Gastrostomy in paediatric surgery (author's transl)

Gastrostomy has the same field of application as the feeding tube which is introduced either orally or nasally. With careful nursing and surgical technique, only few and slight disturbances are to be expected. This method, however, ist not suited for routine application by the premature baby because of its possible septic complications.     

Results with the Clinicard analyser in a paediatric hospital (author's transl)

The most important chemical pathological investigations which require to be undertaken in the emergency laboratory of a paediatric hospital are of the serum electrolytes, blood glucose, cerebrospinal fluid glucose, blood urea nitrogen, total proteins, bilirubin and calcium. It is imperative to have the opportunity of controlling these parameters both during the day and night. In order to be independent of the presence of a technician we were interested in finding an instrument which can be used by untrained personnel and gives results of sufficient accuracy. Hence, the clinicard analyser was tested in regard to reproducibility and accuracy of results when used by highly-trained technicians and by persons without knowledge of laboratory work. It was established that the values obtained by these two groups are similar and sufficiently reproducible for emergency use. The accuracy of the instrument was tested with 2 charges of cuvettes and with different control sera. In the case of total proteins differences were found between the different control sera used. The values obtained for blood urea nitrogen and for blood glucose lay within the range given for Labtrol and for Seronorm. The accuracy of bilirubin was tested with 5 different control sera and all values lay within the ranged given by the factory. Calcium was tested with Labtrol and Fluinorm and also with sera and urines from different patients. The values were within the range given for the test sera and were comparable to those measured with the calcium analyser of EEL, but were about 7% lower than those determined using atomic absorption. The values obtained for cerebrospinal fluid glucose correlated well with those obtained by the routine method.     

Cerebral aneurysm surgery in a patient with phaeochromocytoma

This case report describes the peri-operative management of a 48-year-old woman with three cerebral aneurysms and phaeochromocytoma. The pharmacological and anaesthetic management of such patients is complex, and needs to be managed carefully by titrating anaesthetic agents and vasoactive drugs. The primary concern is the maintenance of cerebral perfusion pressure and autoregulation throughout the procedure, although these states cannot be monitored directly. The patient survived the operation neurologically intact, and it is presumed that the course of management which was chosen helped to achieve this result.     

Circulating androgen and estrogen concentrations in lizards (Iguana iguana)

Bilateral tooth measurements in twins are partitioned into three orthogonal contrasts, each associated with one degree of freedom, to estimate three parameters: discordance, asymmetry, and mirror imagery. The probability levels of the within-pair variance ratios were used to test for significance of these estimates. The results provided strong evidences for the existence of significant genetic determinants of almost all of the individual tooth dimensions, but little or no evidence for a genetic basis of asymmetry. The analysis gave no indication that monozygotic twinning was associated with an increased degree of either fluctuating asymmetry or mirror imagery, when compared to dizygotic twins. The data on monozygotic twins further suggested that for most variables examined, the increment of environmental discordance resulting from the twinning phenomena was greater than the developmental noise that caused asymmetry within individual cotwins.     

Schizophrenia and the dopamine-beta-hydroxylase gene: results of a linkage and association study

PURPOSE: A dose-finding study to investigate the use of epidural infusions of ropivacaine for postoperative analgesia following orthopaedic surgery. METHODS: This was a randomized, double-blind study. Surgery was performed using a combination of a lumbar epidural block utilizing ropivacaine 0.5% and a standardized general anaesthetic. Postoperatively, an epidural infusion of the study solution (saline, ropivacaine 0.1%, 0.2% or 0.3%) was started at the rate of 10 ml.hr-1 and continued for 21 hr after arrival in the PACU. Analgesia was supplemented with PCA morphine (dose = 1.0 mg, lock-out = 5 min). RESULTS: Forty-four patients completed the study. The ropivacaine 0.1%, 0.2%, 0.3% groups required less morphine over the 21 hr than the saline group (P < 0.01). The VAS pain scores were also lower in the three ropivacaine groups (P < 0.001). The ropivacaine groups maintained sensory anaesthesia to pinprick when compared with saline (P < 0.05). The motor block in the 0.3% group was significantly higher than the saline group at all times (P < 0.05), and higher than the 0.1% group at eight hours (P < 0.01), while the 0.2% group had higher Bromage scores than saline at 4 and 21 hr (P < 0.05). CONCLUSIONS: The use of continuous epidural infusions of ropivacaine 0.1%, 0.2% and 0.3% at 10 ml.hr-1 improved postoperative pain relief and decreased PCA morphine requirements in patients undergoing major orthopaedic surgery. The 0.1% and 0.2% concentrations produced similar sensory anaesthesia with less motor blockade than the 0.3% concentration.     

