Multiple Malignant Intra-abdominal Hemangiopericytomas-Rare Sites

Multiple intra-abdominal hemangiopericytomas with a subcutaneous mass in the left femoral triangle are reported with a short review of the literature. The problems of diagnosis and management encountered are also discussed.     

Bartter's syndrome and diabetes mellitus

Abstract. We here report a case of Bartter's syndrome occurring in association with diabetes mellitus. The patient, an insulin-dependent diabetic, presented with hypokalaemia, inappropriate kaliuresis and metabolic alkalosis. He had high plasma renin activity, relatively low plasma aldosterone, and resistance to infused angiotensin II. A high potassium diet raised total body potassium and serum potassium, did not affect plasma renin activity, but raised plasma aldosterone significantly and did not alter the resistance to angiotensin II. Indomethacin administered acutely reduced urinary potassium and kallikrein excretion and, on chronic administration, lowered plasma renin activity, urinary chloride excretion, and raised serum potassium. Salt restriction resulted in a prompt and significant reduction in urinary sodium and chloride excretion. Urinary kallikrein excretion was very high throughout, increased with sodium restriction, and decreased with sodium loading. Oral potassium supplementation partially corrected the hypokalaemia, but did not affect blood sugar control. In this patient the primary defect appears to have been primary urinary potassium wasting, rather than sodium or chloride wasting. The striking effects of indomethacin suggest that prostaglandins may play a fundamental role in the genesis of the syndrome.     

Gastrointestinal Leiomyomas

An exogastric asymptomatic leiomyoma and an ileal leiomyoma presenting as an intussusception are reported on account of rarity. The diagnostic problem involved are discussed with a short review of the literature.     

MORPHINE-6-GLUCURONIDE DISPOSITION IN RENAL IMPAIRMENT

Twelve patients with chronic renal failure (dialysis-dependent)and six with good renal function after renal transplantationreceived i.v. morphine-6-glucuronide (M6G) 30 fig kg^-1 as partof a standardized anaesthetic technique for minor surgery. Continuousperitoneal dialysis was commenced 6 h after M6G administrationin six of the dialysis-dependent patients. Serum was sampledfor up to 12 h and analysed for morphine and M6G by high pressureliquid chromatography. Morphine was not detected. Mean (so)derived pharmacokinetic variables for the three groups (transplant,renally impaired non-dia/ysed and renally impaired dia-lysed,respectively) were: elimination half-life 2.14 (0.69) h, 27.10(15.8) h, 17.33 (4.6) h; clearance 96.0 (34.9) ml min-1, 10.57(5.57) ml min'1, 14.3 (6.2) ml min-1; volume of distribution0.19 (0.03) litre kg-7, 0.25 (0.06) litre kg-1, 0.27 (0.06)litre kg^-1. The elimination half-life was shorter (P < 0.01)and the clearance greater (P < 0.01) for the transplantedgroup compared with the dialysed and non-dia/ysed groups. Peritonealdialysis for the second 6 h after drug administration had littleeffect on M6G disposition as assessed by comparison with dataobtained from the non-dia/ysed group. (Br. J. Anaesth. 1993;70: 511–514) ^*Presemt address: Department of Anaesthesia, Neath General Hospital,West Glamorgan, Wales.     

The Indian Experience of Percutaneous Transvenous Mitral Commissurotomy: Comparison of the Triple Lumen (Inoue) and Double Lumen (Accura) Variable Sized Single Balloon With Regard to Procedural Outcome and Cost Savings

The efficacy, safety, and cost of percutaneous mitral commissurotomy (PTMC), using variable volume dependent sized catheters, compared a triple lumen (Inoue) with a double lumen (Accura) catheter. PTMC was performed using Accura balloons in 400 patients and Inoue balloons in 512 patients. The group demographics, increase in mitral valve area, and incidence of significant complications were similar. The catheters were similar with respect to maneuverability and procedure (fluoroscopy) time. The Accura balloons could be reutilized statistically more often (6.3 ± 1.4 for Accura and 5.2 ± 0.8 for Inoue, P < 0.05). Accura balloons were more cost-effective, with 6.3 usages lowering the per procedural catheter cost to $214.00, while the Inoue balloons, with 5.2 usages, had a final catheter cost of $395.00. The potential savings would have been $155,340.00 if Accura balloons were utilized. Conclusions: Accura and Inoue mitral valvuloplasty balloons were comparable with regard to efficacy and safety, but the Accura balloon was significantly less costly and is therefore more suitable for use in India and other nations where resources are limited.     

Keeping the {heartsuit} Beat in Grampian--a case study in community participation and ownership

In the Grampian Region of Scotland, a new 10 year heart healthinitiative, ‘Keeping the Beat in Grampian’ waslaunched in October 1991. Although this programme is based ona number of well-tested health promotion principles it is uniquein a number of aspects. The concepts of community ownership,corporate identity and people empowerment have been extendedto a much greater degree. The programme is registered as a privatecompany with charitable status so that management, decision-makingand budgetary control are vested totally in the community.     

A Study of Growth Factor Receptors in Human Lens Epithelial Cells and their Relationship to Fiber Differentiation

Recent studies have demonstrated that several growth factors enhance fiber differentiation in cultured human lens epithelial (HLE) cells in early passages. However, these effects gradually decrease in cells of later passages. The purpose of this investigation is to test the hypothesis that the decreasing effect of growth factors on fiber differentiation in later passages may be due to a decrease or the inactivation of growth factor receptors as a function of serial subcultures. Specimens of HLE cells were obtained from infants. First through to fourth passage cells were treated with 10 ng ml⁻¹of epidermal growth factor, basic fibroblast growth factor or insulin-like growth factor-I. Fiber differentiation was determined from spontaneous lentoid formation by phase-contrast and transmission electron microscopy. Growth factor binding to the receptor on the cell surface was determined by transmission electron microscopy using the conjugates of colloidal gold and growth factors, and the number of receptors on the cell surface were also quantified by immunocytochemistry. Spontaneous lentoid formation was enhanced by all of the growth factors studied in the first passage. However, in the second and third passage only double layering of cells without characteristic fiber differentiation was observed while in the fourth passage, growth factors had no effect on differentiation. The number of growth factor bindings as well as the number of growth factor receptors gradually decreased with the number of passages. The loss of effect of growth factors on fiber differentiation with increasing number of passages correlated with the decrease in receptor number.     

An Unusual Cause of Asystole during a Routine Pacemaker Generator Change

A 74-year-old pacemaker-dependent male patient, who underwent a pacemaker generator change due to elective replacement indicator, had a 4-second pause during interrogation of the new pacemaker generator out of the device pocket due to a specific feature that was programmed on called " enhanced transtelephonic monitoring. "