent diabetes mellitus (IDDM) patients (17 with diabetic peripheral neuropathy and 16 without) as well as from 20 normals. Pure-tone audiometry, speech reception threshold and discrimination were also evaluated. Sub-clinical pure-tone threshold elevation was observed for IDDM patients with neuropathy. Pure-tone thresholds of IDDM patients without neuropathy were not significantly different from those of normals. ABEP abnormality (at 10/sec click rate) was observed in 31% of IDDM patients with neuropathy, rising to 44% when 55/sec click rate measures were included. Abnormalities included bilateral and symmetrical peak-latency prolongations for all waves, greater for the later waves, and prolongation of V-I and V-III interpeak latency differences, all at 10/sec, and only prolonged peak latency for I at increased rate. Abnormalities coincided with microangiopathy and peripheral neuropathy. The incidence of ABEP abnormality for IDDM patients without neuropathy was only 12%, unilateral and sporadic in nature. As a group, IDDM patients with neuropathy had significantly prolonged IV and V peak-latencies, compared with the normals, or with the IDDM patients without peripheral neuropathy. In contrast, IDDM patients without neuropathy resembled the normals in all respects. ABEP have proven useful in understanding the variety of pathologies underlying the clinical manifestation of diabetes.

Blood flow in the skin of the foot related to posture in diabetes mellitus

Normal healthy subjects show a reflex rise in precapillary resistance in the skin of the foot when they rise from lying to standing. To investigate the integrity of this reflex in patients with diabetes mellitus blood flow in the plantar region of the big toe was measured, using a laser Doppler flowmeter. The responses of diabetic patients with and without peripheral sensory neuropathy and healthy control subjects matched for age and sex were studied, with the foot at heart level and the foot passively lowered to 50 cm below the heart. In normal subjects mean blood flow recorded during the third to fourth minute of dependency fell to 18.1 (SD 11.9)% of the preceding resting flow determined with the foot at heart level. In the diabetic patients without neuropathy blood flow fell to 28.9 (18.6)% of the preceding resting flow. In the diabetic patients with neuropathy blood flow fell to 53.5 (23.7)% of the preceding resting flow, which was significantly different from the value achieved by the diabetics without neuropathy (p less than 0.02) and the healthy controls (p less than 0.002). Six normal subjects were indirectly heated to release sympathetic tone and achieve the same mean skin temperature of the foot as the diabetic patients with neuropathy, and blood flow fell to 38.7 (24.3)% of the preceding resting flow, a value not significantly different from the response seen in the patients with neuropathy. These findings suggest that the postural control of blood flow in the foot is disturbed in patients with diabetic neuropathy, and this disturbance is compatible with a loss of sympathetic vascular tone. The resultant hyperperfusion on dependency may account for the oedema seen in some patients with neuropathy and may also act as a stimulus for the thickening of capillary basement membranes.

Simultaneous occurrence of acute poststreptococcal glomerulonephritis and acute rheumatic fever

The simultaneous occurrence of acute poststreptococcal glomerulonephritis and acute rheumatic fever is a rarity. We report here such an occurrence in a 9-year-old Saudi boy whose kidney biopsy showed diffuse exudative glomerulonephritis with subepithelial humps on electron microscopy in the presence of active rheumatic carditis.

Growth and biochemical changes in mammary glands of ewes from 1 to 18 months of age

Growth and development of the mammary gland of ewe lambs was characterized by changes of various biochemical constituents. Mammary glands were removed from 49 ewe lambs ranging between 1 and 18 mo of age, weighed before and after trimming, and samples of the trimmed glands were fat extracted and dried. The dried fat-free tissues were weighed, ground, and analyzed for nucleic acids, nitrogen, sodium, potassium, and chloride contents. Fresh samples were used for glycogen determination. Trimmed weight of mammary glands increased rapidly after the 9th mo of age. The pattern was similar for nucleic acid content of mammary glands. Dry matter and fat contents of mammary glands increased up to the 9th mo, fat decreased thereafter, and dry matter remained constant. Protein content was low up to the 9th mo and increased thereafter. Sodium and glycogen content in mammary glands increased, but potassium decreased linearly from 1 to 18 mo of age. Allometric growth of mammary tissue started at about 3 mo of age, before onset of puberty at 8 mo of age, but intense mammary metabolic activity started only after the ewe attained puberty.

