bluuebunny/crossref_metadata_2025 huggingface dataset:
Development of anti‐HLA antibodies following renal transplantation‐their characteristics and natural history
Authors: Lobo Peter I.
Published: December 2008

Sera from 75 recipients of first cadaver donor renal transplants were analyzed for the development of anti‐HLA antibodies utilizing a complement dependent micro‐cytotoxicity assay. Anti‐HLA activity was assayed utilizing peripheral blood lymphocytes from a panel of normal donors. Anti‐HLA reactivity was felt to be present when a cell‐serum interaction yielded greater than 30% cell death. Reactivity was quantified as the percentage of donors reacting to a particular serum (PRL). Marked increase in PRL activity was demonstrated in 22 of 44 recipients rejecting their allografts and in some development of PRL reactivity could be demonstrated during immunosuppression and before allograft removal. In contrast, PRL reactivity was minimal in recipients with successful allograft (5 of 31 recipients) and this anti‐HLA activity was transient, disappearing after 6 months. Careful analysis of these anti‐HLA antibodies developing post‐transplantation, revealed that these antibodies to a large extent were very broadly reactive (multi‐specific) and could be absorbed out with platelets. Rather surprisingly, development of monospecific antibodies reactive to the mismatched HLA antigens, even early in the transplant course, was uncommon. These observations necessitate a re‐evaluation of “unacceptable” donor HLA antigens for second transplant recipients, especially since anti‐HLA alloantibody formation lacked “private” specificity and was present in only half the recipients rejecting their allograft. Additionally, these observations make one wonder whether “public” specificities on the HI.A molecule arc important in transplant compatibility.

Since only half the recipients rejecting their allografts developed these broadly reactive alloantibodies, it became important to analyze factors that could predispose to alloantibody formation. Previous transfusions, pregnancies, number of rejections, degree of HLA antigen mismatch and presence of autolymphocytotoxins did not appear to have a major influence. However, recipients with HLA—A3 and a mismatch at the B locus appeared to have a decreased likelihood of developing these antibodies.
HLA‐A, B, C, DR antigens, Bf, C4 and glyoxalase I (GLO) polymorphisms in French Basques with insulin‐dependent diabetes mellitus (IDDM)
Authors: Mouzon A. Cambon‐De , Ohayon E. , Hauptmann G. , Sevin A. , Abbal M. , Sommer E. , Vergnes H. , Ducos J.
Published: December 2008

The Basques were previously shown to present a high frequency of HLA—B18 and Bf Fl. which are known to be associated with insulin dependent diabetes mellitus (IDDM). During the VIII International Histocompatibility Workshop, we studied HLA‐A, B, C, DR; Bf, C4 and GLO.I polymorphisms in 51 unrelated French Basque IDDM patients and in 50 controls. Haplotypes were established by family studies in all controls and some patients. Two haplotypes were frequently found in the controls: HLA‐A1, Bw57, Bf S, C4 FIS, DR7 and HLA‐Aw30, Cw5, B18, Bf Fl, C4 Fs°, DR3. The first one was not found in the patients. All the components of the second haplotype had increased frequencies possibly as a consequence of linkage disequilibrium with HLA—DR3: a highly significant association between IDDM and HLA‐DR3 was observed (90.2% vs 24.0%, relative risk (RR) = 29.1. P < 10−11). The HLA‐DR4 frequency was slightly increased (37.3% vs 16.0%). and HLA—DR2 was not found. The silent allele C4 s° was particularly associated with early diagnosed IDDM (86.7% in patients with age at onset under 20 years vs 57.1% in other patients, P < 0.02). The high relative risk for HLA‐DR3/DR4 heterozygous vs that of individuals, possibly HLA‐DR3 homozygous, supported the hypothesis that two HLA‐DR linked genetic factors could be involved in the inheritance of IDDM susceptibility.
Evaluation of different technical approaches for the research of human anti‐la alloantisera
Authors: Borelli I. , Amoroso A. , And P. Richiardi , Curtoni E. S.
Published: December 2008

Several strategies have been proposed for the research of human anti‐la alloantisera. The present work evaluates the results of a screening made on multiparous sera, using either platelet‐absorbed sera or unabsorbed sera against cells coated by anti‐human‐beta‐2‐microglobulin antibodies. When the results of the two approaches were compared, it was observed that the latter shows a higher frequency of positive reactions, being able to detect weak anti‐la, and possibly non‐HLA antibodies, which are not revealed with the usual test on platelet‐absorbed serum. A significant correlation has been noted between the presence of anti‐HLA‐A,B,C and of anti‐la, demonstrating that the best source of Ia antibodies from multiparous women are sera also containing anti‐HLA‐A,B,C.
Applications of automated simultaneous double fluorescence (SDF): I. Unbiased, quantitative HLA‐A,B phenotyping
Authors: Laundy G. J. , Newcombe L. , Bradley B. A.
Published: December 2008

An automated HLA typing method has been developed and standardized. The procedure involves simultaneous excitation and reading of two fluorochromes, carboxy‐fluorescein diacetate and propidium iodide, by a purpose‐built Terasaki tray scanner known as the Astroscan 2100. Data obtained from 95 donors typed by this method and by the classical NIH dye exclusion method prove this system 10 be suitable for routine HLA‐A,‐B typing (similarity coefficient 0.9861). This comparison has highlighted significant observer bias, whereby the observer tends to downgrade very weakly positive reactions to negative and upgrade moderately positive reactions to strong positive. Elimination of this bias reduces the chances of any clinically disastrous consequence.
HLA‐DQB1 allele typing by a new PCR‐RFLP method: Correlation with a PCR‐SSO method
Authors: Salazar Marcela , Yunis Juan J. , Delgado Maria Belen , Bing David , Yunis Edmond J.
Published: December 2008

