Comparable postoperative pulmonary atelectasis in patients given 30% or 80% oxygen during and 2 hours after colon resection.

BACKGROUND: High concentrations of inspired oxygen are associated with pulmonary atelectasis but also provide recognized advantages. Consequently, the appropriate inspired oxygen concentration for general surgical use remains controversial. The authors tested the hypothesis that atelectasis and pulmonary dysfunction on the first postoperative day are comparable in patients given 30% or 80% perioperative oxygen. METHODS: Thirty patients aged 18-65 yr were anesthetized with isoflurane and randomly assigned to 30% or 80% oxygen during and for 2 h after colon resection. Chest radiographs and pulmonary function tests (forced vital capacity and forced expiratory volume) were obtained preoperatively and on the first postoperative day. Arterial blood gas measurements were obtained intraoperatively, after 2 h of recovery, and on the first postoperative day. Computed tomography scans of the chest were also obtained on the first postoperative day. RESULTS: Postoperative pulmonary mechanical function was significantly reduced compared with preoperative values, but there was no difference between the groups at either time. Arterial gas partial pressures and the alveolar-arterial oxygen difference were also comparable in the two groups. All preoperative chest radiographs were normal. Postoperative radiographs showed atelectasis in 36% of the patients in the 30%-oxygen group and in 44% of those in the 80%-oxygen group. Relatively small amounts of pulmonary atelectasis (expressed as a percentage of total lung volume) were observed on the computed tomography scans, and the percentages (mean +/- SD) did not differ significantly in the patients given 30% oxygen (2.5% +/- 3.2%) or 80% oxygen (3.0% +/- 1.8%). These data provided a 99% chance of detecting a 2% difference in atelectasis volume at an alpha level of 0.05. CONCLUSIONS: Lung volumes, the incidence and severity of atelectasis, and alveolar gas exchange were comparable in patients given 30% and 80% perioperative oxygen. The authors conclude that administration of 80% oxygen in the perioperative period does not worsen lung function. Therefore, patients who may benefit from generous oxygen partial pressures should not be denied supplemental perioperative oxygen for fear of causing atelectasis.

Parallel image segmentation using the L4 network.

Each processing element in the outer plexiform layer of the fly's (Musca domestica) compound eye has a single copy of a monopolar cell called L4 whose function is still unknown. This paper proposes that L4 acts as an image segmentor receiving data from the L1 and L2 cell layer above it. The photoreceptor terminals R1 through R6 and L1 and L2 form a cartridge with shunting current inhibition that enhances contrast at the first synaptic contact. The photoreceptors feeding their respective terminals share a common optical axis. What was realized for this entire structure that led up to and included L1 and L2, was that it forms a single processing element which outputs a weighted function based on current shunting between the photoreceptor axon terminals around L1 and L2. Thus the basic biological 'algorithm' that this paper proposes for L1 and L2 involves a summation of the differences between a central reference cell (referred to as Rref) and the six neighboring photoreceptor terminals R1-R6 within the cartridge of L1 and L2. Simulation implementing this simple algorithm on a hexagonal packed matrix in Matlab, suggest that objects with even small differences in intensity with the background, can readily be distinguished from the background. This high pass filter biological model allows edge detection and segmentation, independent of scale in a parallel, modular fashion. Implementation of such a biological algorithm using analog circuitry forms a preprocessing unit that introduces virtually no delay in the processing of image information, in comparison to present DSP techniques, that require iterative approaches and costly computing time.

Early cardiorespiratory patterns in severely burned patients with concomitant inhalation injury.

Hemodynamic and oxygenation parameters were determined during the first 24 h in 13 burned patients with concomitant inhalation injury (burn surface area 40-60 percent). In all patients right ventricular function was severely compromised evidenced as a significant increase in end-diastolic volumes, decrease in ejection fractions, low stroke work indices and increased pulmonary vascular resistances. Inotropic support with dobutamine and careful titration of volume infusion according to end-diastolic volume indices improved the hemodynamics as demonstrated by significant increases in right ventricular ejection fractions in all patients without any changes in mean arterial pressures, urine output and oxygenation. Assessment of ventricular performance by a specially designed pulmonary artery catheter is helpful in the management of severely burned patients with concomitant inhalation injury.

Peri-operative thoracic epidural analgesia for thoracotomy.

