CASE REPORT: Antibiotic-associated haemorrhagic colitis

Antibiotic-associated haemorrhagic colitis is an uncommon cause of bloody diarrhoea in patients taking penicillin or penicillin-related antibiotics. Symptoms of abdominal pain and bloody diarrhoea occur within 1 week of antibiotic use and resolve without specific therapy within days of discontinuing the offending antibiotic. There is an apparent increased incidence of the disease in patients of Oriental ethnicity. The pathogenesis is unknown. We present two cases of haemorrhagic colitis in patients taking penicillin-related antibiotics who presented within 4 months of each other. One of the patients was being treated for Helicobacter pylori infection. The published literature is reviewed with particular emphasis on the histology and pathogenesis of the condition.     

ENCLOSED AFFERENT RESERVOIR BREATHING SYSTEMS: Description and Clinical Evaluation

A new group of breathing systems, namely the Enclosed AfferentReservoir (EAR) systems, is described. They allow for the selectiveelimination of alveolar gas in association with both spontaneousand controlled ventilation. A comparison with the Bain systemin controlled ventilation demonstrates greater efficiency ineliminating carbon dioxide. A fresh gas flow (F) of 70 ml kg^–1 min^–1 using an EAR systemgave mild hypocarbia which equated to a F of 100 ml kg^–1 min^–1 using the Bainsystem. Smaller minute volumes of ventilation are required foroptimal performance than with the Bain system. The minimum recommendedminute volume of ventilation (l) should equal F plus anatomical deadspace ventilation (D^anat).The pattern of ventilation appears to have little influenceupon the efficiency of carbon dioxide elimination when usingan EAR system, whereas the Bain system does appear to be affected.     

Inhibition of the Mixed Lymphocyte Culture Response by Antibody Following Successful Human Renal Transplantation

Immunoglobulin G, appearing after several months in the serum of a recipient of a successful kidney transplant from a closely matched sibling donor, was demonstrated to progressively inhibit unidirectional mixed lymphocyte cultures when donor lymphocytes were used either in responding or stimulating cell populations. The active recipient IgG had no effect in cultures in which donor cells were not used, nor did IgG obtained from other individuals show nonspecific inhibitory effects on cultures containing donor cells. It is suggested that the MLC inhibitory immunoglobulin may serve an immunoregulatory function after renal transplantation.     

EARLY DETECTION OF "REBREATHING" IN AFFERENT AND EFFERENT RESERVOIR BREATHING SYSTEMS USING CAPNOGRAPHY

Capnography was used to determine the onset rebreathing in afferent(AR) and efferent (ER) reservoir breathing systems in a spontaneousventilation lung model. In the case of the Lack and enclosedAR systems, the best sampling site was found to be in the exhaustlimb of the systems, 5 cm from the Y connector. For the Magillsystem, fitted with a hooded scavenging valve, the best sitewas deep inside the hooded valve. In contrast, the best samplingsite in an ER system (e.g. Bain system) was in the trachealtube. For AR systems, the loss of a fresh gas elimination pattern(carbon dioxide trace failing to reach zero) was shown to occurat the onset of rebreathing. As the sampling site was moveddistally into the exhaust limb, the same pattern was seen atgreater flow rates-that is, before rebreathing was actuallyoccurring. When sampling was within the tracheal tube, usingER systems, a typical "rebreathing wave" occurred at the onsetof established rebreathing.     

THE "ON CALL" SERVICE OFFERED BY THE DEPARTMENT OF ANAESTHESIA, MANCHESTER ROYAL INFIRMARY

The "on-call" service offered by the Department of Anaesthesia,Manchester Royal Infirmary was studied in December 1981. Thereasons for any delay in service were analysed and suggestionsfor improvement discussed. ^*Present address: Main Theatre, Hope Hospital, Eccles Old Road,Salford     

Developmental Toxicity of L-Selenomethionine in Macaca fascicularis

Forty pregnant long-tailed macaques were dosed via nasogastricintubation with 0, 25, 150, or 300 µg/kg of L-selenomethionine(Se) daily during organogenesis [Gestational Day (GD) 20–50].Clinical examination of the dams, maternal body weights, sonographicevaluations, clinical chemistry screens, and measures of serumprogesterone and urinary estrone conjugates were used as indicatorsof maternal and fetal status in all animals. The pregnanciesof two to three dams from each dose group were followed untilterm ({small tilde}GD 165); the remainder (N = 7/dose group)were scheduled for hysterotomy on GD 100 ± 2. A standardteratologic evaluation was performed including visceral andskeletal examinations. Fetal liver, kidney, skin, and smooth,cardiac, and skeletal muscles were examined by light microscopy;heart muscle was also evaluated by transmission electron microscopy.Neonates delivered at term remained with the dams and were removedperiodically for morphometric, neurologic, behavorial, and ophthalmologicassessments on Days 1, 8, 15, 22, and 30 of age. Dose-dependentmaternal toxicity as evidenced by anorexia, vomiting, and asignificant reduction in body weight increased with increasingduration of Se exposure. One growth-retarded fetus was recoveredon GD 131 from a compromised dam exposed to 25 /ig/kg-day; oneearly embryonic death (GD 35) and two fetal deaths [GD 68 (followedby maternal death) and GD 123] occurred among animals dosedwith 300 µg/kg-day. Pregnancy loss among treated animalswas not significantly different from concurrent or historicalcontrols. No statistically significant treatment-related effectswere observed at necropsy on GD 100 ± 2. One infant exposedto 150 Mg/kg-day prenatally exhibited a unilateral corticalcataract, which may have been a spontaneous occurrence. Thelimited developmental effects observed and reported teratogenesisin nonmammalian species suggest that comparative pharmacokineticstudies are required before the full public health significanceof elevated Se is understood.