Nonoperative Management of Post Thoracotomy Diaphragmatic Paralysis in two Neonates

Two neonates with diaphragmatic paralysis following thoracotomy are reported. The first was treated by prolonged endotracheal intubation with recovery of function of the paralysed diaphragm, although the baby eventually died. The second case was not much distressed by the paralysed diaphragm and therefore did not require specific treatment. The purpose of this paper is to indicate that non-operative management of post-thoracotomy diaphragmatic paralysis in neonates is feasible and that operative treatment, as recommended by some authors, is not always necessary.     

LONGTERM PERGOLIDE TREATMENT OF ACROMEGALY

The effect of pergolide mesylate, a new potent longacting dopamine agonist, was investigated in eight patients with active acromegaly, none of whom had received pituitary irradiation. Patients were assessed at different dose levels for clinical response and biochemical response by measuring mean fasting growth hormone (GH), mean ambulant GH and glucose-induced GH response. Six patients had definite clinical improvement. No major side effects were noted. All patients showed a statistically significant reduction in GH, although in two reduction was not below 75% of pretreatment levels. On 500 μg pergolide daily the overall response for the group of eight patients was a reduction of fasting serum GH, mean ambulant GH and of GH response to glucose to 55% of pretreatment values. When the daily dose was increased to 1000 μg there was a further significant reduction in GH in some patients; on this dose the response for the group was a decrease in fasting serum GH and mean ambulant GH to 40% of pretreatment values. In three patients GH concentrations of 5 mU/1 or less were achieved. In two patients the daily dose was increased to 1500 μg but no extra benefit was obtained. We conclude that pergolide given once daily has a beneficial effect in acromegaly, with significant reduction in serum GH; it promises to be a useful therapeutic agent.     

STANDARDIZATION OF CERVICAL/VAGINAL CYTOPATHOLOGY REPORTING: THE BETHESDA SYSTEM (TBS) FOR REPORTING CERVICAL/VAGINAL CYTOLOGIC DIAGNOSES

The complex detection system leading to the discovery and treatment of precancerous lesions and early cancers of the uterine cervix is touched upon. By far the most difficult and underestimated component of this system is the screening and interpretation of cervical smears. Emphasis on the latest system of reporting, The Bethesda system is highlighted upon. Weaker points of the previous systems and the need for a newer system for reporting are stressed upon. The classification of the precursors of invasive squamous cancers is not easy, and various groups have advocated several schemes, none is yet perfect or universally accepted. The variation in nomenclature become less significant when the cytopathologist is a full member of a team made up of a clinician, histopathologist, colposcopist, and oncologist. As long as all members speak to each other frequently and use the same language and terminology, they will be able to determine the best treatment for the patient.KEY WORDS: Cervical smears, Epithelial cell abnormalities, The Bethesda system, Vaginal smears     

Intestinal parasites and bacteria in Aboriginal children in South West Australia

In a study of intestinal parasites in 697 Aboriginal children under the age of 6 years in South-west Australia, Giardia lamblia was recorded in 26% and Hymenolepis nana in 13.9%. G. lamblia infections occurred above 4 months of age, and H. nana infections above 18 months of age. There was a close correlation between infection with these two species (X², P <0.001). Campylobacter jejuni , the predominant bacterial species recorded, was isolated in 2.3%, and was related to bowel symptoms in one child. G. lamblia was more prevalent in the country areas than in the Perth metropolitan area (X², P <0.05. H. nana was more prevalent in children whose weight was below the third percentile (X², P <0.02), and in those with diarrhoea (X², P <0.01). There were strong correlations between low weight (below third percentile), a history of recent diarrhoea, and discharging ears.     

Effects of Flecainide, Encainide, and Clofilium on Ventricular Refractory Period Extension by Transcardiac Shocks

Objective: The mechanisms by which pharmacological agents alter electrical defibrillation are not fully understood. It has been proposed that, in addition to directly stimulating tissue, defibrillation may involve refractory period extension (RPE) produced by the shock. Accordingly, pharmacological agents might modulate defibrillation by altering RPE. This study examined the effect of Class I and Class III antiarrhythmic agents on RPE by transcardiac shocks. Methods: In four groups of pentobarbital anesthetized dogs, RPE was measured during rapid ventricular pacing before and after administration of either the Class I agents flecainide (n = 7) or encainide (n = 7), the Class III agent clofilium (n = 7), or vehicle (n = 5). Measurements included QRS duration during sinus rhythm and a conduction time, QT_C interval and refractory period, and RPE for 4- to 10-V/cm shocks delivered 20–80 ms before the end of the tissue absolute refractory period. For the 6-V/cm shocks, the interval after the shock during which tissue remained refractory (RIAS) was also computed. Results: Drugs affected QRS duration, conduction time, QT_C, and refractory period (without shocks) in accordance with their anticipated Class I and Class III actions. Without drugs, significant RPE was observed in all animals for all shocks delivered 40 ms or less before the end of the refractory period. Clofilium, encainide, and flecainide had a tendency to increase RPE hut only clofilium produced a significant increase. For 6-V/cm shocks with different timings, the minimum RIAS was found to be approximately 43 ms, and occurred for shocks given 20–30 ms before the end of the refractory period. Conclusions: At drug dosages that produced moderate Class III (=15%) or strong Class I (=35%) effects, only the Class III agent significantly increased RPE and RIAS. Thus, in addition to altering tissue excitability, the effect of antiarrhythmic agents to increase RPE and the minimum RIAS may help explain their influence on defibrillation threshold.