FIVE MICRO-CURIE UREA BREATH TEST FOR THE DIAGNOSIS OF HELICOBACTER PYLORI INFECTION: EVALUATION IN A SOUTH-EAST ASIAN POPULATION

Background : Helicobacter pylori is an important pathogen responsible for significant morbidity and mortality. Its prevalence varies widely in different geographical locations and is especially high in parts of Asia. Methods : A double-blind study was carried out to evaluate the use of the 5 μCi (185 KBq) [14C]-urea breath test ([¹⁴C]-UBT) in a South-East Asian population by validating its diagnostic accuracy against histology and the CLO test. Results : The sensitivity and specificity of the [¹⁴C]-UBT was 100% when compared against the CLO test. When histology was used as the ‘gold standard’, the sensitivity and specificity were 100% and 97.2%, respectively. There was no overlap or indeterminate values between positive and negative results on the [¹⁴C]-UBT. Conclusions : Among South-East Asian populations where the prevalence of H. pylori infection is high, the high sensitivity of the 5 μCi [¹⁴C]-UBT makes it a very important test in the detection of H. pylori.     

小儿胃食管返流的诊断和治疗

总结33例小儿胃食管返流的诊治经验。并对胃食管返流的概念,与胃食管返流有关的解剖生理因素、诊断方法、手术治疗中的术式选择及要点,提出了讨论、评价及介绍。推荐了诊断上应行多项综合性检查,特别是动态性的钡餐造影观察来确定。手术29例。效果好。     

PROCEDURES FOR OBJECTIVE EVALUATION OF NERVE BLOCKS

Unilateral ulnar-nerve blocks were made in 10 volunteers and changes in the pain sensation, the temperature, the response to pain stimuli of the sympathogalvanic reflex, and in the muscle power were recorded. All methods gave parallel and similar curves of the onset of the block, its completion and its duration.
The best objective methods for the evaluation of a nerve block seemed to be the recording of relative changes, i.e. changes between the blocked and the unblocked side, in the sympathogalvanic reflex and the recording of relative changes in the muscle power.

ZUSAMMENFASSUNG UND SCHLUSSFOLGERUNGEN

Bei 10 Freiwilligen wurden einseitige Blockaden des Nervus ulnaris aus-geführt und Veränderungen des Schmerzgefühls, der Temperatur, der Antwort auf Schmerzreize des sympathogalvanischen Reflexes und der Muskelkraft registriert. Alle Methoden ergaben parallele und ähnliche Kurven für den Beginn, die Vollständigkeit und die Dauer des Blocks.
Die besten objektiven Auswertungsmethoden für einen Nervblock schienen die Registrierung der relativen Veränderungen zu sein, das heisst, der Unter-schiede zwischen der blockierten und unblockierten Seite bezüglich des sympathogalvanischen Reflexes, sowie die Registrierung der relativen Änderungen der Muskelkraft.     

TOWARDS BLOOD-GAS AUTOANALYSIS: AN EVALUATION OF THE RADIOMETER ABL

The performance of the Radiometer ABL 1 blood-gas analyser hasbeen evaluated using tonometered blood samples of known Po2and Pco2. The pH electrode was compared with two other pH electrodesystems and the haemoglobin estimations were compared with measurementsmade by the standard cyanmethaemoglobin method. The accuracyof the machine compared well with standard blood-gas equipment,but the haemoglobin values had a small error because of a zerooffset in the machine. The analyser is simple to operate andhas low running costs.     

成人环状胰腺(附5例报告)

环状胰腺属先天性畸形,是引起新生儿十二指肠梗阻的常见原因之—。但成人环状胰腺所致的十二指肠梗阻实属罕见,我们自1960年至1991年共收治5例,术前均误诊,术中始明确诊断。本文就其成人环胰的发病特点,临床误诊原因,诊断和治疗原则进行讨论。     

THE CLINICAL EVALUATION OF NARCOTIC AND SEDATIVE DRUGS III: AN EVALUATION OF M.183

In previous papers the authors have described a combined techniquefor the assessment of analgesic and sedative drugs, and appliedthe method to a re-evaluation of pethidine and Pethilorfan.In this paper M.183, a new thebaine derivative with 6,000 timesthe molar potency of morphine, has been studied. It was foundthat in equipotent dosage this drug was as good an analgesicand sedative as morphine, with a shorter onset and durationof action. The degree of respiratory depression produced, however,was significantly greater and the incidence of unpleasant sideeffects was high. The advantages of the combined method of studyhave been demonstrated and will be applied to other new drugsas they become available.     

THE EVALUATION AND IMPROVEMENT OF AN ANTI-POLLUTION SYSTEM

A recently installed anti-pollution system, initially designedto function in a passive mode, was evaluated, but found to beinconstant in its performance. A simple method of making thesystem active is described and evaluated.     

继发性胰腺感染25例诊治体会

本文小结继发性胰腺感染２５例（感染性胰腺坏死３例，胰腺脓肿１８例，胰腺假性囊肿并感染４例）诊治体会。认为按“个体化”原则治疗急性胰腺炎；早期诊断，适时引流感染灶；选用胰液中高分布的抗菌素；注意并存的高血糖，胰瘘的处理是治疗的要点。     

AN EVALUATION OF THE CYPRANE® TRILENE INHALER

Seven Cyprane trilene inhalers were studied in an experimental set-up, and the trilene concentrations delivered were measured by refractometry. A factory-new inhaler was used as a standard, and the other six inhalers, which had been in clinical use for varying periods of time, were compared with it. Two of the six inhalers delivered concentrations which were about half of that delivered by the standard. As no technical fault could be demonstrated in the inhalers, it must be assumed that the trilene values delivered, also by factory-new Cyprane inhalers, show considerable variation. It is dierefore necessary to carry out individual adjustment of the inhalers in order to obtain the desired analgesic effect and to avoid overdosage.

