Response of lower esophageal contractility to changing concentrations of halothane or isoflurane: A multicenter study

A multiple-center study was performed to determine the relationship between lower esophageal contractility, clinical signs, and anesthetic concentration as expressed by minimum alveolar concentration (MAC). One hundred four American Society of Anesthesiologists Class I through III patients were exposed to isoflurane (with and without nitrous oxide) or halothane in concentrations of 0.5, 1.0, and 1.5 MAC. Heart rate and systolic blood pressure were continuously monitored. Both the amplitude and frequency of spontaneous and provoked lower esophageal contractions were measured in situ by using a 24-F probe equipped with provoking and measuring balloons. Combined results demonstrated statistically significant correlations (P<0.001) between lower esophageal contractility and MAC. Spontaneous lower esophageal contractions decreased from 1.10±0.12 (SEM) contractions per minute (0.5 MAC) to 0.42±0.05 (1 MAC) to 0.18±0.05 (1.5 MAC). Provoked lower esophageal contractility values decreased from 45±4 mm Hg (0.5 MAC) to 29±3 (1 MAC) to 19±2 (1.5 MAC). Heart rate changes did not correlate with MAC, and systolic blood pressure correlated in only one of three centers. Intracenter and intercenter analyses failed to demonstrate a significant relationship between lower esophageal contractility and heart rate or systolic blood pressure. No intracenter differences in either amplitude or frequency of lower esophageal contractions were observed, despite differences in volatile agents, induction techniques and agents, patient populations, and duration of anesthesia. Our studies indicate that lower esophageal contractility may be an indicator of anesthetic depth as reflected by MAC, but further studies are needed to quantify the effects of surgical stimulus, intravenous anesthetics, vasodilators, anticholinergics, calcium channel blockers, beta-adrenergic agonists, and the presence of a nasogastric tube.     

泌尿生殖道炎症患者沙眼衣原体感染的临床研究

目的　探讨在泌尿生殖道有炎症表现的情况下沙眼衣原体 (CT)感染的状况。方法　采用C -C快速法。结果　CT在泌尿生殖道炎症时的阳性率显著高于无炎症表现者 (P <0 .0 5) ;男性在有无炎症表现情况下的CT阳性率差异有显著性 (P <0 .0 5) ,而女性差异无显著性 (P >0 .0 5) ;2 1～ 50岁为高发年龄段。结论　CT感染症状隐匿 ,临床无症状者也应注意CT的检测 ,尤其是女性和高危人群。     

Increased carbon monoxide levels in the nasal airways of subjects with a history of seasonal allergic rhinitis and in patients with upper respiratory tract infection

BACKGROUND: Carbon monoxide (CO) has emerged as an endogenously produced gaseous mediator known to be involved in bronchial smooth muscle regulation. Increased amounts of CO have been found in exhaled air during asthma and lower airway inflammation. Recently CO has been shown to be produced in the nasal airways, but there are no reports of altered CO levels in nasal airways during inflammation. OBJECTIVE: This study was designed to investigate if CO levels increase in the human nasal airways during inflammatory conditions, such as allergy and upper airway respiratory tract infection (URTI). METHODS: CO was sampled separately from the upper and lower airways of 13 healthy control subjects, six patients with a history of allergic rhinitis and six patients with URTI. RESULTS: Nasal CO levels were increased in subjects with allergic rhinitis, compared to healthy controls (2.07 +/- 0.15 ppm, n = 6 and 1.62 +/- 0.08 ppm, n = 13, respectively, P < 0.01). CO levels were also increased in patients with URTI, compared to the same controls (1.92 +/- 0.09 ppm, n = 6, P < 0.05). Normal levels of CO were found in air from the lower airways among subjects with allergic rhinitis, whereas corresponding levels in the URTI patients were increased. CONCLUSION: The present data demonstrates that upper airway CO levels increase in parallel with different inflammatory stimuli, such as allergy and infection, suggesting a role for CO as marker or mediator of nasal inflammation.     

