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

Perioperative hemodynamic changes of hemodialysed patients were investigated and the changes of emergency cases (group E, n = 8) were compared with those of scheduled ones (group S, n = 13). By preoperative hemodialysis (HD), the values of blood urea nitrogen, serum creatinine, serum potassium, serum bicarbonate, and hematocrit were adjusted within normal range in group E, with no significant difference from those of group S. On the other hand, concerning the effect of preoperative removal of body water by HD, cardio-thoracic ratio (CTR, 53.6 +/- 3.1%) and pulmonary artery diastolic pressure (PADP, 11.6 +/- 5.0 mmHg) of group E were significantly higher than those of group S (CTR = 46.9 +/- 4.5%, PADP = 7.8 +/- 3.0 mmHg), indicating that the removal of body water by preoperative HD might be less in group E. However, group E patients required more administration of fluid and pressor agents in order to maintain their blood pressure and/or cardiac output during operation. Although with less water removal preoperatively and more fluid intraoperatively, postoperative PADP was significantly reduced (8.3 +/- 3.0 mmHg) in group E, suggesting that the requirement of perioperative water is more in group E. We conclude that the safe perioperative hemodynamic management for emergency surgery of hemodialysed patients requires following points; (1) The excessive removal of body water by preoperative HD should be avoided. (2) Intraoperative fluid infusion should be adequate so that they do not fall into hemodynamic collapse.
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PMID:[Perioperative hemodynamic changes and management of hemodialysed patients]. 224 11

Clinical assessment of the activity of tumor necrosis factor (TNF) against human cancer has been limited by a dose-dependent cardiovascular toxicity, most frequently hypotension. TNF is also thought to mediate the vascular collapse resulting from bacterial endotoxin. The present studies address the mechanism by which TNF causes hypotension and provide evidence for elevated production of nitric oxide, a potent vasodilator initially characterized as endothelium-derived relaxing factor. Nitric oxide is synthesized by several cell types, including endothelial cells and macrophages, from the guanidino nitrogen of L-arginine; the enzymatic pathway is competitively inhibited by NG-methyl-L-arginine. We found that hypotension induced in pentobarbital-anesthetized dogs by TNF (10 micrograms/kg, i.v., resulting in a fall in mean systemic arterial pressure from 124.7 +/- 7 to 62.0 +/- 22.9 mmHg; 1 mmHg = 133 Pa) was completely reversed within 2 min following administration of NG-methyl-L-arginine (4.4 mg/kg, i.v.). In contrast, NG-methyl-L-arginine failed to reverse the hypotensive response to an equivalent depressor dose of nitroglycerin, a compound that acts by forming nitric oxide by a nonenzymatic, arginine-independent mechanism. The effect of NG-methyl-L-arginine on TNF-induced hypotension was antagonized, and the hypotension restored, by administration of excess L-arginine (100 mg/kg, i.v.). Our findings suggest that excessive nitric oxide production mediates the hypotensive effect of TNF.
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PMID:NG-methyl-L-arginine inhibits tumor necrosis factor-induced hypotension: implications for the involvement of nitric oxide. 233 6

The development of atelectasis and effects on gas exchange during enflurane anaesthesia in nitrogen/oxygen or nitrous oxide/oxygen (inspired oxygen fraction 0.4) were studied in 16 lung-healthy patients (mean age 49 years). Awake, no subject displayed atelectasis as assessed by computed x-ray tomography of the thorax. Pulmonary gas exchange, studied by multiple inert gas elimination technique, and blood gases were normal. After 10 min of enflurane anaesthesia in nitrogen/oxygen, 14 of 16 subjects had developed atelectasis. After 30 min of enflurane anaesthesia in nitrogen/oxygen or nitrous oxide/oxygen, all patients had developed atelectasis, and a further increase was observed after 90 min of anaesthesia to approximately 5% of the intrathoracic area. There was no difference between the two anaesthesia groups. In the nitrogen group, shunt rose to a maximum of 5.8% at 30 min of enflurane anaesthesia, with a significant reduction to the initial anaesthesia level after 90 min of anaesthesia (3.4%). Perfusion of poorly ventilated lung regions (low VA/Q) averaged 4-5% and did not vary significantly during the anaesthesia. In the nitrous oxide group, shunt increased to 6.3% after 90 min of anaesthesia, and there was a parallel decrease in perfusion of low VA/Q regions. The findings suggest that besides prompt collapse of lung tissue during induction of anaesthesia, absorption of gas from closed-off or poorly ventilated regions takes place and further increases the atelectatic area.
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PMID:Atelectasis and gas exchange impairment during enflurane/nitrous oxide anaesthesia. 258 94

