Influence of volume loading on intraoperative hemodynamics and perioperative fluid retention in patients with valvular regurgitation undergoing prosthetic replacement

Preload and afterload were controlled intraoperatively in 2 groups of patients with valvular regurgitation and congestive heart failure in order to determine the effect of fluid loading on weight gain and subsequent recovery. As a part of their anesthetic management before cardiopulmonary bypass, 16 patients were given 1 liter of crystalloid with nitroprusside infused at 1 microgram/kg/min and 16 received 4 liters of crystalloid with nitroprusside at 4 micrograms/kg/min. Arterial and filling pressures were kept the same in both groups. Heart rate and vascular resistance became significantly lower and cardiac index and stroke volume significantly higher in the fluid-augmented group. The transition to cardiopulmonary bypass was smoother for the fluid-augmented patients. All patients survived, and 2 in each group were ventilated beyond 24 hours. The mean weight gain at surgery was the same in the 2 groups (3 kg). For the first 2 postoperative days, body weight remained unchanged and thereafter, both groups lost weight at 0.6 kg/day. Preoperative weight was reached on day 7 and discharge occurred on day 15, 2 kg below control. Thus, a modest operative weight gain in these patients is inevitable, benign, and independent of the volume of fluid infused before bypass.     

Molar labeling interventions: Two case studies

The efficacy of molar labeling interventions, a novel cognitive-behavioral approach to the treatment of emotionally disturbed children, was investigated in two case studies. In Study I, supervised paraprofessional childcare workers employed the experimental intervention in a short-term residential treatment center. In Study II, parents were taught to employ the experimental treatment to alter the within-home behavior of their child. Both studies evidenced rapid treatment effects on multiple target behaviors and generalization to non-target responses. In Study II, there was some evidence of 4-month maintenance of treatment effects as well as generalization to extra-therapeutic settings. In sum, these initial investigations provided promising, though preliminary, demonstrations of treatment efficacy.     

Variation in ragweed pollen concentration to a height of 108 meters

Ragweed pollen concentrations were measured at 5 levels from 1.5 to 108 M. on a meteorology tower at Brookhaven National Laboratory. Samples were taken over an 11 year period using both the rotoslide and the slide-edge cylinder samplers. Vertical pollen profiles showed great variability from day to day but, when averaged over pollen seasons or longer periods, little systematic change in height was found. These results suggest that long-term patient exposure at upper levels of tall buildings would be similar to that at ground level in the absence of nearby pollen sources.     

Burn wound complicated by marked neurofibromatosis

A case is described of a burn wound and graft donor sites complicated by the presence of multiple neurofibromata.     

遗传性高胆红素血症1例报道并文献回顾

目的探讨遗传性高胆红素血症的发病机制及临床特点。方法本文报告了一例较为罕见的遗传性高胆红素血症的病例,并进行了相关的文献复习。结果本例13岁的患几经多次的生化学、血液学、影像学、组织学检查,并进行苯巴比妥的诊断性治疗有效,提示该患儿为遗传性高胆红素血症：1．Gilbert综合症？2．Crigler-Najjar综合症（Ⅱ型）？结论遗传性高胆红素血症在临床上较为罕见,需要对患者的病史、家族史、临床特征及实验室检查做仔细分析,并可结合诊断性治疗,如苯巴比妥等进行诊断,早期治疗对患者的预后有一定的帮助,基因检测可进一步明确诊断。     

The molecular basis of jaundice: An old symptom revisited

Increased serum bilirubin level is a widely used diagnostic marker for hepatic illnesses. Nevertheless, mild elevation of unconjugated serum bilirubin (such as in Gilbert syndrome) has been recently demonstrated to correlate with low risk of chronic inflammatory and/or oxidative stress‐mediated diseases. In accord, a low serum bilirubin level has emerged as an important predisposing factor or a biomarker of these pathologic conditions including cardiovascular, tumour, and possibly neurodegenerative diseases. Bilirubin possesses multiple biological actions with interaction in a complex network of enzymatic and signalling pathways. The fact that the liver is the main organ controlling the bioavailability of bilirubin emphasizes the central role of this organ in human health.     

Neonatal hyperbilirubinemia and a common mutation of the bilirubin uridine diphosphate-glucuronosyltransferase gene in Japanese

Neonatal hyperbilirubinemia, which is prevalent among Asian peoples, has been considered as a physiological phenomenon, and its metabolic basis has not been clearly explained. Gilbert syndrome is a common inherited disease of unconjugated hyperbilirubinemia due to decreased bilirubin uridine diphosphate-glucuronosyltransferase (B-UGT), and its role in neonatal jaundice has recently been considered. We have previously reported that the Gly71Arg mutation of the B-UGT gene associated with Gilbert syndrome is prevalent in Japanese, Korean, and Chinese populations and was more frequently detected in neonates with severe hyperbilirubinemia than in control subjects. We have studied 159 Japanese full-term neonates, evaluating the relationship between the B-UGT genotype and the severity of jaundice, as assessed with a transcutaneous bilirubinometer. The gene frequency of the Gly71Arg mutation in these neonates was 0.19, and neonates carrying the Gly71Arg mutation had significantly increased bilirubin levels on days 2–4, manifested in a gene dose-dependent manner. The frequency of the Gly71Arg mutation was 0.47 in the neonates who required phototherapy (i.e., those with more severe hyperbilirubinemia), significantly higher than 0.16 in the neonates who did not require the therapy. The gene frequency of the TA repeat promoter polymorphism, the (TA)₇ mutation, was 0.07, and neonates carrying this mutation did not have an increase in bilirubin. These results suggested that the Gly71Arg mutation contributes to the high incidence of neonatal hyperbilirubinemia in Japanese. Received: June 16, 1998 / Accepted: August 5, 1998