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[Choice of lung ventilation at suspension laryngoscopy in patients with laryngeal neoplasms].

Three methods of artificial ventilation (AV) (volumetric, high-frequency injection, and high-frequency percutaneous transtracheal jet ventilations) were studied in 340 patients when laryngeal tumors were removed, by using a Stortz laryngoscope under multicomponent general anesthesia and local airways anesthesia. Examining the parameters of respiration and circulation in the use of three AV methods has indicated the advantages of the high-frequency percutaneous ventilation that ensures the prevention of aspiration complications and steady-state values of gas exchange and blood circulation, including in those with laryngeal stenosis and at a high risk for hemorrhage.

Adult↗

Choice of nebulisers and compressors for delivery of carbenicillin aerosol.

Although aerosol antibiotics have been used successfully to treat respiratory tract infection in patients with cystic fibrosis, little information exists concerning the correct nebulisation technique for antibiotic solutions. We have measured aerosol output, droplet size and nebulisation time for 1 g carbenicillin (Pyopen, Beechams) diluted with 3 ml or 4 ml water for injection and delivered from six brands of jet nebuliser (Cirrus, DeVilbiss, Inspiron, Turret, Unicorn and Upmist). Three relatively weak compressors (Medix Traveller, Medic-Aid PortaNeb 50 and Inspiron) and three more powerful compressors (Medix WOBL, Medix Maxi mark I and Gast) were used as driving sources. Maxi and Gast compressors increased the quantity of "respirable" (less than 5 micron diameter) carbenicillin aerosol, and reduced nebulisation times; with the weaker compressors, nebulisation times (up to 50 min) were unacceptably long. The Turret nebuliser proved to be the most efficient, but several other brands would also be acceptable if used with a powerful compressor.

Aerosols↗

The water jet as a new tool for endoprosthesis revision surgery--an in vitro study on human bone and bone cement.

In revision surgeries of endoprostheses, the interface between implant and bone cement or bone must be loosened. Conventional tools have many disadvantages because of their size and limited range. Taking advantage of the selective and athermic cutting process, a plain water jet is already used in order to cut soft tissues. This study investigates the possibilities of both a plain and an abrasive water jet as cutting tools for revision surgery. Samples of the mid-diaphysis of human femora and bone cement (CMW3) were cut with a plain water jet (PWJ) and an abrasive water jet (AWJ) at two different jet-to-surface angles (30 degrees,90 degrees ) and at five different pressure levels (30, 40, 50, 60, 70 MPa). For a PWJ a selective pressure range was identified, where only bone cement was cut. Injecting a bio-compatible abrasive (lactose) to the jet stream resulted in significantly higher cut depths in both materials. Material removal in bone was significantly less at the smaller jet-to-surface angle for both techniques. No clear selectivity between bone and bone cement was observed for application of the AWJ. However, the material removal rate was significantly higher for bone cement than for bone at all pressure levels. The results indicate that an AWJ might be an alternative tool for cement removal. The possibility for localised cutting at interfaces could be an advantage for revision of a non-cemented prosthesis.

Aged↗

Jet vaccination.

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Humans↗

Advances in insulin therapy for insulin-dependent diabetic children.

During the last two decades new forms of insulin and a better understanding of the physiological insulin secretion profile have led to great changes in insulin therapy. New insulin regimens mimicking the normal insulin secretory pattern, called intensive insulin therapy, and new insulin-delivery systems have been introduced. Self-monitoring of blood glucose levels and the use of glycosylated hemoglobin determination for objective evaluation of long-term control have made the achievement of near normoglycemia a practical goal for most patients taking insulin. 1. New forms of insulin: Beef and pork insulin were replaced by monocomponent pork insulin and now monocomponent human insulin is most popularly used. 2. Intensive insulin therapy: Intensified conventional insulin therapy, that is a multiple injection regimen and a twice a-day insulin regimen using a mixture of intermediate- and short-acting insulins has been commonly accepted. New devices such as pen-type injectors and jet-injectors have also been introduced for simplifying the multiple injection regimen. Continuous subcutaneous insulin injection (CSII) has also been adopted by adolescents and young adults.

Child↗

Flow-injection detector incorporating a screen-printed disposable amperometric biosensor for monitoring organophosphate pesticides.

