Bispectral index monitoring in fast track pediatric cardiac surgery

BACKGROUND: We evaluated the changes in the bispectral index (BIS) as a potential indicator of level of consciousness in infants and children undergoing fast track cardiac surgery. METHODS: Twenty-one children undergoing fast track cardiac surgery were recruited into this study. Anesthesia was maintained with inhaled sevoflurane and intravenous fentanyl 10 microg x kg(-1). Cardiopulmonary bypass (CPB) with mild hypothermia and an immediate tracheal extubation protocol were used. BIS was recorded throughout the operation. RESULTS: In average, BIS was kept almost under 70 with 0.5-3.0% of sevoflurane. During rewarming from mild hypothermia, BIS increased temporarily over 70 in about a half of children. We, therefore, treated them by increasing sevoflurane concentration. Nineteen children were extubated in the operating room, and two patients were extubated in ICU within three hours after surgery. CONCLUSIONS: BIS was kept within the level of adequate sedation during surgery. However, since the increase in BIS during the rewarming phase could reflect light anesthesia, caution should be taken around this phase.     

Extrapleural pneumonectomy of malignant pleural mesothelioma

We analyzed 7 patients with malignant pleural mesothelioma who underwent extrapleural pneumonectomy. Six men and a woman had a mean age of 65 years old. The postoperative mortality rate was 14% (1 death) and morbidity, 43% (3 cases). According to staging of International Mesothelioma Interest Group, 2 patients had stage I disease, 1 did stage II, 3 did stage III and 1 did stage IV. Local recurrences were found in 3 patients and metastasis in 2. In patients with local recurrences, 2 had irradiation with chemotherapy and 1, irradiation. In patients with recurrences of metastasis, 1 had chemotherapy and 1, supportive care. Seven patients with extrapleural pneumonectomy and 10 without surgery had median survivals of 16 months and 10 months, 1-year survival rates of 71% and 40% and 2-year survival rates of 57% and 0% respectively (p=0.071). Extrapleural pneumonectomy with adjuvant therapy could be effective treatment for malignant pleural mesothelioma.     

Correlation of neuron-specific enolase and S100B with histological cerebral damage in fetal sheep after severe asphyxia

Experimental brain damage was induced in 16 fetal sheep by umbilical cord occlusion, and the correlation of neuron-specific enolase (NSE) or S100B with the damage grade was investigated in seven fetuses. Significant correlations of damage degree with NSE (p = 0.016) and S100B (p = 0.018) in serum 2 h after insult were shown by Spearman's test. These findings suggest that they represent potentially useful markers for detecting brain damage at early stage after ischemic insult.     

A combination of serum low albumin and above-average cholesterol level was associated with excess mortality

BACKGROUND: There is no population-based prospective study concerning the relation between serum albumin and mortality in a non-Western population, and few previous studies included the subgroup analysis stratified by serum cholesterol level. METHODS: A 13.7-year cohort study was conducted on 6,957 males and females aged 30-59 years from 300 randomly selected areas throughout Japan, who participated in the National Survey on Circulatory Disorders in 1980. RESULTS: In the group with median and above of total cholesterol, one standard deviation (SD) increment of serum albumin (2.6 g/L for males and 2.4 g/L for females) was inversely associated with all-cause mortality for both males and females (relative risk RR = 0.68 and 0.81: 95% confidence interval CI = 0.53-0.87 and 0.68-0.98), and with cancer mortality for females (RR = 0.74; 95% Cl = 0.57-0.96);and the lowest category of serum albumin (< or = 43 g/L) showed the highest cardiovascular mortality for males (RR = 5.04; 95% CI = 1.04-24.5) among the three albumin categories. These relationships were not evident in the group with total cholesterol level below median. CONCLUSION: A combination of a low albumin level and above average cholesterol level, even both within the clinical normal range,is associated with excess mortality in the Japanese general population.     

Postischemic hyperthermia induced caspase-3 activation in the newborn rat brain after hypoxia-ischemia and exacerbated the brain damage

The effects of postischemic hyperthermia were investigated in the newborn rat brain after hypoxia-ischemia (HI). Seven-day-old rats were subjected to left carotid artery ligation followed by 8% oxygen for 30 min, and divided into a hyperthermia group (rectal temperature at 39 degrees C for 6 h) and a normothermia group. Hyperthermia resulted in an approximately 5-fold increase in activated caspase-3 24 h after HI when compared with the normothermia group, and gross loss of brain tissue was observed only in the hyperthermia group at 7 and 30 days after HI. Our results show that postischemic hyperthermia exacerbates HI injury in immature brains, and that the mechanism is strongly associated with activation of an apoptotic pathway.     

