Burdened by training not by anaesthesia

Editor—Larsson and colleagues¹ have investigated importantbut often ignored aspects of anaesthetic practice. However,they imply that specialist anaesthetists experience reducedlevels of stress when compared with trainees because they havedeveloped successful coping mechanisms over the years. Thisconclusion cannot be drawn because the specialists' attitudesto work were identified at a particular time and cannot showa progression in learned coping abilities. To demonstrate thedevelopment of these skills, the specialists would have hadto be interviewed     

Treatment of hemospermia caused by dilated seminal vesicles by direct drug injection guided by ultrasonography

Bilateral seminal vesicle puncture and injection of drugs with ultrasound guidance were performed in patients with hemospermia resistant to conservative therapy and with dilated seminal vesicles. Of 7 patients 6 had resolution of hemospermia for 2 to 3 months and then relapse. No side effect was noted.     

Amplification by hyperoxia of coronary vasodilation induced by propofol

We tested the hypothesis that in vitro coronary and myocardial effects of propofol (10-300 microM) should be significantly modified in an isolated and erythrocyte-perfused rabbit heart model in the absence (PaO(2) = 137 +/- 16 mm Hg, n = 12) or in the presence (PaO(2) = 541 +/- 138 mm Hg, n = 12) of hyperoxia. The induction of hyperoxia provoked a significant coronary vasoconstriction (-13% +/- 7%). Propofol induced increased coronary vasodilation in the presence of hyperoxia. Because high oxygen tension has been reported to induce a coronary vasoconstriction mediated by the closure of adenosine triphosphate-sensitive potassium channels, we studied the effects of propofol in 2 additional groups of hearts (n = 6 in each group) pretreated by glibenclamide (0.6 microM) and cromakalim (0.5 microM) in the absence and presence of hyperoxia, respectively. The pretreatment by glibenclamide induced a coronary vasoconstriction (-16% +/- 7%) which did not affect propofol coronary vasodilation. The pretreatment by cromakalim abolished the amplification of propofol coronary vasodilation in the presence of hyperoxia. Propofol induced a significant decrease in myocardial performance for a concentration >100 micro M both in the absence and presence of hyperoxia. We conclude that propofol coronary vasodilation is amplified in the presence of hyperoxia. This phenomenon is not explained by the previous coronary vasoconstriction induced by glibenclamide. However, the pretreatment of hearts by cromakalim abolished the amplification of propofol coronary vasodilation in the presence of hyperoxia. The myocardial effects of propofol were not affected by the presence of hyperoxia. IMPLICATIONS: Propofol induced a coronary vasodilation that was amplified in the presence of hyperoxia. This phenomenon does not seem to be related to previous coronary vasoconstriction. The myocardial effects of propofol were not significantly modified in the presence of hyperoxia.     

Direct plexus repair by grafts supplemented by nerve transfers

This article reviews the Louisiana State University Health Sciences Center experience with direct repair of brachial plexus lacerations, gunshot wounds, and stretch/contusive/avulsive injuries. In the stretch category, limited outcomes with direct repair have led to addition of nerve transfers rather than their exclusive use. It is important to per-form direct plexus repair in conjunction with nerve transfers in the same patient when-ever possible. The intent of such a "pants-over-vest" approach is to maximize axonal input to denervated structures.     

Lavage by laparoscopy fares better than lavage by laparotomy

Background: Although carbon dioxide (CO2) pneumoperitoneum is proposed increasingly for treatment of secondary peritonitis, associated deleterious effects have been reported in experimental models, with the hypothesis that increased intraperitoneal pressure might facilitate bacterial translocation. The purpose of this study was to compare the outcome (and qualitative microbiologic analysis) from peritonitis in rats after lavage by laparoscopy with the outcome after lavage by laparotomy. Methods: After determination of the standard innoculum for this study in 30 animals, 120 male Wistar rats received 1 ml of Escherichi coli 106 colony-forming unit (CFU), Bacteroides fragilis 107 CFU, Enterococcus faecalis 107 CFU in a sterile rat feces-barium sulfate suspension adjuvant, were anesthetized with intramuscular ketamine, and then underwent peritoneal lavage by either laparotomy (n = 60) or laparoscopy (n = 60). The duration of peritonitis defined two groups: group A: duration less than 3 h (n = 20) and group B: duration 3 h or more (n = 40). Both groups underwent successive lavage with 10-ml aliquots (total, 50 ml) of 0.9% saline solution at 37°C. Five 2-ml samples of liquid lavage were drawn for culture and microbiologic analysis. Blood (0.2 ml) and peritoneal liquid lavage samples were incubated 48 h at 37°C and cultured. Results: All the animals survived. Mean duration of peritoneal lavage was 13.2 min (range, 6-25 min) for laparoscopy and 9.7 min (range, 6-15 min) and for laparotomy. The difference was not statistically significant. The mean duration of operation was significantly longer with laparoscopy than with laparotomy: 44.5 min (range, 35-62 min) and 25 min (range, 16-40 min), respectively (p = 0.0001). The collected lavage volumes were not statistically different: 48.5 ml (range, 40-54 ml) and 46.7 ml (range, 37-56 ml), respectively. No statistically significant differences were found between the laparoscopy and laparotomy groups in terms of E. coli bacteremia, irrespective of peritonitis duration. The rates of positive blood culture for B. fragilis and E. faecalis were signficantly lower after laparoscopy than after laparotomy, both in the overall group (p = 0.025 and p = 0.045, respectively) and when duration of peritonitis exceeded 3 h (p = 0.001 and p = 0.044, respectively). Conclusions: In this animal model of secondary peritonitis, lavage by laparoscopy was associated with less bacteremia for B. fragilis and E. faecalis than peritoneal lavage by laparotomy.     

