Lumbar epidurography with multi-orifice and single orifice epidural catheters.

The spread of iohexol in the epidural space was studied using two types of epidural catheter. Twenty pre-menopausal women undergoing hysterectomy received lumbar epidural analgesia via either multi-orifice or single orifice catheters. Twenty-four hours after surgery, iohexol was injected before catheter removal with the patient lying supine. Whereas there was no significant difference in the total number of vertebral segments covered by dye or the total number of segments reached above or below the level of epidural insertion, spread was more even to the right and left of midline using the single orifice catheters. Sacral spread of dye was only observed when a single orifice catheter was used. Epidural catheter design affects the distribution of solutions in the epidural space, with single orifice epidural catheters producing more even distribution of dye with sacral extension.

Delayed gastric emptying as a factor in delayed postprandial glycaemic response in pregnancy.

OBJECTIVE: To determine whether an alteration in gastric emptying contributes to an altered postprandial glycaemic response in normal pregnancy. DESIGN: A longitudinal study in normal pregnancy and postpartum. SETTING: Teaching hospital in Sheffield. SUBJECTS: Primigravid women with uncomplicated pregnancies. INTERVENTIONS: Simultaneous meal tolerance and paracetamol absorption tests. MAIN OUTCOME MEASURES: 1. Gastric emptying: maximum concentration (Cmax) and time to maximum concentration (Tmax) of paracetamol; 2. glycaemic response: Cmax, Tmax, and area under the curve of plasma glucose; 3. insulinaemic response: Cmax, Tmax, area under the curve of plasma insulin. RESULTS: An increased, but not delayed, insulin response, and an increased initial glucose response to a test meal in the third trimester were not accompanied by any simultaneous delay in gastric emptying. CONCLUSION: Gastric emptying does not seem to be a factor in the glycaemic response of pregnancy.

Gastric emptying is delayed at 8-12 weeks' gestation.

Gastric emptying was studied indirectly by paracetamol absorption in 20 patients at 8-12 weeks' gestation and also in 20 non-pregnant controls. Subjects received paracetamol 1.5 g in a tablet with 50 ml of water and remained semi-recumbent for 2 h while venous blood samples were obtained at 15-min intervals. The maximum concentration of paracetamol was significantly lower and the time to maximum concentration significantly greater in pregnant patients. In addition, the areas under the time-concentration curves at 60 and 120 min were significantly smaller in the pregnant group. These changes are indicative of a delay in gastric emptying at 8-12 weeks' gestation.

Disposition of alfentanil in burns patients.

We have studied the disposition of alfentanil in six patients (who had suffered 10-30% surface area burns 5-21 days previously) undergoing surgical debridement and grafting and compared the data with those from a control group of six patients matched for age, sex and weight undergoing body surface surgery of similar duration. Plasma samples were collected up to 480 min after an i.v. bolus of alfentanil 50 micrograms kg-1. Drug concentrations were measured by radioimmunoassay and alfentanil binding to plasma proteins by equilibrium dialysis. The burns patients had significantly greater concentrations of alpha-1-acid glycoprotein (AAG) and smaller concentrations of albumin. The mean protein binding of alfentanil was 94.2 (SEM 0.05)% in the burns group and 90.7 (0.4)% in the control group (P = 0.004). There was a good correlation between AAG concentration and protein binding (r = 0.8). The volume of distribution and total clearance of alfentanil were reduced significantly in the burns group. The clearance of the unbound fraction and the elimination half-life of alfentanil were not decreased significantly.

Gastric emptying in pregnancy.

The rate of gastric emptying in pregnancy was measured indirectly using the rate of paracetamol absorption in four groups of 15 patients: non-pregnant controls, first trimester patients presenting for termination of pregnancy, second trimester patients presenting for prostaglandin termination of pregnancy, and patients presenting for elective Caesarean section. All patients were fasted for 6 h and then received paracetamol tablets 1.5 g orally with water 50 ml. Blood samples were taken at 15-min intervals for 120 min and analysed for paracetamol concentration. There was no significant difference between the groups in the maximum concentration and time to maximum concentration (ANOVA). The AUC was reduced for the first trimester group at 60 and 120 min (P less than 0.05). No significant delay in gastric emptying was demonstrated in any of the three trimesters of pregnancy compared with the control group.

Anterior dislocation of the restrained shoulder: a seat-belt injury.

The reduction in morbidity and mortality since the enforcement of seat-belt usage is well documented. Complications from the belt are also reported and the authors present anterior dislocation of the restrained shoulder, an injury not previously described. The mechanism of injury is explained and a change to the present standard of restraints is suggested.

Portal hypertension due to hepatosplenic schistosomiasis: a case report and review of the literature.

Although hepatosplenic schistosomiasis is the commonest cause of liver disease worldwide, the diagnosis is not often considered in European countries. A case of Schistosomiasis mansoni complicated by portal hypertension is reported to demonstrate how diseases endemic to an immigrant's homeland can present many years later in non-endemic countries.

Penetrating brain stem injury from crossbow bolt: a case report and review of the literature.

Because injury to the brain stem is usually associated with diffuse brain damage, recovery is rare and mortality high. A non-fatal penetrating injury involving the brain stem is described from a crossbow bolt. The diagnosis and management of such injuries are discussed.