Eosinophilic spongiosis: a clinical, histologic, and immunopathologic study

BACKGROUND

Epidermal spongiosis with exocytosis of eosinophils (ES) has been reported in biopsy specimens from patients with various dermatoses. Its diagnostic value and the patient's outcome remain poorly understood in those cases in which ES is not associated directly with diagnostic features of a bullous dermatosis.

OBJECTIVE

We evaluated the clinical, histopathologic, and immunopathologic findings and their clinical correlation in patients who had ES in a biopsy specimen but who had no evidence of a bullous dermatosis.

METHODS

A retrospective study of 150 cases with ES was performed. Clinical, histopathologic, direct immunofluorescence, and subsequent follow-up data were collected to assess final diagnosis and outcome.

RESULTS

A total of 144 patients had generalized eruptions; of these, 34 (24%) had autoimmune bullous disease. Fourteen (41%) of those patients had neither a bullous nor a vesicular eruption. Other diagnoses included eczematous dermatitis, arthropod bites, scabies, and drug eruption.

CONCLUSION

The majority of patients whose biopsy specimen revealed only ES had either dermatitis or autoimmune bullous disease, often in the prodromal phase. Direct immunofluorescence is often necessary to distinguish these diseases, and repeated testing may be needed for final diagnosis.

Emergency department two-dimensional echocardiography in the diagnosis of nontraumatic cardiac rupture

Myocardial rupture is a catastrophic complication of acute myocardial infarction that usually results in sudden death. If diagnosed quickly, patients with myocardial rupture may be salvaged. This report describes the application of emergency department two-dimensional echocardiography in the diagnosis of six cases of myocardial rupture over two years. Each demonstrated a characteristic hemopericardium on limited single-window examination. These included four patients who met institutional guidelines for thrombolytic therapy. Three patients survived surgical repair, with two long-term survivors.

[Colonoscopic diagnosis]

Between 1974 and 1992, we perform 3,054 colonoscopies for diagnosis in 2,770 patients, both of sexes, between the ages of 1 and 101 yr, most of them over the fifth decade of life. In 300 procedures the bowel cleansing was made with the standard method of liquid diet and enemas, and in the other 2,754 with the oral administration of saline solution 9% with optimal results. We get the sedation of patients with the intravenous administration of diazepam 10mg, or pethidine 50 mg, or midazolam 2.5 to 5 mg, and in children with ketamine and the anesthesiologist assistance. In 95% of the procedures we can see the cecum and the ileum; the diagnosis was abnormal in 52.78% of cases, normal in 45.20%, and insufficient in 02.02% specially for a bad cleansing of the bowel. In the abnormal group, the most frequent diseases we diagnose were: polyps, cancer, diverticular disease, and specific inflammatory disease of the bowel like TBC, radiation proctosigmoiditis, amebiasis, and non-specific bowel disease: "colitis", ulcerative proctocolitis, erosive colitis, and Crohn's disease. Colonoscopy is a very important method for diagnosis of colon diseases, alone or complementary of double contrast X-ray of the colon.

[The control of arterial hypertension in primary care: the evaluation of a program of self-care]

OBJECTIVE

To evaluate the efficacy of a self-care hypertension programme within primary care.

DESIGN

Two models of intervention by means of self-care were compared, both using individual education and family support, with one of them using group education.

SETTING AND PATIENTS

All those attending 10 health centres in Andalucía and who had a recent diagnosis of light or moderate Hypertension or with their hypertension not monitored over the preceding 6 months, were included.

MEASUREMENTS AND MAIN RESULTS

These 160 people were assigned at random to the intervention group (group education) or the control group (individual education). Data analysis provided the results for the 95 people who completed the study. Both systolic and diastolic arterial pressure (SAP and DAP) diminished significantly during the study period, both in the sample as a whole and in the intervention group. However, the lessening of systolic pressure only reached statistically significant differences in the control group. Over the study period, the lessening of SAP was 6.2 in the intervention group and 8.0 in the control group; whereas the lessening of DAP was 7.0 in the intervention group and 2.3 in the control group.

CONCLUSIONS

Arterial hypertension can be controlled in primary care by health education for self-care. On the basis of this study's findings, it is not valid to conclude that group is more efficacious than individual education.

Effect of naloxone in the median eminence on gonadotrophin secretion in intact male rats

To evaluate whether the median eminence (ME) is a site of action of opioids on gonadotropin secretion, we injected naloxone into the ME in male rats and measured LH and FSH serum levels. Injection into the ME of either 0.5 or 1 microgram of naloxone significantly decreased serum LH levels 10 and 30 min postinjection. A dose of 0.1 microgram had not effect. Naloxone at the doses used had no significant effect on FSH secretion. From these data it can be concluded that endogenous opioids exert a tonic stimulation on LH secretion under our experimental conditions.

Mouth-to-mouth ventilation of cardiac arrested humans using a barrier mask

INTRODUCTION

Concern for possible disease transmission during mouth-to-mouth resuscitation has decreased the incidence of bystander cardiopulmonary resuscitation (CPR). Barrier masks have become available that may be effective in CPR as well as protective against cross-contamination.

