Na+/H+ exchange mediates postprandial ileal water and electrolyte transport.

Feeding stimulates fluid and electrolyte absorption in the small intestine. Previous studies have suggested that Na+/glucose cotransport is important in initiating this response in the jejunum. The purpose of this study was to determine whether Na+/H+ exchange plays a role in meal-induced absorption. Exteriorized, neurovascularly intact jejunal and ileal loops (25 cm) were constructed in dogs. Following a two-week period of postoperative recovery, the loops of awake dogs were perfused with standard buffer alone or with increasing concentrations of amiloride, a Na+/H+ exchange inhibitor. Water, sodium, and chloride fluxes were calculated following a meal using [14C]PEG as a volume marker. The meal significantly increased absorption in both the jejunum (P < 0.001) and ileum (P < 0.01) in those animals perfused with buffer alone. More significantly, amiloride suppressed the increased absorption seen following a meal in the ileum (P < 0.001) but not the jejunum. The response in the ileum was dose dependent. These findings suggest that a major mediator of postprandial sodium and water absorption in the ileum is the Na+/H+ exchanger.

Endometritis following vaginal delivery.

The authors reviewed 158 cases of endometritis complicating vaginal delivery. The diagnostic criteria included fever over 100F with uterine tenderness and/or foul lochia. The mean temperature at diagnosis was 102.2F, and only 21 (13%) had temperature less than 100.9F. The majority of patients did not have traditional risk factors. Endometritis was characterized as generally early in onset (84% within 7 days) and usually mild in course (5.0% had bacteremia, 93.7% responded to initial antibiotics). Yet a small group (1.9%) developed documented pelvic abscess, fulminant peritonitis, or suspected septic pelvic thrombophlebitis.

Management of acute chorioamnionitis.

Acute chorioamnionitis has been recognized as a major threat to both mother and fetus, but there has been little study of its therapy. On this service, the plan of management consists of parenteral, broad-spectrum antibiotic therapy and prompt action to effect delivery. Cesarean section was generally performed only when there were additional obstetric indications. No arbitrary time limit was set for the diagnosis-to-delivery interval. The perinatal mortality rate was increased fourfold, but few deaths could be attributed to infection. Maternal outcome was usually good following vaginal delivery and more complicated following abdominal delivery. Over 90% of patients were delivered within 12 hours of diagnosis of chorioamnionitis.