Incarcerated indirect inguinal hernia: a complication of spilled gallstones.

Spillage of gallstones during laparoscopic cholecystectomy is not a rare event. We present a patient with spilled calculi causing an incarcerated hernia.

Five-year follow-up for adverse outcomes in males with at least minimally positive angiograms: importance of "denial" in assessing psychosocial risk factors.

The purpose of this study was to test the role of "denial" (spouse/friend minus self-ratings on parallel versions of the same questionnaire) in diluting the predictive value of emotional distress for cardiac events (deaths, new MIs, and/or revascularizations). One hundred forty-four men with no history of prior revascularization who had at least minimally positive diagnostic coronary angiograms, and someone they selected as "someone who knows you well," completed parallel versions of the Ketterer Stress Symptom Frequency Checklist (KSSFC). They were followed up by phone an average of 59.7 months after recruitment. Length of follow-up, baseline cardiac risk factors, and a number of baseline-obtained psychosocial risk factors were tested as prospective predictors of combined events (death by any cause, new MIs, and/or revascularizations) and current anginal frequency. Only spouse/friend observed anxiety on the KSSFC predicted current anginal frequency (p = 0.001). On the self-report version of the KSSFC, patients with one or more events reported less anger (p = 0.031), depression (p = 0.008), and anxiety (p = 0.003). These results may be attributable to "denial" because there were no differences in spouse/friend ratings, and difference scores (spouse/friend minus patient) on the KSSFC scales, particularly anger, were also related to events: AIAI (p = 0.002); depression (p = 0.063); and anxiety (p = 0.010). Denial may be a major limiting factor in accurately assessing emotional distress in cardiac populations, and may help account for a number of the previous findings.

Smooth muscle tumors of the stomach.

Six cases of smooth muscle tumors of the stomach are reported. These comprise one leiomyosarcoma and five leiomyomas, observed over a period of five years. Clinical presentation, diagnosis difficulties and the method of treatment are discussed and the literature is reviewed.

Stability of vitamin B12 in the presence of ascorbic acid in food and serum: restoration by cyanide of apparent loss.

Ascorbic acid in varying amounts was added to food and serum samples and heated at 37 C. Vitamin B12 was then measured by radioimmunoassay and microbiologically using several extraction methods. B12 values in a cottage cheese meal were lower than controls when concentrations of ascorbic acid greater than but not equal or less than 0.5 mg/ml were added and if KCN was not used during extraction, but when 70 micrograms/ml KCN was added after ascorbic acid exposure B12 was quantitatively recovered. Serum B12 was variably decreased by lesser concentrations of ascorbic acid but was also quantitatively restored by increasing KCN concentration during extraction. In the absence of KCN in the extraction step some loss of B12 at 100 C was observed; the loss was greater with added ascorbic acid. Our results indicate that previous reports on B12 loss in the presence of ascorbic acid are artifacts of the methods used. In view of these in vitro findings B12 destruction by ascorbic acid in vivo seems highly improbable.

Studies on the effects of oestradiol, progesterone and some steroidal contraceptives on the adrenal cortex of albino rats.

PIP: An investigation was carried out on albino rats in order to study the effects of estradiol, progesterone, and some of the different synthetically prepared steroid combinations on the adrenocortical activity. Biochemical determination of adrenocortical alkaline phosphatase activity was carried out in normal female rats, ovariectomized rats, and ovariectomized rats injected with estradiol or progesterone. Also, adrenocortical alkaline phosphatase activity was determined in groups of rats given different contraceptive pills (lyndiol 2.5, lyndiol 5, gyn-anovlar, eugynon, and ovulen) 1 tablet/rat/day for a period of 2 weeks. No pathological findings were detected in rats given contraceptive pills for 2 weeks, but after 6 weeks of treatment, the animals started to die and definite pathological changes were detected mainly in the liver, spleen, and lungs. It was determined that ovariectomy resulted in a decrease in the activity of the adrenal cortex. Progesterone had no effect, but estradiol injection caused a significant increase in the activity of alkaline phosphatase of the adrenal cortex to values exceeding that of normal females. There was an increase in the activity of the adrenal cortex with any of the pills. The increase was highest with lyndiol 2.5 and lyndiol 5 and least with ovulen. Histological investigation revealed a similarity between the glands subjected to the effects of oral contraceptives and those stimulated by adrenocorticotropic hormone, mainly in the narrowing or even absence of the zona glomerulosa.^ieng

Ovarian changes during and after long term steroid contraceptive therapy.

