The Papworth BiVent tube: a feasibility study of a novel double-lumen endotracheal tube and bronchial blocker in human cadavers.
A novel double-lumen endotracheal tube, the Papworth BiVent tube, has been designed to allow the rapid passage of a blocker into either main bronchus, without fibreoptic endoscopic guidance.



The feasibility of lung isolation and one-lung ventilation (OLV) in human cadavers is examined, along with displacement of the bronchus blocker during head and neck movement.



Cadaveric endotracheal intubation with the Papworth BiVent tube was straightforward and comparable with intubation with a conventional single-lumen tube (SLT). Reliable lung isolation was achieved considerably faster using the Papworth BiVent tube than with a bronchoscopically guided bronchial blocker through an SLT (mean 7.75 s BiVent tube vs 128.2 s SLT). The Papworth BiVent tube also prevented displacement of the blocker from its position in the bronchus on head movement.



This study in human cadavers has shown that it is feasible to use the Papworth BiVent tube to attain rapid and secure lung isolation for OLV. Further work is required in clinical settings.

title: Dopexamine hydrochloride: pharmacology and use in low cardiac output states.
abstract: T HE TERM “INOTROPE” is broadly used to describe agents that enhance cardiac performance, although the mechanism by which some of these drugs improve myocardial function may be attributable less to their effect on myocardial contractility than to the other hemodynamic changes that are associated with their use. In the treatment of cardiac failure, agents with pharmacodynamic profiles that combine relatively mild direct effects on the myocardium with those resulting from a relatively greater effect on preload and afterload offer potential benefits from the standpoint of myocardial energy use. This is of prime concern in both the acutely or chronically ischemic heart and following cardiopulmonary bypass (CPB) when cardiac failure can, on occasion, be ascribed more to unavailability of energy reserves than to persisting ischemia. Dopexamine hydrochloride, a synthetic analog of dopamine, is characterized by just such a profile of action and may offer a favorable alternative to the more established therapeutic regimens of dopamine and dobutamine. The pharmacology of dopexamine and its use in the treatment of chronic or postoperative cardiac failure is reviewed here.

title: The Papworth BiVent tube: a new device for lung isolation.
abstract: Provision of one lung ventilation can be technically challenging, particularly for anaesthetists who are only occasionally required to isolate one lung from the other. A new double lumen endotracheal tube, the Papworth BiVent Tube, has been designed to enable rapid and reliable lung isolation using any bronchus blocker without the need for fibreoptic endoscopic guidance. In this study, an airway-training manikin was used to assess ease of tracheal intubation and lung isolation using the Papworth BiVent tube. Ease of intubation was compared to a single lumen endotracheal tube and a conventional double lumen endobronchial tube. Ease of lung isolation when using a bronchus blocker was compared to a single lumen tube combined with a bronchial blocker. Tracheal intubation using the Papworth BiVent tube was found to be easier than when using a conventional double lumen endobronchial tube. Lung isolation using the Papworth BiVent tube used in combination with a bronchus blocker was achieved more reliably and rapidly than when using a single lumen tube and bronchus blocker.

title: Endotoxin-induced organ injury.
abstract: To review the effects of endotoxemia on the major organ systems of the body and discuss potential mechanisms of tissue injury.



Appraisal of 60 articles representing a cross section of studies relating to in vivo and in vitro responses to endotoxin.



Cell cultures, isolated tissue preparations, animal and human studies.



Endotoxemia results in the activation of numerous cellular and hematogenous mediators. These mediators range from prostaglandins, thromboxanes, and leukotrienes, to complement components. Tumor necrosis factor may be responsible for initiating many of the observed responses to endotoxin. Species and tissue specificity are a prominent feature of the response to endotoxin.



No single agent can yet be implicated as the common mediator of endotoxin-induced organ injury. Endotoxin initiates the elaboration of a cascade of secondary mediators that amplify the response to the initial insult. The relative importance of individual agents as mediators of the response to endotoxin varies with the experimental model studied.

title: Management of donors for heart and heart-lung transplantation.
abstract: The quality of donor organs will determine the quality of life for the recipient and the importance of optimal management of the multi-organ donor is that the organs may benefit up to five, critically ill, patients. The basic principle is to maintain sufficient preload to minimise the need for inotropic support and it is recommended that all multiple organ donors should have central venous and arterial pressure monitoring in addition to adequate venous access. The importance of the choice of fluid for volume expansion and the management of the hormonal disturbances which follow brain death are considered.

title: Pulmonary adenocarcinoma is associated with poor long-term survival after surgical resection. Effect of allogeneic blood transfusion.
abstract: The significance of allogeneic blood transfusion in the prognosis of patients with nonsmall lung carcinoma (NSCLC) remains controversial. Reports have suggested that patients with adenocarcinoma have a worse prognosis from cancer than patients with squamous cell carcinoma (SCC), but this evidence is lacking in NSCLC. The objective of the current study was to elucidate the correlation between perioperative allogeneic blood transfusion and the prognosis in patients with adenocarcinoma and SCC.



