Ondansetron versus placebo for the control of nausea and vomiting during Caesarean section under spinal anaesthesia

This prospective, randomised, placebo-controlled, double-blind study was performed to evaluate the effects of ondansetron on nausea and vomiting during elective Caesarean section under spinal anaesthesia. Seventy-four full-term parturients were studied. After umbilical-cord clamping, ondansetron 4 mg or 0.9% saline was injected intravenously and the study period continued for 2 h. The severity of nausea was graded from 0 = none to 10 = maximum, while that of vomiting was graded from single = once per min to continuous = multiple per min. The incidence of vomiting was lower following ondansetron (36%) compared with the control group (58%, p < 0.028). Neither the severity of vomiting nor the incidence of nausea was influenced by ondansetron. However, for those who experienced nausea, ondansetron reduced its severity (p = 0.05). We conclude that the intra-operative administration of 4 mg ondansetron intravenously during Caesarean section under spinal anaesthesia significantly reduces the incidence of vomiting and the severity of nausea.

Innovation and survival: a case study in planning medical library services

In the information age, information utilities like libraries are as sensitive to the stresses of change as any other organization. This article is a case study of a small, specialized medical library as it attempted to understand, and cope with, the complex simultaneous challenges of serious budgetary constraints, technological change, and shifting user demands in the mid 1990s. To support planning decisions in a period of declining use statistics, the Medical Library at Women's College Hospital, Toronto, carried out a user survey that posed choices about priorities among services. Conclusions drawn from the survey and its related planning process may help similar organizations design an appropriate service blend for future users.

Zollinger-Ellison syndrome. Improved treatment options for this complex disorder

Zollinger-Ellison syndrome is a rare disorder characterized by severe peptic ulcer disease, gastric acid hypersecretion, and non-beta islet cell tumors of the pancreas. Most gastrinomas are found within an anatomic area known as the gastrinoma triangle. However, they commonly occur in extrapancreatic sites in multiple endocrine neoplasia type 1 syndrome. In patients in whom Zollinger-Ellison syndrome is suspected, laboratory evidence of hypergastrinemia and hyperacidity establishes the diagnosis. Until the advent of proton pump inhibitors, total gastrectomy was the treatment of choice. Therapy with these agents (eg, omeprazole, lansoprazole) can prevent ulcer disease. However, surgical removal of gastrinomas offers a chance for cure and can improve longevity by preventing the malignant spread of the tumors.

Role of fever in infection: has induced fever any therapeutic potential in HIV infection?

Ancient societies had no rational understanding of fever. The Greeks were the first to recognise that it may be part of nature's method of effecting cure in some diseases. How best to assist nature went through many trials and errors. Appreciation of the prognostic value of fever and how it may be controlled was slow to appear. That there was a place in the therapeutic arsenal for induced fever came only with the 20th century. Finding a suitable, safe, and satisfactory means came slowly. The curative power of well controlled and reproducible levels of fever was proved by the arrest of one deadly and incurable complication of a sexually transmitted disease in the first half of this century. The purpose of this review is to promote discussion and, hopefully, well ordered laboratory and clinical trials aimed at learning whether or not induced fevers have a place in the care of patients with HIV/AIDS.

Synthesis of new d-propoxyphene derivatives and the development of a microparticle-based immunoassay for the detection of propoxyphene and norpropoxyphene

The synthesis of [S-(R,S)]-4-[[methyl[2-methyl-3-(1-oxopropoxy)-3, 4-diphenylbutyl]amino]-1-oxobutoxy]-2,5-pyrrolidinedione+ ++ (propoxyphene active ester, 2) is described. This was used as an intermediate to prepare a propoxyphene immunogen, [S-(R,S)]-4-[methyl][2-methyl-3-(1-oxopropoxy)-3,4-diphenylbuty l]-amino]- 1-oxobutyl-Bovine Thyroglobulin (3). This immunogen was then used to generate antibodies which demonstrate good cross-reactivity to d-propoxyphene, d-norpropoxyphene, and other propoxyphene metabolites. In addition, these antibodies were shown to have very low cross-reactivity to methadone, a structurally related compound. The introduction of an aminomethyl benzoate spacer into the propoxyphene active ester (2), followed by the activation of the carboxylic acid, provided for a more stable active ester (5). This stable active ester, together with the antibodies generated from the propoxyphene immunogen, has led to the development of an immunoassay based on the Kinetic Interaction of Microparticles in Solution (KIMS).

