The presence of Hb J-Bangkok caused spuriously low glycated hemoglobin value on the Tosoh G7

Systolic toe blood pressure was measured in 10 normal subjects and in 17 patients with peripheral arterial disease during a wanning and a cooling period, in which the skin temperature on the first toe was changed from 33d`C to 24d` C. In normal subjects systolic toe blood pressure increased from an average of 110 mm Hg to 120 mm Hg during cooling (P<0.01), while the systolic arm blood pressure was unchanged during the study (125 mm Hg). Among the patients systolic toe blood pressure increased from an average of 56 mm Hg to an average of 70 mm Hg (P<0.01), while arm blood pressure increased from an average of 167/79 mm Hg during warming to 175/83 mm Hg during the cooling period. It is emphazised that despite the small, but significant, increase in digital blood pressure during the cooling period, changes in distal temperature will only have a small influence on the digital blood pressure, when one is evaluating patients with suspected or manifest peripheral arterial disease. In general, measurement during vasodilatation is to be preferred, since curves are easily obtainable.     

Arterial catecholamines in hypoxic exercise in man.

1. We measured the minute ventilation and arterial blood catecholamine concentrations in four normal men standing and at two levels of moderate treadmill exercise breathing 14% oxygen or air. 2. Minute ventilation was significantly higher during hypoxic exercise than during normoxic exercise at an oxygen uptake of 1500 ml/min. 3. Arterial plasma noradrenaline during hypoxic exercise at an oxygen uptake of 1500 ml/min was significantly greater than at rest. 4. Arterial plasma noradrenaline during normoxic exercise at an oxygen uptake of 1500 ml/min was not elevated above the resting concentration. 5. The results are compatible with the suggestion that increased concentrations of arterial plasma noradrenaline contribute to the hypoxic potentiation of the respiratory response to moderate exercise.     

Digital blood pressure in normal subjects and patients with peripheral arterial disease.

Systolic toe blood pressure was measured in 10 normal subjects and 17 patients with peripheral arterial disease during a warming and a cooling period, in which the skin temperature on the first toe was changed from 33 degrees C to 24 degrees C. In normal subjects systolic toe blood pressure increased from an average of 110 mm Hg to 120 mm Hg during cooling (P less than 0.01), while the systolic arm blood pressure was unchanged during the study (125 mm Hg). Among the patients systolic toe blood pressure increased from an average of 56 mm Hg to an average of 70 mm Hg (P less than 0.01), while arm blood pressure increased from an average of 167/79 mm Hg during warming to 175/83 mm Hg during the cooling period. It is emphazised that despite the small, but significant, increase in digital blood pressure during the cooling period, changes in distal temperature will only have a small influence on the digital blood pressure, when one is evaluating patients with suspected or manifest peripheral arterial disease. In general, measurement during vasodilatation is to be preferred, since curves are easily obtainable.     

The A-R Interval as Exercise Indicator: A New Option for Rate Adaptation in Single and Dual Chamber Pacing

RUITER, J.H., ET AL.: The A-R Interval as Exercise Indicator: A New Option for Rate Adaptation in Single and Dual Chamber Pacing. We investigated the possibility to use the interval from an atrial stimulus to the Ventricular R wave [A-R interval) as an indicator of physical stress, in 16 patients with pacemakers implanted for severe atrial bradycardia but with intact AV conduction. The A-R interval was studied during incremental atrial pacing at rest and during exercise with a constant workload. In addition, the atrial pacing rate was kept constant just above spontaneous sinus rate and the dynamics of the A-R interval were studied during exercise with a low constant workload and during a maximal exercise test with increasing workload. Incremental atrial pacing prolonged the A-R interval and this response was blunted during exercise [p < 0.003). Atrial pacing at a constant rate and during a constant workload resulted in an almost direct shortening of the A-R interval. When the workload was increased but the atrial rate kept constant, a pronounced shortening of the A-R interval was noted [p < 0.0001). It is concluded that changes of the A-R interval during different kinds of exercise were prompt and predictable in patients with sinus node dysfunction but intact AV conduction. In these patients the shortening of the A-R interval during exercise may be a suitable indicator for rate adaptive atrial pacing.     

