Effect of fundus vagotomy on the gastric emptying of the solids and liquids of a meal in patients with and without postoperative duodenal ulcer recurrence

The effects of fundic vagotomy (FV) on gastric emptying in the solid and liquid phases of a meal were studied by an isotopic technique in 12 patients with duodenal ulcer. Postoperative results were compared with those obtained in the same subjects before FV and with control values obtained in an identical group of healthy subjects. Early gastric emptying (perprandial) of the two phases of the meal was enhanced by FV but the results failed to reach statistical significance. Gastric emptying of liquids, measured during the 3 h following the end of the meal, was not significantly modified by FV (half-emptying times: 62 +/- 5 min before FV, 75 +/- 8 min after and 65 +/- 7 min for controls). That of solids was significantly delayed by FV (per cent emptied by min: 0.50 +/- 0.02 p. 100 before FV, 0.40 +/- 0.03 p. 100 after, and 0.49 +/- 0.02 p. 100 for controls); this delay was found in all but one patient, but the difference was very slight. Eleven of the 12 investigated patients cured by the operation, were compared with 6 subjects presenting with post FV recurrence: gastric emptying rates of solids (0.41 +/- 0.02 p. 100/min and 0.47 +/- 0.07 p. 100/min) and half emptying times of liquids (72 +/- 10 min and 61 +/- 10 min) were not significantly different. Thus, the gastric emptying rate of an ordinary meal remains practically unchanged by FV and postoperative recurrences of duodenal ulcer cannot be explained by alteration of gastric evacuation.     

A collaborative dominant lethal study of triethylenemelamine in the rat.

A collaborative dominant lethal study of the known mutagen triethylenemelamine (TEM) was conducted in male rats. Six laboratories were supplied with animals from a common source and with TEM of the same lot number in an attempt to ensure uniformity of strain and drug effect. Male Sprague-Dawley rats, which were proven breeders, were divided into five groups of 15 animals each and were given a single ip injection of TEM at 0 (saline), 0.125, 0.250, 0.375, or 0.500 mg/kg. respectively. After the injection, each male was housed with two virgin females (200 g) each week for a 10-week period. The females were sacrificed by asphyxiation 14 days after the midweek of cohousing, and corpora lutea were counted and the uterine contents were examined. The results showed a highly significant difference among laboratories for the number of corpora lutea per pregnant female and for preimplantation losses over all doses and weeks. Variability among laboratories was least for total implants in both treated and control groups and dead implants in the control group. Although the variation was great between laboratories with respect to the several parameters considered, the results obtained by each laboratory did show that TEM has a significant mutagenic effect in the dominent lethal test.     

The effects of organic compounds used in the manufacture of plastics on the responsivity of murine and human lymphocytes.

The effects of acute exposure to a number of industrially important organic compounds on the immunological responses of human and murine lymphocytes were studied. The compounds were benzene, 1,4-dioxane, toluene diisocyanate (TDI), vinyl chloride, vinylidene chloride, ethylenimine, and epichlorohydrin. Control compounds known to have immunological effects were azothioprine, hydrocortisone acetate, and triethylene melamine (TEM). The uptake of tritiated thymidine ([³H]TdR) of lymphocytes was used to measure their ability to respond to mitogenic agents, allogeneic lymphocytes, or the antigenic nature of the compounds themselves. Most of the compounds were found to be cytotoxic to lymphocytes at high concentrations. Dioxane and TDI showed evidence of specific actions on the immunological system. Dioxane suppressed T-cell responses while augmenting B-cell responses. TDI exhibited stimulatory effects at several concentrations to both human and murine lymphocytes. These findings indicate that of the chemicals studied, both dioxane and TDI have properties which make them capable of affecting lymphocytes in ways other than nonspecific cytoxicity. These properties make TDI and dioxane especially interesting when monitoring immunological systems of industrial workers who have been accidentally exposed to these compounds at high concentrations or who are routinely exposed to minimal levels of these compounds.     

Decrease in paO2 following intratracheal application of a local anesthetic and a 0.9% sodium chloride solution. A prospective study on the use of fiberoptic bronchoscopy in ventilated patients during local anesthesia