HYPOTHESIS

A silicone rubber barrier mask incorporating a one-way-valved airway (Kiss of Life [KOL]) designed to prevent contamination of the rescuer, permits satisfactory mouth-to-mouth ventilation of victims of cardiopulmonary arrest.

METHODS

Ten adult patients who did not survive non-traumatic cardiac arrest were ventilated with exhaled room air using a KOL barrier mask while external cardiac massage continued. Arterial blood gases were obtained every two minutes for a maximum of 10 minutes. The operator was blinded to the results of these blood tests.

RESULTS

Eight men and two women with ages from 55 to 99 years were studied. Four patients were edentulous and two of these had marked mandibular atrophy. The two patients with mandibular atrophy were poorly ventilated with the barrier mask. One other patient was not ventilated successfully. This patient had undergone multiple attempts at endotracheal intubation and had transtracheal needle ventilation performed prior to use of the barrier mask. One patient had elevated PaCO2 despite being well-ventilated clinically. Six patients were ventilated well clinically and had satisfactory PaCO2 and PaO2 values.

CONCLUSION

The barrier mask studied appears to be an effective aid to ventilation in CPR. Patients without facial support, as in edentulous patients with mandibular atrophy, are not ventilated well with this device.

Modulation of LH secretion by progesterone and estradiol after naloxone injection in the median eminence

To evaluate whether the median eminence (ME) is a site of action of opioids on gonadotropin secretion, and to determinate the role of estradiol (E) and progesterone (P) in modifying these secretion in response to naloxone, we injected naloxone (1, 2.5 and 5 micrograms) into the ME in ovariectomized rats treated with estradiol benzoate (OVX+E) or ovariectomized rats treated with estradiol benzoate plus progesterone (OVX+E+P), and measured LH and FSH serum levels 10 and 30 min postinjection. Naloxone injection at doses of 2.5 and 5 micrograms significantly increased serum LH levels in OVX+E animals 10 and 30 min postinjection, whereas naloxone injection at all doses in OVX+E+P rats did not have any significant effect on LH secretion 10 and 30 min postinjection, when compared with values obtained in controls injected with saline. The injection of naloxone into the ME did not modify FSH secretion. We conclude that naloxone, acting within the ME, can elicit LH release in OVX+E rats, while it abolishes this effect in OVX+E+P rats.

Effects of estrogen-progestin replacement therapy on plasma beta-endorphin levels in menopausal women

Serum beta-endorphin, LH, FSH, estradiol (E2) and progesterone (P) were measured in postmenopausal women before and after four different estrogen-progestin replacement therapies. Our result showed that serum E2 increased significantly and serum LH and FSH decreased significantly after all treatments. Serum P levels were similar before and after all treatments. Serum beta-endorphin levels increased significantly after cyclic administration of estrogen-progestin, but not after continuous administration of E2. We conclude that the frequently observed beneficial effects of estrogen-progestin replacement therapy on behavior and mood in postmenopausal women may be related to changes in peripheral opioid levels.

Androgenic status in cyclic and postmenopausal women: a comparison between smokers and nonsmokers

Serum total testosterone (T), free testosterone (fT) sex hormone binding globulin (SHBG), androstenedione (A) and 3 alpha androstanediol glucuronide (3 alpha-diol G) levels as well as serum free androgen index (FAI), fT/T and 3 alpha-diol G/T ratios were measured in premenopausal and cyclic women, grouped according to sexual status and smoking status. Our results showed that serum T, fT, SHBG, A and 3 alpha-diol G levels were lower in cyclic women in the follicular than in the luteal phase of the ovarian cycle, although the differences between these values were not significant. Postmenopausal women had significantly lower values of T, fT, A 3 alpha-diol G, FAI and 3 alpha diolG/T but not SHBG and fT/T than cyclic women. When we compared women smokers and nonsmokers, women smokers had serum levels of T, fT, SHBG, 3 alpha-diol G, and values of FAI, fT/T and 3 alpha-diol G/T, similar to those in nonsmokers. Serum A levels were higher in women smokers than in nonsmokers, although the difference was significant only in postmenopausal women.

Emergency department echocardiography improves outcome in penetrating cardiac injury

STUDY OBJECTIVES

To determine the effect of immediate two-dimensional echocardiography on the time to diagnosis, survival rate, and neurologic outcome of patients with penetrating cardiac injury.

DESIGN

A ten-year retrospective review.

SETTING

Regional trauma center serving a population base of 1.25 million with 85,000 visits yearly.

TYPE OF PARTICIPANTS

All patients presenting to the emergency department with penetrating cardiac injury.