Ultrasonic tissue characterization with integrated backscatter during inotropic stimulation

Ultrasonic tissue characterization with integrated backscatter is an objective method to quantitatively define the physical state of the myocardium. To determine if backscatter imaging during inotropic stimulation could be used objectively to determine the myocardial viability and ischemia in patients with ischemic heart disease, the backscatter changes were examined in 23 patients with myocardial infarction during dobutamine stress two-dimensional (2-D) echocardiography. Coronary angiography was performed within 1 to 2 days after the stress test. The results of this study demonstrated that changes in backscatter variability correlated significantly with the wall motion changes in stress echocardiography during dobutamine infusion (p < 0.0001). In addition, it was shown that the backscatter changes were significantly different in various types of myocardial tissue. In 23 healthy control segments, the ultrasonic backscatter variability was preserved and unchanged during inotropic stimulation (p = NS). In 15 viable infarct zones, restoration or an increase in backscatter variability during low-dose dobutamine infusion was noted, this being lost when ischemia developing during high-dose dobutamine infusion (p < 0.01). In 9 nonviable infarct zones, the phase-weighted variation was usually ≤ 0 and did not change significantly during inotropic stimulation, regardless of the patency of the infarct-related arteries. In 15 remote ischemic myocardial zones, the backscatter variability was preserved at the baseline level, did not change during low-dose dobutamine infusion, but decreased significantly during high-dose dobutamine stress (p < 0.01). In conclusion, dobutamine stress tissue characterization could offer an objective approach for the detection of myocardial viability and ischemia, and might be a useful adjunct to the conventional stress echocardiography.     

Cardiovascular autonomic function tests in cluster headache

While facial autonomic signs are prominent during cluster headache (CH) attacks, cardiovascular autonomic changes have been described in few CH patients. Cardiovascular autonomic function tests (AFT) can be used to assess general autonomic function in CH patients in different stages of the disease. We aimed to assess whether general autonomic function is changed in CH patients during a cluster period. AFT was performed both during a cluster period, but outside an actual attack, and outside a cluster period in 18 patients. Heart rate variability was studied at rest, during deep breathing, after standing up and during a Valsalva manoeuvre. Blood pressure (BP) changes were recorded at rest, during standing up and during sustained handgrip. Measurements during and outside the cluster period were compared using the paired t-test. AFT measurements revealed no significant differences between the two measurements, except for diastolic BP in rest, which was higher during the cluster period [80.3 (SD 12.2) vs. 74.8 (SD 9.0), P = 0.04]. Autonomic dysfunction during a cluster period, but outside an attack, does not include systemic cardiovascular control.     

Carbohydrate metabolism investigations in children of diabetic mothers (author's transl)]

A follow-up examination was conducted in 65 children aged up to 7 years whose mothers manifested diabetes mellitus during pregnancy and who had to be transferred to the Children's Hospital at Glanzing, Vienna for post partum complications. No case of manifest diabetes mellitus was recorded. Carbohydrate metabolism was investigated by determining immunological insulin (IRI) and the insulinogenic index during an oral glucose tolerance (OGTT). Three children showed pathological findings; two of them showed incomplete or delayed insulin secretion during the OGTT. One child displayed an inadequate rise in the insulinogenic index with high individual insulin values during the OGTT, which gave border line results. We support the point of view that children of diabetic mothers should be controlled with regard to carbohydrate metabolism regularly to recognize premanifest diabetic states at an early stage.     

