bluuebunny/crossref_metadata_2025 huggingface dataset:
The epidemiologic approach to studies of association between HLA and disease: I. The basic measures, concepts and estimation procedures
Authors: Green Anders
Published: December 2008

The present report describes the basic epidemiological measures and concepts used in association studies, i.e. measures of disease frequency and the concept of risk, together with their internal relationships. Further, the different types of designs for HLA and association studies are reviewed with particular reference to estimation of association strength. It is shown that the odds ratio from a 2 × 2 table estimates the incidence density ratio which again under certain conditions estimates the relative risk, if the study is based on incident (new) cases. However, most HLA and association studies are prevalence‐based, which implies that the relative risk and incidence density ratio cannot be estimated unless a series of conditions is fulfilled. Finally, it is stressed that a detailed description of study design and the age classes studied as well as the procedure of case ascertainment should be mandatory before comparisons between and pooling of estimates from different studies are performed.
Monoclonal mouse anti‐I‐Ak and anti‐I‐Ek antibodies cross‐reacting with HLA‐DR supertypic and subtypic determinants rather than classical DR allelic specificities
Authors: Pierres Michel , Mercier Pierre , Madsen Melvin , Mawas Claude , Krislensen Tom
Published: December 2008

Thirty monoclonal alloantibodies (mAB) against mouse Iak antigens have been derived by fusion of mouse myeloma and spleen cells from A.TH (Ks Is Dd) mice immune to A.TL (Ks Ik Dd) lymphoid cells. Analysis of: (i) their reactivity (using 125I labelled protein A cell binding or cytotoxicity assays) on lymphoid cells from selected mouse strains with recombinant H‐2 haplotypes; and (ii) the spatial arrangement of the specificities detected on the Iak molecules (studied by means of competitive inhibition of binding of radio‐labelled monoclonal antibodies), permitted the identification of various epitopes present either on the I‐Ak molecules (some of which were apparently identical to the conventional Ia. 2, Ia. 1 and Ia. 19 specificities), or the I‐Ek molecule (some being apparently analogous to the Ia.7 specificity) or on both I‐Ak and I‐Ek products.

These mAB were tested in two different panels of human T and B lymphocytes. Panel (a) consisted of 28 Caucasian unrelated individuals, highly selected with regard to HLA—DR specificities, while panel (b) concerned 53 random HLA‐A, B, C, DR typed individuals. The standard complement dependent lymphocytotoxicity microtechnique of histocompatibility workshop VIII was used throughout. All mAB were negative on resting T cells. Testing on B cells produced three patterns: 1) ten mAB did not react with any B cell tested; 2) four mAb reacted with all the panel cells; 3) sixteen mAb reacted with different sets of the panel indicating identification of polymorphic determinants.

However, the strength of positivity obtained with a majority of single mAb varied considerably in the panel, suggesting identification of cross‐reactive determinants. This necessitated the use of individual assignment criteria for each mAb. Following this procedure, 8 mAb were ascertained as reacting with HLA—DR supertypic determinants, 6 with associations to MT1, MT2, or both. Eight mAb reacted with HLA‐DR subtypic determinants (more restricted than a classical DR allele). No mAb were ascertained, reacting exquisitly with acknowledged HLA‐DR allelic specificities.
HLA in pigment dispersion and glaucoma
Authors: Shin Dong H. , Sugar H. Saul
Published: December 2008

Histocompatibility antigen typing was performed on 12 Caucasian patients with the pigment despersion syndrome. Increased prevalence of HLA‐B13 and Bw17 that had been observed in a previous study (Becker et al. 1977) could not be comfirmed in the present study. There were no significant increases of HLA‐B7 and B12 in glaucoma patients with or without the pigment dispersion syndrome. HLA‐Bw35 was increased in white patients with primary open‐angle glaucoma in the Greater Detroit area.
HLA antigens in nickel sensitive females: Based on a twin and a patient population
Authors: HaNSEN H. E. , Menné T. , Larsen S. Olesen
Published: December 2008

HLA typing was performed in three groups of nickel sensitive persons: a) 27 pairs of female monozygous twins, b) 34 pairs of female dizygous twins, e) 51 unrelated females. Persons who had developed hand eczema were considered separately. In none of these groups did the frequencies of HLA antigens differ significantly from those found among the controls. Thus, no confirmation of the earlier results indicating an association between HLA and nickel sensitivity was established.
Polymorphism of the mixed lymphocyte culture response in the rabbit
Authors: Tissot Robert G.
Published: December 2008

We have investigated the amount of polymorphism of the mixed lymphocyte culture response in unrelated or distantly related rabbits from 6 independent sources. Nine RLA‐D alleles have been isolated in the homozygous state with evidence for at least 2 additional alleles. These estimates are similar to the mixed lymphocyte polymorphisms found in the rat and in man.
Allele‐specific occurrence of multiple C4 and Slp mRNAs
Authors: Bruisten S. M. , Robins D. M. , Demant P.
Published: December 2008

The H‐2 S region genes C4 (fourth complement component) and Slp (sex‐limited protein) are highly homologous. In males with C4high, Slpa alleles, both proteins are expressed in plasma and the two genes are each transcribed in a single species of mRNA which is indistinguishable in length. The Sk region of the H‐2k haplotype carries C4low, Sip° alleles, characterized by very low C4 protein levels in plasma and absence of Slp protein in plasma. We show that mice carrying the Sk region express multiple C4 and Slp mRNAs (RNA doublets) in contrast to mice with any other S region. This represents a genetic polymorphism at the level of RNA multiplicity. The RNA doublets do not result from the use of an alternative upstream initiation site of transcription. We hypothesize that their existence is caused by alternative splicing; however, the use of alternative polyadenylation signals cannot be ruled out. The Occurrence of multiple RNA species in strains which carry the C4low. Slp° alleles is possibly related to the very low level of C4 protein expression characteristic for these alleles.
Adult onset spinocerebellar ataxia linked to HLA in a South African kindred of mixed ancestry
Authors: Bryer A. , Martell R. W. , Du Toit E. D. , Beighton P.
Published: December 2008