MEASUREMENTS AND MAIN RESULTS

The records of 49 patients with penetrating cardiac injury were reviewed. Of these, 28 received immediate two-dimensional echocardiography in the ED (echo group) and 21 did not (nonecho group). The probability of survival was derived using TRISS methodology. Differences between groups were determined using either the two sample t-test for parametric data or the Mann-Whitney test for nonparametric data. The overall probability of survival was 33.2%, and the actual survival rate was 81.6%. The probability of survival was 34.2% and 31.8% for the echo group and nonecho group, respectively. The actual survival was 100% in the echo group and 57.1% in the nonecho group. The average time to diagnosis and disposition for surgical intervention was 15.5 +/- 11.4 minutes for the echo group and 42.4 +/- 21.7 minutes for the nonecho group (P less than .001). The Glasgow Outcome Score was 5.0 for the echo group and 4.2 for the nonecho group (P = .007).

CONCLUSION

Since the introduction of immediate ED two-dimensional echocardiography, the time to diagnosis of penetrating cardiac injury has decreased and both the survival rate and neurologic outcome of survivors has improved.

Survival after emergency department versus operating room thoracotomy for penetrating cardiac injuries

The authors undertook a 6-year retrospective review to assess their experience with penetrating cardiac injuries. Special emphasis was placed on identifying patients with and without tamponade and those requiring emergency department (ED) thoracotomy. Forty-eight patients were identified. Overall survival was 64.6 per cent. Thirty-three patients had tamponade, with 20 requiring ED thoracotomy. Fifteen patients did not have tamponade and two of these needed ED thoracotomy. Five patients who had ED thoracotomy were long-term survivors (22.7%). The remaining 26 patients, 13 with tamponade and 13 without, received operating room (OR) thoracotomy and all survived. The data shows that excellent results are possible with OR thoracotomy for penetrating cardiac injuries, with or without tamponade. However, results are not as good when ED thoracotomy is necessary. This may relate to the severity of the injury, the duration of tamponade, or the inability to control cardiac bleeding during thoracotomy in the ED setting. Even though survival is low with ED thoracotomy, it is high enough to continue to support its use in the deteriorating patient with a penetrating cardiac wound.

[Antimalarial effect of n-hentriacontanol isolated from Cuatresia sp (Solanaceae)]

The antimalarial activity of the fatty alcohol, n-hentriacontanol, isolated from the bolivian Solanaceae, Cuatresia sp, is investigated in vivo through a classical four-day suppressive test against Plasmodium berghei and P. vinckei in mice. This product markedly reduced the virulence of experimentally induced P. vinckei infection. n-Hentriacontanol belongs to a new class of antimalarial natural compounds to be exploited for therapeutic purposes.

Internal cardiac massage and mediastinal irrigation in hypothermic cardiac arrest

Two unconscious patients with unknown past medical histories were found to be severely hypothermic, with core temperatures of 80.2 degrees F and 86.7 degrees F, respectively. During the course of active internal rewarming, both patients sustained a cardiac arrest. Emergency thoracotomies were immediately done, and internal cardiac massage with warmed mediastinal irrigation was performed. Spontaneous cardiac activity developed in both patients. Within 24 hours after resuscitation, both patients were responsive and following commands.

Correlation of emergency health care use, 911 volume, and jail activity with welfare check distribution

STUDY OBJECTIVES

The purpose of this study was to examine the relationship among emergency health care use, 911 call volume, and jail admissions with the timing of the distribution of General Assistance, Aid to Families With Dependent Children, and Minnesota Supplemental Aid welfare checks.

DESIGN

This was a retrospective study analyzing previously collected census and welfare check distribution data.

SETTING

The data used in this study were obtained from the Hennepin County Medical Center, the Hennepin County jail and alcoholic receiving center, and Department of Economic Assistance.

INTERVENTIONS

The daily census for the years 1986 through 1988 in the Hennepin County Medical Center emergency department, ED resuscitation room, pediatric ED, crisis intervention center, urgent care center, and alcoholic receiving center was obtained. The numbers of daily ambulance runs, nonelective hospital admissions, Hennepin County 911 calls, and Hennepin County jail admissions for the same years also were obtained. Means for each day of the month were computed across the 36 months of observation. These data were correlated with the number of days elapsed since the monthly issuance of the General Assistance, Aid to Families With Dependent Children, and Minnesota Supplemental Aid welfare checks.

MEASUREMENTS AND MAIN RESULTS

There were significant correlations between the number of days after distribution of the checks and the average values of the census of the alcoholic receiving center (r = -.96, P less than .00001), the ED (r = -.80, P less than .0001), ambulance runs (r = -.68, P less than .0001), 911 calls (r = -.45, P = .01), jail admissions (r = -.45, P = .01), nonelective hospital admissions (r = -.44, P = .01), and the crisis intervention center visits (r = -.39, P = .03).

CONCLUSIONS

The findings suggest that scheduling and staffing practices of various emergency service areas in Hennepin County reflect patient load variation associated with time of welfare check distribution. Systematic variation of time or amount of welfare could lead to improved distribution and reduction of emergency services demand.

