Gastric juice lactic acidosis

The basal lactic acid concentration is higher in the gastric juice of Australian patients than in a similar Japanese population. A gastric juice lactic acidosis is associated with advanced gastric carcinoma in both groups. The extent of the gastric juice lactic acidosis in gastric carcinoma appears to be related to the size of the carcinoma. There was no correlation between lactic acid concentration and acid output, suggesting that atrophic gastritis is not a major determinant of the lactic acid concentration.     

Recombinant interleukin-2 (rIL-2) in acquired immune deficiency syndrome (AIDS): preliminary report in patients with lymphoma associated with HIV infection.

In an ongoing phase II study, 12 patients with lymphoma and HIV infection were treated with zidovudine (ZDV) and recombinant interleukin-2 (rIL-2) to evaluate if this association may produce beneficial effect on the immunologic status and the outcome of lymphoma. The protocol included daily doses of rIL-2 at 6 MIU/m2 over 5 days in c.i. per week for a total 4 courses; ZDV was associated at 600 mg/d in the period under study. An improved CD4 count, exceeding 2- to 4-fold the basal count, was obtained in patients with a basal CD4 number greater than 100/microliters accompanied by a significant increase of NK and LAK activity (p less than 0.001). From the clinical point of view the reduction of tumor manifestation was proportional to CD4 basal number; 2 patients from those with CD4 greater than 100/microliters obtained a complete remission after rIL-2 and ZVD. The p24 antigen, taken as parameter of viral replication, remained invariably negative after rIL-2 and ZDV in patients already negative and became negative in 1 patient previously positive. Our conclusion is that the association of rIL-2 and AZT is safe and useful in patients with lymphoma and HIV infection.     

Barotrauma due to obstruction of the breathing system during a CT-scan examination in a child

A case of pulmonary barotrauma is described in a child undergoing a CT scan in the prone position. Anaesthesia was uneventful until the final exiting movement from the scanner when inadvertent total occlusion of the expiratory limb of a Jackson-Rees modification of the Ayre's T-piece occurred. The rapid rise in intrapulmonary pressure caused bilateral pneumothoraces despite the use of an uncuffed tracheal tube. The unusual demands of anaesthesia in the X-ray department may have contributed to this uncommon complication of the use of an Ayre's T-piece.     

Patient controlled analgesia—assessment of machine feedback to patients

The effect of varying patient-controlled analgesia machine feedback was studied in two groups of patients following a standard surgical procedure using patient controlled analgesia with morphine to control postoperative pain. Analgesic demands, morphine consumption, pain scores and side effects were compared and comments from the patients were noted. There was no significant difference between those whose machines signalled only successful demands compared with those who had every demand acknowledged. The patients in the former group appreciated the extra input and the nursing staff found this machine configuration to be less disturbing to the ward. There was no evidence of a clinically useful placebo effect in the latter group.     

Local anaesthetic: does it really reduce the pain of insertion of all sizes of venous cannula?

A recent study performed in this department showed that a subcutaneous injection of local anaesthetic was significantly less painful than the insertion of a 22-gauge venous cannula. However, our colleagues remained sceptical that local anaesthetic infiltration would eliminate the pain of cannulation. Consequently a further study was undertaken to compare the pain of cannulation with and without the use of local anaesthetic. The results show that pain of cannulation is significantly (p < 0.003) reduced after subcutaneous infiltration with 1% lignocaine when compared to cannulation without local infiltration. Persistent discomfort at the site of cannulation was eliminated by the use of local anaesthetic.