Abstract: We have developed a new PCR‐RFLP method for HLA‐DQB1 typing. This method was easy to follow, requiring only one DQB1 generic amplification and 5 endonucleases to assign 14 out of 15 HLA‐DQB1 alleles. In addition, we determined that by using one generic amplification and two enzymes (Sau96 I and Hae III) it was possible to type the generic specificities: DQw2, DQw4, DQw5, DQw6, and DQw7, DQw8‐9, providing a practical alternative for serological HLA‐DQ generic typing. We also performed a side‐by‐side correlation with a PCR‐SSO typing method and found an almost 100% concordance between the methods. The limitations of these methods were: 1) the PCR‐RFLP method did not allow the differentiation between the HLA‐DQB1 *0602 and *0603 alleles; 2) the PCR‐SSO method gave crosshybridization signals in the detection of *0302 or *0303 alleles. Our results suggested that both methods, PCR‐RFLP and PCR‐SSO, are useful alternatives for HLA‐DQB1 typing.
Distribution of HLA class II alleles among Scandinavian patients with systemic lupus erythematosus (SLE): An increased risk of SLE among non[DRB1*03,DQA1*0501,DQB1*0201] Class II homozygotes?
Authors: Skarsvåg S. , Hansen K. E. , Holst A. , Moen T.
Published: December 2008

Abstract: HLA‐DRB1, ‐DRB3, ‐DQA1 and ‐DQB1 alleles were determined by DNA typing in 51 Scandinavian patients with systemic lupus erythematosus (SLE) and 129 controls. DRB1*03,DRB3*0101,DQ‐A1*0501,DQB1*0201 were significantly increased in the patient group, with relative risks (RR) of 2.80, 3.07, 3.55 and 2.12, respectively. These alleles are in strong linkage disequilibrium, and their possible relative contributions in predisposition to SLE are difficult to distinguish. The strongest association was found for DQA1*0501, which is in linkage disequilibrium with DRB1*03 as well as DRB1*11,12 (DR5). An increased frequency of DRB1*11,12 was observed (RR=1.89, ns). No association with DRB1*15,16 (DR2) was found. The patients had a higher frequency of HLA class II homozygosity than the controls (RR=5.05, p = 0.0005). When compared to the low‐risk group (nonDRB1*03 class II heterozygotes), the cases homozygous for DRB1*03,DQA1*0501,DQ‐B 1*0201, known to be in linkage disequilibrium with the complement allele C4A*Q0, had the highest relative risk of developing SLE (RR = 16.39, p = 0.0002). However non[DRB1*03,DQA1*0501,DQB1*0201] class II homozygotes had a higher relative risk (RR = 4.68, p = 0.0147) than DRB1*03,DQA1*0501,DQB1*0201 heterozygotes, known to carry the C4A*Q0 allele (RR = 2.72, p = 0.0088). This may suggest that HLA class II molecules are directly involved in susceptibility to SLE.
Studies of RFLP‐inferred HLA‐DR‐DQ haplotypes in Danish women with recurrent fetal losses
Authors: Christiansen O. B. , Mathiesen O. , Husth M. , Jersild C. , Grunnet N.
Published: December 2008

Abstract: Results of HLA‐DR and ‐DQ typing by RFLP in 152 unrelated women with at least 3 unexplained fetal losses were compared with those of 210 normal controls. The overall distribution of DR‐DQ phenotypes did not differ significantly between patients and controls. In a subgroup of 59 patients having had at least 4 fetal losses, a significantly higher number of patients than controls were DRw17,DQw2‐positive (RR = 2.9, pcorrected<0.02). DR‐DQ haplotypes which carry DQB1 alleles encoding an amino acid other than aspartic acid at codon 57 in the second exon (non‐Asp57 haplotypes) have been reported to confer susceptibility to several immunologically‐mediated diseases. We found that the total frequency of non‐Asp57 haplotypes (other than DR7,DQw2 which has unique features) was significantly increased in patients (50.0%) compared with controls (39.3%) (p<0.005). In the total group of patients and in the group with at least 4 fetal losses, 22.4% and 32.2% respectively were homozygous non‐Asp57/non‐Asp57 compared with 13.3% among controls (RR = 1.9, p<0.025 and RR = 3.1, p<0.001, respectively). The results suggest that DRw17,DQw2 confers susceptibility to suffer recurrent fetal losses. However, it is possible that the HLA‐associated susceptibility may be primarily conferred by DQ molecules lacking aspartic acid at codon 57 in the DQβ chain.
HLA‐DPB1 typing with polymerase chain reaction and restriction fragment length polymorphism technique in Danes
Authors: Hviid Thomas V. G. , Madsen Hans O. , Morling Niels
Published: December 2008

Abstract: We have used the polymerase chain reaction (PCR) in combination with the restriction fragment length polymorphism (RFLP) technique for HLA‐DBP1 typing. After PCR amplification of the polymorphic second exon of the HLA‐DPB1 locus, the PCR product was degested with seven allele‐specific restriction endonucleases; RsaI, FokI, ApaI, SacI, BstUI, EcoNI, and DdeI, and the DNA fragments were separated by electrophoresis in agarose gels. Altogether, 71 individuals were investigated and 16 different HLA‐DPB1 types were observed in 26 different heterozygotic combinations, as well as five possible homozygotes. Four heterozygotes could not be unequivocally typed with the PCR‐RFLP method. The HLA‐DPB1 typing results obtained with the PCR‐RFLP method were compared with the typing results obtained with PCR allele‐specific oligonucleotides (PCR‐ASO) in 50 individuals. The results obtained with the two methods were concordant in 84% of the cases. One of the HLA‐DPB1 types was sdiscrepant in six heterozygotes, both HLA‐DPB1 types were discrepant in one heterozygote, and in one individual two HLA‐DPB1 types was discrepant in six heterozygotes, both HLA‐DPB1 types were discrepant in one heterozygote, and in one individual two hLA‐DPB1 types were identified with the PCR‐RFLP technique while only one HLA‐DPB1 type could be demonstrated with the PCR‐ASO technique. The frequencies of the HLA‐DPB1 genotypes deduced from technique. The frequencies of the HLA‐DPB1 genotypes deduced from the results of PCR‐RFLP typing were estimated in 71 healthy Danes.
Nitric oxide production by a human osteoblast cell line stimulated with Aggregatibacter actinomycetemcomitans lipopolysaccharide
Authors: Sosroseno W. , Bird P. S. , Seymour G. J.
Published: December 2008

Background/aim:  Human osteoblasts induced by inflammatory stimuli express an inducible nitric oxide synthase (iNOS). The aim of the present study was to test the hypothesis that Aggregatibacter actinomycetemcomitans lipopolysaccharide stimulates the production of nitric oxide (NO) by a human osteoblast‐like cell line (HOS cells).

