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It is generally accepted, that the progress in surgical treatment of congenital malformation is closely related to the progress in highly-specialised methods of newborn anaesthesia. The safe methods of anaesthesia have to be adapted to anatomical and physiological peculiarities of the earliest days of life as well as to different reaction to drugs and anaesthetics. The preoperative preparation in newborns used to be often very short, because most of the problems of the neonatal period are emergency surgical interventions and there is no time for treatment even of the serious disturbances of basic physiological functions. The purpose of this study was to estimate methods of general anaesthesia in newborns, which have been introduced in the Anaesthesiology Department of the National Research Institute of Mother and Child. The main element of these methods was general anaesthesia with muscle relaxants and controlled ventilation as a routine. The estimation was based on general analysis of 10 years practice when these methods of anaesthesia were used. During this time 515 anaesthesias to 408 both-sex newborns were given (Tab. I, Fig. 1). 85% of anaesthetized newborns were operated because of congenital malformations (Tab. I); 46% of operations were performed during their first week of life, 21% were operated in first 24 hours of life, mostly as an emergency (Fig. 3). 10% of operations were performed is prematures (body weight below 2500 g) (Fig. 4). The "routine" anaesthesia was given in 82% cases. Awake intubation in unpremedicated newborns was performed. Anaesthesia was maintained with nitrous oxide-oxygen mixture (1:1 or 2:1). D-tubocurarine in 95% of cases was used. The initial dose 0,5 with matures and 0,25 mg with premature babies was used. If necessary supplementary doses were given. During anaesthesia, intermittent positive pressure ventilation (IPPV) with frequency at least 60/min. was used. During this ventilation, hyperventilation and positive end-expiratory pressure (PEEP) were obtained. Precordial stetoscope and thermometer probe was used as a routine. In some special cases eCG, end-expired CO2 (capnography), pletysmography were also recorded; blood gas analyses were checked. All intra- and postoperative complications as well as postoperative mortality have been analysed in details. During 3,3% of operations some complications had been observed. The total incidence of early psotoeprative complications was 20%. In this group the most frequent were respiratory complications (16,1%). Serious disturbances in pulmonary gas exchange during operation and early postoperative period were not found.(ABSTRACT TRUNCATED AT 400 WORDS)
Probl Med Wieku Rozwoj 1979
PMID:[General anesthesia in infants]. 40 Jul 70

1. Indomethacin, an inhibitor of the cyclo-oxygenase system that converts arachidonic acid into prostaglandins and related substances, was infused intravenously in 12 healthy volunteer subjects. 2. Systemic systolic and diastolic blood pressures and heart rate were recorded in all subjects, and in most of them also the systemic arteriovenous oxygen difference, the total oxygen uptake and the pulmonary arterial and wedge pressures. 3. The infusion of indomethacin was followed by a decreased cardiac output (from 7.3 +/- 0.3 to 6.3 +/- 0.3 litres/min) and an increased mean systemic blood pressure (from 92 +/- 1 to 102 +/- 1 mmHg), indicating an elevation of the total systemic vascular resistance (from 98 +/- 4 to 124 +/- 5 kPa 1(-1) s) by indomethacin. The ventilation and the pulmonary vascular resistance did not change after the infusion of indomethacin. 4. The results suggest that products formed by the cyclo-oxygenase system at rest exert a relaxing effect in certain parts of the systemic vascular bed, thereby lowering the systemic vascular resistance.
Clin Sci Mol Med 1978 Feb
PMID:Influence of indomethacin on the systemic and pulmonary vascular resistance in man. 41 88

