The influence of pyridoxin in the treatment of tetanus neonatorum

During a 2-year-period (1988-1990) 31 patients with tetanus neonatorum were recruited for this study. The patients were divided into 2 groups: The first group (15 patients) was treated with ATS injection, oral metronidazole and amoxycillin, and diazepam suppositoria. The second group (16 patients) was treated with the same regimen, as the first group plus pyridoxin injection 100 mg on the first day followed by 25 mg orally on the next days. There was no statistical difference in the two groups concerning the gestation period, sex, severity of the disease (p greater than 0.05), place of delivery (all at home) and mode of delivery delivered by traditional midwife/dukun). The mortality of the first group (without pyridoxin) was 60% and the second (with pyridoxin) 37.5% (p less than 0.05).     

Surge Capacity Associated with Restrictions on Nonurgent Hospital Utilization and Expected Admissions during an Influenza Pandemic: Lessons from the Toronto Severe Acute Respiratory Syndrome Outbreak

Background Current influenza pandemic models predict a surge in influenza‐related hospitalizations in affected jurisdictions. One proposed strategy to increase hospital surge capacity is to restrict elective hospitalizations, yet the degree to which this measure would meet the anticipated is unknown. Objectives To compare the reduction in hospitalizations resulting from widespread nonurgent hospital admission restrictions during the Toronto severe acute respiratory syndrome (SARS) outbreak with the expected increase in admissions resulting from an influenza pandemic in Toronto. Methods The authors compared the expected influenza‐related hospitalizations in the first eight weeks of a mild, moderate, or severe pandemic with the actual reduction in the number of hospital admissions in Toronto, Ontario, during the first eight weeks of the SARS‐related restrictions. Results Influenza modeling for Toronto predicts that there will be 4,819, 8,032, or 11,245 influenza‐related admissions in the first eight weeks of a mild, moderate, or severe pandemic, respectively. In the first eight weeks of SARS‐related hospital admission restrictions, there were 3,654 fewer hospitalizations than expected in Toronto, representing a modest 12% decrease in the overall admission rate (a reduction of 1.40 admissions per 1,000 population). Therefore, influenza‐related admissions could exceed the reduction in admissions resulting from restricted hospital utilization by 1,165 to 7,591 patient admissions, depending on pandemic severity, which corresponds to an excess of 0.44 to 2.91 influenza‐related admissions per 1,000 population per eight weeks, and an increase of 4% to 25% in the overall number of admissions, when compared with nonpandemic conditions. Conclusions Pandemic modeling for Toronto suggests that influenza‐related admissions would exceed the reduction in hospitalizations seen during SARS‐related nonurgent hospital admission restrictions, even in a mild pandemic. Sufficient surge capacity in a pandemic will likely require the implementation of other measures, including possibly stricter implementation of hospital utilization restrictions.     

带真皮下血管网超薄皮瓣血运重建的实验研究（三）超薄皮瓣的再血管化与血供变化

以猪作为动物模型，对带真皮下血管网超薄皮瓣的血运重建规律进行了探讨。以超薄皮瓣为实验组，保留真皮下血管网皮片为对照组，按自身配对原则随机分为６个组。通过荧光素显色，透明标本，组织学，明胶墨汁灌注过程中超薄皮瓣的染色情况等观察，发现超薄皮瓣的再血管化发生在术后第５天，至第７天新生血管通过塑形趋于成熟。它既发生在皮瓣与受床之间，又发生在皮瓣与创缘之间，而且由皮瓣成活部分远端渐至近端。     

Induction, Recovery, and Safety Characteristics of Sevoflurane in Children Undergoing Ambulatory Surgery: A Comparison with Halothane

Background: Sevoflurane is an inhalational anesthetic with characteristics suited for use in children. To determine whether the induction, recovery, and safety characteristics of sevoflurane differ from those of halothane, the following open-labeled, multicenter, randomized, controlled, phase III study in children undergoing ambulatory surgery was designed.

Methods: Three hundred seventy-five children, ASA physical status 1 or 2, were randomly assigned in a 2:1 ratio to receive either sevoflurane or halothane, both in 60% N2 O and 40% O2. Anesthesia was induced using a mask with an Ayre's t piece or Bain circuit in four of the centers and a mask with a circle circuit in the fifth center. Maximum inspired concentrations during induction of anesthesia were 7% sevoflurane and 4.3% halothane. Anesthesia was maintained by spontaneous ventilation, without tracheal intubation. End-tidal concentrations of both inhalational anesthetics were adjusted to 1.0 MAC for at least 10 min before the end of surgery. Induction and recovery characteristics and all side effects were recorded. The plasma concentration of inorganic fluoride was measured at induction of and 1 h after anesthesia.

Results: During induction of anesthesia, the time to loss of the eyelash reflex with sevoflurane was 0.3 min faster than with halothane (P < 0.001). The incidence of airway reflex responses was similar, albeit infrequent with both anesthetics. The total MAC *symbol* h exposure to sevoflurane was 11% less than the exposure to halothane (P < 0.013), although the end-tidal MAC multiple during the final 10 min of anesthesia was similar for both groups. Early recovery as evidenced by the time to response to commands after sevoflurane was 33% more rapid than it was after halothane (P < 0.001), although the time to discharge from hospital was similar for both anesthetics. The mean (+/-SD) plasma concentration of inorganic fluoride 1 h after discontinuation of sevoflurane was 10.3+/-3.5 micro Meter. The overall incidence of adverse events attributable to sevoflurane was similar to that of halothane, although the incidence of agitation attributable to sevoflurane was almost threefold greater than that attributable to halothane (P < 0.004).     

COPD患者营养状况与生活质量的关系

观察５６例男性慢性阻塞性肺病（ＣＯＰＤ）患者的体检营养指标，并分析其与生活质量的关系，实测体重占理想体重的百分比和生活质量测评表中的日常生活能力，社会活动情况，抑郁心理障碍等项评分有显著相关性（Ｐ〈０．０５），上臂中点肌肉臂围与日常生活能力和社会活动情况的评分的相关也有统计学意义（Ｐ〈０．０５）。提示改善ＣＯＰＤ患者的营养状况对提高生活质量有重要意义。     

Recanalisation of occluded peripheral arteries by excimer laser

Laser recanalisation was attempted in 24 patients with total segmental occlusions of the lower extremity arteries and the aortic arch branches. All patients were men aged 40-82 years, in 20 the lesions were caused by atherosclerosis, in three by Buerger's thromboangiitis and in one by postembolic occlusion. Angioplasty was performed using excimer lasers with a wavelength of 308 nm and with monofiber waveguides in the transcutaneous transcatheter mode. Recanalisation of the vessel throughout the length of the obliterated segment was successful in 13 out of 24 patients. In all patients with thromboangiitis, energy losses were less than in atherosclerotic occlusions and no problems were experienced in patients with severe calcification. A high percentage of failures is a result of imperfect technology and low effectiveness of control, this must be improved. The Vishnevsky Institute of Surgery in collaboration with the Institute of General Physics has been developing a method of recanalisation of occluded arteries using excimer laser radiation. This paper is a preliminary analysis of our first clinical results.