Penetration of an aerosol, produced by film atomization, through the carinal bifurcation

We have measured the size of spots produced by atomization of simulated biofilm particles from a tracheal tube. Draughtsman's ink was atomized from 8.5-mm i.d. Portex tracheal tubes, using an airflow of 1 litre s-1, and trapped on vertical acetate sheets. The spots produced by these particles were compared with the spot size after entrainment and dissemination from an ink-lined tracheal tube through a bifurcating tracheobronchial tube towards a glass plate. Spot dimensions were measured by computer-assisted image analysis of a video image. The smallest particles observed on the acetate sheets were 4-17 microns in size. In the bifurcating tube experiment, large particles were deposited around the carinal bifurcation, but smaller particles traversed the bend. The smallest spot size observed (7 microns minimum; 17 microns median) corresponds to particles small enough to penetrate further into the lower respiratory tract. Travel via a tube similar to the carinal bifurcation suggests that fragments of biofilm entrained in the tracheal tube could be propelled deeper into the respiratory tract during the inspiratory phase of mechanical ventilation.

Cognitive function during moderate hypoxaemia

The effect of hypoxaemia (mean SpO2 78%) on cognitive function was measured in two groups of twelve normal subjects. A series of psychometric tests was administered to each subject in the same sequence and consisted of the Reitan trail-making test, a digit symbol substitution test, a visuospatial orientation test and the simple unprepared reaction-time test. Psychomotor performance was assessed in a double-blind manner while the subjects were breathing first air and then either air or a hypoxic mixture. While there was improvement in time for the trail-making test during a repeat study breathing air, there was significant deterioration of time to completion of the test in conditions of hypoxia. A significant learning effect in the orientation test was seen in the control group but this did not occur in hypoxic subjects. Hypoxaemia was shown to cause a significant impairment of simple unprepared reaction time compared with controls. All the changes in cognitive function were small and there were no subjective differences in the air or hypoxic groups. The usefulness of the Reitan trail-making and the simple unprepared reaction-time test in the assessment of psychomotor performance deficit under conditions of hypoxaemia has been demonstrated by this study in normal subjects. It was concluded that a mean oxygen saturation of 78% caused only minor changes in cognitive function in normal subjects.

The rightward gas vesicle operon in Halobacterium plasmid pNRC100: identification of the gvpA and gvpC gene products by use of antibody probes and genetic analysis of the region downstream of gvpC

The extreme halophile Halobacterium halobium synthesizes intracellular gas-filled vesicles that confer buoyancy. A cluster of 13 genes on the 200-kb endogenous plasmid pNRC100 has been implicated in the biosynthesis of gas vesicles. Here, we show that two gas vesicle proteins are encoded by genes in the rightward operon, gvpA and gvpC, by Western blotting (immunoblotting) analysis with antibodies directed against LacZ-GvpA and LacZ-GvpC fusion proteins. Our results are consistent with previous data showing that the gvpA gene product is the major gas vesicle protein and demonstrate for the first time that the gvpC gene product is also present in H. halobium gas vesicles. Northern (RNA) blotting analysis showed two RNA species, an abundant 0.35-kb transcript of gvpA and a minor 2.5-kb transcript of gvpAC, and a third gene 3' to gvpAC, named gvpN. The gvpN gene encodes a hypothetical acidic protein with a molecular weight of 39,000 and a nucleotide binding motif. We used a site-directed mutagenesis method involving double recombination in Escherichia coli to insert a kanamycin resistance cassette just beyond the stop codon of gvpN. Introduction of the mutated gene cluster into an H. halobium mutant with a deletion of the entire gas vesicle gene cluster resulted in gas vesicle-positive transformants; this result suggests that gvpN is the last gene of the rightward gas vesicle transcription unit. We discuss the design and utility of the kanamycin resistance cassette for the mutagenesis of other genes in large operons.

Umbilical cord clamping and preterm infants: a randomised trial

OBJECTIVE

To investigate the clinical effects of regulating umbilical cord clamping in preterm infants.

DESIGN

A prospective randomised study.

SETTING

The Queen Mother's Hospital, Glasgow.

SUBJECTS

36 vaginally delivered infants over 27 and under 33 weeks' gestation.

INTERVENTION

Holding the infant 20 cm below the introitus for 30 seconds before clamping the umbilical cord ("regulated" group, 17 patients), or conventional management ("random" group, 19 patients).

MAIN OUTCOME MEASURES

Initial packed cell volume, peak serum bilirubin concentrations, red cell transfusion requirements, and respiratory impairment (assessed by ventilatory requirements, arterial-alveolar oxygen tension ratio over the first day in ventilated infants, and duration of dependence on supplemental oxygen).

