PLASMA ENDOTOXIN CONCENTRATIONS IN PATIENTS WITH URINARY TRACT INFECTIONS

Background:
Although endotoxin elicits a variety of pathophysiological activities in hosts with gram-negative bacterial infections, the clinical significance of plasma endotoxin levels have not been clearly defined in the patients with urinary tract infections. The purpose of the study was to measure plasma endotoxin concentrations in relation to the types of urinary tract infections and to examine their correlation with inflammatory parameters.
Methods:
Using chromogenic Limulus-amebocyte lysate assay, plasma endotoxin concentrations were measured in a total of 63 patients with various types of nonspecific urinary tract infections. Results: The mean plasma endotoxin concentrations in patients with sterile pyuria, chronic complicated cystitis, acute uncomplicated pyelonephritis or acute exacerbation of chronic complicated pyelonephritis, chronic complicated pyelonephritis, and acute bacterial prostatitis or epididymitis were significantly higher than those in healthy individuals and in patients with acute uncomplicated cystitis. The correlation coefficients between plasma endotoxin concentrations and body temperatures, white blood cell counts in peripheral blood, erythrocyte sedimentation rates, and C-reactive proteins were 0.678 ( P 0.01), 0.503 ( P 0.01), 0.416 ( P 0.01), and 0.330 ( P 0.01), respectively. Conclusions: Patients with urinary tract infections may respond to endotoxin locally and generally depending on the sites of infection involved. However, endotoxin levels do not always correlate to clinical findings or inflammatory parameters.     

ALTERATIONS OF RESPIRATORY FUNCTION IN PATIENTS WITH SEVERE HEAD INJURIES

Studies were made of the ventilation and arterial acid-basebalance of twenty-three patients who had suffered severe headinjuries. The most frequent findings were an increased minutevolume, an increased production of carbon dioxide, an arterialhypoxaemia, hypocapnia and a raised arterial pH. There was noinstance of respiratory acidosis, and only three patients showednormal ventilation and acid-base values. The increased minutevolume was associated not only with an increased carbon dioxideproduction, but also with a reduced arterial carbon dioxidetension and, therefore, with an increased alveolar ventilation,which may be due to hypoxaemia or to central factors which werenot investigated. The hypoxaemia was associated with increasedalveolar-arterial differences in oxygen tension, and with largevalues for the "physiological deadspace"; these indicated irregularventilation-perfusion relationships. Aspiration and atelectasisat the time of the head injury may initiate the hypoxaemia,the increase in ventilation, and the arterial respiratory alkalosiswhich have been recorded.     

MULTIPLE LAPAROTOMIES FOR SEVERE INTRA-ABDOMINAL INFECTION

Background : Mortality rates for patients with severe peritoneal infection are high. The present study was undertaken in order to examine mortality rates in patients with severe peritoneal infection who were managed by planned re-laparotomy. Methods : Retrospective analysis of patients presenting at the King Faisal Specialist Hospital and Research Centre between 1992 and 1994 with severe peritoneal infection was undertaken. Results : A total of 52 patients underwent either single (n= 30) or multiple (n= 22) peritoneal lavage, and Acute Physiology and Chronic Health Evaluation (APACHE II) scores and predicted mortality rates were calculated for these patients. The predicted mortality rate for patients undergoing a single washout was 42.4%, actual mortality: 23%. The predicted mortality for patients undergoing multiple washouts was 55.6%, actual mortality: 36.3%. No patient with a predicted mortality of < 30% who underwent multiple washouts died. Of nine patients with a predicted mortality between 31 and 60%, one died (11.1%). For a predicted mortality of 61–80%, five of six patients died (83.3%), and for patients with a predicted mortality of > 80%, two of three died (66.7%). Conclusions : The utilization of planned re-look laparotomy and peritoneal lavage in patients with severe peritonitis may result in a significant decrease in mortality as predicted by APACHE II scoring.     

改善胃肠动力在重症急性胰腺炎治疗中的作用

目的 探讨改善胃肠动力在重症急性胰腺炎治疗中的作用。方法 将重症急性胰腺炎患者随机分为两组,治疗组从胃管给予生甘遂改善胃肠动力,对照组行单纯胃肠减压,比较两种治疗方法虱腹水消失时间,胰腺、胰周感染的机会。结果 治疗组病人腹水消退时间明显缩短,胰腺、胰周感染的机会少于对照组（Ｐ〈０．０５）。结论 改善胃肠动力可减少肠道菌群易位导致的感染,提高疗效。     

