INTERACTIONS BETWEEN THE CIRCULATORY EFFECTS OF CENTRAL HYPOVOLAEMIA AND ARTERIAL HYPOXIA IN CONSCIOUS RABBITS

1. Eight conscious rabbits were repeatedly subjected to progressive reduction in central blood volume by gradually inflating a thoracic inferior vena caval-cuff so cardiac index (CI) fell at a constant 8.5% of baseline/min. 2. Caval-cuff inflations were performed after 10 min exposure to 100, 21, 12–14 and 8–10% O₂, with and without the addition of 3–4% CO₂, in randomized order. 3. The haemodynamic response to progressive reduction in central blood volume was biphasic. In Phase I, systemic vascular conductance index (SVCI) fell linearly, supporting mean arterial pressure (MAP). When CI had fallen to a critical level, Phase II occurred in which SVCI rose abruptly, MAP plummeted and respiratory drive progressively increased. 4. During Phase I, there were independent linear relationships between Pao₂ (but not Pao₂) and the rates at which SVCI and MAP changed during the progressive fall of CI. The higher the level of Pao₂, the greater was the rate of fall of SVCI and the less the rate of fall of MAP. 5. There was an inverted U-shaped effect of Pao₂, on the level of CI at which Phase II occurred: (a) during hyperoxia (100% O₂), Phase II occurred later than during normoxia (21% O₂); and (b) across the normoxic and hypoxic gas mixtures (21–8% O₂, with and without added CO₂), there was an independent linear relationship between Pao₂ (but not Pao₂ or Pao₂×Pao₂) and the level of CI at which Phase II occurred. That is, the lower the level of Pao₂, the later was the onset of Phase II. This interaction is best explained by an increased level of central sympathetic vasoconstrictor drive during hypoxia.     

Single-dose oral omeprazole for reduction of gastric residual acidity in adults for outpatient surgery

Omeprazole is a substituted benzimidazole that causes dose-dependent intracellular inhibition of gastric acid secretion in humans. This double-blind study examined the effect of omeprazole in decreasing gastric acidity and gastric residual volume in outpatient adults. Unpremedicated outpatients, ASA I-III, 18 years or older (n = 17), were randomly assigned to receive omeprazole 80 mg, or placebo by mouth the night before scheduled elective outpatient surgery. The patients were fasted for 8 h prior to surgery. After the patient was anesthetized, an orogastric tube was inserted with proper placement verified by auscultation for gastric sounds. Gastric residual contents were withdrawn into a Luken's trap, and pH was then determined and gastric volume indexed to weight (ml.kg-1). Data were analyzed by a t-test, with P less than 0.05 considered statistically significant. Patient characteristics of both groups were similar. There was a statistically significant difference between the two groups for pH (P = 0.02), but not between the two groups for gastric volume indexed to weight (P = 0.07).     

Percutaneous transluminal angioplasty (PTA) of the deep femoral artery.

Between 1979 and 1988 43 percutaneous transluminal angioplasties (PTA) of the deep femoral artery were performed for treatment of severe claudication (n = 15) or for limb salvage (n = 28). Ateriographically, all patients had a long occlusion of the superficial femoral artery. Additional PTA of significant obstructions in the iliac and common femoral artery were performed in 6 patients of each group. Technical success was achieved in 41 of the 43 procedures (95%). Early clinical success was 60% for claudicants and 68% for patients with limb threatening ischemia. Success rates tended to be higher if additional PTA of the inflow tract was performed (75% versus 61%, n.s.). Patient with a good distal outflow benefited more frequently from PTA if they were treated for limb salvage (p less than 0.05). Within a follow-up period up to 24 months (mean 18.0 months) 5 patients died and one late failure occurred. Life table analysis lasting success in patients dilated for limb salvage, whereas success rate decreased to 48% in claudicants. PTA of the deep femoral artery is a less invasive and efficient treatment particularly for patients with limb threatening ischemia, an appropriate obstruction morphology provided.     

Angiographic and histologic findings in high frequency rotational ablation in coronary arteries in vitro

