Repair of a massive inguinal hernia

secretion, the thirst centre and osmoreceptors in the hypothalamus. The observed thrombocytopenia may have been related to the patient's chronic hypothermia; in hypothermic animals, platelets become sequestrated in the liver and possibly the spleen6. What of the cardiac arrhythmia? A well-documented consequence of hypothalamic injuries, it may have been the cause of this patient's sudden death. The excessive salivation may be relevant. This is an unusual feature of hypothalamic damage and has been reported in a patient with a third ventricle tumour7. In rats, lesions of the lateral hypothalamus are followed by excessive salivation8. Since salivation is a parasympathetic response, it may reflect high vagal tone, a cause of bradycardia. Excessive salivation and bradycardia in a patient with hypothalamic damage may therefore warrant early insertion of a pacemaker. In this case it is possible that hypothermia contributed to the cardiac arrhythmia. REFERENCES