We have measured the effects of ephedrine, adrenaline, noradrenaline and isoprenaline on halothane-induced contractures in muscle biopsies from patients potentially susceptible to malignant hyperthermia (MH). At concentrations of 4-24 mmol litre-1, ephedrine induced in vitro contractures in halothane 0.44 mmol litre-1-prechallenged muscle, whilst adrenaline, noradrenaline and isoprenaline had no effect. There was a shift of the ephedrine concentration-response curve to the left and an increased maximum muscle contracture in the MH susceptible group compared with the MH negative group (P < 0.001). We conclude that ephedrine increased halothane-induced muscle contractures in vitro either by an unknown pharmacological mechanism or by an adrenergic stimulation which was different from those of the other investigated adrenoceptor agonists.
Primary peritonitis accounts for 1 to 2 per cent of all paediatric abdominal emergencies and for about 15 per cent of diffuse peritoneal sepsis. The condition is still mainly seen in infants and in mid-childhood years, Most frequently in children four to eight years of age, with females outnumbering the males except among neonates where the males predominate. The mortality rate is about 50 per cent for infants, but drops to 10 to 15 per cent in older children. The origin of the infecting organism may be a haematogenous spread or ascension through the female genital tract, but transdiaphragmatic lymphatics and transmural migration through the gut wall may also be possible sources. The incidence of primary peritonitis is increased in children with nephrotic syndrome, postnecrotic cirrhosis with ascites and immunologic deficiency. Practically all kinds of pathogenic organisms are found, but a relative increase in staphylococcal and gram-negative infections has been noted.
Acute mesenteric ischemia remains a diagnostic and therapeutic challenge. The mortality rate lies between 50 and 97.3 %. New approaches take into consideration different elements of pathophysiology: toxic oxygen radicals are probably causing tissue injury during reperfusion after ischemia, oxygen scavengers may be beneficial. Angiography is the keystone of the diagnosis and treatment: followed by an early aggressive therapy it allows a decrease of the mortality rate to about 30%. Our multidisciplinary approach includes early diagnosis with angiography, pharmacological action on mesenteric vasoconstriction and on reperfusion tissue damage, improvement of flow and assessment of tissue viability. Various techniques are used to reestablish flow: selective thrombolysis, transluminal angioplasty, surgical angioplasty or bypass and combination of these techniques. A full-dose heparin anticoagulation is performed. We present two successful cases with a follow-up of more than 1 year.
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