Amplification by hyperoxia of coronary vasodilation induced by propofol

We tested the hypothesis that in vitro coronary and myocardial effects of propofol (10-300 microM) should be significantly modified in an isolated and erythrocyte-perfused rabbit heart model in the absence (PaO(2) = 137 +/- 16 mm Hg, n = 12) or in the presence (PaO(2) = 541 +/- 138 mm Hg, n = 12) of hyperoxia. The induction of hyperoxia provoked a significant coronary vasoconstriction (-13% +/- 7%). Propofol induced increased coronary vasodilation in the presence of hyperoxia. Because high oxygen tension has been reported to induce a coronary vasoconstriction mediated by the closure of adenosine triphosphate-sensitive potassium channels, we studied the effects of propofol in 2 additional groups of hearts (n = 6 in each group) pretreated by glibenclamide (0.6 microM) and cromakalim (0.5 microM) in the absence and presence of hyperoxia, respectively. The pretreatment by glibenclamide induced a coronary vasoconstriction (-16% +/- 7%) which did not affect propofol coronary vasodilation. The pretreatment by cromakalim abolished the amplification of propofol coronary vasodilation in the presence of hyperoxia. Propofol induced a significant decrease in myocardial performance for a concentration >100 micro M both in the absence and presence of hyperoxia. We conclude that propofol coronary vasodilation is amplified in the presence of hyperoxia. This phenomenon is not explained by the previous coronary vasoconstriction induced by glibenclamide. However, the pretreatment of hearts by cromakalim abolished the amplification of propofol coronary vasodilation in the presence of hyperoxia. The myocardial effects of propofol were not affected by the presence of hyperoxia. IMPLICATIONS: Propofol induced a coronary vasodilation that was amplified in the presence of hyperoxia. This phenomenon does not seem to be related to previous coronary vasoconstriction. The myocardial effects of propofol were not significantly modified in the presence of hyperoxia.     

Reversal by nalbuphine of respiratory depression caused by fentanyl

In 60 ASA class I or II patients given intravenous fentanyl for elective operations in doses large enough to produce postoperative respiratory depression, the intravenous administration of 20 mg nalbuphine resulted in prompt reversal of respiratory depression without loss of analgesia.     

Treatment of hemospermia caused by dilated seminal vesicles by direct drug injection guided by ultrasonography

Bilateral seminal vesicle puncture and injection of drugs with ultrasound guidance were performed in patients with hemospermia resistant to conservative therapy and with dilated seminal vesicles. Of 7 patients 6 had resolution of hemospermia for 2 to 3 months and then relapse. No side effect was noted.     

碱性成纤维细胞生长因子增强人重组骨形态发生蛋白-2诱导成骨的调节机理

目的：对ｂＦＧＦ增强ｒｈＢＭＰ－２诱导成骨的调节机理进行探讨。方法：２１０只ＢＡＬＢ／ｃ小鼠随机分为３组,每组７０只,试验侧均位于右后肢。设立ｒｈＢＭＰ－２／牛松质骨载体、单纯牛松质骨载体为对照组,分别于术后１２ｈ～２１ｄ共１１个时间点取材,观察其诱导成骨过程。结果：ｒｈＢＭＰ－２／ｂＦＧＦ／聚乙烯吡咯啉酮／牛松质骨载体组在诱导间充质细胞增殖、分化,软骨细胞、新生骨形成方面均早于ｒｈＢＭＰ－２／牛松质骨载体组,成骨量优于ｒｈＢＭＰ－２／牛松质骨载体组,而单纯牛松质骨载体组在２１ｄ仅出现了少量增殖的间充质细胞。结论：ｒｈＢＭＰ－２和ｂＦＧＦ在诱导成骨调节中存在着协同作用。     

Effects of management by wandering around launched by nursing department

目的 探讨护理部实施走动式管理模式进行全院护理质量控制的效果.方法 护理部坚持每天不定时下病房,跟班巡查,了解临床护理工作的落实和护理人员的需求,并按照护理管理质量标准动态管理.实施1年后评价效果.结果 实施走动式管理后,基础护理、特一级护理、护理文件书写及病区质量管理等8项护理质量质控得分显著高于实施前(均P＜0.01).结论 护理部实施走动式管理,能及时发现工作中的不足并改进,提高护理质量.     

