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PubMed1992

On the alteration of pulmonary arteries in different experimental pneumoconioses.

CFY rats were treated intratracheally on one occasion with 60 mg of DQ12 quartz, illite (aluminosilicate) and enargite (dead rocks of a metal mine) suspended in 1 ml physiological saline. After a year, the structure of the pulmonary arterial system of pneumoconiotic rats was investigated by means of injection-corrosion cast and gelatin-India ink samples in thick preparations. In the identically treated animals, blood-gas analysis was made of samples of femoral arteries before and after intravenous treatment with noradrenaline and acetylcholine (40-40 micrograms/b.w.) under sodium pentobarbital narcosis. It has been stated that in focal alterations characteristic of different types of pneumoconioses, arborisation of the pulmonary arteries is and a newly developed and/or transformed vascular structure can be observed around the foci. In pneumonoconiotic lungs, arteriovenous shunts are more frequent. The authors assumed some connection between the vascularization of foci and the progression of the fibrotic process: richer vascularization around and inside the foci was accompanied by significant fibrosis. The blood-gas values suggested compensated respiratory acidosis. In the examined pneumoconioses, the effect of vasoactive substances - in terms of blood-gas values - had not changed significantly.

Acetylcholine↗
PubMed1992

[Intracellular pH of surface epithelial cells and the movement of bicarbonate ions under acid-base imbalance in gastric mucosa].

To investigate the effect of the acid-base imbalance on the gastric mucosal defense mechanism, the intracellular pH of gastric surface epithelial cells were measured with double-barreled H+ selective microelectrodes in the isolated antral mucosa of bullfrog stomach. By knowing the intracellular pH and the PCO2 of the serosal perfusate, the intracellular HCO3- concentration was estimated, and the rate of HCO3- secretion was directly measured with the pH-stat method in mounted preparations on a Ussing's chamber. Both the calculated intracellular HCO3- concentration and the rate of HCO3- secretion were dependent on the exogenous HCO3- supplied from the serosal perfusate. The alkaline tide raised the intracellular HCO3- concentration, thus increasing the mucosal buffering power against acid. Under mild respiratory acidosis, the production of endogenous HCO3- from the serosal CO2 was enhanced, and both the intracellular HCO3- concentration and the rate of HCO3- secretion were increased. As a result, the intracellular pH was maintained at a physiologically optimal level, and the ability of gastric mucosal protection was strengthened by enrichment of cellular bicarbonate supply. It is confirmed in this study that the maintenance of acid-base status in the cell is indispensable in the protection of gastric mucosa against acid invasion.

Acid-Base Imbalance↗
PubMedDate not supplied

A Japanese adult case of cystic fibrosis causing bone demineralization.

Cystic fibrosis is an inherited, multisystem disorder characterized by an abnormality in exocrine gland function. It leads to chronic pulmonary disease in most cases and pancreatic insufficiency in 85 percent of patients. Although this disease is not uncommon in Caucasians, it has been considered very rare among Japanese. The majority of patients are diagnosed in infancy or childhood. The patient in this case report was a 45-year-old Japanese man who had not been diagnosed as having cystic fibrosis. This patient had recurrent episodes of pulmonary infection that started in childhood, and plain films of the chest showed increased interstitial markings, hyperaeration, and bronchiectasis. CT of the upper abdomen showed a generally enlarged pancreas with complete fatty replacement. Serum and urine pancreatic enzyme levels were low, suggesting pancreatic insufficiency. Repeated sweat tests were positive. A roentgenologic skeletal survey showed general demineralization, which may be multifactorial. In this case, it was concluded that vitamin D deficiency caused by vitamin D malabsorption and/or insufficient sunlight exposure was mainly responsible for the demineralization and that chronic respiratory acidosis might also be partially responsible.

Bone and Bones↗
PubMedDate not supplied

[Continuous intravenous anesthesia in dogs using a combination of xylazine, ketamine and guaifenesin].

