新型高级创伤外科机动救治力量及其培训体系的建立

未来远海环境下的舰艇编队作战将成为我海军主要作战形式。远海作战战场广阔、攻防形势转换快、所致伤情伤势复杂,易在任意时间、任意战场地点瞬间产生批量伤员,救治难度极大。本文系统介绍了一种针对远海舰艇编队作战的新型高级创伤外科机动救治队伍及其专属模块化、标准化、轻量化的手术复苏装备系统,并阐述其培训体系构想,以备卫勤研究者、参与者借鉴参考。     

Developmental transition in plasticity properties of differentiating astrocytes: age-related biochemical profile of plasminogen activators in astroglial cultures

Plasminogen activator (PA) is a key enzyme in control of the cascade of extracellular proteolytic activities, proteases that degrade the extracellular components. Mammalian cells produce two molecular forms of PA, the urokinase type (u-PA) and the tissue type (t-PA); the u-PA type enzyme regulates cell migration/invasion and related tissue plasticity events. Thus, these plasticity properties of cells are defined by their PAs' biochemical profiles. The capacity of the differentiating glial cells of the central nervous system (CNS) to express and regulate the two types of PA activities has been examined as a function of cell age in culture. Results of the study suggest that only the immature astrocyte is endowed with these plasticity properties. Differentiating heterogeneous rat glial cells in culture express PA activity. Astroglia were identified as the primary source for the glial PA activity, as no PA activity was detected in the purified oligodendroglia. Cellular PA activity levels of differentiating rat and mouse astroglia are developmentally regulated. The specific activity of PA reached its highest level in rat astroglia at a cell age corresponding to 20-32 postnatal days (P20-P32) and in mouse astroglia at P8-P14; thereafter, this declined (three- to fourfold decrease) within 2 weeks to a low value. At comparable ages (P0-P35), the magnitudes of the PA specific activities of the differentiating rat astroglia and of the developing cerebrum, the tissue from which these cells were purified, were similar. Differentiating rat astroglia produce u-PA and t-PA, the cellular content of both is developmentally regulated, and the u-PA form is only found in the immature cells. u-PA is the predominant form in the immature astrocyte until age P13. Both forms are found in cells at ages P14-P30, and at later stages u-PA disappears while the t-PA type persists as the sole form. After 3 more weeks neither of the PA types was detected. Astroglia express also PA inhibitory activity; the rat astroglial PA inhibitor (PAI) seemed to be identical to PAI-1, one of the known types of PAIs. Stimulation of astroglial proliferation by their subculturing in contrast to Schwann cells did not lead to an increase; rather, beyond a certain cell age (P13) it resulted in a threefold irreversible decline in the PA specific activity of the daughter cells. It has been established that various biochemical properties of CNS mature glia appear on schedule with cell age in culture, thus defining "mature"glia in vitro.(ABSTRACT TRUNCATED AT 400 WORDS)     

Heterogeneity in the Dorsal Subiculum of the Rat. Distinct Neuronal Zones Project to Different Cortical and Subcortical Targets

The aim of the present study was to relate the distribution of efferents of the dorsal subiculum to their origin along the proximodistal axis of the subiculum. The distribution of subicular projections was studied in detail by means of the sensitive anterograde tracer Phaseolus vulgaris-leucoagglutinin (PHA-L), and the precise origin of these projections analysed with retrogradely transported fluorescent tracers, using double- and triple-labelling protocols. Injections of PHA-L in the proximal part of the dorsal subiculum, i.e. that part which borders field CA1, result in labelling of the infralimbic, entorhinal and perirhinal cortices, the nucleus accumbens and the lateral septal region, the interanteromedial nucleus of the thalamus, the core of the nucleus gelatinosus, and the mammillary nuclei, in particular in the rostral parts of the medial nucleus. In contrast, injections in the distal part of the dorsal subiculum, i.e. that part which borders the presubiculum, give rise to labelling in the retrosplenial and postrhinal cortices, the presubiculum, the anterior thalamic complex, the shell of the nucleus gelatinosus, and the mammillary nuclei, preferentially in the caudal part of the medial nucleus. The results of injections of different retrograde tracers, simultaneously placed in two or three targets of the subicular efferents, confirm the results of the anterograde tracing experiments. Moreover, they clearly demonstrate that the population of subicular neurons which, for example, projects to the nucleus accumbens and the interanteromedial nucleus of the thalamus is almost completely segregated from the population that projects to the retrosplenial cortex and the anterior complex of the thalamus. Thus within the dorsal subiculum, populations of neurons can be differentiated so that each population projects to a unique set of target structures. These cell populations are differentially positioned along the proximo-distal axis. In view of additional evidence indicating that some of the major afferents to the subiculum are organized along the same axis, we suggest that the heterogeneity of the dorsal subiculum along the proximo-distal axis reflects a general organizational characteristic of this hippocampal field.     

