Effective and Safe Anesthesia for Yorkshire and Yucatan Swine with and without Cardiovascular Injury and Intervention

The goal of this study was to identify an injectable anesthetic protocol that provides sedation sufficient for peripheral vascular catheterization, intubation, and transport while minimizing cardiovascular changes in Yorkshire and Yucatan pigs with and without cardiovascular injury and intervention (CI). Phase 1 examined the safety and efficacy of acepromazine–ketamine, diazepam–ketamine, midazolam–ketamine, and medetomidine–ketamine in 5 healthy Yorkshire pigs. For each drug combination, we obtained multiple measurements of heart rate, blood pressure, respiratory rate, temperature, sedation score, ability to catheterize and intubate, and recovery score. Phase 2 evaluated and refined the dose of the most effective Phase 1 anesthetic combination (midazolam–ketamine) in healthy and CI Yorkshire pigs (n = 53 trials). Phase 3 mirrored Phase 2 but tested midazolam–ketamine in healthy and CI Yucatan pigs (n = 34 trials). Midazolam (0.5 mg/kg)–ketamine (25 to 27 mg/kg) was the most effective anesthetic combination in healthy Yorkshire pigs, but this dose was less effective in healthy Yucatan pigs and CI Yorkshire and Yucatan pigs. Midazolam–ketamine resulted in tachycardia and apnea more frequently in CI pigs than healthy pigs. This combination also caused vomiting in one CI Yucatan pig. Overall, midazolam–ketamine provided safe and effective sedation for catheterization and intubation of both healthy and CI pigs. This study suggests Yucatan pigs may require a higher dose midazolam–ketamine to achieve the same level of sedation as that in Yorkshire pigs. Although anesthetic complication rates were higher in CI pigs, our results indicate that midazolam–ketamine can be safely used for sedation of both pig breeds with and without CI.Abbreviation: CI, cardiovascular injury and interventionPigs (Sus scrofa) are common models of cardiovascular injury and intervention (CI) that largely have replaced traditional canine cardiology models. Advantages of swine compared with dogs include anatomic and physiologic characteristics similar to humans, such as similar coronary artery distribution and effective collateralized blood flow to the myocardium after coronary artery blockage.²³ However, pigs are difficult to restrain and anesthetize due to their size and resistance to sedative drug combinations, including those with morphine.²⁴ Injectable sedative drugs may result in cardiovascular and respiratory effects such as increased cardiac work and oxygen consumption, tachycardia, bradycardia, apnea, hypertension, and hypotension.^{5,6,8-12,14,19,20,25-29} These side effects can pose considerable problems for CI pigs, and anesthesia protocols with minimal effects on cardiovascular function are needed. A literature review revealed no published studies of anesthetic protocols in swine with existing cardiovascular injury; published research is limited to investigating anesthesia protocols for experimental induction of CI or determining in vitro and in vivo drug effects on healthy cardiovascular systems.^{4-6,8-12,14,19-21,25-29} Other published studies have limited investigations to studying sedative and physiologic effects in healthy Yorkshire, Yucatan, mixed-breed, Landrace, and Gottingen miniature swine.^{2,3,10,13,17,18,20-22}We conducted the current study to address the need for a systematic investigation of anesthetic protocols in CI Yorkshire and Yucatan pigs. The goals of this study were to determine an injectable-only anesthetic protocol for both Yorkshire and Yucatan pigs that yielded sufficient sedation for peripheral vascular catheterization, sufficient duration for transport, and minimal cardiovascular effects while being safe and effective for CI pigs.     

Urogenital Infections in the Male and Their Implications on Fertility

Male infertility is a clinical manifestation which concerns approximately 15 % of all couples in Europe. Male causes for infertility are found in 50% of involuntarily childless couples. For Germany this counts for a number of an equivalent of 50 000 men/year, No causal factor is found in 60%-75% of cases （idiopathic male infertility）. Nevertheless, reduced male fertility can be the result of congenital and acquired urogenital abnormalities, increased scrotal temperature （varicocele）, endocrine disturbances, genetic abnormalities and immunological factors. Furthermore, urogenital inflammations and infections play an important role. Indications for microbiological assessment include abnormal urine samples, urinary tract infections, prostatitis, epididymitis, orchitis, ejaculate infections and sexually transmitted diseases. In the following review, different infectious diseases of the male urogenital tract and their implications on fertility were reviewed.     

