bluuebunny/crossref_metadata_2025 huggingface dataset:
ANAESTHETIC MANAGEMENT OF THE MYASTHENIG PATIENT A Review of 33 Cases
Authors: Secher Ole
Published: December 2008

Within the period from 1946 to 1966 Rigshospitalet (the University Hospital, Copenhagen) had 33 patients with myasthenia gravis under treatment. Of these, 26 were operated on for their current disease, while three were treated for myasthenic crises, and four were operated on for intercurrent diseases.

Of the 26 patients, 21 were subjected to thymectomy, four to extirpation of a thymoma, and one patient to both.

The five patients who had a thymoma removed had no postoperative respiratory complications. Of the 21 patients treated by thymectomy, seven had tracheostomy done, and eight were treated on respirator for periods of 2 to 9 days postoperatively. Two patients died postoperatively.

Three patients were treated anaesthesiologically on respirator for myasthenic crises. One of these died after 32 days, and one was treated anaesthesiologically for 68 days without recovering and died later in a local hospital. The third patient recovered after 19 days, in response to respirator treatment and cortisone.

Three patients were operated on for intercurrent diseases without complications. One died from respiratory insufficiency.

The postoperative difficulties were caused by the secretion owing to treatment with anticholinesterases. Very long respirator treatment of such patients may be required. The possibilities of shortening this before operation are mentioned. Patients in a myasthenic crisis who do not respond to any treatment should be subjected to thoracotomy.

Während der Berichtsperiode von 1946 bis 1966 standen im Rigshospital (dem Universitätsspital von Kopenhagen) 33 Patienten mit Myasthenia gravis in Behandlung. Von diesen wurden 26 wegen ihrer Erkrankung operiert, bei drei wurden myasthenische Krisen behandelt und vier wurden wegen inter‐currenter Krankheiten operiert.

Von den 26 operativen Patienten wurden 21 thymektomiert, bei vier ein Thymom extirpiert, während bei einem beide Eingriffe durchgeführt wurden.

Nach den fünf Thymomextirpationen traten keine postoperativen Atem‐störungen auf. Von den 21 Thymektomiepatienten mussten sieben tracheo‐tomiert werden und acht erhielten Respiratorbehandlungen von 2 bis 9 Tagen Dauer. Zwei Patienten starben postoperativ.

Drei Patienten wurden wegen myasthenischer Krisen einer anaesthesio‐logischen Respiratorbehandlung unterzogen. Von diesen starb einer nach 32 Tagen, einer wurde 68, zum Teil mit Anaesthetika, ohne Erfolg behandelt und starb später in einem örtlichen Spital. Der dritte Fall, eine Patientin, erholte sich nach 19 Tagen im Gefolge der Respirator‐ und Cortisonbehandlung.

Drei Patienten wurden ohne Komplikationen wegen intercurrenter Er‐krankung operiert.

Postoperative Schwierigkeiten entstanden durch Sekretionsvermehrung als Folge der Anticholinesterasetherapie. Bei solchen Patienten kann eine pro‐longierte Respiratorbehandlung erforderlich sein. Die Möglichkeiten, diese vor der Operation abzukürzen, werden erörtert. Patienten, die in einer myasthe‐nischen Krise auf keine Therapie ansprechen, sollten thorakotomiert werden.
CONTROLLED RESPIRATION THROUGH A VENTILATING BRONCHOSGOPE
Authors: Steglich‐Petersen Jan
Published: December 2008

In 19 patients subjected to bronchoscopy under general anesthesia and muscular relaxation, manual ventilation with 10 litres of nitrous oxide and 10 litres of oxygen was performed through a ventilating bronchoscope. During the bronchoscopic examination, the arterial oxygen tension increased in all the patients. The arterial carbon dioxide tension increased in nine patients, and the same nine patients revealed a fall in the pH level. The greatest increase in PaCO2 was 12 mm Hg, and the greatest fall in pH was 0.1. Accordingly, one half of the patients were slightly hypoventilated. This must be assumed to be due to “loss of gas” because of the discrepancy between the diameters of the bronchoscope tube and the airway, possibly combined with insufficient muscular relaxation. On the other hand, the fact that the positive‐pressure ventilation was given intermittently does not seem to have been of importance in this connexion, since there was no correlation between the duration of the insufflation and the changes in the carbon dioxide tension. Presumably, the explanation is that the duration of the insufflation was short, and possibly that the gas flow was relatively large.

The use of the ventilating bronchoscope with ROSEN'S swivel device must be regarded as fully warrantable when the bronchoscopic and anaesthetic techniques described here are used. Good oxygenation of the arterial blood is maintained, and the tendency to respiratory acidosis, which was seen in one half of the patients, is very moderate.

ZUSAMMENFASSUNG UND SCHLUSSFOLGERUNGEN

19 Patienten, die unter Allgemeinnarkose und Muskelrelaxation broncho‐skopiert wurden, wurden mit je 10 1 Lachgas und Sauerstoff über ein Beat‐mungsbronchoskop manuell beatmet. Wahrend der bronchoskopischen Unter‐suchung stieg der arterielle SauerstofTdruck bei alien Patienten. Die arterielle CO2‐Spannung war bei 9 Patienten erhöht und die gleichen 9 Patienten zeigten ein Absinken des pH. Der höchste PaCO2‐Anstieg war 12 mm Hg, der stärkste pH‐Abfall 0,1. Offenbar war die Hälfte der Patienten schwach hypo‐ventiliert. Man muss annehmen, dass dies durch den “Gasverlust” bedingt war, der durch das Missverhältnis zwischen dem Lumen des Bronchoskops und der Trachea bedingt war, moglicherweise auch infolge ungenügender Muskeler‐schlaffung. Anderseits scheint die Tatsache, dass die Überdruckbehandlung intermittierend erfolgte, in diseem Zusammenhang bedeutungslos gewesen zu sein, da sich keine Korrelation zwischen der Dauer der Insufflation und den CO2‐Druckveränderungen ergab. Eine vermutliche Erklärung dafür ist die zu kurze Insufflationsdauer, möglicherweise auch der relativ hohe Gasstrom.

