CLINICO-PATHOLOGICAL CORRELATION IN NEONATAL AUTOPSIES

Of the 253 neonates admitted to a neonate intensive care unit during the period Jan 91 to Sep 93, 43 neonates died. Autopsy was done in 23 of these (53%). The mean duration of stay of the neonates in the intensive care unit prior to death was 5.6 days (range 2 hours to 10 days). Antemortem diagnoses included asphyxia neonatorum (4), meconium aspiration syndrome (2), septicemia (5), prematurity (3), birth trauma (2), congenital anomalies (2), hypoxic ischemic encephalopathy (1), and non-specific diagnosis (4). There were 6 major autopsy findings that, if known prior to death, would have altered clinical management and might have resulted in cure or prolonged survival. There were 8 additional major findings that, if known prior to death, would not have altered management There were 14 minor findings related to major diagnoses but unrelated to the primary cause of death.KEY WORDS: Autopsy, Cause of death, Perinatal mortality     

Review of 59 patients with hypergonadotrophic amenorrhoea

Summary. Fifty-nine patients presented with elevated concentrations of gonadotrophins and secondary amenorrhoea before the age of 35 years. Fifty-three underwent laparoscopic examination and primordial follicles were observed in 16. Two others had follicles as they later became pregnant and a third showed biochemical evidence of spontaneous ovulation. There were streak ovaries in 12, two with follicles and three others with chromosomal abnormalities, two being 47XXX and one XO/XX. Two other patients had only one ovary each but no follicles. Chromosomal abnormalities were detected in two further patients one being XO/XX and the other a recombinant. Six patients became pregnant, two of them twice, resulting in four term deliveries and four spontaneous abortions. Three other patients showed biochemical evidence of ovulation; one spontaneously, one after oestrogen therapy and the third after treatment with gonadotrophin releasing hormone analogue.     

Hypothermic effects of apomorphine homologues in mice

A single intraperitoneal (i.p.) injection in mice of apomorphine (I) and its analogues norapomorphine (II), N-ethylnorapomorphine (III), N-n-propylnorapomorphine (IV) and apocodeine (V), caused dose-related decreases in deep-core body temperature. The neuroleptic agent haloperidol blocked the hypothermia produced by these apomorphines but α-methyl-p-tyrosine failed to do so. This indicated a direct post-synaptic stimulation of dopamine receptors. Methysergide potentiated the hypothermic effect of the apomorphine analogues. Taking the amount of apomorphine to produce a 3 °C fall in temperature at 30 min as unity, the approximate relative potencies were: I 1.00, II 0.06, III 47.50, IV 85.00, V 0.340. The doses of the apomorphines needed to produce hypothermia were much less than those needed to cause stereotypy. The ratios of the minimal doses required to produce hypothermia, to those producing stereotypy were: I 8.82, II 4.00, III 125.00, IV 28.50, V 1.43.     

Brain lesions modifying the abstinence signs in morphine-dependent rats.

Abstinence signs, mastication (teeth chattering), myoclonic twitch and repetitive shaking movements (wet shakes) were precipitated by naloxone and were recorded electromyographically from the suprahyoideal muscle in morphine-dependent rats anaesthetized with urethane. Transverse brain lesions were made bilaterally with an iridectomy knife in urethane anaesthetized morphine-dependent rats. Lesions at the level of the anterior commissure did not inhibit the myoclonic twitch and mastication but markedly potentiated wet shakes. Lesions which separated the connection between the corpus striatum and the thalamus completely abolished mastication, but the twitching activity and wet shakes were not affected. Mid-thalamus lesions did not inhibit wet shakes and mastication, but the myoclonic twitch activity was markedly reduced. Lesions at the mid-collicular level abolished all of the three activities observed. The results suggest that different precipitated withdrawal signs may originate from different brain areas.     

Tubular site of renal sodium retention in ascitic liver cirrhosis evaluated by lithium clearance

Abstract. Renal tubular sodium handling was evaluated in 27 non-azotemic cirrhotic patients with ascites and positive sodium balance and in 17 controls after at least 5 days of a constant sodium intake using the lithium clearance as an index of fluid delivery to the distal tubule. Plasma renin activity and plasma aldos-terone were also evaluated. Sodium fractional excretion, filtered sodium load, absolute sodium distal delivery, lithium fractional excretion and absolute distal sodium reabsorption were significantly lower in cirrhotics than in controls (0.58 ± 0.11 vs. 1.29 ± 0.12%, < 0.001; 12529± 677 vs. 15707±796 μEq min^-1 1.73 m^-2 BSA, <0.005; 2384±135.2 vs. 3685±219.3 μEq min^-1 1.73 m^-2 BSA, < 0.001; 19.5±1.0 vs. 24.2±l.3%, < 0.01; 2299±127 vs. 3485±214 μEq min^-1 1.73 m^-2 BSA, <0.001, respectively). A correlation was found between lithium clearance and sodium clearance only in cirrhotic patients ( r = 0.62; <0.01). Distal sodium reabsorption evaluated as a per cent of filtered sodium load was lower in cirrhotics than in controls (19.1 ±1.0 vs. 22.4±1.2%, <0.05) while distal sodium reabsorption evaluated as a per cent of sodium distal delivery was higher in cirrhotics than in controls (96.7 ± 0.4 vs. 94.4± 0.5%,< 0.005). In both groups a correlation was found between log plasma aldosterone and distal sodium reabsorption evaluated as a per cent of absolute sodium distal delivery ( r = 0.61, <0.01 and r =0.52,<0.05 respectively).
Our study indicates that a decrease in filtered sodium load and an increase in proximal sodium reabsorption play a critical role in the impairment of renal sodium handling in non-azotemic cirrhotic patients with ascites.     

Effect of nasal and oral breathing on exercise-induced asthma

The effect of nasal as well as oral breathing during level-ground running for 6 min on the post exercise bronchial response was studied in fifteen people (five asthmatics with exercise liability, five asthmatics with no such liability and five normals). Each patient did the exercise twice; once with the nose clipped and once with the mouth closed. FEV₁ was measured before exercise, immediately after exercise and at 5,10, 15,20and 30 min thereafter. A fall in FEV₁ of 20% or more from the basal level was taken as evidence of bronchoconstriction. When the patients were required to breath only through the nose during the exercise, the post-exercise bronchoconstrictive response was markedly reduced as compared with the response obtained by oral breathing during exercise, indicating a beneficial effect of nasal breathing. Nasal breathing was beneficial as compared with oral breathing in normals as well. In the five asthmatics with no exercise liability no appreciable difference was observed. This study suggests that the oropharynx and nasopharynx play important roles in the causation of exercise-induced asthma.