Prediction of severe postoperative complications in patients admitted to neuroanaesthesia

The purpose of this study was to identify factors which will predict the risk of severe postoperative complications in individual patients in a neurosurgical unit. Eleven risk factors were investigated in 363 neurosurgical patients, of whom 40 (11%) developed postoperative complications requiring mechanical ventilation for more than 24 h in an intensive care unit, 16 were found to be severely disabled or in a vegetative state at follow-up 1 month after admission, and 28 patients died. By applying stepwise, logistic regression analysis to the patient's data, we were able to select two significant risk variables, i.e. the Glasgow Coma Scale (GCS) 8 or less preoperatively and emergency anaesthesia. The presence of GCS 8 or less on the consciousness scale was associated with postoperative complications in approximately 40% of the cases. Emergency patients with severe neurological damage had the greatest risk of postoperative complications (93%). Fatal outcome for patients with postoperative complications was seen in 40% of the cases.     

A double-blind cross-over study of nifedipine retard in patients with Raynaud's phenomenon

Summary The effectiveness of nifedipine retard as a treatment for Raynaud's phenomenon was assessed in 15 patients in a placebo controlled double blind study. An associated connective tissue disease was evident in 7 patients. Changes in finger and forearm blood flow (venous occlusion plethysmography), digital skin temperature and digital systolic pressure were measured acutely before and after a 2-week treatment period. Subjective assessment of efficacy was based on patient diary data. In addition alpha₂-adrenoceptor density on platelets was measured before and after chronic nifedipine therapy in both the patient group and in an age-and-sex-matched control group. No significant haemodynamic changes were observed. Nifedipine retard significantly reduced the frequency (p<0.05) with no change in either the duration or severity of vasospastic attacks. Side effects were commono following nifedipine retard. A reduction in alpha₂-adrenoceptor density on platelets was observed in patients compared to a control group (p<0.05). Alpha₂-adrenoceptor density was unchanged following a 2-week treatment period with nifedipine retard. This study concludes that nifedipine retard is not effective in the treatment of Raynaud's phenomenon over a short time course. Patients with Raynaud's phenomenon have reduced alpha₂-adrenoceptor densities on their platelets.     

Allergy to barium sulfate suspension with angioedema of the stomach and small bowel

Hypersensitivity reactions occurring during barium studies of the gastrointestinal tract are rare. A case is presented with radiographically demonstrated angioedema in the stomach and small bowel accompanied by allergic rhinitis, which was apparently an allergic response to the barium sulfate suspension. The reaction was documented twice during separate challenges to the barium suspension performed several months apart.     

Vascular cell adhesion molecule-1 modulation by tumor necrosis factor in experimental allergic encephalomyelitis

Anti-tumor necrosis factor (TNF) antibodies inhibit passively transferred experimental allergic encephalomyelitis (EAE) in SJL mice. The possibility that this occurs through interference in TNF's upregulation of endothelial cell adhesion molecules was investigated. Expression of both vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1) on spinal cord vessels increased during EAE. The upregulation of VCAM-1 was markedly reduced or prevented by anti-TNF treatment. Leukocytic infiltration was 15-fold lower in anti-TNF-treated than diseased animals. Spinal cord endothelial expression of VCAM-1, though not ICAM-1 or fibronectin, positively correlated with the extent of T cell, B cell or monocyte infiltration in each animal.     

糖皮质激素受体阻断对烫伤大鼠肺、肾血管壁通透性变化的影响

我们以糖皮质激素受体（ＧＲ）的竞争性拮抗剂ＲＵ３８４８６（简称ＲＵ４８６）阻断大鼠体内的ＧＲ，并通过检测肺、肾组织匀浆中荧光标记白蛋白的含量，观察了烫伤后１２ｈ大鼠肺、肾血管壁通透性的变化以及阻断ＧＲ对这种变化的影响。结果显示：烫伤后１２ｈ，大鼠肺、肾组织匀浆中荧光标记白蛋白含量明显高于对照组（肺：Ｐ＜０．０５；肾：Ｐ＜０．００１）；阻断ＧＲ后再烫伤大鼠，其肺、肾组织匀浆中的荧光白蛋白含量又显著高于烫伤组（Ｐ＜０．０５）。提示：①烫伤后１２ｈ，大鼠肺、肾血管壁通透性明显升高。②ＧＲ减少可加重烫伤所致的血管壁通透性升高，并可逆转内源性糖皮质激素（ＧＣ）稳定血管壁通透性的作用。     

蛛网膜下腔出血后正常颅压脑积水(附20例分析)

本文分析了20例有明确蛛网膜下腔出血病史的正常颅压脑积水患者的临床表现,其中有智能、步态障碍、尿失禁三联征典型表现者占11例(55％),有其中二个症状者4例。CT是诊断脑积水的首选检查。本文还结合文献对正常颅压脑积水的发生发展,与之有关的因素及临床表现进行讨论。     

Subhepatic collections complicating laparoscopic cholecystectomy: Percutaneous management

Ten patients with subhepatic fluid collections complicating laparoscopic Cholecystectomy were successfully treated by interventional radiological procedures. The series included five abscesses, three hematomas, one biloma, and one serous collection. Abdominal pain or fever developed from 3 to 21 days after the laparoscopic intervention. All patients were asymptomatic 72 h after percutaneous drainage and there were no complications related to the procedure. Subhepatic fluid accumulations are common findings after laparoscopic cholecystectomies and have been considered an unreliable indicator of infection or other postoperative complications. However, the significance of these collections should not be underestimated in symptomatic patients. In such cases we propose diagnostic aspiration and drainage, when necessary, to safely and promptly establish the precise diagnosis and treatment. More serious complications can be avoided by early percutaneous intervention.     

同型半胱氨酸对大鼠血管平滑肌细胞胶原蛋白合成及其mRNA表达的影响

目的 :观察同型半胱氨酸 ( Hcy)对血管平滑肌细胞 ( VSMCs)胶原合成的影响 ,并探讨其作用机制。方法 :本实验采用体外培养的大鼠 VSMCs,加入不同浓度的 Hcy,通过 3 H-脯氨酸掺入、α1[ ]型胶原测定观察 Hcy对 VSMCs胶原合成的影响 ,并通过半定量 RT- PCR检测其对 α1[ ]型胶原 m RNA表达的影响。结果 :Hcy促进 VSMCs的胶原合成及 α1[ ]型胶原 m RNA表达 ,并呈剂量依赖效应。结论 :Hcy促进 VSMCs的胶原合成 ,可能是通过促进 α1[ ]型胶原 m RNA表达实现的。提示 Hcy促进胶原合成可能是动脉粥样硬化的发病机制之一     

An improved technique for treating tracheostomal stenosis following laryngectomy

Stenosis of the tracheostome is an occasional complication following laryngectomy. Having tried a number of procedures recommended for correction of such stenoses with limited results, we developed a new technique. This technique which is based on multiple Y-V plasties has been applied to 20 patients. Measurements of the stomal area following surgery in 18 patients showed an average increase in stomal size by a factor of 3.8. One patient apparently had no increase of the stoma. In 2, no post-operative measurements were available. Post-operative infection resulted in recurrence of the stenosis in one patient. He was successfully reoperated using the same technique. Follow-up revealed that none of the patients had complaints related to their stoma.