Die Anwendung des Beatmungsbronchoskops in der Modification von ROSEN muss als völlig berechtigt angesehen werden, wenn die hier beschriebenen bronchoskopischen und anaesthesiologischen Techniken befolgt werden. Gute Sauerstoffsättigung des arteriellen Blutes bleibt gewährleistet und die Tendenz zu respiratorischer Azidose, die bei der Hälfte unserer Patienten gesehen wurde, ist sehr gering.
A COMPARISON OF THE EFFECTS OF NICOMORPHINE AND PETHIDINE ON RESPIRATION AT PaCO= 45 mm Hg
Authors: Henningsen P. , Stephensen N. , Johansen S. H. , Dyrberg V.
Published: December 2008

Healthy subjects whose alveolar carbon dioxide tensions were maintained constantly at 45 mm Hg by inhalation of adjusted carbon dioxide‐air mixtures were given nicomorphine and pethidine in equianalgesic doses. No difference between reductions in respiratory minute volumes could be demonstrated.

Gesunde Versuchspersonen, deren alveoläre Kohlensäuredrucke durch die Inhalation von entsprechend adjustierten Kohlensäure‐Luft‐Gemischen auf 44 mm Hg konstant gehalten wurden, bekamen Nikomorphin und Pethidin in äquianalgetischen Dosen. Es konnten keine Unterschiede in der Abnahme der Atemminutenvolumina demonstriert werden.
The Poorly Nourished Patient and Abdominal Surgery
Authors: Dannert F. , Holm I. , Lundh G. , Löfström B.
Published: December 2008

A thorough study of a surgical case material from one year revealed that in about 6% of the laparotomies the major postoperative problem seemed to be related to a poor nutritional state of the patient.

Inadequate nutrition is fairly common in the pre‐operative period. In many cases, the poor nutritional state will not be obvious until after surgery.

The poor nutritional state could not be compensated for even with intensive parenteral feeding in the postoperative period.

In the postoperative period adequate nutrition is essential until a reasonably good oral intake has been established. If this rule is not followed, the patient will have a severe handicap if surgical complications should occur.

It is essential in all matters concerning nutrition that an account of the actual daily intake (calories, carbohydrates, fat and amino acids) is made both during the pre‐ and the postoperative periods. Enriched appetizing meals in the pre‐operative period, as well as carbohydrates, amino acids and often fat parenterally in high quantities in the postoperative period, are essential means to maintain an acceptable nutritive state in the surgical patients.

ZUSAMMENFASSUNG UND SCHLUSSFOLGERUNG

Eine sorgfältige Sichtung des chirurgischen Krankengutes eines Jahres brachte zum Vorschein, dass in ungefähr 6% der Laparotomien das Hauptproblem in der postoperativen Phase im schlechten Ernährungszustand der Patienten gelegen war.

In der präoperativen Periode ist inadequate Ernährung relativ haufig. In vielen Fällen wird der schlechte Ernährungszustand jedoch erst nach dem chirurgischen Eingriff augenfällig.

Der schlechte Ernährungszustand konnte auch mit intensiver parenteraler Fütterung in der postoperativen Periode nicht ausgeglichen werden.

In der postoperativen Periode ist adequate Ernährung bedeutungsvoll, solange bisausreichend gute orale Nahrungsaufnahme möglich ist. Wenn man diese Regel nicht befolgt, ist der Patient beim Auftreten chirurgischer Komplikationen mit einem schweren Handikap belastet.

In allem mit der Ernährung zusammenhängenden Dingen ist es von besonderer Bedeutung, dass eine genaue tägliche Bilanz geführt wird und zwar über Kalorien, Kohlehydrate, Fett‐ und Aminosäuren, sowohl während der prä‐ als auch postoperativen Periode. Schmackhafte, kalorien‐reiche Mahlzeiten in der präoperativen Phase, ebenso wie in grösseren Mengen parenteral zugeführte Kohlehydrate, Aminosäure und oft auch Fett in der postoperativen Periode sind von grösster Bedeutung für die Erhaltung eines annehmbaren Ernährungszustandes chirurgischer Patienten.
A New Valve for Paediatric Anaesthesia
Authors: Holm Hans Henrik
Published: December 2008

A new non‐rebreathing valve is described. Its small size and lightness combined with simple construction and minimal dead space make it particularly suitable for paediatric anaesthesia.

Es wird ein neues Nicht‐Rückatem‐Ventil beschrieben. Seine Kleinheit und Leichtigkeit, zusammen mit einfacher Konstruktion und geringstem Totraum, lassen es für die pädiatrische Anaesthesie besonders geeignet erscheinen.
Splanchnic and Portal Angiographic Patterns During Increasing Pentobarbital Sodium Intoxication
Authors: Ahlgren I. , Aronsen K. F. , Nylander G.
Published: December 2008

The splanchnic and portal angiographic patterns during increasing pentobarbital intoxication were studied in 10 dogs. Arterial, portal and inferior caval vein pressure readings were performed throughout the experiments.

On increasing depth of intoxication a progressive vasoconstriction within the splanchnic arterial and portal vascular areas was observed. The hepato‐graphic effect also became premature, and a premature drainage of the contrast medium into the inferior caval vein was seen, which indicates accelerated trans‐hepatic portal circulation.

Apart from a final drop in arterial pressure and an increase in portal pressure, the arterial, portal and inferior caval vein pressures remained fairly constant throughout the experiments independent of repeated injections of the anaesthetic. The final rise in the portal pressure and the unchanged inferior caval vein pressure, i.e. increased hepatic perfusion pressure, were explained by portal vasoconstriction in response to the reduction in arterial blood pressure.

After manual ventilation die angiographic changes were found to return to the appearance found initially when there was light anaesthesia.

The clinical application of these findings is discussed.

