Model-based measurement of gas exchange in healthy subjects using ALPE essential--influence of age, posture and gender.

The ALPE Essential device for model-based measurement of pulmonary gas exchange status may be a useful alternative to current methods for diagnosing, monitoring and evaluating treatment related to pulmonary gas exchange. In this study, shunt and ventilation/perfusion mismatch were measured with ALPE Essential in 106 healthy subjects with the aim of investigating the influence of age, posture and gender on gas exchange parameters and evaluating the test-retest reliability of the measurements. Age and gender did not have statistically significant influence on gas exchange parameters, although there was a tendency for poorer matching of ventilation and perfusion with age. Posture was shown to be important when measuring gas exchange parameters. Absolute measurement reliability was acceptable with future studies in patients being necessary for accurate evaluation of relative reliability.

Can new pulmonary gas exchange parameters contribute to evaluation of pulmonary congestion in left-sided heart failure?

BACKGROUND: Assessment of pulmonary congestion in left-sided heart failure is necessary for guiding anticongestive therapy. Clinical examination and chest x-ray are semiquantitative methods with poor diagnostic accuracy and reproducibility. OBJECTIVES: To establish reference values, describe reproducibility, and investigate the diagnostic and monitoring properties in relation to pulmonary congestion of new pulmonary gas exchange parameters describing ventilation/perfusion mismatch (variable fraction of ventilation [fA2] or the drop in oxygen pressure from the mixed alveolar air of the two ventilated compartments to the nonshunted end-capillary blood [DeltaPO(2)]) and pulmonary shunt. METHODS: Sixty healthy volunteers and 69 patients requiring an acute chest x-ray in a cardiac care unit were included. The gas exchange parameters were estimated by analyzing standard bedside respiratory and circulatory measurements obtained during short-term exposure to different levels of inspired oxygen. Nine patients were classified as having pulmonary congestion using a reference diagnosis and were followed during 30 days of anticongestive therapy. Diagnostic and monitoring properties were compared with chest x-ray, N-terminal probrain natriuretic peptide (NT-proBNP), spirometry values, arterial oxygen tension, alveolar-arterial oxygen difference and venous admixture. RESULTS: The 95% reference intervals for healthy subjects were narrow (ie, fA2 [0.75 to 0.90], DeltaPO(2) [0.0 kPa to 0.5 kPa] and pulmonary shunt [0.0% to 8.2%]). Reproducibility was relatively good with small within subject coefficients of variation (ie, fA2 [0.05], DeltaPO(2) [0.4 kPa] and pulmonary shunt [2.0%]). fA2, DeltaPO(2) and NT-proBNP had significantly better diagnostic properties, with high sensitivities (100%) but low specificities (30% to 40%). During successful anticongestive therapy, fA2, DeltaPO(2), NT-proBNP and spirometry values showed significant improvements. CONCLUSIONS: The gas exchange parameter for ventilation/perfusion mismatch but not pulmonary shunt can have a possible role in rejecting the diagnosis of pulmonary congestion and in monitoring anticongestive therapy.

Uni- and bilateral torsion of the testes in the neonate; a report of two cases.

One case of unilateral and one case of bilateral torsion of the testes in the neonate are presented together with a review of the literature for bilateral cases. Finally some recommendations are made for the dealing with this rare but important illness of the neonate.

[Testicular torsion in neonates. With special emphasis on bilateral cases]. / Testestorsion hos nyfødte. Med speciel vaegt på bilaterale tilfaelde.

The literature concerning torsion of the testis in neonates is reviewed with special reference to bilateral cases. The incidence, pathogenesis, diagnosis, differential diagnoses and treatment are discussed. The importance of immediate surgical intervention is emphasized in order to avoid necrosis of spermatogenic tissue and subsequent infertility.

Endometriosis of the round ligament.

A case of endometriosis of the extraperitoneal part of the round ligament is presented. The incidence, symptoms, diagnostic possibilities as well as treatment are discussed.

Giant diverticulum of the sigmoid colon.

A case of a giant diverticulum of the sigmoid colon is presented. The etiology, differential diagnosis, clinical features and treatment are discussed.

Influence of the cupric ion on the ampicillin concentration in cervical mucus.

PIP: It might be expected that the effect of antibiotics used in the treatment of lower genital tract infection in women using a copper-IUD for contraception would be reduced, and this hypothesis is the reason for the present investigation. Additionally, the correlation between the concentrations of ampicillin in serum and cervicul mucus is sought. 10 fertile healthy women, with no recent history of lower genital tract infection, participated. All of the women wanted an IUD for contraceptive reasons. No patients with known or suspected penicillin-allergy were asked. The Cu-T-200 was inserted in all the women in the proliferative phase (6-11 day), and the patients were studied with the IUD in situ in the next cycle on approximately the same day as the insertions were made. Blood and cervical mucus samples were taken before insertion of the IUD and again 1 month later, each woman serving as her own control. Prior to insertion of the IUD, the patients received 350 mg Pivampicillin and 500 mg Probenicid orally. Samples were taken approximately 1 hour afterwards for determination of the ampicillin concentration in serum and cervical mucus. After 1 month, new measurements were performed with the IUD in situ. There was no significant fall in the ampicillin concentration in cervical mucus after insertion of a copper-IUD. The correlation coefficient for the ampicillin concentration in serum and cervical mucus before insertion of IUD is 0.13 and after insertion of the IUD is 0.503. None of these figures is significant. Before insertion of the IUD, the mean ampicillin concentration in cervical mucus was 16.2% of the serum ampicillin concentration; it was 15.2% after insertion of the IUD. As the insertion of a copper IUD does not result in a fall of the ampicillin concentration in cervical mucus, it is not necessary to remove a copper IUD before treatment of a lower genital tract infection with ampicillin. There is also no reason to increase the dose of ampicillin given to women using the copper IUD.^ieng

Effect of endogenous and exogenous glucagon on pentagastrin-stimulated lower esophageal sphincter pressure in man.

The effect of endogenously released pancreatic glucagon on pentagastrin-stimulated lower esophageal sphincter pressure (LES-P) was studied in 10 healthy subjects. Glucagon was released by continuous intravenous infusion of 1-arginine in a dose of 0.6 g/kg-h, which resulted in plasma concentrations of pancreatic glucagon comparable to those seen after a protein meal. Infusion of arginine resulted in a significant inhibition of pentagastrin (0.5 mug/kg-h) stimulated LES-P. Five of the subjects furthermore had a study of the effect of exogenous glucagon in a dose of 1.6 mjg/kg-h on pentagastrin-stimulated LES-P. This dose of glucagon also reduced LES-P, but in spite of higher plasma glucagon concentrations, to a lesser degree than arginine.