Characteristic modifications of the breathing pattern of mice to evaluate the effects of airborne chemicals on the respiratory tract

A system was developed for exposure of unanesthetized mice to airborne chemicals and for continuous measurement of their breathing pattern prior to, during and following exposure. By measuring inspiratory and expiratory airflows (VI and VE), and integration with time to yield tidal volume (VT), we obtained characteristic modifications to the normal breathing pattern. These permitted recognition that a specific portion of the respiratory tract was affected by the selected airborne chemicals. Following recognition, we also quantitated the degree of effect using one specific measurement in each case. An effect on the upper respiratory tract, induced by the sensory irritant, 2-chlorobenzylchloride, was quantitated by measuring a decrease in respiratory frequency. An effect on the conducting airways, induced by the airway constrictor, carbamylcholine, was quantitated by a decrease in VE at the mid-point of VT. An effect at the alveolar level, induced either by the vagal nerve ending stimulant, propranolol, or by the pulmonary irritant, machining fluid G, was quantitated by an increase in the length of a pause induced at the end of expiration. The system is easy to construct and operate and can be used to rapidly evaluate the effects of airborne chemicals on the respiratory tract.     

长春地区儿童急性呼吸道感染的病原趋势

目的:探讨北方地区小儿急性呼吸道感染(ARIs)病原构成特点,为临床诊断及治疗提供依据。方法:采用酶联免疫吸附试验(ELISA)方法,对574例ARIs患儿进行了肺炎支原体(Mp)、沙眼衣原体(CT)、肺炎支原体(CP)、呼吸道合胞病毒(RSV)、腺病毒(Adv)、流感病毒A型(Inf-A)、副流感病毒(PIV)等7种病原同步进行急性期血清特异性抗体IgM检测,同时设立健康对照组。结果:574例患儿共334例检出特异性IgM抗体,阳性率58.2%。按检出频率的高低依次为Mp28.9%(166/574),RSV13.6%(78/574),CP5.9%(34/574),CT4.4%(25/574),Adv3.3%(19/574),Inf-A1.2%(7/574),PIV0.9%(5/574),分别占阳性例数的49.7%(166/334)、23.3%(78/334)、10.2%(34/334)、7.5%(25/334)、5.7%(19/334)、2.1%(7/334)和1.5%(5/334);病原分布具有年龄差别。健康对照组仅检出1例MP-IgM阳性(1.7%)。结论:Mp、RSV及CT为小儿ARI的常见病原。Mp感染率逐渐增高,发病年龄有逐渐变小的趋势。     

万艾可治疗ED时对BPH引起LUTS改善的研究

目的 :探索、研究万艾可在治疗阴茎勃起功能障碍 (ED)时对由良性前列腺增生 (BPH)引起的下尿路症状(LUTS)的影响。　方法 :32例ED同时伴有BPH的研究对象 ,采用IIEF 5问卷表和IPSS评分表 ,在服用万艾可前和服药后 6个月分别各填写一次 ,应用单因素方差分析对所得到的前后评分进行统计学分析。结果 :在服药前32例ED中 ,轻、中、重分别为 14、13、5例 ,BPH中轻、中、重分别为 3、15、14例 ;服药后IIEF 5评分平均上升4 2 .36 % ,IPSS评分平均下降 2 0 .14 % ,两者在统计学上都有显著性差异 ,P <0 .0 1。　结论 :在治疗中老年性ED合并BPH中 ,应用万艾可既能治疗ED ,取得完美的性生活 ,又能达到改善由BPH引起的LUTS。万艾可是一治疗ED有效的药物 ,但对于前列腺基质平滑肌亦有辅助性松弛作用 ,因此也有助于BPH时LUTS的缓解。     

Modified Damus–Kaye–Stansel procedure using aortic flap technique for systemic ventricular outflow tract obstruction in functionally univentricular heart