Methods:  Cells were stimulated directly with A. actinomycetemcomitans lipopolysaccharide or pretreated with the following l‐NIL (an iNOS inhibitor), anti‐CD14, Toll‐like receptor 2 (TLR2), or TLR4 antibody before stimulation with A. actinomycetemcomitans lipopolysaccharide. The role of the cyclic nucleotides was assessed by pretreating the cells with the following; ODQ (a guanylyl cyclase inhibitor); SQ22536 (an adenylyl cyclase inhibitor); db‐cAMP (a cyclic adenosine monophosphate analog); br‐cGMP (a cyclic guanosine monophosphate analog); forskolin (an adenylyl cyclase activator), IBMX [a non‐specific phosphodiesterase (PDE) inhibitor], or KT5720 [a protein kinase A (PKA) inhibitor]. The cells were also preincubated with genistein [a protein tyrosine kinase (PTK) inhibitor], bisindolylmaleimide [a protein kinase C (PKC) inhibitor], BPB [a phospholipase A2 (PLA2) inhibitor], and NDGA (a lipoxygenase inhibitor). The iNOS activity and nitrite production in the cell cultures were determined spectrophotometrically.

Results:  The results showed that A. actinomycetemcomitans lipopolysaccharide stimulated both iNOS activity and nitrite production by HOS cells; this was reduced by l‐NIL, anti‐CD14, or anti‐TLR4 antibody, SQ22536, KT5720, genistein, bisindolylmaleimde, BPB, and NDGA, but was enhanced by db‐cAMP, IBMX, and forskolin.

Conclusion:  These results therefore suggest that A. actinomycetemcomitans lipopolysaccharide may induce the production of NO by HOS cells via a CD14–TLR4 molecule complex, a cAMP–PKA pathway, as well as by a PTK, PKC, PLA2, and lipoxygenase‐dependent mechanism.
Detection of oral bacteria in cardiovascular specimens
Authors: Nakano K. , Nemoto H. , Nomura R. , Inaba H. , Yoshioka H. , Taniguchi K. , Amano A. , Ooshima T.
Published: December 2008

Background/aims:  Oral bacteria, including cariogenic and periodontal pathogens, are thought to be etiological factors in the development of cardiovascular diseases. To define this relationship, we analyzed the distribution of oral bacterial species in cardiovascular specimens.

Method:  Following acceptance into the study, 203 consecutive patients were analyzed, from whom 82 aortic valve specimens, 35 mitral valve specimens, and 86 aortic aneurysmal wall specimens, of which 16 contained aneurysmal thrombus tissues, were obtained. In addition, a total of 58 dental plaque specimens were collected from the same group of patients who underwent heart valve replacement or removal of aortic aneurysms. Bacterial DNA was extracted from both cardiovascular tissues and dental plaque in those cases and then species‐specific polymerase chain reaction assays were used to analyze the occurrences of six oral streptococcal and six periodontal bacterial species.

Results:  Streptococcus mutans was the most frequently detected species in the cardiovascular specimens, followed by Aggregatibacter actinomycetemcomitans. As for dental plaque specimens from patients who underwent cardiovascular operations, most of the tested periodontitis‐related species as well as oral streptococci were detected at high frequencies. Furthermore, the positive rate of S. mutans in cardiovascular specimens from patients whose dental plaque specimens were also positive for S. mutans was 78%, which was significantly higher than any other tested species when the same analysis was performed.

Conclusion:  Our results suggest that specific oral bacterial species, such as S. mutans and A. actinomycetemcomitans, are related to bacteremia and may be etiologic factors for the development of cardiovascular diseases.
Chronic kidney disease in children following lung and heart–lung transplantation
Authors: Benden Christian , Kansra Sonal , Ridout Deborah A. , Shaw Nadine L. , Aurora Paul , Elliott Martin J. , Marks Stephen D.
Published: December 2008

Abstract:  CKD is a major co‐morbidity in pediatric lung transplant recipients. We report the prevalence of renal impairment post‐lung transplant at a single center, using a modified, age‐adjusted eGFR for the best approximation of true GFR, and investigated associations and possible predictors of decline in renal function post‐transplant. Renal function was assessed by eGFR pre‐transplant, three and 12 months post‐transplant, and at last follow‐up. Decline in renal function was analyzed as percentage fall in eGFR in two phases (0–3 and 3–12). Furthermore, we investigated impact of gender, age, pre‐transplant diagnosis and renal function, transplant type, early post‐transplant dialysis, and tacrolimus trough levels on decline in eGFR using multivariate analysis. Over a five‐yr period, 30 transplants were performed. Mean eGFR pretransplant was 117 mL/min/1.73 m2 (s.d. 35) with mean decline in eGFR during the first three months post‐transplant of 33% (s.d. 31, p < 0.001). Thereafter, mean decline in eGFR was 8% (s.d. 18, p = 0.02). None of the factors assessed were significantly associated with decline in eGFR post‐transplant. In conclusion, many children have decline in renal function following lung transplantation, particularly early post‐transplant. Unlike in adults, we were unable to detect any predictors of renal impairment in pediatric lung transplant recipients.
Incidence and risk factors for cardiovascular events and death in pediatric renal transplant patients: A single center long‐term outcome study
Authors: Koshy Susan M. , Guttmann Astrid , Hebert Diane , Parkes Robert K. , Logan Alexander G.
Published: December 2008

