Electrophysiological effects of sevoflurane in comparison with propofol in children with Wolff-Parkinson-White syndrome

OBJECTIVE: To evaluate the electrophysiological effects of sevoflurane in children with Wolff-Parkinson-White (WPW) syndrome undergoing radiofrequency ablation. METHODS: We performed a prospective study of 15 patients with WPW syndrome who were scheduled for an electrophysiological study (EPS) and radiofrequency ablation. Anesthesia was induced with fentanyl (2 microg/kg), propofol (3 mg/kg), and vecuronium (0.1 mg/kg), and initially maintained using propofol (100 microg/kg), with bolus administration of fentanyl and vecuronium as required. Four intracardiac catheters were introduced for the EPSpropofol, which included measurements of sinus-node function, sinoatrial-node conduction, refractory periods (atrial, AV-node, accessory pathway anterograde and retrograde, and ventricular), and the characteristics of induced orthodromic tachycardia. The propofol was then replaced with sevoflurane (1 MAC adjusted for age) and the measurements were repeated (EPSsevoflurane). The EPSpropofol and EPSsevoflurane data were compared using the Wilcoxon signed-rank test. RESULTS: The mean (SD) age was 9.3 (6) years. After administration of sevoflurane, the duration of the antegrade effective refractory period of the accessory pathway increased (EPSpropofol, 283 (22) ms; EPSsevoflurane, 298 (25) ms; P = .004), as did the duration of the minimum pacing cycle with 1:1 atrioventricular conduction (EPSpropofol, 244 (41) ms; EPSsevoflurane, 273 (28) ms; P = .028). No significant changes were observed in the other parameters. Ablation of the accessory pathway was achieved in all patients. CONCLUSIONS: Sevoflurane partially modified the properties of the accessory pathway but did not prevent ablation.     

Reversal of vecuronium with neostigmine in patients with diabetes mellitus

Reversal of vecuronium-induced neuromuscular blockade with neostigmine was compared in two groups of 16 subjects: patients with Type 2 diabetes mellitus and normal controls. When the first twitch of the train-of-four had returned to 25% of the control value, neostigmine 40 microg x kg(-1) and atropine 20 microg x kg(-1) were given to reverse the neuromuscular blockade. The train-of-four ratio was lower at 3 min, 6 min, 9 min, 12 min and 15 min after reversal in the diabetic group than in the control group but the differences did not reach statistical significance. Fifteen minutes after reversal, the number of patients in whom recovery from neuromuscular blockade was judged insufficient to guarantee good respiratory function (train-of-four ratio < 0.74) did not differ between the groups. However, 15 min after reversal, the number of patients with a train-of-four ratio < 0.9 was significantly higher in the Diabetic Group than in the Control Group (15 vs. 10, p = 0.033).     

Treatment of Osteoporosis in Men with Fluoride Alone or in Combination with Bisphosphonates

Alendronate has been approved as a first antiresorptive drug for treatment of osteoporosis in men. Except for fluoride, in some countries so far there has been no approved anabolic substance for the treatment of male osteoporosis. From small studies in men and male patients included in studies on postmenopausal osteoporosis there is sufficient evidence that fluoride has the same osteoblast-stimulating potency in men and women. In our own study on 64 men with idiopathic osteoporosis without prevalent fractures, a low-dose intermittent fluoride regimen (15 mg fluoride ions 3 months on, 1 month off) resulted in an average gain of lumbar spine BMD of 3% per year and a lower rate of incident fractures as compared with patients treated with calcium only. A combination of fluoride with an antiresorptive drug may improve the therapeutic results in terms of pattern of biochemical marker response and gain in BMD. This was shown for postemopausal osteoporosis in several studies using fluoride and hormone replacement therapy (HRT). Encouraged by a Dutch study using etidronate/fluoride in corticoid-induced osteoporosis, we performed a pilot study in 33 men with severe established primary osteoporosis giving cyclically etidronate for 14 days followed by fluoride plus calcium/vitamin D for 76 days. This combined regimen resulted in significantly higher increases of BMD than fluoride or etidronate alone. In an ongoing trial we are studying a continuous, combined treatment of alendronate and fluoride plus calcium/vitamin D in established idiopathic osteoporosis in men. The results of a preliminary evaluation look very promising. A large study with a bisphosphonate plus fluoride, taking fractures as the primary endpoint and bone biopsies to assess safety, would be very valuable.     