Bei 10 Hunden wurden die angiographischen Veränderungen des Splanchnikus und Pfortadersystems während forschreitender Pentobarbitalvergiftung untersucht. Während der Experimente wurden kontinuerliche Druckmessungen in einer Arterie, der Pfortader und der Vena cava inferior durchgeführt.

Mit dem Fortschreiten der Vergiftung wurde zunehmende Vasokonstriktion innerhalb des Splanchnikus, des arteriellen und des portalen Gefässsystems beobachtet. Es trat sowohl ein vorzeitiger hepatographischer Effekt auf, als auch eine prämature Drainage des Kontrastmittels in die untere Hohlvene, was auf eine beschleunigte transhepatische Portalzirkulation hindeutet.

Abgesehen von einem terminalen Abfall des arteriellen Druckes und einem Anstieg des Pfortaderdruckes blieben arterieller, portaler und Hohlvenendruck während der Dauer der Experimente ziemlich konstant, unabhängig von den wiederholten Injektionen des Anaesthetikums. Der terminale Anstieg des Pfortaderdruckes und der unveränderte Hohlvenendruck, d.h. der erhöhte Leberfusionsdruck, werden mit portaler Vasokonstriktion als Antwort auf den herabgesetzten arteriellen Blutdruck erklärt.

Nach manueller Beatmung kehrten die angiographischen Veränderungen wieder zu jenem Bild zurück, das sich bei oberflächlicher Anaesthesie gefunden hatte.

Die klinische Nutzanwendung dieser Befunde wird diskutiert.
INFLUENCE OF FLOW PATTERN ON THE DISTRIBUTION OF RESPIRATORY AIR DURING INTERMITTENT POSITIVE‐PRESSURE VENTILATION
Authors: Lyager Søren
Published: December 2008

By means of a lung model it has been demonstrated that the distribution of the inspired air between pulmonary compartments with different mechanical properties is influenced by the form of the flow curve.

In the presence of a great difference in the flow resistance between the pulmonary compartments, the best distribution is obtained when the inspiration occurs at a low flow rate and without volume acceleration. A no‐flow interval between inspiration and expiration gives rise to a redistribution which favours the affected pulmonary compartments.

In the presence of a great difference in the elastic resistance of the pulmonary compartments, it will be an advantage if the inspiration occurs rapidly and at a high volume acceleration. A no‐flow interval between inspiration and expiration is not an advantage for the affected pulmonary compartments.

ZUSAMMENFASSUNG UND SCHLUSSFOLGERUNGEN

Mit Hilfe eines Lungenmodelles konnte dargestellt werden, dass die Ver‐teilung der Einatmungsluft auf Lungenabschnitte mit verschiedenen mechanischen Eigenschaften durch die Form der Luftstromskurve beeinflusst wird.

Wenn ein grosser Unterschied im Strömungswiderstand zwischen verschiedenen Lungenabschnitten vorliegt, wird die beste Verteilung durch eine Inspiration mit niedriger Strömungsgeschwindigkeit und gleichbleibendem Volumen erzielt. Eine komplette Strömungspause zwischen Inspiration und Exspiration führt zu einem Verteilungsausglich, der die befallenen Lungenabschnitte bevorzugt.

Liegt ein grosser Unterschied in der elastischen Resistenz verschiedener Lungenabschnitte vor, dann ist eine rasche Inspiration und grosse Volumsbeschleunigung vorteilhaft. Eine komplette Strömungspause zwischen Inspiration und Exspiration bietet in diesen Fällen für die betroffenen Lungenabschnitte keine Vorteile.
THE NEW ENGSTRÖM RESPIRATOR 300: Clinical Experience and Technical Design
Authors: Norlander Olof P. , Nordén Ingrid , Olofsson Sven , Herzog Paul
Published: December 2008

The new Engström respirator 300 has been used in clinical routine for over 6 month in all types of patients. This respirator is designed basically on the same principle as earlier models and has the same physiological flow‐pressure and power properties. The patient circuit with a special valve box can be sterilized by autoclaving, and rapid access is obtained to valve holders and patient breathing bag by plug‐in construction. The respirator is small, silent and can be used in all conventional breathing systems. These are placed in position by a selector lever acting on a multifunction valve. A description is given of the new respirator and the flow‐pressure curves obtained from the patients. The clinical experience has been very favourable, and autoclaving is easily performed. It is believed that by this method the risks of cross‐infections through inadequately sterilized respirators can be entirely eliminated.

Über einen Zeitraum von 6 Monaten wurde der neue Engström‐Respirator 300 bei den verschiedensten Patienttypen im klinischen Routinebetrieb eingesetzt. Das Grundprinzip dieses Respirators ist dasselbe wie das früherer Modelle und er hat die gleichen pshysiologischen Strömungs‐, Druck‐ und Arbeitseigenschaften. Das mit einem speziellen Ventilbehälter ausgestattete Patientenzirkelsystem kann durch Autoklavieren sterilisiert werden; durch die Steckkonuskonstruktion ist rascher Zugang zu den Ventilbehältern und zum Patientenatembeutel gewährleistet. Der Respirator ist klein, leise und kann für alle üblichen Beatmungssysteme verwendet werden. Die Umstellung von einem System auf ein anderes erfolgt durch einen Auswahlhebel, der auf ein Mehrfach‐Funktionsventil wirkt. Der neue Respirator und die bei Patienten erhobenen Stromdruckkurven werden beschrieben. Die klinischen Erfahrungen waren sehr günstig; das Autoklavieren konnte leicht vorgenommen werden. Wir glauben, dass durch die Anwendung dieses Gerätes das Risiko von Kreuzinfektionen durch ungenügend sterilisierte Respiratoren völlig aus der Welt geschafft wird.
Effect of Altered Arterial Carbon Dioxide Tensions on the Electroencephalogram During Hypothermia
Authors: Ichiyanagi Kunio , Matsuki Michiko , Masuko Kazunori , Nishisaka Tsuyoshi , Watanabe Reiko , Horikawa Hideo
Published: December 2008

The effect of strictly controlled changes in PaC02 on the electro‐encephalogram was observed in dogs under stable anaesthesia and moderate systemic hypothermia. Pulmonary ventilation and amounts of carbon dioxide given were regulated to produce: (1) relative hypocapnia, (2) a constant PaCO2, and (3) relative hypercapnia. Changes in PaCO2 did not significantly affect coldinduced depression of the electro‐encephalogram, thereby negating the prospect that the administration of carbon dioxide may prevent the depression of the electrical activity of the brain which accompanies hypothermia. Inertness of raised PaC02 on the electro‐encephalogram was demonstrated also in hypothermic patients.

