Immunoglobulin A levels in bronchial samples during mechanical ventilation and onset of nosocomial pneumonia in critically ill patients.

Local immunoglobulins play a key role in host defense against lung infection. We investigated the pattern of evolution of bronchial albumin, IgA, and IgG levels in ventilated ICU patients in relation to nosocomial pneumonia. Immunocompetent, critically ill patients underwent serial blood and bronchial protein determinations on Day 1 (intubation day), and on Days 3, 7, 10, and 14.

Effects of topical benzocaine and lignocaine on upper airway reflex sensitivity.

We studied the degree and duration of effect on upper airway reflex sensitivity of oral benzocaine lozenges, nebulised lignocaine and lignocaine sprayed onto the vocal cords under direct vision, using low concentrations of ammonia as a stimulus to upper airway receptors. Ten minutes after the administration of oral benzocaine 20 mg the threshold response of the upper airway to ammonia (NH3TR) had risen significantly from baseline mean (SEM) of 680 (95) to 975 (109) ppm of ammonia with a return to baseline values after 25 min (n = 8, p < 0.05, repeated measures of ANOVA; p < 0.

Effects of morphine on human nasal cilia beat frequency in vitro.

Using human nasal cytological brushings, we have investigated the effects of morphine on ciliary function by measurement of cilia beat frequency in vitro, and we have also determined opioid receptor binding in these specimens. We obtained ciliated samples from seven volunteers, and measured cilia beat frequency using the transmitted light technique during exposure to morphine 10 mumol litre-1 for 4 h. Mean cilia beat frequency of the samples exposed to morphine was 11.

Effects of 3 MAC of halothane, enflurane and isoflurane on cilia beat frequency of human nasal epithelium in vitro.

We have measured the effects of three times the minimum alveolar concentration (MAC) of halothane, enflurane and isoflurane on cilia beat frequency of human nasal epithelial brushings from 18 healthy adult patients. Using the transmitted light technique and paired perfusion chambers, the cilia were exposed to 2.25% halothane, 5% enflurane or 3.

A perfusion system for in vitro measurement of human cilia beat frequency.

We have designed and built a perfusion system and perfusion chamber to allow investigation of the effects of anaesthetic agents on human cilia in vitro. Using this system, samples of human respiratory cilia can be maintained in a stable and controlled environment for several hours. We measured cilia beat frequency of nasal respiratory epithelium from 10 healthy volunteers; cilia beat frequency was constant over a 4-h period, and measurements were found to be in good agreement with previously published work [1].

Metaphyseal dissociation fractures of the proximal tibia. An analysis of treatment and complications.

A study was done of 44 metaphyseal dissociation fractures of the proximal tibia in 42 patients (27 men and 15 women, aged 22 to 77 years; mean, 42 years). Follow-up ranged from 6 months to 4 years. There were 2 study groups: a retrospective group (group 1, 22 fractures) given a variety of treatments ranging from casts to dual plates, and a prospective group (group 2, 22 fractures) treated by combining external fixation and optional minimal internal fixation.

A combined high frequency oscillator and intermittent positive pressure ventilator.

A high frequency oscillator and its interface with the Siemens 900C ventilator form a combined high frequency oscillator and intermittent positive pressure ventilator. This combined high frequency ventilator is designed for use in selected cases of refractory hypoxaemia.

Kinetics of elimination and acute consequences of cerebral air embolism.

The pathophysiology of arterial air embolism inducing brain injuries remains unclear. Previous experiments demonstrated the usefulness of computed tomography (CT) in the detection of air emboli in canine brain. This canine study investigates CT's ability to detect small air bubbles and to determine the kinetics of air elimination from cerebral arteries and its relationship with clinical, electroencephalographic (EEG), and histological manifestations.

Anaesthesia for a patient with tracheobronchomegaly (Mounier-Kuhn syndrome).

Tracheobronchomegaly is a rare condition in which anaesthetic experience is limited. Patients with tracheobronchomegaly are at risk of large airway collapse and obstruction, aspiration pneumonitis and tracheal trauma following airway instrumentation. We describe our anaesthetic technique and problems encountered during nephrectomy in a patient with this condition.

Arthroscopic resection of dorsal ganglion of the wrist.

In summary, arthroscopic resection is a reasonable approach for operative treatment of the dorsal ganglion. Arthroscopy is safe and addresses the key anatomic pathology. Recurrences to date have been equal to or less than with the open technique.

Sleep-related respiratory disturbances in patients with Duchenne muscular dystrophy.