Hereditary spinocerebellar ataxia (SCA) is a relatively common disorder in the Western Cape region of South Africa. At present there are no genetic markers available for prenatal or presymptomatic diagnosis. A large kindred of mixed ancestry with late onset SCA was studied in which the disorder segregated in an autosomal dominant fashion. HLA typing was undertaken on 44 family members, and the HLA haplotypes were assigned on the basis of segregation. The LIPED computer program, with a correction factor allowing for the age of onset, was used to analyze the pedigree for linkage to HLA. Of 22 individuals in whom disease status could be definitely assessed, only one recombinant between HLA and the SCA locus occurred. The lod score reached a maximum of 4.13 at a recombination fraction of 0.05, indicating the odds to be approximately 13 500 to 1 in favor of linkage between HLA and the putative disease allele for SCA. A possible recombination within the HLA region suggested that the disease allele lies telomeric of the HLA region. In view of the recent demonstration of tight linkage between SCA1 and D6S89, however, HLA should not be used for presymptomatic diagnosis or genetic counselling.
Do human leukocyte antigens have a role to play in differential manifestation of multibacillary leprosy: A study on multibacillary leprosy patients from North India
Authors: Rani Rajni , Zaheer S. A. , Mukherjee Rama
Published: December 2008

Abstract: 118 multibacillary leprosy patients with differential manifestations were studied for the antigens they expressed at MHC loci to investigate the role of human leukocyte antigens in the differential response to the same causative agent. While the lepromatous leprosy (LL) patients showed a significant increase of Bw60, DR2, DRw8 and DQw1, borderline lepromatous (BL) patients had Bw52, DR9 and DQw7 significantly more often as compared to the normal controls. A comparison of LL, BL and mid‐borderline (BB) patients showed a significantly higher frequency of Bw60 in LL patients as compared to the BL. However, Bw52, Bw53, DR9 and DQw7 were found significantly more often in the BL patients as compared to the LL patients but the difference failed to reach significance after pc. A comparison of HLA antigens in BB patients with those of either the LL or BL patients did not show any significant differences.
An unusual pattern of B‐cell immunological reconstitution after allogeneic stem cell transplantation: A possible correlation with CMV reactivation?
Authors: Di Martino Daniela , Terranova M. Paola , Valetto Angelo , Scarso Lucia , Faraci Maura , Lanino Edoardo , Morreale Giuseppe
Published: December 2008

Abstract:  IR after HSCT is a slow process that involves several components of the immune response, and, in allogeneic setting, it can be delayed by GvHD and immuno‐suppressive therapy. Our study on IR post‐HSCT included a child with FA who underwent MUD transplantation. To evaluate B, T and NK cell reconstitution and to investigate the differentiation of B lymphocyte repertoire, this patient was carefully monitored at various time points by IgHCDR3 (third complementarity determining region of the immunoglobulin heavy chain) fingerprinting and by FACS analysis. IgHCDR3 fingerprinting showed a strong oligoclonality of IgM and IgG profiles from day +60 to +180 post‐transplant. CMV reactivation was present at the same time points and overlapped the clonal pattern shown in IgHCDR3 fingerprinting. Immunophenotype analysis showed early repopulation of T and NK cells following HSCT, whereas B cells increased first at one yr post‐transplant. The overlapping of virus reactivation and B‐cell clonal expansion seems to suggest that B lymphocytes may be involved in the CMV immunological response, at least in the early time points after HSCT when the immune repertoire is still reconstituting.
Limited sampling strategies for sirolimus after pediatric renal transplantation
Authors: Forbes Nauzer , Schachter Asher D. , Yasin Abeer , Sharma Ajay P. , Filler Guido
Published: December 2008

Abstract:  SRL has been increasingly used in renal transplantation, but limited sampling approaches for estimation of AUC remain elusive. A post‐hoc analysis of 94 PK profiles in 75 patients from four previous studies was performed to generate limited sampling approaches for approximation of AUC based on two to four time points for both BID and OD SRL dosing. AUC was calculated using the trapezoid rule. Stepwise linear regression was performed to generate an abbreviated AUC from the limited sampling approaches. For BID dosing, complete AUC had a strong correlation with the trough levels (r2 = 0.882, p < 0.0001) and with C2 level (r2 = 0.9025, p < 0.0001). A three‐point and a four‐point limited sampling approach showed improved agreement with complete AUC compared with single‐point sampling. A convenient and accurate (r2 = 0.992) four‐point limited sampling approach reads: AUC = 10^(1.085 + 0.117 × log C0 + 0.164 × log C1−0.131 × log C2 + 0.823 × log C4). Similarly, complete AUC had a statistically significant correlation with the trough levels (r2 = 0.549, p < 0.0001) and with C2 level (r2 = 0.716, p < 0.0001) for OD dosing. The estimation of AUC for OD dosing was improved over single‐point sampling (r2 = 0.951) using the formula: AUC = 10^(1.100 + 0.115 × log C0 + 0.803 × log C4). This study represented the first limited sampling approach for SRL. Further studies are required to determine the optimal SRL target AUC.
HEARING TESTS DURING ANAESTHESIA WITH NITROUS OXIDE AND RELAXANTS
Authors: Rosen Jørgen
Published: December 2008

Fifty‐eight patients were anaesthetized with a sleeping dose of Narcodorm® (enibomalnatrium NFN) followed by nitrous oxide and muscle relaxants (Re‐laxan® (gallamoni jodium NFN) and Laudolissin®) for maintenance. Hearing tests were carried out on the patients during the anaesthesia and recollections of this procedure were recorded after recovery of consciousness. No definite range of concentration of nitrous oxide was found which could be said to mark the limits of the clinical analgesic state. Complete recollections of the hearing tests were found with a concentration as high as 71–73 vol. per cent., even where full abdominal relaxation had been present.

