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Some of the changes reported in the ECG of parturients undergoing Caesarean section are suggestive of myocardial ischaemia. This study determined serum CK total and the isoenzyme CK-MB levels in 21 patients during and after Caesarean section under epidural anaesthesia. Twenty patients complained of chest pain, discomfort and pressure, while 12 had ST segmental depression. Although the total CK activity in ten patients was elevated, CK-MB activity in all patients was negative. The electrocardiographic changes were rate-related and occurred at the time pressure was placed upon the upper abdomen and lower thoracic cage by the surgeon to facilitate Caesarean delivery. The data from this study demonstrate that no myocardial injury as measured by CK-MB activity occurs in parturients undergoing Caesarean delivery despite the complaint of chest pain, discomfort and pressure, and ST changes in the ECG.

The case reports of five patients who manifested severe hepatocellular injury secondary to heart failure are presented. All had evidence of severe left ventricular dysfunction and low cardiac output state. The clinical findings of right heart failure were variable and not always present. Liver histology, when obtained, revealed evidence of centrilobular necrosis (CLN). Rapid normalization of the biochemical abnormalities occurred in all patients, irrespective of clinical improvement of their cardiac status.

The removal of a single dominant individual has been shown to trigger a sex change in some coral-reeffish. In the saddleback wrasse (Thalassoma duperrey), however, female-to-male sex change requires visual stimulation from smaller conspecifics. This change is not dependent on the sex or color of the stimulus fish and can be inhibited by larger conspecifics. On the reef, a female probably changes sex when the relative numbers of larger and smaller conspecifics change within her home range.

A stable isotope dilution gas chromatography/mass spectrometry method for the measurement of prostaglandin F2 alpha (PGF2 alpha) in plasma has been developed. The linearity of the method was 0 to 250 pg per ml, day-to-day precision of five percent at a level of 80 pg per ml, and a limit of detection of one pg per ml. Evaluation of the absolute recovery of PGF2 alpha through the sample clean-up steps using tritium labelled PGF2 alpha gave recoveries of 68 +/- 5 percent. A preliminary reference range estimated a mean plasma PGF2 alpha level of 83 +/- 13 pg per ml (n = 7) with a range of 62 to 103 pg per ml in healthy adults. The major application of this method will be in research protocols studying changes of PGF2 alpha in toxemia of pregnancy.

We present a case of adult respiratory distress syndrome (ARDS) after extensive liposuction. On the basis of fever, tachypnea, hypoxia, and ARDS occurring within 48 hours after surgery without evidence of cardiogenic pulmonary edema or sepsis, the etiology is believed to be fat embolism. Although liposuction is generally an effective and safe procedure, awareness of this life-threatening complication is important in order to institute prompt and appropriate treatment. Fat embolism must be differentiated from thromboembolism, as the treatment is different, and heparin is not indicated. It is recommended that training standards and guidelines be devised in order to reduce morbidity and mortality associated with this procedure.

A reported method for the preparation of d3-methoxime derivatives as internal standards for prostaglandin assays by gas chromatography-mass spectrometry was evaluated. Sample derivatization resulted in 1.5-86% exchange of the d3-methoxime in a series of prostaglandins. Exchange was minimal when the methoxime was on the 5-membered ring; whereas, acyclic methoximes exhibited extensive exchange. Induced strain energy due to the steric interaction of the hydroxyl group and the C13-C20 alkyl side chain with the gem-dimethoxylamine transition state is offered as an explanation for the unusual stability of PGE2. The use of 18O exchange of the carboxylic acid function is presented as an alternative for the preparation of unavailable labelled eicosanoids.

We have assessed the role of growth hormone-releasing hormone (GHRH) as a diagnostic test in 40 children and young adults with growth hormone deficiency (GHD), principally using the GHRH(1-29)NH2 analogue. Following 200 micrograms GHRH as an acute intravenous bolus, serum GH rose to normal or just subnormal levels in 13 out of 17 children with structural lesions, and in 8 of 14 patients with idiopathic GHD or panhypopituitarism. Of 9 children (mean age 12 years) with GHD following treatment with cranial irradiation for nonendocrine tumours, all responded acutely to GHRH. 12- and 24-hour infusions with GHRH(1-29)NH2, and 1- and 2-week treatments with twice-daily subcutaneous GHRH(1-29)NH2, showed persistent stimulation of GH release. It is concluded that many children with GHD of diverse aetiology will respond both acutely and chronically to treatment with GHRH.

A stable isotope dilution assay for the measurement of plasma prostaglandin E2 (PGE2) employing capillary column gas chromatography-negative ion chemical ionization mass spectrometry (GC-NICIMS) is described. PGE2 was extracted from plasma using C18 and silica SEP-PAKS. Further purification and separation was accomplished by thin layer chromatography. The prostaglandin was analyzed as its pentafluorobenzyl ester-methoxime-trimethyl-silyl ether, using fragment ions at m/e 524 (protium) and m/e 528 (deuterium) for quantitation. The mean plasma concentration of PGE2 determined in 8 healthy volunteers was 2.8 +/- 2.0 pg/ml.

We present two cases of delayed, massive, life-threatening hemothorax due to intercostal hemorrhage in association with fractured ribs and severe blunt chest trauma (SBCT), a combination we have not seen described in the literature. Blunt chest trauma is not benign. Significant intrathoracic injuries are frequent although usually not life threatening. However, associated extrathoracic injuries are also common and much more lethal. Most cases of hemo- and pneumothorax associated with SBCT can be treated without thoracotomy. However, rapid blood loss requires immediate open thoracotomy and surgical attention. Several days of observation in hospital may be required for patients with SBCT and fractured ribs even without any other obvious intra- or extra-thoracic injuries. Vigorous activity or chest physical therapy may be dangerous during the first several days after the injury.

An 8-month-old white boy with anhidrotic ectodermal dysplasia (AED) who was referred to the North Carolina Baptist Hospital because of recurrent respiratory infections and hypogammaglobulinemia is presented. His mother had partial expression of AED suggesting x-linked recessive inheritance in this family. She was incidentally given oral glucocorticoids during pregnancy for the treatment of chronic urticaria. The patient's serum immunoglobulins G, A and M were low at 8 months but normal by 15 months of age, and immunologic evaluation failed to show a defect in antibody production or cell-mediated immunity. Although rare, the diagnosis of AED must be considered in infant boys with recurrent fever and respiratory infections. The diagnostic features of the disease may be subtle in young child prior to the eruption of the characteristic peg-shaped teeth.