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 28,634 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Severe lung injury (ARDS) has occasionally been observed after sclerotherapy for bleeding oesophageal varices. In order to study the effects of sclerosing agents, which may escape into the systemic circulation during treatment, seven sheep were given either ethanolamine oleate (n = 4) or sodium tetradecyl sulfate (n = 3) intravenously. A control group (n = 3) was treated identically with the others except it did not receive any sclerosing agent. The study showed that both sclerosing agents caused an immediate and severe fall in total respiratory compliance and arterial oxygen tension. There was a marked trapping of platelets in the lungs, which was also reflected by a drop in platelet count in peripheral blood. The lungs from the animals receiving sclerosing agents appeared moderately to severely congested and the wet/dry weight ratio of the lungs was significantly increased compared with untreated normal lungs (p less than 0.01). Histopathological examination revealed severe damage to the alveolar membranes, intraalveolar fibrino-haemorrhagic exudate, collapse of alveolar spaces and numerous eosinophilic leukocytes in the broadened, oedematous alveolar walls. It was concluded that the sclerosing agents used in this study, ethanolamine oleate and sodium tetradecyl sulphate, cause severe lung injury if given intravenously in sheep in doses corresponding to 25-50% of what is normally used during sclerotherapy in patients. The mechanism of this action may be that of an increased microvascular permeability causing marked alveolar damage and destruction of the blood gas barrier of the lungs.
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PMID:Influence of intravenous injection of sclerosing agents on the respiratory function. 337 86

The effect of sodium hyaluronate (Healon) on the post-operative course 1 week, 1 month and 1 year after trabeculectomy is reported. Forty-six eyes of 38 patients with open-angle glaucoma (16 simple, 16 capsular and 14 secondary glaucomas) were operated with the use of sodium hyaluronate. The study was prospective. For comparison, 46 eyes of 38 age-, sex- and diagnosis-matched patients with glaucoma operated during the pre-Healon period were selected. Patients in the study group were operated by the same surgeon and in the control group by different senior staff members. IOP decrease was essentially the same in both groups. No differences in post-operative pressure level existed between the different types of glaucoma. Extremely shallow or flat chamber occurred more frequently in the control series: 15 versus 9. Statistical analysis could not be applied. The trend in favour of Healon is discussed. Pressure rise greater than or equal to 30 mmHg 2-7 days after the operation was diagnosed in 8 eyes of the Healon group and 13 eyes of the control group. IOP rise was relieved by argon laser treatment of the fistula during the first week post-operatively in 6/8 eyes of the Healon group in order to facilitate aqueous drainage. Sodium hyaluronate facilitated the technical performance and prevented collapse of anterior chamber and AC haemorrhages during the operation. Sodium hyaluronate seems to prevent excessive early filtration and hypotony.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Trabeculectomy with the use of sodium hyaluronate. One year follow-up. 343 37

The importance of the renal pressure natriuresis and diuresis mechanisms in long-term control of body fluid volumes and arterial pressure has been controversial and difficult to quantitate experimentally. Recent studies, however, have demonstrated that in several forms of chronic hypertension caused by aldosterone, angiotensin II (AngII), vasopressin, or norepinephrine and adrenocorticotropin, increased renal arterial pressure is essential for maintaining normal excretion of sodium and water in the face of reduced renal excretory capability. When renal arterial pressure was servo-controlled in these models of hypertension, sodium and water retention continued unabated, causing ascites, pulmonary edema, or even complete circulatory collapse within a few days. Apparently, other mechanisms for volume homeostasis, such as the various natriuretic and diuretic factors that have been postulated, are not sufficiently powerful to maintain fluid balance in the absence of increased renal arterial pressure when renal excretory function is reduced in these forms of hypertension. The intrarenal mechanisms responsible for pressure natriuresis and diuresis are not entirely clear, but they seem to involve small increases in glomerular filtration rate and filtered load as well as reductions in fractional reabsorption in proximal and distal tubules. During chronic disturbances of arterial pressure additional factors, especially changes in AngII and aldosterone formation, act to amplify the effectiveness of the basic renal pressure natriuresis and diuresis mechanisms in regulating arterial pressure and body fluid volumes.
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PMID:Regulation of arterial pressure: role of pressure natriuresis and diuresis. 353 87

