Assessing neuromuscular block at the larynx: the effect of change in resting cuff pressure and a comparison with video imaging in anesthetized humans

Neuromuscular block (NMB) at the larynx has been assessed by measuring the cuff pressure (CP) in an endotracheal tube (ETT) placed between the vocal cords. In this study, we evaluated the decrease in resting cuff pressure (RCP) after the administration of rocuronium and the effect of this decrease on the assessment of NMB, and we compared CP measurement with an alternative technique, video imaging (VI). In 20 patients, NMB was determined at the hand by mechanomyography and at the larynx initially by CP and subsequently by VI, recording images using a fiberoptic bronchoscope via a laryngeal mask. Train-of-four stimuli were applied at both sites. After baseline measurements, the ETT was replaced, and rocuronium was infused to achieve a steady-state 50% (n = 10) or 75% (n = 10) block at the hand. CP measurements were recorded before and after restoration of RCP to prerocuronium pressure, followed by further VI measurements. The mean RCP decreased from 21 +/- 4 to 12 +/- 5 mm Hg after rocuronium. At 50% block at the hand, the CP estimate of block at the larynx with reduced RCP was 62% +/- 18%, and that after restoring RCP was 29% +/- 13%; VI estimated 27% +/- 14% block. At 75% block at the hand, CP and VI estimated 52% +/- 11% and 46% +/- 9% block, respectively (RCP maintained). We conclude that RCP decreases after the administration of rocuronium, that restoring RCP significantly alters CP estimates of NMB, and that VI is in agreement with CP measurement if RCP is maintained at prerelaxant values. Implications: In this study, we show that a muscle relaxant-induced decrease in resting tension at the larynx may confound the assessment of neuromuscular block by cuff pressure measurement. The preliminary data suggest that video imaging may provide a suitable alternative to cuff pressure measurement to assess neuromuscular block at the larynx.     

TETRA-BUTYL-MALONAMIDE AND TETRA-ISOBUTYL MALONAMIDE AS EXTRACTANTS FOR URANIUM(VI) AND PLUTONIUM(IV)

ABSTRACT

Two new symmetrical diamides, namely straight-chain alkyl substituted neutral tetra-butyl-malonamide(TBMA) and sterlcally hindered branched-chain alkyl substituted tetra-isobutyl malonamide(TIBMA) were synthesised, characterised and used for the extraction of U(VI) and Pu(IV) from nitric acid media into n-dodecane. Both the cations were found to be extracted as their disolvates. Interestingly TBMA extracted more efficiently than TIBMA but afforded poor selectivity for Pu/U separation. The thermodynamic parameters involved in the extraction, determined by the temperature variation method, indicated the reactions in all cases to be enthalpy favoured. Entropy was found to be counteracting the extraction of U(VI) and favouring the extraction of Pu(IV). The recovery of diamides from the loaded actinides could be easily accomplished by using dilute oxalic acid or dilute U(IV) as the strippant for Pu(IV) and using dilute Na₂C0₃ as that for U(VI).     

Protein kinase C regulation of ATP-induced phosphoinositide hydrolysis in bovine aorta endothelial cells

This study investigated the mechanism of protein kinase C-mediated inhibition of ATP-induced phospholipase C activation in cultured bovine aorta endothelial cells (BAEC). In BAEC labeled with 3H-inositol, phorbol myristate acetate (PMA) prevented ATP-induced inositol bisphosphate and inositol trisphosphate formation. In membranes prepared from these PMA-treated cells, Ca(2+)-, sodium fluoride-, GTP gamma S-, and ATP plus GTP gamma S-stimulated inositol bisphosphate, but not inositol trisphosphate, formation was inhibited. Inositol trisphosphate phosphatase activity was not altered in membranes from PMA-treated BAEC. These results suggest that 1) protein kinase C inhibits ATP-induced phospholipase C activation in BAEC through interference with the coupling of phospholipase C with a G-protein and through an effect on phospholipase C itself, and 2) different mechanisms are responsible for the inhibition by protein kinase C of the phospholipase C-mediated hydrolysis of phosphatidylinositol bisphosphate and phosphatidyl-inositol phosphate.     

An experimental investigation of mixed-mode fracture

In this paper, mixed-mode fracture is investigated experimentally. In the first part, critical conditions for initiation of crack growth are explored. The method of caustics was used in conjunction with a high speed video system to determine critical stress intensity factors at initiation of crack growth. It was found that the maximum tangential stress criterion originally proposed by Erdogan and Sih [1] was the best criterion in terms of predictive capability. Polymethylmethacrylate and Homalite-100 were used in the experiments and Homalite-100 was found to exhibit significant rate dependence. In the second part, crack growth initiated under mixed-mode loading is addressed. It is shown that subsequent slow crack growth in PMMA is under pure mode-I conditions.

---

Résumé On étudie par voie expérimentale les ruptures selon un mode mixte. On explore, dans une première partie, les conditions d'amorçage de la croissance d'une fissure. En utilisant la méthode des caustiques en association avec un système vidéo à grande vitesse, on détermine les facteurs critiques d'intensité de contraintes correspondant à l'amorçage de la fissure. On trouve que le critère de contrainte maximum tangentielle, proposé à l'origine par Erdogan et Sih, est le meilleur en termes de capacité de prédiction. Pour les essais, on a utilisé du plyméthylméthacrylate et de l'Homalite-100, et on a trouvé que ce dernier matériau faisait état d'une sensibilité importante à la vitesse. La deuxième partie du travail est consacrée à la croissance d'une fissure sous un mode de sollicitations mixte. On montre que la propagation lente de la fissure dans le PMMA se produit sous des conditions de pur Mode I.

