Normal and Variant Isoenzymes of Human Blood Cell Hexokinase and the Isoenzyme Patterns in Hemolytic Anemia

Electrophoresis of red cell hexokinase inagarose electrophoresis revealed twomajor (1 and 2) and two minor (3 and 4)bands. Platelet and leukocyte hexokinasepatterns differed from those of red cells.There was a strong band 1, but considerably faster bands termed 5, 6 and7 were also observed which were sensitive to changes in glucose concentration.The presence of contaminating leukocytes can significantly alter the electrophoretic pattern of "red cell" hexokinaseactivity. Bands 2, 3 and 4 of red cellsappeared to be synthesized independently of band 1 and absence of band 1did not effect either red cell metabolismor survival. Absence of bands 2, 3 and4 may be associated with hemolyticanemia, decreased erythrocyte hexokinaseactivity and decreased erythrocyte glycolysis. Young red cells had increasedactivity of all bands, particularly band2. No influence of hemoglobin type onhexokinase patterns was observed, norwas there any selective influence of cellstorage, medium glucose, or 2-mercaptoethanol on individual bands. None ofthe various isoenzyme patterns were associated with abnormal hexokinasekinetics.

Submitted on September 26, 1969 Revised on January 21, 1970 Accepted on January 23, 1970     

Blood glucose and insulin levels during epidural anaesthesia in children receiving dextrose-free solutions

Summary
This study was designed to evaluate the hyperglycaemic response to surgery in two groups of children undergoing minor surgical procedures and receiving dextrose-free solutions during the perioperative period. Twenty-four unpremedicated children of less than eight years of age were randomly assigned to receive either general anaesthesia using halothane, vecuronium and narcotics (GA group, n = 12) or general anaesthesia (halothane, vecuronium) combined with caudal anaesthesia (RA group, n = 12). In both groups blood glucose and insulin concentrations were measured during inhalational induction (T0), at the end of surgery (T1) and 30, 60, 120 min after surgery (T2, T3, T4). A significant hyperglycaemic response to surgery was observed in the GA group, while no changes in blood glucose were observed in the RA group. The maximal blood glucose value was observed 30 min after completion of surgery. Insulin changes followed closely changes in blood glucose values. This study demonstrates that epidural anaesthesia was effective in reducing the hyperglycaemic response to surgery in children scheduled for minor surgical procedures. The lack of increase in blood glucose values under epidural anaesthesia suggests that blood glucose levels should be monitored during the perioperative period, especially after a prolonged fasting time and when oral intake might be delayed.     

Evaluation of current paediatric guidelines for fluid therapy using two different dextrose hydrating solutions

Simplified guidelines for intra-operative fluid therapy were evaluated in two groups of children (aged 3 months-10 years) undergoing minor non-haemorrhagic surgical procedures, randomly assigned to receive either 5% or 2.5% dextrose in 0.3% or 0.4% normal (N) saline. Blood samples were obtained at the time of induction and upon arrival in the recovery room. Fasting time was on average greater than 10 h and hypoglycaemia, defined as blood glucose less than 3.5 mmolċl⁻¹, was observed in 7.4% of the children at the time of induction. In both groups, blood glucose increased at the end of surgery, this increase being more significant in children receiving 5% dextrose than in those receiving 2.5% dextrose. In both groups, post-operative blood glucose values were higher in children of less than 4 years of age than in those aged 4 and over. Blood glucose changes were associated with a decrease in plasma sodium, this decrease being greater in children receiving 5% dextrose in 0.3 _N saline, especially in those less than 4 years of age. This study suggests that the use of a 5% dextrose hydrating solution in 0.3 _N saline is more likely to result in hyperglycaemia and hyponatraemia than a 2.5% dextrose in a 0.4 _N saline, particularly in children younger than 4 years of age.     

Pacemaker Inhibition and Asystole in a Pacemaker Dependent Patient

A 17-year-old female with Kearns Sayre syndrome, complete heart block, and an implanted single chamber (VVIR) pacemaker, underwent testing with a GSM cellular phone that was placed directly over the pacemaker site. The pacemaker was immediately inhibited when the phone began to operate. A 6.5-second period of complete heart block with asystole occurred until the phone was switched off.     

