腰段连续硬膜外阻滞对大鼠妊娠期高血压疾病防治作用的研究

目的:观察连续硬膜外阻滞对大鼠妊娠期高血压疾病的防治作用。方法:Wistar大鼠40只复制妊娠期高血压疾病模型,分为4组,于妊娠14d开始,A组皮下注射生理盐水;B组皮下注射左硝基精氨酸甲酯(L-NAME);C组硬膜外腔置管,但不给药;D组硬膜外腔注入布比卡因。监测妊娠13,20d的体质量、食量、尿量、入水量;从妊娠的13d起,应用鼠尾动脉仪每日监测血压;以磺柳酸法检测孕鼠第13,20日尿蛋白浓度;硝酸还原酶法检测子宫、胎盘组织的一氧化氮(NO)含量。结果:孕20dB、C组与A、D组比较体质量增加(P<0.01),食量下降(P<0.01),入水量无差别(P>0.05),尿量下降(P<0.01);孕20dB、C组与A、D组比较收缩压、心率均显著增高(P<0.01),A组与D组比较心率显著增快(P<0.01);孕20dB、C、D组与A组比较尿蛋白含量明显增加(P<0.01),D组与B、C组比较明显减少(P<0.01);孕20dB、C组与A、D组比较存活率明显下降(P<0.01);孕20dA、D组与B、C组比较NO浓度明显增加(P<0.01)。结论:腰段连续硬膜外阻滞可能对大鼠妊娠期高血压疾病具有防治作用。     

颈神经丛阻滞麻醉致颈动脉窦和迷走神经阻滞的实验研究

目的研究颈丛神经阻滞麻醉对颈动脉窦和迷走神经的影响，探讨颈丛神经阻滞麻醉引起心血管副反应的原因。方法杂种犬20只，通过对犬实施一点法颈深丛神经阻滞麻醉，解剖颈内动脉起始部和颈部迷走神经，观察该麻醉下颈动脉窦和颈部迷走神经被麻醉药物浸润情况；观察麻醉前后颈动脉窦按摩，及麻醉后刺激颈部迷走神经对犬血压及心率的影响。结果颈内动脉起始部距离第4颈椎（C4）横突1.0-1.4cm，而一点法颈深丛阻滞麻醉后距离C4横突约4．0cm范围内组织均明显被麻醉药物浸润。显微镜下观察：颈内动脉起始部血管壁和迷走神经均明显被麻醉药物浸润。颈丛神经阻滞麻醉前按摩颈动脉窦可引起明显的减压反射，而阻滞后按摩颈动脉窦或刺激迷走神经均未引起明显的血压及心率变化。结论颈丛神经阻滞麻醉致颈动脉窦和迷走神经阻滞是引起心血管副反应的主要原因。     

骶管阻滞麻醉用于小儿短小手术的体会

目的观察骶管阻滞在小儿短小手术中的应用，总结小儿短小手术中麻醉异常经过的处理体会。方法选择1-5岁实施短小手术患儿60例，随机分成2组，Ⅰ组为骶管组，采用静脉吸入复合加骶管阻滞麻醉（0．25％罗哌卡因、0．5％利多卡因与生理盐水的混合液1mL／kg）。Ⅱ组为对照组采用静脉吸入复合麻醉，2组均不插管，保留自主呼吸，监测呼吸、ECG、BP、SpO2、HR、苏醒时间、手术时间、恶心、呕吐及术后疼痛等情况。结果Ⅰ组麻醉效果好，苏醒快，术后2h内切口无疼痛。每组各有1例出现喉痉挛。结论骶管阻滞用于小儿短小手术可减少其他静脉麻醉药的用量，苏醒快，并发症少，术后镇痛效果好。     

Radionuclide evaluation of right ventricular wall motion after surgery in tetralogy of Fallot

Summary Regional wall motion patterns in tetralogy of Fallot and its postoperative modifications by electrical and hemodynamic factors were assessed by Fourier analysis of gated radionuclide angiograms in 24 studies performed in children after surgical correction of tetralogy of Fallot. The range of right ventricular (RV) phase angles (standard deviation of the peak [SDP] of RV) as well as the difference between RV and LV (ΔMPh) were used as indices of the synchronicity of wall motion and were correlated with RV apical electrical activation time determined by endocardial electrical mapping. Postoperative studies were divided into two groups according to apical activation: (a) those involving right bundle branch block (RBBB) (nine patients), and (b) those involving distal RBBB (15 patients). ΔMPh was longer in proximal than in distal RBBB. Best discrimination between the two groups was obtained with SDP of RV (proximal=24°±3°, and distal=17°±2°;p<0.0001). These results showed that the range of ventricular phases measured by the SD of the phase distribution of the right ventricle is a good index for distinguishing between proximal and distal RBBB after cardiac surgery.     

食管胸下段癌单纯放疗的预后

分析资料完整、无表浅淋巴结及远处转移、首程放疗的食管癌患者 34 83例 ,均随访 1 0年以上。病人采用60 Co常规外照射 ,剂量均在 5 0Gy以上。若将食管病变部位及病变长度相结合 ,再进行分析对比 ,其结果是食管胸下段癌的生存率与其它各段之间无明显差别。过去认为食管下段癌预后差 ,其原因可能是在分析部位时未将病变长度结合在一起。食管胸下段癌单纯放疗的预后并不是最差的。     

An autopsy case of congenital complete heart block in a newly born of a mother with systemic lupus erythematosus

Summary An autopsy case of congenital atrioventricular (AV) heart block is described. A newborn infant of a mother with systemic lupus erythematosus died 10 h after birth. Autopsy revealed hematoxylin bodies in the AV node, central fibrous body, and fibrous annulus of the heart. Also, immunoglobulin G (IgG) localization in the hematoxylin bodies was demonstrated by an immunoperoxidase technique. It is suggested that IgG or immune complexes crossed the placenta and that the immune deposition directly injured the cardiac conduction system, causing AV block.     