护理部实施走动式管理效果探讨

目的探讨护理部实施走动式管理模式进行全院护理质量控制的效果。方法护理部坚持每天不定时下病房,跟班巡查,了解临床护理工作的落实和护理人员的需求,并按照护理管理质量标准动态管理。实施1年后评价效果。结果实施走动式管理后,基础护理、特一级护理、护理文件书写及病区质量管理等8项护理质量质控得分显著高于实施前(均P<0.01)。结论护理部实施走动式管理,能及时发现工作中的不足并改进,提高护理质量。     

Case of suicide by hanging complicated by cerebral sinus thrombosis

A 43-year-old male with respiratory arrest due to neck hanging was resuscitated at the scene. The head CT on arrival showed diffuse brain swelling predominantly in the right cerebral hemisphere. The swelling improved but right transverse sinus thrombosis was recognized on the 4th hospital day. His conscious state gradually recovered and recanalization of the sinus was confirmed on a subsequent MR venography. He was discharged without neurological deficit. A sinus thrombosis should be considered as a differential diagnosis of brain swelling after hanging.     

Burdened by training not by anaesthesia

Editor—Larsson and colleagues¹ have investigated importantbut often ignored aspects of anaesthetic practice. However,they imply that specialist anaesthetists experience reducedlevels of stress when compared with trainees because they havedeveloped successful coping mechanisms over the years. Thisconclusion cannot be drawn because the specialists' attitudesto work were identified at a particular time and cannot showa progression in learned coping abilities. To demonstrate thedevelopment of these skills, the specialists would have hadto be interviewed     

Acceptance of preoxygenation in clinical routine by patients and by anaesthesiologists

Preoxygenation is a simple technique to expand the time under planned apnea till the patient is endangered by hypoxia. In this study, we analysed how preoxygenation is used by anaesthesiologists in clinical routine and how this method is tolerated by the patients. One hundred and twenty-one anaesthesiologists of 4 hospitals were interviewed anonymously about training level, rank, indication for preoxygenation and techniques of preoxygenation, as well as their estimation of the patients' discomfort during preoxygenation. Data on 100 patients about oxygen-mask-tolerance were acquired by an anonymous questionnaire from a standard quality control inquiry. We received back 76 of the 121 questionnaires of anaesthesiologists (63 %). Fifty-nine percent of the anaesthesiologists (45/76) preoxygenated in clinical routine. With increasing training time and higher ranks, less anaesthesiologists preoxygenated routinely: junior residents: 80 %; senior residents: 68 %; consultants: 60 %; assistant medical directors: 48 %.80 % of the anaesthesiologists (61/76) used imperfect techniques for preoxygenation (e. g. oxygen-flow < 8 l/min). At the time of preoperative evaluation, the patients estimated the discomfort during preoxygenation on a continuous scale (1 to 10) as 2 (median; 1 - 7: 95 % confidence interval). Postoperatively, the patients mentioned no discomfort: 1 (1 - 1). The anaesthesiologists overestimated their patients' discomfort significantly with 5 (3 - 7) (p < 0.001).In conclusion, preoxygenation, a simple safety procedure, is not routinely used by many anaesthesiologists and imperfect methods are often employed. A possible reason for the anaesthesiologists' reluctance to preoxygenate is an overestimation of the patients' discomfort, though the patients tolerate preoxygenation very well.     

外伤性神经瘤切除静脉桥接治疗神经瘤性残端痛

目的探讨外伤性神经瘤切除静脉桥接治疗神经瘤性残端痛的临床疗效.方法对56例外伤性神经瘤患者采用神经瘤切除静脉桥接手术.结果56例均获随访，时间3～18个月.参照尹维田等标准评定疗效：优45例，良7例，可4例，优良率为92．8％。结论采用静脉桥接治疗神经瘤性残端痛，可恢复神经连续性，预防神经瘤的再形成，临床效果确切.     

神经端侧缝合治疗手指顽固性残端痛性神经瘤

目的 介绍一种治疗顽固性残端痛性神经瘤的手术方法.方法 2006年1月至2010年6月,采用神经端侧缝合的方法治疗手指顽固性残端痛性神经瘤共5例6指,术中彻底切除残端神经瘤直至正常神经组织.其中3例将修整后的神经残端直接与邻指正常指神经作端侧缝合;2例(3指)行腓肠神经移植修复,一端与修整后的神经残端作端端缝合,另一端与邻指指神经作端侧缝合.结果 术后经过12～ 63个月的随访,3例残端神经痛完全消失,2年后未复发;1例随访12个月,疼痛无复发;1例环、小指残端痛,术前已有过4次手术,本次术后环指疼痛消失,小指仍有疼痛,术后1个月小指再次行神经松解,随访63个月小指自发性疼痛减轻,但仍有触痛,环指疼痛消失.参照Burchid的疗效评定标准,优良率为83.3％(5/6).结论 神经端侧缝合的方法可有效治疗残端痛性神经瘤.     