Diabetic autonomic neuropathy: Abnormal cardiovascular reactions under general anesthesia

Summary The influence of diabetic autonomic neuropathy upon the behavior of the circulatory system was investigated in 56 patients who had undergone ophthalmological surgery. A standardized test combination (variability in heart rate during deep breathing, Valsalva ratio, 3015 ratio, change in blood pressure from lying to standing, sustained handgrip test) was used to study the patients' cardiovascular reflectory reactions. The patients were then divided into the following groups: Group I, non-diabetics Group II, diabetics without autonomic neuropathy Group III, diabetics with autonomic neuropathy The anesthetic (induction by barbiturates and conduction by inhalation agents) and the surgical procedure (pars plana vitrectomy) were standardized and always identical. During anesthesia patients in group III experienced hypotensive reactions (systolic blood pressure below 90 mm Hg) significantly more often (72.2%) than patients in group I (25%). In order to achieve stability in blood pressure the patients of group III had to be given vasoactive drugs much more often (77.8%) than the patients of group I (12.5%) and those of group II (35.7%). We found a significant correlation between the degree of autonomic dysfunction and the largest drop in blood pressure under narcosis (r=–0.60,P<0.001). However, marked variability in heart rate and cardiac rhythm disorders during anesthesia were seen only in patients of groups I and II. These results prove the atypical hemodynamic behavior and especially the extreme instability in blood pressure in diabetic autonomic neuropathy under general anesthesia. Therefore we consider it to be very helpful to check the cardiovascular reflectory status of diabetics preoperatively.Abbreviations AN autonomic neuropathy - AV atrioventricular - BP blood pressure - bpm beats per minute - cm centimeter - f female - HR heart rate - m male - PD diastolic blood pressure - PS systolic blood pressure     

Klassifikation der Nierenzellkarzinome/Tumoren und ihre Beziehung zum Nephron-Sammelrohrsystem

Summary After a controversial phase of nomenclature (including — among others — the terms hypernephroma and hypernephroid carcinoma) a cytomorphologically defined subtyping of renal cell tumours (adenomas, carcinomas, oncocytomas) is offered, based on new electron microscopical and histochemical observations. These data are in part supported by cytogenetical findings reported in the literature. Phenotypical/histogenetical relations to different parts or cell types, respectively, of the nephron-collecting duct system could be demonstrated. Chromophobe cell carcinoma and oncocytoma exhibit features of the intercalated cells.

Herrn Prof. Dr. Dr. h.c. Adalbert Bohle gewidmet     

Einflu\ eines Β1-Rezeptorenblockers auf die Plasmaspiegel des atrialen natriuretischen Peptids bei Patienten mit essentieller Hypertonie unter Ergometerbelastung

Summary In order to investigate the behaviour of atrial natriuretic peptide (ANP) in untreated mild to moderate essential hypertension and the influence of blood pressure normalisation by a ₁-receptor blocker a study was conducted in groups of normotensive and hypertensive middle aged subjects. 10 normal subjects and 10 patients with essential hypertension (WHO I–II) without any medication and on betaxolol monotherapy were studied at rest and during graded exercise. In addition the response of ANP, cyclic guanosine monophosphate (cGMP) and the renin-aldosterone-system was investigated.Normal subjects and hypertensive patients did not differ in ANP levels at rest and also responded with a comparable exercise dependent increase at all workload levels. A steady decrease of ANP was noticed during the recovery period in both groups. After-blocker treatment in the hypertensive patients ANP concentrations significantly rose, both at rest and more pronounced during exercise. cGMP reacted in a similar way but showed a more inert response. A counter-regulatory behaviour between ANP and PRA or aldosterone, as seen under volume shifts, could not be detected. These findings demonstrate that plasma ANP is not altered in untreated essential hypertension. Increased ANP levels in ₁-blocker treatment may contribute to its blood lowering effect.

