Elévation de la tension artérielle lors de chirurgie sous garrot pneumatique: un mécanisme indépendant de la rénine?

Le but de ce travail a été d’évaluer l’efficacité du captopril dans la prévention de l’élévation de la pression artérielle lors de chirurgie du membre inférieur sous garrot pneumatique en anesthésie balancée. Vingt patients consécutifs ont été inclus dans cette étude et randomisés en deux groupes. L’un (n = 10), recevant un comprimé de captopril de 50 mg avec la prémédication, l’autre (n = 10), recevant un comprimé de placebo au même moment. Les différentes variables étudiées (tension artérielle, fréquence cardiaque) ont été mesurées continuellement. Cette étude a démontré, que le prétraitement par du captopril ne permet pas de prévenir une augmentation de la pression artérielle pendant la durée de gonflage d’un garrot pneumatique, les moyennes des tensions artérielles systoliques et diastoliques, à la fin de la période de gonflage du garrot, s’élèvent à 128 /86 et 128/81 dans le groupe captopril et dans le groupe placebo, respectivement. Ce résultat montre que le système rénine-angiotensine n’intervient pas, ou que peu, dans le phénomène d’augmentation des valeurs tensionnelles induite par un garrot pneumatique. The aim of this study was to evaluate the effectiveness of captopril for the prevention of the increase of arterial pressure during orthopaedic surgery requiring the application of lower limb tourniquets with balanced anaesthesia. Twenty consecutive patients were included in the study and were randomly divided into two groups. The first (n = 10) received 50 mg captopril orally together with the preanaesthetic medication, the second (n = 10) received a placebo at the same time. The different variables studied (arterial pressure, heart rale) were continuously measured. This study demonstrated that the pretreatment with captopril did not prevent an increase of the arterial pressure during the application of a tourniquet. The means of the systolic and diastolic arterial pressures at the end of the application of the tourniquet were 128/86 and 128/81 in the captopril group and the placebo group, respectively. This result shows that the renin-angiotensin system does not significantly contribute to the increase of the arterial pressure induced by a tourniquet.     

Different dose regimens of the mouse monoclonal-antibody 17-1a for therapy of patients with metastatic colorectal-carcinoma

Seventy-one patients with metastatic colorectal carcinoma(CRC) were treated with varying doses of the mouse monoclonal antibody (MAb) 17-1A. One patient achieved a partial remission (PR) (1%) with a survival duration of 114+ months. Further 10 patients showed a minor response (MR) or stable disease > 3 months (SD) (14%). In patients receiving a total dose of MAb17-1A < 2 g the overall response rate was 22% (10/45) (1 PR, 2 MR, 7 SD) while patients treated with a total dose > 2 g had a corresponding figure of 4% (1/26) (1 MR) (p < 0.05). Responding patients (n = 11) survived significantly longer than non-responding patients (n = 60) (median: 20 vs 10 months) (p < 0.0027). In the most intensive treatment group (total 12 g), 14 patients received 500 mg of MAb17-1A tiw for 8 weeks. The frequency and intensity of side-effects were mild and did not cause withdrawal or dose reduction of MAb17-1A, even in the 12 g dose schedule. Patients with a pretreatment ADCC (antibody dependent cellular cytotoxicity) activity above the median of all patients, survived significantly longer than those with a low value (p < 0.05).     

Positive end-expiratory pressure prevents atelectasis during general anaesthesia even in the presence of a high inspired oxygen concentration

BACKGROUND: General anaesthesia impairs the gas exchange in the lungs, and moderate desaturation (SaO2 86-90%) occurred in 50% of anaesthetised patients in a blinded pulse oximetry study. A high FiO2 might reduce the risk of hypoxaemia, but can also promote atelectasis. We hypothesised that a moderate positive end-expiratory pressure (PEEP) level of 10 cmH2O can prevent atelectasis during ventilation with an FiO2 = 1.0. METHODS: Atelectasis was evaluated by computed tomography (CT) in 13 ASA I-II patients undergoing elective surgery. CT scans were obtained before and 15 min after induction of anaesthesia. Then, recruitment of collapsed lung tissue was performed as a "vital capacity manoeuvre" (VCM, inspiration with Paw = 40 cmH2O for 15 s), and a CT scan was obtained at the end of the VCM. Thereafter, PEEP = 0 cmH2O was applied in group 1, and PEEP = 10 cmH2O in group 2. Additional CT scans were obtained after the VCM. Oxygenation was measured before and after the VCM. RESULTS: Atelectasis (> 1 cm2) was present in 12 of the 13 patients after induction of anaesthesia. At 5 and 10 min after the VCM, atelectasis was significantly smaller in group 2 than group 1 (P < 0.005). A significant inverse correlation was found between PaO2 and atelectasis. CONCLUSIONS: PEEP = 10 cmH2O reduced atelectasis formation after a VCM, when FiO2 = 1.0 was used. Thus, a VCM followed by PEEP = 10 cmH2O should be considered when patients are ventilated with a high FiO2 and gas exchange is impaired.     

