Clinical application of a new vital staining method for the conduction system during heart operations

A new method for vital staining of the conduction system during heart operations, the iodine gas method, was used in 12 patients. The right bundle branch stained well in all cases, and could be confirmed by the naked eye. The conduction system was not damaged by the staining procedure. The iodine gas used in this method had no adverse effects on thyroid function (thyroxine, triiodothyronine, thyroxine binding globulin, protein bound iodine) or liver function (serum glutamate oxaloacetate transaminase, serum glutamate pyruvate transaminase, lactic dehydrogenase). This method, therefore, was found to be valuable and without complication for preventing conduction disturbances during cardiac operations.     

The effect of preoperative Lugol's iodine on thyroid blood flow in patients with Graves' hyperthyroidism

A study was conducted to investigate the effect of Lugol's iodine on the superior thyroid artery (STA) blood flow with use of a Duplex ultrasound scanner for 12 patients with Graves' disease. All patients were treated with antithyroid drugs until they were euthyroid and then, with randomization, the patients received either Lugol's iodine, 0.3 ml thrice daily, or placebo for 9 days in a double-blind fashion. Antithyroid drugs were continued throughout the study. Reduction in the diameter, time-averaged velocity (TAV), and volume flow (VF) of the STAs was demonstrated in all patients in the treatment group, whereas there were no consistent trends in the placebo group. The changes in TAV and VF were significantly different between the placebo and treatment groups (p less than 0.01 for TAV and p less than 0.005 for VF). These changes were more marked in patients with high initial VF and minimal in patients with low initial VF. On the basis of these results, we recommend that patients with high thyroid blood flow before thyroidectomy should receive Lugol's iodine preoperatively.     

Thyroidectomy: is Lugol's iodine necessary?

In a randomised controlled clinical trial of Lugol's iodine against placebo in 44 patients undergoing thyroidectomy we have failed to show any benefit in terms of reduced bleeding or operative facility after using iodide solution.     

手术皮肤消毒剂灭菌效果临床观察

目的 了解手术室常用皮肤、黏膜消毒剂的消毒、灭菌效果,寻找高效、安全的消毒剂.方法 将160例择期手术患者分为8组各20例,分别采用3%碘酊75%乙醇、1.5%碘酊75%乙醇、1%活力碘、0.5%活力碘、0.1%活力碘、75%乙醇、0.5%氯己定和0.1%氯己定消毒手术部位,观察消毒效果.结果 8种(组)消毒剂的杀菌率分别为100.0%、100.0%、100.0%、89.9%、83.2%、83.9%、89.7%和82.8%;合格率分别为100.0%、100.0%、100.0%、90.0%、90.0%、80.0%、90.0%和75.0%.结论 3%碘酊75%乙醇、1.5%碘酊75%乙醇、1%活力碘消毒效果好,但前2种(组)对皮肤、黏膜刺激性较大,待干时间长,适用于无菌要求高的择期手术;1%活力碘分别对皮肤、黏膜刺激性小,安全性可靠,省时方便,为较理想的消毒剂.     

Artifact associated with the use of strong iodine solution (Lugol's) in cone biopsies

The preoperative application of strong iodine solution (USP), commonly referred to as Lugol's solution, induces a histologic artifact in epithelial cells of cone biopsy material, most pronounced in dysplastic cells. Cellular shrinkage, cytoplasmic eosinophilia and vacuolization, development of visible intercellular space, and nuclear pyknosis with loss of chromatin detail are the major findings. Since the use of strong iodine solution (USP) is a common practice for delineating the ectocervical extent of disease prior to cone biopsy, the pathologist should recognize the artifact since its presence can make histologic interpretation difficult. Because the artifact may lead to interpretation error, alternatives to strong iodine solution (USP) should be considered.     