Sleep-related respiratory disturbances (SRD) in patients with muscle diseases may have significant clinical implications, because the patients frequently die at night. The aims of the study were to :1) assess the presence and severity of sleep-related respiratory disturbances in patients with Duchenne muscular distrophy (DMD); and 2) investigate the relationship of sleep-related respiratory disturbances to daytime symptoms and pulmonary function. We studied six clinically stable patients with Duchenne muscular dystrophy, mean age (+/- SD) 18 +/- 2 yrs.

Randomised trial of preventive nasal ventilation in Duchenne muscular dystrophy. French Multicentre Cooperative Group on Home Mechanical Ventilation Assistance in Duchenne de Boulogne Muscular Dystrophy.

Duchenne muscular dystrophy (DMD) is the most common muscular dystrophy in children. Paralysis of respiratory muscles causes a decrease in forced vital capacity (FVC) from age 12 years, and death occurs between 20 and 25 years old and is usually related to respiratory insufficiency. Uncontrolled studies suggest that early home use of nasal intermittent positive-pressure ventilation (NIPPV) in DMD patients free of respiratory failure could limit progression of the restrictive syndrome and therefore improve survival because efficacy of preventive NIPPV has not been demonstrated in a controlled trial, we undertook a randomised multicentre study in which 70 patients with DMD were included.

Effects of the cervical collar on cerebrospinal fluid pressure.

We investigated the hypothesis that cervical collars might compress the internal jugular veins and raise intracranial pressure in head-injured patients. In a randomised, single-blind, crossover study of nine patients scheduled for elective spinal anaesthesia the cerebrospinal fluid pressure in the lumbar subarachnoid space was measured with and without a 'Stifneck' cervical collar applied. There was a significant elevation of cerebrospinal fluid pressure in seven of the patients studied when the cervical collar was applied (p < 0.

Effects of mechanical ventilation with normobaric oxygen therapy on the rate of air removal from cerebral arteries.

Objective: We conducted the current study to evaluate the removal rate of air embolism from cerebral arteries after spontaneous breathing at a low FIO2 in comparison with mechanical ventilation at an FIO2 of 1.0.

Design: Randomized, experimental trial.

[Evaluation of hospital care. An experiment at the Public Assistance Hospitals in Paris].

Since 1990 the Assistance Publique--Hôpitaux de Paris (AP-HP) developed a policy of health care assessment in agreement with the implications of the law of July 31, 1991. The department of Evaluation of health care, in close collaboration with the local Committees which operate in most of the hospitals of AP-HP, performed during the last three years about fifty studies dealing with two main topics: professional procedures and quality of care. Through three specific selected studies, the authors emphasize the requirements of an assessment policy to efficiently contribute to the improvement of quality of care.

Improving the induction characteristics of methohexitone. A study of the effect of adding thiopentone to methohexitone.

A double-blind, randomised, controlled study was undertaken to investigate the effects on injection pain and excitatory phenomena of adding thiopentone to methohexitone. One hundred and twenty unpremedicated, day-case patients received one of four induction regimens: unmodified 1% methohexitone, or a mixture of 2.5% thiopentone and 1% methohexitone in ratios of 1:1, 1:3 or 1:9 by volume.

Antiemetic efficacy of prophylactic ondansetron in laparoscopic surgery: randomized, double-blind comparison with metoclopramide.

In a randomized, double-blind study, we have compared the prophylactic antiemetic efficacy of ondansetron with that of metoclopramide in 123 patients undergoing general anaesthesia for day-case gynaecological laparoscopic surgery. The patients received either i.v.

Combined high frequency ventilation in the management of respiratory failure in late pregnancy.

We describe a pregnant patient with respiratory failure due to an atypical pneumonia and asthma that was successfully treated with the combination of high frequency oscillatory ventilation and intermittent positive pressure ventilation. This combined high frequency ventilatory technique is not commonly used in adults with respiratory failure and is largely contraindicated in patients with prolonged respiratory time constants such as occurs in asthma because of the risk of gas trapping. We suggest that this technique be considered in cases of respiratory failure refractory to conventional intermittent positive pressure ventilation and, that with appropriate monitoring of airways pressure, is worthy of a trial in patients with prolonged respiratory time constants.

Plasma exchange morbidity in Guillain-Barré syndrome: results from the French prospective, randomized, multicenter study. The French Cooperative Group.

Objectives: To describe all adverse events occurring during plasma exchange sessions in adult patients with the Guillain-Barré syndrome. To analyze these events with regard to the technical modalities and biological changes induced by sessions, and to try to identify a population at high risk for adverse events.

Design: Double-blind, randomized, prospective, multicenter trial.