ZUSAMMENFASSUNG

Sieben Cypran-Trilen-Inhalatoren wurden in einer experimentellen Versuchs-anordnung uberpriift und die abgegebenen Trilen-Konzentrationen rcfrakto-metrisch gemessen. Ein fabriksneuer Inhalator wurde als Standardmodell beniitzt und die anderen sechs Inhalatoren, die verschieden lang in klinischer Verwendung gestanden waren, wurden mit ihm verglichen. Zwei der sechs Inhalatoren lieferten Konzentrationen von ungefahr der Halfte des Standard-modells. Da in den Inhalatoren kein technischer Fehler nachgewiesen werden konnte, muss angenommen werden, dass die abgegebenen Trilenwerte betracht-liche Abweichungen zeigen, sogar bei fabriksneuen Cypran-Inhalatoren. Es ist daher erforderlich, die Eichung der Inhalatoren individuell durchzufiihren, damit die gewiinschte analgetische Wirkung erreicht und Uberdosierung vermieden werden kann.     

EVALUATION OF AN INTRAOPERATIVE TEST FOR THE COMPLETENESS OF VAGOTOMY

An intraoperative test for the completeness of vagotomy has been evaluated in 103 consecutive operations, including proximal gastric, selective and truncal vagotomies, and truncal vagotomy with antrectomy. At the completion of the vagotomy a pH probe was used to test gastric mucosal response to an intravenous infusion of pentagastrin, aiming to detect undivided vagal fibres by localizing residual areas of acid secretion. Testing was performed in 86 out of 103 vagotomies, and in only 34% was the vagotomy judged complete at the first attempt. Residual areas of acid secretion (usually small) were detected in the remainder, and in nearly all of these it was possible to abolish these areas by dividing further vagal fibres. It is suggested that intraoperative pH testing improves the likelihood of a complete vagotomy, the test is also useful to plot precisely the antral-body junction when antrectomy is combined with vagotomy.     

AN EVALUATION OF THE ACCURACY OF PHARMACOKINETIC DATA FOR THE COMPUTER ASSISTED INFUSION OF ALFENTANIL

The accuracy of using average alfentanil pharmacokinetic datain a computer assisted infusion pump (TIAC) to predict alfentanilplasma concentrations was tested in 35 patients {divided intothree groups) receiving alfentanil and nitrous oxide in oxygenanaesthesia for lower and upper abdominal surgery. By frequentlymeasuring the arterial plasma concentration, it was possibleto determine the average prediction error for individual patientsand for groups of patients. For the groups, there were no significantsystematic over- or underpredictions of the alfentanil plasmaconcentrations (bias). However, there existed a moderate degreeof variability (imprecision) within the groups, caused by deviationsof measured and predicted plasma concentrations in the individualpatients within each group. As a result, prediction errors of22.2-32.5% can be expected with the average pharmacokineticdata used in this study to drive TIAC. It was concluded that,as a result of the moderate degree of imprecision, it is unwiseto rely totally on the absolute values of alfentanil plasmaconcentrations predicted by a computer-regulated infusion pumpsuch as TIAC. However, such devices can be used to attain rapidlya relatively stable plasma concentration that can be adjusted(titrated) to the requirements of an individual patient duringanaesthesia. Overhovenerstr. 12, 6131 B2 Sittard, The Netherlands ^*Department of Anesthesia and Medicine (Clinical Pharmacology),Stanford University Medical Center, Stanford, California 94305,U.S.A. Department of Anesthesiology and Pharmacology, Emory UniversitySchool of Medicine, Atlanta, Georgia 30322, U.S.A.     

EVALUATION OF THE EFFICACY OF AN ACTIVE SCAVENGER FOR CONTROLLING AIR CONTAMINATION IN AN OPERATING THEATRE

Contamination of the air with halothane in a poorly ventilatedENT theatre was found to be very great (median concentration449 µg litre^–1, 177 samples), but was reduced significantly(P<0.005)by the use of an active scavenger of patients' expiredgases (median concentration 159 µg litre^–1, 168samples). For about 18% of the time when the theatre was inuse, the halothane concentration in the air was greater than1000 µg litre^–1, whether or not the patients' expiredgases were being scavenged. Although not measured quantitatively,this appeared to correspond approximately to the period of timein theatre when patients were not connected to the anaestheticcircuit.     

GASTRO-OESOPHAGEAL REFLUX AND RESPIRATORY DISEASE: THE PLACE OF THE SURGEON*

The association between gastro-oesophageal reflux (GER) and respiratory disease is well studied and established.A causal relationship, except in the case of clear cut aspiration, continues to elude proof but is supported by an increasing body of clinical experience. Barium oesophagram is the logical first test to demonstrate reflux, to rule out distal obstruction, and to provide good imaging of the oesophagus. Extended (24 h) oesophageal pH monitoring has proven to be the most reliable test in our hands for the identification of abnormal reflux. The false negative rate with this test was 12%, and false positives were seen only 6% of the time. Radionuclide scintigraphy offers the theoretical possibility for absolute correlation between reflux and aspiration, but in practice the results have been disappointing. Where other treatment measures have failed and where objective tests and clinical evidence point to the probability that respiratory disease is reflux-induced, anti reflux surgery is justified and most often strikingly successful. A Nissen fundoplication with a loose wrap and a short cuff is still the standard treatment for antireflux surgery. Long term follow-up suggests the benefits of antireflux surgery outweigh the occasional complications and side effects where operation is performed to control otherwise intractable reflux-associated symptoms.