The depth of nitrous oxide muscle relaxant anaesthesia can be increased in two ways: (1) by giving a higher concentration of nitrous oxide, (2) by increasing the dose of muscle relaxant. The use of a higher nitrous oxide concentration than 71–73 vol. per cent, is not possible without renouncing the safety precautions. The peripheral action of the curarizing substances gives no definite criteria by which the dose necessary for producing sufficient depression of the central nervous system can be calculated.
MODE OF ACTION OF DEPOLARIZING AGENTS
Authors: Sabawala Phiroze B. , Dillon John B.
Published: December 2008

It has been shown that with suitable doses of decamethonium, succinylcholine, or succinylmonocholine, a two‐phase neuromuscular block can always be seen in isolated human intercostal muscle.

The first phase consists of a neuromuscular block of rapid onset which reaches a maximum in about 15 minutes and then recovers spontaneously in spite of the continued presence of C10in the same concentration. Recovery is maximum at approximately 60 minutes, after which time the second phase begins.

The second phase consists of a slow, progressive neuromuscular block which reaches a steady reproducible state after 6 to 8 hours. If undisturbed, this state remains constant for hours. This phase represents a true competitive neuromuscular block, as evidenced by the fact that it can be reversed by a suitable dose of neostigmine.

Experiments have been described in which these two phases were modified by the addition of d‐tubocurarine and neostigmine. Attempts are made to explain various phenomena on a molecular basis. The clinical significance of this work is presented.
A NEW FORM OF ANAESTHESIA IN SURGICAL TREATMENT OF FOCAL EPILEPSY
Authors: Ingvar David H. , Jeppsson Stig T. , Nordström Lars
Published: December 2008

A description is given of a new form of anaesthesia for surgical procedures in focal epilepsy. It implies the use of regional anaesthesia in combination with nitrous oxide administered with 25% oxygen through an endotracheal tube. Through a perforated double cuff on the tube a local anaesthetic for the trachea can be administered repeatedly.

The administration of nitrous oxide was interrupted for periods of 10–30 minutes in the operations during which electrocorticography was carried out. During such periods it was possible to establish contact with the conscious patients. The periods of wakefulness were endured very well by the patients without side effects due to the presence of the endotracheal tube.

The procedure of anaesthesia described was used with advantage in 23 operations. It was not used when speech functions had to be tested specifically during the operations. A comparison with a group of 26 patients operated upon under regional anaesthesia only showed that the nitrous oxide procedure did not interfere with, or tended to hide, epileptogenic abnormalities in the electrocorticogram. Surgical and EEG results in both groups did not differ substantially.
EFFECT OF SUCCINYLCHOLINE ON THE INTRAspinal FLUID PRESSURE
Authors: Halldin Matts , Wåhlin ÅKe
Published: December 2008

The intraspinal pressure was investigated in 15 patients under anaesthesia after intravenous injection of succinylcholine. In all, 23 experiments were carried out.

The pressure began to rise within 1 minute after the intravenous injection, and the rise in pressure varied between 5 and 320 mm H2O above the initial pressure.

At the end of the apnoea period the pressure began to fall and, after an average of 7 min. 25 sec. following the injection, reached a minimum value between ‐115 and +55 mm H2O in relation to the initial pressure. The pressure subsequently rose again after resumption of spontaneous respiration, but later once more declined.

The effect of hyperventilation on the intraspinal fluid pressure was studied on five anaesthetized patients in a control group.

The relation between the variation of the intraspinal pressure and of the cerebral blood flow is discussed.
OBSERVATIONS OF THE CONJUNCTIVAL VESSELS UNDER THE INFLUENCE OF SUCCINYLCHOLINE WITH INTRAVENOUS NAESTHESIA
Authors: Halldin Matts , Wåhlin ÅKe , Koch Torbjörn
Published: December 2008

In nine patients under anaesthesia, series of photographs were taken over 8–9 minutes showing the variations in the width of the conjunctival vessels under the influence of succinylcholine. The vascularization was also compared. Measurements were made of vessels 27 to 340 μ in width, with a mean of 99 μ.

One or two 50 mg doses of succinylcholine were given intravenously. In all cases this produced dilatation of the conjunctival vessels as indicated by conjunctival reddening, increase in width recorded photographically, and the occurrence of refilled blood vessels in the field. The increase in width of the vessels was between 0 and 136 per cent., with a mean of 38 per cent, for variations under full effect of succinylcholine and of 35 per cent, for the succeeding period of spontaneous respiration. The dose in question produced practically no effect on the pulse and only a slight fall in the systolic blood pressure.
FLUOTHANE COMPARED TO CHLOROFORM AND ETHER IN MICE
Authors: Mørch Ernst Trier , Jobgen Eugene A.
Published: December 2008

Fluothane was compared to chloroform and diethyl ether in mice to determine its anesthetic potency and margin of safety. The anesthetic was mixed with air in known concentrations. Fluothane and chloroform produced similar anesthesia, and was 4 1/2 times more potent than ether. Induction with fluothane was faster than with chloroform and ether.

