Dry Chemistry Instruments in Primary Care. I. Operating Conditions and Financial Considerations

The objectives of this study were to describe the operatingconditions of dry chemistry instruments in primary care, aswell as to elucidate financial aspects in general practice fee-for-servicesettings. We used questionnaires mailed to all users of thetwo most used dry chemistry instruments in Norway, as well asto a 14% random sample of Norwegian GPs. The overall responserate was 79%. The mean number of dry chemistry analyses variedconsiderably between individual users, but in general a substantialnumber of analyses were carried out. Even though most analyseson the instruments' repertoire were available in all user groups,a total of 13 additional constituents were suggested to be includedin the repertoire. In occupational health care most resultswere ready when the client was present; this was not the casein general practice. The instruments were more profitable whenmore constituents were analysed per sample, although profitabilityvaried substantially in the period studied (1986–1989).A discrete time history event analysis revealed that net profitearned, lower instrument price, available information aboutthe technology and being in solo practice significantly influencedthe decision to buy an instrument in fee-for- service practices.     

Immediate Effects on Lung Function of Instilled Human Surfactant in Mechanically Ventilated Newborn Infants with IRDS

ABSTRACT. We have studied the effects on lung volume, respiratory mechanics and ventilation during the first hours after instillation of 60 mg/kg of human surfactant into the trachea of 4 very preterm, newborn infants with severe IRDS under mechanical ventilation. Measurements were made with a "face-out" body plethysmograph and a modified nitrogen wash-out method. In addition to a transient decrease in total and alveolar ventilation immediately after the instillation we found an immediate rise in lung volume, but respiratory compliance decreased. These changes lasted less than two hours. Oxygen requirements fell in 3 out of 4 infants. The changes in lung volume and compliance are explained in terms of changes in the shape of the static recoil pressure characteristics of the diseased lungs after treatment. Mechanisms behind the short duration are sought in mode of instillation, dosage, age at treatment, and severity of disease.     

Effects of Delivery by Caesarean Section on Lung Function in Healthy Newborn Infants

ABSTRACT. With the aim of extending previous studies showing differences in lung function after birth between infants delivered vaginally (VD) and by Caesarean section (CS) we investigated lung volumes, ventilation, efficiency of ventilation, and lung mechanics in 24 healthy, full term infants with no clinical signs of respiratory disease, 12 after VD and 12 after CS. Measurements were made on two occasions: 2 and 26 hours after birth. At 2 hours no differences in any measured quantity were found between the groups. The only difference found 24 hours later was that the average thoracic gas volume (TGV), was lower in infants after CS than after VD. The difference in functional residual capacity was, however, not significant. This means that the difference in TGV, previously also found by other workers, did not affect the ventilated air space. Our results do not support the theory of general inferiority in lung performance after birth in healthy, full term infants without respiratory disease delivered by CS.     

The GlideScope Ranger® video laryngoscope can be useful in airway management of entrapped patients

Background: Airway management of entrapped patients is challenging and alternatives to endotracheal intubation with a Macintosh laryngoscope must be considered. In this study, the GlideScope Ranger^® video laryngoscope has been evaluated as an alternative to standard laryngoscopy.
Methods: Eight anaesthesiologists from a Helicopter Emergency Medical Service intubated the trachea of a Laerdal SimMan^® manikin using the studied laryngoscopes in two scenarios: (A) unrestricted access to the manikin in an ambulance and (B) no access from the head end, simulating an entrapped patient. The time used to secure the airway and the scored level of difficulty were the main variables.
Results: In scenario A, all anaesthesiologists managed to secure the airway using both techniques within the 60-s time limit. In scenario B, all secured the airway when using the video laryngoscope, while 50% succeeded with endotracheal intubation using the Macintosh laryngoscope. The difference in the success rate was statististically significant ( P =0.025). There were no significant differences in the time spent on endotracheal intubation in the two scenarios or between the devices. All stated that the availability of a video laryngsoscope would make drug-facilitated intubation a realistic alternative when access to patients is limited. The lack of visual control when using the Macintosh laryngoscope excludes this technique in real-life settings.
Conclusion: This study suggests that the Glidescope Ranger^® may be merited in situations requiring endotracheal intubation by an experienced intubator in patient entrapment. Further studies are required to clarify whether performance in patients mimics that in a manikin.     

Production of Interferon-α/β by Murine Dendritic Cell Lines Stimulated by Virus and Bacteria

The interferon-α and -β (IFN-α/β) producing ability of the two murine dendritic cell (DC) lines D2SC/1 and FSDC was studied. The D2SC/1 cells produced IFN-α and -β when stimulated by herpes simplex virus (HSV), Sendai virus (SV) or by the bacteria Escherichia coli or Staphylococcus aureus Cowan I. Precultivating (priming) D2SC/1 cells with recombinant IFN-β or a combination of IFN-β and granulocyte–macrophage colony-stimulating factor increased production of IFN-α/β induced by HSV or the bacteria, but not by SV. Also, the kinetics of IFN-α/β responses were different for SV compared to HSV and the bacteria, suggesting different induction mechanisms. The FSDC cells differed from the D2SC/1 cells mainly in that predominantly IFN-β was produced, that little or no IFN-α/β production was induced by the bacteria, and that the IFN-α/β responses were most efficiently primed by IFN-γ. Priming the DC lines with tumour necrosis factor-α, interleukin-10 (IL-10) or IL-4 did not affect the IFN-α/β response induced by HSV. The results show that the two DC lines provide a convenient tool to study the induction and control of the IFN-α/β response, as well as the immunoregulatory role of IFN-α/β produced by DC.     

Erythropoietic protoporphyria: two populations of reticulocytes, with and without protoporphyrin

Erythrocytes from patients with erythropoietic protoporphyria contain large amounts of protoporphyrin. The photosensitivity experienced by these patients is assumed to be due to a leakage of protoporphyrin from the erythrocytes and transfer to the skin, where protoporphyrin acts as a photosensitizer. The leakage of protoporphyrin from the erythrocytes has been offered as an explanation for the great variety in protoporphyrin content observed among erythrocytes in this disease. Based on density gradient separation of red cells, it has been concluded that all reticulocytes and young erythrocytes contain large amounts of protoporphyrin. From our results, density gradient centrifugation is not suitable for age separation of red cells from patients with erythropoietic protoporphyria. By developing a new method for isolation of reticulocytes and applying flow cytometry to determine protoporphyrin content in individual cells, it was observed that two populations of reticulocytes were present in patients with erythropoietic protoporphyria, one with and the other without protoporphyrin. The half-life of protoporphyrin in red cells was found to be 12–14 days, in contrast to 1–2 days described previously, suggesting a slower release of protoporphyrin from the red cells than previously anticipated.     

Partition of the Antigen W16 into Two Subtypic Determinants

The partition of W16 into two subtypic determinants was suggested by its segregation with either W4(4a) or W6(4b) in families. It was confirmed by the serologic reactions of two antisera each of which recognized only one of its subtypic determinants. Gene frequencies of 0.01417 and 0.02711 were tentatively assigned to its W4 and W6 variants respectively.