RESULTS

There were statistically significant differences between the two groups in mean initial packed cell volume (regulated group 0.564, random group 0.509) and median red cell transfusion requirements (regulated group zero, random group 23 ml/kg). 13 infants from each group underwent mechanical ventilation and showed significant differences in mean minimum arterial-alveolar oxygen tension ratio on the first day (regulated group 0.42, random group 0.22) and in median duration of dependence on supplemental oxygen (regulated group three days, random group 10 days). Differences in final outcome measures such as duration of supplemental oxygen dependence and red cell transfusion requirements were mediated primarily through arterial-alveolar oxygen tension ratio and also packed cell volume.

CONCLUSIONS

This intervention at preterm deliveries produces clinical and economic benefits.

Oxygen saturation during hemodialysis

The aim of this study was to examine the saturation patterns of cuprofane and polysulfone membranes in hemodialysis patients, and to correlate that with permeability of the alveolar membrane, unloading of CO2 over the membranes, and production of oxygen free radicals. Polysulfone membranes did not have the same desaturation pattern as the cuprofane membranes. Both membranes were equally effective in the unloading of CO2, and so alveolar hypoventilation does not explain oxygen desaturation during hemodialysis. White blood cells have a central role in the parallel development of early leucopenia and hypoxemia. The precise mechanism is still unknown because there were no changes in permeability of the alveolar membrane or production of oxygen free radicals.

Injection therapy of superficial rheumatoid nodules

Although intralesional corticosteroid injection of subcutaneous rheumatoid nodules was mentioned in 1968, this simple procedure is not commonly practised. A placebo-controlled, double-blind trial of intralesional corticosteroid injection using 24 rheumatoid nodules from 11 patients was carried out to determine the efficacy and safety of the procedure. Nodules injected with methylprednisolone and lignocaine regressed significantly more than nodules injected with placebo (lignocaine alone). This was consistently shown in all modalities of assessments which included patients' assessments (P < 0.001) and investigator's assessments (P < 0.001) of the percentage change in nodule size, and gross measurements of nodule volumes using a pincer (P < 0.001). Nine of 12 active injections produced > or = 50% loss in nodular volume with complete disappearance of two nodules. This compares with only one out of 12 placebo injections which resulted in > or = 50% loss in nodular volume. The patients found all 12 active injections to be worthwhile compared to only two of 12 placebo injections being worthwhile. The only complication of injection therapy observed was that of pain during the procedure.

Evaluation of the actions of general anaesthetics in the human brain

1. General anaesthesia is a state of analgesia and impaired cognitive function that results from the depressant effects of anaesthetics. 2. Graded increases in anaesthetic concentration cause a progressive impairment of cognitive function, the extremes of which are commonly described as "light" and "deep" anaesthesia. 3. Surgical stimulation produces activation in the EEG and may arouse a patient from a deeper to a lighter state of cognitive function. 4. It may be very difficult, particularly in patients with neuromuscular blockade, to identify a change in state which results in conscious awareness. 5. A range of methods has been used for evaluating depth of anaesthesia. 6. The evidence reviewed in this paper suggests that the median frequency in the EEG and the auditory evoked potential appear to be the best techniques for monitoring the graded effects of anaesthetics on the brain. 7. The median frequency, which is 10 Hz in conscious subjects, should be kept below 5 Hz during anaesthesia to ensure that there is no response to verbal command. 8. The auditory evoked potential measures the resulting effects of anaesthetic depression and surgical stimulation which is "depth of anaesthesia". 9. However it is not yet certain whether a particular feature e.g. Nb latency, or a collection of features between 20 and 80 msec gives the most reliable index of conscious awareness.

The antioxidant potential of propofol (2,6-diisopropylphenol)

We have examined in vitro the antioxidant properties of 2,6-diisopropylphenol. In studies using electron spin resonance spectroscopy we have demonstrated that 2,6-diisopropylphenol acts as an antioxidant by reacting with free radicals to form a phenoxyl radical--a property common to all phenol-based free radical scavengers. In additional experiments, the antioxidant properties of the clinical formulation of 2,6-diisopropylphenol (propofol) have been measured using an assay of antioxidant potential. In these experiments, propofol, but not Intralipid, was found to exhibit significant antioxidant activity, such that in the range of propofol concentrations examined (10(-6)-10(-5) mol litre-1), each molecule of 2,6-diisopropylphenol was able to scavenge two radical species. We conclude that the free radical scavenging properties of 2,6-diisopropylphenol resemble those of the endogenous antioxidant alpha-tocopherol (vitamin E).