The tested anaesthesia through a permanent infusion of a xylazine, ketamine and guaifenezine (XKG) mixture was used in ten experimental dogs without clinical signs of a disease and in fifty two patients during different surgical interventions. After joint i.m. atropine (0.05 mg/kg) and xylazine (2 mg/kg) premedication, anaesthesia in dogs was induced by an i.v. administration of 1% ketamine at a dose of 2 mg/kg, and the XKG was infused instantly after the previous treatment. The mixture contained 2.0 ml of 5% ketamine and 1.25 ml of 2% xylazine added to 100 ml of 5% guaifenezine. The infusion was applied at a rate of 3.3 ml/kg for the first five minutes and then it was maintained at constant values of 2.2 ml/kg during the whole surgical intervention (Tab. I). The induction and course of anaesthesia, and waking up and recovery from anaesthesia were evaluated in all dogs, and the trias values were also followed. These additional parameters were followed in the test group: breathing volumes, ECG values and acid-base balance parameters were determined from the collected blood samples. The observation of measurable parameters (Figs. 1 to 5) and ECG analysis did not demonstrate any large departures from the starting values, and the changes in the acid-base balance (Tab. II) suggest the partly compensated respiratory acidosis. On the basis of our results, we can recommend this tested method for general anaesthesia particularly of dogs of larger breeds and for longer-lasting operations. This method is suitable to be used first of all in the veterinary establishments where inhalation anaesthesia is not practicable.

Anesthesia, General↗
PubMed1992

[Graphic evaluation of the significance band for hypercapnia in pulmonary disorders].

Alveolar hypoventilation due to the chronic obstruction of the airway such as pulmonary emphysema, or severe restrictive dysfunction due to sequela of pulmonary tuberculosis causes chronic hypercapnia (chronic respiratory acidosis). Ninety-five percentile of significance band of chronic and acute hypercapnia of both experimental and clinical setting is introduced in the graphic display of the acid-base balance. On acute exacerbation of these disorders, examination of arterial blood gas in series are usually plotted along the significance band of hypercapnia. With clinical improvement, the plot will gradually drop down to the chronic stable area of the band. Although cases with metabolic disorders complicate the interpretation, evaluation of the acid-base status using the graphic display will be of help at bedside assessment.

Bicarbonates↗
PubMed1992

[Acid-base disturbances in heart failure].

Disturbance in acid-base balance is commonly observed in patients with heart failure. The most common disturbance is metabolic alkalosis combined with hypokalemia, as a result of the excessive use of loop diuretics. Occasionary, hypoxia due to pulmonary edema stimulates ventilation, resulting in respiratory alkalosis. When pulmonary edema develops, carbon dioxide retention occurs, resulting in respiratory acidosis. Decreased tissue oxygen delivery may also produce lethal lactic acidosis. Compensatory mechanisms, coexistence of independent acid-base disorders and changes in electrolytes complicate acid-base balance in the individual patients. As acid-base disturbances have harmful effects on the cardiovascular system, precise diagnosis and proper treatment are highly important.

Acidosis↗
PubMed1992

The profile of ICU admissions for acute severe asthma in a general hospital.

The clinical profile of 22 patients admitted to the Intensive Care Unit of Alexandra Hospital over a 2-year period was studied. The mean age was 48.8 years with a majority in the older age group. The attacks leading to admission were generally rapid in evolution with 59% having symptoms for less than 12 hours and 84% for less than 24 hours. Most had a history of severe asthma, and of long duration. The pre-admission therapy had been suboptimal in the majority. Severe respiratory acidosis was a predominant feature. 68% were transferred to the ICU within one hour of arrival at hospital. Mechanical ventilation was required in 86.4% of cases, but the duration of ventilation was usually short. There was no serious complication due to barotrauma. Overall mortality was 23% (5/22). Problems in patient education remain a major hurdle in our attempt to reduce asthma mortality.