The construction of a wall-jet flow cell, which houses a screen-printed amperometric pesticide biosensor, together with a complete flow-injection system, is described. This system was initially employed in studies to stabilise the enzyme acetylcholinesterase (AChE), which was immobilised on a cobalt phthalocyanine screen-printed carbon electrode to form a biosensor. A combination of dextran sulfate and lactitol, and carbodiimide for enzyme immobilisation, resulted in biosensor lifetimes of at least 76 d (at 37 degrees C). Flow-injection and biosensor conditions were optimised, then the system was evaluated by monitoring the model organophosphate pesticides (OP) dichlorvos and paraoxon. The detection limits were 7 x 10(-11) mol dm-3 (for 1 U of AChE) and 4 x 10(-11) mol dm-3 (for 0.05 U of AChE), respectively, which are better than for other electrochemical methods. Initial evaluations on two river water samples have been carried out to test the validity of the system for OP determination in field samples.

Biosensing Techniques↗

Supercritical assisted atomization: a novel technology for microparticles preparation of an asthma-controlling drug.

The objective of this study was to produce microparticles of a new asthma-controlling drug by supercritical assisted atomization (SAA), proposed as an alternative to conventional jet-milling process. SAA is based on the solubilization of supercritical carbon dioxide in a liquid solution containing the drug; the ternary mixture is then sprayed through a nozzle, and microparticles are formed as a consequence of the enhanced atomization. SAA process parameters studied were precipitator temperature, nozzle diameter, and drug concentration in the liquid solution. Their influence was evaluated on morphology and size of precipitated particles. Spherical particles with mean particle size ranging from 1 to 3 microm of the new anti-asthma drug were produced by SAA. The mass median aerodynamic diameter (MMAD) of the SAA micronized particles and of the conventional jet-milled drug was used to compare the results obtainable using the 2 techniques. Particularly, MMADs from 1.6 to 4.0 microm were obtained by SAA at the optimum operating conditions and by varying the concentration of the solution injected. MMAD of 6.0 microm was calculated for the jet-milled drug. SAA samples also exhibited narrower particle size distribution (PSD). A good control of particle size and distribution together with no drug degradation was obtained by SAA process.

Anti-Asthmatic Agents↗

Neuropeptide Y Y1 receptor antagonist (BIBP 3226) attenuates stress evoked tachycardia in conscious spontaneously hypertensive rats.

The effects of a novel neuropeptide Y (NPY) Y1 receptor antagonist on resting mean blood pressure (MBP) and heart rate (HR) were observed in conscious spontaneously hypertensive rats (SHR). The interference of the antagonist with cardiovascular responses to mental stress and administration of exogenous NPY were also investigated. SHR were randomly received either the NPY Y1 receptor antagonist (BIBP 3226; n = 11) or its inactive enantiomer (BIBP 3435; n = 11) as an infusion (6 mg/kg/h for 1.5 hours). Before, during, and after the infusion, rats were first stressed with a jet of air and then given a bolus injection of exogenous NPY (2 nmol/kg). There was no statistically significant difference of resting MBP and HR between the antagonist and enantiomer groups before, during, or after infusion. The stress-induced maximum increase in HR was significantly reduced during antagonist infusion (P < 0.05). The effects of exogenous NPY on both MBP and HR were significantly attenuated by antagonist infusion (P < 0.05, respectively), and the effect lasted at least 1 hour after the end of the infusion. Plasma catecholamine levels in response to stress were not significantly different between the two groups. The results suggest that endogenous NPY Y1-receptor mechanisms may be of minor importance in short-term regulation of MBP and HR in conscious adult SHR, but may be involved in the response to mental stress.

Animals↗

Randomised, controlled field trial of two new techniques for the castration and tail docking of lambs less than two days of age.

Two methods to reduce the pain associated with the castration and tail docking of lambs with rubber rings were tested by 10 shepherds, each using 60 housed lambs. In 20 of the lambs the innervation to the scrotum, testes and tail was crushed with a 'Big Nipper' bloodless castrator, and in 20 local anaesthetic (2 per cent lignocaine with adrenaline) was injected with a newly developed high-pressure jet injector under the rubber rings after they had been applied; 10 lambs were given a placebo treatment and 10 were treated by the shepherds' routine elastrator ring procedure. Both new methods significantly decreased the incidence of limb and tail movement by 78 per cent and the time spent by the lambs in abnormal postures, when compared with either the shepherds' routine treatment or the placebo treatment. An experienced observer and most of the shepherds also assessed that the lambs suffered signficantly less pain when treated by the two new methods than when they were treated with rubber rings alone. No detrimental long-term effects of the two new methods were observed. On average the new methods took 68 seconds to apply, compared with 29 seconds for the rubber rings; of the two new methods most shepherds preferred using the pressure jet injector.