New concepts concerning the pathogenesis and therapy of diabetic ketoacidosis are reviewed. The regulation of ketogenesis by intrahepatic enzymic processes and the roles of insulin deficiency or glucagon or other counterregulatory hormone excess are summarized. Major emphasis is placed on an analysis of the use of low-dose insulin regimens for the treatment of ketoacidosis. Most patients with diabetic ketoacidosis will respond to low-dose, hourly, intravenous or intramuscular regular insulin. Low doses of insulin are as effective as high doses and have fewer associated complications of hypoglycemia and hypokalemia. Phosphorus deficiency is common in diabetic ketoacidosis and hypophosphatemia usually becomes manifest within 4 to 12 h of institution of therapy. Phosphorus supplementation is now generally recommended to replete erythrocyte 2,3-diphosphoglycerate and improve oxygen delivery to tissues. Coexistent and biochemically significant lactic acidosis is a relatively infrequent complication of diabetic ketoacidosis and when present is usually due to underlying disorders associated with poor tissue perfusion.
Ann Intern Med 1978 May
PMID:Diabetic ketoacidosis: new concepts and trends in pathogenesis and treatment. 41 52

To test the feasibility that traditional interval training methods could be adapted to the needs of competitive figure skaters, an interval skating program was conducted during a 3-month period for a group of skaters at diverse levels of proficiency. The program required only a small portion of the total ice time utilized by the skaters on a daily basis, i.e., 1/2 hr, three times a week. On alternate days, the skaters used the same amount of time in a strength training program. A flexibility-stretching facet was to be done by the skaters on a daily basis. Progress was evaluated by treadmill oxygen consumption determinations and ability to perform a 1/2-mile skate effort. Over the course of the 3-month period, the skaters in the program showed an average increase in oxygen consumption of 9% from 44.73 cc per kg per min to 55.51 cc per kg per min. This was accompanied by an average 10-sec reduction in the timed effort at the 1/2-mile skate. Subjectively, the skaters were less fatigued during their freestyle skating programs and were able to improve consistency at skilled maneuvers in the last minute of their performances. This initial effort to evaluate the efficacy of this type of a training program for competitive figure skating seems to have proven to be beneficial to the skaters. Currently, we are continuing our efforts to expand the program.
Am J Sports Med
PMID:Conditioning program for competitive figure skating. 42 Mar 87

The synthesis of some 1,6-dihydro-6-oxo-2-phenylpyrimidine-5-carboxylic acids and esters with potent oral and intravenous antiallergic activity against passive cutaneous anaphylaxis in the rat is described. Requirements for high activity include a free NH group in the pyrimidinone nucleus and a small to medium size ortho alkoxy or alkenyloxy group on the phenyl ring. It is suggested that in the case of the highly active compounds hydrogen bonding occurs between a nitrogen of the pyrimidine ring and the ethereal oxygen. The nature of this bonding and its possible contribution to an optimum configuration for the molecules is discussed.
J Med Chem 1979 Mar
PMID:Antiallergy agents. 1. 1,6-Dihydro-6-oxo-2-phenylpyrimidine-5-carboxylic acids and esters. 42 8

In this study the effects of paraquat on the aerobic metabolism and viability of isolated rabbit alveolar macrophages and lung fibroblasts were investigated, and compared with the effects of other known metabolic inhibitors, i.e. sodium fluoride (NaF) and potassium cyanide (KCN). The manometrically and polarographically determined endogenous oxygen consumption of lavaged alveolar macrophages compared very well (180,9 +/- 35,8 and 169,3 +/- 26,8 nmol per 10(6) viable cells per hour respectively). Exogenous glucose (10 mM) and autologous serum (1:3 v/v) added to the medium had no significant effect on the basal respiration rate. The mean cell protein content, determined by the micro-Kjeldahl and Lowry techniques, amounted to 242,6 +/- 37,6 microgram/10(6) macrophages. Paraquat (2 mM), like NaF (20mM) and KCN (5 mM), decreased the viability of the macrophages far less than it did the oxygen utilization of the viable cells, and resulted in an 80% inhibition of oxygen uptake. In contrast, paraquat (1 mM) induced a marked stimulation (230%) of the cyanide-insensitive respiration of alveolar macrophages. The concentrations of paraquat (nmol/10(3) cells) which reduce macrophage metabolism to almost zero were virtually non-toxic to fibroblasts, as measured by their oxygen consumption.
S Afr Med J 1979 Jan 06
PMID:The effect of paraquat on the aerobic metabolism of rabbit alveolar macrophages and lung fibroblasts. 42 10

