Preparation for elective colorectal surgery

An oral colonic lavage solution containing sodium sulfate and polyethylene glycol was compared with whole-gut irrigation using saline via a nasogastric tube in a randomized blinded study of 34 consecutive well-matched patients undergoing elective colorectal surgery. Both methods were safe and rapid. Patients receiving oral colonic lavage, however, had significantly less (P less than 0.05) water retention, overall distress, cramps, and other complaints. No significant differences were found with regard to fullness, nausea, and rectal discomfort. The bowel cleansings were equally adequate, and most patients achieved a good-to-excellent preparation. Surgical complications appeared not to be related to the preparation used, and wound sepsis were equally frequent. Oral colonic lavage proved to be the most attractive preoperative cleansing method.     

Long Term Therapy of Pernicious Anaemia with the Depot Cobalamin Preparation Betolvex®

The value of a depot cobalamin preparation Betolvex® (cyanocobalamin-tannin complex suspended in a sesame-oil aluminium-monostearate gel) in the maintenance therapy of pernicious anaemia was investigated in 120 patients followed up for between 8 and 15 years. Complete haematological remission was maintained in all patients, and none developed B₁₂ neuropathy after the start of treatment. No side-effects were observed. The mean values of S-cobalamin were above the reference limits when 1 mg cobalamin was given every 2 months, and high within the reference limits when given at 3 monthly intervals. The cobalamin content in the liver tissue in 2 patients who had received 1 mg cobalamin every 3 months for 6 years revealed normal values. Thus, 1 mg of the depot cobalamin preparation given at intervals of 3 months should provide adequate maintenance therapy in pernicious anaemia.     

Surgical treatment of ureterocele. A follow-up study of 56 operated cases in 52 adult patients.

A material covering 25 years and comprising 52 patients with 56 surgically treated ureteroceles was followed up over periods varying from 3 to 27 years, the average being 12 years. The initial symptoms and treatment are described. Most of the patients were treated with transurethral diathermy incision of the ureteroceles. 10 patients had died before the follow-up and one could not be located. 73% of the remaining 41 patients had no complaints at follow-up and 71% of the patients treated with transurethral incision were symptomatically cured. Vesico-ureteric reflux was demonstrated in 9 patients, of whom 3 had pyelonephritic changes in the kidneys. The groups of patients treated with resection or excision of the ureteroceles were too small to allow significant conclusions.     

The Neurovascular Island Pedicle Flap

Nine patients with irreparable damage to the nerves of the thumb, treated with a neurovascular island pedicle flap from the third or fourth finger to the defect thumb, have been re-examined 9 months to 8 years after the operation.

Eight patients had a 2-point discrimination of less than 15 mm corresponding to the flap and all had a positive Ninhydrin test. Two had complete cortical reorientation and three partial reorientation. Six found the function of the thumb to be good or fair. Three described the result as poor and three had to be reoperated because of contractures of the donor finger and/or thumb.

The method can be recommended for use in young, well motivated patients.     

Sexual and hypothalamic dysfunction in the postconcussional syndrome

Nineteen males with a well-developed postconcussional syndrome were studied by CT-scan, by psychometric testing and by endocrinological evaluation including a variety of laboratory tests and an assessment of sexual function, 68% had cerebral atrophy on CT-scan and 79% were intellectually impaired, 37% to a severe degree. Sexual dysfunction (reduced libido and/or erective dysfunction) related to the head injury occurred in 58%, and severe intellectual impairment was significantly more frequent in this group. Increased plasma concentration of follicle stimulating hormone was observed in 37%, suggesting a reduced spermiogenesis. The possibility of a primary hypothalamic disorder causing reduced spermiogenesis is raised. Otherwise no radiological or laboratory evidence of major hypothalamic-pituitary dysfunction was demonstrated. The high frequency of cerebral atrophy and intellectual deterioration in postconcussional syndrome suggests organic brain dysfunction, but not causal relationship was established.     

Pharmacokinetics of doxorubicin and its metabolite doxorubicinol in rabbits with induced acid and alkaline urine

Summary The pharmacokinetics of doxorubicin in rabbits preloaded either with ammonium chloride or sodium hydrogencarbonate have been investigated following single IV administration of 5 mg/kg.Plasma samples and urine collections were obtained over 3 h following administratio, and were assayed in duplicate for doxorubicin and its main metabolite doxorubicinol by reversed-phase high-pressure liquid chromatography.The plasma concentration of doxorubicin was fitted to an open two-compartment model.The areas under the plasma concentration-time curves (AUC) of doxorubicin in rabbits with alkaline urine were approximately half the areas in rabbits with acid urine. A pharmacokinetic analysis indicated an increase in the central volume of distribution, which is interpreted as an increase in tissue permeability in the alkaline state, due to the acid-base properties of the doxorubicin molecule.The renal excretion of doxorubicin and doxorubicinol was quantitatively similar in the two groups of rabbits. The total renal excretion of anthracyclines during the experiment was calculated to approximately 6% of the administered dose. The clearances of doxorubicin were initially three times higher than inulin clearance, but approximated this value at the end of the experiment.The renal handling of doxorubicin in the rabbits is explained by glomerular filtration followed by tubular secretion and finally by a reabsorption mechanism with limited capacity.     

Basophil Histamine Release by RNA, DNA and Aggregated IgG Examined in Rheumatoid Arthritis and Systemic Lupus Erythematosus

Basophils from patients with rheumatoid arthritis (RA) respond to RNA, DNA and immune complexes [aggregated IgG] with histamine release. The RNA response was well correlated to the clinical activity of the disease since histamine liberation was found in all patients with severe activity, whereas no liberation was observed in patients with moderate or quiescent activity. A less significant correlation was obtained with DNA and aggregated IgG. In contrast, no response was obtained with RNA, DNA and aggregated IgG in patients with systemic lupus erythematosus (SLE) or in controls. In the RA and the SLE groups no significant correlation was found between the response of RNA, DNA and aggregated IgG and the serum titres of anti-DNA and antinuclear antibodies. No difference in basophil cell count in peripheral blood and basophil histamine content was found between RA. SLE and controls. Our results point 10 an involvement of an autoimmune type I reaction in the pathogenesis of RA directed against the nuclear components RNA and DNA and against immune complexes.