Spectrum of neuropsychiatric complications in 791 cases of typhoid fever

Over a 6-year period, we studied 791 patients with multidrug-resistant typhoid fever, of whom 665 individuals (84%) developed neuropsychiatric manifestations. These were: acute confusional state (73%); myelitis (6%); cerebellitis (1%); parkinsonism (1%); acute psychosis (0.6%); meningo-encephalitis (0.5%); encephalitis (0.25%); sensory motor polyneuropathy, polymyositis, acute schizophrenia and bizarre neurological syndromes (0.12% each). Severe parkinsonian rigidity and meningo-encephalitis are associated with significant morbidity but very low mortality (0.5%).

Meningococcal carriage: prevalence and sex-related risk factors

A retrospective analysis was done to examine whether sexual behaviour was associated with meningococcal carriage. Over the 4 month period from January to April 1994, 136 (27.4%) of the 496 consecutive new/re-registered genito-urinary medicine clinic attenders showed meningococcal carriage. Two (15.4%) of 13 homosexual men compared with 134 (27.7%) of 484 heterosexual men and women had evidence of meningococcal carriage. Relative risk (RR) of meningococcal carriage was 1.8 with > 10 lifetime partners and 1.2 with 3-10 partners (P < 0.007). RR with age group of 16-25 was 4.2 and for 26-35 it was 3.5. There was no relationship with meningococcal carriage and pharyngeal symptoms, sexual orientation, intravenous drug use, number of partners per month and orogenital sex. Further longitudinal studies may be of value in order to determine whether a high number of sexual partners is a marker for meningococcal carriage. In addition, further study may show whether there is an increased risk of meningococcal carriage and disease in those who live with meningococcal carriers.

Reliability and reproducibility of breath hydrogen and methane in male diabetic subjects

We studied the variability and reliability of breath hydrogen and methane as well as the alterations in intestinal gas profile in response to lactulose ingestion in 13 asymptomatic male patients with diabetes mellitus (DM). Seventeen healthy subjects served as controls. The prevalence of methane producers was 33% in DM and 45% among control subjects (P = NS). The prevalence of nonhydrogen producers was 7.7% and 5.9%, respectively. The coefficient for interday variation of H2 was 72.6 +/- 9.8% in DM and 49.7 +/- 9.8% in controls (P < 0.05). Similarly, the coefficient for interday variation of CH4 was 94.3 +/- 18.8 and 69.4 +/- 16.8% respectively (P = NS). The reproducibility of basal H2 and CH4 among diabetics as assessed by r1 (measure of reliability) was poorer among diabetics when breath analysis was performed on different days (P < 0.001). There was no significant difference between diabetics and controls with respect to basal or peak or area under the curve for H2 and CH4 in response to lactulose. We conclude that there is poor reproducibility of fasting breath gas levels among asymptomatic male subjects with diabetes. In addition, DM is not associated with alterations in hydrogen- or methane-producing potential.

Spontaneous splenic rupture in typhoid fever

Three cases of multidrug-resistant Salmonella typhi infection presenting as spontaneous splenic rupture are presented. One patient died and two recovered completely. This is a previously unreported presentation of typhoid fever.

Detection of autonomic nervous dysfunction by SL manoeuvre

We have evaluated the immediate heart rate response to standing and lying and in 100 Diabetic subjects aged 43 +/- 10 years who underwent five other cardiovascular autonomic tests. Using a specially devised scoring system the patients were divided into three groups: a) 58 subjects without autonomic neuropathy, b) 15 borderliners, c) 27 with autonomic neuropathy. The results were compared with 50, sex and age matched controls. We studied SL1 = ratio between R-R mean before lying and R-R maximum between the 20th to 25th beat and R-R minimum over the first 5 beats after lying. In controls SL1 was 1.35 +/- 0.18 and SL2 was 1.52 +/- 0.23. In diabetic subjects without autonomic neuropathy SL1 was 1.20 +/- 0.86 (p < 0.01), SL2 1.50 +/- 0.02 (p < 0.001). In the group with autonomic neuropathy SL1 was 1.04 +/- 0.02 (p < 0.001) and SL2 was 1.20 +/- 0.09 (p < 0.001). We propose that the lowest normal and highest abnormal limits of SL1 are 1.12 and 1.08 respectively and that normal and highest abnormal limits of SL2 are 1.23 and 1.18 respectively. We suggest the use of SL1 as a pure parasympathetic test and SL2 as a mixed but predominantly sympathetic test in the diagnosis of autonomic neuropathy.

Screening of some Turkish medicinal plants for their analgesic activity

Nine crude extracts of various parts of eight medicinal plants from different regions of Turkey were evaluated for their analgesic activities by tail flick method in mice. The analgesic activities of these extracts were compared with acetylsalicylic acid (300 mg/kg) which is used as a standard drug. Extracts were given orally in doses of 300, 500 and 1000 mg/kg. 0.9% saline was also administered in control group of animals. Results showed that four extracts were having highly significant analgesic activity at all the three doses tested. Three showed significant effects at higher doses while two extracts did not show any significant results.

