Inhibitory effect of anaphylactic reaction of Sosiho-Tang

The Ilizarov method has broad applications for the generation of bone and soft tissue via an external fixator composed of small pins, tensional wires, rings, hinges and distractors. The success of the technique depends on adherence to Ilizarov's principles of tension-stress phenomenon: preservation of the tissues' blood supply, frequent distraction in small increments, and full function of the extremity.     

Parenteral nutrition in postoperative period

Results of surgical procedures in malnutrished patients are worse than in well-nutrished patients. Perioperative nutritional treatment lead to diminished percentage of postoperative complications and mortality. Authors presents the influence of early postoperative enteral nutrition in 35 malnutrished patients on body composition and anthropometrical and biochemical parameters of their nutritional status. Results shows that enteral nutrition in postoperative phase can decrease catabolic effect of surgical treatment.     

Pulmonary function in the early postoperative period

To the author's knowledge, an intensive investigation of pulmonary function during the first 2 postoperative days has not previously been reported. Consequently, in this study the effect of regional surgery on respiratory function, monitored every 4 h during the first 2 postoperative days, was analyzed. Hypoxaemia was a constant finding in all patients undergoing general anaesthesia. The degree and duration of hypoxaemia and spirometry changes were related to the site of surgical incision. Clinical signs of atelectasis were commonly observed during the first postoperative day and occurred after the change in PO2 and spirometry. Atelectasis was more common in patients having upper abdominal surgery. The current investigation reveals that the earliest postoperative change indicative of atelectasis is the fall in PO2; that auscultatory changes do not always occur in the presence of postoperative hypoxaemia; that auscultatory signs are not indicative of the extent of the PO2 fall; and that radiology represents a crude method of assessing postoperative atelectasis.     

Ileus of the small intestine in the postoperative period

It is shown that there are difficulties in establishing the diagnosis of intestinal ileus postoperatively, since therapeutic measures, residual phenomena of the principal lesion and operative trauma alter the clinical picture of intestinal ileus. An experience with treatment of 14 patients, subjected to relaparotomy for intestinal ileus, is reported.     

Successful administration of cytarabine after a previous anaphylactic reaction

Cytarabine (Cyt) is an antimetabolite used primarily in the treatment of leukemia, and both immediate and delayed hypersensitivity reactions have been reported. We studied a 9-year-old girl with lymphoblastic leukemia, who developed three anaphylactoid reactions during Cyt treatment courses over a 1-year period. Three years later, Cyt was required again. Although a skin test was negative to Cyt at the concentration of 4 micrograms/ml, we decided on placebo-controlled administration of the drug. The Cyt was well tolerated, and urine values of N-methylhistamine showed no important variations throughout this period compared to those during the placebo administration. Skin tests carried out 14 days after the study were positive at the concentration of 4 micrograms/ml. The history of different episodes of allergic reactions to Cyt, the last one being the most severe, indicated the possible participation of an immediate hypersensitivity phenomenon, but because no studies had been carried out initially, we could not establish the presence of IgE antibodies. These results indicate that good tolerance existed after the control administration procedure. The long interval, 3 years, between the allergic episode and our protocol and the appearance of a positive skin test 14 days after the protocol indicated that the subject had lost sensitivity and become resensitized after the controlled administration procedure.     

Gastrointestinal myoelectrical activity during the postoperative period in man

Myoelectrical activity of the gastrointestinal tract has been studied in the postoperative period of 13 patients who underwent cholecystectomy. The recordings have been performed by means of extracellular electrodes which were implanted at the levels of stomach, jejunum, ileum and colon during the surgical procedure. The records showed that fast activity is always persistent while the basic electrical rhythm is greatly disorganized during the immediate postoperative period. Such a characteristic pattern of the electrical activity suggested that the lack of peristaltic and propulsive movements, always noted during this period, is not correlated with a disappearance of gastrointestinal contractions, but only with a disturbance in their coordination.     

Inhibition of anaphylactic reaction in guinea pigs by antibodies to fragments of Fc from autologous IgG

The effect of antibodies to Fc subfragments of guinea pig IgG on the anaphylactic reaction in guinea pigs has been studied. Control animals were immunized with guinea pig IgG and Fab, human IgG and albumin. All animals with antibodies to fragments of autologous Fc survived challenge with horse serum, whereas the control animals died in anaphylactic shock.     

Ozone therapy of diffuse peritonitis in the early postoperative period

The functional status of the oxidative-antioxidative system was studied in 72 patients after vast cancer operations. Traditional surgical treatment and its combination with intraoperative irradiation were shown to lead to tense antioxidative defense and to suppressed T-cell immunity and to call for antioxidative and immunomodulating therapy. High intraoperative blood loss complicated by hemorrhagic shock injured the oxidative-antioxidative system greatly. The magnitude of this damage correlated with the rate of prehypoxia. Addition of the potent antioxidant Ceruloplasmin to the drug regimen normalized a recovery period, helped to correct posthypoxic multiorgan insufficiency, to recover oxidative-antioxidative balance, and to decrease the incidence of pyoinflammatory complications. Patients with endogenous intoxication showed activated lipid peroxidation, decreased functional activity of antioxidative defense components and of T-cell immunity in homeostasis. The use of Ceruloplasmin and Laprot had pronounced antiinflammatory and detoxifying effects on the patient's body and activated its antioxidative defense.     