Amputation, Surgical↗

[Application of digital subtraction angiography (DSA) in the neurosurgical field].

Intraarterial digital subtraction angiography (DSA) was applied 44 times to 39 neurosurgical cases. We emphasize the advantage of DSA in relation to conventional angiography. The examination consisted of 25 aortography and 19 selective arteriography. By single small dose injection of contrast medium using DSA, aortic arch and thoracic major vessels were well visualized, so that we could obtain useful information for catheterization to the selective artery. High time resolution of DSA made possible to recognize dynamics of circulation in very short interval, especially in the case of subclavian steal syndrome and right aortic arch. Major four vessels in the cervical region could be visualized by single injection of contrast medium using DSA. Stenosis of carotid artery was recognized by DSA as well as conventional angiography. By aortic injection using DSA, circulatory dynamics of intracranial vessels including collateral circulation were recognized especially in the case of moyamoya disease. Gradual injection of small dose contrast medium reduced jet-effect of the catheter tip and enabled the selective arteriography. Real time display of DSA reduced the time required for examination and enabled repeated angiography to recognize the change of hemodynamics under the different limb position in the case of thoracic outlet syndrome.

Cerebral Angiography↗

Effects of blood viscosity on proximal flow convergence calculations of regurgitant flow rate and jet dimensions as evaluated by color Doppler flow mapping: an in vitro study.

There are limited data on the potential influence of blood viscosity on the quantification of valvular regurgitation by color Doppler in the clinical setting. This study was designed to evaluate the effects of blood viscosity on jet dimensions and the proximal flow convergence (proximal isovelocity surface area, PISA) method of estimating valvular insufficiency severity. We used an in vitro flow model filled with human blood at varying hematocrits (15%, 35%, and 55%) and blood viscosity (blood/water viscosity: 2.6, 4.8, 9.1) in which jets were driven through a known orifice (16 mm(2)) into a 110-mL compliant receiving chamber (compliance: 2.2 mL/mm Hg) by a power injection pump. Blood injections (2 and 4 mL) at flow rates of 4, 6, 8, 10, and 12 mL/s were performed. Proximal flow convergence and spatial distribution of jets were imaged by a 3.5-MHz transducer. Pressure and volume in the flow model were kept constant before each injection. Ultrasound settings were the same for all experiments. Jet area decreased significantly with increasing blood viscosity, but the difference in jet dimensions was much larger for lower than for higher flow rates and for highest blood viscosity. Estimation of flow rate by the PISA method was not significantly influenced by blood viscosity. Blood viscosity has a major influence in jet area, especially for lower flow rates, but did not change significantly the grading of regurgitation by the PISA method. Thus this factor should be considered for determining the method of choice when quantification of valvular regurgitation is performed in patients with anemia or polycythemia.

Blood Viscosity↗

[Experimental study of water jet angioplasty].

A newly invented angioplasty by using water jet energy was investigated for evaluating its safety and effectiveness in 3 dogs. The water jet was produced from a small tip nozzle (0.2 mm in diameter) of catheter by injecting 20 ml of diluted contrast medium. By using this method recanalization of femoral arterial occlusion produced by fresh thrombi was achieved in all 3 dogs. Post recanalization angiography showed no apparent small vessel occlusions. Injection apart more than 5 mm from the inner surface of human aorta provoked no apparent changes histopathologically. Water jet angioplasty may be useful in treating vascular occlusive disease.

Animals↗

Use of hydrogen peroxide to identify internal opening of anal fistula and perianal abscess.

Hydrogen peroxide injected into a fistula or perianal abscess produces a jet of white bubbles from the internal orifice on the dentate line. This technique has been helpful in locating this often elusive ostium. Failure to produce such an efflux warns one that the pathology was different from what was expected. Confidence to abandon the search in the absence of an efflux is developing, provided the dictates of gravity are respected in positioning the patient so that the anus lies above the abscess.

Abscess↗

Jet vaccination.

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Adult↗