Multiple drug resistant typhoid fever outbreak in Kashmir Valley

We report the first ever report of multiple drug resistant salmonella typhi epidemic from Asia. The outbreak started in April 1988 and virtually ended by June 1988. The outbreak occurred in Baramullah town of Kashmir valley. In an epidemiological survey 230 cases were diagnosed as enteric fever. 46 cases (20%) were culture positive. A very rare multiple drug resistant strain of S. typhi was identified as phage type biotype II untypeable (UVS2). The strain was sensitive to Norfloxacin. This outbreak of S. typhi has many similarities with Mexico epidemic. Ingestion of contaminated water seems to be the possible cause for the outbreak.

Misoprostol healed a benign nonsteroidal antiinflammatory drug-induced gastric ulcer in a patient with pentagastrin-fast achlorhydria

A patient with rheumatoid arthritis, who also had documented achlorhydria, first had the diagnosis of an antral ulcer made by barium meal in 1980. She did well taking cimetidine intermittently after that, along with various nonsteroidal antiinflammatory drugs (NSAIDs). In 1988, a shallow antral ulcer was found, but the patient did not respond to H2 blockade or to sucralfate. At that time misoprostol therapy was prescribed. Despite the continued use of NSAIDs, the ulcer healed. It has remained healed for the past 3 years.

Inhibition of adrenaline-induced aggregation of human platelets by Pakistani medicinal plants

The effects of extracts of Pakistani plants claiming medicinal value were observed on adrenaline-induced aggregation of human platelets according to the method of Born (1962). The extracts manifested significant inhibitory activity in doses of 0.625 mgm(-1) to 2.5 mgml(-1) in this in vitro model. The potency of the plant extracts in inhibiting platelet aggregation induced by adrenaline is in the following order: Sida pakistanica, IC50 = 0.90 mgml(-1) > Tribulus terrestris, IC50 = 0.97 mgml(-1) > Solanum surattense, IC50 = 1.34 mgml(-1) Tephrosia subtriflora, IC50 = 1.40 mgml(-1) > Glycyrrhiza glabra (butanolic extract), IC50 = 1.66 mgml(-1) > Urtica dioica IC50 = 2.17 mgml(-1). Further studies are proposed to find out whether the inhibition of adrenaline-induced platelet aggregation is mediated through alpha-adrenoceptor blockade or suppressed synthesis of prostaglandin endoperoxides.

A study of candidosis: the role of fomites

This study investigates treatment failure and recurrences of vulvo-vaginal candidosis. It reviews the factors possibly associated with both. Patients attending a department of genitourinary medicine with recurrent candidosis (N = 186) were entered in the trial. The patients were investigated for evidence of candidosis from vagina, rectal wall and buccal mucosa and were given antifungal therapy. Prevention and reinfection via fomites was studied by means of a single blind parallel study comparing the effect of soaking undergarments in the amphoteric biocide Tego 103G with the effect of a placebo soak. General and possible contributory factors influencing treatment and failure and recurrences were considered. The success rate of miconazole therapy was typical of any imidazole therapy: 85.4%. There was no evidence that modern oral contraceptives played a role in candidosis. Oral nystan reduced the rectal wall carriage from 39.2% to 23.2%. Oral yeast carriage rate in women was 37.6%. The recurrence rate over a six month period was 47.4%. The laboratory results of Tego soaking reduced the yeast carriage on panties from 85.2% to 23.4%. However, no evidence was found in the trial results that panties were a significant source of reinfection.

Cardiovascular effects of Bacopa monnieri (L.) pennel extract in rabbits

The effects of the crude ethanolic extract of whole plant of Bacopa monnieri have been evaluated on left ventricular contractility, heart rate and coronary flow in isolated rabbit hearth showed cardiac depressive activity in all parameters, like quinidine.

An evaluation of the acute in vivo toxicity of benzylidenechroman-4-ones, 1-thiobenzylidenechroman-4-ones and benzylidenetetralones

A series of new compounds were evaluated for acute in vivo toxicity. Their synthesis and antifungal activity have previously been described by us. The naturally occurring class of compounds to which they belong - the benzylidenechroman-4-ones - have been identified as a potential source of new antifungal agents. These compounds were found to be less toxic, as judged by acute toxicity, than existing commercially available antifungals. A number of conclusions can be drawn about the relationship of structural changes in this series of compounds to increases or decreases in acute toxicity.

Changes in e.C.g. And electrolytes during coronary ligation in anaesthetized cat

The ligation of the coronary artery produces cardiac, and haemodynamic disturbances. Electrolytes disturbances were also noted during the assault (Harris et. al., 1954). In present experiments local cardiac ischaemia was produced by coronary ligation and changes in E.C.G. and electrolytes were noted at various stages. Pre-mature ventricular systoles and T wave inversion with an increase in K+ and decrease in Na+ was observed.

