ISOLATED LIVER PERFUSION: THE CHOICE OF ANAESTHETIC

Perfused livers isolated from rats under halothane anaesthesia produced greater amounts of bile, released smaller amounts of aspartate aminotransferase, and had a much greater ability to maintain a constant concentration of glucose in perfusates than those obtained with ether or pentobarbitone. Little or no effect was shown on the ability of the liver to synthesize urea and to retain potassium within the organ. It appears, therefore, that halothane is the anaesthetic of choice when removing the liver from the laboratory rat.     

The Health of Subjects Living with a Permanent Ileostomy

The alms of the present study were to survey the general stateof health of a group of fleostomists, including social, psychologicaland sexual aspects, and to investigate a range of metabolicfunctions in the same patients. The subjects studied were takenat random from patients who had been treated by proctocolectomyand ileostomy in Oxford. There were 39 subjects whose operationhad been performed for ulcerative colitis and 12 subjects whohad had the operation for Crohn's disease involving the colon.A control group consisting of 39 healthy volunteers, matchedfor age and sex with the 39 patients who had had ulcerativecolitis were also studied. The general health of the ileostomists,as judged by their medical history, the findings on completephysical examination and the results of standard biochemicaland haematological investigations was good or excellent Virtuallyall were pursuing their normal occupations. Most of them enjoyedtheir normal recreations but several had given up swimming.An appreciable number considered that they had received inadequateexplanation and guidance before and after the institution ofthe ileostomy. Psychological abnormalities, as judged by responsesto standard inventories, were minor. There was little evidenceof physical impairment of sexual activity but psychologicalproblems were not unusual . The dietary habits of the ileostomists were essentially normalbut they consumed more fluid and more salt than the controlsubjects. In spite of this, the ileostomists showed evidenceof mild dehydration and aldosteronism. It is recommended thatan Qeostomist should consume 15 ml/Kg body weight of additionalfluid and 100 mg/Kg body weight of additional salt each day.There was a mild degree of iron deficiency which was correctibleby oral supplements. Vitamin B₁₂ absorption was enhanced inthe ileostomists who had had ulcerative colitis. There was noevidence of folate depletion. The ileostomists had increasedretention of calcium. This suggests that they were probablydeficient in calcium at the time of operation and were slowlycorrecting the deficit. Male ileostomists had a high incidenceof urinary stones, possibly related to a low pH and volume ofthe urine and a high level of plasma uric acid. The ileostomistshad a high incidence of gallstones. The gastrointestinal hormoneprofile in the fleostomists showed significant differences fromnormal in the values of motflin, en-teroglucagon and neurotensin.     

Counterelectrophoresis in the Diagnosis of Amebiasis

One hundred eighty-one collected sera were tested for amebic serologic reactivity, using the counterelectrophoresis technic (CEP) and compared to the results of the agar gel diffusion (AGD) and the latex agglutination (LA) methods. Of 23 sera from patients with proven amebic liver abscess, 22 (96%) were positive immediately after CEP for one hour and all were positive within 24 hours. Of eight sera from patients with intestinal amebiasis, five were positive immediately and seven within 24 hours. Of 150 sera from patients with nonamebic illnesses, there were no positives with any method used. The CEP and AGD were in agreement on all sera tested.     

Claude Bernard (1813–1878)

The life and works of Claude Bernard (1813-1878) have been discussed with special reference to the importance of his researches in relation to modern anaesthesia and in commemoration of the centenary of his death.     