In a prospective study, experiences with peri-operative thoracic epidural analgesia (TEA) for thoracic surgery were documented. Two hundred and seven patients scheduled for elective thoracotomy were investigated. All patients received thoracic epidural catheters 2 h pre-operatively. The catheters were inserted between T4-5 and T8-9 intervertebral spaces. Epidural medication with bupivacaine and fentanyl was started preoperatively, maintained throughout surgery and was continued post-operatively via patient controlled analgesia (PCA) devices. Patients were anaesthetized with propofol and tracheal intubation was performed following neuromuscular blockade with vecuronium. Ninety-five percent of the patients were extubated immediately after surgery. 70.5% of all the patients had excellent post-operative analgesia (VAS pain scoring 0-2) on the day of surgery, 78% the day after surgery and 91% on the second day after surgery. Additionally early post-operative mobilization could be started in 63% of all patients. No neurological sequelae caused by thoracic epidural catheterization was seen in the early post-operative period.

Immune responses induced by intramuscular or gene gun injection of protective deoxyribonucleic acid vaccines that express the circumsporozoite protein from Plasmodium berghei malaria parasites.

The circumsporozoite protein (CSP) is a target for effector Ab and cell mediated immunity against malaria parasites; DNA vaccination can induce both types of effector response. The immunogenicity and efficacy of two DNA plasmids expressing different amounts of Plasmodium berghei CSP were evaluated by immunizing BALB/c mice i.m. or epidermally and by varying the number of immunizations (one to three doses) and the interval between immunizations. Expanding the interval gave the strongest effect, increasing efficacy and antibody boosting, and, in the case of epidermal vaccination, promoting a switch in CSP-specific IgG isotypes from IgG1 to a balance with IgG2a. The strongest humoral immune response and the greatest level of protection were induced by vaccinating epidermally with high expresser plasmid, using a gene gun to administer three doses at 6-wk intervals. For this group, the mean, repeat-specific, prechallenge antibody titer among mice not infected after challenge was significantly higher than that in infected mice, but the mean prechallenge titers for antibody reactive with whole sporozoites were not significantly different. The interval-dependent induction of IgG2a antibodies by epidermal vaccination contradicts the widely held belief that antibody responses induced by this method are restricted to those that are Th2 dependent.

Postdural puncture headache and back pain after spinal anesthesia with 27-gauge Quincke and 26-gauge Atraucan needles.

BACKGROUND AND OBJECTIVES: The purpose of this study was to determine whether the 26-gauge Atraucan needle shows any benefit on the incidence of postdural puncture headache (PDPH) and back pain as compared with the 27-gauge Quincke needle. METHODS: We investigated 388 patients, 171 men and 217 women, who were receiving spinal anesthesia for subumbilical surgery. We compared spinal anesthesia via the 27-gauge Quincke needle in 202 patients (group Q) and via the 26-gauge Atraucan needle in 186 patients (group A). RESULTS: The incidence of PDPH was 2.97% (6 of 202) in group Q and 2.69% (5 of 186) in group A. The incidence of back pain was 4.95% (10 of 202) in group Q and 5.91% (11 of 186) in group A. There was no statistically significant association of needle type, age, or sex with the incidence of PDPH and back pain. CONCLUSIONS: Both needles are associated with very low incidences of PDPH and back pain, which are not affected by which needle is chosen.

Progress and challenges toward an AIDS vaccine: Brother, can you spare a paradigm?

The development of a safe and effective vaccine for prevention of AIDS has thus far proven to be exceedingly difficult due to the complexities associated with HIV pathogenesis including but not limited to antigenic hypervariability, multiple routes and modes of transmission, a lack of defined correlates of protective immunity, and a tropism for infection of immunoregulatory cells which are essential for orchestrating an effective host immune response. Recent observations, including the identification of significant differences between primary isolates of HIV circulating in the population and laboratory-adapted isolates, animal model protection studies demonstrating prevention of AIDS-like disease progression in nonhuman primates in the absence of sterilizing immunity, and epidemiologic studies which question the current dogma surrounding HIV variation and control, have led to the development of novel approaches for antigen presentation and adjuvant development targeted at AIDS vaccine development. The goal of developing a safe and effective AIDS vaccine will likely occur when continued advances in understanding the immunopathogenesis of HIV is balanced with a healthy dose of empirical testing of innovative candidate AIDS vaccines.

Pharmacodynamics of mivacurium in severely burned patients.

