Influence of gas composition on recurrence of atelectasis after a reexpansion maneuver during general anesthesia

BACKGROUND: Atelectasis, an important cause of impaired gas exchange during general anesthesia, may be eliminated by a vital capacity maneuver. However, it is not clear whether such a maneuver will have a sustained effect. The aim of this study was to determine the impact of gas composition on reappearance of atelectasis and impairment of gas exchange after a vital capacity maneuver. METHODS: A consecutive sample of 12 adults with healthy lungs who were scheduled for elective surgery were studied. Thirty minutes after induction of anesthesia with fentanyl and propofol, the lungs were hyperinflated manually up to an airway pressure of 40 cmH2O. FIO2 was either kept at 0.4 (group 1, n = 6) or changed to 1.0 (group 2, n = 6) during the recruitment maneuver. Atelectasis was assessed by computed tomography. The amount of dense areas was measured at end-expiration in a transverse plane at the base of the lungs. The ventilation-perfusion distributions (VA/Q) were estimated with the multiple inert gas elimination technique. The static compliance of the total respiratory system (Crs) was measured with the flow interruption technique. RESULTS: In group 1 (FIO2 = 0.4), the recruitment maneuver virtually eliminated atelectasis for at least 40 min, reduced shunt (VA/Q < 0.005), and increased at the same time the relative perfusion to poorly ventilated lung units (0.005 < VA/Q < 0.1; mean values are given). The arterial oxygen tension (PaO2) increased from 137 mmHg (18.3 kPa) to 163 mmHg (21.7 kPa; before and 40 min after recruitment, respectively; P = 0.028). In contrast to these findings, atelectasis recurred within 5 min after recruitment in group 2 (FIO2 = 1.0). Comparing the values before and 40 min after recruitment, all parameters of VA/Q were unchanged. In both groups, Crs increased from 57.1/55.0 ml.cmH2O-1 (group 1/group 2) before to 70.1/67.4 ml.cmH2O-1 after the recruitment maneuver. Crs showed a slow decrease thereafter (40 min after recruitment: 61.4/60.0 ml.cmH2O-1), with no difference between the two groups. CONCLUSIONS: The composition of inspiratory gas plays an important role in the recurrence of collapse of previously reexpanded atelectatic lung tissue during general anesthesia in patients with healthy lungs. The reason for the instability of these lung units remains to be established. The change in the amount of atelectasis and shunt appears to be independent of the change in the compliance of the respiratory system.     

Monolithic integration of DFB laser with spot-size transformer forhighly efficient laser fibre coupling

The monolithic integration of a mushroom type InGaAs-InGaAsP MQW DFB laser with a spot-size transformer based on a two-layer lateral taper is reported. Highly efficient coupling to a butt-joined dispersion shifted singlemode fibre with a coupling loss down to 0.9 dB and large alignment tolerances was achieved, maintaining the good spectral characteristics of an isolated DFB-laser structure     

Oral malodor in dogs: measurement using a sulfide monitor

In 28 dogs, oral malodor was assessed organoleptically (0-3 scale) and by measurement of volatile sulfur components (VSC), using two positions ('intraoral' and 'tooth surface') for sampling VSC. Significant correlations were found between: intraoral and tooth surface VSC collection positions (p < 0.0001) and between organoleptic and tooth surface VSC data (p < 0.0001). VSC measurement is a sensitive, repeatable and non-subjective method of assessing oral malodor in dogs.     

Production of hydroxyl radicals in contracting skeletal muscle of cats

Reactive oxygen species increase during exhaustive contraction of skeletal muscle, but characterization of the specific species involved and their rates of production during nonexhaustive muscle contraction have not been investigated. We hypothesized that the production rate of hydroxyl radical (.OH) increases in contracting muscle and that this rate is attenuated by pretreatment with deferoxamine (Def) or dimethylthiourea (DMTU). We measured the rate of production of .OH before, during, and after 5 min of intermittent static contraction of the triceps surae muscles in cats (n = 6) using the formation of p-, m-, and o-tyrosines by hydroxylation of phenylalanine. L-Phenylalanine (30 mg/kg i.v.) was administered to each animal 3 min before contraction. Blood samples were collected from the popliteal vein 1 min before contraction; 1, 3, and 4.5 min during contraction; and 1 min after contraction. During and after contraction, the cumulative production rates of p-, m-, and o-tyrosines were elevated by 42.84 +/- 5.41, 0.25 +/- 0.04, and 0.21 +/- 0.03 nmol.min-1.g-1, respectively, compared with noncontracting triceps surae muscles. Pretreatment with Def (10 mg/kg i.v.; n = 5) or DMTU (10 mg/kg i.v.; n = 4) decreased the cumulative rates of production of p-, m-, and o-tyrosines during and after contraction. Additionally, the rate of tyrosine production increased in proportion to the percentage of maximal tension developed by the triceps surae muscles. These results directly demonstrate that .OH is produced in vivo in the skeletal muscle of cats during intermittent static contraction and that production can occur before the onset of fatigue.     

