Early adrenaline administration does not improve circulatory recovery during resuscitation from severe asphyxia in newborn piglets

Aim of the study

To investigate the effects of early intravenous adrenaline administration on circulatory recovery, cerebral reoxygenation, and plasma catecholamine concentrations, after severe asphyxia-induced bradycardia and hypotension.

Methods

One-day-old piglets were left in apnoea until heart rate and mean arterial pressure were less than 50 min⁻¹ and 25 mmHg, respectively. They randomly received adrenaline, 10 μg kg⁻¹ (n = 16) or placebo (n = 15) and were resuscitated with air ventilation and, when needed, closed-chest cardiac massage (CCCM). Eight not asphyxiated animals served as time controls.

Results

CCCM was required in 13 piglets given adrenaline and in 13 given placebo. Time to return of spontaneous circulation was: 72 (66–85) s vs. 77 (64–178) s [median (quartile range)] (p = 0.35). Time until cerebral regional oxygen saturation (CrSO₂) had increased to 30% was 86 (79–152) s vs. 126 (88–309) s (p = 0.30). The two groups did not differ significantly in CrSO₂, heart rate, arterial pressure, right common carotid artery blood flow, or number of survivors: 13 vs. 11 animals. Plasma concentration of adrenaline, 2.5 min after resuming ventilation, was 498 (268–868) nmol l⁻¹vs. 114 (80–306) nmol l⁻¹ (p = 0.01). Corresponding noradrenaline concentrations were 1799 (1058–4182) nmol l⁻¹vs. 1385 (696–3118) nmol l⁻¹ (ns). In the time controls, the concentrations were 0.4 (0.2–0.6) nmol l⁻¹ of adrenaline and 1.8 (1.3–2.4) nmol l⁻¹ of noradrenaline.

Conclusion

The high endogenous catecholamine levels, especially those of noradrenaline, may explain why early administered adrenaline did not significantly improve resuscitation outcome.     

Transvascular treatment of giant aneurysms of the cavernous carotid and vertebral arteries: Functional investigation and embolization

Functional angiographic investigation and percutaneous embolization using detachable balloons in nine carotid cavernous aneurysms, three petrous aneurysms, one vertebral artery aneurysm, and one posterior inferior cerebellar aneurysm are reported. A double-lumen balloon catheter is used to evaluate acute tolerance to occlusion of the carotid or vertebral arteries. Occlusion is tested under systemic heparinization. Local perfusion of heparinized saline, proximal as well as distal, to the balloon occlusion is used. The procedure was successful in all but one cavernous aneurysm. The arterial lumen was sacrificed in all cases. Clinical improvement occurred in all successful cases. Retroorbital pain was relieved in all. Ocular cranial nerve palsies improved or resolved in most. One delayed ophthalmic episode that improved represents the only complication. No such embolic problems occurred in any case in which the cavernous carotid artery was occluded by balloon trapping. The delayed embolic complications after carotid artery occlusion are related to the collateral vessels to the C-4 and C-5 segments of the artery. Balloon trapping decreases the length of the thrombosed segment and prevents retrograde filling of the aneurysm.     

Duplex ultrasound evaluation of cavernosal peak systolic velocity and waveform acceleration in the penile flaccid state: clinical significance in the assessment of the arterial supply in patients with erectile dysfunction

The aim of this paper was to establish if duplex ultrasound parameters obtained for assessment of the patency of cavernosal arteries in the penile flaccid state can give sufficient clinical information without the use of intracavernosal injection of vasodilatory drugs. We assessed mean cavernosal peak systolic velocity (PSV) in the penile flaccid state (basal PSV), and after PGE1 injection (dynamic PSV) in 339 unselected patients with erectile dysfunction. In 55 of these patients the waveform acceleration in the flaccid state was also assessed. The results of the study can be summarized as follows: (1) a significant relationship was found between basal and dynamic PSV in the 339 patients (r=0.477; p < 0.0001); (2) a basal PSV >12.5 cm/sec was predictive of a dynamic PSV >/=30 cm/sec in 129/139 (92.8%) of the patients, whereas in patients with a basal PSV or <30 cm/sec could be found; and (3) an acceleration >1 m/sec2 in the flaccid state was coupled to a dynamic PSV >30 cm/sec in 43/46 (93.5%) of the patients independent of the basal PSV. In conclusion, these results suggest that the combined duplex ultrasound assessment of PSV and waveform acceleration in the penile flaccid state can predict arterial dynamic inflow in the majority (51/55; 92.7%) of patients with erectile dysfunction, with less time and expense and less discomfort for the patient.     

