Effects of Epidural Analgesia on Plasma Catecholamines and Cortisol in Parturition

To assess the effect of epidural block on plasma catecholamines and cortisol during labour and delivery, plasma epinephrine, norepinephrine and cortisol levels were determined in 26 healthy parturients, all of whom delivered vaginally (18 received an epidural block, eight had meperidine 50 mg intramuscularly). We found a significant drop of plasma epinephrine and cortisol and no significant reduction of plasma norepinephrine 1 h after administration of epidural block compared to preblock values. Observing the data during the whole course of labour in correlation with cervical dilatation, in the control group, where the parturients received meperidine, all hormones rose progressively up to the moment of delivery. One hour after delivery the catecholamines returned to normal levels; cortisol returned more slowly. In the epidural group the increase of plasma epinephrine and cortisol was significantly inhibited but not that of norepinephrine.     

Intravenous glucose tolerance and plasma insulin response in children with homozygous β-thalassaemia

ABSTRACT. Glucose tolerance and insulin secretion were studied after intravenous glucose load in 10 normal and 27 children with homozygous β-thalassaemia of whom 11 received 5–20 units of blood (1.25–5g total iron) and 16 received 50–60 blood units (12.5–40g total iron). Fasting blood glucose and insulin levels were similar in normal and thalassaemic children. Differences were found at 10 and 20 minutes of intravenous glucose administration both in glucose blood levels. (which were considerably higher) and insulin levels (which were significantly lower), in thalassaemic patients compared to normal children. Evidence of depression of pancreatic function was found in three out of 11 patients, with low and in three out of 16 patients with severe iron load. These findings suggest that in thalassaemia pancreatic impairment is not always directly related to the degree of iron overload.     

Thymus dysfunction and chronic inflammatory disease in gp39 transgenic mice

Expression of gp39 on activated T cells provides a co-stimulatory signal in peripheral lymphoid tissue that regulates humoral and cell- mediated immunity. The function of gp39 and its receptor CD40 in thymus remains uncertain. Here we report that overexpression of gp39 in transgenic mouse thymus caused a dose-dependent decline in thymocyte numbers (> 500 fold), loss of cortical epithelium and expansion of CD40+ medullary cells. Transplantation of transgenic bone marrow into normal mice indicated that gp39 significantly diminished thymocyte viability in the context of a 'normal' thymic environment. The peripheral tissues of transgenic mice also accumulated abnormalities in a transgene dose-dependent manner that involved inflammation and lymphoid tissue hypertrophy. Animals with the highest transgene copy numbers acquired a lethal inflammatory bowel disease marked by the infiltration of gp39+ T cells and CD40+ cells into diseased tissues. Examination of cells overexpressing gp39 suggested that these defects were caused, in part, by the saturation of a mechanism that sequesters gp39 inside non-activated cells and thus protects the immune system from inappropriate gp39-CD40 interaction. These results establish a regulatory role for gp39 in thymus function and a causal relationship in mediating chronic inflammatory disease.      

97. Grundsätzliche Indikationsfehler bei kindlichen Frakturen

Zusammenfassung Es wird die Meinung vertreten, daß beim wachsenden Organismus es einen grundsätzlichen Indikationsfehler bedeutet, wenn bei gelenknahen oder Gelenkfrakturen nicht die exakte Rekonstruktion der frakturierten Skeletteile vorgenommen wird. Dieses kann in den meisten Fällen nur durch eine Operation geschehen. Diese Forderung wird im Detail erläutert bei der Schenkelhalsfraktur, der subtrochantären Oberschenkelfraktur, der suprakondylären Femurfraktur und der distalen Humerusfraktur.

---

Summary The opinion is advanced that in the growing organism it is a fundamental mistake in indication not to perform accurate reconstruction of the fractured parts in fractures of or near a joint. In most cases this can only be done by operation. This postulate is illustrated in detail in the case of femoral neck fracture, subtrochanteric fracture of the femur, supracondylar fracture of the femur and distal fracture of the humerus.

     

Choledocholithiasis: treatment with extracorporeal shock wave lithotripsy

In a patient with choledocholithiasis, a duodenal diverticulum precluded endoscopic retrograde bile duct cannulation. A transhepatic catheter was used to opacify the bile ducts and to guide the endoscopic sphincterotome into the major duodenal papilla. Because limited sphincterotomy did not allow extraction or spontaneous passage of the common duct stones, extracorporeal lithotripsy was performed. Following fragmentation, the stones passed spontaneously and without complications.     

Growth in infancy, infant feeding, childhood living conditions, and Helicobacter pylori infection at age 70

Since oxygen has to be given to most children in developing countries on the basis of clinical signs without performing blood gas analyses, possible clinical predictors of hypoxaemia were studied. Sixty nine children between the ages of 2 months and 5 years admitted to hospital with acute lower respiratory tract infection and an oxygen saturation (Sao2) < 90% were compared with 67 children matched for age and diagnosis from the same referral hospital with an Sao2 of 90% or above (control group 1), and 44 unreferred children admitted to a secondary care hospital with acute lower respiratory infection (control group 2). Using multiple logistic regression analysis, sleepiness, arousal, quality of cry, cyanosis, head nodding, decreased air entry, nasal flaring, and upper arm circumference were found to be independent predictors of hypoxaemia on comparison of the cases with control group 1. Using a simple model of cyanosis or head nodding or not crying, the sensitivity to predict hypoxaemia was 59%, and the specificity 94% and 93% compared to control groups 1 and 2, respectively; 80% of the children with an Sao2 < 80% were identified by the combination of these signs. Over half of the children with hypoxaemia could be identified with a combination of three signs: extreme respiratory distress, cyanosis, and severely compromised general status. Further prospective validation of this model with other datasets is warranted. No other signs improved the sensitivity without compromising specificity. If a higher sensitivity is required, pulse oximetry has to be used.     

Comparison of Infasurf (calf lung surfactant extract) to Survanta (Beractant) in the treatment and prevention of respiratory distress syndrome

OBJECTIVE: To compare the relative safety and efficacy of Infasurf (calf lung surfactant extract; ONY, Inc, Amherst, NY, IND #27169) versus Survanta (Beractant, Ross Laboratories, Columbus, OH) in reducing the acute severity of respiratory distress syndrome (RDS) when given at birth and to infants with established RDS. DESIGN: A prospective, randomized, double-blind, multicenter clinical trial. SETTING: Thirteen neonatal intensive care units participated in the treatment arm: seven of these concurrently participated in the prevention arm. PATIENTS: The treatment arm enrolled infants of 相似文献