Human Hepatic Blood Flow and its Relation to Systemic Circulation during Intravenous Infusion of Lidocaine

Twelve healthy young volunteers were studied before and during intravenous administration of lidocaine at a dose rate of 2 or 4 mg/min. Five additional volunteers, who did not receive lidocaine solution but were given the same amount of physiological saline, were studied in the same manner. Heart rate, cardiac output, mean arterial blood pressure, mean right atrial blood pressure, estimated hepatic blood flow and plasma concentration of lidocaine were measured repeatedly. The results showed an increase in heart rate, cardiac output and mean arterial blood pressure, the latter two variables in relation to the plasma concentration of lidocaine. The estimated hepatic blood flow increased, partly as a result of the reduction of splanchnic vascular resistance and partly due to the stimulation of cardiac output. The decrease in splanchnic vascular resistance was proportional to the plasma concentration of lidocaine.     

Neonatal Hip Instability: Incidence, Diagnosis and Treatment at the University Hospital, Uppsala, 1960-1964 and 1970-1974

Neonatal hip instability, its incidence, diagnosis and treatment, has been studied retrospectively for the periods 1960-1964 and 1970-1974. The respective populations for the two periods amounted to 13,065 and 16,274 children all born at the same hospital. During the first period 191 children (14 per mille) were referred from the maternity nard to the orthopaedic department with suspected hip instability; 109 (8.3 per mille) children were considered by the orthopaedic consultant to have unstable hips. During the second period the corresponding figure were 503 (31 per mille) referred to the orthopaedic department and 189 verified as unstable (11.6 per mille). During the first period, 177 children were treated with Frejka pillows for about 3 months, only 14 being left untreated. In seven children the initial treatment was completed with a plaster cast. The results were uniformly good. During the second period, 195 children were treated with a von Rosen-splint for G weeks followed by Frejka pillows for another 6 weeks (seven completed treatment with plaster); in 143 cases Frejka pillows were the sole treatment and 161 had no treatment at all. There was one primary plaster. The treatment resulted in normal hips in all but one girl. In the non-treated group three subluxations were verified after the neonatal period. There were seven “missed” cases (diagnosed after the first month of life) in the first population (0.5 per mille), 15 in the second (0.9 per mille). This difference is not statistically significant. The calculated incidence of dislocations if no treatment had been instituted in the neonatal period is 1.5 per mille in the first population, and 2.5 per milk in the second. The difference is not statistically significant.     

Convulsive properties of lindane, lindane metabolites, and the lindane isomer alpha-hexachlorocyclohexane: effects on the convulsive threshold for pentylenetetrazol and the brain content of gamma-aminobutyric acid (GABA) in the mouse.

The threshold for pentylenetetrazol-induced convulsions in the mouse is affected by lindane in two opposite ways. Following the administration of a single dose of lindane, the threshold first decreases and then, after 2 days, increases above the normal level. None of the tested metabolites of lindane altered the convulsive threshold. When lindane elevates the convulsive threshold it also elevates the content of γ-aminobutyric acid (GABA) in the brain. The lindane isomer α-hexachlorocyclohexane elevates both convulsive threshold and the GABA content. The smallest single oral dose of lindane lowering the convulsive threshold for pentylenetetrazol in the mouse, 3 hr after administration, corresponds to a lindane concentration of 56 ppb in whole blood.     

Serum Somatomedin a and Non-Dialyzable Urinary Hydroxyproline in Girls with Idiopathic Scoliosis

Serum somatomedin A was determined by radioreceptor assay in 31 girls with idiopathic scoliosis and 30 controls, with ages ranging from 9.7-16.2 years. In the material as a whole no significant difference could be found between scoliotics and controls. Similarly no differences were found in the girls under 13 years of age. However, in girls older than 13 years the controls had significantly higher somatomedin A levels than the scoliotics.

In the second part of the study 26 girls with idiopathic scoliosis and 22 controls were examined with regard to the urinary excretion of non-dialyzable hydroxyproline, which has been suggested to be correlated with collagen synthesis. The percentage non-dialyzable fraction of the total hydroxyproline was found to be significantly higher in the control girls. The mean age was 12.8 years for both groups.

The results suggest a higher growth rate in the controls than in the scoliotics for girls over 12 years. There is, however, no definite evidence as to the function of the somatomedins or of the relationship between non-dialyzable hydroxyproline and growth.     