[Continuous ambulatory peritoneal dialysis (CAPD): an alternative for the treatment of children with terminal chronic renal insufficiency in Argentina]

Twenty three children aged 0.4 to 15 years, (x 7.5 years) with end-stage renal disease were treated with continuous ambulatory peritoneal dialysis (CAPD) over 46 months. The mean time of treatment for the group was 13 months (range 1.0 to 31 months). Sixty five percent of the patients had readmission after catheter placement; 53% were for peritonitis. Nine out of 23 patients (39%), presented 20 episodes of peritonitis, an incidence of one episode per 15 patient months. Gram positive organisms were culture in 60% of these episodes. A total of 26 peritoneal catheters were placed in 23 patients. Of the five catheters that required replacement, three were for peritonitis. Seven out of 23 patients had nephrotic syndrome when admitted to CAPD, four of which develop peritonitis. Although no difference was seen between nephrotic and non nephrotic patients in relation to CAPD initiation and peritonitis development, nephrotic patients without peritonitis and non nephrotic had significantly higher initial growth index for height and iron binding capacity than those with nephrotic syndrome and peritonitis (-1.71 +/- 0.90 vs -2.29 +/- 0.27, P less than 0.05, and 265 +/- 50.5 vs 175 +/- 5.0 mg/dL, P less than 0.0005, respectively). No difference in mean plasma gamma globulin concentration was seen between patients with and without peritonitis. In 14 patients followed for a period greater than to 6 months, the delta growth index for weight and height and was: -0.13 +/- 0.31 and -0.31 +/- 0.46, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Fiberoptic intubation in the emergency department

Fiberoptic-aided endotracheal intubation has been shown to be effective in difficult intubation secondary to anatomic abnormalities and traumatic conditions. A retrospective review of emergency airway management in an emergency department during a 30-month period found 35 patients who underwent fiberoptic-aided endotracheal intubation; 31 were treated for medical conditions, and four were trauma patients. Indications in the medical group included failed nasotracheal intubation (ten), anatomic abnormalities (six), and the initial airway maneuver attempted (15). Indications in the trauma group with suspected cervical-spine injury included failed nasotracheal intubation (one) and initial airway maneuver attempted (three). In the medical subgroup, 25 of 31 patients were intubated successfully fiberoptically. All four trauma patients were intubated successfully, and all attempts were done nasally. The limitations of the technique were varied. Twenty of the 25 successful intubations had times recorded for completion (mean time, 1.8 +/- 1.4 minutes [SD]). Four of the six failed attempts had recorded times of 7.8 +/- 1.4 minutes. The mean time of the four trauma cases was 3 +/- 2.2 minutes. The presence of secretions, blood, or vomitus was the cause in five of the six failed intubations. The sixth patient kept swallowing the distal end of the scope. Fiscal restraints may also limit its use. At our institution, the financial commitment has been approximately +17,000 during the past nine years. Repair or replacement of broken equipment appears to be necessary every two or three years. Immediate airway control is often difficult with fiberoptic-aided endotracheal intubation and should be used only in selected patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Activity of the hypothalamo-pituitary ovarian axis in hypothyroid rats with or without triiodothyronine replacement

The hypothalamic pituitary ovarian axis in adult female rats with 131-I induced hypothyroidism was studied before and after triiodothyronine (T3) replacement. Forty days after 131-I, hypothyroid (H) rats showed irregular cycles with predominantly diestrous vaginal smears, atrophied and underweight ovaries, and decreased serum T3, T4, LH and estradiol (E2). T3 replacement restored normal cycles and ovary weight and increased serum E2 levels above control values, while LH levels remained below the limit of detection of the RIA. The GnRH stimulation test performed on the day that the rats exhibited diestrous vaginal smears elicited a greater increase in FSH than in LH in H rats and a greater increase in LH than in FSH in both H-T3 treated and control rats. The data suggest that the lack of thyroid hormones in adult female rats seems to produce a reversion of sexual hormones to a prepubertal pattern, while T3 treatment restored normal estrous cycles and ovarian function.

An analysis of time delays preceding thrombolysis for acute myocardial infarction

For a patient to derive maximal benefit from intravenous thrombolytic therapy for acute myocardial infarction, early treatment is essential. As part of the Thrombolysis in Myocardial Infarction II trial, this study investigated the time delays that preceded treatment of 236 consecutive patients with intravenous tissue-plasminogen activator (TPA) during acute myocardial infarction. The average (+/- SD) time from the onset of symptoms to treatment with TPA was 153 +/- 54 minutes. After arrival in the emergency department, patients waited an average of 19.9 +/- 17.8 minutes for the initial electrocardiogram. Following the diagnosis of acute myocardial infarction by electrocardiogram, an additional 70 +/- 40 minutes elapsed before thrombolytic therapy began. The interval between the initial electrocardiogram and initiation of treatment with TPA was less when the drug was first administered in the emergency department (46.8 +/- 23.4 minutes) rather than after transfer to the coronary care unit (82.1 +/- 34.7 minutes). In-hospital delays at the two academic and two private hospitals accounted for more than half of the total time from the onset of symptoms to initiation of thrombolytic therapy. We conclude that significant in-hospital delays are likely to occur before a patient receives thrombolytic therapy for acute myocardial infarction. Various factors conspire to create these delays, but a well-organized team approach to treatment will help to minimize delays in the implementation of this new form of therapy.

