Gallstone obstruction of the colon. Thorough treatment prevents serious complications.

Formation of a fistula between the gallbladder and bowel may allow a gallstone to enter the intestinal tract. In the two cases described here, the colon was involved. The authors describe diagnosis and management of these cases and make treatment recommendations based on their experience.     

Endolumph volume changes during osmotic dehydration measured by two marker techniques

The processes underlying endolymph volume regulation during osmotic disturbances were investigated in vivo using ionic volume markers. The markers utilized were tetramethylammonium (TMA⁺) or hexafluoroarsenate (AsF₆⁻). Both ions were used in concentrations low enough not to be toxic, but readily detectable by ion-selective microelectrodes (typically < 1 mM). Two marker techniques were developed. In one, termed the ‘perfused volume marker’ (PVM) method, the marker was loaded into endolymph throughout the cochlea by perfusion of the perilymphatic space. Concentration changes of the marker were measured with a double-barreled ion-selective microelectrode. These recordings were insensitive to longitudinal movements of endolymph. The second technique, termed the ‘iontophoresed volume marker’ (IVM) method, utilized a localized, iontophoretic injection of marker into endolymph. In this method, marker changes were recorded from two ion-selective electrodes, one placed basal and one placed apical to the injection site. These data were used to compute changes in cross-sectional area and longitudinal movements of endolymph. Changes in endolymph volume were induced by perfusion of the perilymphatic space with hypertonic media. The endolymph potassium increase produced by osmotic dehydration was of similar magnitude and time course to that of a volume marker loaded by the PVM method. Using the IVM method, it was shown that these concentration increases arose by two distinct processes. One component was the area decrease of scala media. A second component was a small apically directed movement of endolymph during dehydration, thereby concentrating the available electrolytes within a smaller volume. This latter component was estimated to contribute approximately one third of the electrolyte increase during dehydration. Both the present and previous studies show that in the undisturbed state, longitudinal endolymph movements are extremely small and cannot make a significant contribution to ionic homeostasis. However, when endolymph volume is disturbed, longitudinal movements contribute to the electrolyte changes and are part of the compensation process. This study provides the first direct evidence supporting the long-standing hypotheses that local, radial homeostasis and longitudinal volume corrections both occur in the mammalian cochlea.     

Dexamethasone concentration gradients along scala tympani after application to the round window membrane.

HYPOTHESIS: Local application of dexamethasone-21-dihydrogen-phosphate (Dex-P) to the round window (RW) membrane of guinea pigs produces a substantial basal-apical concentration gradient in scala tympani (ST) perilymph. BACKGROUND: In recent years, intratympanically applied glucocorticoids are increasingly being used for the treatment of inner ear disease. Although measurements of intracochlear concentrations after RW application exist, there is limited information on the distribution of these drugs in the inner ear fluids. It has been predicted from computer simulations that substantial concentration gradients will occur after RW application, with lower concentrations expected in apical turns. Concentration gradients of other substances along the cochlea have recently been confirmed using a sequential apical sampling method to obtain perilymph. METHODS: Dexamethasone-21-dihydrogen-phosphate (10 mg/ml) was administered to the RW membrane of guinea pigs (n = 9) in vivo for 2 to 3 hours. Perilymph was then collected using a protocol in which 10 samples, each of approximately 1 mul, were taken sequentially from the cochlear apex into capillary tubes. Dexamethasone-21-dihydrogen-phosphate concentration of the samples was analyzed by high-performance liquid chromatography. Interpretation of sample data using a finite element model allowed the longitudinal gradients of Dex-P in ST to be quantified. RESULTS: The Dex-P content of the first sample in each experiment (dominated by perilymph from apical regions) was substantially lower than that of the third and fourth sample (dominated by basal turn perilymph). These findings qualitatively demonstrated the existence of a concentration gradient along ST. After detailed analysis of the measured sample concentrations using an established finite element computer model, the mean basal-apical concentration gradient was estimated to be 17,000. Both absolute concentrations of Dex-P in ST and the basal-apical gradients were found to vary substantially. CONCLUSION: The existence of substantial basal-apical concentration gradients of Dex-P in ST perilymph were demonstrated experimentally. If the variability in peak concentration and gradient is also present under clinical conditions, this may contribute to the heterogeneity of outcome that is observed after intratympanic application of glucocorticoids for various inner ear diseases.     

Inhibition of noradrenaline uptake 2 in the isolated rat heart by steroids, clonidine and methoxylated phenylethylamines

Various steroids (corticosterone, testosterone, progesterone, β-oestradiol) produced a dose-dependent inhibition of the uptake of ³H-noradrenaline by the uptake₂ mechanism in the isolated perfused rat heart. These compounds were potent and selective inhibitors of uptake₂, with the exception of β-oestradiol which also inhibited noradrenaline accumulation in sympathetic nerves by the uptake₁ mechanism. The hypotensive drug, clonidine, was a moderately potent and highly selective inhibitor of uptake₂. Uptake was also inhibited by certain methoxylated phenylethylamine derivatives, but was unaffected by cocaine, desipramine, amitriptyline, angiotensin, histamine, ethanol or prostaglandins.