NEUROMUSCULAR REFRACTORINESS DURING BLOCKAGE OF TRANSMISSION: A quantitative study

The effects of suxamethonium and tubocurarine on the refractorinessof neuromuscular transmission were studied in 21 anaesthetizedadult subjects under various levels of neuromuscular block.The ulnar nerve was stimulated every 12 s with twin supramaximalstimuli 4 ms apart. At any level of block, the refractory fraction(the fractional decrement of the compound electromyographicresponse of the adductor pollicis to the second twin stimulus,relative to the response to the first) was used to quantifyneuromuscular refractoriness. The magnitude of block was determinedby the response to the first stimulus. Correlation between refractorinessand the degree of block was sought. Without block, neuromusculartransmission averaged 23% (SEM 4) refractory with this twininterval. The refractory fraction was increased markedly bysuxamethonium, reaching 0.69 (SEM 0.1) at 50% block. Completerefractoriness occurred during 25–75% block in eight of11 instances. Tubocurarine did not significantly alter refractoriness,paired responses to the twin stimuli decreasing proportionatelyduring block.     

Independence of Gonadotropin and Adrenal Androgen Secretion*

Fünf Gruppen von je fünf gesunden erwachsenen Männern wurden untersucht. Die Gruppe l erhielt Clomiphen, Gruppe 2 exogenes FSH und Gruppe 3 Testosteron. Diese drei Gruppen erhielten die Medikamente, urn FSH und LH zu stimulieren, und um jeweils die Spiegel von FSH oder LH anzuheben oder zu senken. Die Werte für Testosteron (T), Östron (E₁) und 17-Hydroxyprogesteron (17-OHP) im Blut änderten sich, während die Serumkonzentrationen von Androstendion (A), Dehydroepiandrosteron (DHA), Dehydroepiandrosteronsulfat (DS) und der 17-Ketosteroide (17-KS) im Urin gleichblieben. Bei den anderen zwei Gruppen von fünf erwachsenen Männern wurden die Spiegel der NNR-Androgene durch die Verabfolgung von Dexamethason oder ACTH unter-drückt oder stimuliert. Die Serumwerte von 17-OHP, A, DHA und DS sowie die 17-KS im Urin wurden verändert, während die Gonadotropine gleich blieben. Damit hat sich gezeigt, daß keine Beziehung zwischen den Werten für die NNR-Androgene und den Gonadotropinen im strömenden Blut besteht.     

Low-level chronic mercury exposure in children and adolescents: Meta-analysis

BACKGROUND: Mercury is a well-known neurotoxin. There are three kinds of mercury exposure: elemental mercury poisoning, inorganic mercury poisoning and organomercury poisoning. Organomercury is the most toxic. Twenty-four hour urine for mercury and blood mercury are the gold standards for diagnosis of mercury poisoning, including low-level chronic mercury exposure. Other tests for mercury level are discussed. The purpose of the present paper was to review recent data on the nature, pathophysiology, pharmacokinetics, diagnostic methods, treatment and the linkage to neurodevelopmental disabilities of mercury exposure in children. METHODS: A literature search was undertaken of MEDLINE (1980-2003), and American Academy of Pediatrics, American Medical Association, American Dental Association, World Health Organization and Center for Disease Control websites. The search string 'mercury' was used in MEDLINE and articles were selected as appropriate by two independent reviewers. All relevant information was reviewed and data were extracted by two independent reviewers. RESULTS: Based on the meta-analysis of the accuracy of hair mercury, hair mercury levels correlated with mercury level in blood (sample size weighted correlation coefficient, r w = 0.61), with 24 h urine ( r w = 0.46) and with cord blood ( r w = 0.64). However, the correlation for hair mercury level with 24 h urine level and blood level was not high enough to replace them in clinical decision-making of individual patient. Epidemiological evidence has shown that low-level mercury poisoning is not a cause of autism (relative risk = 0.49, 95%CI = 0.36-0.66). The risk of neurodevelopmental disabilities from low-level exposure to methylmercury from the regular consumption of fish is still controversial even after combining results from different epidemiological studies worldwide. There is a lack of data in the literature about the effect of chelation therapy in children with neurodevelopmental disabilities. CONCLUSION: Mercury poisoning should be diagnosed only with validated methods. There is no evidence to support the association between mercury poisoning and autism.