Tracheal constriction by morphine and by fentanyl in man

The effects of morphine and fentanyl on tracheal smooth muscle tone were studied in 38 patients during induction of anesthesia. Endotracheal tube cuff pressure was used to measure tracheal tone. Anesthesia was maintained with nitrous oxide, 70 per cent in oxygen, and pancuronium and ventilation was controlled with a respirator. Morphine, 0.5 mg/kg, produced a biphasic response, initially causing tracheal dilatation and then tracheal constriction. Ten minutes after morphine injection, cuff pressure increased to significantly (21 +/- 8 per cent) above control. Morphine-induced tracheal constriction could be completely blocked by the prior administration of atropine, 0.5 mg. Fentanyl, 0.006 mg/kg, also produced significant tracheal constriction, cuff pressures increasing to 44 +/- 11 per cent above control at 10 min. Fentanyl-induced tracheal constriction could be blocked by pretreatment with droperidol, 0.25 mg/kg. At equianalgesic doses, morphine and fentanyl produced similar tracheal constriction.     

Reversal by nalbuphine of respiratory depression caused by fentanyl

In 60 ASA class I or II patients given intravenous fentanyl for elective operations in doses large enough to produce postoperative respiratory depression, the intravenous administration of 20 mg nalbuphine resulted in prompt reversal of respiratory depression without loss of analgesia.     

Bladder carcinoma treated by preoperative radiotherapy followed by cystectomy

Summary In 1969 a clinical trial was started where patients with bladder carcinoma stage T2 and grade 3 were subjected to preoperative radiotherapy followed by cystectomy. The survival rate in this series was higher than in a previous series of comparable patients who were given full irradiation without cystectomy.     

Popliteal artery occlusion caused by cystic adventitial disease: successful treatment by urokinase followed by nonresectional cystotomy

Preoperative diagnosis of an occluded popliteal artery caused by cystic adventitial disease allowed use of urokinase to successfully dissolve secondary thrombosis. Subsequent non-resectional adventitial cystotomy and evacuation of cyst contents allowed lasting restoration of a patent arterial lumen and return of normal distal pulses. This nongrafting technique may serve as a model for future patients with occluded arteries caused by this condition.     

碱性成纤维细胞生长因子增强人重组骨形态发生蛋白-2诱导成骨的调节机理

目的：对ｂＦＧＦ增强ｒｈＢＭＰ－２诱导成骨的调节机理进行探讨。方法：２１０只ＢＡＬＢ／ｃ小鼠随机分为３组,每组７０只,试验侧均位于右后肢。设立ｒｈＢＭＰ－２／牛松质骨载体、单纯牛松质骨载体为对照组,分别于术后１２ｈ～２１ｄ共１１个时间点取材,观察其诱导成骨过程。结果：ｒｈＢＭＰ－２／ｂＦＧＦ／聚乙烯吡咯啉酮／牛松质骨载体组在诱导间充质细胞增殖、分化,软骨细胞、新生骨形成方面均早于ｒｈＢＭＰ－２／牛松质骨载体组,成骨量优于ｒｈＢＭＰ－２／牛松质骨载体组,而单纯牛松质骨载体组在２１ｄ仅出现了少量增殖的间充质细胞。结论：ｒｈＢＭＰ－２和ｂＦＧＦ在诱导成骨调节中存在着协同作用。     

鼻内镜下经下鼻道钻孔上颌窦囊肿切除术

目的　探讨鼻内镜下简单有效的上颌窦囊肿手术切除方法。　方法　应用Rudolf 4 5mm套管穿刺针 ,经下鼻道钻孔 ,套管内追踪囊肿 ,上颌窦活检钳钳夹切除囊肿 36例。　结果　 30例随访 0 5年～ 3年 ,复查X线片或CT无复发。　结论　鼻内镜下经下鼻道钻孔上颌窦囊肿切除 ,是一种手术创伤小 ,疗效肯定的术式。