Bei Hunden wurde unter gleichbleibenden Narkosebedingungen und mäßiger allgemeiner Hypothermic die Wirkung genau kontrollierter Veränderungen des arteriellen Kohlensäuredrucks auf das EEG untersucht. Die Lungenventilation und Zugabe von Kohlensäure wurden so reguliert, daß sie 1) eine relative Hypokapnie, 2) ein konstantes PaC02 und 3) relative Hyperkapnie erzeugten. Veränderungen des PaC02 beeinflußten die k#aUlteinduzierte Dämpfung des Elektroenzephalogramms nicht signifikant. Womit die Vorstellung zu negieren ist, daß die Gabe von Kohlensäure imstande ist, die mit der Hypothermic einhergehende Dämpfung der elektrischen Aktivität des Gehirns zu verhindern. Die Wirkungslosigkeit erhöhter arterieller Kohlensäuredrucke auf das EEG wurde auch bei hypothermen Patienten demonstriert.
PARACERVICAL BLOCKADE WITH MARCAINE/ADRENALINE: Plasma Concentration of Marcaine and Foetal Acid‐Base Balance
Authors: Hollmén Arno , Ojala Aimo , Korhonen Mikko
Published: December 2008

Paracervical blockade (PCB) was performed for alleviation of labour pains in 10 normal patients who had no signs of foetal asphyxia. The anaesthetic agent used was 20 ml of 0.5% Marcaine (bupivacaine) with adrenaline (1:200,000). The maternal plasma concentration of Marcaine was determined by gas chromatography from venous blood drawn 5, 10, 15, 20, 30, 45 and 60 minutes after PCB. The Marcaine concentration was also determined at the time of delivery from samples taken simultaneously from the mother and the umbilical vein of the infant. The acid‐base balance of the infant was observed before and after PCB from capillary blood samples taken by Saling's technique.

The median values of the maternal plasma concentrations of Marcaine remained below 0.25 μ/ml. At the time of delivery, the Marcaine concentration in the maternal plasma was definitely higher than that in umbilical vein blood, which was very low. As labour progressed there was, as in normal deliveries, a steady fall in the foetal pH and an increase in metabolic acidosis. The slowly increasing foctal metabolic acidosis showed no obvious correlation to simultaneous changes in maternal plasma concentrations of Marcaine (cf. fig. 3).

Paracervikalblockade (PCB) wurde zur Erleichterung des Wehenschmerzes bei 10 gesunden Patientinnen ausgeführt, bei denen keine Zeichen von foetaler Asphyxie vorlagen. Als Lokalanaesthetikum wurde 20 ml halbprozentiges Marcain (Bupivakain) mit Adrenalin (1:200,000) verwendet. Die mütterliche Plasmakonzentration von Marcain wurde mittels Gaschromatographie aus dem venösen Blut bestimmt, das 5, 10, 15, 20, 30, 45 und 60 Minuten nach Anlegen der Blockade abgenommen worden war. Die Konzentrationen von Marcain wurden auch zum Zeitpunkt der Geburt bestimmt, und zwar aus Blutproben, die gleichzeitig von der Mutter und aus der Nabelvene des Kindes abgenommen wurden. Der Säure‐Basen‐Status des Kindes wurde vor und nach der PCB aus kapillaren Blutproben bestimmt, die nach der Saling'schen Tech‐nik entnommen worden waren.

Die mitderen Werte der mütterlichen Plasmakonzentration von Marcain blieben unter 0,25 μ/ml. Zum Zeitpunkt der Geburt war die Marcain‐Konzentration im mütterlichen Plasma eindeutig höher als im Nabelvenenblut, wo sie sehr gering war. Mit fortschreitender Wehentätigkeit zeigte sich, wie bei normalen Entbindungen, ein stetiger Abfall des foetalen pH und ein Ansteigen der metabolischen Azidose. Die langsam ansteigende foetale metabolische Azidose stand in keiner eindeutigen Relation zu gleichzeitigen Veränderungen in der m|uUtterlichen Plasmakonzentration von Marcain (siehe Abbildung 3).
BLOOD‐VOLUME MEASUREMENTS BEFORE AND AFTER OPERATION AND DETERMINATION OF OPERATIVE BLOOD LOSS: A Comparative Study
Authors: Brøckner J. , Ladegaard‐Pedersen H. J. , Engell H. C. , Donvig M.
Published: December 2008

The purpose of this study comprising 54 surgical operation was to compare the value of measurement of external blood loss and of pre‐ and postoperative blood‐volume determination, respectively, in guiding blood‐volume replacement during major surgery. The external blood loss was measured partly by weighing the sponges, partly by washing all linen in a Haemoporrhometer®. The pre‐ and postoperative blood volumes were determined by a semi‐automatic apparatus (Volemetron®). From the blood‐volume measurements it was calculated how the peroperative loss is distributed between plasma volume and red‐cell volume.

The external blood loss measured averaged 1500 ml. The blood‐volume determinations revealed a further average loss of 200 ml with a scatter of ±500 ml (2 xSD). In 28 cases of laparotomy an excess plasma loss averaging 25 % of the total volume loss was revealed. In thoracic and vascular operations the excess plasma loss was 6‐8%.

In six out of 54 cases the changes found in blood volume could not be accounted for. It is recommended to make duplicate determination of the blood volume pre‐operatively. When postoperative serial determinations of blood volume are deemed to be necessary, a catheter placed in a central vein should be used for blood sampling and injection of tracer substance.

