A fibreoptic intubation technique for children with mucopolysaccharidoses using the laryngeal mask airway

Children with mucopolysaccharidoses present the anaesthetist with both a difficult airway and often an impossible intubation using conventional techniques. A technique for airway management and tracheal intubation is described utilizing the Brain laryngeal mask airway, the fibreoptic bronchoscope, a guide wire and a ureteral dilator. Two case reports of children with mucopolysaccharidoses are presented who were managed successfully with this technique. The advantages of the technique are discussed.     

To surgeons and physicians

The subscriber is prepared to furnish a person fully competent to administer his compound to patients who are to have surgical operations performed, and when it is desired by the Operator that the patient should be rendered insensible to pain. Personal or written application may be made toW. T. G. MORTON,Dentist,No. 19, Tremont Row, Boston.     

彩色多普勒血流显像在评估输卵管妊娠保守治疗中的作用

目的评价彩色多普勒超声在输卵管妊娠保守治疗中的作用.方法利用彩色血流显像观察45例输卵管妊娠包块周围的血流状况及血流参数.结果包块周围血流稀少,血流阻力增高者,滋养血管阻力下降则治疗成功率下降.结论彩色多普勒技术对异位妊娠保守治疗评估占有重要的位置.     

光导纤维喉镜用于气管插管时循环系统的变化

３０例外科手术病人，分为三组。Ⅰ组为普通喉镜顺利气管插管，Ⅱ组为光导纤维喉镜顺利插管组，Ⅲ组为光导纤维喉镜困难插管组。结果表明：三组病人插管时均可引起剧烈的心血管反应，但变化幅度以Ⅲ组最大，本文提示，与普通喉镜相比，光导纤维喉镜和于并无困难插管的病人引起的心血管反应相似，而用于困难插管的病人也可产生严重的心血管反应，可能与插管困难的病人暴露困难致使插管时间较长或刺激强度增大有关。     

小剂量甲氨蝶呤多次肌内注射治疗输卵管妊娠72例

目的 :观察小剂量甲氨蝶呤 (methotrex ate ,MTX)多次肌内注射治疗未破裂型输卵管妊娠的临床效果。方法 :将 72例未破裂型输卵管妊娠的病人采用MTX ,2 0mg ,im ,qd ,5d为一个疗程 ,用药后每 3d测定人绒毛膜促性腺素 β亚基 (β humanchorionicgonadotropin ,β HCG) ,外周血白细胞及血小板 ,每周B超检查盆腔包块。结果 :治疗 72例病人中治愈 6 3例 ,治愈率为 88%。结论 :小剂量MTX多次肌内注射治疗未破裂型输卵管妊娠是一种安全有效的好方法。     

医用臭氧在介入治疗输卵管阻塞性不孕症中的临床应用

目的探讨输卵管阻塞性不孕症介入治疗后应用医用臭氧灌注降低再粘连发生率的可能性。方法45例输卵管阻塞性不孕症分为两组。治疗组28例,56支输卵管阻塞;对照组17例34支输卵管阻塞。治疗组在介入性再通术后向输卵管内注入医用臭氧;对照组单纯行介入性输卵管再通术。所有病例6个月后复查并比较两组的疗效。结果治疗组妊娠率为42.86%,术后再粘连率为7.14%;对照组妊娠率为29.41%,术后再粘连率为26.47%（P〈0.05）。结论医用臭氧灌注可明显降低输卵管再通术后粘连率,提高妊娠率。     

Gas Exchange and Lung Mechanics during Percutaneous Transtracheal Ventilation in an Unparalyzed Canine Model

