Unexpected findings at diagnostic laparoscopy: caecal incarceration with concurrent appendicitis in a patient with bilateral broad ligament defects

Internal herniations through broad ligament defects are very rare. We present the first report of the triad of broad ligament defect, internal herniation of the caecum and appendicitis. A 36-year-old woman with phocomelia presented with right iliac fossa pain and vomiting. The patient had no previous history of trauma or surgery. Abdominal ultrasound showed a small amount of free fluid. At laparoscopy, bilateral broad ligament defects were found, with herniation of the caecum and an inflamed appendix through the right-sided defect. A laparoscopic salpingo-oophorectomy was required for reduction of the herniated bowel, and an appendicectomy was performed. Broad ligament defects may be congenital or acquired. In this case, in light of the limb abnormality and absence of previous surgery, a congenital aetiology is more likely. Ultrasound scan is not reliable and, although computed tomography may be of help, a diagnostic laparoscopy is the best investigation.     

Factors determining serum-insulin response in a population sample

Summary Serum-insulin levels were measured in 1770 subjects one hour after a 50 g glucose load. Multiple regression analyses reveal that a substantial proportion of the variability of log₁₀ serum-insulin can be attributed to significant independent effect of blood-sugar, age, the food-interval, sex, parameters of body size, and scserum uric acid. Females have significantly higher levels of serum-insulin than males One-hour blood-sugar levels exceeding 160 nag/100 ml are associated with declining insulin levels. An independent association of increasing age with increasing serum-insulin is evident at 50 years and over. The findings provide strong support for the biological significance of serum-immunoreactive insulin.

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Einfluß verschiedener Faktoren auf die Seruminsulinausschüttung bei einer Reihenuntersuchung

Zusammenfassung Die Seruminsulinspiegel 1 Std nach oraler Verabreichung von 50 g Glucose wurden bei 1770 Probanden bestimmt. Eine multiple Regressionsanalyse der Zehnerlogarithmuswerte für die Seruminsulinkonzentrationen ergab, daß ein beträchtlicher Teil der Variationsbreite durch signifikante und von einander unabhängige Einflüsse des Blutzuckers, des Alters, der Intervalle zwischen den Mahlzeiten, des Geschlechtes, des Körpergewichtes und der Harnsäure bedingt ist. Frauen wiesen significant höhere Insulinwerte als Männer auf. Häufig waren 1 Std Blutzuckerwerte über 160 mg% mit sinkenden Insulinspiegeln gekoppelt. Bei über 50 jährigen stiegen mit zunehmendem Alter auch die Insulinwerte an. Die Befunde stützen die Annahme, daß den immunologisch gemessenen Seruminsulinspiegeln biologische Bedeutung zukommt.

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Facteurs déterminant la réponse de Vinsuline sérique dans un échantillon de population

Résumé Les taux d'insuline sérique ont été mesurés chez 1770 sujets une heure après une charge en glucose de 50 g. Des analyses de régression multiple révèlent qu'une proportion considérable de la variabilité du log₁₀ de l'insuline sérique revient de façon significative aux effets indépendants entre eux de la glycémie, de l'âge, de l'intervalle entre les repas, du sexe, des paramètres de la taille corporelle et de l'acide urique sérique. Les femmes ont des niveaux d'insuline sérique significativement plus élevés que les hommes. Les taux de la glycémie une heure après, dépassant 160 mg/100 ml sont associés à une défaillance des taux d'insuline. Une association indépendante entre l'augmentation de l'âge et l'augmentation de l'insuline sérique est évidente à 50 ans et plus. Ces résultats apportent un argument solide pour l'importance biologique de l'insuline immunoréactive du sérum.

     

Discriminant analysis of data in ulcer and nonulcer populations

The purpose of this study was to assess whether consideration of age and body weight measurements improved discrimination between normal subjects and duodenal ulcer subjects using the maximal acid output test. Seventy-seven male volunteers were the normal group, and 155 patients with surgically proven duodenal ulcers were the ulcer group. We found that the ratio of maximal acid output to actual weight gave the best discrimination between the two groups. Using this ratio, there were 45 hypersecretors in the ulcer group, and only 1 false-positive among the normal subjects. A graphic method is described which employs the ratio of acid to weight and can correctly classify two-thirds of the ulcer group. The disadvantage of this method, however, is that one-third of the control group in our series were misclassified as hypersecretors; therefore, the clinician must consider history and barium meal findings as well as this evaluation of the subject.Deceased.     

Chronic effects of cannabis on sensory gating

Chronic cannabis use has been associated with neurocognitive deficits, alterations in brain structure and function, and with psychosis. This study investigated the effects of chronic cannabis use on P50 sensory-gating in regular users, and explored the association between sensory gating, cannabis use history and the development of psychotic-like symptoms. Twenty controls and 21 regular cannabis users completed a P50 paired-click (S1 and S2) paradigm with an inter-pair interval of 9 s. The groups were compared on P50 amplitude to S1 and S2, P50 ratio (S2/S1) and P50 difference score (S1–S2). While cannabis users overall did not differ from controls on P50 measures, prolonged duration of regular use was associated with greater impairment in sensory gating as indexed by both P50 ratio and difference scores (including after controlling for tobacco use). Long-term cannabis users were found to have worse sensory gating ratios and difference scores compared to short-term users and controls. P50 metrics did not correlate significantly with any measure of psychotic-like symptoms in cannabis users. These results suggest that prolonged exposure to cannabis results in impaired P50 sensory-gating in long-term cannabis users. While it is possible that these deficits may have pre-dated cannabis use and reflect a vulnerability to cannabis use, their association with increasing years of cannabis use suggests that this is not the case. Impaired P50 sensory-gating ratios have also been reported in patients with schizophrenia and may indicate a similar underlying pathology.     

New evidence for,and challenges in,linking small CGG repeat expansion FMR1 alleles with Parkinson's disease

We recently reported a significant increase in the frequency of carriers of grey zone (GZ) alleles of FMR1 gene in Australian males with Parkinson's disease (PD) from Victoria and Tasmania. Here, we report data comparing an independent sample of 817 PD patients from Queensland to 1078 consecutive Australian male newborns from Victoria. We confirmed the earlier finding by observing a significant excess of GZ alleles in PD (4.8%) compared to controls (1.5%). Although both studies provided evidence in support of an association between GZ‐carrier status and increased risk for parkinsonism, the existing evidence in the literature from screening studies remains equivocal and we discuss the need for alternative approaches to resolve the issue.