Zweck dieser Untersuchung bei insgesamt 54 chirurgischen Operationen war es, den Wert der Messung des äusseren Blutverlustes mit der prae‐ und postoperativen Blutvolumsbestimmung zu vergleichen, um eine Richtschnur für den Blutvolumsersatz bei grösseren chirurgischen EingrifFen zu gewinnen. Der äussere Blutverlust wurde zum Teil durch Abwiegen der Operationstücher, zum Teil durch Auswaschen der gesamten Operationswäsche in einem Hae‐moporrhometer bestimmt. Die Bestimmung des prae‐ und postoperativen Blutvolumens wurde mit Hilfe eines halbautomatischen Gerätes (Volemetron) durchgeführt. Dabei wurde gleichzeitig errechnet, wie sich der intraoperative Blutverlust zwischen Plasmavolumen und Erythrozytenvolumen verteilt.

Der gemessene äussere Blutverlust betrug im Mittel 1500 ml. Die Blutvolumsbestimmungen deckten einen weiteren durchschnitdichen Blutverlust von 200 ml auf, mit einer Streuung von ±500 ml (2 mal SD). Bei 28 Laparotomien ergab sich ein zusätzlicher Plasmaverlust von durchschnittlich 25% des gesamten Volumenverlustes. Bei Thorax‐ und Gefassoperationen war der zusätzliceh Plasmaverlust nur 6‐8%.

Bei 6 von 54 Fällen konnten die aufgefundenen Veränderungen des Blutvolumens nicht ausreichend erklärt werden. Es wird empfohlen, Doppelbestim‐mungen des praeoperativen Blutvolumens durchzufuhren. Wenn Serienbe‐stimmung des Blutvolumens in der postoperativen Phase notwendig erscheinen, sollte durch Blutabnahme und Injektion der markierten Substanzen ein zentraler Venenkadieter eingelegt werden.
WOUND SEPARATION AND INTRA‐ABDOMINAL PRESSURE
Authors: Kewenter J. , Kock N. G. , Lundberg H.
Published: December 2008

In patients undergoing cholecystectomy, increases in intra‐abdominal pressure were recorded by means of a balloon in the peritoneal cavity during recovery from general anaesthesia, and during coughing and straining on the first to seventh day after operation. In three of 16 patients, the highest increases in intra‐abdominal pressure were recorded during bronchial toilette performed before extubation. In most of the patients, the intra‐abdominal pressure elevations during coughing increased successively on the postoperative days. In this investigation, coughing produced greater increases than did straining. The possibility of wound separation occurring at the time of bronchial toilette during recovery from general anaesthesia, due to an increase in intra‐abdominal pressure, is emphasised and discussed. It is recommended that, if possible, bronchial suction and extubation should be performed before the patient has regained full muscular tone.

Bei Patienten, die cholecystektomiert worden waren, wurden intraabdominelle Druckanstiege mit Hilfe eines in die Bauchhöhle eingelegten Ballons registriert, und zwar während der Erholung aus der Allgemeinnarkose, sowie während des Hustens und Pressens am 1. bis 7. postoperativen Tag. Bei 3 der 16 Patienten wurden die höchsten intraabdominellen Druckanstiege während der bronchialen Absaugung vor der Extubation registriert. Bei den meisten Patienten erhöhten sich die Druckanstiege während des Hustens sukzessive in Laufe der postoperativen Tage. Bei dieser Untersuchung erzeugte Husten stärkere Druckanstiege als Pressen. Die Möglichkeit des Entstehens einer Wunddehiszenz zum Zeitpunkt der bronchialen Absaugung am Ende einer Narkose durch die dabei entstehende intraabdominelle Druckerhöhung wird hervorgehoben und diskutiert. Es wird empfohlen, die bronchiale Absaugung und Extubation nach Möglichkeit noch durchzuführen, bevor der Patient seinen vollen Muskeltonus wieder erreicht hat.
LIVER NECROSIS AFTER REPEATED FLUOTHANE ANAESTHESIA
Authors: Hansen Valdemar
Published: December 2008

Two cases of liver necrosis observed after repeated minor operations performed under fluothane anaesthesia are reported. It is discussed whether the necrosis was referable to a hepatotoxic effect of the repeated exposure to fluothane.

Es wird liber zwei Falle von Lebernekrosen berichtet, die nach wiederholten kleineren Operationen unter Halothan‐Narkosen beobachtet wurden. Dabei wird erwogen, ob die Nekrosen auf einen hepatotoxischen Effekt der wiederholten Flubthanverabreichung zuriickgefuhrt werden konnte.
MEASUREMENTS OF HALOTHANE IN THE ATMOSPHERE OF AN OPERATING THEATRE AND IN EXPIRED AIRAND BLOOD OF THE PERSONNEL DURING ROUTINE ANAESTHETIC WORK
Authors: Hallen B. , Ehrner‐Samuel Harriet , Thomason M.
Published: December 2008

The exposure of operating‐theatre personnel to vapours of halothane during routine anaesthetic work was studied. The concentrations of halothane in the atmosphere of an operating theatre and in expired air and blood from the personnel were determined by means of gas chromatography. Possible deleterious effects of repeated exposures are discussed. The need for reducing the amount of waste anaesthetic vapours in operating theatres is pointed out.

Die Beeintrachtigung des Operationssaalpersonals durch Halothandampfe wahrend der Routine‐Narkosearbeit wurde untersucht. Mittels der Gaschro‐matographie wurden die Konzentrationen von Halothan in der Operations‐saalatmosphare, in der Ausatmungsluft und in Blut des Personals bestimmt. Mogliche schadliche Wirkungen des wiederholten Ausgesetztseins werden diskutiert. Schliesslich wird auf die Notwendigkeit hingewiesen, den Uber‐schuss von Narkosedampfen in den Operationssalen zu reduzieren.
THE EFFECT OF SUCCINYLCHOLINE DURING ELECTRICAL STIMULATION OF THE URINARY BLADDER
Authors: Boman J. , Wåhlin Å.
Published: December 2008

During operations on six male patients, the exposed urinary bladder was electrically stimulated, with synchronous measurements of the intravesical pressure. No significant change of the pressure could be demonstrated after intravenous administration of succinylcholine in clinical apnoeic doses.

