Treatment of acute self-poisoning in a respiratory intensive care unit. A 5-year review

A study of 103 cases of drug-related suicide attempts admitted to the Respiratory Intensive Care Unit, Groote Schuur Hospital, over a 5-year period (1980-1984) was carried out. This group constituted 4.8% of all patients admitted to this hospital with acute self-poisoning. The majority of patients made an uneventful recovery (survival rate 91.7%). No association was found between initial admission status and ultimate recovery. Haemoperfusion was useful in treating patients with severe barbiturate poisoning.     

Admissions to a psychiatric hospital. Factors associated with admission and inpatient care

A detailed cross-cultural analysis was carried out of demographic, social, family and diagnostic variables responsible for, or associated with, the admission of 460 sequentially admitted patients to an area psychiatric hospital (Valkenberg Hospital). All patients were socio-economically disadvantaged compared with the population from which they were drawn and socio-economic factors played a significant part in admission. Larger proportions of coloured and black schizophrenics and substance abusers were admitted, and this is related to socio-economic conditions and the fact that the population generally are younger. There were indications that the period of inpatient stay, particularly for coloured and black patients, was too short in many cases for meaningful preparation for discharge, and that supervision after discharge was inadequate. Treatment of the type offered by this hospital appears largely to achieve the diminution or control of aberrant or difficult behaviour and symptoms while functional impairment is little improved.     

The effect of anesthesia and surgery on diaphragmatic lymph vessel flow after endotoxin in sheep

Increases in diaphragmatic lymph vessel flow (Qdi) may be important in preventing ascites because diaphragmatic lymph vessels drain the peritoneal space. However, lymphatic vessel function may be depressed in anesthetized, open chested animals. To test this hypothesis, we cannulated diaphragmatic lymph vessels in five sheep which were anesthetized with 1-2% halothane. We performed a thoracotomy and cannulated a diaphragmatic lymph vessel in each sheep. Then we infused 0.75-1.0 micrograms/kg of E. coli endotoxin intravenously and we measured Qdi and the lymph protein concentration for 2-4 hrs. The data were compared to previously reported data for five unanesthetized sheep (J. Appl. Physiol. 62:706-710, 1987). At baseline Qdi = 0.8 +/- 0.7 (SD) in the anesthetized sheep and 1.0 +/- 0.8 ml/hr in the unanesthetized sheep. After endotoxin, Qdi increased to 4.5 +/- 3.1 ml/hr in the unanesthetized sheep (p less than 0.05) but Qdi did not change in the anesthetized sheep. However, the lymph protein concentration increased similarly in each group, indicating that endotoxin caused the same degree of injury in each group. Our results indicate that diaphragmatic lymph vessel function is depressed in anesthetized, open chested sheep.     

Effects of two gonadotropic hormones on polysaccharide synthesis in the albumen gland of Lymnaea stagnalis, studied with the organ culture technique

A medium for culturing organs of the basommatophoran freshwater snail Lymnaea stagnalis is described. One of the accessory sex glands, the albumen gland, which produces proteins and galactogen as nutritive substances for the embryos, was cultured along with parts of the central nervous system (CNS), including the female gonadotropic hormone-producing dorsal bodies (DB). Culture time was 4 days. The cerebral ganglia and the DB appeared to have a strong stimulating influence on polysaccharide synthesis in the albumen gland. The remaining part of the CNS has a weak stimulating effect. The use of extracts (culture time 6–26 hr) of parts of the cerebral ganglia and of the DB showed that not only the dorsal body hormone (DBH), but also the ovulation hormone (CDCH)—a neurohormone produced by the caudodorsal cells located in the cerebral ganglia—stimulates the synthetic activity of the albumen gland. The action of these hormones is direct; i.e., it is not exerted via the gonad. Dose- and time-response relations for the DBH and the CDCH are very similar. No additional rise in stimulation occurred when the two hormones were administered together. Experiments with albumen glands of adult snails demonstrated that the presence of large quantities of secretory material in the gland inhibits the response to DBH and CDCH.     

Readmissions to a psychiatric hospital. Outcome on follow-up

Readmissions to South African psychiatric hospitals form 45% of their intake and constitute a considerable burden on staff and facilities. The situation was investigated in a series of 460 patients sequentially admitted to a large, actively admitting hospital (Valkenberg Hospital, Cape Town). There was a difference in the proportion of readmissions within 1 year for different population groups--26,5% for white, 41% for coloured and 42% for black patients. The factors influencing this are explored. There was a marked difference in diagnoses--schizophrenics and affective disorders being more common in the black and coloured cohorts. Possible reasons for this are discussed. A 2-year post-discharge follow-up study showed a marked and sustained fall in the severity of psychiatric symptoms and difficult behaviour for all cohorts, but not of functional impairment, which was present in approximately 90% of all patients. Adequate aftercare and rehabilitation facilities in the community are evidently lacking.     

Hypo-osmolar intravascular volume overload during anaesthesia for transurethral prostatectomy. A report of 2 cases

Two cases are reported in which absorption of surgical irrigant into the vascular system during transurethral resection of the prostate gland (TUR) resulted in life-threatening complications due to hypo-osmolar volume overload (also known as water intoxication or the TUR syndrome). Manifestations common to both cases were haemolysis of red cells, cardiac arrhythmias, a drop in the serum sodium level, and an elevated central venous pressure. In addition, one patient developed acute pulmonary oedema and the other hypokalaemia, confusion and visual disturbances due to cerebral oedema. Water as an irrigant for TUR should be superseded by glycine 1,5%, which is safer.