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Effects of psychotropics on the periodic fluctuation in EEG synchronized with respiratory rhythms during cough reflex.

It is known that the psychotropics reduce the cough reflex. To clarify the relation between the higher centers and cough reflex, we investigated the psychotropics property of the respiratory periodic fluctuation in EEG during cough reflex and after administration of psychotropics. Male mongrel dogs immobilized were maintained with artificial respiration. The efferent activities of phrenic nerve and scalp EEG were recorded, and on the basis of the resulting observations, crosscorrelation coefficients were computed using a digital computer. The cough reflex was accompanied by an increase in crosscorrelation coefficient (C. C.) between EEG and phrenic nerve activities. the C. C. between EEG and phrenic nerve activities decreased after iv administration of chlorpromazine ( mg/kg), while administration of imipramine (1-3 mg/kg) and diazepam (1-3 mg/kg) increased the C. C., respectively. The increase in the C. C. observed during cough reflex was inhibited by iv administration of these three drugs. The fact that the C. C. increased during cough reflex suggested that the ascending output from respiratory center to the higher center reinforced during this period. Furthermore, it is suggested that the psychotropics inhibited the neuronal mechanisms of the brain stem that plays an important role in cough reflex by acting upon the feedback loop located between the respiratory center and the higher centers.

Animals↗

Effects of anesthetics and electrical stimulation on nigrostriatal dopaminergic neurons.

Induction of anesthesia with pentobarbital (40 mg/kg), urethane (1.8 g/kg), chloral hydrate (400 mg/kg) or ketamine (150 mg/kg) followed by a 20-min sham implantation of a bipolar electrode in substantia nigra fibers caused a marked, ipsilateral increase in caudate dihydroxyphenylacetic acid (DO-PAC). Conversely, no sham stimulation was found after gamma-butyrolactone (500 mg/kg) anesthesia or in a paralyzed, artificially respired preparation. By using gamma-butyrolactone anesthesia, the nigrostriatal fibers were electrically stimulated (25 Hz, 1.5 msec duration) at differing current intensities (40, 80, 100, 120 and 180 microA). The maximum increase in caudate DOPAC occurred at 120 microA. Electrical stimulation (100 microA, 25 Hz, 1.5 msec duration) in the paralyzed preparation yielded similar increases in caudate DOPAC. By using a 50% effective current (100 microA), variation of the frequency (5, 10, 25 and 125 Hz) produced a maximum in caudate DOPAC at 10 Hz. These data reveal an interaction between many anesthetics and physical disruption of dopaminergic neurons, as well as provide an in vivo model of stimulus-dependent dopamine release.

3,4-Dihydroxyphenylacetic Acid↗

[Perforation of the skull base during nasogastric intubation].

The skull base was perforated and extensive wounds occurred in the brain during the passage of a nasogastric tube on a 48 year old woman, under general anaesthetic. The patient was treated by artificial respiration but died on the 14th day. The site of entry was the sphenoid sinus. False passage of the tube was favoured by a marked septal deviation, underdevelopment of the turbinates, and a high-grade pneumatisation of the paranasal sinus. 10 more cases of intracranial passage of a nasogastric tube were found in the literature.

Adolescent↗

[Development of a s-IMV-technique for Bird apparatus (author's transl)].

We have developed our IMV-technique described previously to a s-IMV-technique. The principle of this s-IMV-technique is the following: it is necessary to equip two Bird Mark 7 machines with a special system of tubes. Then, an additional inspiratory volume is exactly given with the inspiration, triggered by the patient. for this purpose we constructed an electronic set which is able to recognize the spontaneous breathing of the patient by means of a thermistor and a bedside monitor. Then, more frequency variable inspiration volumes are applied exactly with the breathing of the patient. The adaptation of this apparatus to the patient is reached by impressing of a red stylus (on the left side of the Bird) by an electromagnet according to the inspiration of the patient. With this method it is possible to vary the treatment of patients with respiratory insufficiency, for instance, controlled artificial respiration, s-IMV up to spontaneous breathing. The F.I.O2 of the inspired gas can be chosen and lies between 9,21 and 1,0. CPAP and PEEP are possible.

