A severe type of rectus sheath hematoma requiring surgery: report of a case.

This report illustrates the case of a 79-year-old woman in whom a severe type of rectus sheath hematoma was found during conservative therapy for myocardial infarction. Although establishing a correct diagnosis and initiating conservative therapy is usually considered the most appropriate management of this clinical entity, the rectus sheath hematoma in this patient required surgical treatment.

Prader-Willi syndrome with elevated follicle stimulating hormone levels and diabetes mellitus.

A 21 -year-old man with Prader-Willi syndrome (PWS) was hospitalized due to hyperglycemia. After diet therapy and transient insulin administration, his blood glucose levels improved. Based on the fact that his urinary C-peptide levels increased, the diabetes mellitus may have been due to insulin resistance with obesity. In addition, his testes had become atrophied. Testosterone levels remained low even after human chorionic gonadotropin (HCG) administration. Luteinizing hormone (LH) levels were also low after LH releasing hormone (LHRH) administration. The LH response increased slightly after daily LHRH administration, indicating hypothalamic hypogonadism. Follicle stimulating hormone (FSH) levels were, however, high and increased after LHRH administration. The selective FSH elevation may have been due to the accompanying idiopathic oligospermia.

[Role of pharmacist in cancer pain management].

It is essential for patients to have understanding of the significance of morphine administration and to cope well with its side effects, as it leads to enhancement of the analgesic effects of morphine in the treatment of cancer pain. Since August 1993 we have used the booklet "Relieving Pain Effectively--Manual for Patients" and have consulted up to date approximately 670 patients about taking narcotics. The initial information eliminates the anxiety before taking morphine--we set up the time that each patient should take medicine to fit their life-style and explain about the the medicine and its side-effects. For this reason, the above information takes approximately 30 to 60 minutes per patient. We guide the patient over to over till the pain and side-effects have disappeared and file a "Morphine Education Record" with the details. We also prepare a "Pain and Side-Effect Control Sheet" that consists of 6 items and a pain scale where 0 equals no pain and no side-effect and 5 equals most pain and side-effects. Patients select the scale themselves every day. Pharmacists provide the information to a doctor and advise him on steps against side-effects, selection of dose, interval and rescue-dose. This is a report on the role of the pharmacist in patient narcotics guideline for cancer pain management.

Plasma concentrations of endothelin-1 and endothelin-3 are altered differently in various pathophysiological conditions in humans.

Several studies have indicated that endothelin-1 (ET-1) and endothelin-3 (ET-3) are produced by different cells. Although ET-1 is produced by vascular endothelial cells, these cells do not produce ET-3. In the present study, we measured plasma concentrations of both ET-1 and ET-3 by sandwich-enzyme immunoassays which we developed recently in patients on chronic hemodialysis, age-matched normal subjects, patients with acute myocardial infarction, patients undergoing surgery, and healthy subjects before and after strenuous endurance exercise. Plasma levels of ET-1 and ET-3 were demonstrated to be altered differently in the above conditions in humans. Although the exact origin of circulating endothelins has yet to be elucidated, the different alterations of plasma levels suggest that both ET-1 and ET-3 may play different roles in physiological and/or pathophysiological responses to various conditions in humans.