Use of sodium ceftiofur in the combined therapy of complicated septic diseases in cattle

The present study was undertaken to determine the role of metabolic disturbance in noise-induced hearing loss by histochemical studies of cytochrome oxidase activity. Adult normal albino guinea pigs were used. The experimental animals were exposed to broad-band noise at 105 dB SPL for 24 h. The control animals were not exposed to the noise. The thresholds of the auditory brainstem response (ABR) of all guinea pigs were measured 3 times: before noise exposure, 1 day and 1 month later. The difference between the ABR thresholds before and after noise exposure was statistically significant. Vibratome sections of decalcified cochleae of the noise-exposed (n = 8) and control groups (n = 4) were incubated with Spector's medium and embedded with Epon. Thin sections (2 microm) and ultrathin sections (100 nm) were cut to observe cytochrome oxidase activity in the stria vascularis under light and electron microscopes, respectively. A decreased activity of cytochrome oxidase was consistently shown in the normal-appearing stria vascularis of most noise-exposed ears. Acoustic trauma has an adverse effect on cytochrome oxidase activity in the stria vascularis as well as on hearing. A decrease in the activity of cytochrome oxidase implicates that metabolic damage may play a role in noise-induced hearing loss.     

Surgical treatment of a septic dentigerous cyst in a goat

A slowly growing lesion of the rostral mandible of a goat was diagnosed to be a septic dentigerous cyst. The lesion was treated surgically to remove one displaced tooth and debride the cystic cavity, and systemic antibiotic therapy was applied. Thirty-four weeks later the goat was clinically and radiographically improved and the problem had not recurred.     

Use of bronchopulmonary lavage for eliminating inhaled fume particles from a patient with arc welder's lung

A 42-year-old man, who had worked as a welder for 20 years, was admitted to our hospital complaining of a dry cough. A chest radiograph showed diffuse small nodular shadows and chest computed tomography revealed small patchy opacities. A transbronchial lung biopsy specimen showed welding fume particles mainly located in alveolar space with mild fibrosis of alveolar septa. In order to prevent further fibrosis, bronchopulmonary lavage (BPL) was performed to eliminate the fume particles. The amount of iron particles derived from the total lavage fluid was 911.7 mg.     

支气管肺泡灌洗术治疗婴幼儿重症肺炎应用效果观察

ICU肺部严重感染患儿,因其免疫功能和咳嗽反射较差,常合并其它系统的疾病,极易出现肺部感染加重、肺不张等情况,使病情恶化,增加住院时间和费用.纤维支气管镜因可直接冲洗支气管中分泌物、减轻肺不张、缓解肺部急症等优点,目前已广泛应用于成人以及大龄儿童肺部感染,但在婴幼儿重症肺炎中应用及疗效等情况目前报道颇少.     

大功率数字变频调速系统的研究与应用

简要介绍一种大功率数字变频调速系统的结构及原理。该系统主回路为高低高结构电流源型变频器，采用单片机为核心的数字控制器，其控制策略采用转子磁通定向直接矢量控制。通过对定子电压方程做有条件的简化，得到一种转子磁通观测算法。以此为基础通过单片机实现了一种简易无速度传感器控制方案。     

Use of a modified Roux-en-Y procedure for treatment of pyloroduodenal obstruction in a horse

A modification of the Roux-en-Y anastomosis procedure was used to bypass a pyloroduodenal mass in a 12-year-old Arabian stallion. Clinical signs had consisted of a 4-week progression of ventral and hind limb edema, hypoproteinemia, fecal occult blood, intermittent abdominal pain, weight loss, and gastric reflux. On exploratory celiotomy, an obstructive mass was found in the pylorus and proximal portion of the duodenum. Gastrojejunostomy and duodenojejunostomy were performed by use of stapled side-to-side anastomosis techniques. Inaccessibility of the obstructed pyloric region prevented resection of the affected area.     

Norepinephrine or dopamine for the treatment of hyperdynamic septic shock?

