Effects of sounds presented during general anaesthesia on postoperative course.

In a double-blind, randomized study, patients undergoing cholecystectomy were administered one of four different sounds during general anaesthesia: positive suggestions, nonsense suggestions, seaside sounds or sounds from the operating theatre. The effect of these sounds on the postoperative course was examined to assess intraoperative auditory registration. No differences were found between the four groups in postoperative variables.

Diagnostic evaluation and survival analysis of colorectal cancer patients with liver metastases.

Clinical features and their prognostic value were evaluated in 83 colorectal cancer patients with liver metastasis. The clinical features analysed included presenting symptoms and signs, liver function tests, extent of liver involvement, associated extrahepatic tumor growth, and physical condition of the patients. Overall median survival time after diagnosis of liver metastases was 8.4 months. Prognostic factors related to survival were symptoms, when referable to liver metastasis, and 5' Nt. Information is supplied to survey what selection of patients should be considered for various treatment options. A predominance of the patients showed bilobar liver involvement (79.6%), extrahepatic tumor growth (49.4%), or had an unresectable primary tumor (30.1%), thus leaving only 6% of the patients with liver metastases for surgical treatment with the intention of cure.

Scintimetric detection of choroidal malignant melanoma with [123I]-5-iodo-2-thiouracil.

[123I]-5-iodo-2-thiouracil (123I-ITU) was evaluated as a radiopharmaceutical for tumor detection in 10 patients with proven choroidal melanoma. Uptake of 123I-ITU was measured with a specially designed single eye probe collimator, 24 h after administration of 123I-ITU. Increased uptake in the tumor-bearing eye as compared to the fellow nontumor bearing eye was found in 7 out of 10 cases when the probe was located 3.5 cm in front of the eye (p less than 0.01). By using a double pinhole collimator tests were positive in 3 out of 10 123I-ITU studies only. Tests with 123I-ITU were compared with 67Ga tests in the same patients. The 67Ga tests with the single eye probe collimator were positive in 6 out 10 cases when the probe was located 6 cm in front of the eye. With the double pinhole collimator tests were positive in 7 out of 10 67Ga studies. It is concluded that 123I-labeled thiouracil is at least as useful as a radiopharmaceutical for ocular melanoma diagnosis as 67Ga-citrate, provided measurements are performed with a single eye probe.

Effect of low-dose oral contraceptives on lipoproteins and lipolytic enzymes: differences between two commonly used preparations.

Changes in circulating lipoproteins, which may be related to the risk for atherosclerotic vascular disease, were studied in a control group and in two groups of 24 or 26 women using different preparations of low-dose oral contraceptives for 3 months. One preparation contained 150 micrograms levo-norgestrel and 30 micrograms ethinylestradiol (Stediril-d 150/30); the other contained 750 micrograms lynestrenol and 37.5 micrograms ethinylestradiol (Ministat). No significant changes were found with either of the preparations in serum cholesterol or high density lipoprotein cholesterol (HDL-C) levels. Apolipoprotein A-II levels increased during Ministat treatment from 50.4 to 61.4 mg/dL and during Stediril-d 150/30 treatment from 52.7 to 58.9 mg/dL (both P less than 0.001). These changes differed significantly from each other (P less than 0.01). Apolipoprotein A-I levels increased significantly during use of Ministat only. Apolipoprotein B in low density lipoprotein increased by about 20% (P less than 0.001) in both groups. Post-heparin lipoprotein lipase activity did not change, but hepatic lipase activity decreased to the same extent in both groups (P less than 0.001). Reductions in post-heparin lipase activity were not correlated with increases in HLD-C.

Hemostasis and intracranial surgery.

Preoperative and postoperative coagulation studies were performed in 25 patients undergoing various intracranial surgical procedures. Coagulation abnormalities, mostly consisting of an increase of fibrin/fibrinogen degradation product concentration, either appeared or increased postoperatively in 18 patients. This incidence of postoperative appearance or increase of coagulation abnormalities is higher than that reported in a comparable study of patients after general surgical procedures, and also higher than that of coagulation abnormalities in a previous study of patients after blunt head injury. Although the coagulation abnormalities after intracranial surgery were usually small, they tended to be larger in patients with more extensive intracranial procedures.

Head injury and coagulation disorders.

Coagulation studies (plasma fibrinogen, ethanol gelation test, and fibrin/fibrinogen degradation product concentration) were done in 150 patients who were admitted after blunt head injury. Results were abnormal in 60 patients and were found to be correlated with the level of consciousness and with the presence of neurological signs. Many of these patients had fractures, but findings in a control group of 26 patients with major fractures without head injury indicate that fractures were not of paramount importance in causing clotting changes. Conclusive evidence of disseminated intravascular coagulation was found in 12 patients. Cases with a fatal clinical course were mostly associated with very high fibrin/fibrinogen degradation product concentrations. Some case histories are reported, confirming the hypothesized correlation between coagulation results and brain tissue destruction rather than brain compression. It was concluded that some degree of disseminated intravascular coagulation in patients with blunt head injury occurs more often than expected and that coagulation studies might have both diagnostic and prognostic value.