Magnesium oxide augmentation of verapamil maintenance therapy in mania

The authors compared the antimanic effects of a verapamil-magnesium oxide (V-M) combination with a verapamil-placebo combination (V-P) in patients pretreated with verapamil. BPRS scores and serum magnesium levels were compared. The V-M combination was found to be significantly more effective than V-P in reducing manic symptoms (P=0.015). Serum magnesium levels were significantly higher in the V-M group (P<0.04). These data suggest that magnesium may increase antimanic efficacy of verapamil by mechanisms which may operate at the intracellular level. The magnesium-verapamil combination may have clinical application as an adjunct to verapamil in the maintenance therapy of mania.     

Pathogenesis of Rickets and Osteomalacia in Familial Hypophosphataemia

Calcium and/or phosphate tolerance tests were performed on patients with familial hypophosphataemia, normal control subjects, and patients with vitamin D deficient osteomalacia.Intestinal calcium absorption was similar in patients with familial hypophosphataemia and control subjects. The phosphate tolerance test, which is known to be `flat'' in patients with familial hypophosphataemia, was normal in patients with vitamin D deficient osteomalacia.These findings suggest that rickets and osteomalacia in familial and some cases of non-familial hypophosphataemia are unrelated to abnormal metabolism of vitamin D. This hypothesis is supported by the fact that intestinal calcium absorption as measured by calcium tolerance test is normal in familial hypophosphataemia.It is suggested that the primary abnormality in familial hypophosphataemia is a partial metabolic block in the intestinal absorption and renal tubular reabsorption of phosphate.     

Local anesthesia for neonatal circumcision. Effects on distress and cortisol response

A controlled, double-blind investigation was conducted to determine whether the dorsal penile nerve block using lidocaine hydrochloride without epinephrine would effectively reduce behavioral distress and adrenocortical responses to routine neonatal circumcision. The subjects were healthy male newborns whose parents had requested circumcision. Equal numbers (n = 20) were randomly assigned to circumcision with lidocaine, saline, or no injection. Dorsal penile nerve block was found to be a safe and easy technique that was effective in reducing behavioral distress and modifying the adrenocortical stress response. The injection itself did not increase stress reactions and did not offset the beneficial effects of anesthesia. If circumcisions are to be performed, they should be done as humanely as possible.     

Biotransformation of Sisomicin to Gentamicin C2b

Sisomicin was transformed to gentamicin C_2b by Micromonospora rhodorangea NRRL 5326. The mechanisms involved in the biotransformation are the 6′-N-methylation and the (4′-5′)-reduction. The progression of the methylation was followed by the isotope technique, but the reduction reaction was not monitored.     

Cryptococcal eye disease

A survey is given of the clinical picture of an infection with Cryptococcus neoformans. The symptoms and therapy are reviewed and the case history of a 13 year old boy suffering from this fungus infection is discussed.     

Primary Carcinoma of the Gallbladder

One-hundred-and-seventeen patients with histologically proven carcinoma of the gallbladder are reviewed. The majority of the patients presented with advanced disease with extension and metastasis to the liver and to lymph nodes along the common bile duct. Four patients had localized disease recognized at the time of operation; two were treated with cholecystectomy and two with cholecystectomy and hepatic resection. There were no five-year survivals among these patients. Fourteen patients had clinically inapparent carcinoma at the time of cholecystectomy; the diagnosis being established postoperatively by histologic examination of the excised gallbladder. There were two five-year survivors in this group of patients. Both survivors had early papillary carcinoma confined to the gallbladder wall. The remaining patients with inapparent carcinoma died within three years of the time of operation with recurrent carcinoma. The present report and review of the recent literature emphasizes the poor prognosis associated with carcinoma of the gallbladder. Even with apparently localized lesions, the survival rate is extremely poor. Extended resection, while not of proven value, may improve the survival rate.