Flow requirements for the Bain breathing circuit during anaesthesia for caesarean section

We studied the relationship between arterial carbon dioxide tension (PaCO2) and fresh gas flow (FGF) during use of the Bain breathing circuit for Caesarean section anaesthesia. Thirty-one patients undergoing Caesarean section were anaesthetised using the Bain circuit with intermittent positive pressure ventilation. The PaCO2 were measured at FGF of 70 ml X kg-1 X min-1, 80 ml X kg-1 X min-1, and 100 ml X kg-1 X min-1. The FGF requirement to maintain a given PaCO2 during Caesarean section anaesthesia is the same as the requirements for nonpregnant subjects, despite the increase in carbon dioxide production associated with pregnancy. This is probably because the total FGF determined by body weight and given during Caesarean section anaesthesia is 15-20 per cent higher than nonpregnant levels, due to the weight gain associated with pregnancy. A FGF of 100 ml X kg-1 of pregnant weight/min maintains PaCO2 of 4.44 kPa predelivery, which is in the desirable range of PaCO2 during Caesarean section.     

Localized osteolysis in stable, non-septic total hip replacement

We are reporting four cases of extensive, localized bone resorption adjacent to a rigidly anchored, cemented total hip replacement. None of these hips showed evidence of infection on clinical, bacteriological, or pathological evaluation. The tissue from the regions of osteolysis showed sheets of macrophages and foreign-body giant cells invading the femoral cortices. Abundant methylmethacrylate particulate debris was present in the tissues, but polyethylene wear debris was absent. The histological appearance of this tissue resembled that reported about loosened total hip implants with the exception of the synovial-like layer at the cement surface. The cases reported here show that aggressive bone lysis may occur around stable cemented total hip arthroplasties without the presence of sepsis or malignant disease.     

Study on extensive lymph node dissection: metastatic lymph nodes in papillary carcinoma of the thyroid

Bilateral cervical lymph node dissection was performed in 71 cases of papillary thyroid carcinoma, considered to be relatively early cases because of mobility, irrespective of the size of tumor or presence of node enlargement. Of these, 33 cases received additional node dissection of the anterosuperior mediastinum through longitudinal sternotomy. The number of lymph nodes examined per subject averaged 89.9, the number of metastatic nodes was 13.8, and metastasis was noted in 88.7% of all cases. Lymph node metastasis tended to be more frequent on the affected side, but was simultaneously scattered over the whole cervical area. As to sites, metastasis of paratracheal nodes on the affected side occurred at a frequency of 66.2%, inferior and superior jugular nodes at 62.0% and 59.0% respectively, pretracheal nodes at 50.7%, and tracheoesophageal nodes at 47.9%. The high incidence of para- and pretracheal nodes suggests that the lymph flow in this direction is of great importance in metastasis. In fact, lymph nodes in the mediastinum, which were directly continuous with these nodes, showed as high as 39.4% metastasis in cases of anterosuperior mediastinal extirpation. This extensive node dissection is considered to be very preferable as at least the agony of survival with carcinoma can be lessened.     

The influence of alcohol on the outcome of automated static perimetry

It is well known that perimetric findings fluctuate within a single examination. There is additional fluctuation between perimetric examinations. The cause of this fluctuation is not yet fully understood, but such things as changes in attention, patient cooperation, or drugs have been discussed. To study such possible factors, we carried out perimetry on subjects who had consumed alcohol and who had not. The results indicate that alcohol, at a blood concentration of approximately 0.08%, barely influences the results of static automated perimetry. Differential light sensitivity remained unchanged by alcohol at all eccentricities tested. A decrease in the ability to cooperate was manifested by a significant higher score of false-positives in catch trials. There was also a tendency toward an increase in false-negative responses in catch trials, an increase in the number of stimuli presentations required, and higher short-term fluctuation. Lack of the influence of alcohol on the differential light threshold does not necessarily mean that alcohol has no influence on visual function. It indicates, however, that differential light sensitivity, as measured with the automated perimeter Octopus, is not influenced by moderate alcohol ingestion.     

Experimental demonstration of the immunogenicity of silicone-protein complexes

Although silicones, as a class, are nontoxic in animal and tissue studies, implanted silicone prostheses and medical devices are associated with various local and systemic host inflammatory reactions. They also have been associated with a form of autoimmune disease. To test the hypothesis that silicones may evoke an immunologically mediated inflammatory reaction, 10 guinea pigs were stimulated for 1 month with intraperitoneal injections of sterile medical-grade silicone oil admixed with homologous serum and complete Freund's adjuvant. Ten controls were stimulated with saline. Four additional animals were passively sensitized with splenic homogenates from four sensitized animals. Intradermal antigenic challenges consisted of silicone-homologous serum, pure silicone, saline-homologous serum, and purified protein derivative. Cutaneous reaction patterns were graded grossly and microscopically. Silicone-serum and purified protein derivative antigens evoked three to four times greater palpable lesions in all 10 actively and all 4 passively sensitized animals at approximately 24 h compared to controls. Biopsies showed a moderate to marked lymphocytic infiltrate. Control sites and naive animals showed only edema at the challenge sites. The data suggest that silicone-protein complexes are potentially immunogenic.