A Familial Hemorrhagic Diathesis due to an Antithrombin

1) A familial hemorrhagic diathesis has been found to be due to an antithrombin.

2) This antithrombin is not fibrinogen, antithrombin II, III, or IV, and isnot similar in its characteristics to the antithrombins described in secondaryhemorrhagic conditions.

3) The inheritance of this disorder is not sex-linked but is otherwise notclear. The factor may be a dominant, the expression of which is modified byunknown factors.

Submitted on July 6, 1962 Accepted on October 17, 1962     

CEREBRO-SIVNAL MENINGITIS REPORT OF AN EPIDEMIC IN SOUTH HUNAN

This paper is not intended as a treatise on cerebro-spinal meningitis, but is a simple. report on an epidemic which brought to our hospital: in the course of three months, an intereshng series of forty three cases. During some I2 years in south Hunan, we had seen less than ten cases of cerebro-spinal meningitis, of the meningococcus type, prior fo the epidemic in the Spring of 1934. Previous cases were always sporadic, since, even when we received three cases in one day from a certain government school, there was never any further outbreak. Tuberculous and pneumococcic meningitis (and possible leprous meningitis) have been met with, but have no place in this report.     

Volume shifts,unfolding and rolling of haustra in the isolated guinea pig caecum

The large intestine extracts water from chyme and compacts chyme into faecal conglomerates; it is unclear what role the special pockets known as colonic haustra have in these events. Here we monitored the movements of haustra in isolated preparations of guinea pig caecum using videocamera and ultrasound and related them to contractions of muscle flaps and movements of glass beads in haustral pockets. We found that in partially filled caecal loops localized contractions of taeniae shift volume back and forth between adjacent haustra; volume unfolds haustral walls in a characteristic sweep with sequential intrahaustral folds popping out; cyclic contractions and relaxations of the fold then produce the caterpillar-like movement known as haustral rolling; ultrasound showed that haustral rolling made the haustral flow channel narrower and longer as haustral folds increase their height from 7.5 ± 1.5 mm to 16 ± 4 mm and their distance from 4.1 ± 0.2 mm to 7.9 ± 0.3 mm; luminal contents were alternatively shaken off the haustral wall, whirled around the lumen or left to settle. We also suspended the row of haustra between two taeniae inside a frame and attached flaps of taeniae and haustral folds to strain gauges to record their mechanical activity; both taeniae and haustral folds produced an undulating baseline tension; during rolling, folds produced phasic contractions at 17 ± 2 cycles min^?1 which propagated distally across haustral septa; rolling constantly shuffled around glass beads placed inside the haustra. When we stimulated the intramural nerves to the caecum through bipolar electrodes, all contractile activity was temporarily inhibited and haustral septa flattened; a rebound contraction then propagated aborally from the caecal pole and swept the glass beads ahead of it. Thus, tonic contractions of taeniae shift caecal contents back and forth across haustral septa; expansion of haustra triggers haustral rolling which shuffles contents; both these movements produce local flow within and between haustra which might enhance the separation of solid and liquid colonic contents.     

Crush syndrome

Objective: To describe the clinical features of crush syndrome, the inter-relationship between rhabdomyolysis, compartment syndrome and crush syndrome, and to make recommendations on the pre-hospital and emergency department management of the condition. Clinical features: Three case reports are described of patients presenting with crush syndrome following drug induced coma, including one patient in cardiac arrest. Raised compartment pressures were confirmed by manometry, and extensive rhabdomyolysis by myoglobinuria and raised creatine kinase. Intervention and outcome: Vigorous medical management was undertaken including infusion of large volumes of intravenous fluid, and therapy with bicarbonate; mannitol, frusemide and dopamine. Surgical fasciotomy was not performed and a good outcome resulted in each case. Conclusion: Drug induced coma is now the commonest cause of the crush syndrome. Effective medical management may obviate the need for surgical fasciotomy in cases with raised compartment pressures.