STUDY OBJECTIVE: To compare the ability of dopamine and norepinephrine to reverse hemodynamic and metabolic abnormalities of human hyperdynamic septic shock. DESIGN: Prospective, double-blind, randomized trial. SETTING: An ICU in a university hospital. PATIENTS: Adult patients with hyperdynamic septic shock after fluid resuscitation. INTERVENTIONS: Patients were assigned to receive either dopamine (2.5 to 25 micrograms/kg/min) or norepinephrine (0.5 to 5.0 micrograms/kg/min). If hemodynamic and metabolic abnormalities were not corrected with the maximum dose of one drug, the other was added. MEASUREMENTS AND RESULTS: The aim of therapy was to achieve and maintain for at least 6 h all of the following: (1) systemic vascular resistance index > 1,100 dynes.s/cm5.m2 and/or mean systemic blood pressure > or = 80 mm Hg; (2) cardiac index > or = 4.0 L/min/m2; (3) oxygen delivery > 550 ml/min/m2; and (4) oxygen uptake > 150 ml/min/m2. With the use of dopamine 10 to 25 micrograms/kg/min, 5 of 16 patients (31 percent) were successfully treated, as compared with 15 of 16 patients (93 percent) by norepinephrine at a dose of 1.5 +/- 1.2 micrograms/kg/min (p < 0.001). Ten of 11 patients who did not respond to dopamine and remained hypotensive and oliguric were successfully treated with the addition of norepinephrine. CONCLUSIONS: At the doses tested, norepinephrine was found, in the present study, to be more effective and reliable than dopamine to reverse the abnormalities of hyperdynamic septic shock. In the great majority of the study patients, norepinephrine was able to increase mean perfusing pressure without apparent adverse effect on peripheral blood flow or on renal blood flow (since urine flow was reestablished). At the same time, oxygen uptake was increased.     

Selected treatment strategies for septic shock based on proposed mechanisms of pathogenesis

PURPOSE: To review selected new therapies for septic shock designed to inhibit bacterial toxins or endogenous mediators of inflammation. DATA SOURCES: Scientific journals, scientific meeting proceedings, and Food and Drug Administration advisory committee proceedings. STUDY SELECTION AND EXTRACTION: Preclinical and clinical data from trials using core-directed antiendotoxin antibodies and anticytokine therapies for sepsis and studies in animal models of sepsis from our laboratory. RESULTS OF DATA SYNTHESIS: Ten clinical trials using core-directed antiendotoxin antibodies produced inconsistent results and did not conclusively establish the safety or benefit of this approach. Both anti-interleukin-1 and anti-tumor necrosis factor (TNF) therapies have been beneficial in some animal models of sepsis but did not clearly improve survival in initial human trials, and one anti-TNF therapy actually produced harm. Neutrophils, another target for therapeutic intervention, protect the host from infection but may also contribute to the development of tissue injury during sepsis. In a canine model of septic shock, granulocyte colony-stimulating factor increased the number of circulating neutrophils and improved survival, but an anti-integrin (CD11/18) antibody that inhibits neutrophil function worsened outcome. Nitric oxide, a vasodilator produced by the host, causes hypotension during septic shock but may also protect the endothelium and maintain organ blood flow. In dogs challenged with endotoxin, the inhibition of nitric oxide production decreased cardiac index and did not improve survival. CONCLUSIONS: No new therapy for sepsis has shown clinical efficacy. Perhaps more accurate clinical and laboratory predictors are needed to identify patients who may benefit from a given treatment strategy. On the other hand, the therapeutic premises may be flawed. Targeting a single microbial toxin such as endotoxin may not represent a viable strategy for treating a complex inflammatory response to diverse gram-negative bacteria. Similarly, the strategy of inhibiting the host inflammatory response may not be beneficial because immune cells and cytokines play both pathogenic and protective roles. Finally, our scientific knowledge of the complex timing of mediator release and balance during sepsis may be insufficient to develop successful therapeutic interventions for this syndrome.     