Effects of hyperthermia on hypoxic-ischemic brain damage in the immature rat: its influence on caspase-3-like protease

OBJECTIVE: Recent clinical studies suggested that intrapartum maternal fever is a strong independent risk factor for neonatal encephalopathy. With use of a well-studied rat model of neonatal hypoxic-ischemic encepalopathy, this study investigated the hypothesis that intraischemic hyperthermia accelerates and worsens brain injury in immature animals and examined whether apoptotic cell death machinery is involved in the underlying mechanisms. STUDY DESIGN: Seven-day-old rats underwent a combination of left common carotid artery ligation and exposure to 8% oxygen for 15 minutes (n = 32 rats). During the 15-minute hypoxic insult, body temperature was elevated to 40 degrees C in 16 animals (hyperthermic hypoxic insult group), and was maintained at 37 degrees C in 16 animals (normothermic hypoxic insult group). Then both groups were placed in the same chamber in a water bath at 37 degrees C for 24 hours and finally returned to the mothers. Caspase-3-like activity was assessed 36 hours after the hypoxic-ischemic insult. One week later, microtubule-associated protein-2 immunostaining was used to examine neuronal damage. RESULTS: Intraischemic hyperthermia was shown to activate the caspase-3 activity 36 hours after hypoxia-ischemia while caspase-3 was activated insignificantly in the normothermic hypoxic insult group at that time. The hyperthermic hypoxic insult group also showed a reduced microtubule-associated protein-2-positive area 7 days after hypoxia-ischemia compared with that in the normothermia group. CONCLUSION: Hyperthermia during hypoxia-ischemia makes the immature brain inordinately susceptible to hypoxic-ischemic insult and causes brain injury, even if hypoxic-ischemic insult is so mild that it causes no or little injury by itself. This effect may be mediated by the escalation of the apoptotic cell death pathway in the immature animal.     

Acoustic tensor tympani response and vestibular-evoked myogenic potential

OBJECTIVE: To investigate the acoustic response properties and the vestibular-evoked myogenic potential (VEMP) in various lesions. STUDY DESIGN: Retrospective study of the clinical records of patients. METHODS: Neurotological tests including acoustic response and VEMP were performed and analyzed in 62 patients with facial palsy, otosclerosis, ossicular chain interruption, sensorineural hearing loss, or acoustic tumor. RESULTS: Inverted acoustic responses were observed in 25 of 38 (65.8%) patients with facial palsy, in 5 of 6 (83.3%) patients with acoustic tumor, and in all patients with otosclerosis, ossicular chain interruption, or sensorineural hearing loss. These inverted responses were obtained only when ipsilateral stimulation was used. The thresholds of the inverted responses were statistically significantly higher than those of the normal response. CONCLUSIONS: The vibration of the eardrum is thought to stimulate the ipsilateral trigeminal nerve, leading to contraction of the tensor tympani muscle. The stapedius response had an inhibitory effect on the inverted response. Vibration of the stapes footplate (which requires a normal middle ear conduction system) is necessary to induce the VEMP, whereas the functioning of the facial and cochlear nerves is independent of the VEMP response.     

Acute cerebral infarction: effect of JPEG compression on detection at CT

PURPOSE: To evaluate the effect of Joint Photographic Experts Group (JPEG) compression ratios of 10:1 and 20:1 on detection of acute cerebral infarction at computed tomography (CT). MATERIALS AND METHODS: CT images obtained in 25 patients with acute cerebral infarction and 25 patients with no lesions were compressed by means of a JPEG algorithm at ratios of 10:1 and 20:1. Normal and abnormal sections (on original and compressed images) were reviewed by using a color soft-copy computed monochrome cathode ray tube monitor. Five observers rated the presence or absence of a lesion with a 50-point scale (0, definitely absent; 25, equivocal; and 50, definitely present). Diagnostic accuracy was evaluated with receiver operating characteristic (ROC) curve analysis. Significant difference was defined as a P value less than.05 for the area tested with a two-tailed paired Student t test. RESULTS: At ROC analysis, no statistically significant difference was detected for all cases considered together (Az [area under the ROC curve] = 0.887 +/- 0.038 [mean +/- SD] on noncompressed images, Az = 0.897 +/- 0.038 on 10:1 compressed images, and Az = 0.842 +/- 0.073 on 20:1 compressed images; P >.05). CONCLUSION: JPEG compression at ratios of 10:1 and 20:1 was tolerated in the detection of acute cerebral infarction at CT.