Bei sechs mannlichen Patienten wurde im Verlauf von Operationen die freigelegte Blase elektrisch stimuliert und gleichzeitig der intravesicale Druck gemessen. Nach der i.v. Verabreichung klinisch‐apnoischer Dosen von Succi‐nylcholin konnte keine signifikante Anderung des Blaseninnendruckes fest‐gestellt werden.
CARBON DIOXIDE ADMINISTRATION FOR CORRECTION OF POSTOPERATIVE HYPOXAEMIA
Authors: Hald Tage , Johansen Sophus H.
Published: December 2008

Twenty‐three patients were exposed to inhalation of 2 per cent carbon dioxide in air for 20 minutes after completion of surgery. During the administration period an increase in PaOa and ventilation was observed, whereas PaCOa remained unchanged. A comparison with a similar group of 11 untreated patients suggested that this effect is temporary.

The recovery from the effects of anaesthesia appeared to be accelerated by carbon dioxide inhalation.

23 Patienten wurden fur 20 Minuten nach Operationsende einer Konzen‐tration von 2% G02 im Inhalationsgemisch ausgesetzt. Wahrend dieser Periode wurde ein Anstieg des PaOs und der Ventilation beobachtet, wahrend das PaCOa unverandert blieb. Der Vergleich mit einer ahnlichen Gruppe von 11 unbehandelten Patienten zeigte, dass es sich um einen temporSren Effekt handelt.

Die Erholung von den Narkoseauswirkungen schien durch die Kohlen‐saureinhalation beschleunigt zu werden.
AN INTERMITTENTLY CLOSED ANAESTHESIA CIRCUIT
Authors: Ruben Henning
Published: December 2008

An essential drawback of the conventionally used semi‐closed circuit is its poor control of the inflated volume. An intermittently closed circuit, i.e. a circuit which is closed during each inflation, but open with low resistance during each expiration, is described. It displays the following advantages: better control of die volume inflated into the lungs widi each bag compression; early recognition of changes in resistance to inflation; more optimal pressure conditions in the respiratory system and dierefore also in die chest; no adjustment of die pop‐off valve is necessary. The function of die intermitter, die incorporation of which converts die semi‐closed circuit to an intermittently closed circuit, is described.

This circuit can be improvised from generally available anaesdiesia component.

Ein wesentlicher Nachteil der konventionell verwendeten halbgeschlossenen Systeme ist die schlechte Kontrolle iiber das eingeblasene Volumen. Es wird ein intermittierend geschlossenes System beschrieben, d. h. ein Kreissystem, das bei jeder Beatmung geschlossen, jedoch wahrend jeder Exspiration bei niedrigem Widerstand offen ist. Es bringt die nachstehenden Vorteile: bessere Kontrolle des Volumens, das bei jeder Atembeutelkompression in die Lunge geblasen wird; friihe Erkennung der Widerstandsanderungen bei der Beatmung; opti‐malere Druckbedingungen im Atemsystem und damit auch im Thorax; es sind keine Adjustierungen des Uberlaufventils notwendig. Die Funktion des Unter‐brechers, dessen Einbeziehung das halbgeschlossene in ein intermittierend geschlossenes System verwandelt, wird beschrieben.

Dieses Kreissystem kann aus allgemein erhaldichen Anaesthesiegeratbe‐standteilen improvisiert werden.
Pollinators, flowering phenology and floral longevity in two Mediterranean Aristolochia species, with a review of flower visitor records for the genus
Authors: Berjano R. , Ortiz P. L. , Arista M. , Talavera S.
Published: December 2008

The pollination of Aristolochia involves the temporary confinement of visitors inside the flower. A literature review has shown that some species are visited by one or a few dipteran families, while others are visited by a wider variety of dipterans, but only some of these are effective pollinators. We observed flowering phenology and temporal patterns of pollinator attendance in diverse populations of Aristolochia baetica and A. paucinervis, two species that grow in SW Spain, frequently in mixed populations. The two species had overlapping floral phenologies, extended flowering periods and long‐lived flowers. A. baetica attracted a higher number of visitors than A. paucinervis. Drosophilids and, to a lesser extent, phorids, were the main pollinators of A. baetica, whereas in A. paucinervis, phorids were the only pollinators. Attendance to A. paucinervis flowers by phorids in mixed populations was markedly lower than in pure populations. This effect was more evident in years with lower pollinator density. Our results suggest that A. baetica and A. paucinervis may compete for pollinators in mixed populations.
Co‐localisation of membranes and actin in growing infected cells of Glycine max root nodules
Authors: Bulbul N. , Kaneko Y.
Published: December 2008

The root nodule of Glycine max (L.) Merr. is almost spherical at maturity, and its central tissue consists of infected cells filled with numerous symbiosomes containing bacteroids, interspersed with uninfected cells. During the growth of the nodule, the volume of each infected cell and the number of bacteroids per cell increases, and thus abundant membranes are required for the proliferation of symbiosomes. In expanding infected cells, there are areas adjacent to the nucleus that are devoid of bacteroids, but these areas are filled with numerous membranes and actin filaments, surrounded by endoplasmic reticulum membranes, indicating a perinuclear reservoir of newly formed membranes and a role for actin in delivering membranes to proliferating symbiosomes.
The pig CART (cocaine‐ and amphetamine‐regulated transcript) gene and association of its microsatellite polymorphism with production traits
Authors: Stachowiak M. , Cieslak J. , Skorczyk A. , Nowakowska J. , Szczerbal I. , Szydlowski M. , Switonski M.
Published: December 2008