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Abkürzungsverzeichnis ANP atriales natriuretisches Peptid - ALD Aldosteron - C_In Inulin Clearance - cGMP zyklisches Guanosinmonophosphat - irANP immunoreaktives atriales natriuretisches Peptid - PAH Paraaminohippursäure - PRA Plasma-Renin-Aktivität - RAA-System Renin-Angiotensin-Aldosteron-System - RBF renaler Blutflu - RIA Radioimmunoassay - RVR renaler Gefä\widerstand     

Flexible effects of quantified cigarette-smoke delivery on EEG dimensional complexity

A quantified smoke delivery system (QSDS) was used to experimentally control the administration of inhaled cigarette smoke to 28 male smokers. One puff (2 s, 35 cc) was taken every 30 s on a cigarette (nicotine yield 1.0 mg) until the char line reached 3 mm from the filter wrap. The smoke was inhaled for 5 s. Resting eyes-closed and eyes-open EEG was recorded from F3, F4, P3, and P4 before and after quantified smoke delivery (QSD). EEG dimensional complexity (DC _x, a measure derived from chaos theory) was computed using the Takens-Ellner method. QSD appeared to have a flexible effect on EEGDC _x, primarily lowering it in subjects whose pre-smoking level was high, not affecting it in subjects whose pre-smoking level was intermediate, and tending to raise it in subjects whose pre-smoking level was low. This replicates previous results obtained with ad libitum smoking, suggesting the hypothesis that smoking may have an optimizing effect on the complexity of brain dynamics.     

Natural frequency/damping coefficient relationship of the catheter-manometer system required for high-fidelity measurement of the pulmonary arterial pressure

Using a digital simulation method, we analyzed the relationship between natural frequency (f _n ) and damping coefficient () of the catheter-manometer system required for high-fidelity measurement of the pulmonary arterial pressure. The pulmonary artery pressure waveform was obtained with a catheter-tip transducer and it was fed into a dynamic simulator programmed on a computer. The original waveform and the output of the simulator were compared and judged visually for the fidelity. From this analysis, the combination of f _n and was obtained and was plotted on a f _n – diagram. It showed as an area, which was convex on the left side and open on the right side. The left-convex endpoint was located at a damping coefficient of about 0.7. At a lower heart rate, this area was extended to the lower frequency side, while, at a higher heart rate, this area was limited to the higher frequency side. The f _n – diagram was also constructed theoretically by calculating the relations between natural frequencies and damping coefficients of a second order system with the amplitude and phase error tolerance set at +/–5% respectively.(Kinefuchi Y, Suzuki T, Takiguchi M, et al.: Natural frequency/Damping coefficient relationship of the catheter-manometer system required for high-fidelity measurement of the pulmonary arterial pressure. J Anesth 7: 419--426, 1993)     

Bolus doses of esmolol for the prevention of perioperative hyper-tension and tachycardia

The effectiveness of esmolol, an ultra short-acting cardioselective beta blocker, in the prevention and treatment of post-intubation haemodynamic perturbations, was investigated. Forty-eight ASA physical status I and II patients undergoing hysterectomy were randomly assigned to receive a single intravenous bolus of placebo, esmolol 100 mg, or esmolol 200 mg in a double-blind fashion. This was administered over 15 sec, and immediately followed by thiopentone 3-5 mg.kg-1, succinylcholine 1.5 mg.kg-1, and tracheal intubation 90 sec later. The heart rate following induction of anaesthesia was lower in the esmolol 200 mg group (P less than 0.01); following intubation, the increase in heart rate in the placebo group was greater than in the esmolol groups (P less than 0.05). The systolic blood pressure post-induction was lower in the esmolol 200 mg group (P less than 0.05); following intubation, however, no significant differences were seen among groups in systolic, diastolic, or mean blood pressures. Following tracheal intubation, the incidence of ventricular arrhythmias was lower in the esmolol groups (P less than 0.05). In summary, esmolol in 100 mg and 200 mg doses was effective in mitigating the haemodynamic response following tracheal intubation.     

A comparison of the haemodynamic and hormonal effects of low and conventional dose cyclopenthiazide in normal volunteers

Summary In this study we compared low (125 g) and conventional (500 g) doses of cyclopenthiazide on the renin angiotensin system, plasma and extracellular fluid volumes and the pressor responsiveness to angiotensin II since we have previously shown that the two doses have the same antihypertensive effect but different effects on plasma renin activity.Following a two week placebo run-in period, 8 healthy male volunteers received 125 g or 500 g of cyclopenthiazide for 2 treatment periods of 4 weeks as part of a double blind, 2-part crossover study with treatment periods separated by a 4-week placebo washout phase. Measurements were made on two study days at the beginning and end of the active treatment periods. On the first day serum potassium, plasma renin activity and plasma angiotensin II levels were measured after a 1 h period of supine rest. Plasma and extracellular fluid volumes were also measured after appropriate equilibration times. The blood pressure responses to angiotensin II were assessed on day 2.The 500 g dose of cyclopenthiazide had a greater effect than the 125 g dose on plasma renin activity, serum potassium, angiotensin II levels and extracellular fluid volumes. Neither drug had any effect on plasma volume or the responsiveness to infused angiotensin II.Low dose cyclopenthiazide failed to increase angiotensin II levels, contract body fluid volumes or attenuate vascular reactivity in normotensive volunteers.