Dosage of colloidal bismuth subcitrate in duodenal ulcer healing and clearance of Campylobacter pylori

Sixty consecutive patients with endoscopically proven duodenal ulcers were given colloidal bismuth subcitrate tablets either as 120 mg q.d.s. or 240 mg b.d., in a randomized single-blind study. The efficacy of each regimen was determined by endoscopic examination and antral biopsy at 4 weeks; if the ulcer remained unhealed, treatment was continued and endoscopy repeated at 8 weeks. The ulcer-healing efficacy of the two regimens was identical; however, in the four times daily group only 27% remained Campylobacter pylori positive after 8 weeks of treatment compared with 58% of the twice-daily group. Similarly, only 21% of twice daily patients were free of histological gastritis compared with 42% of the four times daily patients.     

Cerebral osmoregulatory reduction of plasma renin concentration in sheep

A centrally mediated inhibitory influence of plasma hypertonicity on renin secretion was investigated in conscious, Na-depleted sheep. Infusions of hypertonic solutions were made into the carotid artery or jugular vein, and the effects on plasma renin concentration (PRC) compared. Intracarotid infusion of 1.65 M NaCl significantly reduced PRC (to 74% of the pre-infusion value) within 15 min of the commencement of the infusion whereas corresponding intrajugular infusion did not. Intracarotid infusion of 3 M sorbitol for 45 min also reduced PRC (to 64% of the pre-infusion level) significantly after 15 min of infusion. By contrast, neither intrajugular infusion of 3 M sorbitol, nor intracarotid infusion of isotonic 0.15 M NaCl for 45 min significantly reduced PRC. Intracarotid infusion of hypertonic sorbitol for 45 min did not inhibit PRC in sheep with cerebral lesions of the lamina terminalis. These results show that plasma hypertonicity may have an inhibitory influence on renin secretion. The inhibition is probably mediated by an effect of hypertonicity on the CNS, rather than a direct effect on the kidney.     

Histologically Confirmed Cholesterol Atheroemboli with Identification of the Source by Transesophageal Echocardiography

Cholesterol embolization may occur after catheter manipulation of the descending aorta in patients with diffuse atherosclerosis. A clinical diagnosis of cholesterol embolism after manipulation of the descending aorta is suspected by the presence of systemic atheroemboli. Transesophageal echocardiography (TEE) is an excellent technique for detecting atheromatous plaques of the aorta. TEE is becoming more commonly used in the work-up of cerebrovascular events but we suggest its scope should be broadened to include patients with suspected intra-aortic atherosclerotic disease prior to cardiac catheterization. The findings at TEE would help alert the clinician to use extreme caution if an invasive aortic procedure was felt to be essential. Our patient illustrates the constellation of clinical findings in atheroembolic disease that occurred after cardiac catheterization with biopsy confirmation of cholesterol emboli. TEE revealed several large protruding atheromatous plaques of the descending aorta that were most probably responsible for the systemic manifestations of renal insufficiency and digital infarctions.     

Simplified method for compression of femoral false aneurysms

False aneurysm formation is a not uncommon complication of cardiaccatheterization. Until recently, surgical repair was the onlytherapeutic option available when conservative management failed.However, Doppler-guided compression of the aneurysm has beenadvocated in recent years; the method requires prolonged indirectmanual compression of the femoral artery aneurysm and is uncomfortablefor both the patient and operator. In ten consecutive patientsthe use of Doppler-guided clamp placement and aneurysm compressionfor 60 min resulted in complete thrombosis of the aneurysm ineight, and only one patient required surgical repair. The procedurewas well tolerated by all patients (analgesia was administeredliberally). Eight patients were discharged within 24 h, oneafter 2 days and the single surgical patient remained an inpatientfor 6 days. Doppler-guided clamp compression of false aneurysmsis a safe, effective and cost effective method of managing thesepatients.     

The LW: C3 recombination fraction in female meioses

No recombinants between LW and C3 , using a C3 DNA probe, were observed in 16 female meioses: z 4·216 at θ= 0·00. Combined with the data of Sistonen (1984) the recombination fraction between LW and C3 is estimated to be 0.09 ( 3·773) in females.     

