Growth hormone and prolactin stimulation by Madopar in Parkinson's disease

Madopar, a combination of levodopa with benserazide, induced an inconsistent rise in plasma growth hormone in unmedicated patients with Parkinson's disease and in controls, and a greater growth hormone rise in Parkinsonian subjects on chronic Madopar therapy. In subjects on chronic therapy with levodopa and carbidopa (Sinemet), the growth hormone releasing effect of Madopar was blunted. Madopar increased plasma prolactin (PRL) in controls, unmedicated patients and patients on Madopar therapy while in patients on Sinemet therapy the PRL-releasing effect of Madopar was strikingly reduced. Since these data were interpreted as due to a defective dopamine tone in the hypothalamus of Parkinsonian subjects on Madopar but not Sinemet therapy, a direct dopamine receptor agonist, lisuride was administered. Lisuride, however, elicited a blunted growth hormone response both in patients on Madopar and Sinemet therapy, without revealing a state of supersensitivity of dopamine receptors for growth hormone control in Parkinsonian subjects on Madopar therapy. No difference was present in the PRL-lowering effect of lisuride in the different experimental groups. These findings suggest that: (1) hypothalamic dopamine function is impaired in Parkinsonian subjects on Madopar therapy, preserved in unmedicated patients and enhanced in patients on Sinemet therapy; (2) the endocrine effects observed in Parkinsonian subjects on chronic Madopar therapy may be due to some penetration of benserazide across the blood brain barrier in the region of the hypothalamus; (3) since Madopar and Sinemet are in essence equally effective antiparkinsonian remedies, penetration of benserazide does not occur across the blood brain barrier surrounding the nigrostriatal system.     

Cine CT of the mediastinum in pediatric patients

Cine computed tomographic (CT) examinations of the mediastinum were performed in 83 pediatric patients. Lesions imaged include neoplastic, inflammatory, and vascular abnormalities. The 50-msec scan time of cine CT provides for superb depiction of the heart and airway, minimizes motion artifact, allows examinations to be done with little or no sedation, and permits optimal opacification of all vascular structures with as little as 0.5 mL of intravenously administered contrast medium per kg of body weight. Scanning time for an examination in which images in 20 sections are obtained is approximately 10 seconds. Radiation dose is significantly lower than that in comparable CT or plain radiographic studies. Preliminary experience shows cine CT to be an excellent imaging modality for the examination of the mediastinum in children.     

Red cells in sickle cell crisis: observations on the pathophysiology of crisis

The pathophysiology of the occurrence and resolution of sickle cell crisis is unknown. The molecular abnormality is constant, while crisis is episodic. In the present study, red cell filterability and sickling with deoxygenation have been measured during sickle cell crises. Recovery from sickle crisis is associated with an increased filterability of the circulating red cell and a decreased susceptibility of the red cell to sickle with deoxygenation (p less than 0.05). The possibility that these changes are responsible for the resolution of crisis is suggested.     

EFFECT OF KETANSERIN ON INTRAOPERATIVE BLOOD LOSS DURING TOTAL HIP ARTHROPLASTY IN ELDERLY PATIENTS UNDER GENERAL ANAESTHESIA

We have studied the effect of ketanserin, a selective serotoninS-receptor antagonist, on surgical bleeding in a double-blind,placebo-controlled study in elderly patients undergoing totalhip arthroplasty. One group of patients (n = 9) received ketanserin10 mg i.v. followed by an infusion of 0.075 mg kg^–1 h^–1The second group (n = 8) received placebo. Both groups werecomparable with regard to age, height and body weight. Meanintraoperative blood loss was 454 ml with ketanserin and 894ml with placebo (P = 0.004; Wilcoxon two-sample test). Meanduration of the operation was less with ketanserin (112 min)than with placebo (134 min) (P = 0.004), but rate of blood losswas also less with ketanserin (4.1 vs 6.7 ml min^–1; P= 0.03). In the ketanserin group, mean arterial pressures tendedto be less than in the placebo group. Reductions in centralvenous pressure were similar in both groups. There were no complicationsin relation to the use of ketanserin.     