The effect of supervised rehabilitation on strength, postural sway, position sense and re-injury risk after acute ankle ligament sprain

The effect of an early rehabilitation program, including postural training, on ankle joint function after an ankle ligament sprain was investigated prospectively. Ninety-two subjects, matched for age, sex, and level of sports activity, were randomized to a control or training group. All subject received the same standard information regarding early ankle mobilization. In addition, the training group participated in supervised physical therapy rehabilitation (1 h, twice weekly) with emphasis on balance training. Postural sway, position sense and isometric ankle strength were measured 6 weeks and 4 months after the injury, and at 12 months re-injury data were obtained. In the training group, there was a significant difference between the injured and uninjured side for plantar flexion (P < 0.01), eversion (P < 0.01) and inversion (P < 0.05), but not for dorsiflexion at 6 weeks. In the control group, there was a significant difference between the injured and uninjured side for plantar flexion (P < 0.01), eversion (P < 0.01), inversion (P < 0.01), and dorsiflexion (P < 0.05) at 6 weeks. Postural sway, but not position sense, differed between the injured and uninjured side in both groups (P < 0.01) at 6 weeks. The side-to-side percent differences were similar in both groups for all variables (P > 0.05) at 6 weeks, and there were no side-to-side differences at 4 months in either group. In the control group, 11/38 (29%) suffered a re-injury, while this number was only 2/29 (7%) in the training group (P < 0.05). These data showed that an ankle injury resulted in reduced ankle strength and postural control at 6 weeks, but that these variables had normalized at 4 months, independent of the supervised rehabilitation. However, the findings also demonstrated that supervised rehabilitation may reduce the number of re-injuries, and therefore may play a role in injury prevention.     

Effects of enkephalins and two enzyme resistant analogues on monoamine synthesis and metabolism in rat brain

Summary Methionine-enkephalin and leucineenkephalin, administered into the lateral ventricle of intact rats, increased the accumulation of DOPA by a naloxone-sensitive mechanism in different brain regions after inhibition of the aromatic l-amino acid decarboxylase. Because of the rapid enzymatic degradation of both enkephalins large doses (500 g) were required to enhance brain catecholamine synthesis. The two enzyme resistant enkephalin analogues d-Ala²-methionine enkephalin amide (DALA (4–256 g) and FK 33-824 (0.003–1 g) also increased the synthesis of DOPA, dose-dependently and by naloxone-sensitive mechanisms, but at much lower dosage level. The enkephalins markedly enhanced the brain tyrosine concentration but this effect was not antagonized by naloxone, probably because the enzymatic cleavage releases tyrosine from the administered peptides. In contrast, neither DALA nor FK 33-824 increased the brain tyrosine concentration. The formation of 5-HTP and the brain tryptophan concentration were also increased by the enkephalins, although these effects were not blocked by naloxone. The enkephalin analogues, however, enhanced the formation of 5-HTP and the brain tryptophan concentration by naloxonesensitive mechanisms. All four peptides accelerated the disappearance of dopamine, noradrenaline and 5-hydroxytryptamine after inhibition of monoamine synthesis. The results suggest that endogenous enkephalins, through the activation of opiate receptors, are involved in the short-term regulation of central monoaminergic systems.Preliminary data were presented at the Nobel Symposium 42, Principles for the Central Regulation of the Endocrine System, Stockholm, June 8–10, 1978, and at the 4th International Catecholamine Symposium, Asilomar Conference Center, Pacific Grove, California, September 17–22, 1978     

The adjuvant effect of tuberculin in experimental sensitization to merthiolate

Summary When guinea pigs were sensitized to tuberculin by exposure to complete Freund's adjuvant the size of the intradermal PPD test was positively correlated to the body weigth of the animal. Old Tuberculin showed stimulating effect in a subsequent sensitization to merthiolate (thimerosal). The high frequency of delayed cutaneous allergy to merthiolate in the Swedish population is probably explained by sensitization through intradermal testing with tuberculin containing merthiolatc as a preservative.

