Acute arteriomesenteric duodenal ileus as a complication following operative correction of scoliosis.

(Lillehei et al., 1967). This is attributed to the vasodilator and positive inotropic action of such large doses of hydrocortisone. Similar therapy was successful in our patient. Recent reports recommend that a rapidly acting thyroid hormone should be promptly administered to patients in myxoedema coma or pre-coma. The danger, particularly to the cardio-vascular system, must be balanced against the patient's need for urgent replacement of thyroid hormone. There are conflicting recommendations for the choice of drug (L-thyroxine or tri-iodothyronine), the method of administration (intravenously or orally) and the dose (Rosenberg, 1968). Dyson & Wood (1956) suggest that 100 jig of tri-iodothyronine intravenously every 12 hr is adequate in coma and should not be exceeded. Ivy (1965) recommends that in pre-coma the initial dose should be 25 ,ug of tri-iodothyronine 12-hourly, which should be increased if the level of consciousness falls. Serious cardiac arrhythmia has been precipitated with as little as 10 ,ug intravenously given as a single dose albeit combined with metaraminol (Perlmutter & Cohn, 1964) and this writer recommends oral administration. Tri-iodothyronine is said to have a measurable effect after 6 hr and reach its maximum effect after 48-72 hr (Asper, Selenkow & Plamondon, 1953). There would seem, therefore, to be no advantage in giving the drug as a continuous infusion. The patient hasnow returned to her Welfare Home. When seen 3 months after this illness she was alert, mobile and able to hold a rational conversation. Her appetitite was normal and the clinical signs of myxoedema had receded.