The study group comprised 329 consecutive patients (172 men and 157 women) with a mean age of 67 years who underwent lung resection between 1996 and 2003 in 1 unit. The clinicopathologic and survival data were compared between 62 patients (42.7%) with adenocarcinoma and 58 patients (48.3%) with SCC who received a perioperative blood transfusion and 83 patients (57.3 %) with adenocarcinoma and 126 patients (61.3%) with SCC who did not.



The overall surgical mortality rate was 3.9% (13 deaths). The median surgical blood loss was 380 mL (range, 125-4500 mL). The mean blood transfusion received was 1.9 U (range, 0-8 U). The overall actuarial 1, 3, and 5-year survival rates in the adenocarcinoma and SCC groups were 82.3%, 49.6%, and 19.4% and 87.9%, 71.7%, and 32.7%, respectively (P = 0.021). Multivariate analysis demonstrated that the factors that appeared to be independent prognostic factors in both groups were T-classification (P < 0.001), lymph node metastasis (P < 0.001), and postoperative complications (P = 0.029). Perioperative blood transfusion was not an independent prognostic indicator in either group.



The current study demonstrated that long-term survival in patients with adenocarcinoma of the lung was significantly worse compared with patients with SCC, but was independent of allogeneic perioperative blood transfusion. The results reaffirmed the importance of tumor invasion and lymph node involvement in the overall poor prognosis of these patients.

title: Clearance of acanthosis nigricans associated with insulinoma following surgical resection.
abstract: Acanthosis nigricans is said to be a marker of insulin resistance. It is known to occur in patients with insulinoma where there is marked hyperinsulinaemia. We report a case wherein the acanthosis disappeared following surgical resection of insulinoma and this strengthens the hypothesis that hyperinsulinaemia is responsible for acanthosis.

title: Study of properties of cholinephosphotransferase from fetal guinea pig lung mitochondria and microsomes
abstract: SummaryWe have reported earlier that cholinephosphotransferase (EC 2.7.8.2) is present in both mitochondria and microsomes of fetal guinea pig lung. This study was designed to compare the properties of mitochondrial and microsomal cholinephosphotransferase in fetal guinea pig lung. Various parameters, such as substrate specificity, Km values, sensitivity to N-ethylmaleimide, dithiothreitol and trypsin were measured. Both showed significant preference for unsaturated diacylglycerols over saturated diacylglycerols. Data on Km and Vmax indicate that the affinity of this enzyme for different diacylglycerols varies between the two forms. The ID50 values for N-ethylmaleimide were 20 mM and 12.5 mM for the mitochondrial and microsomal form of the enzyme, respectively. Dithiothreitol showed an inhibitory effect on both; however, the mitochondrial form was inhibited less than the microsomal form. The effects of N-ethylmaleimide and dithiothreitol on both forms of enzyme indicated that the microsomal cholinephosphotransferase requires a higher concentration of -SH for its activity than the mitochondrial enzyme does. The enzyme was inhibited by trypsin in both mitochondria and microsome under isotonic condition suggesting that this enzyme is on the outside of the membrane in both endoplasmic reticulum and mitochondria.

title: A novel non-parametric regression reveals linkage on chromosome 4 for the number of externalizing symptoms in sib-pairs.
abstract: In this report, we present results of a genome-wide linkage scan using as a phenotype the number of externalizing symptoms associated with alcohol use disorders. Subjects were collected by the Collaborative Study on the Genetics of Alcoholism project from families in which at least three first degree relatives were affected by alcohol dependence. We use a novel non-parametric regression method based on kernel smoothing for our analysis. We report a statistically significant linkage close to the ADH gene cluster on Chromosome 4. We also obtain evidence for epistatic interaction between a region on Chromosome 1 and one on Chromosome 15. Although alcoholism as a covariate does not have any effect on the linkage scan, it has an effect on the epistatic interaction.

title: Noninvasive electrocardiographic imaging (ECGI) of a univentricular heart with Wolff-Parkinson-White syndrome.
abstract: Electrocardiographic imaging (ECGI) is a noninvasive functional imaging modality which reconstructs epicardial potentials, electrograms, and activation and recovery maps from body-surface ECG potentials. For this purpose, up to 256 ECGs are recorded by a 256-channel body surface potential mapping (BSPM) system and the heart-torso geometry is obtained using thoracic computed tomography (CT)1,2. This technique was developed and validated extensively in normal and abnormal canine hearts3–11. More recently, ECGI was validated in humans by comparison with direct intra-operative epicardial mapping in patients undergoing open-heart surgery12. To date, ECGI has been applied in adult human subjects for the following purposes: 1. To study cardiac electrophysiology of the normal adult human heart2. 2. To image electrophysiologic responses to pacing in heart failure patients undergoing cardiac resynchronization therapy13 (pacing sites were localized with an accuracy better than 10 mm)14. 3. To guide catheter ablation of focal ventricular and atrial tachycardias15,16. 4. To image typical atrial flutter prior to catheter ablation1 and atypical atrial flutter prior to a surgical Cox-Maze procedure17. 
 
Here we describe for the first time, a case where ECGI was applied to a pediatric patient with a congenital structural heart defect. The patient had a univentricular heart and Wolff-Parkinson-White syndrome, and ECGI was used to localize the accessory pathway and help guide catheter ablation. To date, there have been no reported cases of ECGI in the pediatric population.