Airflow through the auxiliary line of the laser fiber prevents ignition of intra-airway fire during endoscopic laser surgery

BACKGROUND AND OBJECTIVES: Ignition accidents during bronchoscopic laser irradiation have occasionally been reported, but the mechanisms responsible for the ignition accidents are not fully understood. We examined causative factors including ignition site, oxygen concentration, and role of airflow through the laser fiber. STUDY DESIGN/MATERIALS AND METHODS: Porcine muscle tissue was placed in a bottle and irradiated by laser under various conditions. Also, a piece of porcine muscle was wedged in a main bronchus of the isolated porcine lungs and irradiated by laser in the same way. RESULTS: Flashing occurred on the tissue exposed to the laser, and this flashing reached the ignition when the oxygen concentration was above 30%. Increasing airflow through the laser fiber prevented the ignition even at an oxygen concentration at 100%. CONCLUSIONS: In laser irradiation, the tissue exposed to the laser can be the ignition site of fire. Increasing airflow through the laser fiber was an effective technique to prevent airway fire.     

End-tidal oxygen concentration and pulse oximetry for monitoring oxygenation during intratracheal jet ventilation

Objective. In this study, we evaluated the usefulness of end-tidal oxygen monitoring during intratracheal jet ventilation (ITJV) for endolaryngeal laser surgery.Methods. A total of 20 consecutive patients of both genders scheduled for endolaryngeal procedures under general anesthesia were studied. Inspiratory oxygen concentration and respiratory rate were varied, with patients serving as their own controls. Readings of pulse oximetry, airway oxygen, and carbon dioxide concentrations were recorded, and arterial blood samples for blood gas analysis were taken.Results. At jet cycle rates of 20 cycles/min, end-tidal oxygen (ETo₂) concentration indicated alveolar hypoxia 30 to 60 sec before hypoxemia was detected by pulse oximetry. Jet mixing of inspiratory and expiratory gas caused a larger difference between end-tidal and arterial gas concentrations than normally seen with conventional ventilation. Correlations between ETo₂ concentrations, oxygen saturations, and arterial oxygen levels depended on respiratory rate and inspiratory oxygen concentration; correlations were stronger at low than at high inspiratory oxygen concentrations and stronger at low than at high respiratory rates.Conclusions. ETo₂ concentration should be maintained well over 21% during ITJV to prevent alveolar and arterial hypoxia. Monitoring of respiratory oxygen concentrations at jet cycle rates of 20 cycles/min and less verifies safe oxygen levels during laser surgery, and confirms adequate alveolar oxygenation.We are grateful to Anneli Innanmaa, RN, for her skillful help with this study, and to Hannu Laine, fine mechanic, for the construction of the copper tubes.Grants were received from Instrumentarium Scientific Foundation, Helsinki, for construction of the special jet ventilator and the pressure curve monitor. Datex, Helsinki, provided the OSCAR OXY monitor.Part of the results of this study were presented at the 10th World Congress of Anaesthesiologists, The Hague, 1992 (Abstract A41 [ISBN 90-800899-2-3]).     

试论心肾相交、水火既济

心肾相交、水火既济是中医学中的一个重要概念，目前对其论述比较混乱。文章从古代论述、阴阳理论、五行角度系统梳理了水火既济和心肾相交的含义，阐述了阴阳冲和、水火既济、心肾相交三者之间的区别及联系，提山了心肾相交应有广义和狭义之分，广义的心肾相交是指心肾之气的全面交感，狭义的心肾相交单指肾水与心火的相交，并指出了心肾相交的途径、时间和其他含义。     

清热泻火法治疗面部痤疮60例临床研究

目的：观察清热泻火法对面部痤疮的疗效。方法：60例面部痤疮病例，采用清热泻火法，以清痤灵加减。每日1剂，分2次口服，4周为1疗程，治疗2个疗程，观察皮疹消退情况。结果：痊愈38例（63．3％），显效12例（20%），有效6例（10％），无效4例（6．7％），愈显率83．3％，总有效率93．3％。结论：清热泻火法治疗面部痤疮疗效显著。     

"阴火"辨惑

对李东垣《脾胃论》所提出的“阴火”之论,以及傅衍魁等主编《医方发挥》对“阴火”的解释,并结合明代诸多医家对“阴火”的理解,加以分析辨惑,强调元气盛衰与“阴火”关系最为密切。     

滋阴降火汤治疗复发性口腔溃疡93例疗效观察

目的:探讨滋阴降火汤治疗复发性口腔溃疡阴虚火旺型的疗效。方法:将132例复发性口腔溃疡阴虚火旺型患者随机分为两组,对照组39例每日予口服强的松、复合维生素B,并含服华素片;治疗组93例在对照组的基础上加用中药。疗程5天。治疗结束后复诊,记录症状变化,评定两组疗效。结果:两组治愈率与总有效率均有显著性差异(P>0.05)。结论:滋阴降火法治疗复发性口腔溃疡阴虚火旺型临床有效。     

健脾益胃汤治疗消化性溃疡96例临床观察

目的:观察健脾益胃汤治疗消化性溃疡的疗效,2年复发率,并与H2受体拮抗剂疗效的比较.方法:回顾性分析,中药治疗组消化性溃疡96例用健脾益胃汤治疗,对照组88例用西咪替丁治疗,用电子胃镜观察疗效.结果:用健脾益胃汤治疗4～8周,总有效率为99.0%,溃疡愈合率为84.4%,2年复发率为26.6%,对照组用西咪替丁治疗6～12周,总有效率为77.3%,溃疡愈合率为51.1%,2年复发率为52.3%.结论:中药治疗组疗效明显优于对照组(P<0.01).