Fluothane seems slightly more potent than chloroform and has an equal margin of safety. The margin of safety expressed as the ratio of LD50to AD50was 2 for fluothane and chloroform, 2.25 for ether. Recovery from fluothane and chloroform was about equal and much faster than from ether.
CARDIAC ARREST DURING ANAESTHESIA AND SURGERY With Special Reference to the Electrocardiogram
Authors: Engell H. C. , Price J. , Secher O.
Published: December 2008

In this paper the term cardiac arrest is defined as the condition or state existing when the contractions of the left ventricle are insufficient to open the aortic valves and pump the blood out to the peripheral arteries.

The precipitating factor in the production of cardiac arrest is myocardial anoxia due to hypoxia, overdose of anaesthetic agent, haemorrhage, hypotension and reflex activity.

This paper is based on 30 cases of cardiac arrest, and in this study an attempt was made to correlate the sequence of events which led to the cardiac arrest, the heart action during the episodes and the outcome of the resuscitative measures.

In 6 patients, cardiac arrest occurred during anaesthesia for non‐thoracic procedures or prior to thoracotomy. In 3 cases it ensued during diagnostic procedures. The remaining 21 patients were intrathoracic cases, 20 of them undergoing operations on the heart and the great vessels.

Of the 14 patients who developed cardiac arrest unaccompanied by fibrillation, 13 survived primarily. Of 16 patients who developed ventricular fibrillation, 9 were defibrillated. Only in one case did cardiac action recommence spontaneously; cardiac massage was given in all the other cases.
USE OF PRESUREN® IN CAESAREAN SECTIONS
Authors: Kivalo Inkeri , Tammisto T.
Published: December 2008

The paper reports on a series of 65 cases in which Presuren (Hydroxydion, Schering) was used as an anaesthetic for Caesarean section.

The total dose for induction was 1.0 to 1.5 g supplemented after the delivery by nitrous oxide and oxygen or by V.A.M. (May & Baker). Three different methods of induction were used in order to find the most suitable application of the drug: Presuren alone, Presuren with d‐tubocurarine, and Presuren supplemented by succinylcholine. The last method seemed to give the most satisfactory results.
THE USE OF NARCOTIC ANTAGONISTS IN ANAESTHESIA
Authors: Swerdlow Mark
Published: December 2008

The effects of the opiate antagonists are briefly described. A detailed account is then given of the use of these antagonists in pre‐ and postoperative medication and in anaesthesia. Finally, the value of the antagonists in the treatment of opiate overdosage is discussed.
THE EFFECT OF ERGOTAMINE ON BLOOD PRESSURE AND CARDIAC OUTPUT DURING SPINAL ANAESTHESIA IN MAN
Authors: Dunér H. , Granath A. , Klingenström P.
Published: December 2008

The effect of ergotamine on circulation during spinal anaesthesia was studied with the aid of right heart catheterisation in four healthy subjects.

The pulse frequency, the pressures in the brachial and pulmonary arteries, the cardiac output and stroke volume were determined.

The determinations were done at rest before anaesthesia and during spinal anaesthesia up to the Th II‐III level before and after intravenous administration of 0.125 mg ergotamine.

During anaesthesia the pulse rate was unchanged in three and slightly lowered in one case. The pressure in the brachial artery decreased in all cases and in the pulmonary artery in three cases. The cardiac output and stroke volume decreased in all cases.

After administration of ergotamine there was a tendency to a decreased pulse rate in three cases. The pressure in the brachial and in the pulmonary arteries increased in all cases. The stroke volume and cardiac output rose in three cases.

The results are discussed and the increase in blood pressure and stroke volume after 1.5–2 μgergotamine/kg body weight in spinal anaesthesia is supposed to be caused by a direct constrictor action of ergotamine on the smooth muscles of the blood vessels.

Die Wirkung von Ergotamin auf den Kreislauf während der Spinalanaesthesie wurde an 4 gesunden Versuchspersonen mit Hilfe der Katheterisierung des rechten Herzens untersucht.

Die Pulsfrequenz, der Druck in der A. brachialis und A. pulmonalis sowie das Minuten‐ und das Schlagvolumen wurden bestimmt. Die Bestimmungen wurden einerseits in Ruhe vor Beginn der Anaesthesie, anderseits wahrend einer Spinalanaesthesie bis zur Höhe von Th II‐III vor und nach intravenöser Verabreichung von 0.125 mg Ergotamin durchgeführt.

Während der Anaesthesie blieb die Pulsfrequenz in 3 Fällen unverändert und war in einem Fall leicht herabgesetzt. Der Druck in der Brachialarterie war in alien Fällen vermindert, der pulmonale Arteriendruck in 3 Fällen. Schlagund Minutenvolumen waren in alien Fällen reduziert.

Nach der Verabreichung von Ergotamin bestand die Tendenz zu verminderter Pulsfrequenz in 3 Fällen. Der arterielle Druck stieg sowohl in der A. brachialis als auch A. pulmonalis in alien Fällen. Schlag‐ und Minutenvolumen steigerten sich in 3 Fällen.

Die Resultate wurden diskutiert und dabei die Annahme vertreten, dass die Erhöhung von Blutdruck und Schlagvolumen nach 1.5–2 μg Ergotamin pro kg Körpergewicht während der Spinalanaesthesie auf einer direkten konstriktorischen Wirkung des Ergotamins auf die glatte Muskulatur der Blutgefässe beruht.
RESUSCITATION OF STILLBORN INFANTS BY CARDIAC MASSAGE
Authors: Jacobson Lennart , Gjessing Jon
Published: December 2008

A report is given of two cases of neonatal cardiac arrest just before actual delivery in which cardiac massage had a permanent successful effect in one case and a transient effect in the other.

The conditions and indications for cardiac massage in stillborn infants are discussed on the basis of a review of the literature on the aetiology, pathophysiology and prognosis of peri‐ and neonatal cardiorespiratory arrest. It appears that neonatal cardiac massage, of which only a few reports have as yet been published, is a useful resuscitative method in such cases.