Incidence and diagnosis of C7-T1 fractures and subluxations in multiple-trauma patients: evaluation of the advanced trauma life support guidelines

A 5-year retrospective review was done to evaluate C-7 and C7-T1 cervical spine injuries and to assess the advanced trauma life support guidelines for cervical spine evaluation. Eighteen fractures of C-7 and four fracture-dislocation at C7-T1 were identified. Nineteen of the patients had neck pain, tenderness, or neurologic findings on initial examination. Three patients were awake and asymptomatic. The initial diagnosis could be made from lateral cervical spine x-ray film in only three of the 22 patients. In the remaining patients, the diagnosis was made by either swimmer's view (7 of 8 positive), oblique views (1 of 1 positive), flexion-extension views (2 of 3 positive), or computed tomography (CT) scan (7 of 7 positive). In two patients, the diagnosis was not made in the first 24 hours. Follow-up x-ray films were positive in 3 of 22 lateral cervical spine films, 10 of 14 swimmer's views, 2 of 3 oblique views, 2 of 3 flexion-extension views, and 14 of 20 CT scans. The data support the advanced trauma life support recommendation for liberal use of cervical spine radiologic screening. We recommend that the screening examination consist of a lateral cervical spine film, and a swimmer's view, if necessary, to visualize C-7 and the C7-T1 interspace. We further recommend that strong consideration be given to the use of a five-view trauma series. CT scan should be viewed as complementary to conventional film techniques.

A comparison of open peritoneal lavage with modified closed peritoneal lavage in blunt abdominal trauma

A randomized prospective study compared open peritoneal lavage using a peritoneal dialysis catheter with modified closed lavage using either the Lazarus-Nelson or Cook lavage catheter. The time required to perform the lavage, technical difficulties, complications, and accuracy were assessed in 63 adult victims of blunt abdominal trauma. The average time to perform lavage was 21.1 minutes for open lavage, 14.7 minutes for Lazarus-Nelson closed lavage, and 9.8 minutes for Cook closed lavage. The closed technique using the Cook catheter was significantly faster than open lavage. Technical difficulties were significantly less frequent with Cook catheter closed lavage than with Lazarus-Nelson catheter closed lavage. The overall complication rate was 1.8%, and the overall accuracy was 98.1%, without apparent difference among techniques. It is concluded that, when no contraindications to closed lavage exist, and when time is of importance, closed lavage with the Cook catheter is the preferred technique.

Comparison of single-dose meperidine, butorphanol, and dihydroergotamine in the treatment of vascular headache

We treated 64 emergency room patients with a primary vascular headache with dihydroergotamine (DHE), meperidine, or butorphanol. Post-treatment pain scores were lowest in the DHE group (p less than 0.01). Eight of 21 patients receiving DHE had greater than 90% reduction in pain compared with three of 19 patients receiving butorphanol and none of 22 receiving meperidine.

Cricothyrotomy in the emergency department revisited

Thirty-nine emergency cricothyrotomies were reviewed from the emergency department of Hennepin County Medical Center during the 4-year period ending December 1985. Due to technical changes in airway management and a desire to assess their impact, this experience was compared with a previously reported series of 38 emergency cricothyrotomies from the same department. Technical changes include the use of paralyzing agents, transtracheal needle ventilation, and the use of only vertical skin incisions and #4 Shiley tubes when cricothyrotomy is performed. The presenting problem, indications for cricothyrotomy and complications of the procedure were compared between the two series. Fewer cricothyrotomies were done as a fraction of total surgical and nonsurgical tracheal intubations in the present series (1.7%) compared to the previous series (2.7%). The complication rate decreased from 40% in the previous series to 23% in the present series. Incorrect site of tube placement (10%) and hemorrhage (8%) remain the two leading complications. However, the tube was in the trachea in all cases, and acceptable ventilation was achieved. No patient developed a clinically significant hematoma or hemorrhage from cricothyrotomy. It is concluded that our technical changes in airway management have helped to decrease both the relative frequency of cricothyrotomy and the complication rate.

Balance of production and consumption of ATP in ammonium-starved Saccharomyces cerevisiae

To establish a balance between the ATP produced in catabolism and the ATP consumed in net biosynthesis of cellular components the energy metabolism of Saccharomyces cerevisiae utilizing glucose in the absence of a nitrogen source (resting cells) was studied. The following results were obtained. (i) Cell number and biomass increased 2- and 2.5-fold, respectively, during the first 8 h of ammonium starvation. After this period, both values remained constant. (ii) The rate of sugar consumption and ATP production decreased with the duration of starvation to about 20% of the original in 24 h. (iii) About 60% of the sugar consumed was fermented to ethanol and about 10% assimilated as cellular material. Of the assimilated sugar, as much as 80% was accumulated as carbohydrate. (iv) Only 15% of the total ATP produced in catabolism seems to be consumed in net biosynthesis and maintenance of intracellular pH. The fate of the remaining 85% is unknown.

