Psychological features of acromegaly.

Acromegaly is a serious but often undiagnosed condition that is often unrecognized for many years. The delay from onset of symptoms until the time of diagnosis results in a unique constellation of physical and mental problems for patients and health care professionals. The purpose of this chapter is to identify the psychological consequences experienced by individuals affected with pituitary tumors which alter growth hormone release. As little research has been completed on the subject, very little is known, or has been applied, in the treatment of these patients. To identify the presence of psychological features, the research which exists and an in-depth qualitative analysis of the personal experience of one of the author (K.F.), having suffered a pituitary macroadenoma with accompanying acromegaly, is described. Our findings are compared with those from an earlier series and the few published reports.

[Esophagogastric bypass anastomosis for benign stricture of cardia]. / Zespolenie przelykowo-zoladkowe w nienowotworowych zwezeniach wpustu.

The aim of the study is to discuss our observations concerning oesophagogastric bypass anastomosis in cases with scar stricture of cardia in long-term achalasia (megaoesophagus). The Heller operation is ineffective in such patients and the resection of cardia with oesophagogastric anastomosis is a large and controversial operation. 16 patients were operated (6 of them after ineffective cardiomyotomy). In all cases long-term dysphagia, big loss of weight and large, S-shaped oesophagus lying on the diaphragm were found. The left side thoracotomy was performed and fundus of the stomach was dislocated to the chest through dilatatored oesophageal hiatus and with the oesophagus above the cardia. There were no postoperative complications. However, dysphagia regressed. The remote results (from 1 year to 7 years) in 11 patients were analysed. The general condition was satisfactory. No dysphagia and gastrooesophageal reflux was revealed. Anastomosis was efficient in X-ray examination. Our observations indicate that oesophagogastric anastomosis is a procedure of choice in the treatment of long-term achalasia with stricture of cardia and megaoesophagus.

Valoración cinética y dinámica de la lidocaína y mepivacaína en odontopediatría / Kinetic and dynamic evaluation of lidocaine and mepivacaine in pediatric dentistry

En una población pediátrica de 20 niños se evalúa el comportamiento cinético y dinámico dela lidocaína y mepivacaína asociados con adrenalina, con referencia específica al período de latencia, profundidad y duración del efecto anestésico

South African traditional herbal medicines used during pregnancy and childbirth.

Many black South African women use traditional herbal remedies as antenatal medications or to induce or augment labour. Very little is known about the pharmacology and potential toxicity of the plants used in these herbal remedies. The ethnic background and traditional usage of these remedies was researched and a literature survey revealed that 57 different plants were used in herbal remedies during pregnancy and childbirth. Several of these plants are poisonous and details of their toxicity are given.

Preliminary isolated organ studies using an aqueous extract of Clivia miniata leaves.

An infusion of Clivia miniata leaves is a traditional medicine taken by Black South African women to induce or augment labour. A boiling water extract of C. miniata leaves was studied for its pharmacological effects on rat uterus and ileum. The extract caused concentration-dependent contractions in both the uterus and ileum, but at a fraction of the intrinsic activity of acetylcholine. When the organs were pretreated with the extract before the cumulative addition of either oxytocin or acetylcholine, the extract augmented the initial response of the organs to the reference drugs. The frequency of contractions in the spontaneously contracting uterus was increased by the presence of the extract. C. miniata extract, however, inhibited the maximal response of the ileum to acetylcholine in a non-competitive way. It did not affect the maximal response of the uterus to either oxytocin or acetylcholine.

The caffeine contents of non-alcoholic beverages.

The caffeine content of a number of non-alcoholic beverages was determined using HPLC. It was found that Diet Coke had a greater caffeine content than Coke (4.15 compared with 3.13 mg/fl oz), Tab is virtually caffeine free, and Lucozade, sold as a tonic, contains more caffeine than any of the other carbonated beverages tested (5.17 mg/fl oz). The pure instant coffee tested contained much more caffeine than the coffee/chicory mixtures (12.61 compared with 3.18 mg/fl oz). The caffeine content of Ceylon tea blends increases with the time the tea is allowed to draw (from about 8 mg/fl oz after 1 min to about 12 mg/fl oz after 20 min). Tea that has been allowed to draw for 20 min has a caffeine content similar to that of pure coffee.

Solubility changes on mixing short- and long-acting insulin preparations.

The loss of solubility of short-acting insulins when mixed in a ratio of 1:1 with intermediate-acting insulins in vitro was determined using high-performance liquid chromatography. Insulin preparations (porcine and human) from three different manufacturers were tested and various times of mixing (0-24 h) were investigated. The loss of solubility with mixtures of human insulins and with mixtures of porcine Velosulin (Nordisk) and Insulatard (Nordisk) was small at all the times used. A mixture of porcine Actrapid MC (Novo) and Monotard MC (Novo) led to a 60-95% loss of the soluble component, depending on the duration of mixing. The greater the time the greater the loss. These in vitro data indicate that short-acting insulins may lose solubility when mixed with long- or intermediate-acting ones. This phenomenon could be clinically relevant when patients are changed from mixtures of monocomponent to human insulins.

Facilities for treatment and patients on renal replacement therapy in South Africa. A report on the 1982 registration.

