Effects of PEEP on extra vascular lung water and central blood volume in the dog

Twenty-four mongrel dogs were anaesthetized and ventilated mechanically in the supine position. Extravascular lung water (EVLW) and central blood volume (CBV) were measured with a double indicator (dye/cold) dilution technique. Both indicators were detected intravascularly in the aortic root with a fibreoptic thermistor catheter. Seven dogs ventilated with a positive end-expiratory pressure (PEEP) of 1.0 kPa (10 cmH2O) for a short period of time (less than 20 min) displayed no significant change in EVLW as measured with the indicator dilution technique (= EVLWi), while reductions were seen in both CBV (15%, P less than 0.01) and cardiac output (CO-thermodilution technique) (10%, P less than 0.05). Another seven dogs ventilated with a PEEP of 1.0 kPa for 8 h showed a gradual increase in EVLWi. After 8 h, a mean increase of 34% (P less than 0.01) was recorded, and the increase was also verified by post-mortem gravimetric determination of EVLW (= EVLWg), displaying an increase of 61% (P less than 0.01). In five dogs ventilated with zero end-expiratory pressure (ZEEP) for 8 h, no changes in EVLWi, CO, and CBV were observed, and EVLWg was mean 4.39 g/kg body weight (BW). Five additional dogs were sacrificed after 15 min of anaesthesia without catheterization and EVLWg was found to be 4.24 g/kg BW. It is concluded that EVLWi does not change measurably during ZEEP or short periods of PEEP. However, long periods (8 h) of PEEP result in elevated EVLWi values. Gravimetry supports these conclusions.(ABSTRACT TRUNCATED AT 250 WORDS)     

Isolated angiitis of the central nervous system: involvement of penetrating vessels at the base of the brain

Summary Isolated angiitis of the central nervous system (IAC) was diagnosed in a 40-year-old Caucasian male by histological examination of a leptomeningeal biopsy specimen, and the exclusion of systemic inflammatory or infective disease. Therapy with prednisone 30 mg/day and cyclophosphamide 100 mg/day resulted in clinical and radiological improvement, which have been maintained for an 8-month follow-up period. Magnetic resonance imaging (MRI) showed lesions implicating involvement of specific penetrating vessels at the base of the brain, an unusual complication of IAC, and allowed an accurate MRI-clinical correlation.     

Severe Electrolyte Disturbances in Lethal Subclavian Catheter Dialysis

Abstract: Syncope, irreversible shock, and respiratory and circulatory arrest developed in a 54-year-old diabetic man chronically dialyzed with a subclavian catheter (SC) minutes after the end of a dialysis session. Resuscitation attempts remained unsuccessful. During the resuscitation attempt, a blood analysis showed severe hyponatremia, acidosis, and hypochloremia. Respiratory and cardiac arrest developed during dialysis in a 64-year-old woman on chronic SC dialysis. Resuscitation was unsuccessful; chloremia levels were 79 mEq/L, and calcemia levels were 20 mg%. Both patients were dialyzed with a standard dialysate solution. The reasons for the electrolyte disturbances could not be explained technically. The autopsy showed myocardial perforation by the SC and accumulation in the pericardium of the fluids administered during the resuscitation attempt (e.g., glucose 5%, bicarbonate, Ca gluconate, human albumines), thus explaining the erroneous electrolyte results. The reason for the perforation was a too-rigid central femoral vein catheter, erroneously labeled a subclavian catheter by the supplying firm. Because of a syndrome of progressive vena subcla-via and vena cava sclerosis with insufficient arterial phase flow and venous-phase bleeding around the puncture site during single-needle dialysis, the original SC had to be replaced by a longer one with the tip located in the atrium (this SC was actually a femoral catheter). Analysis of the fluid aspirated through the SC can determine the diagnosis in sudden death of SC dialysis patients.     

654─2在小儿急性脑水肿及中枢性呼吸衰竭中的应用探讨

感染性脑水肿病儿在感染得到有效控制，应用654—2（山莨菪碱）后未再用脱水剂，笔者认为．654—2具有解除脑血管痉挛及微循环障碍的作用。急性脑水肿在脱水剂应用后，用654—2有利于脑水肿液的吸收和回流。目前，治疗小儿捂热综合征（IMS）之细胞内水肿仍没有有效的方法，研究结果表明654—2能改善脑细胞供氧．其还能通过解除呼吸中枢血管痉挛而治疗中枢性呼吸衰竭。     

21世纪加强医学生人文素质培养的思考

医学科学从来就是科学知识与人文精神密切结合的一门学科。现代科学技术越来越多地应用于医学研究和医学实践,大大地促进了医学科学的发展,然而也呼唤着更多的医学人文精神的关怀。如何把医学科学知识与医学人文精神有机地结合起来,是我国医学院校教育的重要课题。     