On the distribution of catecholamines in Promesostoma balticum (Turbellaria, Neorhabdocoela, Promesostomatidae)

The distribution of putative catecholamines has been previously studied in the nervous system of three Promesostoma species using the glyoxylic-acid-induced fluorescence (GAIF) method. In this communication, the results are reported of a similar study of Promesostoma balticum, which is classified to another group of species in the genus. Promesostoma species from two different species groups differed in the position of neurons associated with the ventral and lateral cords. All the studied species of Promesostoma demonstrated doubled dorsal neurons in so called anterior complex (AnDo), a character which differentiates this genus from the other studied Typhloplanoida.     

Necrosis of a phaeochromocytoma associated with spontaneous remission of diabetes and hypertension

The diagnosis of phaeochromocytoma is sometimes difficult since its clinical presentation is quite variable. We report a 52-year-old woman who presented with acute diabetes mellitus and severe hypertension, which spontaneously disappeared. MIBG-scintigraphy and urine and plasma catecholamines were normal. At surgery, a largely necrotic phaeochromocytoma was found. Pathological examination demonstrated extensive avascular necrosis, which had occurred spontaneously without any major symptoms.     

Comparative study of plasma dopamine-beta-hydroxylase activities in noradrenaline-secreting and adrenaline-secreting phaeochromocytomae

1. Circulating dopamine-beta-hydroxylase activities were measured in two hypertensive patients, with a phaeochromocytoma tumour. Tumours were found to differ by their secretory properties, one secreting noradrenaline, the other adrenaline. After removal of the tumour, the plasma dopamine-beta-hydroxylase activities in both patients gradually decreased to reach a stable value in correlation with urinary, excreted catecholamine levels. The only difference was the rate of the plasma enzyme activity decrease. 2. Thus, it appeared that some phaeochromocytomae are able to secrete dopamine-beta-hydroxylase in addition to catecholamines. Therefore, dopamine-beta-hydroxylase activity measurements may be of interest: (1) in determining secretory properties of phaeochromocytoma tumours, and (2) in following the evolution during the postoperative period.     

Circulating vascular endothelial growth factor (VEGF) is a possible tumor marker for metastasis in human hepatocellular carcinoma

Vascular endothelial growth factor (VEGF) is closely related to angiogenesis in various human cancers. However, little is known of its circulating levels in hepatocellular carcinoma (HCC). We examined circulating VEGF levels in chronic liver disease to assess their clinical significance. Plasma VEGF concentrations were determined, by enzyme immunoassay, in patients with chronic hepatitis (CH; n = 36), liver cirrhosis (LC; n = 77), and HCC (n = 86) for a cross-sectional study. Plasma VEGF levels in healthy controls (n = 20) and CH, LC, and HCC patients were 17.7 +/- 5.4 (mean +/- SD), 30.6 +/- 22.8, 34.4 +/- 27.0, and 51.1 +/- 71.9 pg/ml, respectively. The levels were significantly elevated in the HCC group, compared with the control, CH, and LC groups. Plasma VEGF levels in stage I, II, III, IVA, and IVB HCC patients were 27.6 +/- 16.1, 26.5 +/- 13.7, 35.8 +/- 15.3, 45.4 +/- 39.4, and 103.1 +/- 123.2 pg/ml, respectively. The stage IVB patients with remote metastasis showed significantly marked elevation compared with the patients at the other stages. Platelet numbers were weakly correlated with plasma VEGF levels in the HCC group. Plasma VEGF level was highly elevated in patients with HCC, particularly those with metastatic disease. We consider that plasma VEGF is a possible tumor marker for metastasis of HCC. Circulating VEGF may be derived mainly from the large burden of tumor cells, and partly from platelets activated by the vascular invasion of HCC cells.     