Chemiluminescence of neutrophils in patients with glomerulonephritis treated with methylprednisolone

The effect of high dose methylprednisolone (Solu-Medrol, Up John) (1000 mg) on chemiluminescence (CL) of peripheral blood neutrophils in patients with various primary glomerulopathies was determined. Contrary to the well-established influence of corticosteroids onin vitro suppression of leukocytic chemiluminescence, our studies disclose a remarkable enhancement of neutrophil chemiluminescent activity in patients receiving pulse methylprednisolone infusion. Subsequent administrations of the drug did not result in any significant change of the analysed parameters. Increased chemiluminescence returned to the pretreatment values within approximately seven days. A possible explanation for the observed phenomenon is discussed.     

Comparison of clofibrate with halofenate in diabetics with hyperlipidaemia.

In a double-blind, randomized study which lasted 48 weeks the effects of clofibrate and halofenate were compared in maturity-onset diabetics with hyperlipidaemia. With the use of both clofibrate and halofenate serum cholesterol values were lowered only slightly. Both agents significantly reduced triglyceride values, but the decreases were modest and transient. Both drugs significantly lowered serum urate values, although the effect of halofenate was distinctly greater. Halofenate, but not clofibrate, had a considerable hypoglycaemic effect on the patients, most of whom were also receiving oral antidiabetic medicines. The drugs produced a number of clinical and biochemical adverse reactions, and in about 20% of all patients the trial had to be discontinued prematurely. The management of hyperlipidaemia in maturity-onset diabetics is briefly discussed, and it is concluded that neither clofibrate nor halofenate is to be recommended.     

Tomographic studies of rCBF with99mTc-HM-PAO SPECT in comparison with PET in patients with primary brain tumors

^99mTc-hexamethyl-propyleneamine-oxime (HM-PAO) was developed as a radiotracer of regional cerebral blood flow (rCBF) with SPECT. THe purpose of this study was to investigate if HM-PAO is able to trace rCBF in primary brain tumors. In 10 patients with glioblastoma grade IV the intracerebral distribution of HM-PAO was studied in comparison with C¹⁵O₂ steady state inhalation technique and PET for rCBF evaluation. In all instances the cerebral HMPAO distribution was comparable with rCBF pattern as confirmed by a significant correlation of tumor to cortex ratios. The results indicate the clinical usefulness of HMPAO for tracing rCBF in brain tumors.     

Detection of Endoparasites with Zoonotic Potential in Dogs with Gastrointestinal Disease in the UK

We report a substantial prevalence study in symptomatic pet dogs of important zoonotic parasitic enteric infections. A total of 4526 dogs which had a faecal sample submitted to a diagnostic laboratory in the UK between 2003 and 2005 were included in the study. The most common parasite was Giardia spp., which was found in 380/4526 dogs (8.4%, 95% CI 7.6–9.2%). Surprisingly, Cryptosporidium spp. infection was detected in only 29/4526 (0.6%, 95% CI 0.4–0.9%). Toxocara canis was found in 63/4526 dogs (1.4%; 95% CI 1.1–1.8%). Prevalence of Giardia (P < 0.001) was significantly higher in dogs <12 months of age, with nearly one‐fifth of all symptomatic dogs under 6 months being infected with Giardia. Some seasonality was detected with a higher prevalence of Cryptosporidium oocyst shedding found from October to December. These data are of importance for veterinarians in judging the likelihood of enteric parasitic infection in an individual with clinical signs. Moreover, they provide information to direct future work in determining the risk to the human population from parasitic zoonoses of dogs.     