Effects of long-term fasting on insulin responses to fatty acids in man

OBJECTIVE: To investigate whether the prolonged physiological elevation of nonesterified fatty acids (NEFA) seen in man during fasting associates with an altered acute insulin response to NEFA. SUBJECTS AND METHODS: Fourteen non-diabetic subjects, age 18-25 years, BMI 23.2 +/- 0.8 kg/m2 underwent hyperglycemic clamps (blood glucose 11 mM) for 120 min, during which either saline or Intralipid was administered in the last 60 min. Subjects were tested after an overnight as well as after a 58 h fast. RESULTS: After the overnight fast, insulin levels increased during Intralipid infusion, at min 120 reaching an increment of 33.0 +/- 8.5 microU/ml vs. 9.5 +/- 4.4 microU/ml during saline; p<0.05 for difference. Conversely, after the 58 h fast. Intralipid failed to promote a successive increase of insulin levels (increment during Intralipid at min 120: 0.5 +/- 5.8 microU/ml vs. -4.3 +/- 2.5 microU/ml during saline, NS). Insulin sensitivity as assessed by the amount of infused glucose and its ratio to insulin was enhanced by Intralipid after an overnight fast, but was decreased after a 58 h fast. CONCLUSION: Long-term elevated NEFA during fasting associates with diminished beta cell responsiveness to an acute elevation of fatty acids in conjunction with negative effects on insulin sensitivity.     

Cardiovascular Reflex Responses During Migraine Attack

SYNOPSIS
The cardiovascular reflex responses of 10 migraine patients were recorded during both migraine attacks andheadache-free intervals. Ten healthy subjects of similar age and sex served as a control group.When the results of the measurements for migraine patients performing an isometric work test duringmigraine attacks and during headache-free intervals were compared, during migraine attacks a statisticallysignificant smaller increase in diastolic B.P. was encountered than interictally (p<0.05).When the results for migraine patients during migraine attack, and controls, were compared, statisticallysignificant differences were encountered in the pulse rate variation in Valsalva manoeuvre, in an orthostatictest, and in the systolic and diastolic blood pressure reactions in an isometric work test. The mean Valsalvaratio and R-R-interval ratio during the orthostatic test were lower in migraine patients during migraine attackthan in controls, and the mean blood pressure rise in the isometric work test was also lower in the migrainepatients group during attacks.There were no statistically significant differences between the results of the migraine patients duringheadache-free intervals and those of the control subjects.     

Fibrinolytic activity of the gastric mucosa in Ménétrièr''s disease

Biopsies of the gastric mucosa were collected from two patients with Ménétrièr's disease before, during, and after treatment with cimetidine and studied for fibrinolytic activity. The fibrinolytic activity in the homogenates or in the potassium thiocyanate soluble fractions increased markedly during the treatment. Immunological characterization of the activity indicated that its major component was an endothelium-derived type of plasminogen activator, and that the increase in activity was caused solely by an increase in the concentration of this component. This suggests an increase in the vascularity of the mucosal layers during treatment thus reflecting a repair process.     

Does veno-arterial bypass without an artificial lung improve the outcome in dogs undergoing cardiac arrest?

We hypothesized that maintaining circulation and blood pressure by veno-arterial bypass (V-A bypass) without oxygenation would improve cardiopulmonary resuscitation (CPR) and survival rates. A total of 32 dogs, divided into four groups, were subjected to normothermic ventricular fibrillation (VF) for 15 min. The method of CPR was the same in the four groups, except for the method and timing of V-A bypass. We attempted to resuscitate the dogs without V-A bypass (control), with V-A bypass not including an artificial lung during VF, with V-A bypass not including an artificial lung during CPR, and with V-A bypass including an artificial lung during CPR. CPR was continued until restoration of spontaneous circulation (ROSC) or for 30 min. Although blood pressure was well maintained, severe hypoxemia was observed during V-A bypass without an artificial lung. The resultant hypoxemia was very detrimental. ROSC was achieved more easily in all dogs in the bypass group with an artificial lung. No significant difference in survival rates was demonstrated among the four groups (P = 0.11). We concluded that V-A bypass without oxygenation does not improve the chances for CPR and outcome after cardiac arrest in dogs. Our results suggest that oxygenation is indispensable in CPR.     

Maternal presence, childrearing practices, and children's response to an injection

The purpose of the study was to investigate the effects of maternal presence or absence and childrearing practices on young children's response to an injection. One hundred thirty-eight mothers and their children, who were attending health screening clinic, were assigned to one of four groups in which mothers were either present or absent during an interview and an immunization. Mothers were asked to fill out a questionnaire about their childrearing practices. Child behavior was observed during both the interview and the immunization. Results indicated that while maternal presence was associated with the children behaving more distressed during the interview, maternal presence had no effect on child behavior during the immunization. Children whose mothers reported high levels of both control and warmth in their relationship (authoritative parents) were found to be significantly less distressed during the immunization than children of either the low-control, high-warmth (permissive), high-control, low-warmth (authoritarian) or low-control, low-warmth (nonresponsive) parent groups.     

