- Email: [email protected]
A non-surgical method for termination of early pregnancy
Notes
320 N
Automatic external defibrillator in cardiac arrest.
ike viral gstroenteritis
A large
outbreak of Norwalk-like viral gastroenteritis a&z&d staff, guests and diners at a hotel over a period of 8 days. Epidemiologic evidence associated illness with food prepared by the cold-food chef. The authors conclude that he contaminated food whilst asymptomatic after a very short bout of illness. Virus was demonstrated in his faeces 2 days after recovery from illness by immunoelectron microscopy (but not by routine electronmicroscopy). The vulnerability of cold foods is demonstrated, and the authors query current expert guidelines which allow such food-handlers to resume work once asymptomatic. The report is also concerned about environmental contamination following vomiting, which could cause infections. Viral ~nt~ination of the environment is not currently demonstrable. J.A. Reid (I ) Hatton Health Authority, Runcorn WA7 4TH. UK
A wwawgkai methodfor termhtion of early pregnancy.
Progesterone is indispensable to sustain p~gnan~y. Espostane a synthetic compound inhibits 3-beta hydroxysteroid dehydrogenase (3&HSD}, an enzyme involved in the synthesis of progesterone. In animal and clinical trials epostane has been demonstrated to reduce progesterone synthesis, terminate pregnancy and there was no impaitment of subsequent reproductive cycle. In a clinical trial administration of epostane (8OOmg/day/f days) terminated pregnancy (up to 8 weeks) in 84 % and the treatment failed in 16 % of the cases whose pregnancies were terminated by D&C. Progesterone level decreased signi&antly in the former group while a similar levet of decrease was not seen in the latter. A similar profile was observed in the levels of chorionic gonadotropin. On average blood loss occurred on day 3 and the conception product was expelled by day 5. Menstruation, normalised in the majority by day 42. Nausea was the major complaint. ‘IIre majority of volunteers opted for this method and a few did have reservations. It is concluded that use of epostane is an acceptable effective non-surgical alternative method for termination of early unwanted pregnancy. However it is not a “do it yourself” method. It should be used only under a Physician’s supe~ision. R. Rao (2) AeademischZiekenhuisVrije Universiteit, 1081HV Amsterdam, The Netherlands
(1) The Lancet (1988) ii, 321. (2) N. [email protected]. Med.(1988)319, 814.
Automatic external detibrillators (AED) are emergency cardiac devices that can be used by first aid providers to treat cardiac arrest and ventricular ~brillation. In 2 years, 1287 patients with out-of-hospital cardiac arrest were evaluated. Six hundred and eighty-seven (53 %) received initial treatment by firefighters who used the AED before paramedics arrived. For the remaining 600, the first response team could provide only cardiopulmonary resuscitation until arrival of paramedics. The AED permitted treatment 5.1+3.2 minutes earlier to these patients than would otherwise have been possible. There were 504 patients found in vent~cular fibrihation - 276 were treated by the AED, and 228 received only cardiopulmonary resuscitation prior to arrival of paramedics. Survival rates were significantly higher if an AED was used prior to paramedic arrival (30 % vs. 19 o/a,P 200 UV) younger age of the patients, a shorter paramedic response time and initial use of AED (odds; 9SCL 1.8; 1.I-2.9). We concluded that the AED is a device that has obvious utility where paramedic services did not exist, and even in sophisticated emergency systems that exist in urban areas. Standing protocols and evaluations of the rhythms and treatments are mandatory by the physician responsible for the service. W.A. Weaver (3) University of Washington, Seattle, WA 98195, USA
Malignant pancreatic endocrinetumors.
Over a five-year period, plasma samples were received for gut hormone assay from 353 patients with subsequently proven pancreatic endocrine tumors. During the 26 months (SEMf4.8 months) subsequent to their initial diagnosis, twenty-four patients with malignant pancreatic endocrine tumors (at least 6.8 % of all patients with pancreatic tumors) developed elevation of other hormone levels with new associated clinical symptoms. Thirteen of these patients (8 glucagonomas, 3 VIPomas and 2 insulinomas) developed hypergastrinaemia with the clinical features of a gastrinoma. The recognition that gastrinomas may develop in patients with pancreatic endocrine tumors who initially have a serum gastrin within normal hmits is clinically important since in 5 of the 13 ga!;trinoma
(31 N. Engl. J. Med.(1988) 319, $62.