Adult↗
PubMedDate not supplied

[Assessment of pulmonary function of preterm newborn infants with respiratory distress syndrome at different positive end expiratory pressure levels].

OBJECTIVE: To verify the alterations of pulmonary function in preterm newborn infants with respiratory distress syndrome (RDS). The parameters analyzed were Dynamic Compliance (Cdyn), Inspiratory Tidal Volume (TVinsp), partial arterial pressure of carbon dioxide (PaCO2). METHODS: Eleven preterm newborn infants, with gestational age <35 weeks, and birth weight <2,500 g, were include in a control case study. All infants presented RDS and were treated with 120 mg/Kg of porcine surfactant. The initial positive end expiratory pressure (PEEP) was 3 cm H2O. A pneumotachograph with a graphical monitor was used to assess the pulmonary function. After each increase in the PEEP (4 and 6 cm H2O), there was an interval of 20 minutes before measuring the arterial data of pulmonary function and arterial gases. RESULTS: There were three males and eight females (1:2.7) among the infants with RDS. The mean gestational age was 30.78. +/- 2.05 weeks, ranging from 26 to 34 weeks. The increase in the PEEP from 3 to 6 cm H2O caused significant decrease in the TVinsp (6.46 +/- 3.43 to 4.20 +/- 2.35, P=0.0262). With the increase in the PEEP from 4 to 6 cm H2O, there was also a decrease in the TVinsp (5.98 +/- 3.33 to 4.20 +/- 2.35), (P=0.0044). Regarding the Cdyn, when there was an increase in the PEEP from 3 to 6 cm H2O, the reduction was statistically significant (0.58 +/- 0.27 to 0.46 +/- 0.25, P=0.0408) and from 4 to 6 cm H2O, the reduction in the Cdyn was also important (0.77 +/- 0.27 to 0.46 +/- 0.25), (P=0.0164). Increases in the PEEP from 4 to 6 cm H2O caused increases in the PaCO2 (52.81 +/- 15.49 to 64.90 +/- 12.69), (P= 0.0141). A more significant increase was observed when the PEEP was elevated from 3 to 6 cm H2O (41.45 +/- 7.87 to 64.90 +/- 12.69, P=0.0033). CONCLUSIONS: The study showed that the PEEP from 3 to 4 cm H2O produces better results in terms of Cdyn and less collateral effects regarding respiratory acidosis and pulmonary hyperventilation with impairment of the alveolar ventilation, evidenced by the increase in the PaCO2 and the decrease in the TVinsp.

English Abstract↗
PubMed1950

Biochemical alterations in acute human poliomyelitis electrolyte patterns and trends.

Pronounced alterations occur in the biochemical findings in acute poliomyelitis. These are derived from three major mechanisms: (a) inefficient pulmonary gaseous exchange, resulting in respiratory acidosis; (b) profound changes in nitrogen metabolism, resulting in decreased serum albumin, tissue destruction, and increased urinary nitrogen; (c) losses of electrolytes through extrarenal channels such as lung and tracheal secretions, sweating, and gastrointestinal disturbances. The extent of these alterations may be defined by appropriate serum and urinary biochemical determinations. These determinations are valuable both from a therapeutic and a prognostic standpoint. They also contribute to further understanding of physiologic and pathologic conditions in acute poliomyelitis.

Electrolytes↗
PubMed1992

[Cerebral blood flow dynamics in fetus].

