Anaesthetic technique for transvenous pulmonary embolectomy.

Transvenous pulmonary catheter embolectomy is being used as a method of treatment for patients suffering from massive pulmonary embolism. The anaesthetic management of these patients can be complex. Presented is a case of transvenous pulmonary embolectomy in a patient who also had an intravascular volume deficit secondary to haemorrhage and possible reperfusion oedema.

Effect of eucapnic hypoxia on bronchomotor tone and on the bronchomotor response to dry air in asthmatic subjects.

Because hypoxia has been shown to cause bronchoconstriction and to potentiate bronchomotor responsiveness in animals, we investigated whether hypoxia has similar effects in subjects with asthma. We measured specific airway resistance (SRaw; the mean of 5 sequential readings taken 30 s apart) before and immediately after each of 15 asthmatic subjects breathed a mixture of 8% O2 in N2 until hemoglobin saturation (SaO2; by ear oximetry) fell to 80% or less for at least 2 min. We maintained end-tidal CO2 at resting levels, the temperature of the inspirate at 22.

Purification of gelatin-specific neutral protease from human skin by conventional and high-performance liquid chromatography.

Human skin, maintained in serum-free organ culture, secretes a neutral metalloendopeptidase which is remarkably specific for gelatin. Because the product peptides from the action of collagenase on collagen become denatured into random coil polypeptides of 25000 and 75000 daltons at physiological temperature, it is thought that this "gelatinase" is the second, and possibly the only other enzyme in the pathway of extracellular collagen degradation. New types of high-performance liquid chromatography (HPLC) columns have enabled us to improve the yields of active gelatinase from skin culture medium.

Nitroglycerin-controlled circulation in orthognathic surgery.

Significant blood loss is a potential complication of maxillary osteotomies and maxillary and mandibular osteotomies. Controlling circulation by lowering blood pressure is a technique that has been used successfully to avoid this problem. Of the various agents available, nitroglycerin was chosen because of its known beneficial cardiovascular effects and its lack of toxicity as compared with sodium nitroprusside.

Density gradient study of bronchial mucus aspirates from healthy volunteers (smokers and nonsmokers) and from patients with tracheostomy.

Because it is difficult to obtain, little is known of bronchial mucus from the normal human airway; it has been mainly studied as sputum expectorated in chronic bronchitis with particular attention to epithelial glycoprotein. We have now applied density gradient methods to study this and other macromolecules and lipids in normal airway mucus. After lavage at bronchoscopy, mucus was aspirated from six normal volunteers, that include one light and two heavy smokers.

Correlation of allergy test results obtained by IgE FAST, RAST, and prick-puncture methods.

Prick skin testing and IgE FASTTM results were compared in eight atopic patients, using a comparable class system. Identical results were found in 53.5% of the cases; a total of 85.

Patient-initiated autonomous pacemaker tachycardia.

Multiparameter programmable DDD pacemakers are said to have an uncountable number of possible parameter combinations. It is probable that a number of these combinations, particularly when triggered by one or more critically timed native events, will result in bizarre and unanticipated rhythms sustained entirely within the timing circuit of the pulse generator. We report the occurrence and analysis of one such rhythm termed a sustained autonomous pacemaker tachycardia.

Isolated regional perfusion; anaesthetic technique, monitoring and blood replacement.

Isolated regional perfusion for the treatment of malignant melanoma is an accepted method of treatment. No standard of anaesthetic practice has been established for those individuals. Perioperative records of patients undergoing isolated limb perfusion were studied to determine adequate blood replacement.

Morphologic correlation of physiologic changes caused by SO2-induced bronchitis in dogs. The role of inflammation.

Chronic bronchitis was induced in 6 mongrel dogs by exposure to SO2 gas for 6 to 18 months. All of the dogs developed cough and mucus hypersecretion. Chronic airway obstruction and decreased airway responsiveness to inhaled histamine developed in 5 of the dogs.

Generalized dominant epidermolysis bullosa simplex: decreased activity of a gelatinolytic protease in cultured fibroblasts as a phenotypic marker.

To characterize biochemical traits associated with various forms of epidermolysis bullosa (EB), we used skin fibroblast cultures to measure a gelatin-specific neutral metalloprotease. Compared to normal cultures, levels of this gelatinase were 7-fold decreased in cell cultures from 3 patients from 3 kindreds with generalized dominant EB simplex of the Koebner type (DEBS-K) (p less than 0.001).