320 N
Automatic external defibrillator in cardiac arrest.
ike viral gstroenteritis
A large
outbreak of Norwalk-like viral gastroenteritis a&z&d staff, guests and diners at a hotel over a period of 8 days. Epidemiologic evidence associated illness with food prepared by the cold-food chef. The authors conclude that he contaminated food whilst asymptomatic after a very short bout of illness. Virus was demonstrated in his faeces 2 days after recovery from illness by immunoelectron microscopy (but not by routine electronmicroscopy). The vulnerability of cold foods is demonstrated, and the authors query current expert guidelines which allow such food-handlers to resume work once asymptomatic. The report is also concerned about environmental contamination following vomiting, which could cause infections. Viral ~nt~ination of the environment is not currently demonstrable. J.A. Reid (I ) Hatton Health Authority, Runcorn WA7 4TH. UK
A wwawgkai methodfor termhtion of early pregnancy.
Progesterone is indispensable to sustain p~gnan~y. Espostane a synthetic compound inhibits 3-beta hydroxysteroid dehydrogenase (3&HSD}, an enzyme involved in the synthesis of progesterone. In animal and clinical trials epostane has been demonstrated to reduce progesterone synthesis, terminate pregnancy and there was no impaitment of subsequent reproductive cycle. In a clinical trial administration of epostane (8OOmg/day/f days) terminated pregnancy (up to 8 weeks) in 84 % and the treatment failed in 16 % of the cases whose pregnancies were terminated by D&C. Progesterone level decreased signi&antly in the former group while a similar levet of decrease was not seen in the latter. A similar profile was observed in the levels of chorionic gonadotropin. On average blood loss occurred on day 3 and the conception product was expelled by day 5. Menstruation, normalised in the majority by day 42. Nausea was the major complaint. ‘IIre majority of volunteers opted for this method and a few did have reservations. It is concluded that use of epostane is an acceptable effective non-surgical alternative method for termination of early unwanted pregnancy. However it is not a “do it yourself” method. It should be used only under a Physician’s supe~ision. R. Rao (2) AeademischZiekenhuisVrije Universiteit, 1081HV Amsterdam, The Netherlands
(1) The Lancet (1988) ii, 321. (2) N. [email protected]. Med.(1988)319, 814.
Automatic external detibrillators (AED) are emergency cardiac devices that can be used by first aid providers to treat cardiac arrest and ventricular ~brillation. In 2 years, 1287 patients with out-of-hospital cardiac arrest were evaluated. Six hundred and eighty-seven (53 %) received initial treatment by firefighters who used the AED before paramedics arrived. For the remaining 600, the first response team could provide only cardiopulmonary resuscitation until arrival of paramedics. The AED permitted treatment 5.1+3.2 minutes earlier to these patients than would otherwise have been possible. There were 504 patients found in vent~cular fibrihation - 276 were treated by the AED, and 228 received only cardiopulmonary resuscitation prior to arrival of paramedics. Survival rates were significantly higher if an AED was used prior to paramedic arrival (30 % vs. 19 o/a,P
Malignant pancreatic endocrinetumors.
Over a five-year period, plasma samples were received for gut hormone assay from 353 patients with subsequently proven pancreatic endocrine tumors. During the 26 months (SEMf4.8 months) subsequent to their initial diagnosis, twenty-four patients with malignant pancreatic endocrine tumors (at least 6.8 % of all patients with pancreatic tumors) developed elevation of other hormone levels with new associated clinical symptoms. Thirteen of these patients (8 glucagonomas, 3 VIPomas and 2 insulinomas) developed hypergastrinaemia with the clinical features of a gastrinoma. The recognition that gastrinomas may develop in patients with pancreatic endocrine tumors who initially have a serum gastrin within normal hmits is clinically important since in 5 of the 13 ga!;trinoma
(31 N. Engl. J. Med.(1988) 319, $62.