Objective : To compare the efficacy of percutaneous transtracheal ventilation (PTV) in the unparalyzed state with that in the paralyzed state using a sedated nonobstructed canine model.
Methods : Eight mongrel dogs (16.8–32 kg) were anesthetized, instrumented, and placed in a volume ple-thysmograph. Anesthesia was achieved with pentobarbital sodium (up to 30 mg/kg). The spontaneous respiratory drive was kept intact. PTV was performed using a 13-ga transtracheal catheter and compressed air at 45 psi at an I:E ratio of 1:3 (15 breaths/min). Each dog was sequentially ventilated in both the paralyzed and unparalyzed states. The paralyzed/unparalyzed sequence was alternated among the animals to avoid sequence bias. Paralysis was achieved with succinylcholine (0.1 mg/kg bolus and 0.01 mg/kg/min drip). Reversal of paralysis was achieved by discontinuing the succinylcholine infusion. Key variables, including arterial blood gas, tidal volume, and pulmonary mechanics, were measured and compared for the paralyzed and unparalyzed states.
Results : Gas exchanges and lung mechanics were similar between the unparalyzed and paralyzed states. There was no significant difference in mean pH, pCO₂, pO₂, tidal volume, or peak inspiratory transpulmonary pressure. There was also no significant difference in pulmonary resistance or pulmonary compliance.
Conclusion : In a sedated nonobstructed canine model, PTV is as efficacious in the unparalyzed state as it is in the paralyzed state. The lung mechanics are also similar in the 2 states. These data suggest that it may be unnecessary to induce paralysis when using PTV for emergency ventilation in the heavily sedated state.     

Fertilization and early embryology: Normal development and metabolic activity of preimplantation embryos in vitro from patients with polycystic ovaries

Polycystic ovary syndrome (PCOS) is closely associated withhigh miscarriage rates and, following in-vitro fertilization(IVF), with decreased fertilization rates, suggesting that oocytesand embryos are of poor quality. In this prospective study,we examined the development, metabolic activity and blastocystcell number of embryos following IVF from 51 patients with eitheranovulatory PCOS, ovulatory PCOS or tubal disease. The numberof oocytes retrieved and the fertilization rates were similarfor patients with PCOS and tubal disease. Following embryo transfer,46% of the patients with PCOS and 36% of patients with tubaldisease became pregnant. A similar proportion of surplus embryosfrom patients with PCOS and tubal disease developed to the blastocyststage (38% and 43% respectively). Patients with anovulatoryPCOS had embryos with less fragmentation which cleaved faster,cavitated earlier and had more cells at the blastocyst stagethan embryos from patients with tubal disease. While the profileof glucose uptake and lactate production was similar for allgroups throughout preimplantation development, patients withtubal disease who underwent ovulation induction using the ‘titrated’regimen optimized for PCOS patients resulted in embryos withreduced pyruvate uptake, in addition to low blastocyst cellnumbers. This study demonstrates that with an optimized ovulationinduction regimen, embryos from PCOS patients are of good qualityand developmental potential.     

Pre-hospital tracheal intubation versus esophageal gastric tube airway use: a prospective study

A prospective study compared the respiratory effectiveness of the endotracheal tube (ET) with that of the esophageal gastric tube airway (EGTA) for victims of nontraumatic cardiac arrest in the pre-hospital setting. Arterial blood gases were obtained within 3 minutes of hospital arrival, and survival (defined as discharge from the hospital) was determined. During EGTA ventilation, mean pH was 7.12 +/- 0.2, mean P02 was 77 +/- 92 mm Hg, and mean PC02 was 78.2 +/- 42.9 mm Hg; the survival rate was 4.5%. During ET ventilation, mean pH was 7.34 +/- 0.2, mean P02 was 265 +/- 151 mm Hg, mean PC02 was 35 +/- 20.5 mm Hg; the survival rate was 7%. The authors conclude that endotracheal intubation remains the procedure of choice for airway management in the victim of cardiopulmonary arrest.     

艾司洛尔和乌拉地尔在全麻插管期间对血液对力学及脑电参数、心率变异性的影响

比较全麻病人插管前静脉给予艾司洛尔或用乌拉地尔预防气管插管反应的效果。60例病人随机分为3组，每组20例，Ⅰ组为对照组，插管前2min静注生理盐水10ml。Ⅱ组为艾司洛尔组，插管前2min，1．5mg／kg艾司洛尔加生理盐水10ml静注。Ⅲ组乌拉地尔组，插管前4min，0．4mg／kg乌拉地尔加生理盐水10ml静注。观察插管前、插管后3组SP、DP、HR、BIS、HRV变化。Ⅰ组SP和DP于插管后1min显著升高（P〈0.05），HR在插管后显著升高（P〈0．05），Ⅱ组SP在插管后轻微升高，HR在插管后显著下降（P〈0．05）．Ⅲ组SP于插管后显著下降（P〈0．05），DP于插管后1min显著下降（P〈0．05），艾司洛尔和乌拉地尔均可有效降低应激引起的心血管反应，与乌拉地尔相比，艾司洛尔尚可降低心率，对于心率较快的病人更为有利。