John A. Shepherd

Rupture of Liver Associated with Parturition

given in Chart 2. The protein content of the ascitic fluid varied between 2 and 2.5 g. %. By this time the patient was markedly emaciated and the abdomen was grossly distended by ascitic fluid and a large spleen, which reached right down into the pelvis. His liver, however, was only slightly enlarged. On July 2 an estimation of the plasma protein gave a reading of 5.1 g. %, and a hippuric-acid test showed that the amount of hippuric acid passed in the four-hour period was only 2.7922 g., with the maximum excretion in the second hour. It was therefore decided to give 1 g. of choline chloride and 1 g. of cystine twice daily. This was done on the assumption that choline and cystine can help to prevent hepatic cirrhosis due to a very low protein intake. The hippuric-acid tests were repeated, with the following results

Ferrous Sulphate Poisoning with Gross Stricture of Stomach

Ascaris ova were found in the stools in all cases; ancylostoma were also present in 13 cases; Giardia lamblia in four cases, and Hymenolepis nana in three cases. The following three dosage schedules were applied: (1) 0.3 g. (one tablet) a day for each year of life up to 6 years, and 1.8 g. (six tablets) a day from 6 years upward. This was given to 25 cases. Five children received the dosage for seven days, six for five days, and 14 for three days. (2) 0.6 g. a day for each year of life up to 6 years, and 3.6 g. a day from 6 years upwards-that is, double the dosage administered to Group 1. Twenty-one cases, including two failures from the previous group, were treated for one day. Eleven cases, including four failures from the preceding cases, were treated for two days. (3) 0.75 g. a day for each year of life up to 6 years, and 4.5 g. a day from 6 years upwards. Thirty-five cases, including one failure from the second group, were treated for one day. Treatment consisted solely of the administration of tablets of piperazine adipate as described above; no special diet was recommended during treatment. No pre-treatment measures were undertaken. The daily dose of the drug was given in three or four equal portions during the day, at four-hourly intervals, after meals. A mild saline purge was given on the day after the completion of treatment.

Rupture of Congenital Solitary Kidney

circulation depends on a patent ductus arteriosus, and is compatible only with a few weeks or months of life. The adult type consists of a localized narrowing about the level of the ductus arteriosus, and these patients may live for many years; in Abbotts series the ages of death varied from 3 to 92 years, with an average of 32. In 200 cases which came to necropsy the atresia was complete in 47, extreme (under 6 mm.) in 108, and moderate in 45. The figures of Reifenstein et al. (1947) are similar, the average age at death being 35. Both workers found that rupture of the aorta was a common cause of death, especially among younger patients. Abbott found it 40 times in her 200 cases examined at necropsy, and all Reifensteins cases occurred between the ages of 10 and 30. The rupture generally occurred in the ascending aorta, but was sometimes seen at, or near the site of, the obliterated ductus. Here the aorta was often dilated at the emergence of the intercostal arteries, or kinked by the ligamentum arteriosum. Histological examination of the aorta nearly always showed medial degeneration. There was interruption and diminution of the elastica and muscle, with fatty and hyaline degeneration. The connective tissue was increased: Gore and Seiwert (1952) found this in 85 cases of dissecting aneurysm, not necessarily associated with coarctation; hypertension was present in only 58 % of cases. The recognition of coarctation of the aorta is not difficult if the diagnosis is kept in mind. Hypertension is present in most cases, but may be only slight in children. A systolic murmur is often heard over the front and back of the chest, where the enlarged collateral circulation may be seen and felt; the unusual site of the murmur is most suggestive of a coarctation. The femoral pulses are absent, or are feeble and delayed. Radiology may show notching of the lower borders of the ribs due to the hypertrophied intercostal arteries. Surgical treatment of the condition is generally undertaken in children and young adults; therefore it is necessary to make the diagnosis early, generally before any symptoms arise. If the femoral arteries are palpated as a routine during a medical examination cases of coarctation of the aorta will not be missed.

Perforated gastric ulcer associated with subcapsular haemorrhage of spleen.

negative staphylococci and atypical Gram-positive cocci were isolated from a few cases later during treatment, but are not included in the tables). Primary infection refers to the organism isolated on first culture ; ,secondary infection to those isolated from a second or later sample, if different from the first. The striking fall in incidence of secondary coliform infection followirtg the use of streptomycin is shown in two unselected series of 500 consecutive swabs received from the hand-dressing unit (Table II); one was taken during the penicillin period and one during the streptomycin period. TABLE X1