Humans↗

Studies on bitolterol, di-p-toluate ester of N-tert.-butylarterenol: a new long-acting bronchodilator with reduced cardiovascular effects.

The bronchodilator activity of bitolterol, the di-p-toluate ester of N-tert.-butylarterenol (N-t-B) was evaluated by comparing it with the activity of the parent compound (N-t-B), isoproterenol and in some experiments with salbutamol in the anesthetized, open-chest dog maintained under artificial respiration. Bronchodilation was expressed as percent inhibition of the control bronchoconstriction induced by intravenous carbachol or histamine. At equiactive intravenous bronchodilator doses, the duration of action of bitolterol was 10 times that of N-t-B or isoproterenol. In the cardiovascular studies in anesthetized dogs, chronotropic, inotropic and blood pressure effects of bitolterol were markedly reduced relative to its bronchodilator effect. The bronchodilator/heart rate ratio for bitolterol was 22 times that of isoproterenol and 6 times that of N-t-B or salbutamol suggesting greater selectivity for beta2 adrenoreceptors for bitolterol. A good intraduodenal bronchodilator activity with a prolonged duration of action was obtained with bitolterol when compared with N-t-B and isoproterenol. The intraduodenal/intravenous bronchodilator dose ratio for bitolterol was 2 compared with 240 and 960 for N-t-B and isoproterenol, respectively. Bitolterol showed a significantly less (P less than .01) chronotropic effect than salbutamol at equibronchodilator doses (ED60) by intraduodenal or aerosol administration. A similar difference in chronotropic effect was observed in the unanesthetized dog. The prolonged bronchodilator effect of bitolterol was attributed to high concentration of the ester in lung tissues and to its slow hydrolysis, gradually releasing the active catecholamine, N-t-B.

Albuterol↗

Decreased heart rate variation in decerebration syndrome: quantitative clinical criterion of brain death?

Heart rate variation (HRV) was measured in 12 children with brain death. Computer analysis demonstrated an overall heart rate variation (RMSM) of 3.5 to 9.6 msec (mean, 6.0 msec). The respective figures for beat-to-beat variation (RMSSD) were 4 to 16 msec (mean, 7.7 msec). Normal infants (RMSM, 20 to 30 msec) and children (RMSM, 50 to 90 msec) and infants with respiratory distress syndrome (RMSM, 10 to 20 msec) have a clearly higher HRV than those with brain death. In all subjects a periodic component of the HRV with a cycle length of 5.9 +/- 0.26 seconds was discovered. In five patients an additional periodic component was found that corresponded exactly to the rate of artificial respiration. This study demonstrated the value of accurate digital techniques in the characterization of fixed heart rate in decerebration. This phenomenon could be considered one clinical criterion of brain death.

Adolescent↗

[The differential diagnosis of the unilateral by hyperlucent lung. Two case reports (author's transl)].

The "unilateral hyperlucent lung" is a roentgenologic diagnosis based on an increased radiolucency of one lung. Aetiology and pathogenesis of this clinical syndrome are discussed together with two own case reports about a 9-year-old girl and a 3-month old boy. Anamnesis, bronchography, scintigraphy and angiocardiography in the girl revealed a Swyer-James syndrome, where typically only one lung is damaged by obliterating bronchiolitis. In the patient the pulmonary changes developed subsequently to a measles-pneumonia, possibly enhanced by an additional pollinosis. The 3-month old infant had a left-sided pulmonary artery hypoplasia and obstructive bronchitis in both lungs. Up to its 7th month of life the child developed sufficiently under conservative therapy, but then a life threatening pneumonia with obstructive bronchitis and respiratory failure occurred, 3 weeks of artificial respiration were without success. The subsequent pneumectomy revealed a hypoplasia of the left lung and a big tracheal cyst as cause of the severe obstruction.

Age Factors↗

New theory of the development of myocardial infarction.