Continuous measurements of oxygen saturation during haemodialysis

A new technique for recording and analysing continuous measurements of oxygen saturation (SpO2) by pulse oximeter during haemodialysis was used to compare changes in SpO2 in eight patients during two 4 h periods of dialysis using a cuprophane membrane, once using an acetate dialysate, and once using bicarbonate. The computer-derived patterns of SpO2 show whether hypoxaemia was caused mainly by extrapulmonary abnormalities (ventilatory control) or intrapulmonary abnormalities (V/Q distribution). The patterns of oxygen saturation were analysed for (i) stability, (ii) the lower median 20th centile of SpO2, and (iii) time below a SpO2 of 90%. Not all patients had reduced oxygenation during acetate dialysis. Three of eight patients had a stable pattern with acetate dialysis and six of eight were stable with bicarbonate. Five of eight patients had a lower SpO2 with acetate but one patient had a lower SpO2 with bicarbonate. Four patients had prolonged, clinically significant periods of oxygen desaturation with SpO2 less than 90%; two of these had particularly prolonged periods during acetate (62 min and 12 min), but one patient showed a longer period during bicarbonate than acetate dialysis (7 min). In two patients the SpO2 declined to less than 84%. The patterns of SpO2 suggested that the decrease in oxygen saturation was due more to extrapulmonary abnormalities causing an instability in ventilatory control rather than to venous admixture. It is recommended that pulse oximetry is used to identify patients at risk of hypoxaemia, to monitor these patients during haemodialysis, and to administer oxygen to those whose SpO2 falls below 90%, particularly if they have anaemia or cardiovascular disease.

Altered consciousness: pharmacology and phenomenology BAP Summer Meeting, York, July 1991: Sleep and general anaesthesia as altered states of consciousness

In this article parallels are drawn between sleep and anaesthesia. Both can be described as 'behavioural states' in which stimulation and inhibition of certain neuronal groups will give rise to specific psychological states. The neuronal mechanisms leading to these states are reviewed and compared. Sensory information flow through the thalamus is reduced in sleep and anaesthesia, the thalamic gating being controlled by other areas of the brain including the sensory cortex. Thus a feedback loop may exist with the brain determining its own level of arousal. Anaesthesia increases gating at the thalamus and thus specifically reduces arousal. Consciousness is a specific attribute of the brain and is not required for the processing of sensory stimuli and learning, both of which have been shown to occur during sleep and anaesthesia. The implications of these findings for monitoring awareness during anaesthesia are discussed.

Clinical features of giant cell arteritis

The clinical features of GCA can be classified into: (1) the systemic manifestations of malaise, weight loss, fever, night sweats and depression; (2) the proximal muscle pain and stiffness of polymyalgia rheumatica; (3) arteritic manifestations of pain or tenderness due to local inflammation; and (4) arteritic manifestations of ischaemia due to narrowing or occlusion of vessels. These may occur singly or in any combination and may come and go with the passage of time. Thus GCA can result in many different clinical signs and symptoms. The feared ocular and cerebrovascular complications of the condition can be prevented by the early institution of corticosteroid treatment. Early diagnosis is therefore vital. This is a simple matter when GCA presents in the classical textbook manner, but in atypical cases diagnosis can be exceedingly difficult. The absence of a reliable way of excluding the disease means that diagnosis is often a clinical exercise. A sound knowledge of the many and varied clinical manifestations of GCA is therefore required if the physician is going to prevent the ocular and cerebrovascular complications of GCA by early diagnosis and treatment.

Methanol oxidation and assimilation in Hansenula polymorpha. An analysis by 13C n.m.r. in vivo

The metabolism of methanol was monitored in whole cells of the methylotrophic yeast Hansenula polymorpha by using [13C]methanol and n.m.r. in vivo. The main products observed under normal conditions were trehalose and glycerol, whereas cells that were starved before exposure to [13C]methanol also accumulated glutamate, glutamine and alanine; formate was also more prominent in spectra from starved cells. Cells exposed to high methanol concentration together with high oxygenation oxidized methanol extensively, leading to formaldehyde accumulation; label was not found in any subsequent metabolic products, indicating possible cell inactivation. [13C]Formate was incorporated into metabolic products in glucose-grown cells exposed to 150 mM-methanol for 3 h, but not in cells starved for 3 h, in which it was oxidized. At 21 degrees C such 3 h-starved cells showed a slower metabolism of [13C]methanol compared with those at 37 degrees C, and also converted methanol into formate rather than into assimilation products. The labelling pattern in trehalose from starved cells at 37 degrees C was consistent with methanol assimilation via the pentose phosphate pathway. Lack of appearance of labelled formaldehyde and formate during metabolism under normal conditions suggests that the linear oxidation pathway is not a major contributor to methanol oxidation; their appearance in extreme conditions suggests instead a more likely role in detoxification.