[Effects of age and obesity on the conversion of androstenedione to estrone in postmenopausal women]

The effects of aging as well as body weight on conversion of circulating Androstendione (A) to Estrone (E1) in 21 postmenopausal women of different ages and body weights have been studied. Serum concentration of A and E1 were measured by RIA. The E1/A ratio was correlated with total body weight, body mass index, excessive body weight, age and years after cessation of menstruation. The results show that the E1/A ratio was significantly correlated with total body weight, body mass index and excessive body weight. In contrast the E1/A ratio is not significantly correlated with age or years after cessation of menstruation.

Influence of intracerebroventricular (ICV) injection of ACTH (1-24) on plasma gonadotropin in female rats: dose-response study

The intracerebroventricular (ICV) injection of ACTH (1-24) (0.1, 1.0 and 2.5 micrograms) to adult conscious ovariectomized (OVX) rats caused a dose-related inhibition of plasma LH at 10 min postinjection. The ICV injection of ACTH (1-24) (2.5 micrograms) to OVX rats in the absence or presence of a single dose of estradiol benzoate (OVX + EB): a) Decreased significantly plasma LH levels in OVX rats at 10 and 30 min postinjection. b) Decreased significantly plasma LH levels in (OVX + EB) rats at 10 min but not at 30 min postinjection. c) Did not change plasma FSH levels at 10 or 30 min postinjection in both (OVX) or (OVX + EB) rats. d) Did not change plasma ACTH levels at 10 or 30 min postinjection in (OVX) rats. Our observation suggest that ACTH (1-24) inhibited plasma LH, possibly through brain sites of action.

Comparison of gastric lavage and thoracic cavity lavage in the treatment of severe hypothermia in dogs

A study was undertaken to compare warm gastric (Group 1) and closed thoracic cavity (Group 2) lavage for rewarming severely hypothermic dogs. Adult mongrel dogs were monitored by intra-arterial catheter, central venous catheter, and ECG, and by central venous, esophageal, and rectal temperature probes. Animals were externally cooled to an average of 21.2 C using ice bags. Eight Group 1 and eight Group 2 animals underwent continuous warm saline gastric or closed thoracic cavity lavage, respectively, using afferent and efferent nasogastric and thoracostomy tubes. No animal suffered ventricular fibrillation during tube placement. The closed lavage system consisted of a high-efficiency heat exchanger, a roller pump infusion device, and a heat exchange fluid bath. The lavage fluid circulated at a flow rate of 550 mL/min and a temperature of 39 C. Thoracic lavage animals were followed clinically for 24 hours for evidence of complications, then euthanized and autopsied. The mean time required to rewarm the animals 10 C by central venous temperature probe was 210.9 +/- 18.6 minutes for the gastric group and 99.3 +/- 23.0 minutes for the thoracic group (P less than .001). Rectal temperature consistently lagged behind central venous temperature during both the cooling and rewarming phases in both treatment groups. All of the thoracic lavage animals made an uneventful recovery. Continuous warm saline thoracic cavity lavage for core rewarming of severely hypothermic dogs is more effective than gastric lavage, and appears to be safe.(ABSTRACT TRUNCATED AT 250 WORDS)

Testosterone implants into the lateral septum of male rats, a positive effect on LH and FSH secretion

After two days, testosterone implanted into the lateral septum increased serum levels of LH and FSH in male Wistar rats. As measured by RIA, LH in animals with testosterone implanted in them in comparison to those with an empty cannula was 0.220 +/- 0.015 vs. 0.111 +/- 0.019 ng/ml; p less than 0.001 and FSH was 3.20 + 0.21 vs. 1.50 + 0.21 ng/ml; p less than 0.001. Serum testosterone was not increased to a statistically significant extent by the implants (4.12 +/- 0.54 vs. 2.87 +/- 0.42 ng/ml; ns). It was concluded that testosterone or possibly one of its metabolites acting in the lateral septum facilitates the release of LH and FSH.

Use of pneumatic antishock trousers in the management of pediatric pelvic hemorrhage

We applied pediatric pneumatic antishock trousers to five young patients who had severe pelvic fractures with evidence of significant retroperitoneal hemorrhage. The trousers were in place for 24 to 96 hours. Utilization of the trousers resulted in stabilization of vital signs and appeared to have decreased ongoing pelvic hemorrhage. No significant complications were noted. We describe a technique for long-term maintenance of pressure within the pneumatic antishock trousers.

