[Withdrawal of chronic mechanical ventilation at home: coordination, organisation and implementation].

In the Netherlands, an increasing number of patients are dependent on domiciliary ventilation. General practitioners and elderly care physicians caring for these patients are increasingly confronted with problems related to chronic ventilation. Most patients die due to progression of respiratory failure, however, patients may ask their physician to electively withdraw their assisted ventilation.

The Genetic Background of Neonatal Disease.

More than 27,000 human genes have been sequenced and described. Only a few of these genes are relevant for common human diseases with regard to diagnostic or therapeutic purposes. This review describes the genetics of common traits and diseases with a particular focus on perspectives for drug discovery and drug therapy in neonates.

Pneumothorax as a complication of lung volume recruitment.

Lung volume recruitment involves deep inflation techniques to achieve maximum insufflation capacity in patients with respiratory muscle weakness, in order to increase peak cough flow, thus helping to maintain airway patency and improve ventilation. One of these techniques is air stacking, in which a manual resuscitator is used in order to inflate the lungs. Although intrathoracic pressures can rise considerably, there have been no reports of respiratory complications due to air stacking.

Treatment of respiratory impairment in patients with motor neuron disease in the Netherlands: patient preference and timing of referral.

Background And Purpose: We assessed the first evaluation at a large ventilation clinic in the Netherlands to: (i) determine what proportion of patients with motor neuron disease would benefit from earlier referral; and (ii) examine the patient preferences regarding ventilatory support.

Methods: Observational study at a single centre with a catchment area of 7.6 million inhabitants.

[Lung volume recruitment in impending respiratory failure].

Lung volume recruitment can improve peak cough flows and respiratory compliance in patients who either do or do not require mechanical ventilation. There are several lung volume recruitment techniques: air stacking, glossopharyngeal breathing and mechanical insufflation-exsufflation with cough assist devices. The principle of lung volume recruitment is based on the insufflation of air in the lungs after maximal inspiration.

[Obesity hypoventilation syndrome--serious but reversible providing weight is lost].

Obesity hypoventilation syndrome (OHS) is a condition in which obesity and chronic hypoventilation during waking hours are combined. Patients with OHS are more likely to be hospitalized and to require intensive-care monitoring compared with patients with similar degrees of obesity without hypoventilation. Treatment with chronic non-invasive positive pressure ventilation (NPPV) is associated with a lower morbidity and mortality.

Vocal cord dysfunction in amyotrophic lateral sclerosis: four cases and a review of the literature.

We describe 4 patients with amyotrophic lateral sclerosis (ALS) and glottic narrowing due to vocal cord dysfunction, and review the literature found using the following search terms: amyotrophic lateral sclerosis, motor neuron disease, stridor, laryngospasm, vocal cord abductor paresis, and hoarseness. Neurological literature rarely reports vocal cord dysfunction in ALS, in contrast to otolaryngology literature (4%-30% of patients with ALS). Both infranuclear and supranuclear mechanisms may play a role.

[Amyotrophic lateral sclerosis: mechanical ventilation--or not right?].

In two patients (men aged 64 and 62 years, respectively) with amyotrophic lateral sclerosis (ALS) tracheostomy ventilation was initiated following (imminent) acute respiratory failure; in one patient this was done because advance directives were lacking, while in the other non-invasive ventilation (NIPPV) was no longer an option. A third ALS patient, a woman aged 36 years, already had chronic respiratory failure when she presented at the local centre for home mechanical ventilation. As a result, the placement of a percutaneous endoscopic gastrostomy (PEG) was impossible.

Phosphane-Free Palladium-Catalyzed Coupling Reactions: The Decisive Role of Pd Nanoparticles.

Nanosized palladium colloids, generated in situ by reduction of Pd(II) to Pd(0) [Eq. (a)], are involved in the catalysis of phosphane-free Heck and Suzuki reactions with simple palladium salts such as PdCl(2) or Pd(OAc)(2), as demonstrated by transmission electron microscopic investigations.

Osmotic stimulation of pepsin secretion in the rat.

The effect of the osmolarity of intragastric instillates on pepsin secretion was studied in rats anaesthetised with urethane. Irrigation of the stomach with solutions of sucrose and NaCl, resp. caused a concentration-dependent increase in pepsin output.

Action of phenylisopropyl-adenosine (PIA) on the synthesis of corticosterone in rats.

The effects of the stereoisomers of phenylisopropyl-adenosine (l- and d-PIA) were studied on the synthesis of corticosterone in rats in vivo and in rat adrenal slices in vitro. In vivo l- and d-PIA elevated plasma corticosterone level in normal but not in dexamethasone-pretreated rats. l-PIA was at least 20 times more active than d-PIA.

Stimulation of adenylate cyclase of guinea pig gastric mucosa by histamine, sodium fluoride and 5'-guanylylimidodiphosphate and inhibition by histamine H1- and H2-receptor antagonists in vitro.

There are experimental data indicating that cyclic AMP is involved in the regulation of gastric acid secretion in various mammalian species. In a broken cell preparation of guinea pig gastric mucosa the effects of some stimulants of gastric acid secretion on the activity of adenylate cyclase were studied. The basal adenylate cyclase activity was 483 +/- 43 pmoles cyclic AMP/mg protein x 10 min.

Effects of cimetidine on adenylate cyclase activity of guinea pig gastric mucosa stimulated by histamine, sodium fluoride and 5'-guanylylimidodiphosphate.

Cimetidine, a recently developed histamine H2-receptor blocking agent has been shown to be a potent inhibitor of histamine-stimulated gastric acid secretion in rat, cat, dog and man. To study the mode of action of cimetidine the modification of stimulatory effects of histamine, sodium flouride and 5'-guanylylimidodiphosphate by cimetidine on the adenylate cyclase activity of guinea pig gastric mucosa was studied. The effect of cimetidine was also compared to that of metiamide, an older histamine H2-receptor antagonist.

Actions of various methylxanthines and papaverine on the synthesis of corticosterone in vitro.

Actions of various methylxanthines (theophylline, theobromine, caffeine) and papaverine, i.e. drugs which are known to inhibit phosphodiesterase (PDE), were studied on the basal and stimulated synthesis of corticosterone in vitro by using rat adrenal slices.

Stereospecificity in some central and circulatory effects of phenylisopropyl-adenosine (PIA).

The effects of l- and d-stereoisomers of phenylisopropyl-adenosine (PIA) were tested on the central nervous and circulatory system. In mice l-PIA in doses of 0.1--0.