Effect of fluoxetine alone and in combination with sildenafil in patients with premature ejaculation

INTRODUCTION: The aim of this study was to compare the efficacy of fluoxetine alone and combined with sildenafil in patients complaining of premature ejaculation. PATIENTS AND METHODS: Ninety-one married potent men, 21-43 years old, with premature ejaculation but without any obvious organic cause were enrolled. Pretreatment evaluation included history, physical examination, and self-administration of the International Index of Erectile Function questionnaire. The patients were randomly divided into two groups: group A patients (n = 48) received 20 mg fluoxetine daily for 4 weeks and then 20 mg as needed 2-3 h before sexual activity for 4 months, and group B patients (n = 43) received group A regimen plus 50 mg sildenafil as needed 1 h before sexual activity for 4 months. RESULTS: Ejaculatory latency time and intercourse satisfaction significantly improved in group B as compared with group A (p < 0.05). CONCLUSION: Fluoxetine combined with sildenafil seems to provide significantly better ejaculatory latency time and intercourse satisfaction as compared with fluoxetine alone in patients with premature ejaculation.     

Nephroscopy with carbon dioxide in combination with laparoscopy in the treatment of urinary stones

ObjectiveLaparoscopy in combination with nephroscopy is rarely used for the treatment of complex urinary stones or anatomical abnormalities with difficult access stones. During the nephroscopy, in an opened renal pelvis, large amounts of fluid leaks and collects in the peritoneal cavity and can be a drawback. In these cases, the nephroscopy with use of carbon dioxide (CO2) can be an alternative. We present our experience in with this technique.Material and methodWe performed surgeries using the 3-port transperitoneal technique. Five patients with urolithiasis were included. Three patients had concomitant ureteropelvic junction stenosis, one with stones in ectopic kidney, and the third had a large stone impacted in the proximal ureter. Patients were treated by pyelolithotomy or ureterolithotomy combined with flexible nephroscopy using CO2 and dismembered pyeloplasty was performed in appropriate cases. A flexible cystoscope was passed through a port and guided laparascopically through the opening in the renal pelvis. The gas cannula was connected to the irrigation channel of the endoscope to insufflate CO2 and calculi were extracted with a nitinol basket.ResultsMedian age was 45 years (24-58). Mean operative time of nephroscopy was 22.4 minutes (range 15-48). Mean intra-operative blood loss was inestimable. There were no complications or conversion. Residual lithiasis requiring ureteroscopy was present in one patient.ConclusionsFlexible nephroscopy using CO2 in combination with laparoscopy is a feasible and effective technique for the treatment of urinary stones in selected cases to avoid accumulation of fluid in the peritoneal cavity.     

Lithogenecity of bile in patients with cholelithiasis with different morphologic changes in hepatic tissue

Lithogenecity of bile was studied in patients with cholelithiasis and choledocholithiasis. It is demonstrated that synthesis of lithogenic bile depends on morphologic state of hepatic cells; chronic disease of the liver is the risk of the cholelithiasis.     

Results of elbow endoprostheses in patients with rheumatoid arthritis in correlation with previous operations