Better control of esophageal variceal bleeding by sclerotherapy followed by surgery

This paper reports the clinical results of a retrospective study comparing endoscopic injection sclerotherapy (EIS) and back-up surgical treatment after EIS in the management of acute variceal bleeding. The 74 patients included in the study were divided into 2 groups. Group I consisted of 41 patients who received EIS over a mean period of 2.2 sessions and Group II consisted of 33 patients who underwent EIS and subsequent surgical intervention, in the form of 19 distal splenorenal shunts and 14 nonshunting procedures. The overall percentage of patients in whom initial control of variceal bleeding was achieved was 91.8 per cent. Four of the Group II patients were saved by emergency nonshunting operations. Rebleeding was experienced by 4 (28.6 per cent) of the 14 patients who underwent nonshunting surgery but by only 1 (5.3 per cent) of the 19 patients who underwent selective shunt surgery. The cumulative survival in Group II was significantly superior to that in Group I with 2 year survival being achieved in 66.7 per cent of the Group II patients but in only 23 per cent of Group I patients. Thus, the combination of initial EIS and back-up surgical intervention may be more benefical than sclerotherapy alone for patients with acute variceal bleeding, while, the distal splenorenal shunt may be a more suitable surgical technique for patients having previously EIS.     

Identification of brain tissue necrosis by MRI: validation by histomorphometry

The volume of an experimental necrotic lesion of the cortex expands up to 400% of its initial size within the first 24 h after the insult. Lesion expansion, a clinically well known phenomenon, is often accompanied by perifocal brain edema and consequently difficult to image and to analyze by magnetic resonance imaging (MRI). Therefore we aimed to validate a T(2)-weighted spin echo sequence upon its ability to distinguish necrotic from edematous brain tissue. Male Sprague-Dawley rats (n = 5 per group) were subjected to a cortical freezing lesion leading to immediate tissue necrosis with subsequent perifocal vasogenic brain edema. Immediately and 4, 12, and 24 h after the lesion the maximal area of necrosis was quantified longitudinally by coronal T(2)-weighted spin echo MRI-scans. After the last scan, animals were sacrificed for direct comparison of the lesion area obtained by MRI and histomorphometry. In parallel groups of animals, lesion expansion was quantified by histology. The acquired T(2)-maps clearly distinguish the cortical necrosis from perifocal edema and healthy brain. Focal freezing led to a cortical lesion of 5.24 +/- 0.36 mm(2) immediately after trauma (0 h; 100%) which expanded progressively to a maximum of 6.82 +/- 0.34 mm(2) after 24 h (131%; *p < 0.01 vs. 0 h). Lesion expansion quantified by histology was almost identical (132% within 24 h). Histological assessment resulted in smaller absolute lesion areas compared to MRI, most likely due to shrinking during tissue processing (4.72 +/- 0.26 mm(2) vs. 6.82 +/- 0.34 mm(2), p < 0.01). The current study shows that necrotic brain tissue can be distinguished from surrounding brain edema by T(2)-mapping. The technique is sensitive enough to detect small changes in necrosis expansion in vivo as validated by histology. The presented technique may be a useful future tool for the non-invasive identification of necrotic brain tissue following brain injury (e. g., from trauma or ischemia).     

Better control of esophageal variceal bleeding by sclerotherapy followed by surgery

This paper reports the clinical results of a retrospective study comparing endoscopic injection sclerotherapy (EIS) and back-up surgical treatment after EIS in the management of acute variceal bleeding. The 74 patients included in the study were divided into 2 groups. Group I consisted of 41 patients who received EIS over a mean period of 2.2 sessions and Group II consisted of 33 patients who underwent EIS and subsequent surgical intervention, in the form of 19 distal splenorenal shunts and 14 nonshunting procedures. The overall percentage of patients in whom initial control of variceal bleeding was achieved was 91.8 per cent. Four of the Group II patients were saved by emergency nonshunting operations. Rebleeding was experienced by 4 (28.6 per cent) of the 14 patients who underwent nonshunting surgery but by only 1 (5.3 per cent) of the 19 patients who underwent selective shunt surgery. The cumulative survival in Group II was significantly superior to that in Group I with 2 year survival being achieved in 66.7 per cent of the Group II patients but in only 23 per cent of Group I patients. Thus, the combination of initial EIS and back-up surgical intervention may be more beneficial than sclerotherapy alone for patients with acute variceal bleeding, while, the distal splenorenal shunt may be a more suitable surgical technique for patients having previously EIS.