Hypermagnesemia from antacid administration in a newborn infant.
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Biomedical subjects
Publications and source records attributed to M Humphrey.
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The development of appropriate animal model systems has been proposed as a means of facilitating the study of human colorectal cancer. This report describes the development and use of a blind-colorectal pouch in a carcinoma mouse model. The blind-pouch was prepared in C57BL/6J mice by surgically exteriorizing the descending colon and producing two stomata in the abdominal wall. The proximal stoma served as an end colostomy and the distal stoma created as a mucous fistula. Surgical closure of the anus thus provided a colorectal pouch. In pilot studies it was found that N-methyl-N-nitrosourea (MNU) and radiation together but neither separately produced tumors in the pouch of surviving mice. Further, inoculation of C38 syngeneic tumor cell suspension into the pouch and immediate closure resulted in tumor takes within three to four weeks. The use of this model in carcinogenesis and the immunology of colon cancer simulate the human colorectal cancer problem more closely than previous animal models.
The literature on occupational resettlement after head injury is confounded by varying standards of clinical severity and social outcome. A comparison of eleven key studies in the light of the authors' own research yielded a success rate ranging from 50 to 99 per cent, but this was based on superficial evidence. A more searching enquiry is needed, using objective methods and avoiding the technical inadequacies of most previous work. This would be unlikely to challenge the importance of age and length of post-traumatic amnesia as determinants of return to work, but should lead to a better understanding of other factors such as previous occupational status, cognitive deficits and personality changes.
A group of 54 patients who had suffered severe closed head injury (PTA >24 hours) were followed from the time of their injury for a period of two years. Relatives were interviewed within the first four weeks to assess the patient's previous personality and social adjustment. Patients and relatives were then assessed personally six and 12 months later and by postal questionnaires after two years. Only six patients were still not back at work after two years but more had not resumed all their leisure activities. Family relationships appeared to have settled down again by this stage but social contacts were still less frequent. Personality changes were associated with prior family relationships, cognitive changes with diminished social contacts whilst premorbid personality and physical deficits were associated with time taken to return to work.
The level of social recovery achieved by a representative series of 50 young adults was assessed six months after a severe closed head injury (post-traumatic amnesia greater than 24 hours). Work, leisure activities, and contact with friends were the areas of life most affected, whereas family life and marital relationships appeared to withstand changes at this stage in the recovery process. Many patients were still suffering from subjective symptoms, but these appeared to have relatively minor effects on ability to resume normal activities. Physical disability was a much more important factor at this stage. A control group of patients with limb injuries suffered similar disruption of their lives, but reported few subjective complaints.
As part of a prospective study of closed head injury, 54 relatives were interviewed within a month of the patient's accident and again six and twelve months later. The degree of stress on the relatives was measured by means of the Wakefield Depression Scale and by interview questions. The worst period of stress for the majority of relatives appeared to be during the first month after the accident. However, the degree of stress appeared to level off by the sixth month and no further diminution was found at twelve months. Stress was apparently mediated by the relatives' perception of personality changes and subjective defects. It was not affected by the severity of the head injury or associated disabilities, nor by whether the patient had resumed work and leisure activities. The nature of the stress is analysed and methods of alleviating it discussed.
In the control trials on near-term pregnant women before the onset of labour, nalorphine was found to cause a mild respiratory acidosis in the mother and metabolic acidosis in the fetus. These effects were not apparent when naloxone was administered.
This paper reports two randomized control trials on the effects of nalorphine, pethidine, morphine and heroin on fetal and maternal acid base status. The drugs decreased pH and increased pCO2 in the mother, and decreased pH and base excess in the fetus. The changes in the fetus were independent of the changes in the mother. In equivalent dosages, nalorphine increased maternal pCO2 more than pethidine and morphine. The effects of heroin were found to be greater than that of other drugs, and we suggest that heroin should be avoided where the fetus is already at risk.
A progressive fetal respiratory acidosis occurs in the second stage of labour. A double-blind controlled trial showed that the intravenous infusion of Ritodrine abolished this.
A marital questionnaire, completed by 40 fertile and 50 infertile couples, revealed greater unanimity of response between childless partners, who may however have been tempted to idealize their relationship. It is suggested that parenthood may limit the scope of communication between spouses. Childlessness may be stressful but it can also make for closer mutual affinity in the couple's thoughts and feelings.
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