Abstract:  There are considerable mortality data associated with renal transplantation in children; however, morbidity data, especially related to CV disease, are scarce. The objectives of this study were to determine incidence of non‐fatal and fatal CV events and all‐cause mortality in PRTx and evaluate risk factors for these conditions. Using a population‐based retrospective cohort design, 274 PRTx with or without a functioning graft was followed until death or date of last contact (median follow‐up 11.9 yr). Primary outcomes (time to first fatal or non‐fatal CV event and all‐cause mortality after first transplant) were ascertained from chart review and linkage with administrative databases of a universal health care system. During 3073 patient‐years, there were 46 deaths; 13 were because of CV disease. Twenty patients had CV events that did not result in death. Post‐transplant diabetes mellitus (10.5%) was associated with increased risk of death (HR: 2.79, 95% CI: 1.04–7.44) and CV events (HR: 3.90, 95% CI: 1.31–11.59). Low estimated glomerular filtration rate at one yr post‐transplant was also associated with increased risk of death. The rates of developing CV disease and dying prematurely are extraordinarily high in PRTx, underscoring the need for early and aggressive intervention to reduce the burden of suffering in this patient population.
CARDIOVASCULAR EFFECTS OF PROCAINE AND LIDOCAINE (XYLOCAINE®) DURING GENERAL ANESTHESIA
Authors: Kimmey James R. , Steinhaus John E.
Published: December 2008

The cardiovascular effects of intravenous procaine and lidocaine were compared in two series of patients under nitrous‐oxide‐thiobarbiturate anesthesia. The arterial blood pressure and electrocardiogram of these patients were continuously monitored while standarized doses of 2.2 mg/kg and 1.1 mg/kg of the test drug were administered. It was found that procaine administration was followed by cardiovascular depression in 50 % of the doses administered, while a blood pressure increase was noted following 47 % of the lidocaine injections. The lack of vasomotor depression with the administration of lidocaine is advantageous when this agent is used to supplement general anesthesia.
THE ACTION OF SUCCINYLCHOLINE ON THE SKELETAL MUSCLES OF THE FROG An Electromyographic Study
Authors: Björk ÅKe , Wåhlin ÅKe
Published: December 2008

As a supplement to similar investigations in man, the preparalytic activity of succinylcholine was studied in cold‐blooded animals with the aid of electromyography.

The recording was done from the gastrocnemius muscle in intact, decapitated and cordless animals.

A technique devised for intravenous injection into frogs is described.

In general, the normal action potentials proved to be biphasic with an average duration of 6.76 ± 0.48 msec. They showed only slight variation in duration and form.

Under the effect of succinylcholine a gradual shortening of the duration of the potentials was noted, leading to very small potentials of the fibrillation type. This is regarded as indicating a breaking down of the motor units.

Fasciculations following injection of succinylcholine were observed and recorded electromyographically in most cases.

Even in cordless frogs, fasciculations appeared spontaneously, which indicates that they can occur entirely without the aid of the spinal cord.
CHANGES IN NEUROMUSCULAR BLOCKING ACTIVITY OF TUBOCURARINE AND DIMETHYL TUBOCURARINE INDUCED BY THE ADMINISTRATION OF CARBON DIOXIDE
Authors: Payne J. P.
Published: December 2008

The effects of carbon dioxide on the neuromuscular blocking properties of dimethyl tubocurarine were studied in the intact cat and compared with the response of tubocurarine under similar circumstances.

It was shown that the action of dimethyl tubocurarine was antagonised, whereas the action of tubocurarine was enhanced.

Evidence was presented to indicate that the enhanced activity of tubocurarine was due to a change in the ionic state of the phenolic hydroxyl groups. No completely satisfactory explanation could be given for the reduced activity of dimethyl tubocurarine, but it was suggested that carbon dioxide modified the motor end‐plates in such a way that their resistance to relaxant drugs is increased.
AIR PASSAGE THROUGH THE HYPOPHARYNX IN UNCONSCIOUS PATIENTS IN THE PRONE POSITION
Authors: Asmussen E. , Hahn‐Petersen A. , Rosendal Th.
Published: December 2008

The air passage through the hypopharynx was studied radiographically in nine anaesthetised and curarised patients and in eight conscious subjects in the prone position, with the head placed either in the normal position or with maximal extension in the atlanto‐occipital joint. In six of the unconscious and five of the Conscious individuals, the hypopharynx was obstructed (the sagittal diameter at the second cervical vertebra was zero) when the head was in the normal position. With maximal extension of the head in the atlanto‐occipital joint, the air passage through the hypopharynx was found to be unobstructed in all the individuals studied.
PULMONARY VENTILATION AND RESPIRATORY GAS EXCHANGE DURING MANUAL ARTIFICIAL RESPIRATION AND EXPIRED‐AIR RESUSCITATION ON APNOEIC NORMAL ADULTS
Authors: Poulsen Henning , Skall‐Jensen Jørgen , Staffeldt Ingrid , Lange Morten
Published: December 2008

Comparative experimental studies on resuscitation by the mouth‐to‐mouth and Holger Nielsen (back‐pressure arm‐lift) methods are reported. The experiments were performed on five normal unconscious apnoeic adults and extended over periods of from 20 to 40 minutes.

Tidal air, minute volume and alveolar ventilation/min. were determined pneumographically and/or spirometrically and/or volumetrically.

The oxygen saturation and carbon dioxide tension of the arterial blood were determined during the experiments.

Sufficient alveolar ventilation with normal arterial oxygen saturation and PCO2 was obtained by the mouth‐to‐mouth method in four out of five cases. In one case, hypoventilation occurred during the performance of the mouth‐to‐mouth method.

Sufficient alveolar ventilation with normal arterial oxygen saturation and constant PCO2 was obtained by the Holger Nielsen method in one out of five cases. In four cases, variable degrees of hypoventilation occurred during the performance of the manual manoeuvres with an increase in the PCO2 of the arterial blood. However, an arterial oxygen saturation of more than 80% was maintained throughout the experimental period (30–40 minutes), although resuscitation with atmospheric air was given during the greater part of the period.

The advantages and disadvantages of the two methods are discussed.