Trasplante renal mediante reconstrucción de conducto vascular en riñones de donantes fallecidos con arterias renales múltiples y venas renales cortas

BackgroundTransplantation of kidneys with vascular anatomical variants remains a challenge. Due to its varying success in regard to graft function after transplantation, these organs have been frequently discarded assuming in advance an unaffordable rate of vascular complications.Patients and methodsWe performed three kidney transplants using organs from deceased donors harboring vascular variants (multiple arteries and short veins), including an unsplittable horseshoe kidney. Different grafts harvested from the same donor aorta, common iliac artery, and inferior vena cava, were used to reconstruct the initial vascular configuration by creating single arterial and venous conduits aimed to simplify the vascular anastomoses in the recipient.ResultsNo post-operative complications were recorded. Warm ischemia times remained comparable to single artery renal allografts. No delayed graft function was noted in any case, and every patient regained normal renal function after transplantation.ConclusionsVascular reconstruction using arterial and venous grafts harvested from the same deceased donor may result a helpful tool to simplify vascular anastomoses during transplantation surgery, thus avoiding their discard in advance, minimizing perioperative complications, and enabling normal graft function rates in the long-term follow-up. The successful outcome obtained by using this approach would help to expand the donor criteria for the inclusion of organs containing vascular anatomical variants.     

利用腹壁下动脉穿支皮瓣阴茎再造的临床研究

目的 探讨腹壁下动脉穿支(DIEP)皮瓣阴茎再造手术方法的临床疗效.方法 2003年12月至2006年11月收治体外热疗致阴茎严重烧伤2例、假两性畸形1例、动物咬伤致阴茎大部缺损1例.患者平均年龄31岁.术前残余阴茎常态下长度0.5～1.5 cm.应用DIEP皮瓣及第12肋骨植入行一期阴茎再造术.结果 4例手术均成功,皮瓣完全成活,术后未发生感染、尿道狭窄等并发症.3例术后随访5～32个月,再造阴茎外形逼真,阴茎定型长度7.5～11.0 cm,排尿正常,未发生严重感染及尿道狭窄,皮肤感觉与勃起功能良好.1例近期手术者随访3个月阴茎感觉仍在恢复中.结论 该手术方法设计合理,手术一期完成,术后再造阴茎形态功能良好,能满足患者及配偶性生活的要求.供区损伤小,是比较理想的阴茎再造方法.     

妊娠高血压综合征患者胎盘绒毛组织内皮素1和内皮型一氧化氮合成酶的基因表达及其脐动脉血流变化

目的　研究妊娠高血压综合征 (简称妊高征 )患者胎盘绒毛组织内皮素 1(endothelin- 1,ET- 1)及内皮型一氧化氮合成酶 (endothelial nitric oxide synthase,e NOS)的基因表达 ,探讨 ET- 1及一氧化氮在妊高征患者胎儿胎盘循环中对脐动脉血流变化的作用。　方法　对妊高征患者及正常妊娠孕妇的胎盘绒毛组织 ,用地高辛标记的 ET- 1及 e NOS互补脱氧核糖核酸 (com plem entary deoxyri-bonucleotide,c DNA)探针进行点印迹杂交 ,利用 L eica QWIN图象处理系统测量每个杂交点的平均光密度值。在分娩前一日用彩色超声多普勒仪测定其脐动脉血流 S/ D值。　结果　妊高征患者胎盘绒毛组织 ET- 1基因表达明显增多 ,其平均光密度值妊高征组为 0 .43± 0 .0 3,正常组为 0 .2 3± 0 .44两组间差别显著 P<0 .0 5。而妊高征组胎盘绒毛组织 e NOS基因的表达明显低于正常对照组 ,其平均光密度值妊高征组为 0 .19± 0 .2 2 ,正常组为 0 .38± 0 .0 2 ,两组间差别显著 P<0 .0 5。妊高征组脐动脉S/ D值明显高于正常对照组 ,分别为 5 .92± 2 .13和 2 .11± 0 .2 2 ,两组间差别显著 P<0 .0 5。　结论　妊高征患者胎盘绒毛组织 ET- 1的表达明显增加 ,而内 e NOS的表达明显减少 ,脐动脉血流阻力亦明显增加。妊高征患者脐动脉血流