Corticosteroid responsive tenosynovitis is a common pathway for limited joint mobility in the diabetic hand

OBJECTIVE: To test the hypothesis that diabetic tenosynovitis participates in the contractures of the syndrome of limited joint mobility (SLJM). METHODS: Adults with diabetes mellitus were referred for the evaluation of diabetic hand conditions. Patients with SLJM or diabetic trigger finger were studied after Dupuytren's contracture, hand neuropathy, carpal tunnel syndrome, and arthritis were excluded. A time series design was employed in which patients were observed for 3 mo to obtain a baseline, then the planar flexor tendon sheaths were injected with 10 mg of methylprednisolone acetate or 10 mg triamcinolone acetonide and were reassessed at 1, 3, and 12 mo. RESULTS: Response rates, defined by complete resolution of digital contractures and triggering after corticosteroid injection, were 94% (31/33), 76% 28/33), and 61% (17/29) at 1, 3, and 12 mo, respectively, which were all significantly different from preinjection (p < 0.001). Individual response rates for SLJM and trigger finger were similar. No appreciable differences between methylprednisolone acetate and triamcinolone acetonide were observed, although there was a trend for earlier recurrence with methylprednisolone. CONCLUSION: Corticosteroid injection is a safe and effective therapy that should be considered in patients with SLJM or diabetic trigger finger. The excellent response to injection indicates that diabetic tenosynovitis is a common pathway in diabetic hand conditions.     

One-step needle aspiration and lavage for the treatment of abdominal and pelvic abscesses

OBJECTIVE: This retrospective study was undertaken to show the efficacy and safety of one-step needle aspiration and lavage for the treatment of nonenteric, nonpancreatic abdominal and pelvic abscesses. MATERIALS AND METHODS: Eighty-two nonconsecutive patients (age range, 4-81 years old) with 97 abdominal and pelvic abscesses were treated over 16 years with a one-step percutaneous needle aspiration and lavage technique. Abscesses were drained with sonographic or CT guidance in a single session. An 18-gauge needle was used for aspiration and repeated saline lavage; no drainage catheter was left in place. For collections that appeared multiloculated, needle repositioning and repeated aspiration and lavage were performed during the single session. All patients received i.v. antibiotics. RESULTS: Eighty-seven (90%) of 97 abscesses in 72 of 82 patients were successfully treated, including 17 (85%) of 20 abscesses that were multiloculated. The only two complications were transient sepsis in one patient and hemorrhage in one patient that resolved with transfusion and conservative treatment. Needle aspiration and lavage failures were associated with diffuse peritonitis, occult malignancy, unsuspected enteric communication, and a dropped surgical clip. CONCLUSION: Percutaneous needle aspiration and lavage can be a safe, effective alternative to the more conventional treatment of prolonged catheter drainage. In selected patients, including certain patients with multiloculated abscesses, one-step needle aspiration and lavage should be considered as the initial method of treatment.     

Use of Diprivan for digestive system endoscopy

After evaluation of the patient's clinical condition and appropriate premedication is seems reasonable to suggest for: 1. Endoscopic procedures involving the gastro-intestinal tract: slow, titrated induction, using 0.5 to 1 mg.kg-1 of propofol, until the required level of sedation has been achieved; this may or not be preceded by the injection of a low dose of midazolam (0.02 to 0.03 mg.kg-1) or of alfentanil (5 micrograms.kg-1); maintenance is achieved by bolus injections of 20 mg (up to 0.5 mg.kg-1); maintenance of spontaneous ventilation, with oxygen administration is the rule; SpO2 is monitored routinely; anaesthesia has to be performed according to the recommendations of the French Society of Anaesthesia and Intensive Care (SFAR) and the anaesthetist must be prepared to manage any incident during the endoscopy and the recovery period. 2. Procedures involving the biliary tract and the oesophagus, which require deeper anaesthesia: induction should again be titrated using a very slow infusion, with doses ranging from 0.9 to 2.2 mg.kg-1); the maintenance requires a continuous infusion, doses ranging from 4 to 6 mg.kg-1.h-1 when propofol is administered alone and from 4 to 12 mg.kg-1.h-1 when combined with an opioid; continuous oxygenation is necessary using a nasal airway; the need for intubation depends on the type of procedure and the status of the patient; the same monitoring devices and similar safety measures are required during and after procedure as for any anaesthetic or sedation, especially when it is performed in day-case patients or outside the operating theatre.     