Effect of single oral dose of azithromycin, clarithromycin, and roxithromycin on polymorphonuclear leukocyte function assessed ex vivo by flow cytometry

Azithromycin was given as a single oral dose (20 mg/kg of body weight) to 12 volunteers in a crossover study with roxithromycin (8 to 12 mg/kg) and clarithromycin (8 to 12 mg/kg). Flow cytometry was used to study the phagocytic functions and the release of reactive oxygen products following phagocytosis by neutrophil granulocytes prior to administration of the three drugs, 16 h after azithromycin administration, and 3 h after clarithromycin and roxithromycin administration. Phagocytic capacity was assessed by measuring the uptake of fluorescein isothiocyanate-labeled bacteria. Reactive oxygen generation after phagocytosis of unlabeled bacteria was estimated by the amount of dihydrorhodamine 123 converted to rhodamine 123 intracellularly. Azithromycin resulted in decreased capacities of the cells to phagocytize Escherichia coli (median [range], 62% [27 to 91%] of the control values; P < 0.01) and generate reactive oxygen products (75% [34 to 26%] of the control values; P < 0.01). Clarithromycin resulted in reduced phagocytosis (82% [75 to 98%] of control values; P < 0.01) but did not alter reactive oxygen production (84% [63 to 113%] of the control values; P > 0.05). Roxithromycin treatment did not affect granulocyte phagocytosis (92% [62 to 118%] of the control values; P > 0.05) or reactive oxygen production (94% [66 to 128%] of the control value; P > 0.05). No relation between intra- and/or extracellular concentrations of azithromycin and/or roxithromycin and the polymorphonuclear phagocyte function and/or reactive oxygen production existed (P > 0.05 for all comparisons). These results demonstrate that the accumulation of macrolides in neutrophils can suppress the response of phagocytic cells to bacterial pathogens after a therapeutic dose.     

Adult survivors of childhood sexual abuse. Do I have them in my practice?

The long term sequelae of childhood sexual abuse include many symptoms commonly encountered in general practice settings. Guidelines to empathic history taking, comprehensive assessment, and an overview of management are presented, together with a contextual background.     

Ewald Hering und die Gegenfarbtheorie

Ewald Hering's color-opponent-theory is still considered one of the foundations of the visual sciences. Prior to Hering, Hermann v. Helmholtz introduced a theory of color appearance, which was based primarily on the physical aspects of the stimulus. In contrast to Helmholtz, Hering's theory strongly emphasized the subject's perception of color. As a consequence, Hering considered Helmholtz' theory inadequate. Contrary to some historical accounts, he did not object to Helmholtz's three-receptor explanation for color-mixture. Instead of Helmholtz' fundamental colors red, green, and blue, Hering suggested that the colors possess opponent character: blue-yellow; red-green; and, black-white. Helmholtz, on the other hand, refused to accept Hering's theory. Finally, a student with Helmholtz, Johannes v. Kries, developed the so-called “zone-theory”, which combines both, Young-Helmholtz's and Hering's theory at different stages of the visual information processing system.     

Surface structure of silver thin films on In2O3:Sn and Al2O 3 †

Surface structure of thin silver films (200 Å) on two technologically important films, indium tin oxide (ITO) and aluminium oxide, has been studied using scanning tunneling microscope. ITO films were prepared by reactive electron beam evaporation. Aluminium oxide films were prepared by oxidizing 2000 Å thick aluminium films evaporated on to H₂ terminated single crystal silicon substrates. The surface structure of silver on ITO and aluminium oxide appeared to be same and was characteristic of Stranski-Krastanov type. The observed asymmetry in the island shape was attributed to the anisotropic nature of the strain fields surrounding the nucleation centres.     

Low-voltage BiCMOS dynamic minimum circuit using a parallelcomparison algorithm for fuzzy controllers

The authors present a low-voltage BiCMOS dynamic minimum circuit using a parallel comparison algorithm for VLSI implementation of fuzzy controllers. Using low-voltage BiCMOS dynamic circuits and a parallel comparison algorithm, a four-4-bit-input minimum circuit designed, based on a 1μm BiCMOS technology, shows a 9.5ns comparison time, which is a ×2.5 improvement in speed as compared to that based on CMOS technology