Prediction of outcome from intensive care after gastroenterologic emergency

Prognostic factors determining the outcome from intensive care were studied in 952 patients admitted to 25 Finnish ICUs after gastroenterologic emergency. Logistic regression analysis was used to create predictive models based on the APACHE II–system. The models were constructed by using data from a random two–thirds of the study population and validated in the remaining independent one–third together with the original APACHE II–index. The Acute Physiology Score, age, and a pre–existing liver disease were the three most important determinants of outcome. The inclusion of the TISS score describing the intensity of treatment into a model did not enhance the accuracy of the prediction. Our models were better calibrated than the original APACHE II–equation when tested by the goodness–of–fit –statistics. These statistical models may help the clinicians to predict the outcome for an individual patient by providing them information about the relative impacts of predictive factors or about the probability of death. These probabilities should be interpreted cautiously, taking into acount the limitations of statistical methods. This is especially important when assessing the highrisk patients. Their number in our study was too low for accurate outcome prediction.     

CONTROL OF BREATHING AFTER FENTANYL AND INNOVAR ANAESTHESIA

Ventilation (VI), end-tidal (Pco₂), mixed venous (PVco₂) andthe ventilatory response to carbon dioxide were measured beforesurgery, and during the first 4h of recovery in 18 adult patientswho underwent elective limb surgery under fentanyl or Innovaranaesthesia. End-tidal and mixed venous PCO₂ were increasedsignificantly in the first 150 min after the last dose of drug(P<0.001, P<0.01). but had returned to control valuesby 4 h. Ventilation and ventilatory response to carbon dioxidewere significantly depressed in all patients (P < 0.001),but returned to near control values at 4 h. Fentanyl and Innovaranaesthesia displaced the carbon dioxide response to the right,but no correlation was found between either the magnitude ofthe displacement of the response curve or the alteration inslope and the control values. This suggests that patients witha low value of VI/Pco₂ are not more susceptible to the ventilatorydepressant action of narcotic anaesthetics. Recovery of ventilatoryresponsiveness towards normal during the 4 h after anaesthesia,occurred in a graded and progressive manner; there was no evidenceof a biphasic pattern of recovery. ^*Present address: Centre for Advanced Studies in Health Sciences,Western Australian Institute of Technology, Bentley, WesternAustralia. Presented to the annual meeting of the Canadian AnaesthetistsSociety, Ottawa, Ontario, June 1978.     

Enumeration of T cell subsets with monoclonal antibodies in minor salivary glands of patients with rheumatoid arthritis

Abstract – Labial salivary glands of 51 patients with rheumatoid arthritis and those of 25 control patients were examined by the ANAE (acid α-naphthyl acetate esterase) technique to determine the percentages of B- and T-lymphocytes and mononuclear phagocytes (MPS cells). Using monoclonal antibodies (OKT3 for all T cells, OKT4 for helper/inducer T cells, OKT6 for thymocytes, and OKT8 for suppressor/cytotoxic T cells) T cell subsets were enumerated. B- lymphocytes predominated in both series of salivary glands, and the percentages of B and T cells were equal in both series. The absolute cell counts in the salivary glands of rheumatics were significantly higher (P<0.001) than in those of healthy controls. The number of OKT4⁺ cells was increased in rheumatics, leading to an elevated OKT4⁺/OKT8⁺ ratio when compared with that in controls (P<0.01). The results suggest that the basic phenomenon behind the B cell hyperactivity noticed in rheumatics might be due to increased activity of T helper cells rather than reduced number of T suppressor cells, which were shown to remain almost unaffected in the salivary glands of patients with rheumatoid arthritis.     

Utilization of 1-hydroxybenzotriazole in mixed anhydride coupling reactions

The coupling of Boc-Val-OH to either H-Pro-OBzl or H-Pro-Gly-Val-Gly-OBzl by the mixed anhydride method leads to the formation of a urethane by-product in yields of 40–60%. This side reaction can be suppressed by the addition of HOBt to the reaction mixture before the amino component is added. This results in a substantially increased yield of the desired peptide.     

Trimethoprim Prophylaxis of Acute Exacerbations in Chronic Obstructive Pulmonary Diseases

ABSTRACT. Liippo K, Pelliniemi T-T, Lehto H (Department of Diseases of the Chest and Haematology, University of Turku, and the Research Center of the Farmos Group Ltd., Turku, Finland). Trimethoprim prophylaxis of acute exacerbations in chronic obstructive pulmonary diseases. Acta Med Scand 1987; 221:455–9. A double-blind randomized trial was carried out to study the efficacy and tolerance of trimethoprim with a daily single dose of 300 mg in long-term prophylaxis of acute exacerbations of chronic obstructive pulmonary diseases (COPD). The patients, 13 in the trimethoprim group and 11 in the placebo group, were followed up at fixed intervals and checked for respiratory functions and haematological parameters for six months. The number of exacerbations were significantly lower than during the previous winter in both groups: 0.6 compared to 3.8 in the trimethoprim group, and 0.6 to 3.0 in the placebo group. Tolerance of trimethoprim was good and did not differ from that of placebo. The necessity of double-blind trials in evaluating the prophylactic value of antibiotics in COPD is emphasized, since the exacerbations are also dependent on many unknown factors. There were no statistically significant differences in blood counts of folate levels.     