Unintended pregnancies in women delivering at 18 South American hospitals. NFP-ECLAMC Group. Latin American Collaborative Study of Congenital Malformations

Unintended pregnancies are accepted as associated with social, maternal and perinatal risks, but few data exist in South America. In a selected network of hospitals participating in the ECLAMC (Spanish acronym for Latin American Collaborative Study of Congenital Malformations), the frequency of unintended pregnancies was 49.8% in 5155 mothers of normal liveborns, as interviewed in the post-partum period (1992-1994). Compared with the intended pregnancy group, these mothers were more frequently multiparous, conceived easily, had a surprisingly higher mean maternal age, lower educational level, and Black ancestors. The frequency of mistimed pregnancies was the highest among primiparae. No adverse perinatal outcome could be found with regard to low birthweight (< 2500 g), prematurity (< 37 weeks), and early neonatal death. The rates of Caesarean delivery, twinning and sex ratio were similar in intended and unintended groups. Logistic regression analysis showed that maternal education could be a confounding factor associated with other maternal variables. The rate of unintended pregnancies in the present study is significantly higher than that described for other regions. Knowledge of the characteristics of women experiencing unintended pregnancies would allow proper public health strategies.      

Anastomotic strictures of the upper gastrointestinal tract: results of balloon dilation

Enteroenteric anastomotic strictures of the upper gastrointestinal tract are common and require treatment if significant obstruction occurs. The authors performed 44 fluoroscopically guided balloon dilations in 19 patients with symptomatic anastomotic strictures. The anastomoses were esophagoesophageal (n = 5), esophagogastric (n = 8), esophagoileocolonic (n = 4), and gastrojejunal (n = 2). Nine patients required only one balloon dilation for stricture lysis and relief of clinical symptoms. Recurrent symptoms developed in the remaining ten patients, who required two to eight dilations. Radiographically, stenoses made up 40%-90% of the anastomotic lumen before dilation (mean, 72%). Complete resolution of the stricture was achieved during the procedure in 24 instances. Residual stenosis in 18 instances varied from 7% to 45% (mean, 21%). Two complications, a mucosal tear and a perforation, were immediately recognized and successfully treated non-operatively. The authors conclude that fluoroscopically guided balloon dilation has an important role in the treatment of anastomotic strictures of the upper gastrointestinal tract.     

Percutaneous aspiration thromboembolectomy

Percutaneous aspiration thromboembolectomy (PAT) was used as an angioplastic tool to remove from arteries of the lower limbs thromboembolitic material originating from any source. PAT was performed with a custom-designed catheter/sheath system, alone or in combination with balloon dilatation and/or local lytic infusion therapy with streptokinase or urokinase. PAT completed the restoration of blood flow, thus improving the results of the preceding angioplastic interventions. Clinical improvement was high, with 93% success (42 of 45 procedures). Only one below-the-knee amputation occurred, and could not be prevented. No patient became worse because of PAT intervention. The Fogarty catheter technique remains the method of choice for removing emboli within the aorto-iliac region, but in the smaller vessels below the inguinal ligament-especially in the distal superficial femoral, popliteal, and tibial regions--in our experience PAT is superior. This has been substantiated also in studies of laboratory animals, using barium-impregnated emboli.     

The window for embryo transfer in oocyte donation cycles depends on the duration of progesterone therapy

In 192 oocyte donation cycles performed between January 1993 and July 1996, we examined the width of 'the window for embryo transfer' using standard hormonal replacement methods. All transfers were performed within 48 h of insemination. We varied the day of embryo transfer with regard to the initiation of progesterone therapy and, thus, the duration of endometrial exposure to progesterone and analysed the resulting pregnancy rates. Patients were divided into five groups (I-V) and embryo transfers were performed 2, 3, 4, 5 or 6 days following initiation of progesterone therapy. The number of pregnancies per transfer cycle achieved in groups I-V were 0 (0%), 3 (12%), 16 (40%), 29 (48.3%), and 10 (20.4%) respectively. The increased pregnancy rate in group III in comparison to group II is statistically significant (P < 0.03). Furthermore, the pregnancy rate in group IV (5 days of progesterone administration before embryo transfer) was significantly higher than in group V (6 days of progesterone administration before embryo transfer; P < 0.005). We also noted that, when embryos were transferred 4 or 5 days after initiation of progesterone therapy, the pregnancy rates were not significantly different between menopausal and cycling recipients (50% vs 43.7%). Our results indicate that the window for embryo transfer is dependent on duration of treatment with progesterone; it begins approximately 48 h after starting progesterone administration and lasts for approximately 4 days. The optimum period for transferring embryos at the 4- to 8-cell stage corresponds to cycle days 18 and 19. Transfers performed on the 17th and 20th days of the cycle can result in successful implantation, although the rates of implantation are highest when transfers are done on days 18 and 19.