EQUALITY OF THE IN VIVO AND IN VITRO OXYGEN-BINDING CAPACITY OF HAEMOGLOBIN IN PATIENTS WITH SEVERE RESPIRATORY DISEASE

The in vivo and in vitro oxygen-binding capacity of haemoglobinwas determined on 10 occasions in nine patients who requiredmechanical ventilation. The in vitro sample was tonometeredwith 97% oxygen for 10 min and then with air, while the in vivosample was obtained after 20 min of lung ventilation with pureoxygen. Subsequent laboratory procedures were identical forboth samples. The mean oxygen-binding capacity of haemoglobinin vitro and in vivo samples were almost equal (1.365±0.010and 1.366±0.007 ml per g Hb). When the measured inactivefractions of haemoglobin (carboxy- and methaemoglobin) weretaken into account, these values increased to 1.392±0.005and 1.392±0.007 ml per g Hb respectively.     

EFFECTS OF ALFENTANIL AND FENTANYL ON INDUCTION OF ANAESTHESIA IN PATIENTS WITH SEVERE PREGNANCY-INDUCED HYPERTENSION

Forty patients with severe pregnancy-induced hypertension presentingfor Caesarean section under general anaesthesia were allocatedrandomly to receive either fentanyl 2.5 µg kg^–1or alfentanil 10 µg kg^–1 as part of the anaestheticinduction sequence. In all patients, the cardiovascular responseto tracheal intubation was measured. Both drugs attenuated theresponse equally but did not abolish it in all patients. Alfentanil10 µg kg^–1 is a suitable alternative to fentanyl2.5 µg kg^–1 for patients with pregnancy-inducedhypertension.     

MUSCLE BIOPSY FOR DIAGNOSIS OF MALIGNANT HYPERTHERMIA SUSCEPTIBILITY IN TWO PATIENTS WITH SEVERE EXERCISE-INDUCED MYOLYSIS

Muscle biopsy and in vitro contracture tests for diagnosis ofsusceptibility to malignant hyperthermia (MH) were performedin two patients who had developed fever and severe myolysisduring exercise. MH susceptibility was confirmed in one patientbut in the other, exercise-induced heat stroke proved to bethe correct diagnosis. Clinical presentation and epidemiologyof exercise-induced MH and its relation to the heat stroke syndromeare discussed.     

PROLONGED SUXAMETHONIUM-INDUCED NEUROMUSCULAR BLOCKADE ASSOCIATED WITH ORGANOPHOSPHATE POISONING

We report a patient, exposed to Malathion during agriculturalwork, who suffered a prolonged apnoea after the administrationof suxamethonium. He had a normal phenotype (E₁^u E₁^u), but anextremely low plasma cholinesterase activity. The diagnosiswas made by assaying cholinesterase activity and analysing theenzymic components by electrophoresis on polyacrylamide gelslabs. The results indicated that the apnoea was a result ofthe low activity of plasma cholinesterase induced by Malathion.     

DIFFUSE INTRA-ABDOMINAL FIBROMATOSIS IN ASSOCIATION WITH BILATERAL OVARIAN FIBROMATOSIS AND OEDEMA

A case of bilateral ovarian enlargement secondary to massive ovarian oedema with underlying intra-abdominal and pelvic fibromatosis is presented. Bilateral salpingo-oophorectomy and hysterectomy led to rapid progression of the intra-abdominal and pelvic fibromatosis, which was previously unsuspected. The case highlights the importance of recognizing massive oedema of the ovary as a distinct entity as it is a benign condition affecting young females and can be confused with ovarian neoplasm. In this case, the major morbidity was from the underlying diffuse intra-abdominal fibromatosis. Conservative management with prolonged bowel rest, total parenteral nutrition, and intravenous steroid and Tamoxifen successfully led to complete resolution of bowel obstruction from diffuse fibromatosis.     

重症心不停搏双瓣置换术

本文介绍了心不停搏双瓣置换术的体外循环及手术技术。特别强调：①体外循环流量必须维持平均动脉压大于6.7kpa，预充液内加入少量去甲肾上腺素（1μm/kg）有助于提高灌注压。②33℃浅低温有利于心脑等重要脏器保护和手术操作。③主动脉瓣转换时，冠状静脉窦送行灌注流量在200-300ml/min之间。④左心术毕，注意充气排气。     

PRETREATMENT WITH NON-DEPOLARIZING NEUROMUSCULAR BLOCKING AGENTS AND SUXAMETHONIUM-INDUCED INCREASES IN RESTING JAW TENSION IN CHILDREN

