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Background and objective: Sevoflurane has been used for the induction and maintenance of anaesthesia during cardiac surgery owing to its favourable haemodynamic effects. It has been suggested that it offers protection against myocardial ischaemia-reperfusion injury. Methods: We investigated the effect of sevoflurane on plasma concentrations of tumour necrosis factor-α (TNF-α) after ex vivo stimulation of whole-blood leukocytes by lipopolysaccharide from 20 patients undergoing coronary artery bypass surgery. The patients were randomized to two groups. Group 1 patients were induced and maintained with sevoflurane; those in Group 2 were anaesthetized with moderate doses of midazolamsufentanil. Blood samples were drawn from the patients on seven occasions from before induction of anaesthesia until 24 h after skin closure. Results: Plasma concentrations of TNF-α were lower in Group 1 than in Group 2 after cessation of cardiopulmonary bypass (median (interquartiles): 25 (21-30) versus 37 (28-79) pg mL[sup -1]; P < 0.05) and 24 h after skin closure (196 (100-355) versus 382 (233-718) pg mL[sup -1]; P < 0.05). Postoperatively, two cases of myocardial infarction were recorded, one in each group. Six patients in Group 2 needed continued inotropic support after the first morning to maintain haemodynamic stability versus one patient in Group 1 (P < 0.05). The length of stay in the intensive care unit was significantly lower in Group 1 than in Group 2 (mean ± SD: 25 ± 16 versus 54 ± 30 h; P < 0.05). Conclusions: Sevoflurane reduces production of TNF-α more than total intravenous anaesthesia with midazolamsufentanil during cardiac surgery. This may reduce cardiac morbidity and the length of stay in the intensive care unit. [ABSTRACT FROM AUTHOR]

Investigates the different anesthetic techniques that alter the pro-inflammatory cytokine response to cardiac surgery. Effects of different anesthetic techniques on plasma levels of tumor necrosis factor, interleukin 6 and 8; Correlation between aortic clamping time and serum concentration of interleukin-6 and 8; Difference between the volatile induction and maintenance of the anesthesia methods.

A double-blind, placebo-controlled, clinical study was performed to assess the effects of oral betahistine hydrochloride (Serc) on mental impairment and physical disability in patients with established cerebrovascular disease. Fifty-three patients were admitted to the study during 18 months. Forty-five patients completed the study. They received either betahistine 24 mg daily or placebo for eight weeks. Clinical assessments of general functional activity were done and a battery of nine mental function tests was administered pretreatment and at two-weekly intervals during therapy. The results were analysed statistically using distribution-free tests. Significant differences were demonstrated between betahistine and placebo at week 8 of treatment for associate learning, digit retention, general knowledge, orientation, sentence learning and simple arithmetic. These differences were consistently in favour of betahistine at or close to the 5% level of significance. The results of the remaining mental function tests showed no significant differences between betahistine and placebo, but trends were in favour of the former. General functional activity assessments also demonstrated that betahistine-treated patients were significantly better than those on placebo (P less than or equal to 0.05). No untoward side-effects were noted during the study. [ABSTRACT FROM AUTHOR]

A study was carried out to test the hypothesis that chronic inflammation is associated with increased sensitivity or contractility of human airway smooth muscle. Bronchiolar strips from 30 patients, 12 of whom had chronic bronchitis, were examined in the organ bath for their responses to histamine, methacholine, and leukotriene (LT) C4. The same airways were also studied histologically and small airway disease was quantified by subjective grading of the degree of inflammatory cell infiltration, smooth muscle hypertrophy, fibrosis, and goblet cell hyperplasia. The degree of small airway disease varied widely among patients both with and without chronic bronchitis. Multiple regression analysis failed to show increased sensitivity (-log EC50) to histamine, methacholine, or LTC4 in relation to small airway disease. In contrast, the only significant correlations found were between a decreased -log EC50 to histamine and methacholine and an increased small airway disease score. Contractile responses (Tmax) to histamine and methacholine in peripheral airways tended to be higher in patients with chronic bronchitis than in those without. Tmax was not related to small airway disease scores. These results suggest that chronic airway inflammation does not cause in vitro hyperresponsiveness of human small airway smooth muscle. [ABSTRACT FROM PUBLISHER]

Based on data from the Dutch Central Bureau of Statistics, the impact of influenza on mortality In The Netherlands was estimated for a 22.5-year period (1967–1989) in four age groups and three entities of disease, using Poisson regression techniques. Our analysis suggests that, on average, more than 2000 people died from influenza in The Netherlands each year, but in only a fraction of these deaths was influenza recognized as the cause of death. For each case of death registered as caused by influenza (registered influenza mortality), 2.6 additional cases of death registered as due to causes other than influenza, nevertheless, were influenza-related (non-registered influenza mortality). Therefore, the overall impact of influenza on mortality is estimated to be greater than registered influenza mortality by a factor of 3.6. Those under 60 years of age accounted for 5% of all non-registered influenza deaths, whereas people aged 60–69, 70–79 years and >80 years accounted for 12%, 29% and 54% of such deaths, respectively. When extrapolating the figures for the Dutch population of 1989, we could attribute, on average per season-year, 82 deaths per 100000 people >60 years, 143 in people >70 years, and 280 in people >80 years. Of all non-registered influenza cases of death, 47% were estimated to occur in people with heart disease as a primarily reported cause of death, 23% in those with lung disease, and 30% in those with other diseases. This study stresses the serious effects of influenza, mainly in the elderly (95% of non-registered influenza mortality). Prophylactic measures (vaccination) should not only be stimulated among populations with defined underlying diseases, but generally among all people ≥60 years. Future research should address the pathological mechanisms which lead to influenza-related excess mortality. [ABSTRACT FROM PUBLISHER]

Analysis of the literature shows that dissemination of choroidal melanomas generally occurs after the 7 mm diameter stage, that doubling times of uveal melanomas vary from 30 to 365 days, and that death from metastases occurs 30-40 doubling times after dissemination. Tumour related death within three years after therapy is caused by pre-existing metastases. Survival rates for less than four years after therapy are therefore irrelevant in evaluating the efficacy of therapeutic regimens. Considerably higher postirradiation than postenucleation death rates after a mean 10-year follow-up period have been reported, and this difference can be explained by a reported mean clinical tumour regression rate of 31% two years after irradiation and histopathological studies which revealed that 42 out of 43 irradiated melanomas contained viable tumour, while only 50% showed necrosis. The doubtful value of preserving vision does not justify the high risk of avoidable death from metastases in irradiated patients. [ABSTRACT FROM PUBLISHER]

Protection against influenza after killed influenza spray vaccine was assessed in nine double blind, placebocontrolled clinical trials and two field studies, involving a total number of 10,000 subjects. Monovalent vaccine, containing 300-360 IU A/Hong Kong/1/68 (H3N2) or bivalent vaccine, containing 300-360 IU A/Aichi/2/68 (H3N2) and 200-240 IU B/Mass/3/66 per dose was used. Administration by the intranasal route appeared to be acceptable as an alternative to the parenteral route. The protective efficacy found was comparable with that attained after parenteral vaccination. It has, however, the advantages of a characteristic lack of side-effects and of the fact that no injection is involved. This will probably enhance the acceptance of influenza immunization by the population and thus lead to a higher vaccination rate in the communities we want to protect against influenza. [ABSTRACT FROM PUBLISHER]