Maintenance of a patent airway during artificial respiration must be considered to constitute a conditio sine qua non.

If the Holger Nielsen method is to produce sufficient alveolar ventilation in the field, the respiratory frequency must be 15–16 breaths per minute, and the victim's head should be bent backwards (extension in the atlanto‐occipital joint).

The authors are unable to recommend one of the two methods as being superior to the other in adults, but agree with the American investigators in their recommendation of the mouth‐to‐mouth method in infants and small children. The view is expressed that it would be desirable to train the general population as “two‐method” resuscitation operators.
THE EFFECT OF ETHER ANESTHESIA ON ANAPHYLACTIC SHOCK
Authors: Waugh Robert E. , Greene Nicholas M.
Published: December 2008

Ether anesthesia provides a partial but statistically significant protection against fatal anaphylactic shock in the guinea pig. This protection is related in part to the concurrent reflex release of catechol amines produced by the ether.
PERIDURAL SPINAL ANAESTHESIA FOR CAESAREAN SECTION
Authors: Ebbli Carlo , Barricalla Aldo
Published: December 2008

The technique of peridural spinal anaesthesia commonly used by the authors in Caesarean section is described. The advantages of this type of anaesthesia and its possibilities of success both as regards the mother and the foetus are considered. The conditions in which it may be contra‐indicated, or in which the technique may prove unsuccessful, are discussed.
A COMPARISON OF PETHIDINE AND DIHYDROCODEINE FOR THE RELIEF OF LABOUR PAIN*
Authors: Lund Ivar , Lind Björn
Published: December 2008

The pain‐relieving effect of pethidine 100 mg and dihydrocodeine 30 mg was investigated in 419 women during labour pain in three hospitals.

A double‐blind technique was used, and the two drugs were given as the first and second injection to every other parturient woman. The analgesic effects of the drugs were rated as “good” when more than 50% pain relief was obtained, “fair” when 50% relief was obtained, and “poor” when less than 50% pain relief was achieved. The results from the three hospitals were consistent enough to warrant pooling of the data.

When the total number of doses for each drug were compared, pethidine 100 mg gave “good” pain relief in 64.2% against 41.4% when dihydrocodeine 30 mg was used.

When “paired doses” of the drugs were considered, the percentage of “good” pain relief afforded by pethidine was 76.5 and that by dihydrocodeine 47.1.

The newborn infants were given a score according to a system suggested by V. Apgar (1953)1. Evaluation of the data thus obtained revealed that the scores of the infants whose mothers had received pethidine within 4 hours prior to delivery were significantly lower than the scores of those whose mothers had been given no analgesic. The number of observations on infants whose mothers had been given dihydrocodeine was small, and the differences between this group and the two others may have been due to chance.
CLINICAL TRIALS OF A NEW LOCAL ANAESTHETIC
Authors: Eriksson Ejnar , Gordh Torsten
Published: December 2008

In conjunction with comparative studies of Xylocaine® and a new local anaesthetic agent, L67, it could be demonstrated that a greater and more statistically reliable difference in duration in favour of L67 could be obtained with finger blocks than with the customary cutaneous wheals. A correlation between age and duration of anaesthesia was obtained for finger blocks with both agents. The effects of concentration and age upon duration and latent period were more closely studied for L67. Age was found to affect duration but not the length of the latent period. Concentration affected duration in the older age groups but not in the younger. The length of the latent period was inversely proportional to concentration in all age groups. The results stress the importance of uniformity with regard to age between the groups when different groups are compared in clinical trials of local anaesthetics. Furthermore, a practical consequence is that greater attention should be paid to the concentration of the local anaesthetic used for finger blocks in older persons.

The effect of age is supposed to depend upon variations in the vascularization of the anaesthetized region. If this is the case, it remains to be determined whether the differences in the duration of anaesthesia for different agents without vasoconstrictors depend upon differences in the effects of the agents upon blood vessels more than upon different affinities for nerve tissue.
THE EFFECT OF PALFIUM®, (2,2‐DIPHENYL‐3‐METHYL‐4‐MORPHOLINO‐BUTYRYL‐PYRROLIDINE) ON RESPIRATORY GASEOUS EXCHANGE, ITS SIDE ACTIONS AND ANALGESIC POTENCY
Authors: Lund Ivar , Erikson Harald
Published: December 2008

In 9 healthy volunteers a respiratory depression of the same magnitude as that caused by 10 mg of morphine was observed after 7.5 and 10 mg of Palfium. The reduced ventilation was found to be due to a decrease in the respiratory rate while the respiratory volume remained unchanged. The respiration after Palfium was conspicuous by its irregular type, and in 4 out of the 9 subjects, periods of apnoea were observed, lasting from1/2to 2 minutes.

A great number of characteristic side reactions was exhibited by the subjects after Palfium.

The analgesic effect of Palfium on postoperative pain was compared with that of morphine by means of a double‐blind technique. As regards analgesic potency, 7.5 mg of Palfium was found to correspond approximately to 10 mg of morphine. A case of respiratory arrest after 10 mg of Palfium occurred in a 29‐year‐old male patient. Respiration was re‐established after 8 mg of nalorphine hydrobromide had been administered intravenously.

The use of Palfium in postoperative pain is not recommended.
NUNCITAL®, MEPROBAMATE AND PLACEBO IN A DOUBLE‐BLIND PREMEDICATION STUDY
Authors: Herbring Bengt‐Göran , Wiklund Per Erik
Published: December 2008

A new internuncial blocking agent, Nuncital® (1‐ethyl‐1‐methyl propyl carbamate) was compared with meprobamate and a placebo for its effect in premedication.

The clinical series consisted of 195 cases given either 200 or 600 mg of the compounds on the night before, and one hour prior to, operation.

No significant differences were observed between meprobamate and a placebo, both being considered to give an adequate pre‐operative sedation. Nuncital does not cause any sedation, but seems to enhance alertness and vigilance in the patients.

No side effects were recorded.