In order to obtain quantitative data concerning the changes of fetal cerebral blood flow occurring in relation to hypoxia and acidemia, we evaluated correlations between fetal blood gases and blood flow velocity waveforms in fetuses. A total of 24 Doppler examinations were carried out to investigate the waveforms of middle cerebral and umbilical arteries in 17 intrauterine growth retardation (IUGR) fetuses. Within 24 hours after blood flow measurements, cordocentesis was performed and umbilical venous blood gases and pH were determined. There was a significant positive correlation between the gestationally adjusted resistance index value [delta SD (RI)] for middle cerebral artery and PO2 or pH, while a negative correlation was noted between the middle cerebral artery delta SD (RI) and PCO2. The umbilical artery delta SD (RI) and pH showed a negative correlation, but there was no correlation between the umbilical artery delta SD (RI) and PCO2 or PCO2. In the presence of partly compensated respiratory acidosis, the delta SD (RI) for middle cerebral artery was still high, while that for umbilical artery did not increase although PO2 was reduced. These findings suggest that blood flow changes in fetal middle cerebral and umbilical arteries are different in IUGR. Middle cerebral artery blood flow may respond directly to changes in PO2. Furthermore, fetal acid-base disorders may modify the relationship between blood flow changes and fetal PCO2.

Acid-Base Equilibrium↗
PubMed1992

[A case report of a 63-year-old patient with malignant hyperthermia].

We have experienced a case of fulminant malignant hyperthermia who was a 63-year-old female weighing 44 kg. There was no particular past history nor family history. She underwent right mastoidectomy because of chronic otitis media. Her preoperative physical status was ASA I. She was premedicated with diazepam 10 mg and loxatigine 75 mg P.O. The induction was done with thiamylal 200 mg IV and fentanyl 0.1 mg IV followed by vecuronium 6 mg IV for endotracheal intubation. Intubation was easy and uneventful. Anesthesia was maintained with nitrous oxide 3 l.min-1, oxygen 3 l.min-1 and enflurane 2.0%. Seventy min after the induction of anesthesia, arterial blood gas analysis showed severe respiratory acidosis (PCO2: 63.2 mmHg, pH: 7.27) and it was improved with manual hyperventilation at that time. Pulse rate increased from 80 to 115 b.p.m. 20 minutes later. Then, the patient was ventilated with 100% oxygen, and anesthetic circuits and machine were exchanged for new units. Surgery was postponed. Muscle stiffness of upper extremities was observed and her temperature increased to a maximum of 38.9 degrees C. Surface cooling was started and dantrolene sodium 60 mg and furosemide 20 mg were given intravenously. The patient was transferred to the intensive care unit, and clinical signs improved gradually within one hour. Serum enzymes; CPK, LDH, GOT and GPT increased on the first postoperative day. On the 11 th postoperative day skeletal muscle biopsy was done under local anesthesia with 1% procaine and Ca-induced Ca-release rate test revealed positive for enflurane. This is the oldest patient of malignant hyperthermia reported in Japan.

Anesthesia, Inhalation↗
PubMed1992

Cardiopulmonary, anesthetic, and postanesthetic effects of intravenous infusions of propofol in greyhounds and non-greyhounds.

The cardiopulmonary, anesthetic, and postanesthetic effects of an IV infusion of the hypnotic agent propofol were assessed in 6 Greyhounds and 7 non-Greyhounds. After IM injection of acetylpromazine and atropine, a bolus injection of propofol sufficient to allow endotracheal intubation (mean +/- SEM = 4.0 +/- 0.3 mg/kg of body weight in Greyhounds; 3.2 +/- 0.1 mg/kg in non-Greyhounds) was administered, followed by continuous infusion at a rate of 0.4 mg/kg/min for 60 minutes, during which time dogs breathed 100% oxygen. In 23% of all dogs (3 of 13), apnea developed after initial bolus administration of propofol. Arterial blood pressure was well maintained in all dogs, but heart and respiratory rates were decreased significantly (P less than 0.05) during the infusion in Greyhounds. In Greyhounds, mild respiratory acidosis developed after 45 minutes, whereas arterial carbon dioxide tension was increased at all times after propofol administration in non-Greyhounds. In all dogs, PCV and total plasma proteins were unaffected by propofol. Rectal temperature decreased during treatment. Muscle tremors were observed in approximately 50% of dogs (in 3 of 6 Greyhounds and 3 of 7 non-Greyhounds) during and after infusion of propofol. Non-Greyhounds lifted their heads, assumed sternal recumbency, and stood 10 +/- 1, 15 +/- 3, and 28 +/- 5 minutes, respectively, after the end of the infusion; in Greyhounds, the corresponding times were 36 +/- 4, 43 +/- 6, and 63 +/- 7 minutes.