Effects of unilateral ovariectomization on the numbers of sperm in the oviducts, uterus and cervix of rabbits

The experiment was designed to determine the effect of removing one of the rabbits' ovaries on the numbers of sperm in the oviducts, uterine horns and cervices. The possible relationship between the anatomical asymmetry of the two sides of the reproductive tract and the distribution of sperm within different segments of the tract was also studied. Fifteen female rabbits were used; five were kept intact as the control group, five were right ovariectomized and five were left ovariectomized. All rabbits were injected with 50 IU HCG to induce ovulation and then inseminated with 60x10(6) sperm in 0.25 ml semen. Does were inseminated one month after unilateral ovariectomy. Animals were sacrificed 10 hrs later and sperm was recovered from the right and left oviducts, uterine horns and cervices. Unilateral ovariectomy significantly reduced the total numbers of sperm recovered as compared with intact does. The total numbers of sperm recovered from each of the two sides of the tract were not affected by the site of the removed ovary. Sperm numbers were high in the cervices of all groups and then decreased gradually in the upper segments of the tract. Sperm numbers that reached the oviduct of the intact rabbits were greater than those of both unilateral ovariectomized groups of rabbits. Differences between the length of the left and right cervices and uterine horns were not significant, but the right oviduct was significantly longer than the left oviduct.

The effect of seminal sperm concentration on sperm transport in the reproductive tract of female rabbits treated with progesterone or diethylstilbestrol

Forty-two mature Baladi female rabbits were used in a randomized 3x2 factorial experiment to determine the effects of three treatments (control, progesterone injection: 2 mg/doe and DES injection: 0.1 mg/doe) and two semen sperm cell concentrations (1x10(6) and 60x10(6) sperm/0.25 ml semen on sperm transport and distribution in the female reproductive tract. The injections were given for three consecutive days after which rabbits were injected with 5 IU HCG and inseminated with 0.25 ml semen. The does were sacrificed 10 hrs after insemination and the sperm were recovered and counted from the oviducts, uterine horns, cervices and vagina. Total spermatozoa recovered was high when rabbits were inseminated with 60x10(6) sperm as compared to those inseminated with 1x10(6) sperm. When rabbits were injected with progesterone or DES, the number of sperm recovered relative to the total number of sperm inseminated was high in rabbits inseminated with 1x10(6) sperm, in comparison to those inseminated with 6x10(6) sperm. The number of sperm recovered was highest from cervix which was followed by vagina, uterus and oviducts. DES increased the number of the total sperm recovered while progesterone decreased the number as compared to control. This trend was also observed within the different segments of the reproductive tract and with groups inseminated with 1x10(6) or 60x10(6) sperm/0.25 ml semen. The effect of DES was more obvious with does inseminated with low sperm numbers. Significant correlation coefficients were found between the sperm numbers recovered in the uterus and oviducts and in the cervix and uterus of all groups of rabbits.

The endogenous stages of Sarcocystis cameli (Mason, 1910)

The endogenous stages of Sarcocystis cameli (Mason, 1910) in the small intestine of dogs are described. These stages are mainly in the posterior third of the small intestine. They were observed only in the lamina propria of the distal third of the villi. There was no schizogonic process. Micro and macrogamonts were differentiated 18 h p.i. The first zygote was observed 24 h later. Unsporulated oocysts were found 30, 36, 42, 48 h and 4 days p.i. The oocysts started sporulation on the 5th day p.i. Completely sporulated oocysts were formed 8 days p.i.

Identification of the oestrogenic isoflavones in fresh and fermented berseem clover (Trifolium alexandrinum)

A thin layer chromatography technique was used to identify and semiquantitate the oestrogenic isoflavones in berseem clover (Trifolium alexandrinum). Biochanin A and genistein were the most prominent isoflavones in all the three cuts of fresh berseem clover. Low concentrations of formononetin and daidzein were also detected. The concentrations of the all oestrogenic isoflavones gradually decreased in the successive cuts. Fermentation of all three fresh cuts in silo or in rumen fluid increased the concentrations of these isoflavones. Incubation of the silage materials with rumen fluid had little effect on the concentrations of the isoflavones. The concentrations of the oestrogenic isoflavones in fresh or fermented materials considered were too small to have any adverse effects on growth or reproduction of farm animals.

Mercury poisoning in Nicaragua: a case study of the export of environmental and occupational health hazards by a multinational corporation

Pennwalt Inc., a multinational chemical and pharmaceutical firm based in the United States, operates a chloralkali plant in Managua, Nicaragua. This plant utilizes elemental mercury in the production of chlorine and caustic soda for markets throughout Central America. The plant was recently found to be contaminating the waters of Lake Managua (on which the plant is located) with 2 to 4 tons of inorganic mercury effluent per year-over 40 tons in the 13-year history of the plant. Examination of the 152 workers employed in the plant showed that 56(37 percent) were suffering symptoms and signs of mercury poisoning, including tremors (in 45), memory and attention deficits (in 45) and paresthesias (in 52). Levels of airborne mercury vapor in the plant were found to range as high as 600 microgram/m3. (The airborne standard set by the U.S. Occupational Safety and Health Administration is 100 microgram/m3.) Workers in the plant had never been alerted to the hazards of mercury. The plant was found to be in deteriorated condition, with no recent investments in maintenance or modern safety equipment. It is reported that the parent corporation, Pennwalt, has been withdrawing capital from the operation (and from Nicaragua) since the fall of the Somoza regime.