Nuncital (1‐aethyl‐l‐methyl‐propyl‐carbamat), ein neuer internuntialer Blocker, wurde in Hinsicht auf seine Wirkung bei der Praemedikation mit Meprobamat und einem Placebo verglichen.

Die klinische Serie bestand aus 195 Fällen, denen entweder 200 oder 600 mg der Medikamente am Vorabend und 1 Stunde vor der Operation verabreicht wurde.

Keine signifikanten Wirkungsunterschiede wurden zwischen Meprobamat und dem Placebo gesehen, bei beiden wurde die präoperative Sedierung als ausreichend betrachtet. Nuncital fährte zu keiner Beruhigung, ja es schien sogar den Wachheitszustand der Patienten zu erhöhen.

Nebeneffekte wurden nicht beobachtet.
THE EFFECT OF SUCCINYLCHOLINE ON THE GAT DIAPHRAGM: An Electromyographic Study
Authors: Björk ÅKe , Wåhlin ÅKe
Published: December 2008

The excitatory activity elicited by succinylcholine in the form of muscle twitches has been studied electromyographically on the diaphragm of the anaesthetised cat.

Since the spontaneous breathing persisted under anaesthesia, the effect of the drug could be studied under conditions of practically normal respiration.

The electromyographic pattern reported in the earlier studies of the authors on the effect of succinylcholine was also found to apply to the diaphragm.

In the present study, this pattern was also recorded after division of the phrenic nerve. The muscle twitches which were then observed do not appear to have been caused by the central nervous system, but are presumably elicited by the action of the drug on the nerve endings.

Die, sich in Form von Muskelzuckungen ausdrückende, Erregungsaktivität des Succinylcholins wurde elektromyographisch am Zwerchfell der narkotisierten Katze untersucht.

Da die Spontanatmung während der Narkose erhalten blieb, konnte die Wirkung des Mittels unter praktisch normalen Atmungsbedingungen studiert werden. Das elektromyographische Muster, über das die Autoren schon in ihren früheren Arbeiten über den Effekt des Succinylcholins berichtet hatten, wurde auch am Katzenzwerchfell gefunden.

Bei dieser jüngsten Untersuchung wurde das gleiche Muster auch nach Durchtrennung des Nervus phrenicus beobachtet. Die Muskelzuckungen, welche dann gesehen wurden, scheinen ihre Ursache daher nicht in einer Wirkung am Zentralnervensystem, sondern vermutlich in einem direkten Angriff des Mittels auf die Nervenendigungen zu haben.
RECTAL PENTOTHAL IN PEDIATRIC ANESTHESIA: A Comparative Clinical Study
Authors: Benson Francis , Saarne Apollon
Published: December 2008

Rectal pentothal was used in 450 children in a good general condition, different dosages of pentothal and different premedication agents being employed. Either instructed nurses or anesthesiologists have handled all procedures. Two control groups each of 50 patients were used. All patients were closely observed. The following conclusions were made:—

Satisfactory results are obtained with a pentothal dosage of 0.04 g per kg; 0.03 g per kg gives good results when the premedication agent is scopolamine. When atropine is used, basal anesthesia is obtained in 53 per cent and a state of basal hypnosis in 44 per cent. The dosage of 0.02 g per kg is inadequate.

It is best to manage all procedures in a quiet anesthetic room. Rapidity of onset has been revealed. Exact timing is important. The method is safe for good‐risk patients in the hands of instructed nurses. The length of the postoperative recovery period depends on the pentothal dosage, premedication agent used and the person managing anesthesia. Rectal pentothal has an antisialogue, antiemetic and amnestic effect.

Three cases from another series are briefly mentioned because they give important information concerning prolonged postoperative sleep and respiratory depression in connection with rectal pentothal.

Pentothal wurde bei 450 Kindern in gutem Allgemeinzustand als rectaler Einlauf gegeben, wobei man sich verschiedener Dosierungen des Mittels und verschiedener Prämedikationen bediente. Die Prozeduren wurden entweder von eingeschulten Schwestern oder von Anaesthesisten durchgeführt. Zwei Gruppen von je 50 Patienten dienten als Kontrollgruppen. Alle Patienten wurden genauestens beobachtet und dabei konnten folgende Schlüsse gezogen werden:

Zufriedenstellende Resultate wurden mit einer Dosis von 0,04 g Pentothal pro kg erzielt; 0,03 g pro kg ergab nur dann gute Resultate, wenn Scopolamin zur Vorbereitung gegeben worden war. Wurde hingegen Atropin verwendet, dann konnte eine Basisanaesthesie nur in 53% und eine Art Basishypnose in 44% der Fälle erreicht werden. Pentothal in einer Dosierung von 0,02 g/kg war nicht ausreichend.

Die Prozeduren sollten vorzugsweise in einem ruhigen Vorbereitungsraum durchgeführt werden. Die Geschwindigkeit des Narkoseeintrittes wurde untersucht. Exakte Zeitmessung ist wichtig. Die Methode ist für Patienten in gutem Zustand auch in den Händen von eingeschulten Schwestern sicher. Die Dauer der postoperativen Erholungsperiode hängt ab von der Pentothaldosis, dem Prämedikationsmittel und der Person, die die Anaesthesie durchgeführt hat. Rectales Pentothal hat einen speichelhemmenden, antiemetischen und amnestischen Effekt.

Drei Falle aus einer anderen Serie wurden kurz erwähnt, weil sie wichtige Informationen über prolongierten postoperativen Schlaf und Atemdämpfung in Verbindung mit rectalem Pentothal abgaben.
VIADRIL ANASTHESIA SUPPLEMENTED WITH PALFIUM
Authors: Salenius P. , Hollmen A.
Published: December 2008

The authors have employed the new analgesic Palfium in Viadril anaesthesia for general surgery. The average dose of Palfium was 0.029 ± 0.001 mg/kg, which corresponds to 2.1 mg to a person weighing 70 kg. The largest amount given per kg was 0.06 mg and the smallest 0.009 mg, the extreme absolute amounts being 3.5 mg and 0.5 mg. When Palfium was administered, the time required for the patients to regain consciousness was much shorter than when the analgesic was not employed. The average amount of Viadril administered was also much smaller when Palfium was employed.

