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PubMed1990

[The first lung transplantation in The Netherlands; a brief report].

In September 1989 the first unilateral lung transplantation in The Netherlands was performed on a woman with chronic total respiratory failure due to a concentric constrictive form of obliterating bronchiolitis. The transplantation was right-sided. Total duration of operation was 7 hours; the ischaemia time of the donor lung amounted to 108 minutes. Postoperatively artificial respiration was applied for a long time. No severe infections or rejection signs occurred. The transplanted lung fairly rapidly took over perfusion and ventilation.

Adult↗
PubMedDate not supplied

[The effect of bonnecor on cardiac hemodynamics, blood supply and function in experimental myocardial ischemia].

The effect of a new antiarrhythmic drug bonnecor on the hemodynamics, blood supply and function of the ischemic heart as compared with the famous antiarrhythmic drugs lidocaine and ethacizine was studied in the experiments on anesthetized animals (rats, dogs) under artificial respiration. It was shown that bonnecor administered in a dose of 0.5 mg/kg was able of relieving disturbances of the cardiac hemodynamics and function produced by occlusion of the coronary artery. The drug exerted no significant effect on the blood supply to the focus of acute and chronic myocardial ischemia.

Animals↗
PubMed1989

[The relationship between pilocarpine induced autonomic ganglia stimulating activity and salivary secretion of submandibular gland in pithed rat].

Superior cervical ganglion (SCG)-mediated effect of Pilocarpine (pilo.) on salivation of the rat submandibular gland was investigated. A total of 32 SD male rats, aged 12 weeks was divided into 4 experimental groups I to IV. They were anesthetized by pentobarbital (75 mg/kg, i.p.) and tracheotomized to allow artificial respiration. These rats were then ectomized only right SCG, leaving left SCG and injected with pilo. (8 mg./kg, i.v.). Rats of group I which were treated in the manner stated above were used as a control. Rats of group II and IV, of which adrenal glands were removed 18 hr before, were pithed 20 min before the injection of pilo. Rats of group III and IV were administered hexamethonium (C6) (1 mg/kg, i.v.). 5 min before the injection of pilo. Saliva from groups I to IV were collected separately from both salivary glands and flow rate of saliva were measured. Concentration of Na and K were also measured and total amounts of Na and K were calculated. 1) The flow rate induced by pilo. showed a tendency of increase in SCG-ectomized rats. 2) The flow rate showed also a tendency of increase in pithed rats. 3) The concentration and total amount of protein in saliva were decreased by SCG-ectomy. 4) The concentration of K was decreased in only SCG-ectomized rats whereas the total amount of K was closed in group I and II in spite of pithing and/or SCG ectomy. This reduction in K concentration seems to be caused by the increased flow rate as mentioned in paragraph 1). 5) SCG stimulating effect by pilo. was not antagonized, but rather activated by C6. 6) Submandibular ganglion-stimulating effect of pilo. was revealed in group III receiving C6, but this effect was extinguished in pithed rats of group IV. Considering of these results, it is proposed that SCG-stimulating ability of pilo., as shown previously by others, would be caused by activation of M1 receptor, which has sympathetic nerve stimulating effect on salivary glands, and may modify the salivation induced by stimulating effect of pilo. on M2 receptor. Moreover, results obtained with group III suggest that pilo. has submandibular ganglion-stimulating activity, although it's detailed mechanism is unknown.

Animals↗
PubMed1989

[Accidental drowning with extreme hypothermia--rewarming with extracorporeal circulation].

A 3 1/2 year old boy had fallen into a fishpond. After about one hour the boy was brought to our hospital. He was cyanotic and bloated, the rectal temperature was 18.4 degrees C. There was no heart beat, the pupils were wide without reaction to light. Via a sternotomy the heart lung machine was connected and core rewarming was achieved. After 7 days of artificial respiration the boy could be extubated, after 16 days the boy left our hospital without neurological consequences.