Evaluation of community-based rehabilitation in Punjab, Pakistan: I: Use of the WHO manual, 'Training disabled people in the community'

The WHO community-based rehabilitation programme has been tested in a village and a slum area in Pakistan. House-to-house surveys by physicians identified medical diagnoses and impairments and handicaps according to the ICIDH. Volunteer local supervisors from the communities were taught to identify and train disabled persons according to the CBR manual. The effect of training was evaluated after 1-2 years by an occupational therapist, using questions from the same manual. Of the 82 persons followed up, 80% showed improvement in function. The prevalence of disablement identified by the local supervisors and of handicap identified by a physician agreed well, and was of the order of 5%.

Evaluation of community-based rehabilitation in Punjab, Pakistan: II: The prevalence of diseases, impairments, and handicaps

A health survey using the impairment and handicap classifications from the ICIDH was carried out in conjunction with a study of the WHO community-based rehabilitation programme in a village and a slum area in Pakistan. The prevalence of handicaps defined in this way was about half that of impairments, the most common handicaps being with mobility, occupation, and social integration. There was a slightly higher degree of handicap in the village. In both areas diseases of the musculoskeletal system, the ear, and the respiratory tract were common, but the frequency of infectious, respiratory, endocrine, blood, and digestive diseases was higher in the slum area.

Declaring cure in women with gonorrhoea

The case notes of 426 women who had been treated for uncomplicated gonorrhoea in 1978-83 inclusive, were studied. The findings for 1978 formed a retrospective basis for a prospective study. The aim was to appraise the value of earlier and fewer follow up tests of cure. The new routine was associated with a more assertive approach to other modalities of control. It was concluded that the interests of individual patients, as well as those aimed at control, were adequately served by one set of smear and culture specimens. There was one proviso. Potential "repeaters" need to be identified and treated individually in terms of follow up testing.

Topical treatment of recurrent genital herpes simplex virus infections with trisodium phosphonoformate (foscarnet): double blind, placebo controlled, multicentre study

A double blind, placebo controlled trial was performed in nine sexually transmitted diseases (STD) clinics in the United Kingdom and the Netherlands to investigate the efficacy of trisodium phosphonoformate (foscarnet) cream in treating recurrent genital herpes simplex virus (HSV) infection. The study group comprised 145 male and 85 female patients. Men received 0.3% foscarnet cream and women 1% foscarnet cream for five days. The difference in time to healing between patients receiving foscarnet or placebo was not significant. Fewer patients treated with foscarnet had positive viral cultures after treatment, but the difference was not significant. The development of new lesions, however, was significantly less common in patients given foscarnet. Though topical foscarnet is a safe drug, no appreciable efficacy in treating recurrent genital HSV infection could be shown.

Cardioregulatory properties of indoramin in the rat

The antihypertensive action of the competitive alpha-adrenoceptor antagonist indoramin is not accompanied by reflex tachycardia in animals or man. The possibility that the established local anaesthetic property of indoramin is involved in its cardioinhibitory action has been investigated. Indoramin evoked a dose-dependent bradycardia in anaesthetized/pithed rats. The decrease in heart rate was slightly greater than that evoked in anaesthetized intact animals suggesting that indoramin had a direct action on the heart. Reflex tachycardia was simulated in pithed rats be increasing the frequency of cardiac nerve stimulation from 0.3 to 1 Hz. Indoramin and the local anaesthetic agents, lignocaine and procaine, reduced the positive chronotropic response without markedly altering the basal rate. The response curves were parallel. In contrast, phentolamine decreased the positive chronotropic response, but only at high doses which were associated with a marked decrease in the basal rate. Thymoxamine and prazosin had so significant effects on the chronotropic response. These experiments suggest that the cardioregulatory action of indoramin is attributable to its local anaesthetic property had this action further distinguishes it from the other alpha-adrenoceptor antagonists tested.

Prevalence of rectal and pharyngeal infection in women with gonorrhoea in Sheffield

The prevalence of gonococcal infection of the rectum and pharynx in 239 consecutive women with gonorrhoea presenting as named contacts was 47% and 10% respectively. In 2% of all patients the rectum and pharynx were each the sole sites of infection. Treatment failure occurred in three patients given a single dose of aqueous procaine penicillin 2.4 megaunits intramuscularly, two of whom had rectal infections; no treatment failures occurred in patients with pharyngeal infections. The incidence of rectal gonorrhoea significantly increased with the duration of infection (P less than 0.001). This suggests that autoinoculation from infected vaginal material is of major importance in the transmission of gonococcal infection to the rectum.