Increased blood amylase levels in the postoperative period after liver resection

Preoperative and postoperative values of amylase were assessed in patients submitted to hepatic resections for primary or secondary liver tumours. Among these 40 had underlying liver cirrhosis and 18 normal liver. Preoperative serum amylase levels were increased in patients with cirrhosis. Postoperative amylase levels were found to be overlapping to preoperative one both in patients with normal and cirrhotic liver when no Pringle's manoeuvre was used in the course of surgery. A significant postoperative increase in serum amylase levels was detected in the group of patients where liver resection was carried out under Pringle's manoeuvre. Two patients of the cirrhotic group developed mild pancreatitis. It is suggested that portal congestion relates morphological changes of pancreas and hyperamylasemia and that Pringle's manoeuvre, if prolonged, carries a potential risk of pancreatitis especially in patients with underlying liver cirrhosis.     

Severe and unexpected occurrence of water-electrolyte disorders in the postoperative period

Paradoxical cerebral embolism (PCE) through a patent foramen ovale (PFO) should be considered as a cause of ischemic stroke, particularly in young patients without an alternative cause for stroke. PCE is even more important that it is potentially treatable. However, PCE remains often presumed because it rests upon the rarely demonstrated findings of a deep venous thrombosis and a thrombus lodged in the PFO. Recent studies have shown a rather low stroke recurrence rate in patients with PFO and stroke but suggest that some subgroups of patients with a higher stroke recurrence risk-exist according clinical, echocardiographical and radiological characteristics. For these subgroups, it seems that a more invasive treatment should be required. There are four therapeutic options; antiaggregants, anticoagulation, transcatheter closure of PFO, and surgical closure of PFO. However, these treatments have yet to be evaluated in clinical trials.     

Myocardial injury caused by an anaphylactic reaction to ampicillin/sulbactam in a patient with normal coronary arteries

OBJECTIVES: The study's objective was to examine incidence of fractures and associated activity restriction among children aged 0-12 years. DESIGN: Injuries were prospectively recorded over the four year period from 1992-95 in a cohort of children aged 0-12 years, representing 193,540 children years. Information about length and extent of activity restriction was collected from parents by a mailed questionnaire for a subsample of 192 children with a fracture. RESULTS: A total of 2477 fractures occurred in the study population (128 per 10,000 children annually). The incidence increased linearly with age, by 14 cases per 10,000 children year for each year of age. Boys and girls showed similar patterns of fracture occurrence. There was a significant difference in length of activity restrictions for different types of fractures. The mean and 95% confidence interval (CI) of activity restricted days for leg fractures were 26 (95% CI 7 to 45) days, for arm fractures, 14 (95% CI 8 to 20) days, and for other fractures, 5 (95% CI 1 to 8) days. Arm fractures represented 66% of the cases and 62% of the activity restricted days; leg fractures 19% of cases and 33% of all activity restricted days; and other fractures 16% of the cases but only 5% of the activity restricted days in this population. CONCLUSION: The incidence of fractures increases in childhood. Different types of fractures among children cause different amounts of activity restriction.     

The problem of acute pain in postoperative period]

The problem of postoperative pain remains actual despite the existence of a variety of pharmaceutical and nonpharmaceutical methods of anesthesia. Acute postoperative pain is an essential component of the surgical stress syndrome. Opioid analgetics (Buprenorfin, Nubain, Tramal, Promedol, Morphine) take the leading position among other types of analgetics. Present-day individual approach to administration of analgetics is still imperfect. The use of a standard dose of analgetics appears to be inadequate in a number of patients. The increase of opioids dose may lead to adverse reactions. In view of this it is valid to use nonsteroid antinflammatory medicines (Ketorolac). The choice of a proper dose of an analgetic is critically important in achieving adequate anesthesia. Patient-controlled analgesia (PCA) or "analgesia on demand" is an alternative to administration of analgetics. The major advantage of PCA is the opportunity to achieve the rate of analgesia, according to individual demand of a patient. Besides, PCA allows to reach the desired effect much faster and to maintain the stable plasma level of an analgetic. 2-year experience of the PCA use in more than 200 patients of the National Research Centre for Surgery ICU has been analysed. The authors advocate use of PCA in clinical practice.     

The characteristics of the pneumonias found in those who die in the postoperative period

A clinicomorphological examination of the respiratory organs has been conducted in 25 adults and 30 children who died after abdominal surgery. The authors compared the findings of light and immunofluorescent microscopy with laboratory and clinical evidence. Acute respiratory infections revealed in the examinees appeared of different etiology, many of them proved to be mixed. Viral and Mycoplasma infections were most prevalent and severe. Bacterial pneumonias occurred rarely, were clinically inapparent, often arose preoperatively. Weak aspiration indicated the absence of a direct relation between respiratory infections and disorders of bronchial drainage due to surgery performed.