We have studied the effect of prior administration of non-depolarizingneuromuscular blocking drugs on suxamethonium-induced increasesin masseter muscle tension in 21 children aged 3–10 yr,anaesthetized with nitrous oxide and halothane using supramaximalstimulation of the ulnar nerve and the nerve to masseter. Restingtension and isometric force of contraction were measured inthe adductor pollicis and masseter muscles. A sub-paralysingdose of tubocurarine 0.05 mg kg^–1, a paralysing dose ofatracurium 0.5 mg kg^–1 or saline was given, followed 3min later by suxamethonium 1 mg kg^–1. Onset times of suxamethoniumand atracurium block were shorter in the masseter than in theadductor pollicis muscle. When preceded by a sub-paralysingdose of tubocurarine, suxamethonium produced an increase inmasseter tension (47 (SEM 15) g) similar to that produced bysuxamethonium alone (59 (13) g). Prior administration of a paralysingdose of atracurium almost abolished this increase in tension(2.5 (2.5) g) (P < 0.05 vs saline). The tension increasein adductor pollicis was 0, 3.2 (2.2) and 5.9 (1.1) g in theatracurium, tubocurarine and saline groups, respectively. Tubocurarineand atracurium prevented muscle fasciculations in all patients.It was concluded that increased muscle tone is a normal responseto suxamethonium and is greater in the masseter than adductorpollicis. Sub-paralysing doses of non-depolarizing neuro-muscularblockers have little effect, in contrast with paralysing doses.This suggests that the effect is mediated via postsynaptic receptors.     

SUXAMETHONIUM-INDUCED CHANGES IN SERUM CREATINE PHOSPHOKINASE

In sixty patients undergoing minor surgical procedures withminimal involvement of muscle, there was a significant increasein serum creatine phosphokinase induced by suxamethonium. Theincrease was significantly reduced by prior administration oftubocurarine 3 mg and by pretreatment with suxamethonium 10mg.     

应用皮瓣修复手部重度热压伤112例

目的　探讨应用皮瓣修复手部重度热压伤的疗效。方法　 1989年 1月～ 1998年 12月 ,对 112例各种原因所致手部重度热压伤采用各种皮瓣修复 ,皮瓣最小 6 cm× 8cm ,最大 12 cm× 18cm ,术后尽早给予综合性康复治疗。结果　术后各种皮瓣全部成活。随访到 6 6例 ,时间 6～ 12个月 ,皮瓣颜色、质地均佳 ,外形和功能恢复满意。结论　根据不同的创面选择相应的皮瓣修复手部热压伤 ,并结合早期综合性康复治疗 ,可最大限度地恢复手的外形和功能     

急性重症胆管炎患者胆汁、外周血中内皮素浓度的动态测定及意义

目的 探讨急性重症胆管炎（ａｃｕｔｅ ｃｈｏｌａｎｇｉｔｉｓ ｏｆ ｓｅｖｅｒｅｔｙｐｅ,ＡＣＳＴ）患者胆汁和外周血中内皮素（ｅｎｄｏｔｈｅ－ｌｉｎ,ＥＴ）的变化与肝胆系统和全身病理损害的关系。方法 对２５例ＡＣＳＴ患者术中、术后７天、１４天胆法和外周血中ＥＴ、谷丙转氨酶（ＡＬＴ）和总胆红素进行了动态测定。结果 术后７天、１４天上述指标明显降低（Ｐ〈０．０５和Ｐ〈０,０１）,外周血和胆汁中ＥＴ浓度     

COMPARISON OF THORACIC ELECTRICAL BIOIMPEDANCE AND THERMODILUTION FOR THE MEASUREMENT OF CARDIAC INDEX IN PATIENTS WITH SEVERE SEPSIS

Cardiac index was measured using thoracic bioimpedance (Clbi)and thermodilution (Cltd) in 19 patients with proven sepsis,undergoing artificial ventilation of the lungs. There was apoor correlation between the techniques (r = 0.36, 242 datasets, regression line Clbi = 0.16 Cltd + 2.56 litre min^–1m^–2). The overall bias (Cltd-Clbi) was 1.69 litre min^–1m^–2 with limits of agreement (precision) of +4.17 to –0.79litremin^–1 m^–2. In individual patients the bias was from0.46 to 4.56 litre min¹ m^–2 with the limits of agreementfrom ±0.29 to ±2.55 litre min^–1 m^–2around the bias values. The two techniques cannot be used interchangeablyin this group of patients. (Br. J. Anaesth. 1993; 70: 58–62) ^*Present address, for correspondence: Nuffield Department ofAnaesthetics, Radcliffe Infirmary, Woodstock Road, Oxford OX26HE