科室调整时"军卫一号"的数据转换

科室调整时。病人要随之分配到新的科室，病人的各种医疗数据要转换为新科室的数据。利用结构化查询语言，根据病人的调整情况，实施数据调整。这种数据转换方法，不但适用于新、老药品结构的“军卫一号”，而且其基本原理也适用于科室分开而护理单元不分开的情况。     

Role of cytokines and chemokines in prion infections of the central nervous system

Prion infections of the central nervous system (CNS) are characterised by a reactive gliosis and the subsequent degeneration of neuronal tissue. The activation of glial cells, which precedes neuronal death, is likely to be initially caused by the deposition of misfolded, proteinase K-resistant, isoforms (termed PrP(res)) of the prion protein (PrP) in the brain. Cytokines and chemokines released by PrP(res)-activated glia cells may contribute directly or indirectly to the disease development by enhancement and generalisation of the gliosis and via cytotoxicity for neurons. However, the actual role of prion-induced glia activation and subsequent cytokine/chemokine secretion in disease development is still far from clear. In the present work, we review our present knowledge concerning the functional biology of cytokines and chemokines in prion infections of the CNS.     

37例神经精神狼疮的临床分析

目的:对神经精神狼疮(NPLE)的临床表现、辅助检查及预后进行总结。方法:对37例伴中枢神经系统损害的SLE患者进行回顾性分析。结果:①有局灶性症状及癫痫反复发作者预后差;②MRI检查的阳性率高,但定位缺乏特异性;③神经精神狼疮(NPLE)患者的脑脊液(CSF)蛋白升高,尤其是IgG的升高是其主要特点。结论:NPLE患者症状不同预后有明显差异,MRI检查和脑脊液蛋白的测定为NPLE的诊断、治疗提供依据。     

TK/GCV、CD/5-Fc双自杀基因系统治疗结肠癌的实验研究

目的观察胸苷激酶/丙氧鸟苷(TK/GCV)、胞嘧啶脱氨酶/5-氟胞嘧啶(CD/5-Fc)双自杀基因系统对结肠癌的治疗效果,并结合研究结果进行作用机理的分析。方法采用培养细胞移植法,将人结肠癌细胞系SW480接种于裸鼠背部皮下,建立裸鼠人结肠癌移植瘤模型。将32只裸鼠随机分为4组:空白对照组,TK/GCV治疗组,CD/5-Fc治疗组,TK/GCV CD/5-Fc联合治疗组,每组8只。TK/GCV CD/5-Fc采用逆转录病毒介导,采用瘤体内直接注射法,同时腹腔注射GCV、5-Fc治疗,观察各组小鼠的生存状况及肿瘤体积、瘤重、肿瘤生长抑制率、常规病理、生存期等指标,比较观察各治疗组的治疗效果及对荷瘤裸鼠存活的影响。结果各治疗组裸鼠人结肠癌移植瘤的生长均受到显著抑制,治疗后各组体积数增加(P<0.05),治疗组裸鼠存活期显著延长,TK/GCV CD/5-Fc联合治疗组效果最好,疗效q值=1.675>1.15,即TK/GCV、CD/5-Fc有交互协同作用。结论TK/GCV与CD/5-Fc对人结肠癌SW480细胞有明显抑制作用,TK/GCV、CD/5-Fc双自杀基因系统效果更强。     

皮质发育不良导致的难治性部分性癫癎临床特征分析

目的探讨病理表现为皮质发育不良的难治性部分性癫癎的临床特征。方法回顾分析46例手术切除癫癎灶后，病理证实为皮质发育不良的难治性癫癎病例的影像学和脑电图表现以及手术疗效等资料，分析此类癫癎的临床特征。结果在46例中，癫癎灶的病理类型为轻度皮质发育不良10例、Ⅰ型局灶性皮质发育不良25例、Ⅱ型局灶性皮质发育不良5例、伴有胚胎发育障碍性神经上皮瘤和神经节胶质瘤的分别为4例和2例。通过磁共振成像（MRI）扫描可以发现局灶性皮质异常的12例（26．1％），海马硬化10例（21．7％），未见明显异常的24例（52．2％）。在发作间期，60．9％的病例为区域性的癎性放电，45．7％的病例表现出节律性癎样电活动。手术切除癫癎灶后，69．6％的病例发作消失。结论皮质发育不良约占MRI阴性表现的难治性癫癎病例的50％，以Ⅰ型局灶性皮质发育不良最为常见，发作间期脑电图常常显示节律性癎样电活动。