Es wird über 2 Fälle von Herzstillstand beim Neugeborenen, der unmittelbar vor der Geburt eingetreten war, berichtet. In einem Fall konnte ein bleibender Erfolg, im anderen ein vorübergehender Erfolg erzielt werden.

Die Bedingungen und Indikationen für die Herzmassage bei totgeborenen Kindern werden an Hand einer Literaturübersicht über Aetiologie, Pathophysiologie und Prognose des peri‐ und neo‐natalen Herz‐ und Atemstillstandes diskutiert. Die Herzmassage am Neugeborenen, über die bisher erst in einigen Fallen berichtet wurde, scheint in diesen Fällen eine brauchbare Wiederbelebungsmethode zu sein.
SERIAL CARDIAC OUTPUT ESTIMATIONS DURING ANAESTHESIA WITH THE EVANS BLUE DYE DILUTION TECHNIQUE
Authors: Löf Bengt , Verner I. R. , Payne J. P.
Published: December 2008

The limitations of Evans blue as the indicator in dye dilution studies of cardiac output were discussed. In practice serial output determinations were restricted to four in our hands.

Low cardiac outputs were raised after induction of anaesthesia with halothane and high outputs were lowered. During the first hour of anaesthesia with this drug there was a tendency for the outputs to be raised but if the anaesthetic was prolonged, there was some evidence to suggest that the outputs gradually fell.

After induction with thiopentone the same trend was evident as after induction with halothane but when anaesthesia was continued with nitrous oxide and oxygen there was a gradual drift downwards of the cardiac output.

Es wurden die Grenzen der Evans‐Blau Methode bei Farbverdünnungsuntersuchungen zur Bestimmung des Schlagvolumens diskutiert. In unseren Händen waren in der Praxis Serienbestimmungen auf 4 beschränkt.

Niedrige Schlagvolumina wurden nach Einleitung einer Narkose mit Halothan höher und hohe Schlagvolumina niedriger. Während der ersten Narkosestunde mit diesem Mittel bestand die Tendenz einer Erhöhung der Schlagvolumina, wenn jedoch die Narkose länger dauerte, schien die Neigung zu einer schrittweisen Abnahme des Schlagvolumens zu bestehen.

Nach Einleitung mit Thiopenton bestand die gleiche Tendenz wie nach Einleitung mit Halothan, aber wenn die Narkose mit Lachgas und Sauerstoff fortgesetzt wurde, kam es zu einem schrittweisen Abgleiten des Herzschlag‐volumens.
EFFECT OF LIDOCAINE ADMINISTERED INTRAVENOUSLY DURING ETHER ANESTHESIA
Authors: Siebecker Karl L. , Kimmey James R. , Bamforth Betty J. , Steinhaus John E.
Published: December 2008

Twenty patients were anesthetized with ether to a level of plane 3 of surgical anesthesia. Lidocaine (150 mg) was administered intravenously 27 times to these patients, and resulted in apnea on eight occasions. In the other 19 observations the lidocaine administration produced a reduction of mean alveolar ventilation from 136% to 70% of the calculated requirements. The apparent improvement in respiratory pattern which had been observed following lidocaine administration during ether anesthesia was not due to increased ventilation, but rather due to the quiet respiration resulting from further respiratory depression.

20 Patienten wurden mit Äther in die dritte Stufe des Toleranzstadiums narkotisiert. 150 mg Lidocain wurde 27‐mal intravenös an diese Patienten verabreicht, wobei 8‐mal eine Apnoe resultierte. Bei den anderen 19 Beobachtungen verursachte die Lidocainverabreichung eine Herabsetzung der mittleren Alveolarventilation von 136% auf 70% des kalkulierten Wertes. Die scheinbare Verbesserung der Atmung, die nach Lidocainverabreichung während der Äthernarkose beobachtet worden war, entspricht also nicht einer vermehrten Ventilation, sondern eher einer ruhigen Atmung als Folge einer weiteren Atemdepression.
PROFOUND HYPOTHERMIA IN OPEN HEART SURGERY*
Authors: Björk V. O. , Gjessing J. , Holmdahl M. H:son , Löf B. Ax:son
Published: December 2008

Profound hypothermia is an alternative to the heart‐lung machine with oxygenator. The different perfusion techniques, their development and details are described. A total of 27 patients has been operated upon under profound hypothermia. Fourteen of these died. In three cases, the hypothermic technique itself was considered to be the cause of death. In the other cases, the cardiac defects were inoperable for anatomical reasons. With increasing experience of perfusion under both normo‐ and hypothermia, the indications for the use of profound hypothermia were reduced. The anaesthesia used in these cases was as light as possible with nitrous oxide and a neuromuscular blocking agent. Ventilation was adjusted, so that the patients had an acid‐base balance as near to normal as possible. Moderate metabolic acidosis was found in only a few cases apart from the final stages.

Tiefe Unterkühlung ist eine Alternativmethode zur Herz‐Lungenmaschine mit Oxygenator. Die verschiedenen Perfusionstechniken, ihre Entwicklung und Einzelheiten werden beschrieben. Insgesamt wurden 27 Patienten in tiefer Hypothermie operiert. 14 von diesen starben. In 3 Fällen musste die Unterkühlungstechnik selbst für den tödlichen Ausgang verantwortlich gemacht werden. In den übrigen Fällen lagen anatomisch inoperable Defekte vor. Bei zunehmender Erfahrung mit der künstlichen Perfusion sowohl unter Normo‐ als auch unter Hypothermie wurden die Indikationen zur tiefen Unterkühlung eingeschränkt. Die Narkose wurde bei diesen Fällen so oberflächlich wie möglich gehalten und bestand in der Hauptsache aus Stickoxydul und einem neuromuskulären Blocker. Die Beatmung wurde so eingestellt, dass das Säure‐Basengleichgewicht so nahe wie möglich der Norm blieb. Eine mässige metabolische Acidose wurde—abgesehen von den Endstadien—nur in ganz wenigen Fällen gefunden.
CONTROL OF POSTOPERATIVE VOMITING WITH PERPHENAZINE (TRILAFON®): A Double‐Blind Study
Authors: Lind Björn
Published: December 2008

The present study demonstrated that perphenazine is a potent antiemetic drug with very few side effects. A single injection of 5 mg of perphenazine reduced postoperative vomiting by half in a series where the anaesthetic agents were mainly nitrous oxide‐oxygen and ether. The effectiveness of this injection exceeded 6 hours and seemed to be sufficient to cover 24 hours. The prolongation of the mean awakening time was 9 minutes, which is of little practical importance.