Patterns of oxygenation after thoracotomy

We have studied patterns of oxygen saturation (SpO2) before and after thoracotomy in 20 patients monitored nightly from the preoperative night to the fourth postoperative night. After operation, 10 patients received paravertebral bupivacaine (PVB) infusion and 10 received paravertebral saline (PVS) infusion. Papaveretum was given as required. Before operation the SpO2 profiles formed two groups: stable with SpO2 greater than 94% and stable with a median SpO2 less than 94% (hypoxaemia). During the first night after operation SpO2 profiles formed four groups: stable, not hypoxaemic (2/20); stable, hypoxaemic but improving (8/20); stable and constant hypoxaemia (5/20); unstable, hypoxaemic and deteriorating (5/20). Eleven patients remained hypoxaemic as late as the fourth night after operation. All patients who were hypoxaemic before operation were hypoxaemic after operation. Postoperative hypoxaemia was predicted in only 50% of cases. Papaveretum requirement was reduced in the PVB group, but regional analgesia did not affect the proportion of patients showing each SpO2 profile. Papaveretum caused a decrease in SpO2 in both analgesic groups.

Changes in amplitude and latency of the P300 component of the auditory evoked potential with sedative and anaesthetic concentrations of nitrous oxide

The P300 component of the auditory evoked response was recorded from six subjects whilst they listened via headphones to a series of clicks which were interrupted unpredictably by a tone burst. They were instructed to press a button as quickly as possible after hearing the tone whilst breathing first air and then a series of increasing concentrations of nitrous oxide. Both the amplitude and the latency of the P300 changed in a dose-dependent manner with nitrous oxide, as did minimum reaction time. At nitrous oxide concentrations which prevented recall of any events that occurred whilst breathing the gas, four subjects continued to respond to the tone by pressing the button. In three subjects, the P300 wave was still detectable with a nitrous oxide concentration at which the task was no longer performed. These results show that there is retention of the ability to perform a reaction time task when there is a complete loss of recall of the task. There may be some recognition of an auditory stimulus, as manifest by a P300 wave, albeit reduced greatly in amplitude, in the absence of a motor response to it. The P300, therefore, merits investigation as a tool for studying conscious awareness under anaesthesia.

Adjuvant therapy for neuroendocrine small cell carcinoma of the cervix: review of the literature

Neuroendocrine cell carcinoma of the cervix is a virulent tumor associated with an extremely poor prognosis. Even in clinical Stage I disease, there may be subclinical hematogenous and lymphatic metastases with frequent recurrences. Adjuvant postoperative external pelvic radiotherapy has been reported to offer some degree of local control; however, most patients succumb to distant disease. Following radical abdominal hysterectomy and pelvic lymphadenectomy, with confirmation of the neuroendocrine tumor by electron microscopy and immunohistochemical staining, two patients were given adjuvant systemic chemotherapy with concurrent pelvic radiotherapy, employing regimens with documented activity against small cell carcinoma of the lung of neuroendocrine origin. Despite severe myelotoxicity and persistent neuropathy, both patients are alive without clinical evidence of disease at 28+ and 47+ months.

Driving and arthritis

In a 3-year period, 94 patients with driving difficulties due to a variety of musculoskeletal disorders were assessed by the occupational therapy department of a rheumatology unit. The individual's ability to carry out each part of the driving process was recorded and the patients were classified into six broad categories. While some parts of the driving process often proved difficult, patterns of disability were found with different musculoskeletal disorders. Almost all of these difficulties could be overcome by simple modifications to vehicle or driving technique. Only one severely disabled individual required referral to a specialized mobility unit, while two individuals were found to be unsafe. Thus, almost all arthritic individuals are able to continue driving with the help of simple modifications. By providing an unsophisticated driving assessment service, a rheumatology unit can enable patients to continue driving and so maintain independence.

