THE RESPIRATORY EFFECTS OF A POTENT ANALGESIC (GPA 2087) IN MAN

The respiratory depressant effects of a potent analgesic (GPA2087) were compared with morphine in a randomized double-blindcross-over study in human volunteers. Using a rebreathing technique,carbon dioxide response curves were plotted automatically witha special-purpose analog computer. The respiratory depressantrelative potency of GPA 2087 to morphine was found to be 1.21with lower and upper 95 per cent confidence limits of 0.88 and2.04. Our best estimate based on the displacement of the respiratoryresponse curve is that GPA 2087 8 mg is the equivalent of morphine10 mg in our population of volunteers. ^*Geigy Pharmaceuticals, Ardsley, New York, U.S.A. ^*Present address: Salisbury General Infirmary, Odstock Branch,Salisbury, Wiltshire, England.     

The Standardized Normal Ivy Bleeding Time and Its Prolongation by Aspirin

A standardized, reproducible Ivy bleeding time technic has been describedwhich permits one to obtain accurate bleeding time data in man. Thetechnic was used to standardize an aspirin tolerance test in which 60 normal males had a control bleeding time; were given, on a double blind basis,either placebo or 1 Gm. of aspirin, and had a second bleeding time 2 hourslater. The control values were: mean, 5 min.; mean ± 2 st. dev., 2 min.,30 sec. to 10 min. The values after placebo were: mean, 5 min., 30 sec.;mean ± 2 st. dev., 2 min., 30 sec. to 11 min. The values after aspirin were:mean, 9 min., 30 sec.; mean ± 2 st. dev., 4 min. to 21 min. The differencebetween the mean bleeding time after placebo and after aspirin was highlysignificant (p < 0.001). The distribution of the bleeding times after aspirinsuggested that normal subjects do not respond to aspirin as a single population. The degree of prolongation of the bleeding time and the large size ofthe drops of blood observed in some subjects suggested to us that smallamounts of aspirin may exert a significant effect upon hemostasis in normalindividuals.

Submitted on January 10, 1969 Accepted on April 23, 1969     

Recalcitrant chest wall Aspergillus fumigatus osteomyelitis after coronary artery bypass grafting: successful radical surgical and medical management

This report describes a 62-year-old male diabetic patient with persistent chest wall osteomyelitis that developed after repeat coronary artery bypass grafting. The chronic infection was localized to the right anterior chest wall and refractory to medical and surgical treatment including long-term antiobiotics, five separate intraoperative debridements, and reconstruction with vascularized omentum over a two-year period at outside institutions. Aggressive surgical debridement with flap reconstruction resulted in definitive management. The organism isolated from multiple intraoperative bone, cartilage, and tissue cultures yielded Aspergillus fumigatus; therapy with itraconazole was utilized for 6 months. Surgical management of osteomyelitis and costochondritis is reviewed accompanied by a literature review on this uncommon cause of chronic chest wall infection.     

Avoiding free nipple grafts during reduction mammaplasty in patients with gigantomastia

Excessive breast hypertrophy or gigantomastia (>2000 g excision of tissue per breast) has traditionally been approached with breast amputation and free nipple grafting during reduction mammaplasty procedures. Disadvantages of free nipple grafts include loss of sensation, poor projection, uneven nipple-areolar complex pigmentation, and loss of lactation. We report our experiences utilizing the inferior pedicle technique of reduction mammaplasty with successful preservation of the nipple-areola complex for patients with gigantomastia. Between 2001 and 2003, 15 patients (ages 19--45) were identified with gigantomastia through review of pathology and operative reports. The inferior pedicle technique was performed in all cases by the attending staff assisted by plastic surgery residents. Patients were followed regularly from 1 week up to 1 year postoperatively. All patients reported relief from the physical sequelae of breast hypertrophy. One patient experienced bilateral partial nipple desquamation; she maintained sensation throughout and healed well with moist dressings. Otherwise, there were no complications and all patients achieved satisfactory esthetic outcomes. Our results suggest that inferior pedicle technique can be successfully performed in patients with gigantomastia. Breast amputation with free nipple grafting need not be considered standard practice for this patient population. Maintaining a wider pedicle base and meticulous intraoperative handling of the pedicle may contribute to the increased viability of the nipple-areolar complex during these cases.     

Increased Hemolysis after Intramuscular Iron Administration in Patients with Paroxysmal Nocturnal Hemoglobinuria: Report of Six Occurrences in Four Patients, and Speculations on a Possible Mechanism

Four patients with PNH were described who developed accelerated activityof their disease after the intramuscular administration of iron-dextran fortreatment of iron deficiency. This was considered to reflect a unique effect ofiron on PNH erythrocytes. It was postulated that this effect resulted from celldamage caused by iron catalyzed peroxidation of erythrocyte lipids, a reaction to which PNH erythrocytes could be unusually susceptible by virtue ofan increased content of unsaturated fatty acids or pro-oxidants or decreasedcontent of antioxidants.

Submitted on August 13, 1964 Accepted on November 11, 1964