Sudden infant death syndrome remains a leading cause of post-neonatal mortality in developed countries. Its etiopathogenic mechanisms are unknown. In this neuropathologic study, we noticed that the weights of the brains of infants who died from sudden infant death syndrome (n = 97) were invariably heavier in comparison with those of a group of age-matched controls (n = 23) issuing from the same local population. Brain edema was not a major element, and there were no significant microscopic or macroscopic cerebral anomalies in the brains from either of the study groups. Head circumference did not show a parallel increase in infants with sudden infant death syndrome. The excessive brain weight might reflect abnormal cerebral development and could be detrimental to vital neural control. In a previous study, we disclosed cytokine overexpression in the brains of these victims. Whether increased brain weight is linked to cytokine up-regulation remains, however, a moot case and merits further exploration.
Pain owing to acute ureteral obstruction seems to be related closely to tension in the walls of the renal pelvis. Renal prostaglandins are involved intimately in the events leading to the pain. A prostaglandin-synthetase inhibitor, diclofenac sodium, was used in the treatment of acute ureteral pain, and was compared to the traditional treatment of a combination of spasmolytic and narcotic drugs. Also, the need for overhydration as part of the management was tested. The 91 patients entered into the prospective randomized trial were divided into groups. Diclofenac sodium had a 90 per cent success rate in relieving pain at 30 minutes, and the combination of pethidine and hyoscine butyl bromide had a statistically higher success rate at 97.5 per cent (p equals 0.05). However, the latter therapy had a higher rate of side effects (p equals 0.01). There was no difference in the response between the groups in relation to whether they received intravenous fluids.
Judging from the abundance of papers published in the medical journals there appears to be a global increase in the incidence of urolithiasis. Urinary excretion of various stone-forming salts in a 24-hour urine specimen is the mainstay of the metabolic workup done in stone-formers. According to the findings patients have been classified into neat categories depending on whether they were hypercalciuric, hyperuricosuric, etc. As a group their excretion of calcium, oxalate, and urate was not different from the controls. However, they excreted significantly more phosphate and had lower 24-hour urine volumes than the controls.
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