In one case the administration of 2.5 mg of Palfium during 45 minutes caused apnoea, which, however, was alleviated at once by Nalorphin.

Previous results and those obtained in the present study indicate that a comparative study of the action of Palfium and pethidine in Viadril anaesthesia would be of value.

ZUSAMMENFSSUNG

Die Autoren haben das neue Analgeticum Palfium mit Viadril kombiniert zu Narkosezwecken in der Allgemeinchirurgie angewendet. Die Durchschnittsdosis von Palfium war 0,029 ± 0,001 mg/kg, fur eine 70 kg schwere Person also 2,1 mg. Die höchste Dosis pro kg, die gegeben wurde, war 0,06 mg, die kleinste 0,009 mg, die absolut höchste Menge war 3,5 mg, die absolut geringste 0,5 mg. Wenn Palfium gegeben worden war, dauerte es viel kürzer, bis die Patienten das Bewusstsein wieder erlangten. Auch die Druchschnittsmenge von Viadril war geringer, wenn Palfium angewendet worden war.

In einem Fall verursachte die Gabe von 2,5 mg Palfium, über 45 Minuten gegeben, eine Apnoe, welche jedoch sofort mit Nalorphin behoben werden konnte.

Frühere Resultate, und die in der vorliegenden Untersuchung erzielten, deuten darauf hin, dass eine vergleichende Untersuchung der Wirkung von Pal fium, bzw. Pethidin bei der Viadrilnarkose von grossem Wert wäre.
THE INFLUENCE OF CHANGES IN BLOOD PH ON THE NEUROMUSCULAR BLOCKING PROPERTIES OF TUBOCURARINE AND DIMETHYL TUBOCURARINE IN THE CAT
Authors: Payne J. P.
Published: December 2008

The blood pH of healthy cats was altered by means of infusions of 0.1 N hydrochloric acid and sodium bicarbonate in a strength of 8 g per cent.

The activity of both tubocurarine and dimethyl tubocurarine was tested at different pH values.

It was observed that the activity of both tubocurarine and dimethyl tubocurarine was enhanced when the pH was raised and reduced when it was lowered. The muscle twitch itself was sometimes increased and sometimes decreased by both the acid and the alkaline infusions.

Possible explanations for the phenomena described are considered.

Das Blut‐pH von gesunden Katzen wurde durch Infusionen von 0.1‐normaler Salzsäure bzw. 8% iger Na‐Bicarbonatlösung nach der sauren oder alkalischen Seite verschoben.

Die Aktivität von Tubocurarin bzw. Methyltubocurarin wurde bei verschiedenen pH‐Werten getestet.

Dabei wurde beobachtet, dass die Wirkung von Tubocurarin und Dimethyl‐Tubocurarin in erhöhtem pH verstärkt und bei erniedrigtem pH vermindert war. Die Muskelkontraktion bei indirekter Reizung wurde sowohl durch die saure als auch durch die alkalische Infusion selbst manchmal verstärkt, manchmal vermindert.

Die möglichen Erklärungen für die beschriebenen Phänomene werden diskutiert.
TRIALS WITH A NEW HEAT EXCHANGER FOR DEEP HYPOTHERMIA: A Preliminary Report
Authors: Haglund Goran , Lundberg Hans
Published: December 2008

The authors describe a new heat exchanger for extracorporeal blood cooling for deep hypothermia. Some principles are discussed, and the first clinical experiences with deep hypothermia for open‐heart surgery are reported.

Die Autoren beschreiben einen neuen Temperaturregler für extracorporale Blutkühlung zum Zwecke der tiefen Hypothermie. Einige Grundlagen zur Methode werden diskutiert und über die ersten eigenen klinischen Erfahrungen mit der tiefen Unterkühlung für Operationen am offenen Herzen berichtet.
ACID‐BASE CHANGES UNDER HALOTHANE, NITROUS OXIDE AND OXYGEN ANAESTHESIA DURING SPONTANEOUS RESPIRATION
Authors: Holmdahl Martin H:son , Payne J. P.
Published: December 2008

The effects of 1.5 per cent. halothane on respiration in patients undergoing surgery were studied by means of assessing the acid‐base status of arterial blood. The depression of spontaneous respiration and rise in carbon dioxide tension were found to be less than earlier reported during halothane anaesthesia without concomitant surgery. Earlier findings that halothane does not cause metabolic acidosis in patients under controlled respiration were confirmed in patients allowed to breathe spontaneously. The effect of halothane on the metabolic rate is discussed.

Bei einer Anzahl von Patienten wurde intraoperativ die Wirkung einer Konzentration von 1,5% Halothan auf die Atmung mit Hilfe der Bestimmung des Säure‐Basen‐Status im arteriellen Blut untersucht. Die Dämpfung der Spontanatmung und der Anstieg der Kohlensäurespannung war geringer als bei früheren Studien die während der Halothannarkose, jedoch ohne gleichzeitigen chirurgischen Eingriff, durchgeführt worden waren. Die früheren Befunde, dass Halothan bei Patienten mit kontrollierter Beatmung keine metabolische Acidose hervorruft, konnten an spontanatmenden Patienten bestätigt werden. Die Wirkung von Halothan auf den Grundumsatz wird diskutiert.
LOCAL ANESTHETIC AGENTS IN COMBINATION WITH VASOCONSTRICTORS PART I, EPINEPHRINE*
Authors: Sadove M. S. , Kolodny S.C.
Published: December 2008

By use of the Trypan‐Blue leak‐out test and by later studies of local tissue necrosis at the site of injection, we have found a distinct correlation between tissue irritancy, tissue necrosis, and the combined use of the more potent local anesthetics and epinephrine. We believe this action to be due not to the vasoconstrictor primarily, but rather to retention of the local anesthetic in one tissue area.