Haloperidol for sedation of disruptive emergency patients

Agitated, threatening, or violent behavior often jeopardizes the patient with self-inflicted injury or delays medical evaluation and treatment. Patient cooperation with therapy can be achieved using haloperidol by the IM, IV, or oral route. The safety and efficacy of haloperidol in the emergency department setting was examined. Haloperidol was administered to 136 patients to control behavior. Eighty-eight received the drug in the ED; 18 of these 88 were critical patients receiving the drug during resuscitation. Forty-eight of the 136 were crisis intervention center patients. Ninety patients were acutely intoxicated with ethanol. Twenty-three patients had head trauma; 20 of these also were inebriated. Various other drugs were responsible for the behavior of 15 patients. Acute psychosis was involved in 40 cases. Thirty-one patients were thought to have a personality disorder. The route of administration of haloperidol was intramuscular in 110, IV in 19, and oral in seven patients. Disruptive behavior was alleviated within 30 minutes in 113 of 136 (83%) patients. Effect was judged suboptimal in 20 of 136 (15%), and no effect was noted in three of 136 (2%) patients. Four complications (3%) were noted, three minor and one more serious episode of hypotension in a critical patient. Haloperidol is a safe and efficacious drug for use with disruptive patients in the emergency setting. It is a useful tool for management of agitation of diverse etiologies.

A trial of povidone-iodine in the prevention of infection in sutured lacerations

A prospective, randomized study of 500 consecutive emergency department patients with traumatic lacerations requiring sutures was performed comparing use of topical 1% povidone-iodine (Betadine) and scrubbing with wound management by irrigation with normal saline without scrubbing. A 60-second wound irrigation and scrub with a 1% povidone-iodine solution was the only difference in treatment between the two groups. Data relating to risk factors such as age; degree of contamination; type of closure; ethanol intoxication; mechanism of injury; and bone, joint, or tendon involvement were analyzed. Wounds were classified as clean, infected, or purulent at follow-up examination. One hundred five patients were lost to follow-up. Of the 395 remaining patients, 122 were contacted by phone and were classified based on their description of the wound; 273 were classified at reexamination in the ED. Of 201 povidone-iodine group wounds, 11 became infected; two of them (5.4%) were purulent. Of 194 control wounds, 30 became infected, of which 12 (15.46%) were purulent (P less than .01). These data suggest that use of a topical 1% povidone-iodine solution in traumatic lacerations prior to suturing reduces the incidence of wound infections.

Frequency of hypokalemia after successfully resuscitated out-of-hospital cardiac arrest compared with that in transmural acute myocardial infarction

To evaluate the prevalence of hypokalemia in out-of-hospital cardiac arrest, the initial serum potassium and arterial pH values were reviewed from 138 consecutive patients resuscitated from cardiac arrest. For comparison, the same variables were reviewed for 62 consecutive patients who had transmural acute myocardial infarction (AMI) without cardiac arrest. The mean serum potassium level was lower after resuscitation from cardiac arrest (3.6 +/- 0.6 mEq/liter) than during AMI (3.9 +/- 0.5 mEq/liter) (p less than 0.005). The incidence of hypokalemia (potassium less than 3.5 mEq/liter) was greater in patients sustaining cardiac arrest (41%) than in patients who had AMI without cardiac arrest (11%) (p less than 0.001). Hypokalemia was common after cardiac arrest regardless of the occurrence of AMI at the time of arrest. Hypokalemia after cardiac arrest was independent of arterial pH, epinephrine or bicarbonate therapy during resuscitation, or prior therapy with diuretic drugs, digoxin or propranolol. In 10 patients with marked hypokalemia, the serum potassium level returned to normal rapidly (16 hours) during the hospitalization even though only 29% of the predicted potassium requirement was infused before its normalization. Thus, hypokalemia is prevalent immediately after out-of-hospital cardiac arrest, whereas it is uncommon in AMI in the absence of cardiac arrest. The cause and electrophysiologic consequences of this hypokalemia are unknown; in most cases, it is apparently caused by a shift of potassium from the intravascular compartment rather than a total body depletion of potassium.

Cerebral resuscitation after cardiac arrest using hetastarch hemodilution, hyperbaric oxygenation and magnesium ion

This study was done to investigate the effects of hemodilution, hyperbaric oxygenation, and magnesium sulfate on cerebral resuscitation. Sixteen mongrel dogs were anesthetized, and monitored via pulmonary artery catheter, arterial catheter and electrocardiogram. A left lateral thoracotomy was done. Ventricular fibrillation was obtained by application of a 6-volt AC current. Mechanical ventilation was stopped. Total arrest time was 12 min. All dogs were cardiac resuscitated within 6 min using internal massage, ventilation, bicarbonate, epinephrine and internal defibrillation. The animals were then randomized into three groups. Group I represented controls, and were not treated. Group II dogs received normvolemic hemodilution using hetastarch (Hespan) containing magnesium sulfate (2000 mg/l), resulting in a hematocrit of 20%-30%. Group III dogs received the above hemodilution plus compression in a hyperbaric oxygen chamber to 2 atmospheres absolute. Critical care management and hourly neurologic scoring was performed for 7 days by blinded observers. All dogs at the time of death underwent autopsies for gross study. Data analysis revealed no statistical difference among the three groups with respect to survival time, cardiac function or neurologic scoring.