Solutions of KCl (1%, 10% and 31.2%) administered into the pericardial fluid or applied onto the surface of the heart evoked a dome-like change of the ECG in dogs, rats and guinea-pigs and led to myocardial infarction in 3-5 days. Both the acute changes in ECG and the infarction itself could be prevented by the application of pericardial fluid samples and by administration of three synthetic compounds onto the heart surface. The same substances also inhibited the development of ECG changes elicited by general hypoxia due to stopping artificial respiration. The existence of a peculiar myocardial space beginning with outer pores and reaching the myocardial cells through connective tissue pathways is postulated. Earlier studies showed that 125I-labelled albumin applied to the epicardial surface through a filter paper reached the endomyocardium through some intramyocardial pathways beginning with epicardial pores. In the present experiments intrapericardial application of India ink led to obstruction of these pores and thus prevented the infarction elicited by intrapericardial administration of KCl solutions. This space, being distinct from that accessible from the coronary arteries, serves for transfer of various substances into the myocardium, while other compounds (e.g. noradrenaline) are not effective through this pathway. Oxygen reaching this space from the epicardial surface protects the myocardium from the damaging effects of hypoxia and KCl.

Animals↗

[Impulse activity of hypothalamic neurons during asphyxia].

In immobilized cats, asphyxia produced biphasic changes of the impulse activity of hypothalamic neurons lasting 3--5 min: a short latency period was followed by an increase of firing rate and then gradual and complete disappearance of the discharges. The inhibition of the impulse activity was similar to that during cathodic depression. On the average, the impulse activity in asphyxia lasted during 171 +/- 14 sec in the posterior nucleus, 138 +/- 10 sec in the lateral nucleus, 144 +/- 10 sec in the ventromedial nucleus and 135 +/- 10 sec in the supraoptic nucleus of the hypothalamus. After renewal of artificial respiration the spike discharges reappeared.

Animals↗

[Legionnaires' disease in the Lake Zurich area. Report on 6 sporadic cases].

Six sporadic cases of Legionnaires' disease seen over 13 months in the region of Lake Zurich (Switzerland) are reported. The disease was severe in all cases; 2 patients died while on artificial respiration; 5 patients were heavy smokers; 3 had probably acquired the infection in France. These 6 patients showed the following typical symptoms and signs: fever above 39 degrees C (6 patients), nonproductive cough (4), gastrointestinal symptoms (4), encephalopathy (4), renal insufficiency (5), hepatic involvement (4), bilateral pneumonia (4), and pO2 below 60 mm Hg (4). The disease was diagnosed serologically in all cases and by staining and culturing Legionella pneumophila from lung tissue in one case. The authors propose to treat unusual cases of pneumonia with erythromycin from the outset.

Adult↗

[Rhinoplasty using controlled hypotension].

Hypotension, induced by NNP during simultaneous artificial respiration in intubated patients, has proved its usefulness, especially in plastic surgery of the nose and nasal septum. NNP has shown to be a hypotensive medicament, which is easy to control and in which no secondary effects have been demonstrated. The controlled hypotension with NNP requests an experienced anaesthesist and a careful examination and supervision of the patient.

Anesthesia, General↗

[Effect of 4-methyl-3-penten-2-one (1-phthalazinyl) hydrazone (budralazine) on intra- and extracranial circulation in cats (author's transl)].

Effects of budralazine, a new antihypertensive drug, on regional circulation in various sites of brain and extracranial skeletal muscle and skin in curarized, artificially respirated cats were studied using the thermoelectrical method. Budralazine produced an increase in blood flow in the cerebral cortex and hippocampus. Effects of the drug on blood flow in the hypothalamus and amygdala were inconsistent. Budralazine produced an apparent increase in muscular blood flow, whereas the drug did not consistently alter dermal blood flow. Budralazine produced a mild and sustained fall in blood pressure, particularly after the repeated administration. Thus, the action of budralazine seems to be mainly one of a smooth muscle relaxant effect. The mode of action of the drug seems to differ from that of papaverine or hydralazine.

Animals↗

[Effect of piracetam on the body's resistance to hypoxia].

Piracetam increases the animals' resistance to various types of hypoxia: hypoxic (placing of mice into a sealed chamber, switch off of an artificial respiration apparatus in curarized cats), circulatory (ligation of both carotid arteries in rats), and histotoxic (intravenous injection of sodium cyanide to cats). The drug does not exert protective action in cats, rats and mice with hemic hypoxia induced by injection of sodium nitrite.