Fifty-nine patients with rheumatic destruction of the elbow received 20 St Georg, 20 GSB III, 13 Souter-Strathclyde, and 13 Kudo endoprostheses. Among the various prosthetic categories, 43.9% of the joints had had preceding rheumatoid surgery (a previous synovectomy had been performed in 10 joints at a mean of 4.1 +/- 3.7 years and a resection interposition arthroplasty had been performed in 19 cases 4.2 +/- 1.8 years before endoprosthetic replacement). We examined 51 patients with 54 prostheses after a mean follow-up of 5.7 +/- 4.1 years using the Inglis score and analyzing all radiographs. Complications occurred in 20% of the St Georg prostheses, 25% of the GSB III prostheses, and 23% of the Souter-Strathclyde prostheses. Of the St Georg prostheses, 6 (30%) had to be exchanged, as well as 4 (20%) of the GSB III prostheses and 4 (30.7%) of the Souter-Strathclyde prostheses. Of the primarily implanted joints, the St Georg prostheses measured 77.7 +/- 7.7 on the Inglis score, GSB III 89.6 +/- 7.2, Souter-Strathclyde 88.4 +/- 6.5, and Kudo 89.7 +/- 4.4. Radiolucent lines greater than 1 mm were observed in 26% of the St Georg prostheses, 23% of the GSB III prostheses, 27% of the Souter-Strathclyde prostheses, and 9% of the Kudo prostheses. In contrast to the clinical results, the intraoperative and postoperative complications, as well as the rate of failure and radiolucent lines, showed a statistically significant relationship to previous operations of the joints, especially with the resection interposition arthroplasty. We conclude that resection interposition arthroplasty seems to be associated with complications and failures when a subsequent endoprosthesis is used.     

Absence of microdeletions in the Y chromosome in patients with Prader-Willi syndrome with cryptorchidism

Unilateral or bilateral cryptorchidism is found in 80-100% of male patients with Prader-Willi syndrome (PWS). Recently, the relationship between Yq deletions and cryptorchidism has been assessed. However, the relationship between Yq deletions and PWS patients with cryptorchidism remains unclear. Polymerase chain reaction (PCR) amplification of 51 DNA loci encompassing all of the regions for azoospermia factor (AZF) of the Y chromosome, including the deleted in azoospermia (DAZ) and ribonucleic acid-binding motif (RBM) genes, were examined for microdeletions in 10 PWS males with cryptorchidism and 20 healthy control male subjects. No microdeletions of 51 loci were found in any of the PWS males. The present study therefore suggests that microdeletions in the AZF regions of the Y chromosome do not relate to the occurrence of cryptorchidism in PWS patients.     

联合使用阿托伐他汀和贝那普利对IgA肾病蛋白尿的影响

目的 探讨阿托伐他汀联合贝那普利治疗对IgA肾病患者蛋白尿的影响。方法 将62例IgA肾病患者随机分为对照组30例,应用贝那普利治疗;治疗组32例,应用阿托伐他汀联合贝那普利治疗;2组疗程均为6个月,比较2组治疗前、后,血压、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、尿蛋白（U-pro）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、肌酸激酶（CK）、肌酸激酶同工酶（CK-MB）等指标的变化情况。结果 治疗组治疗后6个月,TC、LDL-C、L卜Pro等指标明显下降,与对照组比较有统计学差异（P〈0．05）;而2组治疗前、后比较,TG、HDL-C、ALT、AST、CK、CK-MB均无统计学差异（P〉0．05）。结论 阿托伐他汀联合贝那普利,能有效降低IgA肾病患者的TC、LDL-C、U-pro水平。     

结肠镜联合腹腔镜下结直肠息肉切除

目的：探讨腹腔镜、结肠镜联合治疗结直肠息肉的手术方式、安全性和可行性。方法：分别采用腹腔镜辅助结肠镜下电凝切除、结肠镜辅助腹腔镜下部分肠壁切除、部分肠段切除及腹腔镜下结肠癌根治等方法,对36例结直肠息肉患者进行治疗。结果：36例均顺利完成手术,无中转开腹。5例在腹腔镜辅助下行结肠镜下息肉切除。22例行结肠镜辅助腹腔镜下部分肠壁切除,其中1例在结肠镜操作过程中发生难于控制的出血,另1例造成穿孔且息肉未完全切除,也行结肠镜辅助的腹腔镜下部分肠壁切除。22例中有18例用Endo-GIA完成。6例行腹腔镜下肠段切除,其中4例因息肉基部广,游离肠段后发现血供差;2例息肉位于直肠上段,且息肉稍大。3例行结肠癌根治术。手术时间70~240 min;手术出血量在20~150 mL;肠功能恢复时间20~48 h。所有患者术后均无肠瘘、肠腔狭窄、术后肠道大出血等并发症发生。结论：结肠镜、腹腔镜联合治疗结直肠息肉,提高了手术的安全性和彻底性,是一种值得推广的微创手术方式。     