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Zusammenfassung Bei Meerschweinen, die mit Hilfe von Freunds Adjuvant gegen Tuberculin sensibilisiert wurden, konnte eine Korrelation zwischen der Größe des Intracutantests und dem Körpergewicht der Tiere festgestellt werden. Old Tuberculin zeigte in einem darauffolgenden Sensibilisierungsversuch mit Merthiolat einen stimulierenden Effekt auf die allergische Reaktion gegen Merthiolat. Die hohe Frequenz von allergischen cutanen Spätreaktionen gegen Merthiolat in der schwedischen Bevölkerung ist wahrscheinlich als Sensibilisierung durch Intracutantest mit Tuberculin, das als Konservierungsmittel Merthiolat enthält, zu erklären.

     

Distribution of cerebral blood flow in the dominant hemisphere during motor ideation and motor performance.

Distribution of activity in the dominant (left) hemisphere was studied with a multidetector instrument during diagnostic measurements of regional cerebral blood flow in 6 patients, 4 of them neurologically normal. Computercalculated charts, in color, of the flow/activity distribution--"cerebral ideograms"-- were obtained in three situations: at rest, during motor ideation (attempts to conceive of rhythmic clenching movements of the right hand), and during actual movements of the right hand. Motor ideation changed the normal "hyperfrontal" resting flow distribution, and an increase of the hemisphere mean flow was recorded. The increase was especially marked in frontal and temporal structures. This pattern differed from the one during actual hand movements, when a rolandic flow increase was seen. The result suggests that centers for motor ideation have a different cerebral location than those which control the actual hand movement.     

The use of non-invasive probes and (13)C nuclear magnetic resonance spectroscopy to assess liver metabolism in humans

Two new methods to assess liver metabolism in humans will be discussed, non-invasive probes and (13)C NMR (nuclear magnetic resonance) spectroscopy. Hepatic UDP-glucose and alpha-ketoglutarate can be sampled by non-invasive probes. This method has been used to quantitate the contribution of the indirect pathway to liver glycogen formation and to estimate relative flow rates and carbon exchange in the Krebs cycle. (13)C NMR spectroscopy has been developed to measure liver glycogen concentrations in vivo. Using this method in combination with measurements of whole body glucose production during fasting, the contribution of gluconeogenesis has been calculated.     

Evaluation of micromotion in cemented vs uncemented knee arthroplasty in osteoarthrosis and rheumatoid arthritis. Randomized study using roentgen stereophotogrammetric analysis

Twenty-four patients (25 knees) with osteoarthrosis (OA) and 19 patients (20 knees) with rheumatoid arthritis (RA) were operated with bi-tricompartmental knee arthroplasty. The patients were randomized to cemented or cementless fixation of the tibial component. The fixation of the tibial components was examined with roentgen stereophotogrammetric analysis (RSA) up to 24 months after operation. The following parameters representing tibial component micromotion were measured: (1) maximum migration of the prosthetic edge (maximum total point motion, MTPM); (2) distal migration of the prosthetic center (subsidence); (3) maximum proximal movements of the prosthetic edge ("lift-off"); and (4) prosthetic rotations, corresponding to internal/external rotation, adduction/abduction, and forward/backward tilt of the tibial component. All prostheses displayed significant micromotions, which tended to decrease 3-6 months after the operation. The average migration after 2 years, when measured as maximum single axis rotation, and MTPM were about 0.9 degrees-1.5 degrees and 1.0-1.5 mm, respectively, in all four groups. There were no statistically significant differences between cemented and cementless prostheses in either the OA or the RA group. The fixation in the RA patients did not significantly differ from that of the OA patients, perhaps because the RA patients had lower weight and were living a more sedentary life.