Duodenoscopic sphincterotomy for acute suppurative cholangitis

Fifteen patients (eight males, seven females; age range: 23-76 years) presenting with acute suppurative cholangitis underwent endoscopic retrograde cholangiography and sphincterotomy within 1-10 days of hospitalization. Cholangitis was due to common duct stones in all patients; all but one of them had their gall-bladders in situ. All of them had fever, jaundice, abdominal pain, leucocytosis and deranged liver function while 26.6% were in shock, 13.3% in coma and 40% in azotaemia. Cardiac or other associated diseases caused 21% of the patients to be high risk candidates for surgery. An adequately sized sphincterotomy was done in 14 (93.3%) patients; in eight of them it was immediately followed by a successful stone extraction while in another four patients either the stone passed out spontaneously (one patient) or was retrieved by a repeat basketing. Thus, the common bile-duct was cleared of stones in 80% patients. Of 14 patients with satisfactory sphincterotomy, 11 (73.3%) had a dramatic clinical improvement, two (14.3%) had a somewhat delayed benefit and one patient died due to unrelieved cholangitis. Ten patients subsequently underwent elective cholecystectomy while three patients continue to have their gall-bladders in situ. There has been no recurrence of biliary tract symptoms in these 13 patients during the subsequent 3-26 months (mean follow-up: 15.1 months). It is concluded that urgent duodenoscopic sphincterotomy is rewarding in patients with acute suppurative cholangitis when it is performed early.     

Immunochemical Investigations of Human Seminal Plasma Acid Phosphatase

Immunchemische Untersuchungen der sauren Phosphatase im menschlichen Seminalplasma
Die saure Phosphatase des menschlichen Seminalplasmas wird in Gegenwart von normalem Kaninchenserum durch nicht-kompetetive Mechanismen gehemmt, wohingegen sich in Gegenwart von Kaninchenantiserum diese Verhältnisse normalisierten und die Aktivität stabilisiert wurde. Kinetische Untersuchungen über die Stabilisierung der sauren Phosphatase durch Antiserum wurden mit L-Tartrat als spezifischem Hemmstoff der sauren Prostataphosphatase kombiniert. L-Tartrat hemmte das Enzym sowohl in Gegenwart als auch in Abwesenheit von normalem und Antiserum kompetetiv; der Prozentsatz der Hemmung bewegte sich in der gleichen Größenordnung, was anzeigt, daß das katalytische Zentrum des Enzyms die Bindung mit den Antikörpern gegen saure Phosphatase nicht in Mitleidenschaft zieht. Die Kinetik der Hitzedenaturierung der sauren Phosphatase läßt darauf schließen, daß die saure Phosphatase des Samens in Gegenwart und Abwesenheit von Normalserum hitzelabiler ist als in Gegenwart von Antiserum. Die Denaturierungstemperatur bei halber Anfangsaktivität (T 1/2) in Gegenwart von Normal- und Antisera war 34° respektive 66° C.
Die nicht-lineare Verteilung nach Arrhenius der Denaturierungsraten des Enzyms läßt auf verschiedene Konformationszustände während der Denaturierung schließen, wobei die Werte für die Aktivierungsenergie Ea zwischen 20.08 und 5.03 Kcal bei 25° bis 65° C lagen.     

AEROMEDICAL ASPECTS OF CONTACT LENSES (SOFT AND SEMISOFT)

A comprehensive clinical study on the effects of various aviation stresses on soft and semisoft contact lenses was carried out to find out their compatibility in aviation environment. Twenty subjects (11 aircrew and 9 non air-crew) participated in the study. Twelve of them were given soft lenses of water contents of 38%, 50% and 78% and rest 8 were given semisoft lenses of daily wear and extended wear type. The environmental trial consisted of exposure to hypoxia, rapid decompression, acceleration, pressure breathing, vibration and high temperature. On successful completion of environmental trials on ground simulators, the inflight trials on high performance aircraft, transport aircraft, passenger aircraft and helicopters were conducted. The soft lenses with low, medium and high water contents and extended wear semisoft lenses (large diameter) were found compatible with all types of aircraft flying.KEY WORDS: Aviation stresses, Acceleration, Contact lenses, Hypoxia, Vibration     

Mechanisms of gastro-oesophageal reflux in the lateral decubitus positions

Gastro-oesophageal reflux is more common in the right than in the left lateral position but the reasons why are not well understood. We have therefore studied the mechanisms underlying reflux in the lateral decubitus positions in patients with reflux disease. Fifteen patients with symptomatic reflux and excessive oesophageal acid exposure were studied (nine male, age 25-63 years). Each was intubated with a perfused manometric assembly, incorporating a Dent sleeve, and a pH probe. Following a 30-min basal period, a 400-kCal meal was infused into the stomach and patients were studied for 60 min in each lateral position. Following infusion of the meal, lower oesophageal sphincter (LOS) pressure fell and transient LOS relaxation (TLOSR) frequency increased. Acid reflux episodes were more common in the postprandial period (fasting 0 (0-6) h, first postprandial hour 1 (0-9) h, P = 0.0002, second postprandial hour 1 (0-22) h, P = 0.02) and occurred more than twice as often in the right lateral position (right 3 (0-22) h, left 0 (0-10) h, P = 0.01). However, TLOSRs, swallow-related relaxations and low basal LOS pressures were equally common in both lateral positions. In patients with reflux disease, postprandial reflux is twice as common in the right lateral position. This does not relate to differences in gastro-oesophageal junctional pressure, suggesting that other aspects of barrier function or differences in the intragastric distribution of chyme may be important.