Pressure support ventilation during inhalational induction with sevoflurane and remifentanil in adults

BACKGROUND AND OBJECTIVE: The purpose of this prospective randomized study was to assess the value of pressure support ventilation during inhalational induction with sevoflurane in adult patients. METHODS: Thirty-five adult patients, ASA I-II and scheduled for ear nose throat surgery were studied. Vital capacity induction with 8% sevoflurane in 8 L min-1 oxygen was performed. Pressure support ventilation was used in Group 1 with pressure set at 15 cmH2O. In Group 2, patients breathed spontaneously. After 2 min, sevoflurane was set to 3% and remifentanil 1 microg kg(-1) was injected over 2 min followed by an infusion of 0.1 microg kg(-1) min(-1). Two minutes after the end of the bolus, intubation was performed. Bispectral index, oxygen saturation, respiratory rate, end-tidal carbon dioxide, expired tidal volume and expired sevoflurane concentration were recorded every minute. RESULTS: Eighteen patients were included in Group 1 and 17 in Group 2. Saturation, respiratory rate and end-tidal carbon dioxide were similar in the two groups. Expired tidal volume was significantly higher and bispectral index values significantly lower in Group 1. Intubating conditions were better in Group 1. CONCLUSIONS: Pressure support ventilation provides both better ventilation and deeper level of anaesthesia during inhalation induction with sevoflurane.     

Induction of anaesthesia with target-controlled inhalation of sevoflurane in adults with the ZEUS anaesthesia machine

Objectives. – To evaluate if the new anaesthesia platform ZEUS^® (Dräger Medical) allows the induction of anaesthesia with target-controlled inhalation of sevoflurane.Study design. – Prospective clinical study.Patients. – Adult ASA I or II patients scheduled for elective surgery under general anaesthesia.Methods. – After preoxygenation during 3 min at 100% oxygen, patients were asked to breathe normally; the target end-tidal concentration of sevoflurane was fixed at 4% without priming of the circuit. Sufentanil (target concentration 0.5 ng/ml) was administered 40 s after.Results. – Ten patients (48 ± 22 yrs) were included. Sevoflurane was detected in the circuit after 36 ± 5 s; the target end-tidal concentration of sevoflurane was obtained at 130 ± 19 s. Loss of consciousness was observed after 119 ± 7 s. The induction was achieved in all patients without any incident.Conclusion. – This new anaesthesia system make available the induction of anaesthesia with sevoflurane without priming of the circuit.     

Experience of Mars therapy with and without transplantation in 101 patients with liver insufficiency

Liver support devices are used to treat life-threatening organ dysfunction until a hepatic graft is available or recovery of the native liver. We used a blood purification system--molecular adsorbent recycling system (MARS)--that is based on removal of both protein-bound and water-soluble substances and toxins. Within 2.5 years we treated 101 patients, who were stratified to three subgroups: acute liver failure (ALF; n = 56), acute decompensation in chronic liver failure (AcOCh; n = 35) and liver graft failure (n = 10). MARS seems to be a promising therapy for ALF, allowing the patient's own liver to recover or to gain enough time to find a liver graft. The most promising results, namely the highest number of livers to recovery were observed among acute patients with liver failure due to a toxic etiology. However, we did not discover much benefit of MARS for patients with AcOCh without liver transplantation.     

Stimulus-induced increase of taste responses in the hamster chorda tympani by repeated exposure to 'novel' tastants

Variations in amplitude of responses of the chorda tympani to repeated application of various novel tastants were measured in familiarized and control groups of adult hamsters. Three groups of 10 hamsters were pre-exposed to 5 mM dulcin, 50 mM potassium L-glutamate (KGlu) or 1 mM 5'guanosine monophosphate (5'GMP). In the fourth group, the tongue was rinsed with 5'GMP for 20 min just prior to recording from the chorda tympani. The tastants were novel to the fifth group (na?ve control). A series of 17 stimuli was repeated six times and responses were quantified relative to the initial response of each of the 50 hamsters. The responses of the chorda tympani increased with repetition in the control group. In contrast, no increase in amplitude of response to the pre-exposed tastants or to stimuli with qualitatively related tastes was observed in the group familiarized with either KGlu or 5'GMP. These results indicate that the response of the chorda tympani depends on previous exposure to a tastant. The sensitivity of taste cells appears to be modulated, possibly by stimulus-induced supplementary receptors.     