The cocaine‐ and amphetamine‐regulated transcript (CART) gene is a candidate gene that may affect performance and body composition traits in the pig. The purpose of this study was to establish the chromosomal localization and genomic sequence of the porcine CART gene, search for polymorphism and analyse its phenotypic effect in 644 pigs representing two breeds, Polish Large White (PLW) and Polish Landrace (PL), and a synthetic line 990 (L990). The CART gene was fluorescence in situ hybridization (FISH)‐mapped to the chromosome 16q21. The 1878 bp DNA fragment covering three exons, two introns and the 5′ flanking region was sequenced and analysed. A new A/G single nucleotide polymorphism (SNP) at position −238 bp was found. The coding sequence was conserved between porcine and human CART genes. Previously unknown short tandem repeat polymorphism (CA)2(CG)n(CA)n was identified in intron 2. Three alleles 251, 253 and 259 bp were found. The 251‐bp allele was predominant in all the analysed populations of pigs, whereas the 253‐bp allele occurred with the lowest frequency. The statistical analysis revealed significant allelic additive effects on meat content in carcass (p < 0.05) and abdominal fat weight (p < 0.01) in PLW, and meat content in carcass (p < 0.05) and backfat thickness (p < 0.05) in PL. Our study confirmed that chromosome region harbouring the CART gene is a promising quantitative trait loci for pig production traits.
Salivary histatin‐5 and oral fungal colonisation in HIV+ individuals
Authors: Torres Sandra R. , Garzino‐Demo Alfredo , Meiller Timothy F. , Meeks Valli , Jabra‐Rizk Mary Ann
Published: December 2008

The oral cavity is a primary target for opportunistic infections, particularly oral candidiasis caused by the opportunistic pathogen Candida albicans. HIV+ individuals constitute a population highly susceptible to oral candidiasis possibly due to a change in the environment of the oral cavity as the result of salivary gland dysfuntion. Histatins are a family of salivary antimicrobial peptides which under normal circumstances have a protective function on the oral mucosa. This study aimed to compare salivary histatin concentrations and oral fungal colonisation in an HIV+ and HIV− control populations. Oral samples for fungal cultures and parotid saliva were collected from all subjects. Fungal identification was determined using standard mycological procedures. In order to determine salivary histatin levels a semi‐quantitative ELISA was designed using a specific polyclonal antibody and extensive statistical analysis was performed. Forty‐seven percent of HIV+ and 17% of control subjects had positive fungal cultures. Mean histatin levels were 7.32 μg ml−1 for the HIV+ group and 9.17 μg ml−1 for control group (P = 0.003). The data from this study demonstrate that the level of fungal colonisation is significantly higher in HIV+ individuals whereas histatin‐5 concentrations are significantly lower, likely contributing to the enhanced predisposition of this population to oral candidiasis.
Volume‐regulated chloride channels and cerebral vascular remodelling
Authors: Tang Yong‐Bo , Zhou Jia‐Guo , Guan Yong‐Yuan
Published: December 2008

Transmembrane Cl− transport through volume‐regulated Cl− channels (VRCC) is implicated in cell cycle control and the proliferation of vascular smooth muscle cells (VSMC). In cerebrovascular VSMC, volume‐regulated Cl− movement is enhanced with the severity of cerebrovascular remodelling induced by hypertension.

Expression of the ClC‐3 chloride channel, a potential molecular candidate for the VRCC, is significantly increased with the progression of VSMC proliferation, but is decreased in apoptosis.

In the present review, we summarize recent findings regarding the functional role of volume‐regulated ClC‐3 chloride channels in VSMC proliferation, apoptosis and cerebrovascular remodelling during the development of hypertension. In addition, we discuss the relationship between the channel and intracellular signalling pathways, including the production of reactive oxygen species and the phosphorylation of Akt.

Recent studies strongly suggest that VRCC/ClC‐3 is involved in the regulation of both cell proliferation and apoptosis. These findings suggest that ClC‐3 chloride channels may be potential new targets for the prevention of the cerebrovascular remodelling that occurs during the development of hypertension.
Bone mass density and associated factors in cystic fibrosis patients of young age
Authors: Douros Konstantinos , Loukou Ioanna , Nicolaidou Polyxeni , Tzonou Anastasia , Doudounakis Stavros
Published: December 2008

Aim:  To investigate bone mineral status in young cystic fibrosis (CF) patients and determine risk factors related with the development of low bone mineral density (BMD).

Methods:  We determined, in 81 patients with CF, 4 to 23‐years‐old, BMD as well as factors, which are thought to play a role in the development of reduced BMD.

Results:  BMD Z‐score was between −1 and −2.5 in 27 (33%) and lower than −2.5 in 9 (11%). Means of BMD Z‐score were lower than the expected value of 0 in the three groups of children, adolescents and young adults (P = 0.004; P < 0.001; P = 0.048, respectively), but they did not differ among them (P = 0.114). Analysis showed that Shwachman–Kulczycki (SK) score, gender and levels of 25‐hydroxy‐vitamin D were significant predictors of BMD Z‐score. Significant also was the interaction between gender and SK score.

Conclusions:  Our study supports that BMD may be reduced from a young age in CF patients though this needs to be confirmed using true volumetric measures of BMD. This defect is related to disease severity with males being more vulnerable. Inefficient levels of vitamin D are very common and contribute significantly to impaired bone health. The latter finding underlines the need for higher supplementation doses.
Spinal glioneuronal tumor with neuropil‐like islands and meningeal dissemination: histopathological and radiological study of a pediatric case
Authors: Poliani Pietro Luigi , Sperli Domenico , Valentini Sergio , Armentano Antonio , Bercich Luisa , Bonetti Maria Fausta , Corriero Giuseppe , Brisigotti Massimo , Quattrone Aldo , Lanza Pier Luigi
Published: December 2008