Anesthesia, Intravenous↗
PubMed2005

The effect of propofol on acid-base balance and ionic composition of venous and arterial blood in goats.

The aim of the present study was to determine the effect of propofol on acid-base balance and ionic composition of arterial and venous blood in clinically healthy goats. The experiment was performed on ten adult goats. Propofol was administered intravenously at bolus dose of 6 mg/kg bw. The heart and breath rate, acid-base balance (pH, pCO2, pO2, HCO3-, BE, O2SAT, ctCO2) and ionic composition (Na+, K+, Cl-) of arterial and venous blood were measured before injection and 3, 6 and 15 min. after. The propofol infusion induced increase of heart rate, decrease of breath rate and compensated respiratory acidosis in venous and arterial blood. It was found that changes of acid-base balance parameters in arterial blood arose faster than in venous blood. The levels of sodium and chloride ions in both types of blood were similar, whereas the level of potassium ions was higher in venous blood during entire experiment.

Acid-Base Equilibrium↗
PubMed1992

[Spinal muscle atrophy in Brown Swiss x Braunvieh cross calves].

The report describes seven SMA-cases in descendents of crossbreeds of American Brown Swiss x Deutsches Braunvieh. Symptoms and course: After initially normal development of the calves for one to six weeks the disease set in suddenly followed by a rapid lethal course of one to one and a half weeks duration due to asphyxia and/or secondary diseases. Only one case was reported having been sick since birth (?). Characteristic signs were rapidly progressing muscular atrophy, paresis and paralysis of the limbs, the trunk and the diaphragm, usually accompanied by progressive dyspnoea. Signs of congenital neuromyodysplasia (arthrogryposis) of different degree were present in four of the seven calves. Six calves had contracted a secondary pneumonia. Blood gas analysis (6/7) revealed a compensated (1x) or decompensated (4x) respiratory acidosis. Neurohistological findings: Degeneration and loss of motor neurons in the ventral horns of the spinal cord and neurogenic muscular atrophy. Immunohistochemistry revealed a pronounced accumulation of type 200 kD-neurofilaments in perikarya and dendrites of ventral horn motoneurons indicating disturbed mechanisms of the axonal transport. The disease seems to be inherited as a recessive trait.

Animals↗
PubMed1992

[Use of xylazine and ketamine in the induction of halothane anesthesia in dogs].

Our experience of the administration of xylazine and ketamine for an induction of halothane inhalation anaesthesia in dogs is described in this paper. After this procedure had been evaluated in 10 test dogs, the xylazine-ketamine induction was used for different surgical interventions in 160 patients. After joint i.m. atropine (0.05 mg/kg) and xylazine (1.5-2 mg/kg) pre-medication general anaesthesia of the dogs was induced by an i.v. administration of 1% ketamine (2 mg/kg). After intubation and anaesthetizer connection halothane vapours had to be applied for 2 to 8 minutes at a 2.5% to 3.5% concentration to induce the tolerance stage of anaesthesia. Then the anaesthesia level was maintained by an application of halothane vapours at a 0.5 to 1.5% concentration (Tab. I). In addition to an evaluation of the anaesthesia proper, breathing-rate, inspiratory and expiratory volumes, internal body temperature were recorded, ECG was made and venous blood samples were taken to evaluate acid-base balance changes. The processing of the obtained data (Figs. 1 to 5, Tab. II) revealed a transient breathing attenuation after the xylazine-ketamine induction and partly compensated respiratory acidosis. On the basis of our results this tested method can replace the traditional thiopental induction associated with the risks of cardiopulmonary depression, or even blood circulation stoppage.