In vitro microleakage associated with posterior composite restorations used with different base/bonding system combinations

The study aimed to determine the base/restoration combination which allowed the least microleakage in Class II cavities. One hundred premolar teeth were prepared with a standardized, minimal two-surface cavity and randomly ascribed to ten equal groups. The cavities were restored by use of one of ten different material/technique combinations. Restored teeth were sealed to within 1 mm of the restoration margins with nail varnish prior to the immersion of the crowns in 5% (buffered) eosin for 48 h. The teeth were then hemisected longitudinally, in a mesio-distal plane, through the midline of the restoration by means of a diamond disc with water coolant, and one half of each tooth was then photographed. The transparencies were examined by image analysis programmed to facilitate calculation of the percentage of the tooth/restoration interface and of the crown dentin exhibiting dye penetration. Light- and chemically-cured glass-ionomer-based restorations showed similar amounts of leakage when expressed as a percentage area of crown dentin. This was significantly (p less than 0.05) less than that shown by cavities both etched and bonded. Cavities restored without enamel etching or involving the use of a bonding system exhibited significantly (p less than 0.05) greatest leakage.

Ulnar tunnel syndrome

The ulnar tunnel syndrome is a relatively uncommon condition resulting from compression of the ulnar nerve as it passes through the loge de Guyon, or ulnar tunnel, in the wrist. The syndrome may cause weakness and atrophy of the intrinsic hand muscles and loss of sensation in the ulnar nerve distribution of the hand. The most common cause of ulnar tunnel syndrome is chronic occupational trauma, either from pressure exerted over the hypothenar eminence by a tool or from the use of the heel of the hand as a hammer. Nonoccupational etiologies include congenital, inflammatory, neoplastic, vascular, metabolic, degenerative and traumatic disorders. Diagnosis often requires neurophysiologic evaluation, in addition to a careful history and physical examination. Conservative treatment aimed at protecting the ulnar tunnel from trauma frequently is effective. Occasionally, surgical decompression of the ulnar tunnel is required.

Methylamine metabolism in Hansenula polymorpha: an in vivo 13C and 31P nuclear magnetic resonance study

Methylamine uptake, oxidation, and assimilation were studied in Hansenula polymorpha, a methylotrophic yeast. The constitutive ammonia transport system was shown to be effective at accumulating methylamine within cells cultured with methylamine or ammonia as a nitrogen source. [13C]methylamine oxidation rates were measured in vivo in methylamine-adapted cells by 13C nuclear magnetic resonance and were found to be lower than its uptake rate into the cells. The 13C label of methylamine was found exclusively in trehalose and glycerol, and [13C]formaldehyde was also extensively assimilated, indicating the presence of an assimilation pathway for the methylamine carbon. In vivo 31P nuclear magnetic resonance analysis showed major differences in the endogenous polyphosphate levels and mean chain length during adaptation of the cells from ammonia to methylamine, indicating that methylamine accumulated in the vacuole in the same manner as basic amino acids and purines. [13C]glucose metabolism was drastically altered during adaptation of the cells from ammonia to methylamine as a nitrogen source. The total rate of glucose utilization and the rate of ethanol production fell. Direct trehalose synthesis from glucose increased, indicating a switch from carbon utilization for growth to that for storage. The rate of methylamine oxidation was sufficient to support a much higher flow of carbon into central biosynthetic pathways. These results suggest that this reduction in biosynthetic carbon flow, rather than nitrogen availability, was the main factor responsible for reducing the growth rate of the yeast when ammonia was replaced by methylamine as the nitrogen source.

Nitrous oxide sedation causes post-hyperventilation apnoea

We have studied, in six normal subjects, the effect of nitrous oxide sedation on the ventilatory pattern and oxygen saturation using pulse oximetry (SpO2) after hyperventilation to an end-tidal carbon dioxide partial pressure (PE'CO2) of 3 kPa. This value of PE'CO2 was shown to be less than the apnoeic threshold of all these subjects when their ventilation vs PE'CO2 response curves were plotted. All subjects became apnoeic when told to relax following hyperventilation while breathing 75% nitrous oxide for 90 s. Apnoea was defined as cessation of breathing for 20 s or more. The mean duration of apnoea was 78 s (range 29-130 s). All subjects demonstrated arterial desaturation (mean SpO2 75%, range 44-87%). In contrast, following hyperventilation with air, no apnoea was seen in any subject, although there was some evidence of desaturation (mean SpO2 92.5%, range 88-98%). It was concluded that subjects who are sedated with nitrous oxide behave similarly to those who are anaesthetized rather than to those who were fully conscious, in that they become apnoeic below the apnoeic threshold point. The reduction in SpO2 after hyperventilation was explained almost entirely by apnoea and may explain abnormalities of respiratory control and hypoxaemia in patients recovering from general anaesthesia or sedation accompanied by hypocapnia. This mechanism may be of importance in obstetric patients after breathing Entonox, when apnoea and hypoxaemia may reduce oxygen delivery to the fetus.

