A comparison of T4 and T7 dermatomal levels of analgesia for caesarean section using the lumbar epidural technique

We compared analgesia to the T₄ dermatomal level with analgesia to the T₇ level with and without prophylactic intramuscular administration of ephedrine 25 mg to determine the adequacy and side effects of such analgesia for caesarean section. Unmedicated patients were prehydrated (727 ± 303 ml of saline solution) and kept in a left lateral tilt position. Sufficient three per cent chloroprocaine was given to obtain analgesia to the T₇ (T₆-T₈) dermatomal level (455 ± 128 mg) or to the T₄ (T₃-T₅) dermatomal level (758 ± 168 mg). Patients who received analgesia to the higher level required less narcotic than those who received analgesia to the lower level (21 per cent versus 48 per cent) (p < 0.05). The incidence of hypotension in patients with analgesia at the T₄ level was 21 per cent for those receiving ephedrine and 64 per cent for those who did not receive ephedrine (p < 0.05). Intramuscular administration of ephedrine 25 mg was not associated with increased plasma levels of norepinephrine, epinephrine or dopamine. There was no difference in Apgar score, behavioural test scores, neonatal acid-base status or oxygenation in children of mothers in the different groups. We conclude that a T₄ dermatomal level of analgesia, combined with intramuscular administration of ephedrine 25 mg, provides more maternal comfort than a T₇ level of analgesia does, with or without ephedrine, and is without significant maternal or foetal side effects.     

The electronic medical assistant

While the applications of computers for administrative procedures in the medical group practice is widely accepted, use of the computer for compiling purely clinical data has merit as well. A Denver-based physician shares his experience of using computers for such manual procedures as taking medical histories, generations of the physical examination record, diagnostic assessments, drug interaction searches, disease indexing, health education programs, and more.     

Growth of Pakistani children in relation to the 1990 growth standards

This study was designed to compare the growth of Pakistani schoolchildren in the UK with the 1990 UK growth standards. Measurements of height, weight, and sitting height were performed on 785 Pakistani schoolchildren aged 5-14 years with the mean values for each age and sex being plotted on the UK growth standards. The results were expressed as SD scores relative to the 1990 reference data. The mean height for the boys was only 0.2 SD scores below the mean for the new growth standards with the mean height for the girls being 0.4 SD scores below the mean. The mean values for weight and body mass index were 0.3 and 0.5 SD scores less than the mean for boys and girls respectively. This study demonstrates that the growth of Pakistani schoolchildren in the UK is comparable to the 1990 UK growth standards with only minor differences. It is not safe to assume that short stature or low body weight in a Pakistani child is due to his or her ethnic background.     

Rural-to-Urban Migration: Socioeconomic Status But Not Acculturation was Associated with Overweight/Obesity Risk

To investigate whether socioeconomic status (SES) and acculturation predict overweight/obesity risk as well as the mediating effect of physical activity (PA) in the context of internal migration. Cross-sectional study of 587 rural-to-urban migrants participating in the PERU MIGRANT study. Analyses were conducted using logistic regression and structured equation modeling. Interaction effects of SES and acculturation were tested. Models were controlled for age, gender and education. Only SES was a significant predictor of overweight/obesity risk. Lower SES decreased the odds of being overweight/obese by 51.4 %. This association did not vary by gender nor was it explained by PA. Mechanisms underlying the relationship between SES and overweight/obesity may differ depending on the geographic location and sociocultural context of the population studied. Research on internal migration and health would benefit from the development of tailored acculturation measures and the evaluation of exploratory models that include diet.     

Hemorrhagic tumor necrosis during a pilot trial of tumor necrosis factor-alpha and anti-GD3 ganglioside monoclonal antibody in patients with metastatic melanoma

Hemorrhagic tumor necrosis is an inflammatory event that leads to selective destruction of malignant tissues, with both potentially toxic and beneficial consequences. A pilot clinical trial was undertaken combining tumor necrosis factor-alpha (TNF-alpha) with the monoclonal antibody R24 (MoAb R24) against GD3 ganglioside in patients with metastatic melanoma. Patients received MoAb R24 to recruit leukocytes to the tumor followed by low doses of recombinant TNF-alpha to activate leukocytes. Eight patients were treated and seven patients had mild toxicity. One patient with extensive metastatic melanoma developed tumor lysis syndrome within hours after treatment with almost complete necrosis of bulky tumors in multiple visceral sites. To our knowledge, this is the first documented case of hemorrhagic tumor necrosis in a patient with metastatic cancer in multiple visceral sites.     

Induction of immune tolerance in patients with hemophilia A and inhibitors treated with porcine VIIIC by home therapy

Home therapy with porcine factor VIIIC was safe and effective when administered to five hemophilic patients over periods of 8 1/2, 6, 4, 3 1/2, and 2 years. No significant transfusion reactions occurred. Before treatment with porcine factor VIIIC, all five had high-level, high- responding anti-human VIIIC inhibitors initially lacking anti-porcine factor VIIIC activity. Although specific anti-porcine VIIIC inhibitors arose in all patients, these were generally transient, and only one patient became refractory to treatment. We believe that porcine factor VIIIC is the treatment of choice in patients whose inhibitors do not cross-react. All five patients lost their original anti-human VIIIC inhibitors after starting treatment with porcine VIIIC, permitting the reintroduction of human VIIIC in three of them. There has been no recurrence of anti-human VIIIC inhibitor activity during 2 to 3 years of regular treatment with human VIIIC in these patients. This suggests that tolerance to human VIIIC has arisen as a result of treatment with porcine VIIIC. Porcine VIIIC may have a role in the desensitization of some factor VIIIC inhibitor patients.