Modification of perseverative behaviour in an adult with anoxic brain damage

A single-case study is reported of an adult female exhibiting perseverative behaviour on the ward, following anoxic brain damage subsequent to an attempted suicide by hanging. Her behaviour consisted of excessive requests to use the telephone, and was accompanied by a lack of insight, impaired memory and blunted affect, with no evidence of anxiety when prevented from using the telephone. Treatment to reduce the persistent requests was given in two stages, and consisted of feedback, and feedback plus extinction. Results indicated a marked reduction in the perseverative behaviour, though it appeared that this did not generalize to the home environment following the woman's discharge from hospital.     

婴幼儿双供肾成人肾移植临床效果研究

目的探讨婴幼儿双供肾成人肾移植的临床疗效。方法回顾性分析2012年12月至2020年11月中山大学附属第一医院25例婴幼儿双供肾成人肾移植的供、受者临床资料。计算术后1、3、5年受者和移植肾存活率,观察受者术后肾功能恢复情况及术后不良事件发生情况。结果25例婴幼儿双供肾成人肾移植受者的第1、3、5年存活率均为95.8%,移植肾及死亡删失移植肾的第1、3、5年存活率均为87.2%。1例受者因急性下壁心肌梗死死亡,3例受者分别因移植肾血管血栓形成或输尿管狭窄、尿漏导致移植肾功能丧失。除受者移植肾功能丧失及死亡外,术后1、2、3年估算肾小球滤过率分别为:(99.35±21.78)ml/(min·1.73 m2)、(103.11±29.20)ml/(min·1.73 m2)、(114.99±28.55)ml/(min·1.73 m2)。结论婴幼儿器官捐献供肾的双肾成人肾移植的总体移植效果较满意,做好供、受者匹配,规范供肾获取及手术流程,加强围术期管理可提高成人受者长期疗效,可作为扩大供者来源的重要途径。     

An adult system versus a Bain system: comparative ability to deliver minute ventilation to an infant lung model with pressure-limited ventilation

We compared the efficacy of an adult circle system versus a Bain system to deliver minute ventilation (V(E)) to an infant test lung model using pressure-limited ventilation. To simulate a wide variety of potential infant clinical states, V(E) was measured with two compliances: at peak inspiratory pressures (PIP) of 20, 30, 40, and 50 cm H2O and at respiratory rates (RR) of 20, 30, 40, and 50 breaths/min. Each measurement was made three times, and their average was used for analysis. Data were analyzed using the multiple regression technique. In both normal and low-compliance lung models, V(E) was nearly identical between adult circle and Bain systems (P = 0.67 for normal compliance model, P = 0.89 for low-compliance model). V(E) positively correlated with RR (P < 0.001), PIP (P < 0.001), and lung compliance (P < 0.001). Very high PIP or RR were required to deliver V(E) to the low-compliance lung model. The adult circle system is equivalent to the Bain system in its ability to ventilate an infant test lung over a wide range of RR, PIP, and two compliances during pressure-limited ventilation. V(E) is dependent of PIP, RR, and lung compliance. With low-compliance lungs, both systems require a high PIP. We conclude that both anesthetic systems deliver ventilation over a wide range of respiratory variables during pressure-limited ventilation in infants. IMPLICATIONS: We obtained results from this infant test lung study that indicate that either an adult circle breathing system or the Bain system can reliably deliver ventilation over a wide range of respiratory variables during pressure-limited ventilation in infants.     

The Penlon Bromsgrove high frequency jet ventilator for adult and paediatric use

The Penlon Bromsgrove is a new high frequency jet ventilator, suitable for use in both adults and children. The jet stream is humidified by means of an integral in-line Bernoulli nebuliser. The self-recharging nebuliser can also convey drugs directly to the airways in the form of an aerosol. Alarms and fail-safe systems are incorporated. A pressure gauge continuously displays the jet drive pressure. There are two digital LED displays; one shows jet frequency in breaths per minute; the other, the jet drive pressure, minimum, maximum and mean patient airway pressures. Two fail-safe systems ensure that these pressures do not become excessive. Both audible and visual alarms are provided. The prototype has proved to be quiet and completely reliable over more than 4000 hours use, with no bronchoscopic or histological evidence of ineffective humidification.     

Overdose of vecuronium during general anesthesia to an infant

We experienced an accidental case in which 5 mg of vecuronium was administered to a 5 kg infant boy, aged 2 months, incrementally for 55 minutes during general anesthesia. He received general anesthesia at the hospital where there is no anesthesiologist. After surgery the surgeon felt an unusual situation during emergence period from general anesthesia and then noticed overdose of vecuronium. They got in touch with our department immediately and requested us to follow him up. When we reached at the bedside, we could not observe voluntary movement by him. By using neuromuscular monitoring, we could determine that a paralysis was still maintained. After a while, he started to move and breathe himself. Extubation was performed safely 4 and half hours after the final administration of vecuronium. Finally, he could recover with no adverse effect. To predict the optimal dose of a non-depolarizing muscle relaxant to a pediatric patient, routine monitoring of neuromuscular block is effective and essential.     

Modification of the Penlon Nuffield 200 series ventilator and IPPV with a laryngeal mask airway

There is a risk of regurgitation if a laryngeal mask airway is used with intermittent positive pressure ventilation. The lower the pressure gradient between airway and stomach, the less will be the likelihood of stomach insufflation with gas and consequent regurgitation. A flow generator ventilator, such as the Penlon Nuffield 200 which achieves a peak pressure at the end of inspiration at any given tidal volume, is likely to produce a higher peak airway pressure than a pressure generator. Replacing the expiratory valve by a venturi gives a preferable flow pattern with an inspiratory pressure plateau. At equal tidal volumes, the venturi modification provided a 10% lower inflation pressure (standard deviation 6%, P < 0.01) and a 1.8% smaller leak (P < 0.05) past the laryngeal mask airway. The same comparison but using identical inflation pressures, gave 8% larger tidal volumes (standard deviation 5.1%, P < 0.01) and a 2% smaller leak (P < 0.01) past the laryngeal mask airway.     

Can infant malnutrition cause adult vertebral stenosis?

Does infant malnutrition produce smaller adult spinal canals? Lumbar and thoracic vertebrae (n X 1073), from a prehistoric American Indian population (15-55 yrs of age), were measured for anteroposterior (AP) and transverse (TR) vertebral canal sizes, nerve root tunnel (intervertebral foramen) widths (NRT), vertebral heights (VH), vertebral osteophytosis (VO), and tibial lengths. They underwent a dietary change from hunting-gathering, protein rich (PR), to maize agriculture, protein deficient (PD), between 950 and 1300 A.D. Multivariate analyses controlled for age, sex, culture, NRT, VH, VO, and wedging. Canal size was significantly smaller in the PD. AP diameters were generally and highly correlated with NRT, and thus both spinal stenosis and sciatica may have a developmental basis. Canal size was independent of statural components. Consequently, canal size is a most powerful tool in assessing the presence infant malnutrition. Moreover, perhaps the association between canal size and low-back pain (LBP) found in living populations has been underestimated, and this component of LBP is preventable.