Decision-making and paediatric pain: a review

The aim of this paper is to present an overview of the literature on the factors influencing decision-making in the nursing care of children in pain. To that effect published and unpublished references were reviewed. The most frequently cited factors influencing the assessment and management of pain in children are summarized and discussed. Finally recommendations are made where further research is warranted.     

Circulating vascular cell adhesion molecule-1 (VCAM-1) in atherosclerotic NIDDM patients

Vascular cell adhesion molecule-1 (VCAM-1) has been shown to be highly expressed in atherosclerotic lesions. Although the soluble form of VCAM-1 (sVCAM-1) is detected in human sera, the relation between the degree of atherosclerosis and serum sVCAM-1 level has not been defined. In the present study, sVCAM-1 concentrations were measured in sera from 101 Japanese NIDDM patients. The mean +/- SD serum sVCAM-1 concentration in 26 patients with symptomatic atherosclerotic vascular diseases (789 +/- 187 ng/ml) was higher than that in 75 patients without the disease (664 +/- 175 ng/ml). Among the 101 NIDDM patients, 56 had atherosclerotic change of the carotid arteries, based on the evaluation by high-resolution B-mode ultrasonography. Their sVCAM-1 level was 759 +/- 201 ng/ml, higher than that in 45 patients without any detectable atherosclerosis of the carotid arteries (619 +/- 130 ng/ml). In addition, there was a positive correlation between sVCAM-1 concentration and thickness of the intimal plus medial complex (IMT) of the carotid arteries in the NIDDM patients (r = 0.41, P < 0.0001). Multivariate regression analysis revealed significant predictors of mean IMT value to be sVCAM-1 concentration (F = 62.88, P = 0.0001) and age (F = 9.59, P = 0.0026). By contrast, sVCAM-1 concentration was not increased in nondiabetic patients with atherosclerotic change of the carotid arteries (668 +/- 191 ng/ml; n = 36) compared with those without the atherosclerotic change (632 +/- 177 ng/ml; n = 28), and there was no correlation between sVCAM-1 level and IMT of the carotid arteries in the nondiabetic subjects. These results indicate that circulating sVCAM-1 may be a marker of atherosclerotic lesions in NIDDM patients with symptomatic and asymptomatic atherosclerosis.     

Exogenous and endogenous catecholamines inhibit the production of macrophage inflammatory protein (MIP) 1 alpha via a beta adrenoceptor mediated mechanism

Noradrenaline (NA) and adrenaline (Ad) are modulators of cytokine production. Here we investigated the role of these neurotransmitters in the regulation of macrophage inflammatory protein (MIP)-1alpha expression. Pretreatment of RAW 264.7 macrophages with NA or Ad decreased, in a concentration-dependent manner (1 nM-100 microM), MIP-1alpha release induced by bacterial lipopolysaccharide (LPS 10 ng ml(-1) LPS). The effect of NA was reversed by the selective beta-adrenoceptor antagonist propranolol (10 microM), but not by the alpha-adrenoceptor antagonist phentolamine (10 microM). In the concentration range of 10 nM-10 microM, isoproterenol, a beta-adrenoceptor agonist, but not phenylephrine (a selective alpha1-adrenoceptor agonist) or UK-14304 (a selective alpha2-adrenoceptor agonist) mimicked the inhibitory effects of catecholamines on MIP-1alpha production. Increases in intracellular cyclic adenosine monophosphate, elicited either by the selective type IV phosphodiesterase inhibitor rolipram (0.1 - 10 microM), or by prostaglandin E2, (10 nM-10 microM) decreased MIP-1alpha release, suggesting that increased cyclic AMP may contribute to the suppression of MIP-1alpha release by beta-adrenoceptor stimulation. Northern blot analysis demonstrated that NA (100 nM-10 microM), Ad, isoproterenol, as well as rolipram (100 nM-10 microM) decreased LPS-induced MIP-1alpha mRNA accumulation. NA and Ad (1-100 microM) also decreased MIP-1alpha production in thioglycollate-elicited murine peritoneal macrophages. Pretreatment of mice with either isoproterenol (10 mg kg(-1), i.p.) or rolipram (25 mg kg(-1), i.p.) decreased LPS-induced plasma levels of MIP-1alpha, while propranolol (10 mg kg(-1), i.p.) augmented the production of this chemokine, confirming the role of a beta-adrenoceptor mediated endogenous catecholamine action in the regulation of MIP-1alpha production in vivo. Thus, based on our data we conclude that catecholamines are important endogenous regulators of MIP-1alpha expression in inflammation.     