In vivo 13C and 15N NMR studies of methylamine metabolism in Pseudomonas species MA

Pseudomonas species MA was grown with methylamine as a sole source of carbon and nitrogen enabling the total flow of carbon and nitrogen into this organism to be simultaneously monitored in vivo using 13C and 15N NMR. [13C]Methylamine was rapidly and extensively incorporated into the methyl group of N-methylglutamate during high oxygenation of the cell suspension, but when the oxygenation rate was lower, a significant portion was also found in the methyl group of gamma-glutamylmethylamide. At later times the carbon label was found in intermediates of the serine assimilation pathway, with glutamate derived from the tricarboxylic acid cycle being the most abundant product. Incorporation of [15N]methylamine was only detected as N-methyl[15N]glutamate, but when protein synthesis was inhibited, the label was also detected in the amino nitrogen of glutamate. When oxygenation rates were lower, the 15N-labeled methylamine was found in the methylamide group of gamma-glutamylmethylamide in addition to being incorporated into N-methylglutamate. gamma-Glutamylmethylamide formation was linked to the overall energy state of the cell and was not affected by inhibition of the carbon assimilation pathway. Neither 5-hydroxy-N-methylpyroglutamate nor N-methyl-alpha-ketoglutaramate were detected to any significant extent. A mechanism was proposed for the role of gamma-glutamylmethylamide in the regulation of endogenous nitrogen supplies in this organism.

Structure and organization of the gas vesicle gene cluster on the Halobacterium halobium plasmid pNRC100

Halobacterium halobium strain NRC-1 contains intracellular gas-filled vesicles (GVs) that confer buoyancy to the cells. Cloning of the major GV protein (GvpA)-encoding gene, gvpA, and analysis of GV-deficient mutants (Vac-) of H. halobium led to the identification of a region of a 200-kb plasmid, pNRC100, important for GV synthesis. We report here the nucleotide sequence of an 8520-bp region which, including gvpA, contains twelve open reading frames (ORFs) that are organized into two divergent transcription units, gvpAC oriented rightward, and gvpD, E, F, G, H, I, J, K, L, and M located upstream from gvpAC and oriented leftward. Insertions into the gvpA promoter and gvpD and E resulted in the Vac- phenotype. The overall gene organization is highly compact with the end of one ORF overlapping with the beginning of the next in most cases. The gene cluster is bracketed by two ISH8 element copies in inverted orientation, an organization suggestive of a composite transposon. Comparison of predicted amino acid sequences showed homology between GvpA, and the gvpJ and gvpM putative gene products. The putative gvpC gene product contains eight copies of an imperfectly repeated sequence with similarity to repeats in a cyanobacterial GvpC plus a highly acidic C-terminal region not found in the cyanobacterial homologue.

The physiological cost of wearing a disposable respirator

In order to gain an understanding of the physiological stresses imposed by the wearing of a single-use disposable respirator, a series of experiments was done to measure the cardiopulmonary effects of wearing the respirator (heart rate, respiratory rate, and blood pressure); resistance to breathing while wearing a respirator; and heat stress imposed by the use of a respirator (changes in inspired and expired air temperature). Ten men, ages 24 to 35, of varying fitness levels, served as volunteers in the studies. All the men exercised on a treadmill both with and without 3M Model 8715 disposable respirators. Workloads corresponding to light, moderate, and heavy levels were calculated for each volunteer based on his maximal oxygen uptake. As work intensity increased, an increase in breathing resistance was found. Peak resistances were in the range of +/- 2 cm water. Work-intensity level increases in respiratory rates were found with and without the respirators, but the respirator use trial had a significantly increased respiratory rate. Heart rate also showed a dose-related increase as work intensity increased and was significantly greater in the respirator trials at heavy levels of work and during recovery. Systolic blood pressure showed a biphasic response to respirator use, being significantly lower at rest and higher at high levels of work. Diastolic blood pressure changes were less dramatic but were elevated in the respirator trials. Clinically important increases in blood pressure were found in two volunteers when respirators were worn. Air temperatures immediately anterior to the face were, on average, 7.5 degrees C higher in the respirator trials.(ABSTRACT TRUNCATED AT 250 WORDS)

Direct detection of free radical generation in an in vivo model of acute lung injury

Electron spin resonance (ESR) spectroscopy has been used to provide direct evidence that free radical production occurs in an in vivo model of acute lung injury. Two experimental groups of rabbits were given the spin trap alpha-phenyl N-tert.-butyl nitrone (PBN), together with endotoxin in the test group, and saline in the control group. Both groups were subsequently briefly ventilated with air containing cigarette smoke. Plasma samples from the endotoxin pretreated group showed a sudden burst of radical formation, detected as PBN spin adduct, which peaked in the first ten minutes after smoke exposure. No signals were detected in the control group. Permeability of the alveolar capillary barrier of the lung, measured by the clearance of 99mTc-DTPA, demonstrated significantly greater damage following smoke in the endotoxin primed animals than in the controls. Temporal studies suggest that this increase in permeability occurred after a burst of radical production. These studies provide supportive evidence for the hypothesis that endotoxin promotes the accumulation of a population of primed white cells within the lung, which when triggered by cigarette smoke, are able to generate a burst of free radicals which produce tissue damage and acute lung injury.