The chromosome 19 linkage group LDLR, C3, LW, APOC2, LU, SE in man

The data establish linkage in both sexes for LDLR:LW (ž= 8.43 at θ= 0.00) and in the male for LDLR:LU (ž= 3.31 at θ= 0.00) and for LW:APOC2 (ž= 3.90 at θ= 0.00) They confirm LDLR:C3 and APOC2:LU linkage in both sexes, and LW:LU linkage in the male. The loci constitute two tightly linked gene clusters, LDLR, C3, LW and APOC2, LU, SE , distinguished by measurable linkage in female meioses within but not between clusters. Argument is supported for a 19p13.2-cen position for LW and a long arm position for LU and SE.     

Fifty Cases of Primary Hyperaldosteronism in Hong Kong Chinese with a High Frequency of Periodic Paralysis. Evaluation of Techniques for Tumour Localisation

Fifty consecutive Chinese patients with primary hyperaldosteronismwere studied. All were considered to have an adrenal corticaladenoma, this being proven by surgery in 46 cases. In contrastto other reports, periodic paralysis was a presenting featurein 42 per cent of patients. Other notable symptoms were palpitations(30 per cent) and syncope (12 per cent). Vascular complicationswere present in 20 per cent of cases. Mean serum potassium levelat presentation was 2.1±0.1 (mean ±SEM) and sodium145.0±0.1 mmol/1. Serum potassium was significantly lowerand plasma aldosterone higher in patients with periodic paralysis.Adrenal venography in order to localise the tumour was unreliableand was misleading in two cases. Adrenal venous sampling forsteroid analysis was much more helpful, despite the difficultyof obtaining right adrenal venous blood. The side of the adenomacould be predicted in 97 per cent of cases from measurementsof left adrenal venous and vena caval aldosterone levels. Theuse of high resolution CT gave 100 per cent accuracy in all18 patients who underwent surgery, the smallest detected tumourbeing 0.8 cm in diameter. Surgery corrected hypokalaemia inall cases, and 37 of the 46 patients required no further antihypertensivetreatment.     

USE OF ALFENTANIL WITH PROPOFOL FOR NASOTRACHEAL INTUBATION WITHOUT NEUROMUSCULAR BLOCK

We have investigated the effect of augmentation of propofolwith alfentanil for nasotracheal intubation without neuromuscularblock in 60 patients undergoing short elective maxillo-facialprocedures as outpatients. After administration of glycopyrronium5 fig kg^–1 i.v., anaesthesia was induced with propofol2.5 mg kg^–1, or alfentanil 20 µg kg^–1 andprofopol 2.5 mg kg^–1. The alfentanil group had improvedjaw relaxation (P < 0.001) and vocalcord conditions (P <0.005). Tracheal intubation was successful in 83% of patientsreceiving alfentanil, and in 73% of patients receiving propofolonly. This difference was not significant. The cardiovascularresponse to intubation was attenuated in the alfentanil group.(Br. J. Anaesth. 1993; 70: 89–91)     

Acute Renal Failure Due to Leptospirosis: Clinical Features and Outcome in Six Cases

Six cases of severe leptospiral infection with renal failureare described. Five of the six patients had acute oliguric renalfailure requiring dialysis. Renal function recovered over threeweeks and by two months all patients had plasma creatinine levels< 200 µmol/litre. The initial diagnosis of leptospirosisdepended on clinical and epidemiological features because serologicalconfirmation was not possible during the first week of the illness.All the patients had either high risk occupations or a historyof exposure to external sources of infection. All had fever,myalgia, jaundice and muscle tenderness. Although biirubin levelswere high (> 350 µmol/litre in five) the elevationsof aspartate transaminase and alkaline phosphatase levels, andprolonga tions of prothrombin times were relatively slight.Thrombocytopenia occurred in five of the six cases. Leptospiracomplement fixation tests were weakly positive or negative onadmission in five cases but rose to significant levels subsequently.Penicillin treathient resulted in Jarisch-Herxheimer reactionsin three cases. The important complications were: upper gastro-intestinalhaemorrhage (five cases), thrombocytopenia <30000 platelets/mm³(four cases), atrial fibrilla tion (three cases), drowsinesswith asterixis (four cases). All six patients were seriouslyill and required intensive supportive therapy. All survived.