Chlorinated diphenyl ethers are environmental contaminants that have been found in Great Lakes fish and birds. Because of their presence in the food chain, and potential for human exposure, the present short-term study was conducted to assess their toxicity. Groups of 10 male and 10 female rats were each given by gavage 2,2',4,4'6-pentachlorodiphenyl ether (CDE1), 2,2',4,4',5,6-hexachlorodiphenyl ether (CDE2) or 2,2',3,3',4,6'-hexachlorodiphenyl ether (CDE3) at dose levels of 0.04, 0.4, 4.0 or 40 mg/kg b.w./day for a period of 28 days. The control group received an equivalent volume of corn oil only (0.5 ml/100 g b.w.). Treatment with the three CDE congeners did not result in suppression of growth rate or food consumption. Increased liver weights were seen in the animals of both sexes fed 40 mg/kg CDE2, in males treated with 40 mg/kg CDE1, and in females with 40 mg/kg CDE3. Hepatic microsomal aminopyrine demethylase activity was significantly higher in the male rats administered 40 mg/kg CDE2, and aniline hydroxylase activity was elevated in the females following the same treatment. Serum glucose, calcium, protein and urea nitrogen of CDE1-treated males were higher than the control. Levels of uric acid, potassium and LDH of CDE3-treated females were also elevated. No hematological changes were observed. Histological examination revealed that the liver and thyroid were the target organs affected by CDE treatment but the morphological changes were mild even at the highest dose level. Changes in the liver consisted of nuclear vesiculation and increased cytoplasmic volume. Alterations in the thyroid were characterized by increased epithelial height and follicular collapse. Based on the data presented above, the 3 CDE congeners can only be considered moderately toxic in the rat.
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PMID:Toxicological assessment of chlorinated diphenyl ethers in the rat. 260 Mar 62

Five women undergoing endometrial ablation with the Nd-YAG laser developed sudden gas embolism. In each case laser intrauterine contact surgery was carried out utilizing coaxial fibers with (three cases) and without (two cases) artificial sapphire tips but commonly cooled by air or nitrogen. Four of the five women died in a sequence of sudden cardiovascular collapse followed by irreversible cardiac arrest. One woman was critically ill and following prolonged hospitalization survived with neurological deficits.
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PMID:Catastrophic injury secondary to the use of coaxial gas-cooled fibers and artificial sapphire tips for intrauterine surgery: a report of five cases. 260 51

The intravertebral vacuum phenomenon is rather uncommon. It is determined by the collapse of the body of the vertebra with successive aspiration ex vacuo of gas (nitrogen) from the surrounding tissues, which collects under the endplates, causing them to appear disconnected. To date, the one who has reported the highest number of cases is Maldague, with sixty examples. Our report concerns four cases seen during the past five years. According to the most widely accepted pathogenetic theory, this phenomenon represents, together with vertebral collapse and increased bone density, a pathognomonic sign of ischemic osteonecrosis of the vertebrae, similar to osteonecrosis of the head of the thigh bone and, like this, favored by many different factors, such as old age, repeated traumas, alcoholism, rheumatoid arthritis, arteriosclerosis and corticosteroid therapy.
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PMID:[The intravertebral vacuum phenomenon or gaseous dissection of the vertebral body]. 275 80

Heart rate, body temperature, arterial blood gas tensions, pHa and hemoglobin concentrations were measured during and after free diving of the Weddell seal (Leptonychotes weddelli), beneath the fast ice of McMurdo Sound, Antarctica. To examine arterial nitrogen tensions (PaN2), 47 samples of arterial blood were obtained from 4 seals diving up to 23 min to depths of 230 m. Peak arterial nitrogen tensions between 2000 and 2500 mmHg were recorded at depths of 40-80 m during descent, indicating that the seal's lung collapses by 25-50 m. Then arterial blood nitrogen tensions slowly decreased to about 1500 mmHg near surfacing. Thus during diving alveolar collapse and redistribution of blood nitrogen allow the seal to avoid nitrogen narcosis and decompression sickness. The arterial PO2 (PaO2) at rest (78 +/- 13 mmHg, mean +/- SD) increased with diving compression to a maximum measured value of 232 mmHg and then rapidly decreased to 25-35 mmHg. The lowest diving PaO2 was 18 mmHg just before the seal surfaced from a 27-min dive. A consistent increase of arterial hemoglobin concentrations occurred during each dive. We suggest that an extension of the sympathetic outflow of the diving reflex caused profound contraction of the Weddell seal's spleen.
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PMID:Arterial gas tensions and hemoglobin concentrations of the freely diving Weddell seal. 280 51