Molecular analysis of amoeboid chemotaxis: parallel observations in amoeboid phagocytes and metastatic tumor cells

Metastasis is a multistep process in which amoeboid chemotaxis plays a key role in the movement of tumor cells into and out of vessels. On a molecular level, much of what is known about amoeboid chemotaxis has been learned through work with Dictyostelium discoideum, a lower eukaryotic amoeboid phagocyte. One of the first and most crucial events to occur in the actin cytoskeleton following chemotactic stimulation is activation of actin nucleation. This is followed by incorporation of specific actin cross-linking proteins into the cytoskeleton, proteins which are implicated in the extension of pseudopods and filopods. Together, these events have been termed the Cortical Expansion Model for amoeboid chemotaxis. Detailed biochemical analysis has implicated a new actin-capping protein and has shown that one of the cross-linking proteins is Elongation Factor 1a, suggesting a link between chemotaxis and growth control. Preliminary data from parallel studies on neoplastic cells are presented.

Effects of a clinically detectable PDA on pulmonary mechanics measures in VLBW infants with RDS

We examined the effect of a clinically detectable patent ductus arteriosus (PDA) and its successful treatment with indomethacin on serial measures of pulmonary mechanics in 10 very-low-birthweight (VLBW) intubated infants with respiratory distress syndrome (RDS). Pulmonary mechanics were measured by the passive expiratory flow technique. Total respiratory system compliance (Crs) gradually improved as RDS resolved. However, a significant decrease in mean Crs was associated with the development of a clinically detectable PDA, ranging from 1.51 +/- 0.21 to 0.90 +/- 0.08 mL/cmH2O/m (P less than 0.05). We also noted an increase in mean Crs, from 0.90 +/- 0.08 to 1.49 +/- 0.21 mL/cmH2O/m (P less than 0.05), after successful treatment of a PDA with indomethacin. Total respiratory system resistance (Rrs) did not change. We conclude that a clinically significant PDA is associated with a decreased Crs and that successful treatment of a PDA with indomethacin is associated with an improvement in lung compliance. These findings imply that the development of a clinically detectable PDA and its subsequent treatment complicates the interpretation of pulmonary mechanics data in VLBW infants with RDS.

Total circulating red cells versus haematocrit as the primary descriptor of oxygen transport by the blood

Peripheral haematocrit (PCV) is the traditional target and monitor in many transfusion regimens. Without negating the importance of PCV as a determinant of whole blood viscosity, the present article outlines two important reasons why the red cell volume (RCV) should replace PCV in the central target role during blood transfusion in intensive care and other emergency situations: 1. PCV reflects both RCV and plasma volume (PV) and is therefore not directly proportional to the total blood oxygen carrying capacity. At best, the relationship between PCV and RCV is hyperbolic and this is often overlooked when relating the two parameters in practice. At worst, the hyperbolic relationship is unreliable because PV and RCV can vary independently and the PCV is a fluctuating ratio of variable numbers. 2. PCV is not a good indicator of blood volume (BV), which is another important determinant of oxygen delivery to tissues and a crucial parameter in intensively managed patients. BV is directly proportional to RCV and this relationship also is often overlooked in clinical practice. The recommended values for RCV are 30 ml/kg in men. 25 ml/kg in women and between 30 ml/kg and 45 ml/kg in neonates within the first week of life.

Heterogeneity in hormone receptor status in primary and metastatic endometrial cancer

The rationale for endocrine therapy in patients with advanced endometrial carcinoma may be based on the presence of estrogen or progesterone receptors in the primary tumor. A study was designed to evaluate tumor cell heterogeneity of steroid hormone receptors in the primary and metastatic sites in endometrial cancer. Primary endometrial cancer tissue samples from 10 patients and 16 metastatic tumor sites were simultaneously analyzed for estrogen and progesterone receptors, using a radioligand biochemical assay. The primary tumor was estrogen receptor (ER) and progesterone receptor (PR) positive in 70 and 60% of the patients, respectively. The metastatic sites were ER positive in 63% and PR positive in 25%. The primary tumor tissue and the metastatic disease showed an identical ER and PR status in only 25 and 19%, respectively. Four patients had multiple metastatic sites analyzed. In two of four patients the PR values, and in three of four patients the ER values, in these metastatic sites were discordant. These data support the concept of tumor cell heterogeneity for steroid hormone receptors in endometrial cancer. To optimize treatment planning, it may be important to biopsy primary, metastatic, and recurrent tumor sites for individual analysis of receptor activity.