The 1982 annual registration has revealed that on 31 December 1981, a total of 1 198 sufferers of end-stage renal disease were being maintained by 22 South African treatment centres. Of these 729 were treated by dialysis (537 by in-centre haemodialysis, 47 by home haemodialysis, 28 by intermittent peritoneal dialysis and 117 by continuous ambulatory peritoneal dialysis). Eight of the centres with transplantation programmes were maintaining an additional 469 patients with functioning grafts. The overall treatment rate was 46,9 per million population.

Experimental paracetamol nephropathy and pyelonephritis in rats.

The nephrotoxicity of paracetamol (acetaminophen) administered to rats in doses of 300 mg/kg/day for periods up to 32 weeks was increased in the presence of experimentally induced pyelonephritis. The same dose of paracetamol failed to cause renal lesions in rats without pyelonephritis. Generally the pyelonephritic reactions were more severe in animals receiving paracetamol as compared to those in whom the drug was witheld. Thickened basement membranes of microvessels and tubules associated with papillary necrosis, and attempted healing of a necrotic papillary stump were unusual experimental findings which resemble pathology considered characteristic of clinical analgesic nephropathy.

Dermal micro-angiopathy in patients with analgesic nephropathy.

Skin biopsy specimens of 10 patients suffering from analgesic nephropathy revealed a micro-angiopathy similar to that seen in the kidney and urinary tract of patients with this disease. It is considered to be part of a disseminated micro-angiopathy. Similar changes were not observed in normal controls or in patients suffering from chronic renal disease due to other causes.

Maintenance dialysis and renal transplantation facilities in South Africa--1977.

A survey undertaken in July 1977 revealed that 27 hospital centres were treating 307 patients with chronic renal failure by maintenance haemodialysis and 22 patients by chronic peritoneal dialysis. An additional 28 patients were receiving home dialysis. Seven of the centres had transplantation programmes and were treating 271 survivors with functioning renal homografts.

Activity of intraperitoneal heparin during peritoneal dialysis.

A pharmacokinetic study of intraperitoneal heparin was undertaken in eleven chronic renal failure patients as a guide for its therapeutic use in peritoneal dialysis. The intraperitoneal heparin was assayed as the activated-partial-thromboplastin time (A-PTT) of peritoneal aspirate or outflow dialyzate added to control plasma. This was noted to decay relatively slowly, the mean t 1/2 of heparin in the peritoneal cavity being 10.8 +/- 0.93 hr. The heparin cofactor antithrombin III determined by both immunological and functional methods was found to be present in low concentration in residual peritoneal fluid aspirated prior to commencing dialysis. Generally this was less than one-third of normal plasma values, and with the repeated dilution and outflow sequences of dialysis the cofactor concentrations rapidly fell to negligible levels that were incapable of activating any heparin present. Systemic blood coagulation was unaffected by single 10000 U doses of heparin administered intraperitoneally in that plasma A-PTT values were not lengthened when measured over the ensuing six hours.

Maintenance dialysis and renal transplantation facilities in South Africa - July 1976.

A survey undertaken at the end of July 1976 revealed that 22 hospital centres were treating 258 patients with chronic renal failure by haemodialysis, and 32 patients by peritoneal dialysis. In addition, 8 patients were receiving home dialysis. Five of the centres that had transplantation programmes were treating 224 survivors with functioning renal homografts.

Peritoneal transfer of thiamphenicol during peritoneal dialysis.

The pharmacokinetics of thiamphenicol (TAP) was studied in 17 functionally anephric patients during peritoneal dialysis. Eleven patients were given single intramuscular injections of TAP in doses of 10 to 20 mg/kg of body weight. After this, serial blood samples and outflow dialysate collections were assayed for TAP by gas chromatography. The mean overall elimination rate constant was 0.036 +/- 0.007/h, the serum half time was 8.4 h, and the apparent volume of distribution was 71.0% (+/-14.39%) of the body weight. These parameters were not significantly different from those determined in anephric patients not on dialysis. The mean recovery of the administered TAP doses in the pooled outflow dialysate was 7.7% (+/-2.76%) over 22 h. In six other patients TAP was added to the inflow dialysate in concentrations of 10 to 20 mg/liter for 22 h. Throughout the dialysis periods, serum TAP levels did not rise above 4 mug/ml in transfer of TAP.

Post-transplantation analgesic dependence in patients who formerly suffered from analgesic neophropathy.

Twenty-two patients with functioning grafts who originally developed renal failure due to analgesic nephropathy ("analgesic" group), and 84 patients with various other causes of renal failure ("non-analgesic" group) were studied over one year to assess the extent of analgesic use and abuse. On each occasion that one of these patients reported to hospital a urine sample was collected and analyzed for N-acetylparaminophenol (NAPA). Of the "analgesic" group of patients, 14% had consistently negative urine samples while 41% showed NAPA in more than half the urines collected. In the "non-analgesic" group 29% of patients had entirely negative urine tests, and in only 7% were more than half of the urines NAPA-positive. Patients in the "non-analgesic" group readily admitted taking anaglesics at frequencies compatible with the observed number of positive tests. This contrasted with the "analgesic" group in which 14 of 19 patients with NAPA-positive urines denied analgesic intake. This is considered to be a guilt manifestation in patients who have developed a psychological dependence on analgesics and have recidivated with full knowledge of the possible harm these drugs may inflict on their grafts.