Series dead space volume assessed as the mean value of a distribution function

Series dead space (VdS) is assumed to be represented by that volume exhaled until alveolar gas is observed. Phase II of the single breath CO₂-diagram contains the (flow, concentration and sequence weighted) distribution off all stationary interfaces (SI) expired before phase III. We describe a new method to estimate the mean value of VdS based on the differentiation of phase II. This approximation of VdS is called the Pre Interface Expirate (PIE) and is compared in this study with the integrative approach of Langley. Tidal volume (Vt) and PEEP were varied from 71 to 123% and from 0 to 6 cmH₂O respectively.The estimation of VdS by differentiation of phase II (PIE) shows excellent reproducibility and depends only on phase II — not on phase III and IV as does VdS-Langley. PIE does not depend on Vt and PEEP per se but reflects the distension of convective airways due to elevated end-inspiratory airway pressure.Our results confirm the predictions of Paiva's model calculations in that the size of VdS is determined by the distension of airways rather than by the altered position of the SI.     

Ifosfamide combination chemotherapy in advanced breast cancer

The objective of our clinical studies was to develop an effective combination chemotherapy regimen (CHT) with acceptable side effects, consisting of the two most potent drugs used as single agents in breast cancer. We tested the combination of an anthracycline, epirubicin (A) at 70 mg/m² i.v. on day 1 or (B) at 120 mg/m² i.v. on day 1 with an alkylating drug ifosfamide (IFO), (C) at 2.5 g/m² in an i.v. infusion given over 4 h on days 1–3 or (D) at 5 g/m² in a 24-h i.v. infusion given on day 1. Courses were repeated every 4 weeks. The combinations were given as first-line therapy as follows: CHT (A, C) in six cases and CHT (B, C) in five cases of advanced breast carcinoma, and CHT (B, D) in seven patients with primary inflammatory breast cancer. Due to side effects (e.g., stomatitis, mental disturbances) and applicability, CHT regimen (B, D) was preferred. Responses (12/18) occurred 1–3 cycles earlier than those previously achieved using the conventional epirubicin/cyclophosphamide CHT. We conclude that 5 g/m² IFO given i.v. over 24 h with uroprotection (mesna) in a two-drug regimen is an effective dose with tolerable toxicity. Alopecia was seen in all cases. However, according to our experience, myelotoxicity is the dose-limiting factor for both of these drugs.Presented at the Satellite Symposium Ifosfamide in Gynecological Tumors of the 5th European Conference on Clinical Oncology and Cancer Nursing, London, September 3–7, 1989     

颈髓段下行传导束诱发电位动物模型研究

目的 :建立 SD鼠脊髓下行传导束诱发电位 ( MEP)模型。 方法 :刺激颈髓段下行传导束 ,于双侧坐骨神经记录电位变化。采用 8个不同刺激强度区间 ,并结合脊髓部分损伤状态 ,评价其潜伏期和波幅的变化。结果 :诱发电位主要由 3个正负波峰组成。 N1的潜伏期 :右侧 ( 2 .89± 0 .2 2 ) ms,左侧 ( 2 .89± 0 .2 4) ms。传导速度 47.9m/s。 N1的波幅 :右侧 ( 3 .61± 2 .10 )μV,左侧 ( 3 .83± 2 .3 2 )μV。不同刺激强度组间潜伏期相差不显著 ,但组间波幅有显著性差异 (右侧 F =2 .2 2 ,df =72 0 1,P=0 .0 3 ;左侧 F =2 .11,df=72 0 6,P=0 .0 4)。 T9平面脊髓部分损伤后 ,潜伏期延长 ,右侧 14 % ,左侧 12 % ;波幅下降 ,右侧5 9 % ,左侧 3 1%。结论 :建立的颈髓段下行传导束诱发电位动物模型有效、可靠 ,重复性好。用此模型可准确地检测脊髓传导束的功能状态     

Urinary excretion of adenosine deaminase binding protein in neonates treated with tobramycin

The potential tubulotoxicity of tobramycin and cefotaxim were assessed in neonates by measuring the urinary level of adenosine deaminase binding protein (ABP) and urinary ₁-microglobulin and ₂-microglobulin. In a prospective study, 33 neonates who received tobramycin and cefotaxim for suspected neonatal sepsis were compared with 48 untreated newborns during the first 10 days of life. The urinary concentrations of ABP and its excretion rates, corrected for body weight and body surface area, were significantly increased from the 1st day of treatment. Urinary ₁-microglobulin and ₂-microglobulin were not elevated under tobramycin and cefotaxim during the first 2 days of treatment. We conclude that ABP may be a sensitive marker for the detection of proximal renal tubular injury during tobramycin and cefotaxim treatments of neonates. The increase in urinary ABP which occurs before an elevation of urinary ₁-microglobulin and ₂-microglobulin may reflect earlier structural than functional alterations. However, since none of the treated infants had signs of electrolyte disorders or glomerular dysfunction, the clinical relevance of ABP measurement should be reevaluated.     