卢戈液染色与p53蛋白检测诊断早期食管癌的可行性研究

目的　验证内镜下卢戈液染色和活组织p5 3检测 ,诊断食管早期癌和表浅癌的可行性。方法　将 97例食管癌手术标本先用卢戈液染色 ,然后对粘膜不着色区行p5 3蛋白免疫组化染色。结果　共有 6 3处直径大于 2mm的粘膜不着色区 ,其中正常粘膜 2处 ,单纯增生 7处 ,不典型增生 42处 ,原位癌 1处 ,鳞状细胞癌 11处 ;p5 3蛋白的阳性表达主要发生在重度不典型 (42 3% )和鳞状细胞癌 (45 5 % )的细胞核内 ,而在正常粘膜、单纯增生和轻至中度不典型增生组织中几乎无表达 (P <0 0 5 )。结论　内镜下卢戈液染色和活组织p5 3检测诊断食管早期癌和表浅癌的设想具有可行性。     

高频电刀引发皮肤消毒液着火的实验研究

目的 探讨电刀引发着火与皮肤消毒液的关系,为安全使用电刀提供依据.方法 将30只大耳白兔随机分为乙醇组、碘酊组、碘伏组3组,每组10只,分别接受75％乙醇、2％碘酊、0.45％～0.55％碘伏消毒,观察消毒后不同时间使用不同输出功率电刀的着火次数.结果 碘伏消毒在所有时点和各个电刀功率下着火次数均为0;乙醇组相同功率各时点着火次数相差不大;50W、60 W、70 W、80 W功率着火次数相对高于20 W、30 W、40 W;碘酊组0～20 s着火次数相对高于其他时点.乙醇组着火次数相对高于碘酊组.结论 碘伏消毒后使用电刀不着火;乙醇着火概率较碘酊高,且高功率(＞50 W)较低功率(＜40 W)更易着火.     

Lugol's iodine: its effect on thyroid blood flow in patients with thyrotoxicosis

It has been established practice for 60 years to prepare thyrotoxic patients undergoing thyroidectomy with Lugol's iodine. However, evidence in support of its claimed benefits, namely a reduction in the vascularity and friability of the toxic thyroid gland, is scanty. We have therefore determined the effect of Lugol's iodine on thyroid blood flow, as measured by thyroid uptake of thallium-201, in nine patients with Graves' disease and one euthyroid patient. Thallium-201 uptake, as well as serum thyroxine and triiodothyronine, fell significantly after treatment with iodine. Although not correlated with thyroid function tests, thallium-201 uptake was significantly correlated with thyroid weight. These results support the contention that thyroid blood flow is reduced in thyrotoxic patients treated with Lugol's iodine.     

Pharmacokinetics of a new skin wound cleanser

Iodophors are effective germicidal agents that have prolonged antiseptic activity in contaminated wounds. A nontoxic surfactant, Pluronic F-68, has been used to formulate a safe and effective iodophor. The parameters necessary to regulate the activity of the iodophor were studied to develop a potent, yet safe bactericidal solution for use in human subjects.The parameters found to be most important were the pH of the solution and the concentration of sodium iodide. Lowering the pH of iodophors increased their stability and antiseptic activity. The free iodine in iodophor solutions prepared with a low pH is predominantly the highly biocidal diatomic iodine (I₂). The concentration of iodide regulated the equilibrium of the dissolved iodine between its free and complexed form. Increasing the concentration of iodide in the iodophor lowered the amount of free iodine in solution and enhanced the concentration of the complexed iodide. It is the level of free iodine in an iodophor that determines its antiseptic activity. Low levels of free iodine yielded iodophors that had a slow bacterial kill rate but a prolonged duration of action. Manipulation of these variables permitted the generation of iodophors that varied considerably in their kill rates of bacteria and their duration of antibacterial activity. Iodophors tested in this study demonstrated a distinct superiority to noncomplexed iodine solutions (tincture and aqueous iodine solutions) as wound and skin cleansers.     

Thyroid uptake of 131-I following kippuran renal scintillation camera studies in children.