Damus–Kaye–Stansel procedure is a useful method to relieve the systemic ventricular outflow tract obstruction in functionally univentricular heart. Regurgitation of pulmonary valve and recurrence of systemic ventricular outflow obstruction are the major concerns at the late phase of this procedure. Modification of original Damus–Kaye–Stansel procedure that can prevent the use of prosthetic materials is evaluated. The modified Damus–Kaye–Stansel procedure using aortic flap technique was performed in eight patients with functionally univentricular heart. Patients’ ages ranged from 3 to 28 months (mean 14 months). Follow-up period was 37 months as a mean (9–71 months), and the follow-up was complete. There was no operative mortality and no late death. In addition, there was no recurrence of systemic ventricular outflow tract obstruction throughout the follow-up period. Regurgitation of the pulmonary valve estimated by echocardiography at the latest follow-up was none to trivial in seven patients and mild in one. The modified Damus–Kaye–Stansel procedure using aortic flap technique is a safe, useful and reproducible technique to solve systemic ventricular outflow tract obstruction in functionally univentricular heart, and it can be an alternative for original technique or the so-called double-barrel modification.     

Urinary dysfunction and autonomic control in amyloid neuropathy

Abstract Uro-neurological assessment was performed in four patients with small-fiber neuropathy due to amyloidosis (2 transthyretin-type/2 immunoglobulin light-chain-type). Voiding difficulties were due to detrusor weakness and impaired bladder sensation. In two patients cholinesterase inhibition treatment caused urge incontinence, indicating detrusor denervation supersensitivity. The underlying mechanisms of urinary dysfunction seem to involve postganglionic cholinergic and afferent somatic nerves.     

Ascending general visceral pathways within the brainstems of two teleost fishes: Ictalurus punctatus and Carassius auratus.

The primary general visceral nucleus in goldfish (Carassius auratus) and catfish (Ictalurus punctatus) is located at the ventroposterior boundary of the vagal gustatory lobe and receives coelomic visceral, but not gustatory inputs. The neuronal tracer horseradish peroxidase (HRP) was employed to visualize sources of input to and ascending projections from the primary general visceral nucleus in these species. In addition, immunocytochemical techniques were utilized to define the cytological divisions within the pontine gustatory-visceral complex. The pontine secondary visceral nuclei in both catfish and goldfish contains numerous somata and fibers immunoreactive for calcitonin gene-related peptide (CGRP). In contrast, the secondary gustatory nuclei are devoid of fibers and cells immunoreactive for CGRP. In both the goldfish and the channel catfish, the primary general visceral nucleus receives input from the vagal gustatory lobe, as well as the medullary reticular formation. In the channel catfish, the primary general visceral nucleus projects bilaterally to the secondary visceral nucleus, which lies rostrolateral to the secondary gustatory nucleus in the dorsal pons. Fibers cross the midline via the rostral part of the isthmic commissure. Injection of HRP into the primary general visceral nucleus of a goldfish labels ascending fibers that project to a secondary visceral nucleus situated ventral, lateral, and rostral to the secondary gustatory complex. In general, the results indicate that general visceral systems ascend in parallel to gustatory systems within the brainstem, and that general visceral but not gustatory nuclei are immunoreactive for the peptide CGRP.     

金属支架植入治疗上尿路闭锁的中期结果

目的评价金属支架植入治疗上尿路闭锁的中期疗效。方法1995年10月至1998年12月，采用金属支架永久植入治疗上尿路闭锁患者13例，其中肾盂输尿管连接部闭锁8例，肾下盏输尿管吻合口闭锁3例，输尿管上段闭锁和输尿管膀膀吻合口闭锁各1例。闭锁长度1．0～3．6cm。采用影像学方法定期随访，必要时行输尿管镜检查。结果13例术后随访1～9年，平均92个月。输尿管引流通畅6例，需辅助停留输尿管内支架管、换管时见支架处上皮覆盖完全3例，因肾功能进行性恶化而行肾切除2例，因肾积脓感染无法控制而取出金属支架2例。3例患者分别于置管后4、6、6个月发现支架内肉芽组织生长，用钬激光汽化肉芽组织。其中1例4个月后又出现肉芽组织生长，再用钬激光汽化后长期留置双J管。2例患者于置管术后28、32个月并发支架近端结石，分别用微创经皮取石术和输尿管镜取出。结论金属支架植入治疗上尿路闭锁安全、有效，中期结果满意，其对上尿路动力学的影响尚需进一步研究。