Increase in anterior tibialis muscle protein synthesis in healthy man during mixed amino acid infusion: studies of incorporation of [1-13C]leucine

1. Anterior tibial muscle protein synthesis in seven healthy postabsorptive men was determined from increases in muscle protein bound leucine enrichment during a primed continuous infusion of L-[1-13C]leucine. Biopsies were taken 30 min after the beginning of leucine infusion (when plasma 13C enrichment was steady), 240 min later during continued fasting and again after 240 min of infusion of a mixed amino acid solution which increased plasma total amino acid concentrations by 37%. The mean enrichment of 13C in plasma alpha-ketoisocaproate was used as an index of the enrichment of the precursor pool for leucine metabolism. 2. Anterior tibial muscle mixed protein synthetic rate during fasting was 0.055 (SD 0.008)%/h and this increased by an average of 35% during infusion of mixed amino acid to 0.074 (SD 0.021)%/h (P less than 0.05). 3. Whole-body protein breakdown (expressed as the rate of endogenous leucine appearance in plasma) was 121 (SD 8) mumol h-1 kg-1 during fasting and decreased (P less than 0.01) by an average of 12% during amino acid infusion. Leucine oxidation was 18 (SD 3) mumol h-1 kg-1 during fasting and increased (P less than 0.001) by 89% during amino acid infusion. Whole-body protein synthesis (non-oxidative leucine disappearance) was 104 (SD 6) mumol h-1 kg-1 during fasting and rose by 13% (P less than 0.001) during mixed amino acid infusion. 4. 13C enrichment of muscle free leucine was only 61 (SD 19)% of that in plasma alpha-ketoisocaproate and this increased to 74 (SD 16)% (P less than 0.02) during mixed amino acid infusion. 5. The results suggest that increased availability of amino acids reverses whole-body protein balance from negative to positive and a major component of this is the increase in muscle protein synthesis.     

Effect of Ventricular Pacing on Coronary Blood Flow in Patients with Normal Coronary Arteries

Although ventricular pacing is thought to produce impairment of left ventricular function by altering the sequence of ventricular activation and AV dyssynchrony, little is known about the effect of ventricular pacing on coronary blood flow. We measured coronary blood flow and coronary flow reserve in the left anterior descending coronary artery during sinus rhythm, and during both atrial and ventricular pacing at a rate of 100 ppm in 14 patients with normal coronary arteries. The double product increased significantly during both types of pacing. Coronary arterial diameter during ventricular pacing significantly increased compared to that during both sinus rhythm and atrial pacing. Coronary flow velocity during ventricular pacing was significantly lower compared to that during both sinus rhythm and atrial pacing. Coronary blood flow increased significantly during atriai pacing (30.7%± 12.1%; P < 0.001), but not significantly during ventricular pacing (23.6%± 47.0%; P = ns). While coronary flow re-serve during both atrial (3.9 ± 1.3) and ventricular pacing (3.8 ± 0.9) was lower compared to its value during sinus rhythm (4,5 ± 1.5), the difference was not significant. There was a significant positive correlation between the coronary flow reserve during sinus rhythm and the increase of coronary blood flow during ventricular pacing (R²= 0.78; P < 0.001). We concluded that an increase in coronary blood flow during ventricular pacing is not a common finding regardless of the increase in metabolic demand. The increase of coronary blood flow during ventricular pacing was less in patients with a reduced coronary flow reserve. These findings suggest that preservation of AV synchrony and the presence of a normal sequence of ventricular activation may play an important role in preserving coranary blaod flow in this subset of patients.     

