Hip sepsis from retroperitoneal rupture of diverticular disease.

Retroperitoneal perforation of diverticular disease is very uncommon and can be difficult to diagnose because of possible pathways of communication between the retroperitoneal space and the thigh. An iliopsoas abscess from a ruptured diverticulum may drain into the hip joint if the capsule has been violated. Cases of abscesses or gas in the thigh have been reported in which thigh pain was the predominant symptom, overshadowing any abdominal signs. We report a case in which hip sepsis due to a ruptured diverticulum was the presenting feature.

Cushing's disease with a unilateral adrenal macronodule: evolutive transition or incidental finding?

Cases of coexisting Cushing's disease and unilateral adrenal tumor are rare, and there are conflicting reports in the literature regarding both the pathophysiology and the incidence. We have reported the case of a patient with a biochemically inactive incidental adrenal mass in whom pituitary-dependent Cushing's syndrome developed during follow-up. Authors of past reports have suggested that transitional change is responsible for the adrenal disease. A complete review of the literature has shown that cases of coexisting pituitary Cushing's disease and unilateral adrenal tumor, although rare, are more common than was previously believed. After studying a case in which the adrenal mass was present before disease developed, we suggest that the coexistence may be incidental in some cases.

Adenosine is an endogenous protectant against stunning during repetitive ischemic episodes in the heart.

To investigate whether adenosine receptor blockade alters the response to serial coronary occlusions in the rabbit heart, we measured changes in segment length with ultrasonic dimension gauges placed in the field of a coronary branch. The coronary branch was subjected to four 5-minute occlusions, each separated by 10 minutes of reperfusion. In control hearts, the percentage of segment shortening fell from 15.7% to 9.3% after release of the first occlusion with no further deterioration after each of the subsequent three occlusions. In hearts in which adenosine receptors were blocked with PD 115,199, a potent blocker of both A1 and A2 receptors, segment shortening again recovered to about two thirds of the preischemic value during the reperfusion period after the first occlusion. Each subsequent occlusion, however, resulted in a further deterioration of function to the extent that shortening was less than 20% of the preischemic value during reperfusion after the fourth occlusion. Therefore the first occlusion of a series of four occlusions, while mildly stunning the heart, also preconditions the myocardium against further stunning by subsequent occlusions. Because that protection was when adenosine receptors were blocked, adenosine must play an important role in the mediation of this protective effect.

Ox bile treatment of severe steatorrhea in an ileectomy-ileostomy patient.

Bile salt therapy is not used in patients with steatorrhea due to bile salt deficiency because of fear that severe diarrhea would be caused or exacerbated. We report a patient who previously had had colectomy, partial ileectomy, and ileostomy for Crohn's disease. She had severe steatorrhea due to bile salt deficiency and severe diarrhea (the latter apparently due to fatty acid inhibition of electrolyte and water absorption). The diarrhea was improved by loperamide, but severe steatorrhea and malnutrition persisted. The steatorrhea and malnutrition were corrected by ox bile, without an increase in diarrhea. Presumably, the deleterious effect of bile salts per se on small bowel absorption of water and electrolytes was mitigated by correction of fat malabsorption. At least in this patient, bile salt therapy was highly beneficial.

Incorporation of 14C stearic acid in lens organ culture.

14C stearic acid was incubated in organ culture of rabbit lens for 6, 12 and 20 hours. Stearic acid did penetrate the lens and was incorporated into triacyl-glycerides and phospholipids. It also served as a carbon source for cholesterol synthesis. Individual fatty acids were isolated and radioactivity measurements were made. Incorporation of label was found in C12:0, C14:0 and C16:0 fatty acids, indicating de novo synthesis in the lens; incorporation was found in C16:1 and C18:1, indicating delta 9 desaturase activity, and incorporation was found in the fatty acids of 20 carbons or longer, indicating the presence of a fatty acid elongation system in the lens.

Analysis of blood cortisol levels in oral surgery patients given various levels of intravenous medication.

Blood cortisol levels of oral surgery patients were analyzed to objectively determine the effect of intravenous sedation on surgical stress. Results showed a measure of sedation but did not adequately reflect the stress of oral surgery or the changes produced by intravenous sedation.