Treatment of hepatic metastases with a combination of hepatic artery infusion chemotherapy and external radiotherapy

Systemic chemotherapy has given good results when compared with that of patients who received no chemotherapy. When resection was performed, the results are slightly better. The group of patients who underwent combined therapy, using infusion chemotherapy, radiation and systemic chemotherapy, had the best results. It appears that infusion chemotherapy and radiotherapy can improve the palliation available for patients with metastases in the liver from carcinoma of the colon and rectum and warrants further investigation.

Hepatic amebiasis: diagnostic counterimmunoelectrophoresis and metronidazole (flagyl) therapy

In an ongoing study of obscure fevers in Cairo, Egypt which is presently in its 6th year, 12 cases of hepatic amebiasis have been diagnosed. Three were diagnosed during the period 1971-1974. With the introduction of amebic serologic techniques, particularly counterimmunoelectrophoresis, nine additional cases have been diagnosed in 1975-1976. Of 9 patients treated with metronidazole 6 were rapidly cured, 2 had a recurrence of fever necessitating surgical drainage of the abscess, and 1 died suddenly on the 3rd day of therapy.

Comparative single/dose treatment of hookworm and roundworm infections with levamisole, pyrantel and bephenium*

One-hundred and forty-five farmers aged 7-45 years who were infected with Ancylostoma duodenale and/or ascaris were treated with a single dose of levamisole, pyrantel, or bephenium. The percentage cure rates were ascaris 100 per cent ahd hookworm 93 per cent for levamisole; ascaris 90 per cent and hookworm 78 per cent for pyrantel; and ascaris 73 per cent and hookworm 81 per cent for bephenium. The 3 drugs were well tolerated. The opinions and assertions contained herein are the private ones of the authors and are not to be construed as official or as reflecting the views of the Department of the Navy or The Egyptian Ministry of Healty.

The value of epicillin and ampicillin in the treatment of meningococcal and pneumococcal meningitis

96 patients with meningitis due to Neisseria meningitidis and Diplococcus pneumoniae were treated with epicillin or ampicillin according to a predesigned randomization chart. Results indicate that epicillin and ampicillin are effective single drugs in the treatment of meningococcal and pneumococcal meningitis. No adverse reactions were noted with either drug and they were comparable in their efficacy.

The value of ethambutol in the treatment of tuberculous meningitis

This is a prospective treatment study of 86 patients with tuberculous meningitis admitted to the Abbassia Fever Hospital Cairo, Egypt. The causative organism was cultured from the cerebro spinal fluidin 47 patients, was identified by Zeihl Nelson stain in five and in the remaining 34 patients the diagnosis was based on the clinical course and changes in the CSF chemistry and cell count. The data indicate that ethambutol can be used as a companion drug to INH and streptomycin in the treatment of the disease and that the mortality is directly dependent on the state of consciousness upon initiation of therapy.

Treatment of chronic enteric fever with amoxicillin

Twelve patients with proven Salmonella typhi or Salmonella paratyphi A bacteriuria and recurrent bacteremia associated with schistosomiasis were treated for four weeks with amoxicillin (250 mg four times daily). Seven of the 12 patients were seriously ill and febrile before treatment. They showed a dramatic response, and, within three to six days of initiation of amoxicillin therapy, they were afebrile and much improved clinically. Amoxicillin was rapidly and highly concentrated in the urine of all patients; peak levels of 115-2,700 mug/ml were obtained within 2-4 hr of the first dose. Concentration of the drug in serum was also rapid and in all but two patients exceeded the minimal inhibitory concentration of the organism within 4 hr of the first dose. Within one week after treatment started, all urine and blood specimens obtained from the patients became negative for Salmonella and remained so throughout the four-week follow-up period, during which the patients were hospitalized.

A comparative evaluation of the treatment of typhoid fevers with co-trimoxazole and chloramphenicol in Egypt

Seventy-two patients with bacteriologically proven enteric fever were treated with either co-trimoxazole (41 cases) or chloramphenicol (31 cases). C0-trimoxazole was found to be superior to chloramphenicol in relieving the toxaemia. The average number of days required for patients to become afebrile was 5-5 days in the co-trimoxazole group and 4-5 days in the chloramphenicol group. The cure rate was 97 per cent in each of the treatment groups. There occurred two relapses in the co-trimoxazole group and four relapses in the chloramphenicol group. No side effects of the co-trimoxazole were detected during the study. Co-trimoxazole can be considered as a good alternative to chloramphenicol in the treatment of the enteric fevers.

Drug-induced respiratory disorders

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