2002-2008年浙江省临安市伤寒副伤寒流行特征分析

目的探讨浙江省临安市伤寒副伤寒流行规律。 方法采用描述流行病学方法对临安市2002 -2008年伤寒副伤寒疫情资料进行统计分析。结果2002-2008年临安市累计报告伤寒副伤寒1085例,无死亡病例,年平均发病率29.41/10万,男性发病多于女性,男女性别比为1.38∶1,发病年龄集中在15~44岁年龄组,职业以农民、民工为主;7年中发生暴发疫情3起,发病例数占58.53%。结论临安市2002-2008年报告伤寒副伤寒发病率呈明显上升趋势,地区分布具有集中趋势,季节主要集中于4-8月;流行菌株为甲型副伤寒杆菌,水源污染是副伤寒高发的主要危险因素。     

Alterations in the mechanical properties of the lung during dyspnea in chronic obstructive pulmonary disease

The mechanical properties of the lungs in seven patients with chronic obstructive pulmonary disease (COPD) were measured before and during dyspnea on exertion, as well as when relief with added oxygen was obtained. Mean pulmonary dynamic compliance was 0.091 liters/cm of H(2)O before dyspnea, 0.057 during dyspnea, and 0.101 liters/cm H(2)O during relief. During dyspnea there was an increase in the total respiratory work (both elastic and nonelastic work) and this fell during relief with oxygen. Nonelastic resistance and respiratory rate were not significantly different during the three periods. In five similar patients a progressive increase in the instantaneous rate of change of transpulmonary pressure (dP/dt) was observed during exercise and this was markedly increased during dyspnea. These changes in dP/dt during exercise could explain the observed fall of pulmonary dynamic compliance.     

EEG during attacks of common and classical migraine

The Copenhagen acute headache clinic offered an opportunity to record EEG during migraine attacks in eleven patients with common migraine and ten patients with classical migraine. The median duration of the attacks was 9 h in common migraine. Three patients were studied during prodromes of classical migraine and seven in the early headache phase. The EEG was recorded in the resting state, during hyperventilation and during photic stimulation. No abnormalities were encountered in patients with common migraine nor in eight patients with classical migraine. In two patients with classical migraine mild abnormalities were seen during prodromes and in the early headache phase, but they were also present at a control EEG taken outside an attack. The present study indicates that migraine attacks are rarely associated with EEG abnormalities.     

改良B-Lynch缝合术治疗剖官产术中出血的护理

目的 探讨改良B-Lynch缝合术用于剖宫产术中出血的止血效果与护理.方法 回顾分析22例剖宫产术中发生产后出血的患者使用改良B-Lynch缝合术的疗效.结果 22例患者均有效地控制出血,成功保留子宫.结论 改良B-Lynch缝合术是治疗剖宫产术中出血的有效的治疗措施,配合有效的护理,能使患者早日康复.     

Role of delayed type hypersensitivity responses in protection during chronic Plasmodium berghei infection as evidenced by homing of radiolabelled bone marrow cells and contact sensitivity

A comparative study of specific and non-specific immunosuppression has been carried out in acute and chronic Plasmodium berghei infected mice in an in vivo system. In our previous studies, immunosuppression during acute P. berghei infection was attributed to T lymphocytes when we studied modulation of blastogenic response of lymphocytes in an in vitro system. In the present study, delayed type hypersensitivity (DTH) was evident from the homing of radiolabelled bone marrow cells into the delayed lesions of antigen challenged foot pads during chronic infection. This response was suppressed during acute infection especially in early stages. A greater concentration of bone marrow cells in the liver and spleen occurred during chronic infection in comparison with acute infection. When radiolabelled bone marrow cells from infected mice were injected into the normal mice previously given malaria antigen in foot pads, no significant change in homing pattern in liver, spleen or foot pads was observed. Contact sensitivity to picryl chloride was suppressed during acute infection, but was intact during chronic infection. Since these responses are mediated by T lymphocytes, significance of these responses is discussed.     

改良B—Lynch缝合术治疗剖宫产术中出血的护理

目的探讨改良B-Lynch缝合术用于剖宫产术中出血的止血效果与护理。方法回顾分析22例剖宫产术中发生产后出血的患者使用改良B-Lynch缝合术的疗效。结果22例患者均有效地控制出血,成功保留子宫。结论改良B-Lynch缝合术是治疗剖宫产术中出血的有效的治疗措施,配合有效的护理,能使患者早日康复。