Acid-Base Equilibrium↗
PubMed1989

[The effect of electrical stimulation of the head of caudate nociceptive neuronal activities in the mesencephalon reticular formation and its relation to the acupuncture effect].

38 rabbits were anesthetized with chloralose and urethane. As soon as the animal recovered its consciousness it was immobilized with flaxedil and artificial respiration. The electrical activities of the nociceptive neurons were recorded by glass microelectrodes (tip 1-3 microns) in the ranges P7-11 R2-3 HO+1-6, with the aid of a stereotaxic apparatus. 116 of the nociceptive units responded to noxious stimuli which applied to the peroneal nerve with a short train of pulses. Among them, 64 units (55%) responded by an increase in frequency of the discharge to noxious stimuli (pain-excitation neuron, PEN). In contrast, there were 52 units (45%), which responded to noxious stimuli quite differently, by having a decrease in the frequency of the discharge (pain-inhibition neuron, PIN). Similar results were obtained by the stimulation of the head of caudate nucleus with the same train of pulses: an excitatory effect was observed in PEN, and an inhibitory effect in PIN. However, after electroacupuncture by penetrating acupoint "Hegu" or dolantin given intravenously, under the same conditions used above. We again stimulated both the head of caudate nucleus, eliciting an inhibitory effect on PEN. And a reduction of inhibition or release from it on PIN. From the results presented, it indicated that head of caudate nucleus was connected with the modulation of the nociceptive neuronal activity in M.R.F. and was related to the effect of acupuncture. The effect of atropine on the head of caudate nucleus stimulation.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

[A case of the successful surgical treatment of mediastinal giant neurogenic tumor, and the chest wall reconstruction by the autologous ribs].

A mediastinal tumor, particularly a neurogenic tumor, sometimes develops into a giant tumor; this large tumor mass then puts pressure on the heart and lungs, and may cause severe complications. In our department, 164 mediastinal tumors were experienced, the largest one was an intrathoracic fibromyoma which weighed 3,760 g. This report deals with our recent experience in which we found a neurogenic tumor weighed out 4,500 g. This tumor was excised in an emergency operation, after which the patient's life was saved by twenty-two days of artificial respiration. Since this tumor was so large, four entire right ribs had to be removed in order to create enough space to excise it. In order to reconstruct the chest wall, three of the removed ribs were retransplanted in their original sites. An extremely good prognosis resulted.

Adult↗
PubMed1989

[Thoracic trauma in the pre-hospital phase].

Preclinically relevant injuries of the thorax are described patho-physiologically. The diagnosis at the scene of accident and the treatment of the emergency of the functional after-effect injury are described. Respiratory insufficiency requires early artificial respiration. A pneumothorax should be drained, at least, on the respired patient. If there is a pneumothorax associated with tension due to the confined air, the relief would be obligatory. The relief should take place after the digital opening of the thorax by silicon drainage. If there is a mediastinal emphysema with a seriously haemodynamic effect, the relief would be indicated by collar mediastinostomy. If there is a pericardium tamponade with circulatory collapse after a perforating trauma, the patient must be brought to the medical attention of a surgeon as quickly as possible. The delay in time must not be the consequence of the relief of puncture. If a person injured in an accident who has a rupture of the trachea can not be respired immediate exposure of the rupture site is imperative. Resuscitation measures in case of an injured thorax must be done at the opened thorax.

Emergencies↗
PubMedDate not supplied

Photo-evoked eyelid microvibration in newborn infants and children--reflex arc and maturational change.

We studied maturational process of the photo-evoked eyelid microvibration (PEMV) in 166 newborns, 72 children and 10 adults free of any neurologic disorders. The results indicate that the latency of PEMV shortens during growth due to the myelination of the nerve fibers of the involved pathway. Age-related normal values were established. The pathway of PEMV probably consists of retina, optic nerve, pretectum, facial nerve, and orbicularis oculi muscle. We also evaluated the effect on this reflex of retinoblastoma, facial nerve paralysis, holoprosencephaly anomalad, and a muscle relaxant used for artificial respiration in respiratory distress syndrome.