Total Parathyroidectomy Alone or with Autograft for Renal Hyperparathyroidism?

Seventy-six patients underwent parathyroidectomy for renal hyperparathyroidism.There were 10 subtotal parathyroidectomies, 49 total parathyroidectomieswith implantation of part of one gland as an autograft, ninetotal parathyroidectomies with no autograft, and eight patientsin whom only three parathyroid glands were found. In 34 dialysis patients who underwent total parathyroidectomywith an autograft there was a high rate of recurrent hyperparathyroidismafter 6 years in those remaining on dialysis. Fifty per centhad asymptomatic recurrent hyperparathyodism and 30 per centrequired partial autograft excision for symptomatic hyperparathyroidism.In contrast, recurrent hyperparathyroidism was rare in renaltransplant recipients with good renal function. This favourableoutcome did not depend upon whether parathyroid surgery wasperformed before or after transplantation, or on the type ofparathyroidectomy. Total parathyroidectomy without an autograftwas performed in nine dialysis patients without any short-termadverse effects, and with clinical and pathological improvementin bone disease. In summary, the results of surgery for renal hyperparathyroidismwere excellent in patients who received a successful renal transplant.However, there was a high incidence of recurrent hyperparathyroidismin patients who remained on long-term dialysis. Total parathyroidectomywithout an autograft may be the treatment of choice in patientsunlikely to receive a renal transplant.     

Nonobstructive Dysphagia in Reflux Esophagitis

Dysphagia in the absence of organic esophageal stricture may occur in patients with reflux esophagitis. Although the exact mechanism of this "nonobstructive dysphagia" (NOD) is not known, it is believed to be related to transient segmental esophageal motor disorder. The goals of this study were to determine the frequency of NOD in patients with reflux esophagitis and correlate it with esophageal pH and motility changes. Sixty-three consecutive patients with symptoms of esophageal dysfunction were studied with endoscopy, infusion esophageal manometry, and 24-h ambulatory esophageal pH monitoring. Forty-seven had severe erosive esophagitis unresponsive to medical therapy; 16 with esophageal motility disorders were used as symptomatic controls. Twenty-eight of 63 patients studied experienced NOD during the 24-h pH study; 22 had esophagitis and six had esophageal dysmotility without esophagitis. NOD was noted with similar frequency in the two groups; 22/47 (46.8%) of patients with esophagitis and 6/16 (37.5%) with esophageal dysmotility experienced NOD during the period of study. NOD correlated with pH less than 4.0 in 88.6% of patients with esophagitis but in only 7% of patients with esophageal dysmotility (p less than 0.001). There was no difference in acid reflux patterns in esophagitis patients who experienced NOD (22/47), and in those who did not (25/47). There was no correlation between NOD and baseline esophageal motility abnormalities. In summary, 1) NOD is a common, intermittent symptom that occurred in up to 46.8% of esophagitis patients and 37.5% of symptomatic controls during the 24-h period of this study; 2) NOD correlates with esophageal pH less than 4.0 in patients with esophagitis and not in patients with esophageal dysmotility. These data strongly suggest that acid in the distal esophagus frequently triggers the sensation of dysphagia in esophagitis patients, but not in patients with esophageal motility disorders. Combined ambulatory intraesophageal motility and pH monitoring may further elucidate the mechanism of dysphagia in these patients.     

Exercise testing in pulmonary sarcoidosis

The change in transfer coefficient (Kco) with increasing heart rate during exercise was studied in 25 normal subjects and in 21 patients with pulmonary sarcoidosis. The slope of the Kco response against heart rate was found to be 0·0053 mmol min⁻¹ kPa⁻¹ l⁻¹ per beat in the normal group but in many of the patients was two standard deviations or more below this normal slope, even when their routine function tests were normal. This response of Kco to exercise is a more sensitive index of changed function than more routine function tests in pulmonary sarcoidosis.