Comparative effects of ephedrine on adrenergic responsiveness in normal and asthmatic subjects.

A comparison was made of the metabolic and pulmonary responses to adrenergic stimulation in 6 normal subjects and 10 patients with mild asthma who were treated with equal amounts of ephedrine for 7 to 10 days. During the control and placebo periods, the measurements of cyclic adenosine monophosphate (AMP) in leukocytes of asthmatic subjects were similar to those of normal subjects. After one week of therapy with ephedrine, both groups exhibited suppression of the leukocyte cyclic AMP responses to adrenergic stimulation in vitro; however, the suppression of response was significantly greater in asthmatic subjects (p < 0.01). The plasma glucose responses to administered epinephrine also decreased in both groups after treatment with ephedrine, but the change occurred earlier in asthmatic subjects. Ephedrine did not alter either the baseline pulmonary functions or the pulmonary responses to administered epinephrine; however, significant changes in pulmonary function were not observed after subcutaneous administration of 200 μg of epinephrine during any of the treatment periods. Morning plasma cortisol concentrations were significantly lower in asthmatic patients than in normal controls (p < 0.001) but were not affected by treatment with ephedrine. Administration of 100 mg of Solu-Cortef intravenously improved the glucose responses to epinephrine in ephedrine-treated asthmatic subjects but did not influence the pulmonary responses or the measurements of leukocyte cyclic AMP in either group. The results indicate that the metabolic responses to adrenergic stimulation are markedly altered in both normal and asthmatic subjects by a short period of treatment with ephedrine. However, loss of metabolic response was not associated with corresponding changes in the pulmonary responses to therapy.     

Arthrography of the knee: a comparative study of the accuracy of single and double contrast techniques

Single and double contrast arthrographic techniques were compared in 951 patinets with suspected meniscal injuries. Exploratory surgery of the knee was performed in 384 of these patients and good clinical follow-up was obtained in 135 patients. In the latter two groups of patients, the single contrast technique was 97% accurate in assessing the medial meniscus and 96% accurate in assessing the lateral meniscus. Double contrast arthrography was 97% accurate in assessing the medial meniscus and 93% accurate in assessing the lateral meniscus. Numerical differences in the results from the two techniques were not statistically significant. Therefore both techniques can be considered equally effective diagnostically.     

Detailed per-oral small bowel examination vs. enteroclysis. Part II: Radiographic accuracy

Accuracy of the detailed per-oral small bowel series and enteroclysis was compared in 134 patients known to have (or not have) disease of the small bowel. Overall sensitivity of the per-oral examination was 92% and specificity 94%, compared to 94% and 89%, respectively, for enteroclysis. There was no difference between the two in Crohn disease, adhesions, and metastatic disease; however, enteroclysis was thought to be more effective in delineating peritoneal adhesions in patients with obstruction. The authors conclude that while the per-oral study and enteroclysis are equally valid methods of examining the small bowel, the per-oral study is preferable as a screening examination because it requires less time, has fewer side effects, and involves a lower radiation exposure.     

One-year outcome and course of recovery after severe traumatic brain injury

Goal  

To describe the outcome of patients with severe traumatic brain injury (TBI) 3, 6 and 12 months after trauma.