Extracochlear eight-channel electrode system

The Cologne-Düren research group has developed a new extracochlear eight-channel electrode system. The first observations on six cases have shown encouraging psychoacoustic results.     

CARDIOVASCULAR EFFECTS OF BETA-RECEPTOR BLOCKING DRUGS DURING HALOTHANE ANAESTHESIA IN MAN

Fifteen patients anaesthetized with halothane were given a beta-adrenergic receptor blocking substance intravenously, either propranolol or l-alprenolol.
The drugs usually induced an insignificant drop in blood pressure, a slight bradycardia, and a small reduction in cardiac output in patients not subjected to concomitant surgery. In one patient, the reaction was more pronounced. The immediate administration of atropine seemed to restore the circulatory state.
Nine patients were subjected to surgery during the administration of the beta-blocking agents. Pronounced hypotension resulted in seven of them. This effect was observed both after propranolol and l-alprenolol. Again, atropine reversed the hypotension.
These observations suggest that the administration of beta-adrenergic receptor blocking agents during anaesthesia should be limited by very strict indications, and be used under carefully controlled conditions.

ZUSAMMENFASSUNG

15 mit Halothan narkotisierte Patienten erhielten i.v. einen Beta-Rezep-torenblocker, und zwar entweder Propanolol oder 1-Alprenolol.
Diese Mittel fiihrten in der Regel zu einem nicht-signifikanten Blutdruck-abfall, zu einer geringgradigen Bradykardie und einer leichten Verminderung des Herzminutenvolumens bei Patienten, die nicht gleichzeitig operiert wurden. Bei einem Patienten war die Reaktion dramatischer. Die sofortige Gabe von Atropin schien den Kreislaufzustand wieder zu normalisieren.
Neun Patienten erhielten Betablocker wahrend einer Operation. Bei sieben von ihnen kam es zu ausgepragten Blutdruckabfall. Diese Wirkung wurde sowohl nach Propranolol als auch nach 1-Alprenolol beobachtet.
Diese Beobachtungen geben Grund zur Empfehlung, Betarezeptoren-blocker wahrend der Narkose nur bei strengster Indikation zu verabreichen und sie nur unter sorgfaltig kontrollierten Bedingungen anzuwenden.     

Postpartum urinary incontinence

BACKGROUND: The aim of the present study was to identify prepregnancy, pregnancy and delivery correlates of urinary incontinence postpartum (PP UI) as reported by women in a cross-sectional population sample. METHODS: A questionnaire-based cross-sectional survey was carried out in 1998 in a random population sample of 3900 20- to 59-year-old women. The present study includes 376 women who had their last delivery during 1993-96. RESULTS: UI immediately after childbirth and 6 months thereafter was reported by 23.4% and 2.7%, respectively. PP UI was strongly associated with UI both before and during the present pregnancy, explaining 37.5% and 51.7% of postpartum UI, respectively. Eight percent experienced their first UI episode ever immediately after the delivery. Among women undergoing a cesarean section 8.8% reported postpartum UI, as contrasted with 24.9% in other women. Postpartum UI was positively associated with perineal suturing but un-associated with labor augmentation, episiotomy, birth weight, and breast-feeding. CONCLUSION: In the present study, which included a comprehensive causal model, postpartum UI could be explained first of all as the decline of pregnancy UI, secondly as a manifestation of a pre-existing tendency to react by UI, and finally as a consequence of the birth process itself.     

Comparison of the hepatic clearances of campesterol,sitosterol, and cholesterol in healthy subjects suggests that efflux transporters controlling intestinal sterol absorption also regulate biliary secretion