Because their blood may "unload" oxygen more readily than normal, people with hemoglobin of low oxygen affinity might be expected to be anemic. We have studied a woman with hemoglobin Hope/beta+ thalassemia, whose hemoglobin level was 10.4 to 12.3 gm/dl (normal 14 +/- 2) despite a P50 of 41 mm Hg (normal 26). Her cardiac index was normal, yielding a calculated mixed venous PO2 of 51 mm Hg (normal 34 to 49). Oxygen transport in patients with low oxygen affinity can be maintained by a variety of homeostatic responses, only one of which is altered erythropoiesis.
J Lab Clin Med 1979 Feb
PMID:Oxygen transport in a woman with hemoglobin Hope/beta+ thalassemia. 42 43

9 figures form the core of this article describing and discussing a case of sudden death, 2 hours after a 30-year old woman presented at a hospital emergency with chest pains. She had taken no medications other than oral contraceptives (OCs) for 10 years. The patient was admitted to the coronary care unit where findings included a palpable blood pressure of 94 mm of Hg, a heart rate of 128/min, and a respiratory rate of 28/minute. Cyanosis was noted, jugular veins were distended, and there were rales over the lung bases bilaterally; cardiac sounds were soft and a third heart sound was audible. Arterial oxygen tension was 15 mm of Hg, and carbon dioxide tension was 42 mm of Hg; pH was 7.2. Ventricular tachycardia developed and ventricular fibrillation ensued. The patient was intubated and well oxygenated, external cardiac compression was performed, sodium bicarbonate, epinephrine, and calcium were administered, and electrical defibrillation was performed. After several attempts, the latter resulted in a slow idioventricular rhythm on the electrocardiogram, but neither the blood pressure nor pulse was detectable. Asystole subsequently developed, and cardiac activity could not be restored. After discussion by a panel of physicians, the final anatomic diagnoses are chronic active nonspecific myocarditis; organizing and acute myocardial microvascular and endocardial mural thrombi; platelet-rich microthrombi in the heart, lungs, and liver; chronic passive pulmonary congestion and edema; and congestive hepatomegaly (2900 g). Any of these may be assciated with longterm OC usage.
Am J Med 1979 May
PMID:Chest pain, shock, arrhythmias and death in a young woman. 44 59

The alveolar-arterial oxygen partial pressure difference (AaDO2) and the arterial/alveolar oxygen partial pressure ratio (a/APO2) were compared for stability when inspired oxygen concentration (FIO2) changed. The analysis was based on a three-compartment lung model and experimental results in 10 patients with respiratory failure receiving assisted ventilation. It was found that a/APO2 was more stable than AaDO2 and more useful for: (1) comparing gas exchange in patients receiving different levels of FIO2, (2) following gas exchange in the same patient as FIO2 is changed, and (3) estimating the PaO2 expected at a given level of FIO2 if blood gas data are available at another level. However, areas with low ventilation/perfusion (V/Q) ratios may cause sudden changes in a/PO2 at certain critical values of PAO2. Most stable is a/APO2 and, therefore, most useful at FIO2 levels greater than 0.3, and PaO2 levels less than 100 torr.
Crit Care Med 1979 Jun
PMID:Stability of the arterial/alveolar oxygen partial pressure ratio. Effects of low ventilation/perfusion regions. 44 59

A computer program was developed to calculate intrapulmonary venous admixture on a Texas Instruments TI 59 programmable calculator. The program incorporates the following characteristics: 1) a correction for saturated water vapor pressure which varies with body temperature; 2) a mathematical model of the standard oxyhemoglobin dissociation curve; and 3) correction factors for shifts of the dissociation curve due to variations in pH and carbon dioxide tension. It also corrects oxygen tensions obtained at electrode temperature to those at patient temperature, and calculates variations of the Bunsen solubility coefficient of oxygen in blood with body temperature.
Crit Care Med 1979 Jun
PMID:An improved program to calculate intrapulmonary shunting. 44 63


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