PIP: This Egyptian study made use of ovarian wedge biopsies from 5 patients (aged 30-37, parity greater than 5) undergoing laparotomy. The contraceptives and durations of treatment were Lyndiol 2.5 (2.5 mg lunestrenol, .075 mg mestranol) 3 years; Gynanovlar 21 (3 mg norethisterone acetate, .05 mg ethinyl estradiol) 1 year; Deladroxate monthly injections (150 mg 16, a 17a dihydroxyprogesteorne acetophonid, 10 mcg estadiol enanthate) 1 year; Lyndiol 2.5, 5 years stopped 2 months before operation; and 1 unidentified contraceptive stopped 5 months before operation. except in the 2 cases receiving Lyndiol 2.5, follicular development and maturation had proceeded normally. The tunic a albugenia generally was more thickened than in full-term pregnancy but markedly less thickened than in Stein-Leventhal ovaries. Hyperthecosis was unobserved. Fibrotic and cystic changes were less in extent than in Stein-Leventhal ovaries. Primary damage after long-term therapy appears to be effected at a higher level than the ovary. The authors warn against long-term therapy given freely to young nulliparas and advise interrupted courses (i.e., 1-2 years followed by a periof of rest of 1-2 ovulations) for patients in general.^ieng

Effect of switching with oral contraceptives.

PIP: Women requesting family planning advice at the Family Planning Clinic at El-Galaa Hospital in Cairo participated in a study investigating some of the main clinicopathological aspects of switching from 1 oral contraceptive to another. The pills were Vestalin M (2.5 mg vinylestrenelone, .1 mg ethinyl estradiol), Vestalin Uno (1 mg vinylestrenelone, .1 mg ethinyl estradiol), Gynovlar (3 mg article says "m" norethisterone acetate, .05 mg ethinyl beta-estradiol), and chlormadinone, .5 mg. Controls used either Vestalin M (68) or Vestalin Uno (55) for 6 months. 24 users of Vestalin M (average 11 months use) switched to Vestalin Uno, thus changing from a higher to lower level of gestagen. 26 users of Vestalin Uno switched to Vestalin M. 3 groups switched from 1 chemical composition to another: 41 Gynovlar users of average 6 months switched to Vestalin Uno, 14 chlormadinone users of average 24 months switched to Vestalin Uno, and 18 chlormadinone users of average 18 months switched to Vestalin M. Post-menstrual endometrial biopsies (cycle days 5-7) were taken before the start of first therapy, before the switch, and at the end of the second drug's trial. Percentages of participants with first-cycle amenorrhea, hypomennorhea, and breakthrough bleeding were 7.5, 3.9, and 9.4 with Vestalin M and 2.0, 8.0, and 2.0 with Vestalin Uno. However, by the fifth cycle, the percentages with hypomennorhea were 25.8 and 12.2, respectively. The high gestagen level reduced the number of endometrial glands and the height of the lining epithelium and caused and excessive decidual reaction of the stroma, a reaction gradually involving the endometrium's compact basal layer, which has no involvement with the luteinization process of the secretory phase in normal women. The material shed included the necks of the endometrial glands responsible for the regeneration of the endometrium in subsequent cycles. When switching from a high to a low gestagen level, the endometrium regenerated and withdrawal bleeding lessened markedly in amount and duration. A few, less systematic, observations are reported for the women changing from 1 chemical composition to another.^ieng

Low dosage gestagens in fertility control.

PIP: A clinical study of a daily dosage of .5 chlormadinone acetate, a progestagen, was carried out on 101 randomly chosen women for a total of 954 cycles in Galaa Hospital and in the University Hospital Mansoura Faculty of Medicine. There were no reportedly pregnancies. One patient discontinued use after 16 days because of continuous bleeding. There were 20 dropouts between cycles 1-8 with reasons not investigated. Minor side effects included headache, giddiness, nausea, distension and breast discomfort. Of 34 lactating women in the study, 32 reported no effect on lactation and 2 reported diminished lactation. Amenorrhea was reported in 10% of the cycles. Cervicle mucus studies showed the mucus to be hostile to sperm.^ieng