BACKGROUND: Recently identified ABCG5/8 transporters are responsible in part for the different absorption rates of campesterol, sitosterol, and cholesterol. These transporters are also expressed in the liver and might regulate biliary sterol secretion. AIMS: This study was therefore conducted to determine the biliary secretion rates and hepatic clearances of campesterol, sitosterol, and cholesterol. SUBJECTS: Six healthy, male volunteers. METHODS: Deuterium labelled sitosterol and campesterol, and unlabelled sitostanol were constantly infused together with a liquid formula using a duodenal perfusion technique. Biliary secretion and hepatic clearance rates were calculated from hourly bile and plasma samples. RESULTS: Plasma concentrations of cholesterol, campesterol, and sitosterol averaged 167.5 (50) mg/dl (SD), 0.50 (0.22) mg/dl, and 0.30 (0.10) mg/dl, respectively. Sitosterol showed a significantly higher biliary secretion rate (1.23 (0.87) mg/h) than campesterol (0.76 (0.54) mg/h, p=0.0321), but both plant sterols had significantly lower biliary secretion rates compared with cholesterol (47.7 (17.5) mg/h; p=0.001 for both). Hepatic clearance of cholesterol (0.31 (0.18) dl/h) was significantly lower compared with campesterol (2.11 (2.51) dl/h) and sitosterol (4.97 (4.70) dl/h; p=0.028 for both), and the clearance of campesterol was significant lower compared with sitosterol (p=0.028). CONCLUSION: The observed inverse relation between hepatic clearance and known intestinal absorption of cholesterol, campesterol, and sitosterol supports the hypothesis that the ABCG5/8 transporters regulating intestinal sterol absorption might also be involved in biliary sterol excretion.     

ANCA-negative subglottische Kehlkopf-Stenose im Kindesalter

A 15-year-old female, having developed recurrent infections of the upper airway, hoarseness, dyspnea, and nasal congestion, was referred to our department. There was no history of trauma or intubation. The subglottic space was circularly narrowed. The test for c-ANCA was negative. Chest X-ray and renal function were normal. A tracheotomy was performed; the histology showed infiltrating plasma cells, but no signs of vasculitis or granulomatous inflammation. One year later the patient developed acute renal failure. Biopsy of the kidney confirmed Wegener's disease. The laryngeal stenosis completely resolved after therapy with cyclophosphamide. Juvenile Wegener's granulomatosis is extremely rare; the larynx and trachea seem to be involved more frequently in children than in adults. The positive testing of c-ANCA can support the diagnosis; however, even when c-ANCA do not test positive, the disease can never be excluded. Surgical interventions within the larynx or trachea might only be considered after ineffective therapy with immunosuppressive drugs.     

Chronic Survival of Calves Implanted with the DeBakey Ventricular Assist Device

The DeBakey ventricular assist device (VAD) is a miniaturized, electromagnetically driven axial flow pump capable of generating in excess of 10 L/min output. The VAD was evaluated in 19 calves during experiments designed to test iterative modifications in the system and to determine the safety of the DeBakey VAD for intermediate to long-term implant. Five of the animals died or were euthanized during the perioperative period (i.e., Days 1-5) due to complications associated with bleeding (n = 3), sudden cardiac arrest (n = 1), or pump occlusion due to a muscle remnant associated with coring (n = 1). The remaining 14 animals survived from 7-145 days. Ten of the 14 animals survived 30 or more days, and 2 animals survived 93 and 145 days before elective euthanasia. Pump function was evaluated in the 14 calves that survived beyond the perioperative period. Pump output at implantation averaged 3 L/min while output at 100 days (n = 2) averaged 4.22 L/min. The electrical current did not change across time during the study, indicating normal operation of the bearings. Pumps consumed less than 10.5 W of power for all support durations. Hemolysis did not occur; the average daily plasma free hemoglobin varied from 2.0 to 8.0 mg/dl. Evaluation of serum biochemical data showed that implantation of the DeBakey VAD in calves with normal hearts did not impair end organ function; BUN, creatinine, and total bilirubin varied minimally within the normal range. The white blood cell count of implanted animals remained within the normal range throughout the study.     