Non-radioactive hybridization in microwells using enzyme linked immune sorbent assay for detection of RT-PCR-Am-plified CK19- and CEA-mRNA

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Somatization in frequent attenders of general practice

The DSM-III-(R) definition of somatization disorder is too restrictive for use in general practice. A more comprehensive definition, the somatic symptom index (SSI) has shown good validity in open populations. However, a definition has to differentiate validlywithin a population of frequent attenders to be a useful diagnostic instrument in general practice. We studied a threshold of five complaints (nearly identical to the SSI) in 80 Dutch general practice patients. Patients were selected on age (20–44 years), history of back, neck or abdominal complaints, and on frequency of consultation—at least 12 consultations in the previous 3 years, corrected for consultations with compelling somatic reason for encounter. Prevalence of somatization in this group was 45%. Women had a 2 times higher risk of somatization. A relation with age was not found. Somatization was related to depressive complaints (relative risk 2.5) and probably also to anxiety. Somatizing patients consulted their general practitioner more often and had more health problems (especially psychic problems) than non-somatizers. These results support the validity of this definition. The distinction between our definition of somatization and somatization defined as a symptom of psychiatric (e.g. depressive or anxiety) disorder is emphasized.     

Radical cystectomy with or without adjuvant polychemotherapy for non-organ-confined transitional cell carcinoma of the urinary bladder: Prognostic impact of lymph node involvement

Objectives

To analyze the effectiveness of adjuvant polychemotherapy after radical cystectomy for nonorgan-confined transitional cell bladder cancer (Stages pT3b, pT4a, and/or pN1 or pN2).

Methods

Of 166 consecutive patients undergoing cystectomy at two institutions from 1987 to 1993, 80 received adjuvant polychemotherapy with methotrexate, vinblastine, and cisplatin plus doxorubicin (MVAC) or epirubicin (MVEC), whereas 86 had cystectomy only. The patients were evaluated for relapse-free survival and length of progression-free interval on the basis of follow-up data obtained in 1995 and 1996.

Results

Kaplan-Meier analysis revealed a significantly higher progression-free rate for patients after adjuvant chemotherapy (P=0.0002, log-rank test). With and without adjuvant chemotherapy, prognosis declined in a stepwise manner, depending on the extent of lymph node involvement. Nevertheless, the superior prognosis of the chemotherapy group could be demonstrated at each lymph node stage. Of the 166 patients, 49 had initially entered a prospective trial comparing adjuvant with no adjuvant treatment. That study was discontinued in December 1990 after an interim analysis revealed a significant prognostic advantage in favor of the 26 patients randomized to receive chemotherapy compared with the 23 control patients. Current follow-up data continue to demonstrate a significant improvement in progression-free survival in favor of patients randomized to receive adjuvant chemotherapy (P=0.0040). The follow-up period of patients living free of disease ranges from 58 to 96 months.

Conclusions

Adjuvant chemotherapy with MVAC/MVEC leads to significant prolongation of relapse-free survival and improvement of the definitive cure rate after radical cystectomy for locally advanced transitional cell carcinoma of the urinary bladder.     

Lidocaine has a narrow antiarrhythmic dose range against ventricular arrhythmias induced by programmed electrical stimulation in conscious postinfarction dogs

Summary The aim of the present study was to investigate the dose-dependent antiarrhythmic efficacy of lidocaine against electrically induced tachycardias in conscious, chronically instrumented postinfarction dogs. Programmed electrical stimulation (PES) was performed in 16 dogs 8 to 21 days after a 4 h occlusion of the left anterior descending coronary artery (LAD). Infusion of saline in 8 control animals with sustained ventricular tachycardia (SVT) inducible at baseline did not affect subsequent inducibility. In the treatment group 7 of 8 animals responded with SVT and one exhibited ventricular fibrillation at baseline. After an initial bolus of 1 mg/kg lidocaine intravenously (i.v.), the drug was infused at infusion rates of 40, 80 and 120 g/kg/min (i.v.). During 80 g/kg/min lidocaine (mean plasma level 3.5 g/ml) 7 out of 8 animals displayed an antiarrhythmic response; both the lower and the higher infusion rate were associated with a smaller antiarrhythmic efficacy (3 of 8 animals responded to 40 g/kg/min and 4 of 8 to 120 g/kg/min). Licocaine did not affect ventricular refractory periods, but induced an increase in intraventricular conduction time at all infusion rates, from 66.2 ms at baseline to 67.7 ms (p<0.05), 67.7 ms (p<0.05), 70.0 ms (p<0.01) respectively.In conclusion the present study demonstrates that lidocaine is of considerable value in the management of PES-induced ventricular arrhythmias in the postinfarction phase. However there is only a small optimal therapeutic plasma level range, where lidocaine exhibits its antiarrhythmic efficacy against this type of arrhythmia; this makes a carefully titration of the drug necessary both in the experimental and in the clinical setting. Send offprint requests to K. Krejcy at the above address