Anesthesia↗
PubMed1992

Meningitis in neonatal calves: 32 cases (1983-1990).

Case records of 32 neonatal calves with the antemortem diagnosis of meningitis were reviewed. Mean age at admission was 6 days (range, 11 hours to 30 days), and the most common concurrent clinical problem was diarrhea (16/32). Twenty-seven of the calves were available for necropsy. At postmortem, there was evidence of septicemia in 22 (81%) of these calves. Escherichia coli was the organism most frequently isolated (11/16; 69%) from the CNS. The major clinical signs of CNS disturbance observed over the course of hospitalization were lethargy, recumbency, anorexia, loss of suckle reflex, and coma. Leukocytosis and a left shift was evident in 11 of 15 (73%) calves. Concurrent metabolic problems that could have aggravated the CNS disturbance included hyperkalemia and respiratory acidosis. Analysis cerebrospinal of fluid from 22 of the calves, revealed pleocytosis, xanthochromia, turbidity, and high total protein concentration. Cytologically, neutrophils predominated in the CSF in calves with acute disease. Mononuclear cells dominated in calves with chronic disease. Microscopically, bacteria were evident in 10 of 22 (45%) of the antemortem CSF samples and bacteria were isolated from slightly more than half (11/19) of the specimens subjected to microbial culturing. Escherichia coli was the agent most frequently isolated from the CSF. Two of the 9 E coli isolates were resistant to trimethoprim potentiated sulfonamide drugs and all (4/4) of the CSF E coli isolates tested for susceptibility to triple-sulfonamide drugs were resistant. Twenty-seven of the 32 calves died or were euthanatized within 2.43 days after hospitalization.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2005

Renal vascular injury during percutaneous nephrolithotomy and migration of a double-J catheter fragment into pulmonary artery in the following nephrectomy--a case report.

A 60-year-old male underwent percutaneous nephrolithotomy (PCNL) for left renal stone at a community hospital. The surgery was, in general, unremarkable and a double-J ureteral catheter was placed before completion of surgery. Dyspnea, irritability, hypotension and flank pain developed in the recovery room. In addition, pleural effusion and elevation of the left hemidiaphragm were revealed on chest roentgenogram, and mild hypoxemia and respiratory acidosis were also detected by gas analysis. He was transferred to our hospital for further management. After arrival at our hospital, we decided to reintubate the patient and transfer him to the intensive care unit (ICU). There, the vital signs deteriorated, so an emergent laparotomy was performed and left nephrectomy was done because of severe and unmanageable renal hemorrhage. A catheter fragment was found to be missing after left kidney was dissected. During the search for the missing fragment, pulseless electrical activity (PEA) happened. The patient recovered shortly after the use of vasopressors. Postoperatively, a chest X-ray (CXR) taken to search for the missing section of the cather revealed that there was a catheter-like foreign body in the heart, which was also demonstrated by computed tomography (CT) scan. The catheter fragment was quickly removed soon via percutaneous angiography. The patient was discharged 2 weeks later. We present this case with two iatrogenic complications, each in two consecutive renal procedures, to emphasize the importance of vigilance in anesthesia.

Catheters, Indwelling↗
PubMed1991

[Search for early indications for reintubation after mechanical ventilation weaning of the newborn].

Early predictive factors for successful extubation were investigated, in order to determine the best moment for respiratory weaning of the newborn, and the risk of subsequent reintubation. PaO2/FiO2 ratio, PCO2 and respiratory rate were measured 2 h after extubation in 100 newborn infants. There was no statistically significant difference for the PaO2/FiO2 ratio and PCO2 between infants who were successfully extubated (group 1) and those who required subsequent reintubation (group 2). By contrast, the respiratory rate 2 h after extubation was significantly higher in group 2, and a respiratory rate greater than 70/min appears to be the earliest ventilatory modification predictive of the need for further mechanical ventilation before the occurrence of hypoxemia and respiratory acidosis.

Humans↗