Despite the widespread use of non-steroidal anti-inflammatory drugs (NSAIDs), the current number of reported cases of poisoning is small. However, with the introduction of 'over-the-counter' preparations of NSAIDs in some countries (e.g. ibuprofen in the UK and USA) an increased incidence of acute poisoning from this group of drugs can be expected. Conventionally, NSAIDs are divided into the following groups based on their chemical structure: arylpropionic acids, indole and indene acetic acids, heteroarylacetic acids, fenamates, phenylacetic acids, pyrazolones and oxicams. Unless NSAIDs are ingested in substantial overdose, acute poisoning with these agents does not usually result in significant morbidity or mortality. In most cases the clinical features are mild and confined to the gastrointestinal and central nervous systems, though acute renal failure, hepatic dysfunction, respiratory depression, coma, convulsions, cardiovascular collapse and cardiac arrest may complicate severe poisoning. Arylpropionic acid derivatives were thought initially to have a low order of toxicity in overdose but, in addition to anticipated gastrointestinal symptoms, headache, tinnitus, hyperventilation, sinus tachycardia, hypoprothrombinaemia, haematuria, proteinuria and acute renal failure have been described. In addition, drowsiness, coma, nystagmus, diplopia, hypothermia, hypotension, respiratory depression and cardiac arrest have been reported in severe cases of poisoning. Oxyphenbutazone and phenylbutazone are considerably more toxic in overdose. Complications of severe poisoning include coma, convulsions, hepatic dysfunction, acute renal failure, sodium and water retention, haematuria, cardiovascular collapse, respiratory alkalosis, metabolic acidosis, hypoprothrombinaemia and thrombocytopenia. In contrast, indomethacin appears to be much less toxic. In addition to gastrointestinal symptoms, indomethacin taken in overdose induces headache, tinnitus, dizziness, lethargy, drowsiness, confusion, disorientation and restlessness. Only 1 case of acute sulindac poisoning has been reported in the literature. A 16-year-old boy was admitted with hypokalaemia (2.2 mmol/L), transient granulocytosis and 'scanty' haematemesis after ingesting 12 g sulindac. No case of acute tolmetin poisoning have been reported. The fenamates (flufenamic acid, meclofenamic acid, mefenamic acid, tolfenamic acid) are, with the exception of mefenamic acid, not as widely prescribed as other groups of NSAIDs. In overdose, mefenamic acid may result in nausea, vomiting, diarrhoea, muscle twitching, convulsions and coma.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Acute poisoning due to non-steroidal anti-inflammatory drugs. Clinical features and management. 353 13

Shape alterations induced in human erythrocytes by cationic, anionic, zwitterionic and nonionic amphiphiles (C10-C16) at antihaemolytic concentrations (CAH50 and CAHmax) and at a slightly lytic concentration (2-10% haemolysis) were studied. Anionic (sodium alkyl sulphates) and zwitterionic amphiphiles (3-(alkyldimethylammonio)-1-propanesulfonates) proved to be potent echinocytogenic agents. Among the nonionic amphiphiles there were potent stomatocytogenicagents (octaethyleneglycol alkyl ethers, pentaethyleneglycol dodecyl ether), one potent echinocytogenic agent (dodecyl D-maltoside) and one weak echinocytogenic agent (decyl beta-D-glucopyranoside). Shape alterations induced by cationic amphiphiles (alkyltrimethylammonium bromides, cetylpyridinium chloride and dodecylamine hydrochloride) showed a strong time-dependence. These amphiphiles immediately induced strongly crenated erythrocytes which during incubation shifted to less crenated erythrocytes or to stomatocytes. All of the echinocytogenic amphiphiles induced echinocytes immediately, and there were only small alterations of the induced shape during incubation. Among the stomatocytogenic amphiphiles there were some that induced stomatocytes immediately or after a short lag time while others first passed the erythrocytes through echinocytic stages before stomatocytic shapes were attained. Erythrocytes treated with amphiphiles did not recover their normal discoid shape following repeated washing and reincubation for 1 h in amphiphile-free medium. Our study shows that shape alterations induced by amphiphiles in erythrocytes cannot be explained solely by assuming a selective intercalation of differently charged amphiphiles into the monolayers of the lipid bilayer as suggested in the bilayer couple hypothesis (Sheetz, M.P. and Singer, S.J. (1976) J. Cell Biol. 70, 247-251). We suggest that amphiphiles, when intercalated into the lipid bilayer, trigger a rapid formation of intrabilayer non-bilayer phases which protect the bilayer against a collapse and bring about a transbilayer redistribution of intercalated amphiphiles as well as of bilayer lipids.
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PMID:Shape transformations induced by amphiphiles in erythrocytes. 356 96