Hypotension and other side effects were not observed. The demand for analgesics during the 24‐hour period was not reduced, but perphenazine has a marked sedative effect. Patients are quiet and drowsy, but are easy to arouse and co‐operate normally. Perphenazine may be recommended for routine use to diminish postoperative vomiting.

Die vorliegende Untersuchung zeigte, dass Perphenazin ein starkes Antiemetikum mit sehr wenig Nebenwirkungen ist. Die Einzelinjektion von 5 mg Perphenazin reduzierte in einer Serie, bei der als Narkosemittel hauptsächlich Lachgas‐Aether verwendet worden war, den Prozentsatz von postoperativem Erbrechen auf die Hälfte. Die Wirkungsdauer dieser Injektion überschritt 6 Stunden und war oft bis zu 24 Stunden ausreichend. Die Verlängerung der durchschnittlichen Aufwachzeit betrug 9 Minuten, was man praktisch vernachlässigen kann.

Blutdrucksenkung und andere Nebenerscheinungen wurden nicht beobachtet. Der Verbrauch an Analgeticis während der 24‐Stundenperiode war nicht vermindert, doch besitzt Perphenazin einen deutlichen sedativen Effekt. Die Patienten waren ruhig und schläfrig, aber leicht zu erwecken und zur Mitarbeit zu bewegen. Perphanazin kann zur routinemässigen Verwendung für die Herabsetzung des postoperativem Erbrechens empfohlen werden.
THE INFLATED STOMACH AS AN ACCIDENTAL PHENOMENON IN ANAESTHESIA FOR ANGIOCARDIOGRAPHY
Authors: Carlsson Erik , Wåhlin ÅKe
Published: December 2008

The effect of experimental inflation of the stomach has been studied in dogs. The object was to assess the possibility of reflex disturbances by accidental inflation of the stomach during anaesthesia in angiocardiography, using positive‐pressure artificial ventilation with a mask and breathing bag, as an alternative to intubation.

It is found that inflation of the stomach has only a strikingly small effect on the pressure conditions in the large thoracic vessels. The effect on the large vessels in the abdominal cavity is more pronounced.

The only changes in the ECG observed were those caused by the influence of the elevated diaphragm on the electric axis of the heart.

Es wurde die Wirkung experimenteller Überblähung des Magens am Hund studiert. Ziel dieser Untersuchung war es, die Möglichkeiten von reflektorischen Störungen durch die unabsichtliche Überblähung des Magens während der Narkose für Angiocardiographien zu beurteilen, wobei positive Druckbeatmung mit Maske und Atembeutel als Alternative zur Intubation angewendet wurde.

Man fand dabei, dass die Aufblähung des Magens einen erstaunlich geringen Effekt auf die Druckverhältnisse der grossen Gefässe im Brustraum hatte. Die Wirkung auf die grossen Gefässe in der Bauchhöhle ist stärker ausgeprägt.

Die einzigen Veränderungen die am EKG beobachtet wurden waren solche, die durch das hinaufgeschobene Zwerchfell, also Verschiebung der elektrischen Achse des Herzens, bedingt waren.
CONTROLLED HYPOTENSON IN NEUROLOGICAL SURGERY: Analysis of 482 cases
Authors: Tappura Mirja , Slätis Marjatta , Troupp Henry
Published: December 2008

The use of controlled hypotension with Arfonad in 482 neurosurgical cases is analysed.

There were 83 cases of aneurysm of the internal carotid artery, 57 cases of aneurysm of the middle cerebral artery, 101 cases of aneurysm of the anterior communicating artery, 58 cases of meningeoma and 151 other brain tumours; 32 patients were operated upon for miscellaneous conditions.

It was impossible to pin‐point hypotension injuries by statistical means; too many variable factors were involved. The case records of all patients with significant postoperative complications (usually neurological deficit) were examined; when no neurosurgical cause of the neurological lesion was found but complications during hypotension had arisen, the case was regarded as a possible hypotension injury.

There were 10 such cases in the group with intracranial arterial aneurysm, but only one in the group of brain tumours (a patient with a meningeoma). It is concluded that hypotension may be particularly deleterious to the brain in cases where the cerebral vascular system is subjected to surgical intervention. Hypotension should not be used for any prolonged periods of time; it should not be used when deep‐seated tumours necessitate prolonged surgical manoeuvres with a consequent risk of retractor anaemia; nor should it be used for the control of intracranial pressure.

Es wurden 482 neurochirurgische Fälle, bei denen Arfonad zur kontrollierten Blutdrucksenkung angewendet wurde, genau analysiert.

Das Material bestand aus 83 Fällen von Aneurysma der A. carotis interna, 57 Fällen von Aneurysma der A. cerebralis media, 101 Fälle von Aneurysma der A. communicans anterior, 58 Fälle von Meningeom und 151 andere Gehirntumoren; 32 Patienten wurden unter verschiedenen anderen Diagnosen operiert.

