MONITORING OF BRAINSTEM AUDITORY EVOKED POTENTIALS DURING BASILAR ARTERY OCCLUSION IN MAN

Brainstem auditory evoked potentials (BAEP) were recorded duringsurgery as a monitor of brainstem function in three patientsundergoing posterior fossa surgery for dipping of basilar aneurysms.In two patients, ligation of the basilar artery, and of a vertebralartery, was associated with deterioration in BAEP and resultedin postoperative brainstem dysfunction. In the third patient,postoperative transient neurological dysfunction occurred followingtemporary occlusion of the basilar artery and this correlatedwith intra-and postoperative changes in BAEP. BAEP monitoringis recommended where temporary or permanent occlusion of thevertebrobasilar system is planned. ^*Present address: 86 The Stiles Road, Clontars,Dublin 3     

C73R is a hotspot mutation in the uroporphyrinogen III synthase gene in congenital erythropoietic porphyria

Congenital erythropoietic porphyria (CEP) results from profoundly deficient activity of the fourth enzyme of the haeme biosynthetic pathway, uroporphyrinogen III synthase (UROIIIS). CEP is a rare, recessively inherited disorder, and mutations in the UROIIIS gene detected in CEP patients are heterogeneous. The notable exception to this rule is a single missense mutation, designated C73R, which represents over 40% of all mutant UROIIIS alleles. In this study, we investigated three separate families with CEP from different ethnic backgrounds. We performed haplotype analysis using two microsatellite markers that closely flank the UROIIIS gene on chromosome 10q24, spanning a region of 4 cM on the GB4 linkage panel. Haplotype analysis revealed the occurrence of C73R on different haplotypes in four out of four disease chromosomes studied. The results are consistent with the hypothesis that C73R is a hotspot mutation for CEP, and does not represent wide dispersion of a single ancestral mutant C73R allele.     

澳门地区孕妇B群链球菌筛查和新生儿早发型感染分析

目的了解澳门地区孕妇B群链球菌(GBS)定植、新生儿早发型B群链球菌感染(GBS-EONI)情况及其风险因素。方法研究采用回顾性资料分析,以目的性抽样方法选取2012至2017年于澳门地区政府医院妇产科门诊进行孕晚期GBS筛检的孕妇2 515名,调查孕妇GBS定植率。选取同年在政府医院出生的20 771名活产儿,收集其出生后7 d内血液、脑脊液和下呼吸道标本细菌培养结果,调查GBS-EONI发生率;再分析孕妇人口学特征、母婴围产期临床资料与GBS-EONI的关系。统计软件使用SPSS 20.0,统计方法以卡方分析和二元逻辑回归分析为主。结果孕妇GBS筛检阳性431例,孕妇阴道直肠GBS定植率为17.1%。培养确诊新生儿早发型GBS入侵性感染24例(感染率为1.2/1 000活产儿)。剖腹产(OR=0.353, 95%CI:0.139～0.897)和分娩时预防性使用抗生素(OR=0.108, 95%CI:0.024～0.482)为预防GBS-EONI发生的保护因素。结论澳门地区孕妇GBS定植状况与邻近地区接近,GBS-EONI发生率较高。可全面性推广孕晚期GBS筛检及产时预防性用药,以减少新生儿早发型GBS疾病的发生。     

Can misoprostol and omeprazole reduce nicotine and ethanol induced gastric mucosal injury? A quantitative macroscopic and microscopic analysis in rats

We compared the effects of misoprostol, omeprazole and methylcellulose (control) on gastric mucosal injury induced by nicotine and/or ethanol. The results demonstrate that misoprostol and omeprazole each significantly reduce macroscopic injury and deep injury at a microscopic level (P < 0.05) induced by nicotine alone, ethanol alone or a combination of ethanol and nicotine. Misoprostol and omeprazole each reduced the leakage of fluorescein isothiocyanate-albumin into the interstitium in the gastric mucosa. Misoprostol and omeprazole are each effective in preventing injury induced by nicotine and ethanol and vascular factors are involved.     

Abnormal gastro-oesophageal reflux in Chinese with atypical chest pain

Although atypical chest pain has been well described in the Western population, its frequency in Chinese is unknown. Over a period of 42 months, we studied 521 Chinese patients with chest pain and identified 108 patients (20.7%) whose pain was not related to cardiac causes, as determined by exercise ECG or cardiac catheterization. Using 24 h ambulatory pH monitoring and baseline oesophageal manometry, 28.7, 19.4 and 5.6% of these patients were found to have abnormal reflux parameters, abnormal manometric findings or both, respectively. There were significantly more patients complaining of chest pain during the study in the gastro-oesophageal reflux disease (GERD) group than in the non-GERD group (16/31 vs 20/77; P< 0.001). The lower oesophageal sphincter pressure was lower in those with abnormal reflex parameters than in those with normal reflux parameters (12.7±5.4 vs 17.8±5.8 mmHg; P< 0.05). There was no significant difference in symptoms, such as heartburn (54.8 vs 42.9%), regurgitation (38.7 vs 35.1%) and dysphagia (19.4 vs 24.7%), among the two groups. Non-specific changes were the most frequent baseline motility pattern. In conclusion, atypical chest pain and gastro-oesophageal reflux disease are not uncommon in Chinese and this deserves special emphasis as the continuation of anti-anginal drugs may aggravate their condition.     

Cerebrovascular response to carbon dioxide during sodium nitroprusside- and isoflurane-induced hypotension

We have examined the cerebrovascular response to carbon dioxideduring normotension, sodium nitroprusside (SNP)-induced hypotensionand high dose isoflurane-induced hypotension in 10 patientswho received a standardized general anaesthetic. Carbon dioxidereactivity was determined by varying Pa_co2 between 3.0 and 8.0kPa and recording simultaneously blood flow velocity from themiddle cerebral artery (vmca). The paired vmca-Pa_co2 data wereanalysed using linear regression to determine carbon dioxidereactivity. During hypotension, both high-dose isoflurane andSNP reduced significantly mean absolute (from 17.4 (SEM 2.3)to 13.0 (1.7) and 8.8 (1.3) cm s^–1 kPa^–1 respectively;P < 0.05) and relative (from 32.5 (3.8) to 23.6 (2.0) and15.5 (1.3) % kPa^– respectively; P < 0.05) cerebrovascularreactivity to carbon dioxide. This reduction was greater duringSNP-induced hypotension (P < 0.05). We conclude that cerebrovascularreactivity to carbon dioxide was attenuated during isofluraneand SNP-induced hypotension, and that it was better preservedduring isoflurane-induced hypotension. (Br. J. Anaesth. 1995;74: 296–300) Present addresses: Department of Anaesthesia, The Ipswich Hospital,Ipswich IP4 5PD, UK. Present addresses: Phoenix Anesthesia Group, 2950 North 7thSt, Phoenix, AZ 85014, USA. Present addresses: University of Basel/Kantonsspital, Departmentof Anesthesia, CH-4031, Basel, Switzerland.