Blinking↗
PubMed1989

[Three cases of chronic respiratory failure].

Three patients with chronic respiratory failure of various etiology, who have (had) been in the hospital for some years, were presented. The case 1 is male and was 57 years old on admission. He has been suffered from right thoracic emphysema from October '83, which is under chronic infection of Pseudomonas aeruginosa, with bronchial fistula and aortic valve insufficiency. His pulmonary function is severely restrictive and the grade of his dyspnea has been V of Hugh-Jone's criteria and he is now unable to leave from bed. The case 2 is male and was 41 y.o. on admission. He has been ill with diffuse cystic bronchiectasis from 33 y.o. and bronchorrhea (greater than 200 ml/day) with chronic infection of Pseudomonas aeruginosa has been lasting and recurrent attacks of infection have progressively worsened of his pulmonary and cardiac functions. He is now indispensable to assist ventilation by artificial respirator every 2-3 days. The case 3 was male and 27 y.o. on admission. He had admitted because of severe dyspnea due to familial pulmonary fibrosis on August '86. His disorder had been progressive and resistant against repeated corticosteroid therapy. He died of respiratory failure at 30 years old. The transplantations of lung and heart-lung for critical patients with respiratory failure have been challenged in North America and Europe, but in Japan, many social and medical problems about transplantation have yet been unresolved. The indications for and against lung or heart-lung transplantation to these three patients was discussed with reference to English literatures.

Adult↗
PubMedDate not supplied

[Variations in the internal pressure of the pneumatic cuffs of endotracheal tubes according to their contents and the anesthetic mixtures used. Experimental study].

With the purpose of measuring pressure changes in the pneumatic cuffs of endotracheal tubes when the composition of the mixture of gases used for ventilation had to change for the same content, we designed a model of artificial respiration that consisted of a tube with a low pressure pneumatic cuff measuring 8.5 mm in inner diameter introduced in a replica of a human trachea, adjusted to two anesthetic bags. The cuff valve was connected to a pressure transducer by a three-ended stopcock and, after aspiration of its content, it was inflated with air, saline or nitrous oxide and oxygen at 60% up to a basal pressure of 20 mmHg. The tube was connected to a respirator adjusted to inflate 10 l/min at a rate of 15 insufflations/min of: oxygen 100% for 5 minutes, then nitrous oxide and oxygen at 60% for 30 minutes and oxygen 100% again for 15 minutes. When inflating the pneumatic cuff with air and ventilating with nitrous oxide and oxygen at 60%, its pressure reached a maximum mean value of 58 mmHg (190% with respect to base values). When insufflating with saline and ventilating in the same conditions, pressure reached a maximum mean value of 33 mmHg (65% with respect to base values). When the pneumatic cuff was inflated with nitrous oxide and oxygen at 60%, important changes in pressure were observed when the characteristics of the inspired gases were modified. We conclude that some method for monitoring pneumatic cuff pressure should be systematized.

Anesthesia, Endotracheal↗
PubMedDate not supplied

Repetitive electrical stimulation of X-area and parabrachial lateral nucleus: effects upon ponto-geniculo-occipital activity in the reserpinized cat.

The ponto-geniculo-occipital (PGO) activity is a characteristic field potential of paradoxical sleep, that can be continually induced by reserpine administration. It has been postulated that the X area (XA) and parabrachial lateral nucleus (Pbl) contain the generator cells for the PGO activity. In this study, repetitive electrical stimulation in the XA and Pbl was applied, with the aim of inducing progressive plastic changes in PGO activity, which was recorded from the lateral geniculate nucleus (LGN). Reserpinized cats were used; they were curarized and maintained with artificial respiration. We analyzed the PGO spike frequency at one, five and sixty minutes after stimulation, which was given every 30 minutes for at least 8 consecutive hours. Stimulation of the XA did not produce changes, while that of the Pbl induced a relatively poor progressive increment in the PGO spike frequency. The findings obtained with XA stimulation discard the possibility of inducing functional plastic changes in this region. On the other hand, the response to Pbl stimulation indicates an activation of the PGO spike generator system. These differences suggest that these nuclei have different influence on PGO activity, although it is possible that the responses found in the Pbl were indirect effects, given its anatomical relationships.

