Buprenorphine in balanced anesthesia

Buprenorphine was administered for the balanced general anaesthesia in 300 patients during several operations. The results obtained, the good features of analgesia, morphine-like, the absence of cardiovascular and respiratory side effects are presented.     

Advantages of using the midline incision right retroperitoneal approach for abdominal aortic aneurysm repair

This study was conducted to compare the midline incision right retroperitoneal approach for repairing abdominal aortic aneurysms (AAA) with the transperitoneal approach. The intra- and postoperative course of 15 patients who underwent AAA repair using the transperitoneal approach between 1987 and 1991 and another 15 patients who underwent AAA repair using the retroperitoneal approach between 1991 and 1994 were evaluated. The incidence of postoperative wound complications was also assessed. There was no operative or hospital death in either group. Although a significantly longer interval was required from the incision to the aortic clamp using the extraperitoneal method, there were no statistical differences in the aortic clamping time, total operation time, or blood loss between the two groups. On the other hand, there was a statistically significant improvement in bowel function and a significant reduction in the length of postoperative hospitalization following the extraperitoneal procedure. Furthermore, no wound complications such as those associated with the left flank incision developed after the extraperitoneal procedure. Thus, we recommend the midline incision right retroperitoneal approach for AAA as it does not involve muscle division and is associated with fewer complications.     

Rupture of the posterior tibial tendon: CT and surgical findings

Computed tomography (CT) was performed in 42 patients with 49 clinically suspected tears of the posterior tibial tendon. Twenty-eight of the 49 suspected tears were subsequently surgically explored and repaired. Three patterns of tendon abnormalities were recognized on CT scans: type I-intact, hypertrophied, heterogeneous tendon; type II-attenuated tendon; and type III-absence of a portion of a tendon. Types I and II correlated with partial rupture seen during surgery, and type III correlated with complete rupture of the tendon. CT findings were accurate in 96% of the patients who underwent surgery. In four cases (14%), tendon rupture was seen on CT scans, but the extent of the injury was underestimated and the rupture was misclassified. Reactive periostitis of the distal tibia was seen in 71% of diseased tendons and may represent an important factor in the diagnosis of tendon rupture.     

Non-invasive imaging diagnosis of left renal vein compression causing hematuria. Part 2. CT

Left renal veins of 77 patients were examined by computed tomography (CT) to evaluate its usefulness in determining the left renal vein compression which is causing renal bleeding. From CT image, left renal vein compression was observed in 6 (86%) of the 7 cases which had been classified as idiopathic renal bleeding, in 9 (21%) of the 42 cases which had urinary tract diseases causing hematuria, and in 3 (11%) of the 28 cases which did not have hematuria. In 15 of the 18 cases of left renal vein compression, left renal vein was compressed between the superior mesenteric artery and the abdominal aorta, showing so-called nutcracker phenomenon. In the remaining 3 cases, however, the superior mesenteric artery provided sharp delineation from the abdominal aorta. The superior mesenteric artery and the abdominal aorta made the mean angle of 35.5 degree in patients with normal left renal vein, the mean angle of 45.4 degrees in those with left renal vein compression without nutcracker phenomenon, and the mean angle of 11.9 degrees in those with nutcracker phenomenon. CT was superior to ultrasonography, in revealing left renal vein compression.     

Changes in Ca2+ ion activity within unrestrained rat's hippocampus perfused with alcohol or acetaldehyde

In the freely moving rat, the kinetics of Ca²⁺ ion activity were determined at circumscribed sites in the hippocampus, which was perfused with ethanol, tertiary-butyl alcohol or acetaldehyde. Initially, a region in CA1 or other cell field of the dorsal hippocampus was prelabelled by microinjection of⁴⁵Ca²⁺ through a permanently implanted guide tube. Then the tip of a concentric push-pull cannula assembly was lowered through the guide tube to the labelled site, and an isotonic artificial cerebrospinal fluid was repeatedly perfused at a rate of 25 μ1/min. Each perfusion was timed for 5.0min with a 5.0 min interval between each. Once the washout curve of⁴⁵Ca²⁺ activity had begun to approach its asymptote, ordinarily in the midpoint of a series of perfusions, an isotonic solution of ethanol (188–942 mM), tertiary-butyl alcohol (12–580 mM) or acetaldehyde (10–98 mM) was added to the fourth perfusate. Thereafter, the hippocampal site was again perfused with the normal cerebrospinal fluid for the remainder of the experiment. Although the lowest concentration of ethanol exerted no effect on⁴⁵Ca²⁺ ion activity, an intermediate concentration caused mixed effects in either enhancing or suppressing the efflux into the perfusate of this cation. The highest concentration of ethanol produced in most experiments an initial suppression in Ca²⁺ ion efflux which was followed frequently by an elevation in the release of⁴⁵Ca²⁺. Similar changes in Ca²⁺ ion activity were produced by tertiary-butyl alcohol, but the magnitude of its effect was generally less than that of ethanol, suggesting that its effect on brain tissue differs from that of ethanol. Acetaldehyde evoked an intense and concentration-dependent enhancement of Ca²⁺ ion efflux from the perfused tissue at all of the sites in the hippocampus examined.These results suggest that in the unrestrained rat ethanol could unbind Ca²⁺ ions from hippocampal membranes or retard their uptake into cells of the hippocampus. The dual excitatory and inhibitory effect of ethanol on Ca²⁺ ion activity corresponds to the electrophysiological effects of this alcohol and could alter neurotransmitter release from neurons in this subcortical structure. The mechanism of action of acetaldehyde is envisaged to be due to its affinity to membrane sulfhydryl groups which alters protein conformation and thus interferes with both Ca²⁺channels and Ca²⁺ binding properties.     

Lack of association between angiotensin converting enzyme polymorphism and sporadic Alzheimer's disease

Epidemiological and pathogenetic evidences suggest a strong association between vascular risk factors and sporadic Alzheimer's disease (sAD). In agreement with the vascular hypothesis of AD, the role of various candidate genes for atherosclerosis has been investigated, leading to conflicting results. In order to clarify the significance of angiotensin-converting enzyme (ACE) gene insertion (I)/deletion (D) polymorphism in a group of patients with sAD, we conducted a case-control study including 149 cases and 149 age and sex matched controls. All subjects were genotyped for ACE and Apolipoprotein E (APOE). There were no significant differences in ACE genotype or allele frequencies between cases and controls, even after stratification for APOE4 carrier status. Our data suggest that the ACE I/D polymorphism is not associated to genetic susceptibility in sAD patients.     

Tricuspid valve replacement in a patient with idiopathic tricuspid regurgitation]

Tricuspid regurgitation is often seen but is rarely categorized as "idiopathic". A 66-year-old man suspected of idiopathic tricuspid regurgitation underwent tricuspid valve replacement. With right heart failure over twenty years, his CTR increased to eighty six (86) per cent. During operation, no abnormal findings were observed except for the dilated tricuspid valve ring. Then a stented porcine xenograft (Carpentier-Edwards 33 mm) was inserted in the tricuspid valve annulus. Seven years after replacement, he died. Autopsy demonstrated myocardial hypertrophy of the right ventricle and dilatation of the right heart, supporting the diagnosis of idiopathic tricuspid regurgitation.