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Altering the position (elevated or dependent) had no immediate effect on the blood supply of delayed or transplanted delayed tubed flaps. However, after 72 hours the mean survival length in the dependent tubes was less than that in the elevated tubes. (This difference was only significant in the delayed untransplanted flaps, and not so in the delayed transplanted flaps). All of the dependent tubes had a significant increase in water content (compared to the elevated tubes). This increase was greater in the transplanted delayed tubed flaps. The tissue pCO2 levels were significantly increased after 24 hours in the dependent transplanted tubes, reflecting poor circulation and ischemia in them. The rate of clearance of subcutaneously injected technetium-99m was significantly increased in the dependent transplanted tubes after 72 hours, while in the elevated tubes the clearance rate was similar to that in normal skin. The morphological appearance of the vessels in these flaps complemented the results of the functional study.

Eleven patients were studied to determine the effectiveness of scalp hypothermia in the prevention of chemotherapy-induced hair loss. Scalp hypothermia was induced by the Kold Kap. The cytotoxic regimen used consisted of either cisplatin, doxorubicin, and cyclophosphamide or cisplatin, doxorubicin, and methotrexate given at monthly intervals. All 11 patients required a wig by the end of the fifth course of chemotherapy because of severe hair loss. Ten of the 11 patients (91%) had severe hair loss by the end of the second course of chemotherapy. These results suggest that scalp hypothermia as used in this study is ineffective in preventing chemotherapy-induced alopecia in patients treated with cisplatin and doxorubicin drug combinations in doses commonly used for treatment of gynecologic malignancies.

Jaundice is caused by an increase in bilirubin in the blood. This can occur before the bilirubin is conjugated by the liver, or after the bilirubin has been conjugated. If the bilirubin has not yet ben conjugated, it will not be able to pass through lipid membranes and will not be soluble in water. Therefore it will not be present in urine. Increases in conjugated bilirubin by the liver, or problems in the conjugation itself. If the increase is conjugated bilirubin, the disorder lies within the outlet channels of the hepatocyte, or there is some kind of obstruction in the biliary outlet system. Within the liver itself, the most common causes of difficulty are acute and chronic hepatitis, alcoholic cirrhosis and drug-induced liver dysfunction. Extra-hepatic obstructions are usually associated with the gall bladder, but may result from tumors of sclerosing secondary to chronic bowel disease.

The relation of intracolonic gaseous tension to fecal microflora was investigated by mass spectrometric measurements of intracolonic O2 and CO2 in unanesthetized germfree, conventional, and gnotobiotic rats; ip measurements were obtained in rats whose colons became perforated accidentally; fecal bacterial flora and cecal size were also determined. Gnotobiotes were monoassociated with Escherichia coli, Bacteroides fragilis and Staphylococcus epidermidis, and were diassociated with E. coli plus B. fragilis and with Bacillus macerans plus an aerobic diphtheroid. Mean intracolonic Po2 in conventional rats (11.1 mmHg) was significantly lower than in germfree rats (12.8 mmHg); mean intracolonic Pco2 in conventionals (83.4 mmHg) was greater than in germfree rats (54.6 mmHg). Differences of Po2 values among all rats were slight. However, intracolonic Pco2 values were directly related to CO2 production by the normal intestinal flora, and were thus significantly lower in both germfree and gnotobiotic rats. Intraperitoneal tensions were independent of the status of rats, and the mean ip Po2 and Pco2 (38.9 and 49.1 mmHg, respectively) agreed with values in the literature. The enlarged cecum, characteristic of germfree rats, was also present in gnotobiotic rats. Counts of each bacterial species in feces of monoassociated rats were 10(8) to 10(10)/g; counts were progressively smaller in feces of diassociated rats and conventional rats (10(8) to 10(9)/g and 10(5) to 10(8)/g, respectively). Intracolonic gaseous tensions of CO2 clearly reflected the presence of a normal flora inconventional rats, and were inversely proportional to cecal size.

Twenty-seven consecutive patients with advanced gynecologic malignancies undergoing chemotherapy with cisplatin in combination with other agents were studied in a prospective, randomized fashion to compare the antiemetic efficacy of a combination regimen with high-dose metoclopramide. The combination regimen consisted of prochlorperazine, dexamethasone, and pentobarbital. Patients treated with the combination regimen had significantly less vomitus (P less than 0.01, Student's t test) and fewer vomiting episodes (P less than 0.001, test for homogeneity) than patients treated with metoclopramide. In addition, the sedative and sleep-inducing effect of the barbiturate made the experience of vomiting more tolerable, even in those instances where the combination regimen was not superior to metoclopramide in the control of vomiting.