Tobacco smoking, an independent determinant for unhealthy diet?: A cross-sectional study of Norwegian workers on platforms in the North Sea

The objective of the study was to examine whether male tobaccosmokers had a more unhealthy diet than non-smokers. Data onsmoking and other variables were collected by questionnaireinterviews and food intake by one 24 h recall. The setting was2 oll platforms. The participants were 310 healthy men workingon 2 platforms in the Norwegian sector of the North Sea. Themean ages were 37 and 39 years for non-smokers and smokers.The prevalence of smoking was 50.3%. Smoking decreased withincreasing level of education, but increased with degree ofurbanization. Smokers consumed less vegetables, fruit and fish,but more meat, soft drinks containing sugar and more coffeethan non-smokers. Smokers had a higher intake of fat and a lowerintake of carbohydrate, vitamins A, D and C and dietary fibre.Smoking was an independent predictor for increasing the consumptionof coffee and high intake of energy, energy from fat and cholesteroland a decreasing consumption of vegetables, fruit, energy fromcarbohydrates, dietary fibre and vitamins A and C. It is concludedthat smokers had a more unhealthy diet than non-smokers.     

Dissolution of bovine pulp tissue by endodontic solutions

Pulpal tissue was incubated at 37°C for 10 min with various solutions used for root canal therapy. The dissolved material was assayed for hydroxyproline (HYP) and total phosphate, and the insoluble residue for HYP and dry weight. Sodium hypochlorite (NaOCl) at 5% and diluted to 2.5% showed the strongest solvent capacity measured as loss of HYP and weight from the tissue. Dilution to 0.5% significantly decreased the effectiveness of NaOCl. The absence of HYP from the NaOCl extracts suggested decomposition of this amino acid. The other solutions tested were far inferior in their ability to dissolve pulpal tissue. The demineralizing solutions tested were poor solubilizers of soft tissue; however, they caused a considerable increase in the amount of phosphate released.     

An Investigation of the Ability of Young Male and Female Social Drinkers to Discriminate Between Regular, Calorie Reduced and Low Alcohol Beer

Nine female and nine male social beer drinkers aged 21–28 years participated in a beer discrimination study. Each participant consumed nine glasses of beer. All participants received three glasses of each of Swan Lager (5.0% V/V), Swan Gold (3.7% V/V) and Swan Special Light (0.9% V/V) in counterbalanced order. Participants were required to identify each glass of beer by brand name—first after one mouthful and again after consuming the whole glass. Results indicated that participants were identifying the beers at chance levels only on the first taste measure. On the second taste measure performance exceeded chance expectation but this was due to the respondents having a response bias towards Lager. There were no sex differences in performance, nor did amount of beer usually consumed have any effect on number of correct identifications. Rising blood alcohol levels/satiation did not have any significant effects on identification performance over the nine trials, nor were there any significant differences in number of correct identifications for each of the three different types of beer over the first and second taste measures.     

Neurologic Sequelae Following Interferon Therapy of Juvenile Laryngeal Papilloma

ABSTRACT. Human leukocyte interferon at doses from 2 million units every two days to 3 million units daily was given to a 2-year-old boy for the treatment of recurrent juvenile laryngeal papilloma. After 7 months of treatment the child developed spastic diplegia, which persisted despite the discontinuation of interferon therapy. The clinical picture was consistent with an upper motor neuron lesion; no evidence of peripheral neuropathy was found.     

Effects of a β-blocking agent, timolol maleate, on saliva in healthy volunteers

Abstract — The effects of timolol maleate on the secretion and composition of human saliva were studied in vivo. Eight healthy volunteers received orally 10 mg timolol maleate. Stimulated parotid saliva samples, resting whole saliva samples, and blood samples were collected immediately before and four times after the drug intake at intervals of 1 h. The levels of total protein, lysozyme, IgA, IgG and IgM, salivary peroxidase, myeloperoxidase, lactoferrin, amylase, thiocyanate (SCN^-), and hypothiocyanite (OSCN^-) were analyzed from saliva samples. Drug levels were measured both from parotid saliva and blood samples. Results were compared to the analyses of the samples collected in a similar way but without administration of any drugs. Decreased levels of total protein, lactoferrin, amylase, and salivary peroxidase were observed in parotid saliva after a single oral dose of timolol maleate. No such decrease was found in lysozyme, myeloperoxidase, SCN-, OSCN-, or immunoglobulins. Salivary flow rate was not significantly changed after drug intake. The results suggest that the β-blocking drug may cause qualitative changes in the composition of saliva by inhibiting the synthesis and/or release of acinar proteins.