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Introduction Compte-tenu des risques hemorragiques, nous avons reevalue le benefice de la ponction-biopsie renale (PBR) realisee pour insuffisance renale aigue (IRA) avec diminution preexistante du debit de filtration glomerulaire (DFG). Description Etude retrospective evaluant l’impact des PBR analysables, realisees pour IRA dans notre centre hospitalier du 1/11/2007 au 31/12/2020 (n = 402). Methodes Analyse statistique en univariee puis multivariee par regression logistique (Epi-Info version 7.2.2.6), des facteurs de risque (FDR) de mortalite et de recours a l’epuration extra-renale (EER) a 3 mois et 1 an. Classification stades IRA selon KDIGO, DFG de base disponible estime en CKD-EPI (MRC+ si Resultats Au 15/06/2021, pronostic a M3 recueilli pour 402 PBR, 379 a 1 an. Ratio sexe masculin/feminin 224/178, âge moyen 63,6 ans (15-96). 95 MRC+. 227 KDIGO3 (56,5 %) dont 88 en EER au diagnostic (M0). 48 sejours en reanimation. Mortalite a M3 : 9 % (36/402), FDR independants : âge, KDIGO3, cirrhose. Incidence d’EER a M3 : 14,7 % (59/402). Au stade KDIGO3 : MRC+ associee a une incidence accrue d’EER a M3 (39,6 vs 20,1 % p Fig. 1 ). FDR d’EER a M3 : KDIGO3 (OR = 12,3), EER a M0 (OR = 6,2), lesions de Fibrose Interstitielle Atrophie Tubulaire > 25 % (OR = 2), lesions aigues (OR = 0,3), nephrite interstitielle aigue (NIA, OR = 0,07), MAT (OR = 3,3). Survie sans dialyse a 1 an : 70,5 % (267/379), facteurs predictifs durant le sejour hospitalier initial : lesions aigues (OR = 3,5), EER a M0 (OR = 0,5), KDIGO3 (OR = 0,2), MRC + (OR = 0,3), syndrome nephrotique (OR = 0,4), transfusion erythrocytaire (OR = 0,5). Conclusion Nous confirmons l’interet de la PBR dans la prise en charge de l’IRA, impliquant l’instauration d’une therapeutique specifique pour 1/3 des biopsies analysees. Elle reste pertinente meme en cas d’insuffisance renale preexistante, par sa valeur pronostique, et son impact therapeutique.

Introduction La prevention optimale des complications post-PBR en insuffisance renale aigue (IRA) reste a definir. Description Analyse retrospective d’un registre monocentrique de biopsies de reins natifs realisees du 1/11/2007 au 12/06/2020 (n = 727) : facteurs de risque (FDR) d’echec, complications hemorragiques (C+) et transfusion erythrocytaire durant le sejour : caracteristiques clinicobiologiques, temps de saignement, perfusion de Minirin, technique de reperage, voie transjugulaire (TJ). Methodes Analyse univariee puis multivariee en regression logistique (logiciel EPI-INFO). Resultats Incidence d’echec en percutanee de 4,9 % (echographie 5,5 % vs TDM : 1 %), en diminution depuis 2016 (2,5 vs 6,7 %, OR = 0,3 p 85 kg (OR = 2,5), IRC (OR = 2,5), reperage TDM (OR = 0,1), operateur (> 200 PBR) (OR = 0,3), annee 2016 et apres (OR = 0,4). Incidence de C+ plus elevee en cas d’IRA : 8,9 vs 4,4 % (echecs et TJ exclus, OR = 2,1, p 70 ans (OR = 2,3), cirrhose (OR = 5,6), prelevement comportant de la medullaire en microscopie optique (OR = 2,9), poids FDR de recours a une transfusion erythrocytaire : âge > 70 ans (OR = 2,6), C+ (OR = 4), Hb pre-biopsie 14 jours (OR = 2,5), hemopathie (OR = 2,3). Temps de saignement (TS) non correle a la survenue de C+ mais associe a la prescription du Minirin pour 65 biopsies : 3 C+, toutes avec TS > 9 minutes. Conclusion Nous confirmons l’incidence accrue de complications post-PBR dans le contexte d’IRA. Sa severite (KDIGO3 + hemodialyse) augmente le risque d’etre transfuse. Notre etude nous permet d’envisager des mesures preventives en fonction des FDR mis en evidence : TDM (si FDR d’echecs), ameliorer le reperage (ponctions medullaires), Minirin ou voie transjugulaire pour les biopsies a risque hemorragique.