Retinoic acid inhibition of collagenase and gelatinase expression in human skin fibroblast cultures. Evidence for a dual mechanism.

Human skin fibroblast cultures have been employed to study the effects of a variety of vitamin A analogues (retinoids) on the expression of two enzymes involved in collagen degradation in the skin, collagenase and a gelatinolytic protease. In normal and recessive dystrophic epidermolysis bullosa fibroblast cultures, retinoic acid compounds were effective inhibitors of the accumulation of both enzymes in the culture medium with half-maximal inhibitions occurring at 0.25-1 microM for collagenase and at 3-6 microM for the gelatinolytic protease.

Regulation of gelatinase in human skin organ cultures by glucocorticoids.

Hydrocortisone and dexamethasone prevent the appearance of gelatinase in serum-free explant cultures of normal human skin. Hydrocortisone inhibits maximally at 10(-6) M and dexamethasone at 10(-8) M in culture medium. Glucocorticoids at these concentrations do not cause a generalized decrease in protein synthesis; thus the effect on gelatinase shows specificity.

Regulation of gelatinase in human skin organ cultures by glucocorticoids.

Hydrocortisone and dexamethasone prevent the appearance of gelatinase in serum-free explant cultures of normal human skin. Hydrocortisone inhibits maximally at 10(-6) M and dexamethasone at 10(-8) M in culture medium. Glucocorticoids at these concentrations do not cause a generalized decrease in protein synthesis; thus the effect on gelatinase shows specificity.

Assessment of atrial capture in committed atrioventricular sequential (DVI) pacing systems.

Two patients with committed dual unipolar AV sequential pacing systems are presented in whom atrial capture was unable to be demonstrated on the surface electrocardiogram. The bedside examination is proposed as a means of identifying the presence or absence of atrial capture with subsequent confirmation by M-mode echocardiographs and jugular venous pulse tracings. Mode, rate, and output programmability may aid in the evaluation of these pacing systems.

Histamine contamination of pokeweed mitogen.

The histamine content of commercial preparations of pokeweed mitogen was measured by amino acid analysis technique, automated fluorometry, and bioassay employing the guinea pig ileum. Ten samples from 5 companies were examined and found to contain between 0.026 micrograms and 167.

Changing specialties: do anesthesiologists differ from other physicians?

Career choices of physicians frequently change after senior year in medical school. Although previous studies have documented the magnitude of these changes, they contain no information concerning anesthesiologists. Changes in specialties of 1151 physicians, graduates from the same medical school, between the years 1968 and 1976 were studied.

Inhibition of collagen degradative enzymes by retinoic acid in vitro.

The effects of a variety of retinoids on collagenase and gelatinase expression have been examined in skin fibroblast cultures derived from normal volunteers and from patients with the hereditary blistering disorder, recessive dystrophic epidermolysis bullosa. Both 13-cis- and all-trans-retinoic acid were effective inhibitors of collagenase production in both cell types. In the case of collagenase, the inhibition of collagenase activity was paralleled by a reduction in immunoreactive enzyme protein, suggesting that these retinoids act by inhibiting synthesis and/or secretion of the enzyme.

Arterial and venous dilation by nitroprusside and nitroglycerin--is there a difference?

Whole-body arterial and venous dilating properties of nitroprusside and nitroglycerin were compared with each other in 20 adult patients during cardiopulmonary bypass for coronary artery bypass or valvular heart surgery and were compared with simultaneous forearm vascular measurements. Nitroprusside was found to be a more effective whole-body arterial vasodilator and nitroglycerin a better whole-body venous vasodilator when each drug was infused at rates of 1.5 and 2.

Purification and properties of a gelatin-specific neutral protease from human skin.

A neutral protease with a marked specificity for gelatin as a protein substrate has been purified to homogeneity from medium of human skin in serum-free explant culture. The pH optimum of this gelatinase is between 7.0 and 7.

Autonomic hyperreflexia during upper extremity surgery.

A case is presented of autonomic hyperreflexia in a quadriplegic patient occurring during upper extremity surgery. Tourniquet ischaemia is proposed as the likely causative stimulus. An understanding of the afferent neural pathways involved in this physiological response may be useful in better understanding the subjective phenomena of tourniquet pain in neurologically intact individuals.