Animals↗

[X-ray Investigations in Intensive Care Units. Development, Organization and Methods (author's transl)].

From special care following surgery and from artificial respiration of polio patients the modern and very special intensive medical care has developed. At the same time the provisional "bedside radiology" was improved to one branch of clinical radiology with special organisation and methods of investigation. Importance and urgency of radiological information are requiring close cooperation of all medical branches. Functions of these different groups have to be defined. The movable X-ray apparatus of 20 kV output is necessary for every intensive care unit. Hard beam technique for lung X-rays, scattered radiation grids and adequate positioning of the patient are important to get the same high quality are important to get the same high quality are important to get the same high quality pictures than from the radiological department.

Humans↗

[Effect of strophanthin and celanide on the dynamics of development of postischemic cerebrovascular phenomena].

In acute experiments on anesthetized cats with artificial respiration and isolated autohemoperfusion of the cerebral vessels by the pump of stabilized capacity (heparin was injected intravenously), cerebral ischemia was evoked by the stopping of the perfusion pump for 15 minutes. In the postischemic period (after perfusion resumption), 2 phases of the perfusion pressure (PP) changes were noted: at the beginning the PP lowering followed by the long-term increase (above the basic level). It is assumed that the PP changes reflect the time course of the development of suggestive postischemic cerebrovascular phenomena: hyper- and hypoperfusion. Preliminary intravenous injection (40-90 min before ischemia) of strophanthine and celanide (0.05 and 0.1 mg/kg) enhanced and extended the first phase and hampered the development of the second phase PP changes. Administration of strophanthine 90-120 min after ischemia (during the PP increase phase) did not alter the cerebrovascular resistance to the blood flow. Under these conditions the response of the cerebral vessels to strophanthine decreased as compared to that in intact (non-ischemized) cats.

Animals↗

Amoxicillin in paediatrics, with special reference to its excretion into bronchial secretion.

Pharmacokinetic examinations with amoxicillin in neonates and prematures are reported. Good values of up to 5 mcg/ml after 24 hours were achieved with two doses of 50 mg/kg amoxicillin daily. Amoxicillin was also found in the meconium, although quantities varied greatly. Amoxicillin is recommended for the treatment of disorders of the respiratory tract because of its good absorption, tissue penetration and tolerance. Examinations to assess the excretion of amoxicillin into the bronchial secretion were therefore carried out in 88 children in different age groups. Two artificial respiration bronchoscopies were carried out with an interval of 7 days, and the bronchial secretion collected and tested for organisms and for amoxicillin concentrations. After the first bronchoscopy, patients were given amoxicillin for 7 days, in doses of 125 to 750 mg t.i.d., corresponding to 40-100 mg/kg body weight. Some very high amoxicillin values were found, especially in those groups from whom the secretion was taken 2, 3, or 4 hours after the last amoxicillin treatment. The values were widely scattered. We recommended 50-100 mg/kg for broncho-pulmonary diseases.

Absorption↗

[Electrophysiologic study of somatic representation in Cavia cobaya guinea pig thalamus].

The effects of stimulation of the sciatic nerve and ipsilateral thalamic parafascicular nucleus on the thalamic posterior nucleus have been investigated by recording both the evoked potentials (EP) and neuronal activity in guinea pigs under light chloralose or nembutal anaesthesia. Animals were immobilized by d-tubocurarine and kept under artificial respiration. Widely spread EP to sciatic stimulation were recorded with a latency of about 10-60 ms. In most cases they had a positive-negative configuration which was followed by a secondary wave of a complex composition. Simultaneously recorded neuronal firings had a group character and primarily were related to the positive component or to the onset of the negative component of the EP. Both the EP and neuronal responses to stimulation of the parafascicular nucleus had mainly short latencies (3-12 ms) and monophasic negative configuration. The inhibitory effect of conditioning stimulation of the parafascicular nucleus on somatically evoked responses was demonstrated as well.

Animals↗