High cholesterol diet results in increased expression of interleukin-6 and caspase-1 in the brain of apolipoprotein E knockout and wild type mice

Inflammation in the central nervous system is an early hallmark of many neurodegenerative diseases including Alzheimer's disease (AD). Recently, increasing evidence suggests that hypercholesterolemia during midlife and abnormalities in the cholesterol metabolism could have an important role in the pathogenesis of AD. In the present study, we have evaluated the effect of high cholesterol (HC) diet on the expression of interleukin-6 (IL-6), a cytokine involved in neurodegeneration, and caspase-1, that is responsible for the cleavage of the precursors of interleukin-1 beta (IL-1 beta) and interleukin-18 (IL-18) in the brain of apolipoprotein E (Apo E) knock-out (KO) and wild type (WT) mice. The density of IL-6-positive cells was increased in the hippocampus (p<0.0001) and the dorsal part of the cortex (p<0.001) of KO and WT mice on HC diet (KOHC and WTHC mice, respectively) compared to KO and WT mice on ND (KOND and WTND mice, respectively). KOHC mice had increased caspase-1 positive cells and staining intensity in the hippocampus in comparison with WTHC mice (p<0.01). In the hippocampus, the density of caspase-1 positive cells was also higher in KOHC compared to KOND mice (p<0.05) and KOHC compared with WTHC mice (p<0.01). There was a major increase in caspase-1 immunoreactivity and cell density in both the dosal part of the cortex (p<0.001) and the lateral part of the cortex (p<0.005) in KO and WT mice on HC diet compared to ND. The findings of the present study indicate that chronic exposure to HC diet increases the expression of the two important inflammatory mediators IL-6 and caspase-1 in the brain of KO and WT mice. In the case of caspase-1, we report a major difference in the effect of HC diet on the KO mice compared to WT mice in the hippocampus. Increased expression of inflammatory mediators involved in neurodegeneration could be a potential mechanism by which hypercholesterolemia and HC diet increase the risk of AD.     

Non-Hodgkin's malignant lymphoma of the peripheral nervous system: clinicopathological correlations in ten patients

INTRODUCTION: Identifying tumor infiltration or compression in patients with non-Hodgkin's malignant lymphoma presenting peripheral neuropathy can be a difficult task. METHODS: We collected a series of patients with peripheral neuropathy with demonstrated lymphomatous infiltration or compression managed between October 1977 and October 2001 to search for clinico-pathological correlations. RESULTS: Ten cases were reviewed. Neurological manifestations were the inaugural symptom of the disease in 7 patients. Clinical presentations included 5 focal (3 cranial nerve palsies, 2 brachial radiculopathies) and 5 diffuse neuropathies (3 polyradiculoneuropathies, 1 polyneuropathy and 1 mononeuritis multiplex). The mechanisms of peripheral nerve involvement were classified into lymphomatous meningoradiculitis (5 cases), involvement of cranial nerves or spinal roots in their extraneuraxial course (3 cases) and infiltration of distal peripheral nerves (2 cases). Four long lasting survivals after treatment were observed. CONCLUSIONS: Prognosis depends much more on the haematological disease than on the neurological symptoms or tumor location.     

1H MRS studies in the Finnish boron neutron capture therapy project: detection of 10B-carrier, L-p-boronophenylalanine-fructose

This article summarizes the current status of 1H MRS in detecting and quantifying a boron neutron capture therapy (BNCT) boron carrier, L-p-boronophenylalanine-fructose (BPA-F) in vivo in the Finnish BNCT project. The applicability of 1H MRS to detect BPA-F is evaluated and discussed in a typical situation with a blood containing resection cavity within the gross tumour volume (GTV). 1H MRS is not an ideal method to study BPA concentration in GTV with blood in recent resection cavity. For an optimal identification of BPA signals in the in vivo 1H MR spectrum, both pre- and post-infusion 1H MRS should be performed. The post-infusion spectroscopy studies should be scheduled either prior to or, less optimally, immediately after the BNCT. The pre-BNCT MRS is necessary in order to utilise the MRS results in the actual dose planning.     

Tobacco: a potential inductor of lipid peroxidation of the human spermatozoon membrane?

OBJECTIVE: To determine the membrane lipid peroxidation of human spermatozoon in a cohort of smokers in comparison of never-smokers. MATERIALS AND METHODS: Malondialdehyde (MDA), a stable product of the membrane lipid peroxidation, was assessed in 25 smokers and in 17 never-smokers. In parallel, an evaluation of sperm characteristics was realized for all the studied patients. RESULTS: For the first time, between smokers and never-smokers, a significative increase of MDA concentrations was found by the U-Mann and Whitney test (0.118 +/- 0.176 vs 0.0392 +/- 0.0117 nmol/10(6) spermatozoa), a decrease of the forward motility (grade A), (18 +/- 8 vs 25 +/- 8%) and total sperm count (265.56 +/- 186.96 x 10(6) vs 399.30 +/- 322.23 x10(6)), and also an increase of tapering heads (6 +/- 4 vs 2 +/- 2%) or morphological stress pattern cells (39 +/- 6 vs 24 +/- 5%). In the smokers group, negative significative correlations were found by the non-parametric Spearman test between the MDA concentrations and the sperm count per mL (r=-0.767, p<0.001), the total sperm count (r=-0.656, p<0.001) and the percentage of normal morphology (r=-0.644, p<0.001). CONCLUSIONS: Given of deleterious effects of tobacco in a large panel of human cells and specially on the male gametes, the increase of spermatozoon membrane MDA concentrations and the sperm abnormalities found in the group of smokers may be linked to cigarette smoking.