Flexible fiberoptic bronchoscopy of intubated patients can be performed in general or local anesthesia (LA). Up to now, no results have been published on the effects of LA for bronchoscopy in ventilated patients. We studied the hemodynamic changes caused by bronchoscopy under LA in mechanically ventilated patients and the effect of LA on the endoscopic decline in arterial pO2. Differences between the widely used agents lidocaine and oxybuprocaine hydrochloride were also studied. We found a decline in paO2 after the administration of LA and further investigated the influence of bronchial lavage on paO2. METHOD. A total of 70 ventilator patients, excluding patients with atelectasis, massive mucous-plug retention, and those under muscle relaxants, were examined in a surgical intensive care unit. In 40 long-term ventilator patients bronchoscopy was performed with either oxybuprocaine hydrochloride 1% (Novesin) (group 1; n = 20) or Lidocaine 1% (Xylocaine) (group 2; n = 20) (2-3 ml LA in repeated doses into the trachea and main bronchi; total amount 10 ml). We looked for hemodynamic changes and effects of LA on the bronchoscopic decline in paO2. In 15 long-term ventilator patients (group 3), LA was applied without bronchoscopy to investigate the duration of the LA-caused decline in paO2. In 15 intubated patients (group 4), the influence of intratracheal administration of 10 ml normal saline was examined. Patient data are shown in Table 2. Measurements were performed in groups 1 and 2 before and after LA, immediately after bronchoscopy and 15, 30, and 60 min after bronchoscopy and in groups 3 and 4 before and 5, 15, 30, and 60 min after LA. RESULTS. There was no effect on cardiocirculatory function during bronchoscopy in LA, but we found a decrease in paO2 after administration of LA in all patients (median in group 1 from 100 to 78 mmHg in group 2 from 104 to 86 mmHg). The subsequent bronchoscopy caused only a small, nonsignificant further decline in paO2. The administration of LA without bronchoscopy (group 3) was followed by a fall in paO2 from 86 +/- 12.5 to 69 +/- 11.7 mmHg (mean +/- SD) with oxybuprocaine hydrochloride and from 87 +/- 12.4 to 72 +/- 8.7 mmHg with lidocaine. Even after 30 min the paO2 had not returned to the initial value. The intratracheal application of 10 ml 0.9% NaCl caused a decline in paO2 from 101 +/- 20 to 78 +/- 12 mmHg (mean +/- SD), which also persisted for more than 30 min. CONCLUSIONS. The study shows that in ventilator patients undergoing fiberoptic bronchoscopy in LA, the administration of the LA is an essential factor in the decline in paO2 associated with bronchoscopy. A similar fall in paO2 is observed by intratracheal     

Reperfusion injury in the human forearm is mild and not attenuated by short-term ischaemic preconditioning

1. Ischaemia-reperfusion (IR) injury is an important contributor to tissue damage and has been shown to be attenuated by preconditioning (PC) in some animal models. A recent report has suggested that the forearm can be used for the study of this phenomenon in humans. We aimed to reproduce and further characterize this model. 2. Healthy young adult volunteers (mean (+/-SEM) age 32+/-6 years) were studied on two occasions. During one visit, IR alone was induced by 10 min of upper arm cuff occlusion, whereas on another occasion a PC stimulus (three 3 min cuff inflations) preceded IR. Endothelial function in the ischaemic arm was assessed by measuring arterial flow-mediated dilatation (FMD) and by calculation of forearm blood flow at baseline and 15 and 60 min after IR. Systemic venous blood was sampled from the non-ischaemic arm at baseline, after PC and at 2, 15 and 30 min after IR to assess neutrophil/leucocyte (CD11b) and platelet (bound glycoprotein IIb/IIIa and fibrinogen) activation, as well as numbers of platelet-leucocyte complexes, which were determined by flow cytometry. Because of a lack of measurable effects, the IR experiment was repeated with 20 min ischaemia in six subjects. 3. Five females and eight males completed the study. Flow-mediated dilatation was significantly impaired 30 min after IR (4.1 vs 6.2% at baseline; P<0.05);however, this was not significantly attenuated by ischaemic PC (FMD reduction at 30 min compared with baseline was 2.1+/-0.5% with IR alone and 2.6+/-1.4% with IR after PC; NS). No significant effect was seen on the number of platelet-leucocyte aggregates or on white cell or platelet activation after IR alone or after IR with PC (P>0.6 for all comparisons). Similar results were obtained in six subjects studied subjected to 20 min ischaemia. 4. In conclusion, in healthy young adults, brief periods of skeletal muscle ischaemia lead to arterial endothelial dysfunction, but no significant platelet or white cell activation. Preconditioning does not attenuate this effect on the endothelium. Further experiments with longer ischaemia times and varying PC stimuli may be necessary to produce measurable effects; however, this may prove difficult in conscious human subjects.     

Acute myocardial infarction in a young patient with a primary antiphospholipid syndrome -- a case report

A case of a 34 year old woman with antiphospholipid syndrome, admitted to our hospital due to acute myocardial infarction, is presented. She had a history of deep vein thrombosis, two miscarriages and ischaemic stroke. The patient underwent successful primary coronary angioplasty and was discharged home. Factors predisposing to arterial thrombosis and treatment options are discussed.     

Quality of life of spouses of mentally ill people

BACKGROUND: Spouses of people with mental disorder experience various forms of objective and subjective burden. This should negatively affect their quality of life. However, until now no single study has addressed this question. AIMS: To investigate the quality of life of spouses of people with schizophrenia, depression or anxiety disorders. METHOD: Spouses of patients suffering from schizophrenia (n = 45), depression (n = 49) and anxiety disorders (n = 39) were consecutively recruited from outpatient services in the city of Leipzig. Quality of life was assessed by means of the WHOQOL-BREF, a self-administered questionnaire developed by the World Health Organisation. RESULTS: Compared with the general population, the quality of life of the spouses of mentally ill people was lower in the domains 'psychological well-being' and 'social relationships'. There was a significant association between the patient's functional level and the spouse's quality of life. CONCLUSIONS: Better treatment, professional support and participation in self-help and advocacy groups may help to improve the quality of life of spouses of mentally ill people.