Animals↗
PubMedDate not supplied

The inductorium: the stimulator associated with discovery.

The inductorium, or induction-coil stimulator, introduced in the late 1830s, provided a means for obtaining repetitive stimuli; thereby allowing the discovery of new properties of excitable tissues. Major physiologic discoveries with the inductorium were tetanic contraction of skeletal muscle, inhibition of the heart, the role of vasomotor nerves, and cortical localization. In the hands of clinicians, it was used to diagnose neuromuscular disease and to produce artificial respiration with body-surface electrodes. Because of the historical importance of this tool, its characteristics are described quantitatively. Although it is no longer used, it has a secure place in the history of biomedical instrumentation.

Biomedical Engineering↗
PubMed1989

[Pressure waves induced by electrical stimulation of upper pons and lower midbrain in dogs with experimental subarachnoid hemorrhage].

Neurogenic mechanisms of pressure waves were investigated by means of electrical stimulation of the upper pons and the lower midbrain of 32 dogs in which subarachnoid hemorrhage had experimentally been made. The dogs were slightly anesthetized, immobilized and artificially respired. After subarachnoid infusion of red blood cells, continuous recordings of systemic blood pressure (SBP), intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were made simultaneously. At the stage of increased ICP, pressure waves were induced by electrical stimulation of the upper pons and the lower midbrain from 6 to 12 mm rostral to external auditory meatus. Stimulation parameters, i.e., intensity, duration and frequency, were kept constant at 0.1 mA, 1 msec and 40-50 Hz, respectively, throughout experiments. The induced pressure waves were classified into three types: fast, slow and plateau waves. Fast waves had a duration of 10-30 sec, being associated with a marked increase in SBP. They were induced by stimulation of 41 points in various portions of the pontine and mesencephalic tegmentum. Slow waves had a duration of 30 sec to 3 min, being associated with no change or a decrease in SBP. They were induced by stimulation of 12 points in the rostral pontine reticular formation and the mesencephalic reticular formation. Plateau waves had a duration of 3 min or more, being associated with no change or a decrease in SBP. They were induced by stimulation of 2 points in the mesencephalic reticular formation 2 mm lateral to the red nucleus, where slow waves had been induced at the early stage.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1989

[Role of rostral ventrolateral medulla in the pressor response to intracerebroventricular injection of neostigmine].

Experiments were carried out on 47 urethane-chloralose anesthetized and flaxedil immobilized rabbits under artificial respiration. Intracerebroventricular injection (ICV) of neostigmine (100 micrograms/200 microliters) caused a marked increase in blood pressure (BP), left ventricular pressure (LVP) and renal sympathetic nerve discharge (RND), while femoral blood flow (FBF) and conductance (COND), were decreased and the heart rate (HR) was initially reduced and then slightly increased. Microinjection of atropine (0.25 micrograms/site) into the rostral ventrolateral medulla (rVLM) caused a decrease in BP, HR, RND and LVP and a increase in FBF and COND. Pretreatment of atropine injection into rVLM before ICV of neostigmine blocked the pressor response of neostigmine. These results indicate that rVLM is important for the pressor response to ICV neostigmine, which may be mediated via cholinergic muscarinic receptors in rVLM.

Animals↗
PubMed1989

[The supracardiac type of total anomalous pulmonary venous return in a ten-day-old neonate: report of a successfully treated case].