The risk of toxic effects on the heart of bupivacaine following several kinds of locoregional anaesthesia has been investigated in the dog in situ heart by determining conduction time and effective refractory period in the various parts of the conduction system and the ventricular muscle, as well as the discharge rate of the sinus node. Bupivacaine, i.v. infused at 3 rates, 0.2, 0.3 and 0.4 mg X kg-1 X min-1, proved to have depressant effects on conduction, automatism and excitability. It slows down conduction in all the parts of the myocardium, considerably at high stimulation frequencies, but always much more in the His-Purkinje system and the ventricular contractile fibres than in the atrioventricular node, because it tends to block the sodium rather than the calcium or potassium channel. Its effect remain more moderate, indeed, on sinus automatism and atrial and mainly ventricular refractoriness. Its danger lies, therefore, in the inhibition of conduction, with atrioventricular or His bundle branch block, but more frequently reentrant arrhythmias, likely to result in ventricular fibrillation. However: these alterations are observed with very high plasma levels (about 4 to 9 micrograms X ml-1), much higher than usual peak concentrations following spinal anaesthesia (0.10 micrograms X ml-1) or even epidural anaesthesia or brachial plexus block (1.20 micrograms X ml-1); reversal of these alterations occurs rapidly (reduction by 50% within 30 min for instance), when they have not led to ventricular fibrillation or they have not been associated with circulatory collapse.
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PMID:Electrophysiological study in the dog of the risk of cardiac toxicity of bupivacaine. 363 38

In C6 astrocytoma cells respiring with glucose, 40% of the total production of ATP was provided by glycolysis. Anaerobiosis in the presence of glucose, reduced ATP synthesis by approximately 50%, increased lactate production by 30% and caused a 3-fold decline in [creatine phosphate]/[creatine] and consequently [ATP]free[ADP]free. There was no change in [K+]i which suggests that glycolytic production of ATP provides sufficient energy to ensure normal operation of the Na+/K+ pump. In the absence of glucose, [creatine phosphate]/[creatine] declined to less than 0.1 in 15 min and there was a loss of K+ from cells. A comparison of delta GATP and delta GNa,K under aerobic conditions with and without glucose, showed the former to be larger by 1 - 2 kcal. However, under O2-limited, glucose-restricted conditions delta GATP fell below the level necessary to maintain operation of the Na+/K+ pump and led to a collapse in ionic gradients.
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PMID:Energy relationships between ATP synthesis and K+ gradients in cultured glial-derived cell line. 367 41

The choice between regional versus general anaesthesia for elderly patients undergoing hip surgery is debated. It is vitally important to see if the type of anaesthetic administered affects per- and postoperative morbidity and mortality. Seventy women more than 75 yr old suitable for spinal anaesthesia were included in this study. They were randomly divided into two groups: in one (n = 35), general anaesthesia was given with sodium thiopentone, fentanyl, enflurane and vecuronium; in the other (n = 35), spinal anaesthesia was performed with 3 ml 0.5% bupivacaine in isobaric solution. During the anaesthetic period, there were no statistically significant differences between both groups in systolic arterial pressure falls or in increases in the heart rate X systolic arterial pressure product. No serious cardiovascular collapse was encountered. Seven patients (20%) receiving general anaesthesia had mental changes against four only (14.2%) in the spinal group. In patients having general anaesthesia, 22.9% developed bronchopneumonia as opposed to 8.6% in the spinal anaesthesia group (p less than 0.05). The mortality rate at three months was rather similar in the two groups. It was concluded that, in order to reduce the incidence of postoperative central dysfunction and bronchopneumonia, spinal anaesthesia should be preferred in geriatric patients for lower limb surgery.
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PMID:[Comparative study of general and spinal anesthesia in elderly women in hip surgery]. 370 40

The authors present a case of thoracic phaeochromocytoma responsible for cardio-circulatory arrest during thoracotomy for mediastinal tumour. In such cases, hypertension must be controlled with phentolamine or sodium nitroprusside, cardiac arrhythmia with lignocaine, and collapse with volaemic expansion. The medical literature concerning thoracic phaeochromocytoma is briefly reviewed.
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PMID:[Peroperative circulatory arrest during excision of an unrecognized thoracic pheochromocytoma]. 371 47

An infant with congenital renal salt-losing syndrome is reported. The importance of recognizing this rare disorder is emphasized because early detection, and treatment with sodium supplementation, results in marked growth improvement and may prevent volume depletion, electrolyte disturbance, and cardiovascular collapse. The clinical features and biochemical abnormalities seen in the congenital renal salt-losing syndrome are described. In this condition, natriuresis occurs in the face of normal renal and adrenal function and, as the child gets older, spontaneous resolution occurs. Other causes of hyponatraemia in infancy are discussed.
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PMID:Congenital renal salt-losing syndrome and failure to thrive in infancy. 372 29


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