[Influence of body weight on gonadotrophins and steroid hormone levels in menstruating women]

In order to study the effect of obesity or underweight on gonadotropins and steroid hormone levels, serum concentrations of FSH, LH. Testosterone, Estradiol, Estrone, 17-OH-Progesterone and SHBG were measured by RIA in obese, underweight and control women, all menstruating in the follicular phase. Serum concentrations of all parameters measured did not differ significantly in the underweight and control groups. All obese women had higher levels of estrone than the control group, and only obese patients with a body mass index above 39 showed a lower SHBG level than that of the control group. The data suggest that the increased levels of estrone could play a role in the amenorrhea of obese women.

Phenytoin: does it reverse tricyclic-antidepressant-induced cardiac conduction abnormalities?

Case reports have appeared describing a beneficial effect of phenytoin in reversing cardiac conduction abnormalities induced by tricyclic antidepressant (TCA) overdose. Controlled studies have not been published. The following questions were addressed using intravenous amitriptyline and phenytoin in a rabbit model: Can prophylaxis with phenytoin before amitriptyline poisoning forestall the onset of cardiac abnormalities? Would such prophylactic phenytoin administration allow a higher dose of amitriptyline before death occurs? Would phenytoin reverse the cardiotoxic effects of amitriptyline once in progress? Animals were used in repeated trials with one-week "washout" intervals and served as their own controls in all but the final trial. Prophylactic phenytoin did not change the potency of amitriptyline in inducing abnormal cardiac performance, nor did it allow the animals to be titrated to a higher dose of amitriptyline before death occurred. In 12 animals, phenytoin "rescue" at the point of a widened QRS or arrhythmia was attempted. Two showed improvement; the remainder did not. Because this portion of the experiment was neither blinded nor controlled, nor were respirations or blood pressure monitored, these results must be viewed cautiously. Although our results suggest that prophylactic phenytoin is not useful, its role in therapy of occasional cases requires further investigation.

Partial psychic seizures and brain organization

This research was an attempt to determine the cerebral areas involved in focal epileptic seizures accompanied by psychic manifestations. Six types of partial seizures involving psychic symptomatology and phonatory seizures were included in the study. Sixty-one clinical records of focal epilepsy, which had been revealed by means of a CT-scan examination, were analyzed and a subsample of 25 patients with psychic symptoms was selected. The scans taken of the lesions were transferred to a six-level standard template built for this purpose. Subsequently, templates of patients with the same type of seizures were superimposed. The critical zones for the seven types of seizures studied are presented. A clear correlation was found between these results and our present knowledge of functional brain organization.

A comparison of the supraclavicular approach and the infraclavicular approach for subclavian vein catheterization

Five hundred emergency department patients requiring subclavian vein catheterization were randomized prospectively into one of two groups, supraclavicular or infraclavicular. If catheterization was unsuccessful in a few attempts using the randomized approach, catheterization with the alternate approach was attempted. Two catheters were available for use, a short, 8-French introducer and a long, 16-gauge catheter. There were 38 failures (15.5%) among 245 patients in the supraclavicular group, with one malposition and five complications. There were 51 failures (20.0%) among 255 patients in the infraclavicular group, with 21 malpositions and 13 complications. No differences were significant except that of malpositions (P less than .01). The combination of infraclavicular approach and 16-gauge catheter accounted for 21 of 22 malpositions. When catheterization by the randomized approach failed, catheterization by the alternate approach was successful in all but seven cases, resulting in an overall success rate of 98.6%. Analysis of this series suggests that both the infraclavicular and supraclavicular approaches to subclavian vein catheterization are acceptable alternatives, with little difference in success rate or complications. Using an alternate approach if the initial approach was unsuccessful produced a high overall success rate and a low overall complication rate. A physician who is familiar with both approaches will be more successful at placing central venous catheters safely.

Neuromuscular blockade for critical patients in the emergency department

This retrospective study examines the indications and the effects of 119 doses of succinylcholine or pancuronium given in the emergency department during a 24-month period to patients considered to have immediately life-threatening emergencies. The most common indication for succinylcholine was to accomplish tracheal intubation (20 of 25 patients). Indications for pancuronium included computerized tomography of the head (60 of 94), control of agitation (40 of 94), facilitation of tracheal intubation (20 of 94), control of ventilation (12 of 94), and control of seizure unresponsive to anticonvulsants (4 of 94). Deterioration following succinylcholine occurred in three cases. These included two involving bradycardia and one involving ventricular tachycardia. Major complications following pancuronium included four incidences of ventricular arrhythmias. Intubation failure requiring surgical airway occurred in one patient given succinylcholine, two patients given pancuronium, and one patient who received both succinylcholine and pancuronium. Inadequate documentation of neurological examination prior to blockade was noted in six of 25 succinylcholine and nine of 94 pancuronium cases. Failure to sedate patients who might be aware of paralysis occurred in three of 25 succinylcholine and eight of 94 pancuronium uses. Neuromuscular blocking agents facilitate expeditious management of selected critical patients in the ED. Their prudent use requires anticipation of potential complications, preparation for surgical airway should intubation fail, documentation of physical examination before paralysis, and prior sedation when the patient responds to pain.