The vasoconstrictor permits a high mass‐volume‐time action allowing a 1 % or 2 % local anesthetic concentration, in reality, to act as a 6 % or even higher concentration. Ideally one would desire just that amount of vasoconstrictor necessary to delay absorption of the local agent permitting an adequate saturation of nerve tissue without over‐retention of the irritating local anesthetic drug.

More studies are in progress in order to determine the effects of other vasoconstrictors when combined with the more potent local anesthetics and the possible translation of our data to man. Whatever the results in experimental animals, the importance of any study is as it pertains to man.

Mit Hilfe des Trypan‐Blau‐Sickertestes und durch spätere Untersuchungen von lokalen Gewebsnekrosen an der Stelle der Injektion konnten wir eine deutliche Correlation zwischen der Gewebsreizung, Gewebsnekrose und der kombinierten Anwendung stärkerer Lokalanaesthetica mit Epinephrin fest‐stellen. Wir glauben, dass diese Wirkung nicht so sehr in erster Linie durch den Vasokonstriktor sondern vielmehr durch die Retention des Lokalana‐estheticums in einer bestimmten Gewebsregion bedingt ist.

Der Vasokonstriktor führt zu einer hohen Massen‐Volums‐Zeit‐Wirkung, indem er eine 1– oder 2%ige L.A.‐Konzentration in Wirklichkeit in eine 6%ige oder noch höhere Konzentration umwandelt. Idealerweise würde man wünschen, dass nur so viel Vasokonstriktor vorhanden ist, dass durch die verzögerte Absorption des Lokanaestheticums dieses sich am Nervengewebe zwar in ausreichender Sättigung anlagert, jedoch nicht zu einer irritierenden Überkonzentration führt.

Es sind noch weitere Untersuchungen notwendig, um die Wirkungen anderer Vasokonstriktoren festzustellen, wenn diese mit starken Lokalanaestheticis kombiniert werden. Auch die Übertragung unserer Befunde auf den Menschen muss noch studiert werden. Denn was immer das Resultat am Versuchstier ist, es kommt schliesslich doch im Wesentlichen darauf an, wie weit die Untersuchung auch für den Menschen Gültigkeit hat.
THE EFFECT OF ADRENOXYL® ON BLOOD LOSS DURING RADICAL MASTECTOMY
Authors: Stovner J. , Brennhovd I.
Published: December 2008

Adrenoxyl has been given to 15 patients subjected to radical mastectomy. The patients were given 50 mg of the drug orally 2 hours before operation and 50 mg by continuous intravenous drip infusion during the operation. The blood loss during operation was measured by the gravimetric method. The results were compared with 15 control cases. There was no significant difference in the blood losses between the control group and the group receiving Adrenoxyl. The results indicate that Adrenoxyl probably is of no value in reducing blood loss during radical mastectomy.

15 Patienten, bei denen eine radikale Ablatio mammae durchgeführt wurde, bekamen Adrenoxyl. Die Patienten erhielten 50 mg des Mittels per os 2 Stunden vor der Operation und 50 mg in die i.v. Tropfinfusion während der Operation. Der operative Blutverlust wurde gravimetrisch gemessen und die Resultate mit 15 Kontrollfällen verglichen. Es fand sich kein signifikanter Unterschied des Blutverlustes zwischen der Kontrollgruppe und jener Gruppe, die Adrenoxyl erhalten hatte. Diese Untersuchungen scheinen darauf hinzuweisen, dass Adrenoxyl wahrscheinlich keine Bedeutung für die Verminderung des Blutverlustes wahrend der radikalen Ablatio mammae besitzt.
NEUROLEPT‐ANALGESIA—AN ALTERNATIVE TO GENERAL ANAESTHESIA
Authors: Nilsson Eric , Janssen Paul
Published: December 2008

An account is given of the pharmacological characteristics of haloperidol and phenoperidine, as manifested in experimental animals.

Neurolept‐analgesia is discussed as an alternative “anaesthetic” technique for patients undergoing surgery.

The neurolept‐analgesic state is defined, and reactions manifested by patients so treated are discussed.

A detailed account is given of a neurolept‐analgesic technique as used in a series of 250 patients undergoing surgery.

Complications and their treatment are discussed.

The advantages of neurolept‐analgesia can be summarised as follows:—

1. Administration of toxic agents is reduced to a minimum, and there is thus very little interference with general cell function.

2. The condition produced is easily controllable. In the event of overdosage with phenoperidine, nalorphine is an effective antidote.

3. The condition of the circulatory system remains remarkably stable during neurolept‐analgesia.

4. Patients react well to the trauma of surgery and “anaesthesia,” and their good postoperative condition is noteworthy. Very small amounts of analgesics are required postoperatively.

Die auf Grund von Tierexperimenten festgestellten pharmakologischen Eigenschaften von Haloperidol und Phenoperidin werden geschildert.

Neurolept‐Analgesie wird als Alternativ‐“Anaesthesie”‐Technik fur Patienten diskutiert, die sich chirurgischen Eingriffen unterziehen müssen.

Der Zustand der Neurolept‐Analgesie wird definiert und die Reaktionen der so behandelten Patienten diskutiert.

Die Technik der Neurolept‐Analgesie, wie sie bei einer Serie von 250 chirurgischen Patienten angewendet wurde, wird im Detail geschildert. Komplikationen und deren Behandlung werden besprochen. Die Vorteile der Neurolept‐Analgesie können wie folgt zusammengefasst werden:

1. Die Menge des toxischen Agens wird auf ein Minimum reduziert, daher ist auch der Einfluss auf die allgemeinen Zellfunktionen gering.

2. Der erzeugte Zustand kann leicht kontrolliert werden. Im Falle der Überdosierung mit Phenoperidin ist Nalorphin ein wirkungsvolles Antidot.

3. Der Kreislauf bleibt im Zustand der Neurolept‐Analgesie bemerkenswert stabil.

4. Die Patienten reagieren auf das Trauma der Operation und der “Anaes‐thesie” giinstig und ihr guter postoperativer Zustand ist bemerkenswert. Post‐operativ werden nur kleine Mengen von analgetischen Mitteln benotigt.