This article explores the implications of presenting a medical humanities curriculum in a virtual format, using as a model a fully online humanities course taught in both traditional 15-week and accelerated 5-week formats. The course explores narrative competency and allows baccalaureate students to deepen their practical skills with increased awareness of narrative constructions. The online course design fosters growth in many areas of communication that have otherwise been absent in face-to-face courses taught by this educator. In the virtual format, students showed increased investment in the course content and an openness to communicating their experience as well as to critically challenging their colleagues on narrative-based dilemmas, such as those centered around building empathy, remaining nonjudgmental when challenged with ethical dilemmas, and awareness of signs within themselves of disengagement and burnout.Keywords: medical humanities; narrative medicine; baccalaureate nursing education; online learningAlthough a great deal of literature explores the implications of cultural awareness, critical thinking, and narrative discourse in online humanities curricula within baccalaureate foundations courses, there is little academic precedent for the practi- cal implications of online narrative courses focused on medical humanities. Many graduate programs in these studies require seat-time and face-to-face meetings. The paucity of programs offering narrative medicine online speaks to the very valid hes- itation many scholars might feel about presenting such contextually charged and discussion-intensive content in the virtual landscape.When I was approached about writing a curriculum for a fully online elective course in storytelling in health care, I was intimidated by the format. Like many educators new to the virtual classroom, I worried that face-to-face interaction was necessary to process course content and that my students could not learn narrative discourse in a format that by its nature confined and contained expression.What I learned in the time that I have taught a fully online narrative-based humanities course astounded me: Students endeavoring to practice a narrative style of health care can be fully involved in learning and can challenge one another while never actually meeting face-to-face.COURSE DESCRIPTIONThe course, called Telling the Stories of Medicine, was designed as an upper division humanities elective for the undergraduate nursing program at Pennsylvania College of Health Sciences (2013) in Lancaster, Pennsylvania. The course description reads:This course builds narrative competencies to inform communication between health care professionals and patients while providing creative resources for workplace challenges. Narrative arts will help to facilitate empathy in clinician/ patient interaction. (p. 90)As hospitals embrace relationship-based care and reimbursement hangs in the balance, an appreciation of narrative in health care practice is more relevant than ever before. Therefore, all course objectives focus on applying critical thinking and personal reflection to the construction, evaluation, and analysis of various narra- tive forms. The goal is a new appreciation for and fuller understanding of narra- tive in students' clinical practices.The three major course assignments, aside from participation in discussion forums which accounts for 20% of the final grade, include a literary analysis, a case study based on a personal experience with a patient or family member, and a visual narrative using VoiceThread that focused on a reflective or analytical theme within health care.The online components of the course were designed to reflect the online course design and the implementation standards of the Quality Matters Program (2010), with the ultimate goal of creating an enriching and dynamic virtual classroom that would promote achievement of the learning outcomes. …