The thyroid uptake of radioactive iodine after scintillation camera studies using -131I-labeled hippuran was studied and the radiation dose calculated in 30 euthyroid children with normal renal function. Fifteen children received Lugol's solution which reduced the thyroid uptake and radiation dose significantly.     

碘酊乙醇棉签擦拭瓶盖的数量及放置时间对消毒效果的影响

目的 探讨2％碘酊、75％乙醇棉签安全消毒瓶盖的数量及消毒后安全放置的时间。方法 将0.9%氯化钠注射液（500ml)180瓶扮为6组，每组30瓶，均用1根碘酊棉签消毒、1根乙醇棉签脱磺，连续消毒6个瓶盖，分别取样行细菌培养。另取同样液体150瓶，分为A、B、C、D、E5组，每组30瓶，1根碘酊、乙醇棉签消毒1个瓶盖，分别于消毒后放置0．5、1、2、4、6min取样行细菌培养。结果 1根碘酊、乙醇棉签连续消毒至第4个瓶盖时污染数明显增加（P＜0．05）。消毒后放置4min时污染数明显增加（P＜0．05）。结论 1根2％碘酊、75％乙醇棉签连续消毒3个瓶盖，消毒后放置2min最为安全。     

Clinical appraisal of his bundle electrocardiogram taken under cardiotomy in congenital heart disease

The specialized conduction system in the heart was electrophysiologically delineated under cardiotomy in 74 patients with congenital heart disease primarily to determine the topographic relationship of the conduction system to intracardiac structures. Histological study was also done to evaluate the electrophysiological data. Differences were found between the ordinary ventricular septal defect (VSD), inlet-type perimembranous defect, and the ordinary tetralogy of Fallot (TOF), outlet-type perimembranous defect. A superficial run of the His bundle along the lower rim summit of defect was often demonstrated electrophysiologically in large VSD of types II or III, whereas the bundle took marked leftward course in TOF. The right bundle branch (RBB) ran beneath or slightly posterior to the Lancisi equivalent structure (LES) in VSD, while it ran underor slightly anterior to LES in TOF. This papillary muscle could be a rough landmark of the RBB. The course of the RBB in OTF, however, had to be histologically confirmed, since its deep location made electrophysiological delineation difficult. All the sites with a high deflection were the areas where the conduction system was histologically demonstrated beneath the endocardium.     

Electrical activity in the heart during hyperkalemic hypothermic cardioplegic arrest: site of origin and relationship to specialized conduction tissue

Previous studies from this laboratory have shown that low-amplitude electrical activity (LEA) may occur during standard hyperkalemic hypothermic cardioplegic arrest and be undetected by routine monitoring techniques. The present study was designed to elucidate the electrophysiological nature of LEA. Ten dogs were monitored continuously during standard cardioplegic arrest using a 32-channel data acquisition system. In 7 animals (Part I), electrophysiological mapping of the lower right atrial septum during arrest was performed. The initial site of activation of LEA was consistently recorded from the region of the lower atrial septum prior to atrial or ventricular electrical activation. The site of origin of LEA was thus localized to the anatomical region of the atrial septum containing the atrioventricular nodal conduction tissue. In Part II, the electrophysiological mechanism of LEA was investigated in the remaining 3 animals utilizing an intrinsic property of specialized conduction tissue. Inclusion of a calcium channel-blocking agent in standard cardioplegic solution completely prevented the development of LEA in all 3 animals, which is in contrast to findings in previous studies using standard cardioplegic solution alone. These data suggest that LEA may be related to calcium-mediated activation of specialized conduction tissue. This mechanism of activation may explain why LEA cannot be detected by the intraoperative monitoring techniques routinely employed.     

Effect of preoperative iodine in patients with Graves'' disease controlled with antithyroid drugs and thyroxine.