Onset of vecuronium-induced neuromuscular block after a long priming interval

Purpose. We examined whether a new application of the priming principle, i.e., having the priming dose of vecuronium administered before the insertion of the epidural catheter, would hasten the onset of the neuromuscular block induced by the intubating dose of vecuronium. Methods. Forty-five adult female patients scheduled for general anesthesia combined with epidural anesthesia were studied. In group A (n = 15), the priming dose of vecuronium, 0.01 mg·kg⁻¹, was administered before insertion of the epidural catheter. The intubating dose of vecuronium, 0.09 mg·kg⁻¹, was given after the insertion of the epidural catheter. In group B (n = 15), the priming dose of vecuronium, 0.01 mg·kg⁻¹, was given 4 min before the intubating dose of vecuronium, 0.09 mg·kg⁻¹. In the control group (n = 15), no priming dose was given, and only the intubating dose of vecuronium, 0.10 mg·kg⁻¹, was administered. In all three groups, general anesthesia was induced with propofol 2.5 mg·kg⁻¹, and the trachea was intubated when T1/control value (control twitch height in response to train-of-four stimuli) was less than 0.1. Results. In group A, the priming dose was given 16 ± 3 min (mean ± SD) before the administration of the intubating dose. The times to onset of neuromuscular block in groups A and B, and the control group were: 145 ± 30, 184 ± 45, and 219 ± 23 s, respectively (P < 0.05 among the three groups). In all three groups, intubating conditions (graded on a four-point scale) were excellent (P = 0.59). Before the induction of anesthesia, symptoms of paralysis were observed in 5, 4, and 0 patients in groups A and B and the control group, respectively (P < 0.05 between group A or B vs control group). Conclusions. If the priming dose of vecuronium is given after a long priming interval (16 ± 3 min), the time to onset of the neuromuscular block caused by the intubating dose of vecuronium is markedly shorter than when the conventional priming interval of 4 min is employed. Received: March 5, 2001 / Accepted: October 4, 2001     

Impaction of a Shrapnel Splinter in the Common Bile Duct After Migrating from the Right Thoracic Cavity: Report of a Case

Biliary obstruction is rarely caused by a foreign body. This report describes the case of a 60-year-old Japanese man with jaundice caused by an impacted shrapnel splinter in the common bile duct (CBD) that had migrated from the right thoracic cavity 36 years after initial injury. Biochemical data showed a total bilirubin level of 4.2 mg/dl with a direct bilirubin level of 3.1 mg/dl, an alanine aminotransferase level of 24 IU/l, and an alkaline phosphatase level of 18.5 KA units. It was serially documented that the shrapnel had migrated toward the diaphragm, then burrowed into the liver, settling in the CBD, and causing obstructive jaundice. Choledochotomy and T-tube drainage was performed and the postoperative course was uneventful. To our knowledge, this is the first case report of this type of occurrence in the Japanese literature. Although there are few reports of combat injury in Japan, this diagnosis should be considered in the evaluation of any patient with jaundice who has suffered a previous chest wound involving a foreign body. Received: March 14, 2001 / Accepted: September 11, 2001     

Patterns of X and Y optic nerve fibre terminations in the dorsal lateral geniculate nucleus of the cat

The distributions of X and Y optic nerve fibre terminals in the A and A₁ laminae of the dorsal lateral geniculate nucleus (LGNd) of the cat have been determined by a method that eliminates the Y fibres. A pressure-blocking technique was used in a sterile operation to produce anterograde degeneration in the Y fibres with minimal effect on the X fibres. Subsequently the Fink/Heimer technique was used to stain for degenerating fibres. This showed a strong peak of degeneration in the ventral regions of the laminae. Tritiated leucine was injected into one eye either of a normal cat or of one in which the optic nerve had been pressure-blocked at least one week previously. Subsequent examination of the LGNd by autoradiography showed a more uniform distribution of label in the laminae deprived of Y input (i.e. the pattern of distribution of X fibres). Subtraction of this distribution from that produced in a normal cat (i.e. X + Y input) gave the Y distribution. As in the degeneration studies, this revealed a peak of label in the most ventral part of each lamina but also showed a smaller peak in the most dorsal regions.     

Physiologic-pharmacologic interpretation of the constants in the Hill equation for neuromuscular block: a hypothesis

Neuromuscular block (NMB) is simulated in pharmacodynamic models using the concentration of a muscle relaxant (MR) in the effect compartment and two constants, and IC50. No physiologic or pharmacologic interpretation is offered for either constant. We desired to explore whether the constants are properties of the muscle or the MR and to simulate NMB when the MR binds to two sites at a single receptor. Based on steady state conditions, we defined receptor occupancy using the equilibrium dissociation constants. Two concepts are introduced: threshold occupancy and occupancy at half-maximal NMB, Occ_NMB50. Threshold occupancy is defined as receptor occupancy at the motor end plate of a muscle fiber when the fiber fails to contract and Occ_NMB50 as the median threshold occupancy. NMB may be simulated as a function of either the concentration of the muscle relaxant or receptor occupancy. We suggest: (1) The distribution of threshold occupancies is an intrinsic property of a muscle and is characterized by two constants (_O and Occ_NMB50); (2) _O is numerically equal to the slope of the NMB vs. concentration curves and is independent of the equilibrium dissociation constants. IC50 is codetermined by Occ_NMB50 and by the equilibrium dissociation constants. (3) Binding of a muscle relaxant to the second binding site influences only the estimate of IC50 but not .