Hydrostatic reduction of acute intussusception: a prospective study

Data were collected prospectively on 57 Jamaican children presenting with 62 episodes of acute intussusception over a two year period, for whom operative and hydrostatic methods of reduction were employed. 31 (54 percent) of 57 episodes were reduced successfully using barium (42), saline (11) and air (4) hydrostatically. Among the 31 other episodes, 15 had ileo-colic intussusception, seven caeco-colic, six ileo-ileo-colic and one ileo-ileal. Two patients had spontaneous reduction discovered at surgery. There were two episodes of barium hydrostatic perforation of the colon leading to death in one patient. Hydrostatic reduction is recommended as the first therapeutic option for acute intussusception because it spares the patient a major operative procedure when successful(AU)

The ecophysiology of bacteriophage infecting halophilic archaebacteria

An ecophysiological study of halophages, isolated from the Yallahs Salt Ponds, Jamaica, has been performed to determine (i) what effect, if any, the single most important environmental parameter, salinity, has on phage-bacterium interactions, and (ii) which phage functions and phage-bacterium interactions are most likely to be of long term significance to the co-existence of halophage and halobacteria in nature. Results indicate that the NaCl concentration governs the interactions between halophages and the extremely halophilic strains of halobacterium. Phage growth is invariably attentuated at high salinity. A more detailed study on a single phage isolate, S5100, shows that at high salinities the maturation of phage is repressed, and lytic phage infections give way to persistent infections. In most instances, the frequency of productive infections initiated by each phage on each sensitive host strain is a consistent function of the host rather than the phage. Closer inspection revealed that the intracellular stages of the phage infection process have a higher degree of host specificity than the cellular receptor sites. It has been demonstrated that mutations to higher virulence and/or extended host range occur in the morphological group A1 phages. Phage absorption is implicated as the stage of the phage infection process that is affected by these mutations. The group B1 halophage, S45, is restricted and modified in vivo by strains of Halobacteriums. Three strain-specific activities have been observed. Two of these occur in the same bacterial strain and appear to be due to different kinds of enzymatic activities. One of the restriction specificities is shown to be associated with a strain-specific endonuclease active on unmodified halobacterial DNA. These phenomena that have been observed are discussed with respect to possible implications for phage ecology and evolution (AU)

Whole gut irrigation in strongyloidiasis - abstract

Two patients with chronic Strongyloidiasis, refractory to conventional therapy, were studied by whole gut irrigation and high-dose antihelminthic therapy. Saline (0.9 percent) was given via naso-gastric tube at 50 ml per minute. After solid material was cleared, the gut effluent was collected in 10-minute samples. After one hour baseline collection, mebendazole (1,800 mg in patient 1) or levamisole (1,100 mg in patient 2) was given. Irrigation and collection continued for a further 140 and 170 minutes respectively. Parasitic forms were collected and counted in each sample. In the mebendazole treated patient the spontaneous egg- and larval-shedding rate was 1,501/minute. This was not affected by mebendazole treatment. Adults first appeared in the effluent at 1 hour after treatment and the numbers were increasing at the termination of the infusion. Nineteen adults were recovered. Follow-up showed no diminution in the intensity of infection, demonstrating that only a small proportion of the available adults had been recovered or expelled. In the levamisole treated patient, the pre-treatment effluent contained 49,041 larvae/minute and no adult forms. In contrast to mebendazole, after treatment with levamisole, there was a massive efflux of adults which had not returned to baseline after 3 hours; 88,729 adults were recovered. The post-treatment infection level was reduced dramatically and a further 15,000 adults were recovered within 24 hours. There was no increase in larval output with levamisole. It is concluded that neither mebendazole nor levamisole has a direct on Strongyloides larvae. However, they are both active against the adult forms, with the potency of levamisole appearing to be greater than that of mebendazole. Treatment with these drugs may have to continue for longer than the full maturation time of endogenous larvae. This may be in excess of 4 weeks (AU)

An experimental model of behavioral hyperactivity and its modification by various drugs: Implications for minimal brain dysfunction / Perspectives in differentiation and hypertrophy

The neuropharmacological model used in this study has indicated that hyperactivity in rats results from cholinergic overactivity due to increased brain acetysholine level. Support for this contention comes from the fact that the hyperactivity induced in rats is significantly (P<0.001) attenuated by a cholinergic antagonist-atropine sulphate. Whatever the complexities of the receptor mechanisms, this observation has clear implications both for our understanding of the etiology of hyperkinesia and its treatment. In addition, the fact that chemical methods of treatment clearly ameliorate the syndrome has supported the belief that hyperkinesia is primarily a biologic rather than a psychological disorder. However, experimental animals are not humans and it is therefore quite possible that drugs have effects in man which are different from those in rats. Thus, obvious caution must be used in applying these results and those of other experiments to the understanding of hyperkinesia. Nevertheless, the results presented in this study suggest that anticholinergics might be useful chemotherapy for hyperkinesia (AU)

Salt wasting in severe tetanus

A 42-year-old man with severe tetanus exhibited two episodes of salt wasting. It was not possible to demonstrate either chronic renal failure or adrenal disease, conditions known to be associated with salt wasting. Studies done in this patient suggested a limitation in maximum tubular reabsorptive rate for sodium. Treatment was purely supportive (AU)

Excretion of salt and water by patients with sickle-cell anaemia: effect of a diuretic and solute diuresis

Patients with sickle-cell anaemia were unable to increase free water reabsorption (TcH2O) in response to intravenous hypertonic sodium chloride solution. Ethacrynic acid caused a brisk natriuresis in patients with sickle-cell anaemia but fractional sodium excretion was lower in these patients. These findings could be explained by abnormal function of the loop of Henle.(AU)

Intra-amniotic saline induction for termination of early pregnancy

Experience with a relatively new but safe and simple method for termination of early pregnancy is described. Opinions regarding its mode of action are also discussed (AU)

An unusual type of hemoglobinopathy resembling sickle cell-thalassemia disease in a Jamaican family

Three generations of a Jamaican family of African extraction are desribed, in several members of which an abnormal gene is carried. This gene produces high levels of fetal hemoglobin unassociated with the usual stigmata of thalassemia. It is found in all three generations of the family associated with hemoglobin A only and is also found in at least two members of the family interacting with hemoglobin S. In the latter combination little or no disability results. The mode of inheritance of this abnormal gene is discussed, and reasons are put forward for a possible protective effect of high fetal hemogobin levels due to inhibition of sickling. The findings in the cord blood of the youngest child, including an unusually high percentage of sickling, are discussed, together with follow-up studies to the age of 25 weeks.(AU)