Thirty-four patients with Graves' disease, first rendered euthyroid with antithyroid drugs (ATD) then given supplementary thyroxine (T4), were randomly allocated to three treatment groups. In Group I ATD and T4 were stopped 10 days before partial thyroidectomy and the patients were treated with Lugol's iodine alone. In Group II the patients were treated up to the time of operation with ATD and T4 alone. In Group III ATD and T4 were continued until the day of operation, but the patients also received 10 days' treatment with Lugol's iodine. Analysis of the results showed that pre-operative iodine therapy in patients with Graves' disease, already rendered euthyroid with ATD and T4, made no difference to the vascularity of the gland, operative blood loss or thyroid follicular size. Over a third of patients in Group I, treated with Lugol's iodine alone for 10 days pre-operatively, had subnormal levels of thyroid hormones at the time of operation and this was also the Group in which the complications of partial thyroidectomy tended to occur. It is concluded that the addition of iodine preoperatively is unnecessary in the patient who is already euthyroid on ATD and T4.     

Direct cadiac electorphysiologic effects of sufentanil and vecuronium in isolated guinea-pig hearts

Sufentanil and vecuronium are commonly used simultaneously in anaesthesia. Bradycardia and asystole have been described immediately after the administration of these two compounds. Therefore, the purpose of the present study was to evaluate the direct cardiac effects of sufentanil and vecuronium in all parts of the cardiac pacemaker and conduction system.
The electrophysiological effects of sufentanil and vecuronium were studied in isolated spontaneously beating guinea-pig hearts perfused by the method of Langendorff. At a concentration of 0.1 μmol/1 sufentanil a significant reduction of the spontaneous sinus rate, prolongation of atrioventricular, intraventricular and His' bundle conduction could be observed. The highest concentration of 10 μmol/1 of sufentanil led to an overall slowing of conduction velocity and to an profound slowing of spontaneous sinus rate. AV nodal as well as atrial and ventricular refractoriness were markedly prolonged at this high concentration of sufentanil. In contrast, during perfusion with vecuronium at a concentration of 0.1 μmol/1 up to 10 μmol/1 no significant effects on cardiac conduction and pacemaker activity could be observed.
In conclusion, the electrophysiological effects of sufentanil are comparable to that of unspecific calcium antagonists. Therefore, especially in patients with a preexisting damage of the cardiac conduction system, the indirect effect of the combination of sufentanil and vecuronium which is predominantly responsible for bradycardia and asystole may be worsened by the direct effects of sufentanil.     

Elimination of residual cavities in multiple echinococcosis of liver

The results of operative treatment of 65 patients with multiple echinococcosis of the liver are analysed. For the purpose of treatment of the cyst's residual cavity in 19 cases the authors used furacillin solution warmed up to 70 degrees C. As a result of the study it was established, that at a distance of 2 cm around the fibrous capsule rather high temperature is mounted, which is fatal for oncosphera. This method advantageously differs from others (4% formalin solution, iodine tincture). In 29 cases the residual cavity was treated with 4% formalin solution, in 11 cases 4% formalin solution was combined with iodine tincture, in the rest 6 cases--4% formalin solution was used and 1% chlorhexidinum solution followed by 70% alcohol. For elimination of residual cavities, which appeared after echinococcectomy, combinations of various methods were used, among which the proposed by the authors method of "hood", which is formed from the omentum with vascular pedicle. Complications (purulent fistulas formation) occurred in 5 patients. The authors come to a conclusion that for elimination of residual cavities after echinococcectomy in multiple echinococcosis of the liver the combination of various methods is obligatory.     