A case of a ten-day-old neonate weighing 3,867 g with the supracardiac type of total anomalous pulmonary venous return (TAPVR) is reported. The preoperative diagnosis was determined mainly by digital subtraction angiography. Surgical correction was carried out in this patient as an emergency operation. Under cardiopulmonary bypass on beating which required 3 hours and 7 minutes, anastomosis between the common pulmonary vein and the left atrium, ligation of both the anomalous vertical vein and the persistent ductus arteriosus, and closure of the atrial septal defects were successfully performed. Postoperatively cardiac failure was markedly improved, although 5 days were required for the weaning from the artificial respirator. The angiographic and hemodynamic examinations showed a complete repair of TAPVR. At present, 2 months after the operation, the patient shows an average development.

Female↗
PubMed1989

[Vena cava thrombosis: a rare complication in changing a central venous catheter].

Two cases of complete thrombosis of the superior vena cava are reported as rare complication of changing a catheter in heavily traumatised patients. Thromboses are frequent findings in pathological and radiological examinations, but clinically they become manifest only rarely. If a disease takes a severe course, thrombogenic factors may accumulate. Attention is drawn to the risk implied in changing a catheter especially in situations of marked cardiovascular depression, artificial respiration with a high positive end-expiratory pressure (PEEP) and if there are changes in coagulation physiology. These possible risks must be taken into consideration when performing a routine change of catheters.

Adult↗
PubMed1985

Possible mechanisms by which repeated clozapine administration differentially affects the activity of two subpopulations of midbrain dopamine neurons.

Extracellular single-cell recording techniques were employed to study the mechanism of action of repeated oral clozapine administration on the in vivo spontaneous activity of substantia nigra (A9) and ventral tegmental area (A10) dopamine (DA)-containing neurons in the rat. Clozapine was observed to affect DA neurons differentially within these two regions when compared to haloperidol. Acute treatment (1 hr) with both drugs increased the number of spontaneously firing neurons in both A9 and A10. Chronic (21 day) treatment with haloperidol decreased the number of cells encountered in both regions, whereas repeated treatment with clozapine reduced the number of DA cells per track only in A10. In all cases, the silent DA neurons were inferred to be in a state of depolarization inactivation since they could be induced to discharge normally by the microiontophoretic application of the inhibitory neurotransmitter gamma-aminobutyric acid. These effects were not due to an effect of chloral hydrate anesthesia since they were also observed in gallamine-paralyzed, artificially respired animals. Chronic co-administration with haloperidol of either an anticholinergic (trihexyphenidyl) or the alpha 1-norepinephrine (NE) receptor antagonist, prazosin, but not an alpha 2-NE antagonist, RX781094, resulted in a differential effect on A9 and A10 DA neurons identical to that observed with repeated clozapine administration alone. Thus, chronic treatment with these combinations of drugs resulted in the depolarization inactivation of only A10 cells. These data suggest that anticholinergic and/or alpha 1-NE-blocking properties of clozapine may, in part, mediate its differential effects on A9 and A10 midbrain DA neurons.

Anesthetics↗
PubMed1985

[Value of the injury severity score (ISS)].

The injury severity score (ISS) has been most widely accepted as a practicable method of classifying traumatised patients (ie., patients with accident injuries) according to the severity of their injuries, and has become more popular than all other comparable classification systems. By allocating the patients to different severity groups, it facilitates their classification in respect of prognosis. Over and above this, it enables comparison of patient groups of different hospitals. The authors investigated the validity of ISS classification by studying the case records of 432 patients in a traumatological intensive-care ward. They found good correlation between ISS score on the one hand, and lethality, requirements of banked blood during first-aid care and duration of treatment and artificial respiration of survivors on the other. However, the mean survival time of those patients who had died, did not reveal any connection with the severity of the injury. It is definitely impossible to arrive at any prognosis for an individual patient on the basis of his ISS classification. With increasing age, lethality after an accident increases even if the injury is less severe. The validity of ISS could be increased further if the age of the patients could be taken into account as well.

Adolescent↗