The impact of discussing preoperative fasting with patients.

Patients awaiting surgery are often fasted preoperatively well in excess of the recommended fasting times. Educated perioperative practitioners were asked to discuss preoperative starvation with patients. Preoperative starvation period for clear fluids was significantly reduced from a mean of 8 hours 30 minutes in the original audit, to 6 hours 10 minutes in this study of 113 patients (p < 0.001). Improving patient understanding of preoperative fasting can increase compliance with fasting recommendations.

Laparoscopic cholecystectomy and appendectomy with sickle cell disease.

Thirty-six pediatric and adult patients with sickle cell disease (SCD), cholelithiasis, and repeated abdominal crises underwent laparoscopic cholecystectomy (LC) and appendectomy with minimal complications. We prefer using LC to the open method for patients with SCD, and we propose adjustments to the positions of the four trocars to facilitate both procedures without adversely affecting the patient.

Detection of circulating schistosome antigens in serum and urine of schistosomiasis patients and assessment of cure by a monoclonal antibody.

From a panel of monoclonal antibodies (MAb), an IgM monoclonal antibody (7F1/6B) reactive with repetitive epitopes on S. mansoni soluble egg antigen was selected. This MAb was employed both as antigen capture and detection antibody in a sandwich ELISA and had a detection limit < 1 ng S. mansoni SEA/mi. Serum and urine samples were collected from rural students who had S. mansoni (169 subjects) or mixed S. mansoni and S. haematobium (64 subjects) infections. Samples were collected before and at 4, 8 and 12 weeks after praziquantel therapy. Circulating schistosome antigens (CSA) were demonstrated in 90% of sera and 97% of urine samples of S. mansoni group and in 91% of sera and 100% of urine samples of mixed infection group. All sera from 29 uninfected individuals, 30 patients with other parasites and 70% of 55 S. haematobium-infected subjects were negative in this assay. CSA level in serum and urine samples correlated positively with the number of S. mansoni eggs/g stool in both groups. A significant reduction in CSA level was observed in serum and urine samples after praziquantel therapy. By 12 weeks post-treatment, negativity was 98% in sera and 97% in urine of S. mansoni-infected group and 98% in sera and 91% in urine of mixed infection group. The data demonstrate that the use of MAb 7F1/6B for the detection of CSA provides a sensitive method for immunodiagnosis of schistosomiasis and monitoring of cure.

Immunologic studies of human schistosomiasis. I. Clinical and immunological findings in acute and chronic schistosomiasis.

Sera and ascitic fluid of 26 patients with acute and chronic schistosomiasis were studied for the presence of circulating immune complexes (CIC's), IgG, IgM, IgA, complement C3 and C4, as well as their correlation with the clinical manifestations of the disease. Serum levels of CIC's and IgG were significantly increased in patients with acute S. mansoni and S. haematobium infections and in patients with chronic schistosomiasis. Serum IgA levels were evaluated in 20% of patients with S. mansoni infection, 67% with S. haematobium infections and in 100% of chronically infected patients. Complement C3 levels were normal in all patients. Ascitic fluid analysis revealed the presence of IgG, IgM, IgA, C3 and C4 and high concentrations of CIC's. A significant positive correlation was demonstrated to occur between serum CIC's and IgG, as well as between the serum and ascitic fluid levels of CIC's of chronic patients. These findings also correlated with the degree and severity of the clinical syndrome.

Immunologic studies of human schistosomiasis. II. Interrelationship of serum and ascitic fluid histamine, IgE and total eosinophils in acute and chronic human schistosomiasis.

Sera and ascitic fluid of 26 patients with acute and chronic schistosomiasis were studied for the determination of histamine levels, IgE and total eosinophil counts and their correlation with the clinical manifestations of the disease. Serum histamine levels were significantly increased in acute and chronically infected patients. Serum IgE levels were markedly increased in all patients with S. mansoni infection and S. haematobium infection and moderately elevated in chronic patients. Eosinophilia was found in 60% of patients with S. mansoni infection and in 83% with S. haematobium infection. Ascitic fluid analysis revealed the presence of IgE and high concentrations of histamine. There was also a significant positive correlation (p less than 0.01) between serum and ascitic fluid histamine levels, as well as to IgE levels. These results support the contention that histamine and other immune system components may play a role in the pathophysiology of different stages of schistosomiasis.

Control of intractable atonic postpartum hemorrhage by 15-methyl prostaglandin F2 alpha.

Severe intractable atonic postpartum hemorrhage can be treated by either uterine packing or surgical techniques. However, certain prostaglandins possess properties of potential value for the control of postpartum uterine atony. Two hundred fifty micrograms 15-methyl prostaglandin F2 alpha (15-methyl PGF2 alpha) was given intramuscularly to 16 subjects for whom a uterine pack of operative management was the only other alternative. Fifteen patients responded satisfactorily following a mean of 1.75 injections (437.5 microgram); only 1 patient required hysterectomy. The latter had a case of severe intrauterine infection. The incidence of side effects was very low. The use of intramuscularly administered 15-methyl PGF2 alpha in uncontrollable atonic postpartum hemorrhage appears to be a valuable lifesaving medical tool in critical cases.