Introduction La vitamine C est un antioxydant facilitant l’incorporation du Fer, pouvant ameliorer la synthese d’hemoglobine en hemodialyse chronique, diminuant le stress oxydatif de l’inflammation. La correction de sa carence frequente en hemodialyse chronique peut diminuer les besoins en EPO et en fer, mais l’interet de son depistage et de sa correction systematique compte tenu du risque d’hyperoxalemie reste a demontrer. Patients et methodes Etude prospective sur 3 mois realisee de mai a septembre 2017 chez tous les prevalents hemodialyses chroniques du centre hospitalier de Bethune apres recueil du consentement eclaire. Dosage a M0 : vitamine C et oxalemie. Recueil sur 3 mois : hemoglobinemie, bilan martial, Ca/P, CRP et evaluation des consommations d’EPO et en Fer injectable. Controle a M3 : taux de vitamine C et oxalemie apres supplementation. Protocole de supplementation : 250 mg IV/seance pendant 1 mois, puis 500 mg PO/seance pendant 2 mois. Criteres d’exclusion = deja supplemente dans les 6 mois precedent le debut de l’etude, refus de traitement. Resultats Sur 82 patients prevalents de notre centre, 8 patients avaient un critere d’exclusion. Soixante-neuf patients (âge moyen 73 ans) ont pu beneficier des mesures a M0 : 65 etaient carences, 64 inclus (1 refus de traitement) : 34 hommes, 30 femmes. A 3 mois : 5 deces avant M3, 1 greffe, 7 transferts hors centre, 2 prelevements ininterpretables. L’efficacite de la supplementation a pu etre evaluee pour 57 patients : 11 patients encore carences a M3, 34 patients (60 %) ont eu une reponse jugee positive (baisse de la consommation d’EPO et/ou de Fer IV). La tolerance clinique a ete bonne. L’incidence de l’hyperoxalemie augmentait significativement a 3 mois (47 % vs 18 %). La valeur initiale du taux de Vitamine C etait inversement correlee (p Discussion L’absence d’amelioration des patients potentiellement les plus carences pourrait s’expliquer par un contexte inflammatoire plus marque (necessitant une augmentation de posologie ?). Conclusion Notre etude confirme la frequence des carences en vitamine C, et l’interet potentiel d’une supplementation systematique sur la diminution des besoins en EPO et/ou en Fer injectable. Le risque a long terme de l’hyperoxalemie chronique et du taux serique au depistage restent encore a evaluer.

This study was designed to determine if soluble Tie2 (sTie2) expression inhibits and regresses corneal neovascularization, and if VEGF contributes to its effect. The corneas of BALB/c mice were scraped and the mice were injected with either an adenovirus expressing soluble Tie2 (Ad.sTie2) or an empty adenoviral vector. When injected at the inhibition timepoint (one day prior to corneal injury), the mean percentage of neovascularized corneal area two weeks later in Ad.sTie2-treated mice vs. controls was 56.37+/-9.15% vs. 85.79+/-3.55% (p=0.04). At the regression timepoint (4 weeks after corneal scrape), the mean area of corneal neovascularization in Ad.sTie2-treated mice was 42.89+/-4.74% vs. 75.01+/-3.22% in the control group (p=0.007). VEGF expression was significantly higher in Ad.sTie2-treated mice at the inhibition timepoint and there was no significant difference at the regression timepoint. These findings suggest that sTie2 inhibits and regresses corneal neovascularization in a VEGF-independent manner.

Hereditary non-polyposis colorectal cancer (HNPCC) is one of the most common inherited cancer syndromes, accounting for 3-5% of all cases of colorectal cancer. In most HNPCC families, the disease is caused by a germline mutation in MLH1 or MSH2. In some populations, founder mutations appear to explain a substantial fraction of HNPCC. We report here the identification and preliminary characterization of two putative MLH1 founder mutations. The mutation MLH1c.1831delAT was shown to segregate in two Quebec families of Italian origin who fulfilled the Amsterdam criteria for HNPCC. Haplotype analysis using five intragenic microsatellite/single nucleotide polymorphism markers spanning MLH1 on chromosome 3 showed that these two unrelated families share an identical haplotype. In addition, two other Italian kindred whose affected members carry MLH1g.IVS6 + 3A>G also share a common haplotype, suggesting that, similarly, the latter mutation has a common origin. These mutations are the first putative founder MLH1 mutations to be identified in HNPCC kindred of Italian origin.

There has been interest in the literature in the possible existence of a gene that predisposes to both breast cancer (BC) and colorectal cancer (CRC). We describe the detailed characterisation of one kindred, MON1080, with 10 cases of BC or CRC invasive cancer among 26 first-, second- or third-degree relatives. Linkage analysis suggested that a mutation was present in BRCA2. DNA sequencing from III: 22 (diagnosed with lobular BC) identified a BRCA2 exon 3 542G>T (L105X) mutation. Her sister (III: 25) had BC and endometrial cancer and carries the same mutation. Following immunohistochemical and microsatellite instability studies, mutation analysis by protein truncation test, cDNA sequencing and quantitative real-time PCR revealed a deletion of MSH2 exon 8 in III: 25, confirming her as a double heterozygote for truncating mutations in both BRCA2 and MSH2. The exon 8 deletion was identified as a 14.9 kb deletion occurring between two Alu sequences. The breakpoint lies within a sequence of 45 bp that is identical in both Alu sequences. In this large BC/CRC kindred, MON1080, disease-causing truncating mutations are present in both MSH2 and BRCA2. There appeared to be no increased susceptibility to the development of colorectal tumours in BRCA2 mutation carriers or to the development of breast tumours in MSH2 mutation carriers. Additionally, two double heterozygotes did not appear to have a different phenotype than would be expected from the presence of a mutation in each gene alone.