Electrophysiological effects of intravenous dantrolene on canine heart

The electrophysiological effects of an intravenous dantrolene infusion (10 mg kg-1) were evaluated in healthy, anaesthetized dogs by intracardiac electrophysiological study. Dantrolene administration resulted in a significant prolongation of the refractory periods of the right atrium and ventricle, while the functional refractory period of the AV node was not altered. A slight increase of AV nodal conduction, measured as atrial-His bundle interval, without any change in infranodal conduction, measured as His bundle-ventricular interval, was observed during sinus rhythm. Dantrolene had no significant effects on surface ECG parameters. We conclude that intravenously administered dantrolene, at the maximal recommended doses, has primary effects on electrophysiological parameters. These findings support the hypothesis that the beneficial effects of dantrolene on cardiac arrhythmias associated with malignant hyperthermia may be related to its intrinsic activity on the electrophysiological properties of the heart, but confirmation requires further investigations on induced arrhythmias in experimental models.     

Peripheral nerve damage during limb lengthening. Neurophysiology in five cases of bilateral tibial lengthening

Limb lengthening is used to correct leg length discrepancy and to increase stature. The reported frequency of peripheral nerve complications varies from 5% to 30%, but is probably underestimated. Damage may be direct or be caused by overstretching of the nerves. We have used electrophysiological tests to evaluate five patients during bilateral tibial lengthening by the Ilizarov method. Results after 24 to 107 days of lengthening showed electromyographic evidence of partial muscle denervation in all 10 limbs, with reduced motor conduction velocities in two tibial nerves and three common peroneal nerves. The sensory conduction velocity in the sural nerve was always unchanged. A clear relationship was shown between the amount of tibial lengthening and the degree of electrophysiological abnormality. Our results suggest that subclinical nerve damage is a very frequent complication of tibial lengthening.     

肝组织挤压对大鼠肝内碘化油血流播散的影响

目的 制作一种动物模型以探讨肝组织在受挤压时肝内碘化油随静脉血流播散的规律.方法 SD大鼠分成预先阻断组、非阻断组和对照组.先将40%碘化油溶液0.5～1 mL缓慢注入肝右前叶实质内,制作出碘化油团.阻断组在近肝右前叶根部预置血流阻断带,非阻断组和对照组不埋置血流阻断带.肝组织碘油球挤压采用均匀间断按压肝组织内碘油团20次,压力控制在10～15mm Hg之间.非阻断组无血流阻断带只作按压20次,对照组作开腹和关腹操作不作肝组织按压.碘油在肝内播散范围的评定:在X线下观察实验鼠肝脏及肝外器官播散情况,根据碘油在肝内静脉播散的情况分为:A级:未播散,碘油在原位呈团状;B级:碘油只在本肝叶弥散;C级:碘油弥散进入其他肝叶;D级:碘油弥散进入肝外器官.结果 碘油球能较好地留在肝实质中,未受到挤压时碘油不播散,碘油团注射成功率为80%(36/45).挤压肝组织引起碘化油肝实质播散入周围血管,和对照组相比,播散范围和挤压呈正相关(P＜0.001).肝血流阻断带可控制碘化油播散,和未阻断组比较差异有统计学意义(P＜0.001).结论 挤压能促使碘油肝内播散,减少翻动或挤压可能减少门静脉癌栓播散.     

Pentobarbital Plasma Concentrations and Cardiac Electrophysiology During Prolonged Pentobarbital Infusion Anaesthesia in the Dog

There is need for a prolonged stable level of anaesthesia, and we therefore investigated the cardiac electrophysiological effects of continuous pentobarbital infusion after initial pentobarbital injection to induce anaesthesia in dogs. Plasma concentrations of pentobarbital were measured by gas-liquid chromatography. Heart rate, atrial, atrioventricular (AV) nodal and His-Purkinje conduction times were measured by His bundle electrography, and atrial, AV nodal and ventricular refractoriness by programmed electrical stimulation. Over a 5-h observation period, continuous infusion of pentobarbital 3.5 mg · kg^-1 h^-1 after an initial pentobarbital injection of 25 mg · kg^-1 intravenously gave stable mean plasma concentrations of 140-135 μmol · l^-1. The cardiac electrophysiological variables studied did not change significantly during this period. We conclude that a stable experimental model for cardiac electrophysiological studies can be obtained for several hours by-continuous pentobarbital infusion.