Growth and development of 280 hypothyroids patients at diagnosis

The growth and development of 280 hypothyroidic patients who were diagnosed from 1979 to 1991, has been evaluated by standardized anthropometric criteria. According to the chronologic age during the diagnosis, the patients were divided into five groups of 0–6, 7–12, 13–24, 25–60 and 61–144 months. In these groups, the rates of the patients' weights and heights which were found below the 5th percentile, were as follows; for height 44%, 69%, 71%, 85%, 80% and for weight 38%, 68%, 70%, 55%, 60% respectively. Height age, weight age, head circumference age, and bone age were found to be significantly lower than chronologic age in all the groups, with the exception of the head circumference age in the 0–6 months group. The bone age was found to be significantly retarded compared to the height age in all the groups.     

CONTINUOUS EXTRADURAL ANAESTHESIA IN CHILDREN: Clinical and Haemodynamic Implications

This study reports the experience of a department of paediatricanaesthesia with 234 continuous extradural anaesthetics performedin 229 children over a 15-month period. Fifty-nine of the childrenwere aged 0–2 yr, 71 were aged 2–8 yr and 104 wereolder than 8 yr. The surgical procedures lasted more than 60min (mean 150±10.6 min); all were carried out under lightgeneral anaesthesia. Technical procedure and difficulties arereported. The only local anaesthetic agent used was bupivacainewith or without adrenaline. Mean initial dosage was 0.75 mlkg^–1 for children weighing less than 20 kg and 1 ml/10cm of height for children taller than 100 cm. Using 0.25% bupivacainemean times until a further injection were 92.0±2.0 minfor bupivacaine with adrenaline and 71.0±2.5 min forbupivacaine without adrenaline (P < 0.001). A much longerduration of analgesia was found for younger children using thesolution with adrenaline. A haemodynamic study was performedin 74 unpremedicated children (ASA l; aged 0–2 yr (n =15), 2–8 yr (n = 26) and older than 8 yr (n = 35)). Beforeinduction of anaesthesia, heart rate (HR) was significantlyincreased in the youngest children, but no significant changewas found for systolic arterial pressure (SAP). After extraduralanaesthesia with 0.25% bupivacaine with adrenaline 1:200000,minimal changes in HR or SAP occurred in children younger than8 yr; in those older than 8 yr a significant decrease in bothHR and SAP was observed. Changes in SAP were at their maximum25 min after the extradural block and changes in HR were notstatistically significant before the 25th min following injectionof local anaesthetic. The catheter remained in place in 155children for postoperative analgesia, mainly for the first 48h.     

含L-精氨酸氧合温血肺动脉持续灌注对肺组织的保护作用

目的 体外循环(CPB)期间观察肺动脉持续灌注氧合血及氧合血内加入L-精氨酸对肺组织的保护作用.方法 45例择期常规行二尖瓣置换术病人纳入临床对照研究,随机分成对照组,常规体外循环;灌注组,肺动脉持续灌注氧合血;加药组,肺动脉持续灌注含L-精氨酸(200 mg/kg)的氧合血;每组各15例.3组病人均采用常规CPB,灌注组和加药组从肺动脉根部持续灌注氧合血至CPB开放主动脉结束.分别在麻醉后、开放主动脉1 h,回ICU 0、6、12、24 h取桡动脉血,采用双抗体夹心酶联免疫吸附试验(ELISA法)测定肿瘤坏死因子(TNF-α)、白细胞介素6(IL-6)、白细胞介素10(IL-10)的表达.征得病人本人及家属同意,于CPB前及停机后30min取1.0 cm×1.0cm×1.0cm右下肺组织.光镜观察肺组织结构变化.结果 45例术中及术后经过顺利,均痊愈出院.开放主动脉后,加药组和灌注组血浆中TNF-α、IL-6水平明显低于对照组(P<0.05),加药组优于灌注组;IL-10水平高于对照组,加药组优于灌注组.对照组光镜下见肺泡间质水肿,肺泡内大量中性粒细胞渗出,细胞核碎裂;灌注组肺泡毛细血管轻度充血,肺间质淋巴细胞浸润;加药组基本保持了正常的肺组织结构.结论 CPB期间持续肺动脉灌注氧合血对肺组织有保护作用;L-精氨酸对肺组织也有保护作用.