Gastroduodenal mucosal hemodynamics by endoscopic reflectance spectrophotometry

The reflectance spectrophotometric technique measures an index of mucosal hemoglobin concentration and an index of oxygen saturation by spectral analysis of light reflected from the mucosal surface. Using a commercially available unit, a technique for obtaining reproducible endoscopic measurements with acceptable intraobserver and interobserver variability was developed in the anesthetized dogs. The reflectance spectrophotometric finding that experimentally induced prehepatic portal hypertension did not affect gastric mucosal blood flow was confirmed by hydrogen gas clearance measurements. Endoscopic studies in patients with active duodenal ulcer disease revealed a higher index of mucosal hemoglobin concentration and a normal index of oxygen saturation (i.e., an increase in blood flow) at the margin of the ulcer compared with the adjacent normal appearing mucosa.     

Acquired diverticulosis of the small intestine: case reports and literature review

Eleven cases of small bowel diverticulosis are discussed. Four patients presented with perforation, five with other symptoms attributable to this condition and in two patients diverticulosis was considered an incidental finding. A review of the literature suggests that small bowel diverticulosis may be: present in up to 1.3% of the population; associated with symptoms in approximately 50% of patients, and associated with acute surgical complications in 10% of patients. This may be a disorder of intestinal motility associated with colonic diverticulosis and related to other disorders of smooth muscle and myenteric plexus. Small bowel diverticulosis should not be regarded as a rare, incidental and inconsequential finding.     

Gas-producing infections after lower-limb amputation because of ischemia

Summary During the period 1972–1982, 22 patients with gas-producing infections after lower-limb amputation because of ischemia were reviewed. In 16 cases bacteria of the genus Clostridium could be cultured. Treatment consisted of hyperbaric oxygen, surgical debridement, and antibiotics. The incubation period was 1–11 days after the primary amputation, and the duration of the infection 2–31 days, significantly lower among 14 patients with diabetes mellitus. There was no difference in the course of clostridial and nonclostridial infections. No deaths were attributable to gas-forming infection.

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Zusammenfassung In dem Zeitraum 1972 bis 1982 wurden 22 Patienten mit gasbildenden Infektionen nach Amputationen im Bereich der unteren Extremitäten wegen arterieller Durchblutungsstörungen beobachtet. In 16 Fallen konnten Clostridien kultiviert werden. Die Behandlung bestand aus hyperbarir Sauerstofftherapie, chirurgischem Debridement und Antibiotika. Die Inkubationszeit betrug 1–11 Tage nach der primären Amputation, die Dauer der Infektion 2–31 Tage. 14 der 22 Patienten waren Diabetiker. Bei ihnen war die Dauer der Infektion statistisch zu sichern kürzer. Dagegen war der Verlauf der Infektionen mit und ohne Clostridiennachweis ohne Unterschied. Die Mortalität (7 von 22) kann nicht ursäch-lich der gasbildenden Infektion zugeordnet werden.

     

Hodgkin disease: contributions of chest CT in the initial staging evaluation

Chest radiographs and chest computed tomography (CT) scans were compared in 203 patients with newly diagnosed Hodgkin disease. The incidence of positive findings was tabulated from six intrathoracic lymph node groups, lung parenchyma, pericardium, pleura, and chest wall. The discordant cases were assessed to determine impact on clinical management. The CT scans provided additional evidence of disease involvement, ranging from 0% to 15% at each of the designated anatomic sites. Treatment was altered in 9.4% of all patients (19 of 203), including 13.8% (nine of 65) of those undergoing radiation therapy alone and 8.2% (ten of 122) of those undergoing combined-modality treatment. We conclude that routine chest CT examinations are valuable in the clinical management of those patients for whom radiation therapy is planned.     