High-frequency rotational angioplasty is a recently developed method for coronary angioplasty in the catheter laboratory. An elliptical burr tip (phi 1.25-2.0 mm) with embedded diamant chips (phi 40-50 microns) is rotated by a helical drive shaft at 150,000-180,000 rpm. The burr is advanced over a 0.009-inch coaxial guide wire. To show the effects of this approach in diseased and healthy vessels, which may be present before and behind a stenosis, 17 atherosclerotic coronary arteries of nine human hearts, and 18 normal coronary arteries of nine pig hearts were treated by this method in vitro. Standardized coronary angiography was performed before and after Rotablator treatment, followed by histological examination. From these data the burr-to-vessel-diameter ratio was calculated for each vessel segment and compared with the angiographical and histological outcome. Partial or complete removal of the circumference of the innermost vessel wall layers was observed regularly. The average removal of tissue in human coronary arteries was limited to the intimal layer and in the pig coronary arteries to the internal elastic membrane. In the pig coronary arteries no intimal tears or dissections occurred, in human coronary arteries tears could be seen frequently (13 of 17 vessels (76%)). Media tears were observed in 3 of 17 vessels; one (2%) media dissection could be demonstrated; no perforation occurred. Thus, the in vitro studies suggest that coronary rotational angioplasty has only a slight effect on the vessel segment next to a stenosis, regardless of the burr-to-vessel-diameter ratio.(ABSTRACT TRUNCATED AT 250 WORDS)     

Associations among right minus left brain weight, right- and left-brain weight and the degree of paw preference in right- and left-preferent male and female cats.

The relation of right and left brain weight to right minus left (R-L) brain weight and the relation of R-L paw use to brain weight were studied in adults cats. The R-L brain weight was significantly larger than zero in right-pawed (RH) male and left-pawed (LH) females. The R-L brain weight was significantly smaller than zero in LH males, not significantly different from zero in RH females. The R-L brain weight was negatively linearly correlated with the left-brain weight in RH and LH males (no significant correlations in females). The R-L paw use showed a significant positive linear correlation with the R-L brain weight in RH male and females. There was a significant negative linear correlation between R-L paw use and R-L brain weight especially in LH males. Total brain weight showed a significant negative linear correlation with R-L paw use in RH males, and a positive linear correlation in LH males (no correlations in female cats). These results indicated that intermanual difference in paw use is associated with interhemispheric weight difference and total brain weight, especially in male cats; the left brain seems to be of importance in cerebral lateralization.     

Erectile dysfunction due to venous incompetence treated by dorsal vein ligation

The authors describe 14 cases of erectile dysfunction. The sites of leakage were detected by duplex or colour flow Doppler sonography. Treatment by dorsal vein ligation resulted in fairly good early responses, however, at 4-month follow-up the great majority of patients returned to the original functional state.     

A simple method of tattoo removal

The use of trichloracetic acid in the treatment of decorative tattoos is described. The technique is simple to perform. No anaesthesia or analgesia is required. Complications are uncommon and usually minor. Trichloracetic acid acts by inflicting a chemical burn.     

The synthetic prostaglandin E1 analogue rioprostil reduces the nephrotoxic potential of cyclosporine A

Acute CyA nephrotoxicity involves alteration in the proximal tubule and leads to glomerular lesions. Administration of a vasodilatator agent such as the prostaglandin E1 analogue Rioprostil (Bayer AG, BAY 06893) might prevent preglomerular vasoconstriction and hence reduce cyclosporin nephrotoxicity. As an increased excretion of urinary enzymes as a consequence of CyA-nephrotoxicity is well known we investigated in 40 male Wistar rats the excretion of three urinary enzymes: the brush border enzyme gamma-glutamyltransferase (GGT), the leucine aminopeptidase (LAP), and the lysosomal enzyme N-acetyl-beta-glucosaminidase (NAG). Additionally we determined s-creatinine and CyA plasma level. The kidneys were studied histologically at the end of the study. Wistar rats receiving 20 or 50 mg CyA/kg/d showed a marked deterioration in renal function and an increase of all urinary enzymes determined. In the rats receiving 20 mg CyA/kg/d and Rioprostil (150 micrograms/d) renal function and the enzymes determined remained in the normal range. There was no change in the enzyme excretion and only a minor improvement of renal function in rats receiving 50 mg CyA/kg/d and Rioprostil. Histological findings showed prevention of CyA nephrotoxicity in the 20 mg/kg/d group and diminished renal damage in the 50 mg/kg/d group.     

Complications following combined transrectal aspiration and core biopsy of the prostate

Ultrasound guided biopsy of the prostate with fine needle (22G) as well as trucut needle (18G) was performed in 145 patients with a suspicion of prostate cancer. After three weeks all patients were interviewed about complications associated with the biopsy. Hematuria and/or hemospermia occurred in 2/3 of the patients. None of the hemorrhages was severe and all ceased spontaneously. E. coli infection of the urinary tract occurred in 9 cases (6.2%). Five of the infections caused high fever and necessitated hospital care with parenteral antibiotics for 1 to 8 days. The patients with infection had no signs of immunological defects by which they might have been identified before the biopsy. As a consequence of these observations we now use prophylactic antibiotics when core biopsy of the prostate is performed transrectally.