The use of an indwelling peritoneal catheter in the treatment of chronic renal failure

Thirty-seven patients with end-stage renal failure were treated by dialysis by the peritoneal route, with a Tenckoff catheter. The basic regime was 30 2-litre exchanges twice a week. Two patients died while receiving peritoneal therapy, and 7 patients were transferred to haemodialysis because of catheter failure. Four patients received transplants directly from peritoneal dialysis, 22 were transferred electively to haemodialysis, and 2 are still being treated by peritoneal dialysis. Fourteen (1-2%) of the 1,161 dialyses were complicated by peritoneal infection. This was controlled in 13 instances by the addition of gentamicin to the dialysate, but removal of the catheter was required in one case. The mean duration of peritoneal dialysis was 14-4 weeks; 4 patients underwent this type of therapy for 78, 63, 41 and 40 weeks respectively.     

Use of bovine myeloperoxidase as an indicator of mastitis in dairy cattle

We compared the metabolic response to peripheral intravenous nutrition (peripheral IVN) with the response to central IVN when given after major gastrointestinal surgery. Eighteen consecutive patients who had undergone upper-gastrointestinal surgery were randomly assigned to receive either peripheral IVN (75% nonprotein calories supplied as lipid, n = 9) or central IVN (n = 9). Each group received 0.50 +/- 0.03 g N.kg-1 fat-free mass.day-1 (mean +/- SD with 100:1 kcal:g N (0.42 MJ:1 g N). Metabolic studies were undertaken before IVN (2nd postoperative day) and after 10 days of IVN. Negative nitrogen balance was reversed with both treatments (p < 0.001). The significant net efflux of individual amino acids from peripheral tissue before IVN was reduced toward balance, and there were no significant differences between the groups. The postoperative response of the plasma proteins (fibronectin, prealbumin, and transferrin) was similar in both groups. Peripheral IVN decreased postoperative peripheral net uptake of glucose to a net balance. Central IVN resulted in decreased free fatty acid, glycerol, and beta-hydroxybutyrate concentration with increases in plasma insulin concentration and the net uptake of glucose and pyruvate in peripheral tissue. The effect of intravenous nutrition on the metabolic response to major surgery was similar when nonprotein calories were supplied wholly as glucose requiring a central delivery system or when 75% of nonprotein calories were given as lipid when a peripheral delivery system was used. This study supports the development of peripheral IVN feeding systems.     

The evaluation of a digital system for the automatic analysis of the density of abdominal radiograms

This paper reports the results of the evaluation of an automatic system developed to analyze radiographic densities. This system, called RADEN, has been implemented at the Institute for Information Processing of the Italian National Research Council in Pisa. Forty-three pairs of abdominal X-ray films were obtained before and after the administration of ionic iodate contrast medium (i.i.c.m.) during urographic examinations. The 86 X-ray films were acquired and digitized using a computer-controlled optoelectronic device with a sampling step ranging 125 microns to 250 microns. The resulting images were arrays of 512 x 512 pixels, each one quantified on a byte (256 gray levels). The computing system included a high-performance personal computer equipped with a video RAM board having built-in facilities for image processing and with an optical disk to archive the images. Automatic and semi-automatic procedures were developed to segment, recognize and classify the images and to characterize three homogeneous regions--i.e., bone, water and air. The output data were compared with the area values of the air densities computed directly on the X-ray films by a radiologist. Furthermore, both data sets were compared with the scores given in a blind study by four observers. The subsequent statistic analysis showed the increase in air density areas after i.i.c.m. administration and the applicability of the implemented system to the automatic examination of abdominal radiographic densities. The results encourage to believe that the proposed approach could be employed as a first step for the development of quite a more complex system oriented to X-ray image understanding and to assisted diagnosis.