An open, noncomparative study of amoxapine in borderline disorders

Five patients with borderline personality disorder (BPD) and 5 patients with schizotypal personality disorder (SPD) completed at least 3 weeks of treatment with amoxapine. The patients fulfilled DSM-III criteria for borderline disorders and scored 7 points or more in Gunderson's Diagnostic Interview for Borderlines (DIB). The final median medication in patients with BPD was 200 mg amoxapine/day and 42 mg oxazepam/day. Duration of treatment averaged 28 days. In patients with SPD the corresponding figures were 250 mg amoxapine/day, 36 mg oxazepam/day and 39 days. The study suggests that amoxapine improves schizophrenic-like and depressive symptoms in patients with schizotypal personality disorders (SPD). No effect could be shown in patients with borderline personality disorders (BPD).     

Painful, nonhealing, tooth extraction socket

The oral signs and symptoms of acute leukemia include gingival hypertrophy, gingival hemorrhage, petechiae and ecchymoses, mucosal ulceration, paresthesia, tooth pain, and oral infections. This case was unusual in that the diagnosis of acute leukemia was made only after a biopsy specimen of tissue protruding from the socket of a recently extracted tooth disclosed malignant cells suggestive of leukemia or lymphoma. The diagnosis of epulis granulomatosa should be made only after clinical, radiographic, and microscopic studies have been performed to rule out a malignant process.     

Effect of growth hormone dosing on ultimate weight and length of XO mice

Mice with the karyotype 39, XO and XX mice with the same genetic background were injected for a six month period with daily subcutaneous doses of 0.5 IU biosynthetic human growth hormone (hGH) or with placebo. The XO mice dosed with hGH obtained a significantly higher body weight and greater final length than the XO mice dosed with placebo (39.2 g versus 29.0 g and 21.1 cm versus 19.2 cm respectively). The body weight remained constant after cessation of dosing. The XX mice became significantly longer but not heavier as a result of hGH dosing. The placebo dosed XO mice became significantly longer than the placebo XX mice but their body weights were comparable. Dosing with hGH caused a significant increase in growth rate in both XO and XX mice, and the ultimate body weight was reached within a significantly shorter time period. In the XO mice the hGH injections increased significantly the length and thickness of the femoral bones and the length of the tibia bones. Stimulated endogenous plasma growth hormone levels were significantly higher in XX mice compared to XO mice. Plasma IGF-I levels were significantly higher in XO compared to XX mice, but the levels were not affected by hGH dosing. XO mice may be useful in future metabolic and hormonal studies.     

Interstitial cystitis: review of the literature

Interstitial cystitis is a chronic bladder disease of unknown frequency and unclarified etiology. The condition is often missed and the patients incorrectly treated. The problematic patient is often a woman with a long-lasting urological history, sterile urine, urinary incontinence, dyspareunia or chronic pelvic pain. Here characteristics of 5 patients are described and the literature is reviewed to draw attention to this condition.     

Assessment of perfusion in postoperative patients using tissue oxygen measurements

Subcutaneous tissue oxygen tension was measured as an index of perfusion in 44 postoperative patients. Hypoperfusion was defined as suboptimal tissue oxygen tension unresponsive to increased inspired oxygen but becoming responsive after increased fluid infusion. Twelve of thirty patients who underwent major abdominal and flank operations were found to be suboptimally perfused by this definition despite adequate fluid maintenance according to standard clinical criteria including urine output. Apparently, a significant number of postoperative abdominal surgery patients are not optimally perfused, and this state is not recognized by the present clinical criteria. Tissue oximetry may be a useful objective method of assessing tissue perfusion.     

Randomized clinical investigation of Ro 15-1788, a benzodiazepine antagonist, in reversing the central effects of flunitrazepam

In a double-blind, randomized study the efficacy of Ro 15-1788 as a benzodiazepine antagonist was evaluated in patients anaesthetized with flunitrazepam. The effects were compared with a comparable group of patients who did not receive the antagonist. Ro 15-1788 significantly reversed the sedative and hypnotic effects of flunitrazepam and reduced the degree of anterograde amnesia. No side-effects were attributable to the drug.