Cerebral and spinal location of glioneuronal tumors have been recently described as a novel type of primary CNS neoplasia. A distinctive rare form of glioneuronal tumors with neuropil‐like islands (GTNI) have been reported to occur in the adult cerebrum, whereas spinal GTNI localization is extremely rare. In the present report we describe a case of a 15‐month‐old child with a spinal GTNI of the cervical region and meningeal dissemination. Histologically the tumor was composed of round, small neurocytic‐like cells arranged around eosinophilic neuropil cores and embedded in a diffuse fibrillar glial component forming prominent “rosetted” neuropil islands displaying strong immunoreactivity for neuronal markers. Cerebral GTNI shows abundant glial components not rarely exhibiting anaplastic features that justify their inclusion within the group of diffuse astrocytomas. In contrast, including our case, spinal GTNI do not show histological evidence of anaplastic features and exhibits a significant neuronal component that may imply considering these lesions in a separate group. Nevertheless, due to their exceptional rarity, the natural history of these lesions is not yet fully understood, but spinal GTNI seems to have an unfavorable clinical course despite their benign histopathological features, which must be taken into account for appropriate treatment and follow‐up of the patient.
EXPERIMENTAL STUDIES ON THE EFFECT OF AGING AND ENDOCRINE CONTROL ON COLLAGEN FORMATION IN VARIOUS ORGANS
Authors: Takeda Toshio , Suzuki Yasuhiro , Yao Chee‐Soon
Published: December 2008

Physiological changes with advancing age of collagen content, fiber and fibril sizes in some connective tissues, the morphological profiles and enzy histochemical activities of fibroblasts in different organs, and the effect of gonadectomy, adrenalectomy, hypophysectomy and their hormone replacement on the collagen and fibroblasts were studied using DDD, C57BL/6J, A/Jax, DW/J mice and Wietar rats.

It was suggested that connective tissue in these organs was under the specific control of endocrine organs such as gonads, adrenals and the pituitary and that these controls might be effected through their hormonal effects on the specifically differentiated fibroblast localized in different organs and tissue.
MALIGNANT MESENCHYMOMA OF THE HEART
Authors: Nagmine Yoshiaki , Sasai Kazuhiko , Sasaki Kohsuke
Published: December 2008

An autopsy case of malignant cardiac mesenchymoma, which arose in the atrial septum was presented. This tumor contained Abrosar‐comatous, rhabdomyosarcomatous, chondroaarcomatous and oseeous elements. A small metastatic leeion was found in the lung. Histogenesis of this tumor was also considered with a survey of literature.
PROGRESSIVE MULTIFOCAL LEUKOENCEPHALOPATHY
Authors: Nagashima Kazuo , Yamaguchi Kazuyoshi , Yasui Kotaro , Ogiwara Hiroshi
Published: December 2008

Mechanism of demyelination in progressive multifocal leukoencephalopathy (PML) was elucidated by demonstrating ultrastructurally the relationship between the affected glial cells and myelin sheaths. The myelinating cells in the central nervous system, namely ollgodendroglias, were specifically attacked by PML‐virus, with eventual primary destruction of myelin sheaths. An attempt to isolate PML‐virus from the autopsy material was made. The presence of virus particles in the extracts from the brain, reactions of virions with antibodies and evidence of virus proliferation in the primary human fetal glial cell culture were shown by various techniques including negative staining, immunofluorescence, immunoelectron microscopy, and electron micrography. The isolated virus was antigenically identical with JC type of papovaviruses.
IMMUNOHISTOCHEMICAL LOCALIZATION OF TYPE I, III AND IV (BASEMENT MEMBRANE) COLLAGENS IN THE LIVER
Authors: Konomi Hiroshi , Sano Junjiro , Nagai Yutaka
Published: December 2008

The tissue distribution of type I, III and IV (basement membrane) collagens in normal human and bovine livers was examined by indirect immunofluorescence microscopy, by using type‐specific rabbit antibodies to individual types of bovine collagen. Type I and III collagens were found to distribute in the interstitium of portal tracts as thick fiber bundles and in perisinusoidal spaces as thin fibers like reticulin fibers, both in human and bovine livers. No significant distribution differences of type I and III collagens in the livers was observed under the experimental conditions employed, indicating that both collagens are Involved in in vivo collagen fibrillogenesis in the tissue, regardless of the sizes of collagen fibers, as in the skin (Conn. Tiss. Res. 7: 157–163, 1980). Type IV collagen, when examined with bovine liver, was located in hepatic arteries, portal veins and bile ducts of portal tracts, and was also distributed in the perisinusoidal spaces In a linear fasion.
DYSPLASIA AND RESERVE CELL HYPERPLASIA‐LIKE CHANGE IN HUMAN ESOPHAGUS
Authors: Takubo Kaiyo , Tsuchiya Shin'ichi , Fukushi Katsunari , Shirota Akiro , Mitomo Yoshio
Published: December 2008

The esophagus was totally examined in 264 autopsied cases and 61 operated cases, for a total of 325 cases, to clarify the histogenesis of squamous cell carcinoma of the esophagus. Epithelial dysplasia of the mucosa was present in 27% and subclinical carcinoma was found in 2.4%. Hyperplasia of the duct of the esophageal gland proper was present in 34% and dysplasia of the ductal epithelium in 3%. Reserve cell hyperplasia‐like change of the islet of the ectopic gastric mucosa was found in 4% and reserve cell hyper‐plasia‐like change of the esophagogastric junction zone in 13%. Of the seven cases of microcarcinoma, two showed dysplasia and gradual transition and one presented dysplasia and abrupt transition. Another two were considered to have originated in the ductal epithelium. These findings suggested that they could all be the sites of origin of cancer development.
MESANGIAL BRIDGES
Authors: Watanabe Teruo , Emoto Kanichi
Published: December 2008

Electron microscopic examination of the renal biopsy material obtained from a 34‐year‐old diabetic patient revealed subdivisions of glomerular capillaries into several branches by dendritic mesangial projections built between the mesangium and peripheral loop, a similar process which was described as mesangial bridges in a chronic phase of Masugi nephritis. In comparison with those in experimental animals, mesangial bridges in the present case appeared rather solid with matrix formation, most presumably depending on long duration of the disease state In the diabetic patient. This process may represent a more complicated type of lesion invariably accompanying the nodule formation and is assumed to be an irreversible lesion ultimately undergoing segmental obliteration of glomerular capillaries.