Bilateral Pharmacokinetic Interaction Between Cyclosporine A and Atorvastatin in Renal Transplant Recipients

Atorvastatin is increasingly used as a cholesterol-lowering agent in solid organ transplant recipients receiving cyclosporine A (CsA). However, the potential bilateral pharmacokinetic interaction between atorvastatin and CsA in renal transplant recipients has not previously been examined. Baseline 12-h CsA pharmacokinetic investigation was performed in 21 renal transplant recipients and repeated after 4 weeks of atorvastatin treatment (10 mg/ d). At week 4, 24-h pharmacokinetics of atorvastatin was also performed. All patients received basiliximab induction followed by CsA and prednisolone immunosuppression. Compared with historic controls, CsA-treated patients showed, on average, sixfold higher plasma HMG-CoA reductase inhibitory activity after 4 weeks of atorvastatin treatment (p < 0.05). Atorvastatin had a moderate effect on the pharmacokinetics of CsA and reduced the AUC0-12 (area under curve, 0-12h) by 9.5 +/- 18% (p = 0.013) and Cmax (maximal concentration) by 13.5 +/- 24% (p =0.009), while C12 (trough level) was unchanged (p =0.42). Total and LDL cholesterol decreased by 26.8 +/- 8.4% (p < 0.0001) and 41.5 +/- 11.0% (p < 0.0001), respectively. Bilateral pharmacokinetic interaction between atorvastatin and CsA resulted in sixfold higher plasma HMG-CoA reductase inhibitory activity, but only a moderate decrease in systemic exposure of CsA.     

Adverse reactions in healthy and immunocompromised children under six years of age vaccinated with the Danish BCG vaccine, strain Copenhagen 1331: implications for the vaccination policy in Sweden

A retrospective analysis of the adverse reactions reported between 1979 and 1991, in the 139000 children under six years of age vaccinated in Sweden with the Danish BCG vaccine, strain Copenhagen 1331, showed an incidence of I.9 per 1000 vaccinated children. Regional lymphoglandular swellings and/or abscesses were most commonly reported in 1.4 per 1000. Serious, disseminated, BCG infections developed in four infants vaccinated neonatally. Three of the infants suffered from severe, combined, immunodeficiency syndrome, undiagnosed at the time of vaccination. The incidence of severe, combined, immunodeficiency syndrome was higher in the BCG-vaccinated population (4 per 100000 infants vaccinated within a year of their births), compared with all newborns in Sweden (1 per 100 000). The mean age at the onset of symptoms was 2.4 months for the seven non-BCG-vaccinated infants versus 1.3 months for the four BCG-vaccinated ones, while the immunodeficiency syndrome was diagnosed at an average age of 7.6 months in those who were not vaccinatedversus 5.3 months in those BCG-vaccinated. It is recommended that the selective BCG vaccination of infants at high risk of exposure to tuberculosis should be postponed to six months of age to reduce the risk of inoculating infants suffering from immunodeficiency syndromes.     

Prevalence of pain in the head,back and feet in refugees previously exposed to torture: A ten-year follow-up study

Aim.?To estimate change over 10 years concerning the prevalence of pain in the head, back and feet, among previously tortured refugees settled in Denmark, and to compare associations between methods of torture and prevalent pain at baseline and at 10-year follow-up.

Methods.?139 refugees previously exposed to torture in their home country were interviewed at a Danish rehabilitation clinic on average 8 years after their final release from confinement and re-interviewed 10 years later. Interviews focused on history of exposure to physical and mental torture and on pain in the head, back and feet prevalent at study.

Results.?The mean number of times imprisoned was 2.5 and the mean cumulative duration of imprisonment 19.4 months. The most frequent physical torture method reported was beating (95.0%) and the main mental torture method deprivation (88.5%). Pain reported at follow-up was strongly associated with pain reported at baseline, and the prevalence of pain increased considerably (pain in the head, 47.5% at baseline and 58.3% at follow-up; back, 48.2% and 75.5%; feet, 23.7% and 63.3%). Predictor patterns at baseline and at follow-up had common traits, so that pain in the head and pain in the feet both were associated with the number of torture methods as well as specific methods, both at baseline and at follow-up. Pain in the back at baseline was associated with torture.

Conclusion.?Two decades after the torture took place, increasing proportions of survivors seem to suffer from pain associated with the type and bodily focus of the torture. This presents a considerable challenge to future evidence-based development of effective treatment programs.