Circulating cytomegalovirus (CMV)-infected endothelial cells in patients with an active CMV infection

In 10 of 14 patients with an active cytomegalovirus (CMV) infection, distinctive large cells (35-45 microns in diameter) were present in the peripheral blood. Morphologically these cells closely resembled the classic cytomegalic inclusion cells, generally regarded as a diagnostic hallmark of CMV infection. Moreover, these cells were shown to express CMV antigens belonging to all three stages of the viral replication cycle, indicating a productive CMV infection. In addition, immunologic staining with monoclonal antibodies directed against cell differentiation and marker proteins showed that these circulating cytomegalic cells were of endothelial origin. The presence of CMV-infected endothelial cells in the peripheral blood of patients with an active CMV infection indicates that such an infection might be accompanied by widespread occult vascular damage.     

Characterization of inhibition by haloperidol and chlorpromazine of a voltage-activated K+ current in rat phaeochromocytoma cells

1. Inhibition by haloperidol and chlorpromazine of a voltage-activated K+ current was characterized in rat phaeochromocytoma PC12 cells by use of whole-cell voltage-clamp techniques. 2. Haloperidol or chlorpromazine (1 and 10 microM) inhibited a K+ current activated by a test potential of +20 mV applied from a holding potential of -60 mV. The K+ current inhibition did not exhibit voltage-dependence when test potentials were changed between -10 and +40 mV or when holding potentials were changed between -120 and -60 mV. 3. Effects of compounds that are related to haloperidol and chlorpromazine in their pharmacological actions were examined. Fluspirilene (1 and 10 microM), an antipsychotic drug, inhibited the K+ current, but pimozide (1 and 10 microM), another antipsychotic drug did not significantly inhibit the K+ current. Sulpiride (1 or 10 microM), an antagonist of dopamine D2 receptors, did not affect the K+ current whereas (+)-SCH-23390 (10 microM), an antagonist of dopamine D1 receptors, reduced the K+ current. As for calmodulin antagonists, W-7 (100 microM), but not calmidazolium (1 microM), reduced the K+ current. 4. The inhibition by haloperidol or chlorpromazine of the K+ current was abolished when GTP in intracellular solution was replaced with GDP beta S. Similarly, the inhibition by pimozide, fluspirilene, (+)-SCH-23390 or W-7 was abolished or attenuated in the presence of intracellular GDP beta S. The inhibition by haloperidol or chlorpromazine was not prevented when cells were pretreated with pertussis toxin or when K-252a, an inhibitor of a variety of protein kinases, was included in the intracellular solution. 5. Haloperidol and chlorpromazine reduced a Ba2+ current permeating through Ca2+ channels. Inhibition by haloperidol or chlorpromazine of the Ba2+ current was not affected by GDP beta S included in the intracellular solution. 6. It is concluded that haloperidol and chlorpromazine inhibit voltage-gated K+ channels in PC12 cells by a mechanism involving GTP-binding proteins. The inhibition may not be related to their activity as antagonists of dopamine D2 receptors or calmodulin antagonists.