Treatment of cardiogenic shock with levosimendan in combination with beta-adrenergic antagonists

Levosimendan, a calcium sensitizer, was used in combinationwith ß-adrenergic antagonists in a man aged 56 yrwith cardiogenic shock, complicating acute myocardial infarction,who developed severe tachycardia after dobutamine administration.The patient's trachea was intubated, his lungs were ventilated,and he was started on dopamine 5 µg kg^–1 min^–1and dobutamine 5 µg kg^–1 min^–1, titrated toa mean arterial pressure 65 mm Hg. He progressively became tachycardiac(>120 beats min^–1) with a cardiac index (CI) of 1.4litre min^–1 m^–2 despite adequate preload. Levosimendan6 µg kg^–1 was administered intravenously over 10min followed by a continuous infusion of 0.2 µg kg^–1min^–1 for 24 h. Within 30 min, the patient's CI increasedto 2.2 litre min^–1 m^–2, but the heart rate (HR)also increased from 142 to 155 beats min^–1. Esmolol 1mg kg^–1 i.v. was administered with a consequent transientdecrease in HR to 110 beats min^–1 without adverse haemodynamiceffects; however, HR increased again shortly afterwards. Carvedilol3.125 mg orally twice a day was then administered, and the dosewas increased to 6.25 mg orally twice daily on the followingday. Subsequently, HR decreased over time and both catecholamineswere discontinued 14 h after starting levosimendan infusion.The trachea was extubated within 20 h and the patient was dischargedto the ward on day 4 after admission. In conclusion, levosimendanin combination with a ß-adrenergic antagonist mayhave beneficial effects in patients with cardiogenic shock whoexhibit tachycardia in response to inotropic agents.     

Survey of clinical experience with nimodipine in patients with subarachnoid hemorrhage

The present studies show that nimodipine prevents and/or improves permanent ischemic neurological deficits in patients with subarachnoid hemorrhage. This was particularly marked in four double-blind, placebo-controlled studies in which statistically significant reductions in mortality and morbidity as consequence of cerebral vasospasm were found. The drug has been shown to increase cerebral blood flow, to reduce vasoconstriction, although not to fully prevent angiographic vasospasm, and to improve central conduction time. Nimodipine did not increase the rate of rebleeding. Its administration during anesthesia does not result in management problems.In general, nimodipine was well tolerated. Side effects were recorded mainly in open studies using the intravenous formulation and consisted mainly of decreases in blood pressure and headaches. Transient increases in liver enzymes may be due to the organic solvent.Hence, all results indicate that patients with subarachnoid hemorrhage will benefit from preventive or therapeutic nimodipine treatment.     

Experiences with surgical therapy of scoliosis in patients with myelomeningocele]

This study reports about the experiences in surgical correction of scoliosis, which were performed between 1984 and 1989 in 32 children with myelomeningocele. The average age at time of surgery was 14 years, 1 month; the average degree of scoliosis was 96 degrees preoperatively. 6 different types of surgical techniques were used. In comparison the best results were obtained by a combination of ventral osteodiscectomy with or without instrumentation and dorsal CD-instrumentation; an improvement of 56% was found. Furthermore we sent questionnaires to all patients, who were operated more then one year ago. The majority of them judges the improved sitting stability of the trunk to be the greatest advantage. There is a high rate of postoperative complications. Beside one death, which occurred intraoperatively, especially pseudarthroses of the lumbosacral junction must be mentioned. These pseudarthroses and a to short selected area of fusion are the main reasons for the loss of correction, which was noticed after a mean follow-up period of 24.6 months. The necessity of postoperative bracing was not reduced by using CD-instrumentation.