     

A new technique for performing Syed-Neblett template interstitial implants for gynecologic malignancies using transrectal-ultrasound guidance

The authors review the literature on intra-adenomatous pituitary apoplexy with special emphasis on pathophysiology, diagnosis and therapeutic approach. They present five cases, from a series of 86 patients with pituitary tumors, that developed this syndrome. The patients were diagnosed and followed by the Neurosurgery and Endocrinology Services of Hospital Universitario Clementino Fraga Filho, Universidade Federal do Rio de Janeiro. Diagnosis was confirmed by CT-Scan and MRI in all cases, and the treatment of choice was surgical. Conclusions point to the diagnostic difficulties and the urgency of treatment in this clinical setting.     

Synthesis and characterization of aromatic-alipathic polyamides containing tetraphenylthiophene units into the backbone

Summary Aromatic-aliphatic polyamides were prepared from 2, 5-bis(4-carboxyethylcarbonylphenyl)-3,4-diphenylthiophene (BCDT) with few commercial diamines by using Yamazaki's phosphorylation reaction. The polymers were obtained in good yields and were characterized by solubility tests, viscosity measurements, IR spectroscopy, thermal analysis and X-ray diffraction studies. These polyamides had inherent viscosities in the range of 0.35 to 0.70 dl/g and were amorphous in nature. All the polyamides were readily soluble in solvents such as N,N-dimethylacetamide, N-methyl-2-pyrrolidinone, N,N-dimethylformamide, nitrobenzene, hexamethylphosphoramide, m-cresol, sulphuric acid and did not lose weight below 300°C in air. NCL Communication No:-4815     

Variation in mRNA expression of alpha-adrenergic, neurokinin and muscarinic receptors amongst four arteries of the rat

The effects of Mg2+ concentration (Mg2+o, 0, 1.2, 2.4, and 4.8 mM) on the incidence of reperfusion arrhythmias and on the cellular electrical activity were studied in spontaneously beating rat hearts. The surface electrogram and the membrane potential were recorded in control conditions, during 10 min of regional ischemia (ligature of the left anterior descending coronary artery), and on reflow. Changes in Mg2+o did not alter action potential morphology but the depolarization induced by ischemia decreased with increasing Mg2+o. In hearts perfused with Mg2+ free solution or 1.2 mM subthreshold delayed afterdepolarizations (DADs) were often detected during ischemia. Moreover, DADs could be identified as initial events in the production of extrabeats or tachycardia appearing on reperfusion under these conditions. Chaotic electrical activity during fibrillation precluded the observation of DADs. The overall incidence (100%) and severity of ventricular tachyarrhythmias (80% tachycardia and fibrillation) was similar in both groups. At high Mg2+o, subthreshold DADs were occasionally observed during ischemia and often on reperfusion where they did not lead to the development of overt arrhythmias. Consequently, the incidence, severity, and duration of arrhythmic episodes on reflow was markedly reduced. Raising Mg2+ only on reperfusion did not prevent the development of arrhythmias, whose morphology in the intracellular recordings was similar to that found in hearts perfused without Mg2+ or with 1.2 mM. The recovery of sinus rhythm after 10 min of reperfusion was linearly related to Mg2+o. Our data strengthen the view that reperfusion arrhythmias belong to the Ca2+ mediated non reentrant type and suggest that Mg2+ counteracts these arrhythmias by depressing cytosolic Ca2+ oscillations. Besides, it appears that raising Mg2+o reduces ischemic K+o accumulation. The resulting changes in resting potential could contribute to lower DADs amplitude and thus decrease the arrhythmogenic potential of the Ca2+i oscillations induced by reperfusion.     

Human monocyte-derived macrophages express an approximately 120-kD Ox-LDL binding protein with strong identity to CD68

A protein that specifically binds oxidized LDL (Ox-LDL) has recently been characterized in mouse peritoneal macrophages and identified as macrosialin, a protein with a molecular weight of 95 kD. First, the present work shows that human monocyte-derived macrophages express a membrane protein with a molecular weight of approximately 120 kD that selectively binds Ox-LDL. Second, we tested whether this approximately 120-kD Ox-LDL binding protein had any relation to CD68, the human homologue of macrosialin. The following evidence was obtained to support the role of CD68 as an Ox-LDL binding protein: (1) Ligand blots with Ox-LDL and Western blots with Ki-M6, an anti-human CD68 monoclonal antibody, revealed a single band with a molecular weight of approximately 120 kD under reducing and nonreducing condition. (2) The expression patterns of the approximately 120-kD Ox-LDL binding membrane protein and of CD68 paralleled each other during monocyte/macrophage differentiation. (3) Digestion with N-glycosidase F demonstrated that both CD68 and the Ox-LDL binding protein are glycoproteins; both showed a similar shift of approximately 18 kD in apparent molecular weight. (4) CD68, probed with monoclonal antibody Ki-M6, and the approximately 120-kD Ox-LDL binding protein were coprecipitated with EMB11, another anti-CD68 antibody. About 5000 molecules of CD68 are expressed on the cell surface of human macrophages. Ligation of 125I-Ki-M6 to cells leads to its internalization and degradation. This capacity would be sufficient to allow for the specific uptake and degradation of Ox-LDL. Taken together, these data support a role for CD68 as a specific Ox-LDL binding protein in human monocyte-derived macrophages.