Es war nicht möglich, Schäden als Folge der Blutdrucksenkung statistisch zu erfassen; es lagen zu viele variable Faktoren dabei vor. Die Krankengeschichten aller Patienten mit signifikanten postoperativen Komplikationen (gewöhnlich neurologischer Art) wurden geprüft. Wenn keine neurochirurgische Ursache für die gefundene neurologische Erkrankung festgestellt werden konnte, die Komplikation jedoch während der Blutdrucksenkung aufgetreten war, wurde der Fall als mogliche Hypotensionsschädigung aufgefasst.

In der Gruppe der intracraniellen arteriellen Aneurysmen fanden wir 10 solche Fälle, jedoch nur einen in der Gruppe der Hirntumoren (ein Patient mit einem Meningeom). Wir schliessen daraus, dass die künstliche Blutdrucksenkung möglicherweise für das Gehirn in alien jenen Fällen gefährlich sein kann, bei denen das cerebrale Gefässsystem chirurgischen Eingriffen unterworfen wird. Die künstliche Blutdrucksenkung sollte nicht über lange Zeitröume angewendet werden; sie sollte ferner vermieden werden, wenn tief sitzende Tumoren ein längeres Verdrängen von Gehirnpartien mit nachfolgender Gefahr der Retraktoranaemie erforderlich macht; schliesslich sollte sie nicht zur Kontrolle des intracraniellen Druckes angewendet werden.
LARYNGEAL REGULATION OF RESPIRATION
Authors: Rattenborg Christen
Published: December 2008

The resistance of the larynx decreases when resistance to expiration is increased. This was shown by direct observation, by radiographic studies and by measurements of respiratory tract time constant. The time constant studies indicated a quantitative compensation for the added resistances in a majority of the subjects examined.

It is postulated that the larynx is an important regulator of frequency and depth of breathing.

Der Widerstand des Larynx nimmt ab, wenn der Ausatmungswiderstand erhoht wird. Dies wurde durch direkte Beobachtung, durch röntgenographische Untersuchungen und durch Messungen der Respirationszeitkonstanten festgestellt. Die Untersuchungen der Zeitkonstanten zeigten bei der Mehrzahl der Untersuchten eine quantitative Kompensation gegenüber den erhöhten Widerständen.

Man kann also wohl annehmen, dass der Larynx ein wichtiger Regulator von Atemfrequenz und ‐tiefe ist.
L 67‐EXPERIMENTAL EVALUATION OF A NEW LOCAL ANAESTHETIC IN MAN
Authors: Eriksson Ejnar
Published: December 2008

L 67‐α‐n‐propylamino‐2‐methylpropionanilide—a new local anaesthetic, was compared with Xylocaine® in a series of experimental tests on human beings. Intracutaneous wheals, finger nerve blocks, caudal blocks and spinal blooks were induced, L 67 having a somewhat better anaesthetic effect mainly by virtue of a longer duration of action. No differences in latency were found. L 67 had no demonstrable side effects.

Finger nerve blocks were specially investigated in order to establish the influence of age on the duration of anaesthesia. The role of intact circulation in the duration of anaesthesia produced by intracutaneous administration was also studied. A discussion is presented on the degree to which the observed differences between Xylocaine and L 67 might be due to a direct action of the local anaesthetic upon the circulation in the anaesthetised region.

In einer Serie von Testversuchen an Menschen wurde L 67 (α‐n‐propylamino‐2‐methylpropionanilid) mit Xylocain verglichen. Es wurden intracutane Quaddeln, Fingernervenblokaden, caudale und spinale Blokaden angelegt, und es zeigte sich, dass L 67 eine etwas bessere Wirkung hatte, hauptsächlich auf Grand einer längeren Wirkungsdauer. In der Latenzzeit bis zum Eintritt der Wirkung ergab sich kein Unterschied. L 67 hatte keine nachweisbaren Nebenwirkungen.

Fingernervenblokaden wurden speziell untersucht, um den Einfluss des Alters auf die Wirkungsdauer der Anästhesie festzustellen. Die Rolle, die ein intakter Kreislauf in Bezug auf die Dauer einer durch intracutane Injektion erzeugten Anästhesie spielt, wurde ebenfalls studiert. Es wird erörtert, in welchem Grade die beobachteten Unterschiede zwischen L 67 und Xylocain auf einer direkten Wirkung des Lokalanästheticums auf die Zirkulation in der betäubten Region beruhen könnten.
Restricted feeding restores rhythmicity in the pineal gland of arrhythmic suprachiasmatic‐lesioned rats
Authors: Feillet Céline A. , Mendoza Jorge , Pévet Paul , Challet Etienne
Published: December 2008

In mammals, the rhythmic synthesis of melatonin by the pineal gland is tightly controlled by the master clock located in the suprachiasmatic nuclei (SCN). In behaviourally arrhythmic SCN‐lesioned rats, we investigated the effects of daily restricted feeding (RF) on pineal melatonin synthesis. RF restored not only a rhythmic transcription of the rate‐limiting enzyme for melatonin biosynthesis [arylalkylamine‐N‐acetyltransferase (AANAT)] and a rhythmic expression of c‐FOS but also a rhythmic synthesis of melatonin in the pineal gland. In control rats without functional SCN and fed ad libitum, a daily immobilization stress did not restore any rhythmicity in the pineal gland. Interestingly, a combination of RF and daily stress prior to the time of food access did not markedly impair AaNat mRNA and c‐FOS rhythmicity but did abolish the restoration of rhythmic pineal melatonin. These data indicate that the synchronizing effects of RF on the pineal rhythmicity are not due to, and cannot be mimicked by, high levels of circulating glucocorticoids. In keeping with the multi‐oscillatory nature of the circadian system, the rhythmicity of pineal melatonin in mammals, until now an exclusive output of the SCN, can also be controlled by daily feeding cues when the SCN clock is lacking. Thus, the present study demonstrates that daily RF in SCN‐lesioned rats provides, probably via sympathetic fibres, synchronizing stimuli strong enough to drive rhythmicity in the pineal gland.
Rhythmic expression of clock genes in the ependymal cell layer of the third ventricle of rodents is independent of melatonin signaling
Authors: Yasuo Shinobu , Von Gall Charlotte , Weaver David R. , Korf Horst‐Werner
Published: December 2008