The pharmacodynamics of mivacurium, a new short-acting non-depolarizing muscle relaxant, were studied in nine severely burned patients with concomitant inhalation injury. Complete neuromuscular blockade was achieved within 1.3 min (controls 3.0 min) following the usually recommended intubating dose (0.15 mg/kg/BW 2 x ED95) of mivacurium. The clinical duration of neuromuscular blockade and the recovery times were slightly prolonged, due to significantly reduced serum cholinesterase activity (clinical duration 24.6 min vs. 15.3 min). This pharmacodynamic profile makes mivacurium preferable for intermittent on-demand neuromuscular blockade in the severely burned patient.

[Prolactinoma after craniocerebral trauma]. / Prolaktinom nach Schädel-Hirn-Trauma.

A female patient, now twenty-four years old, suffered from a severe cerebral contusion in 1983 as a result of a car accident. At the time of the accident, she had a regular menstrual cycle. Since 1985, she has contracted oligomenorrhoea and since 1988 secondary amenorrhoea. In 1988, we diagnosed by CT-scan and NMR-imaging an excessive hyperprolactinaemia caused by a pituitary adenoma. Neither surgical intervention, nor conservative medication could reduce the prolactin level to normal. We suspect, that there is an association between the cranial injury and the appearance of the pituitary tumour.

Agnus castus extracts inhibit prolactin secretion of rat pituitary cells.

In our studies on prolactin inhibition by plant extracts we focused on the effects of extracts of Vitex agnus castus and its preparations on rat pituitary cells under basal and stimulated conditions in primary cell culture. Both extracts from Vitex agnus castus as well as synthetic dopamine agonists (Lisuride) significantly inhibit basal as well as TRH-stimulated prolactin secretion of rat pituitary cells in vitro and as a consequence inhibition of prolactin secretion could be blocked by adding a dopamine receptor blocker. Therefore because of its dopaminergic effect Agnus castus could be considered as an efficient alternative phytotherapeutic drug in the treatment of slight hyperprolactinaemia.

Effect of anodal high voltage pulsed current on edema formation in frog hind limbs.

We have recently demonstrated that some forms of cathodal high voltage pulsed current (HVPC) curb posttraumatic edema formation in frog hind limbs. The purpose of this study was to determine, by assessing the capacity of anodal HVPC to curb posttraumatic edema formation, whether polarity is an important variable. Fourteen anesthetized bullfrogs were placed on large dispersive electrodes lining body slings that maintained the frogs' limbs in a dependent position throughout data collection. The frogs' feet were traumatized by impact following initial measurement of limb volumes. At the commencement of each of four 30-minute treatments, hind limbs were immersed in separate beakers and briefly stimulated until motor threshold was determined. One limb, randomly selected, received anodal HVPC at 90% of motor threshold and 120 pulses per second; the other limb served as a control. Treatments were followed by 30-minute rests. Limb volumes were measured by water displacement immediately after trauma and following each treatment and rest period. Data were expressed as changes from pretrauma volumes in milliliters per kilogram of body weight. A repeated-measures analysis of variance was used to test for treatment effect. Despite an aggressive series of treatments, virtually symmetrical bilateral edema occurred; therefore, no treatment effect was evident. This result contrasts with treatment effects previously reported for cathodal HVPC.

Prospects for an AIDS vaccine.

Recent developments, in both animal systems and human trials, have provided encouraging results to counter the pessimism that has prevailed concerning the likelihood of obtaining an effective AIDS vaccine. This review summarizes these findings and their impact on defining and focusing the research agenda for the immediate future.

Second annual meeting of the National Cooperative Vaccine Development Groups for AIDS. 15-18 October 1989; Fort Lauderdale, Florida.

In this short review of the three-day meeting on AIDS vaccine development where numerous scientific advances were described for the first time, it is nearly impossible to capture all of the highlights. Thus, areas such as advances in vaccine adjuvant development, standardized challenge pools for vaccine testing, novel approaches with retroviral vectors for construction of target cells for cellular immune assays, summaries from all of the international AIDS vaccine development programmes, and other topics which were covered at the meeting are not discussed above. In closing the meeting, W. Koff (NIAID) noted that 1989 represented the turning point for AIDS vaccine development, that pessimism had given way to cautious optimism, and that the fundamental focus had changed from 'if a vaccine could be developed' to 'when'. While several challenges still remain in the path toward development of a safe and effective vaccine, the meeting served both to focus the direction of the research agenda for the next year and to build new and stronger collaborations among the international network of scientists dedicated to the common goal of developing a safe and effective AIDS vaccine.