Electromagnetic flow probes were used to measure the fraction of the pulmonary blood flow perfusing the left lower lobe (Ql/Qt) in 16 anaesthetized, open-chest dogs in order to study the effects of right lung airway pressure on the distribution of blood flow to a hypoxic lung lobe. Ventilation of the lobe with 7% oxygen in nitrogen resulted in a 37% reduction in Ql/Qt at the beginning and end of the main procedure, thus confirming that the hypoxic pulmonary vasoconstrictor response was unchanged throughout the study. The effects of varying mean airway pressure to the right lung by changing inspiratory:expiratory time ratio and by the addition of a positive end-expiratory pressure were studied when the left lower lobe was insufflated with oxygen or 7% oxygen in nitrogen, or was collapsed. Insufflation of the lobe with 7% oxygen in nitrogen and collapse reduced Ql/Qt by 61% and 66%, respectively. However, changing mean airway pressure in the right lung produced no significant changes in Ql/Qt in any of the different lobar conditions or when collapse was produced after fluid loading. Fluid loading during collapse increased cardiac output and pulmonary vascular pressures and increased Ql/Qt to a value which was not significantly different from lobar ventilation with 7% oxygen in nitrogen. It is concluded that moderate increases in mean airway pressure do not increase Ql/Qt when this has been reduced by exposure of the lobe to mixed venous blood-gas tensions.
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PMID:Effects of the pattern of ventilation and of an increase in cardiac output on the distribution of blood flow to a hypoxic lung lobe. 312 12

Immunofluorescent studies in human prostatic carcinoma cells (DU 145) and cultured squirrel fish epithelial cells (a non-cancer cell) revealed that estramustine, a conjugate of estradiol and nor-nitrogen mustard, possessed microtubule disassembly properties. Sixty microM estramustine produced disassembly at both the proximal and distal ends of microtubules, producing short pieces of less than 2 microM which were "wavy" and oriented in a random manner. With increased time of drug exposure these short microtubules disappeared, to be accompanied by a gradual disassembly of a small population of longer microtubules (greater than 7-8 microM). In dividing DU 145 cells it was possible to show a different degree of sensitivity of specific microtubule-containing cellular structures. In mitotic figures the asters were most sensitive and disappeared completely following exposure to estramustine. These were followed by the "pole-to-pole" and "chromosomal" fibers. In cytokinesis, the intercellular fibers between daughter cells were comparatively resistant to the drug. Estramustine did not induce disassembly of the vimentin filaments in non-dividing or dividing cells but did cause their collapse around the nucleus or the mitotic apparatus. These data suggest that specific microtubules have differing sensitivity to estramustine.
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PMID:Immunofluorescent studies of the anti-microtubule effects of the anti-cancer drug estramustine. 332 49

Acceleration atelectasis is the absorptional collapse of alveoli in the dependent lung due to increased accelerative forces. It is exacerbated by breathing 100% oxygen and, during +Gz exposure, by the use of an anti-G suit. Experiments were conducted on 12 subjects using simulated aerial combat maneuvers (SACM) with G profiles having peak exposures of either 4.5 G or 9 G. Decreases in vital capacity (VC) measurements were used as quantification of atelectasis, two types of reduction being identified and described. Labile reductions in VC were readily restored by a deep breath or cough. Such reduction approximated 28% following the 4.5-G SACM and 25% following the 9-G SACM. More persistent (so called) stable reductions were of lesser degree, values of -20% being seen following both 9 G and 4.5 G maneuvers. Acceleration atelectasis causes symptoms of chest pain, coughing, and shortness of breath. Subjective ratings of the severity of these symptoms were obtained from the subjects, and these were much greater following the 4.5-G SACM exposures than after the 9-G runs. Acceleration atelectasis was reduced by dilution of the inspired oxygen concentration by argon and nitrogen (evaluated at 95, 82.5, 70, 50, and 20% oxygen); the addition of unassisted positive pressure at 30 mm Hg (4 kPa) to the breathing mask; or the performance of the anti-G straining maneuver (AGSM).
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PMID:Induction and prevention of acceleration atelectasis. 354 76


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