Regional cerebral blood flow and CSF pressures during Cushing response induced by a supratentorial expanding mass

In order to delineate the critical blood flow pattern during the Cushing response in intracranial hypertension, regional cerebral blood flow was measured with radioactive microspheres in 12 anesthetized dogs at respiratory arrest caused either by expansion of an epidural supratentorial balloon or by cisternal infusion. Regional cerebrospinal fluid pressures were recorded and the local cerebral perfusion pressure calculated in various cerebrospinal compartments. In the 8 dogs of the balloon expansion group, the systemic arterial pressure was unmanipulated in 4, while it was kept at a constant low level (48 and 70 mm Hg) in 2 dogs and, in another 2 dogs, at a constant high level (150 and 160 mm Hg) induced by infusion of Aramine. At respiratory arrest, regional cerebral blood flow had a stereotyped pattern and was largely independent of the blood pressure level. In contrast, concomitant pressure gradients between the various cerebrospinal compartments varied markedly in the 3 animal groups, increasing with higher arterial pressure. Flow decreased by 85-100% supratentorially and by 70-100% in the upper brain stem down to the level of the upper pons, while changes in the lower brain stem were minor, on the average 25%. When intracranial pressure was raised by cisternal infusion in 4 dogs, the supratentorial blood flow pattern at respiratory arrest was approximately similar to the flow pattern in the balloon inflation group. However, blood flow decreased markedly (74-85%) also in the lower brain stem. The results constitute another argument in favour of the Cushing response in supratentorial expansion being caused by ischemia in the brain stem. The critical ischemic region seems to be located rostrally to the oblongate medulla, probably in the pons.     

DNA pattern and cytological findings in fine-needle aspirates of untreated prostatic tumors. A flow-cytofluorometric study

The cellular DNA content in fine-needle prostatic aspirates from 500 untreated patients was determined by flow cytofluorometry. According to the DNA patterns diploid, tetraploid, and non-tetraploid aneuploid cases were identified. In 301 cytologically benign cases more than 90% showed diploid DNA patterns. Among 166 carcinomas the incidence of aneuploid DNA values increased with the degree of anaplasia, ie, 44% in well-differentiated, 78% in moderately differentiated, and 97% in poorly differentiated tumors. In aneuploid cases of well-differentiated carcinomas almost exclusively tetraploid DNA patterns were observed, while in poorly differentiated carcinomas about 80% showed non-tetraploid aneuploid DNA distributions. Among aneuploid cases of moderately differentiated carcinomas 2/3 were tetraploid and 1/3 non-tetraploid aneuploid. Morphologically similar tumors may thus be separated by the DNA profiles. The biological significance of these results must be further evaluated by clinical follow-up of the patients.     

Reorganization and orientation of regenerating nerve fibres,perineurium, and epineurium in preformed mesothelial tubes – an experimental study on the sciatic nerve of rats

Regeneration of severed peripheral nerves is unfortunately often incomplete, due to loss of nerve fibers and neuroma formation. A new approach is presented with the intention of improving the conditions for nerve repair. In the first of the two stages, a pseudosynovial tube is formed around a silicone rubber rod, surrounded by a stainless steel spiral, which was placed in the backs of rats. This tube, in the second stage, is used as a free “tube graft” to bridge gaps of about 10–12-mm lengths in the severed sciatic nerve. The tube was kept open by the metal spiral. Regenerating nerve fibers with their sprouts grew into the initially open space in the tube. A new nerve trunk was formed, comprised of closely packed myelinated and unmyelinated axons, organized into fascicles. Demonstration by electron microscopy and by EMG recording of reinnervation of foot muscles supported successful long-term results. The fascicles were delimited by perineurial and epineurial sheaths and, furthermore, showed signs of maturation. It was also demonstrated that the nerve-fiber regeneration ceased after a few weeks if there was no distal nerve inserted into the tube. The importance of optimizing the interaction between local factors and regenerating nerve fibers for reestablishment of functionally valuable motor units is discussed.     

Short-term systemic prophylaxis with cefoxitin and doxycycline in colorectal surgery: A prospective,randomized study

The efficacy of cefoxitin or doxycycline as antibiotic prophylaxis in colorectal surgery was compared in 102 elective operations. Both drugs were used perioperatively only. Cefoxitin was used in 55 cases and doxycycline in 47. Ten patients in the cefoxitin group and 4 in the doxycycline group had wound infections. Three intraabdominal abscesses were seen, one after cefoxitin and two after doxycycline prophylaxis. All three were due to anastomotic leakage. Bacteriologic studies revealed no negative ecologic effects of prophylaxis. The short-term prophylaxis used did protect against serious infectious complications. The extended spectrum of cefoxitin provided no added benefit in prophylaxis. Patients with inflammatory bowel disease treated preoperatively with salicylazosulfapyridine run a greater risk of postoperative infection in spite of the prophylaxis.