Recurrent calcific periarthritis, erosive osteoarthritis and hypophosphatasia: a family study

We describe a mother and 2 daughters with familial recurrent calcific periarthritis in a family with an inherited tendency to develop generalized osteoarthritis (OA). Low levels of serum alkaline phosphatase were found in 1 of the daughters while the mother developed erosive OA in later life. HLA typing was noncontributory. However, the 3 individuals with periarthritis possessed blood group A+, while the 6 unaffected family members were O+. The experience of this family adds weight to the case that recurrent calcific periarthritis may be due to an inherited abnormality of alkaline phosphatase production and suggest that this may also be responsible for the recently observed association of calcific periarthritis and erosive OA.

Postoperative hypoxaemia: mechanisms and time course

Postoperative hypoxaemia results predominantly from two mechanisms. Gas exchange is impaired during anaesthesia as a result of reduced tone in the muscles of the chest wall and probably alterations in bronchomotor and vascular tone, and the resulting changes persist into the postoperative period. In addition, there is an abnormality of control of breathing, which results in episodic obstructive apnoea. These episodes continue for several days after operation and are related to sleep pattern and analgesic administration, although the precise effects of different analgesic regimens have not been evaluated. Oxygen administration is effect in reducing the degree of hypoxaemia.

Red cell volume and cardiac output in anaemic preterm infants

To test the hypothesis that haemoglobin concentration is a poor predictor of benefit from transfusion in preterm infants, and that red cell volume is the most important indicator of anaemia, 24 preterm infants receiving red cell transfusions had red cell volume, haemoglobin concentration, and cardiac output measured before and after transfusion. Red cell volume was measured either using dilution of autologous fetal haemoglobin with donor adult haemoglobin, or with a new technique using biotin as a red cell label. The two techniques give similar results. Mean (SD) values before transfusion were 27.4 (13.3), and after transfusion 45.0 (13.7) ml/kg. Cardiac output was measured using imaging and Doppler ultrasonography, and fell with transfusion from mean 286 (121) to 251 (95.6) ml/kg/min. The red cell volume before transfusion correlated well with changes in cardiac output following transfusion, infants with a red cell volume before transfusion of less than 25 ml/kg showing a fall in cardiac output, and those with a red cell volume of greater than 25 ml/kg not showing a significant fall. There was no correlation between haemoglobin concentration, packed cell volume, or change in packed cell volume with changes in cardiac output after transfusion. A red cell volume of 25 ml/kg seems to be critical in preterm infants with anaemia, and infants with values below this are those most likely to benefit from transfusion.

Lack of weight gain associated with short-term astemizole treatment

The effect of treatment with astemizole for three weeks on weight was assessed in 44 patients with seasonal allergic rhinitis who participated in a randomized, double-blind, placebo-controlled clinical trial. Astemizole 10-mg tablets and identical placebo tablets were used. Compared with baseline, weight increased significantly in astemizole-treated patients (1.07 +/- 1.39 kg; p = 0.0004); however, the mean change in weight in astemizole-treated patients was not statistically significantly different than that seen in placebo-treated patients (0.85 +/- 1.68 kg). No relationship was found between changes in weight and age, sex, initial weight, percentage of obesity, and plasma astemizole concentrations.

In vitro marginal microleakage: examination of measurements used in assessment

Premolar teeth with Class II amalgam restorations placed after the application of cavity varnish (Group A), a light cured glass ionomer base (Group B) and 40 per cent polyacrylic acid as a pretreatment agent, followed by unset cermet cement (Group C) were examined for marginal leakage using dye penetration and image analysis. Including amongst the parameters examined were linear leakage length and leakage area, which were found to have no consistent correlation. Group A and C did not generally show significant differences in the parameters examined, whereas Group B exhibited significantly less linear leakage (P less than 0.001), and significantly less leakage area when the stained area was expressed as a percentage of available dentine (P less than 0.001). While allowing some linear leakage, it was found that the light cured glass ionomer base appeared to prevent the dye from entering the dentine. It is concluded that an assessment based solely on the leakage length is inadequate and that some measurement of penetration into dentine should be included in order to fully assess the microleakage potential of a material or technique.