Reproductive physiology is regulated by the photoperiod in many mammals. Decoding of the photoperiod involves circadian clock mechanisms, although the molecular basis remains unclear. Recent studies have shown that the ependymal cell layer lining the infundibular recess of the third ventricle (EC) is a key structure for the photoperiodic gonadal response. The EC exhibits daylength‐dependent changes in the expression of photoperiodic output genes, including the type 2 deiodinase gene (Dio2 ). Here we investigated whether clock genes (Per1 and Bmal1) and the albumin D‐binding protein gene (Dbp) are expressed in the EC of Syrian hamsters, and whether their expression differs under long‐day and short‐day conditions. Expression of all three genes followed a diurnal rhythm; expression of Per1 and Dbp in the EC peaked around lights‐off, and expression of Bmal1 peaked in the early light phase. The amplitude of Per1 and Dbp expression was higher in hamsters kept under long‐day conditions than in those kept under short‐day conditions. Notably, the expression of these genes was not modified by exogenous melatonin within 25 h after injection, whereas Dio2 expression was inhibited 19 h after injection. Targeted melatonin receptor (MT1, MT2, and both MT1 and MT2) disruption in melatonin‐proficient C3H mice did not affect the rhythmic expression of Per1 in the EC. These data show the existence of a molecular clock in the rodent EC. In the hamster, this clock responds to long‐term changes in the photoperiod, but is independent of acute melatonin signals. In mice, the EC clock is not affected by deletion of melatonin receptors.
Functional characterization of GABAergic pallidopallidal and striatopallidal synapses in the rat globus pallidusin vitro
Authors: Sims Robert E. , Woodhall Gavin L. , Wilson Claire L. , Stanford Ian M.
Published: December 2008

As a central integrator of basal ganglia function, the external segment of the globus pallidus (GP) plays a critical role in the control of voluntary movement. Driven by intrinsic mechanisms and excitatory glutamatergic inputs from the subthalamic nucleus, GP neurons receive GABAergic inhibitory input from the striatum (Str–GP) and from local collaterals of neighbouring pallidal neurons (GP–GP). Here we provide electrophysiological evidence for functional differences between these two inhibitory inputs. The basic synaptic characteristics of GP–GP and Str–GP GABAergic synapses were studied using whole‐cell recordings with paired‐pulse and train stimulation protocols and variance–mean (VM) analysis. We found (i) IPSC kinetics are consistent with local collaterals innervating the soma and proximal dendrites of GP neurons whereas striatal inputs innervate more distal regions. (ii) Compared to GP–GP synapses Str–GP synapses have a greater paired‐pulse ratio, indicative of a lower probability of release. This was confirmed using VM analysis. (iii) In response to 20 and 50 Hz train stimulation, GP–GP synapses are weakly facilitatory in 1 mmexternal calcium and depressant in 2.4 mmcalcium. This is in contrast to Str–GP synapses which display facilitation under both conditions. This is the first quantitative study comparing the properties of GP–GP and Str–GP synapses. The results are consistent with the differential location of these inhibitory synapses and subtle differences in their release probability which underpin stable GP–GP responses and robust short‐term facilitation of Str–GP responses. These fundamental differences may provide the physiological basis for functional specialization.
THE ECONOMICS OF THE UNCOVERED INTEREST PARITY CONDITION FOR EMERGING MARKETS
Authors: Alper C. Emre , Ardic Oya Pinar , Fendoglu Salih
Published: December 2008

Abstract Financial account liberalizations since the second half of the 1980s paved the way for the burgeoning literature that investigates foreign exchange market efficiency in emerging markets (EMs) via testing for the uncovered interest parity (UIP) condition. This paper is the first to provide a broad and critical survey on this recent literature. Specifically, we attempt to answer the following questions. First, are the EMs different from the developed economies in the context of the UIP condition? Second, to what extent can these differences contribute to the debate on the UIP literature? Third, what are the empirical challenges specific to the EMs in testing for the UIP condition?
Access to Land, Rural Development and Public Action: The When and the How
Authors: Bandeira Pablo , Sumpsi José María
Published: December 2008

After being marginalised in the 1980s, land‐reform policies came back to national and international development agendas during the 1990s, resulting in a revival of academic research on the subject. This article reviews the empirical literature on access to land, rural development and public action for evidence on when and how the state should intervene in the allocation of rural land. The review suggests that positive impacts are obtained if, and only if, public actions on the allocation of land are carried out under certain conditions and in a certain way. The article ends by highlighting the need to elaborate empirical models that take into consideration opportunity costs and interactions, and that integrate individual responses with aggregate effects.
Developments in National Policies for Food and Nutrition Security in Brazil
Authors: Rocha Cecilia
Published: December 2008

Brazil is on track to achieve many of the Millennium Development Goals, and this is widely credited to bold and innovative government policies backed by new forms of popular participation in social policy. This article examines evaluation evidence on two of the most important recent initiatives in Brazil's policies for food and nutrition security (conditional cash transfers through Bolsa Família and support for family agriculture through the Programa de Aquisição de Alimentos). It also considers advances in older policies (such as the School Meals programme) and the work of the National Council for Food and Nutrition Security, which has culminated in national legislation establishing food and nutrition security as a right.