Summary There have been several studies of the possible association between oral lichen planus and chronic liver disease; however, aside from various Italian reports no consistent association has been observed. In the present study, frequencies of historical, physical and biochemical evidence of liver disease in 180 UK patients with oral lichen planus were compared with those of 25 disease control patients and 25 healthy controls. No significant association between oral lichen planus and chronic liver disease; however, aside from various Italian reports no consistent

A case study is presented in which a patient received magnetic resonance (MR) imaging of the brain 3 months prior to a severe traumatic brain injury (TBI). The post-TBI MR findings are compared and contrasted with the pre-TBI MR images. The posltraumatic changes demonstrate a significant dilation of the ventricular system which reflects diffuse axonal injury and loss of brain substance. Correspondingly, the neuropsychological studies in this individual reflect global deficits which match the nonspecific, traumatically induced degenerative changes found in the postinjury MR scan. This case study is unique in that specific preinjury MR findings are available for direct comparison and quantitative analysis of TBI-associaled changes in brain structure with neuropsychological outcome.

The Tréstina bronzes have been known about since 1897/1907, when they were found in a site near Città di Castello (Umbria), near the border with Tuscany; they are at now in the Archaeological Museum in Florence. Over the years many authors (M. Pallottino, P. Amandry, L. Banti, M. Gras) have devoted attention to what was generally considered "a hoard", stressing its peculiar stylistic character; it was alleged to be "Urartian", on account of the masterly technique employed in the fashioning of the bronze and iron tripod-stand, whose reconstruction, by the late Clelia Laviosa and Antonella Romualdi, was displayed in a major exhibition held in 2000 at the Museo Civico Archeologico in Bologna, "Principi Etruschi, tra Mediterraneo ed Europa". This paper aims at presenting, briefly from the archaeological aspect, and more thoroughly from the technical and analytical points of view the Tréstina bronzes: not a hoard, and probably not Urartian, nonetheless they are of the greatest interest for the technical skill employed in casting bronze animal's heads and feet on the iron structure of the tripod-stand. Besides, the find includes about 40 more pieces, among which four griffin's heads, probably pertaining to another cauldron, two pairs of appliqués of Etruscan (Chiusi) style, "Cypriot" handle attachments, basins fragments, six "Rhodian" handles, a pair of horse-bits, four conic helmets and a Corinthian one, pieces of furniture, axes, etc., all made of bronze and dating, as a whole, from VII-VI century BC. The scientific investigations mainly aimed at understanding the fabrication technique of the tripod stand and identifying its constituent parts. Non-destructive X-ray fluorescence and atomic spectroscopy analyses proved a reasonable compositional homogeneity within the pieces supposedly pertaining to such a complex object, whereas significant differences were observed with all the other pieces. Further investigations on the casting technique were carried out by X-ray and IACS conductivity measurements; these will not be addressed here, as an extensive treatment of both the archaeological and scientific aspects of this project will be published in the next future.

Hereditary non-polyposis colorectal cancer (HNPCC) is one of the most common inherited cancer syndromes, accounting for 3-5% of all cases of colorectal cancer. In most HNPCC families, the disease is caused by a germline mutation in MLH1 or MSH2. In some populations, founder mutations appear to explain a substantial fraction of HNPCC. We report here the identification and preliminary characterization of two putative MLH1 founder mutations. The mutation MLH1c.1831delAT was shown to segregate in two Quebec families of Italian origin who fulfilled the Amsterdam criteria for HNPCC. Haplotype analysis using five intragenic microsatellite/single nucleotide polymorphism markers spanning MLH1 on chromosome 3 showed that these two unrelated families share an identical haplotype. In addition, two other Italian kindred whose affected members carry MLH1g.IVS6 + 3AG also share a common haplotype, suggesting that, similarly, the latter mutation has a common origin. These mutations are the first putative founder MLH1 mutations to be identified in HNPCC kindred of Italian origin.

This paper discusses the advantages of adopting forms of participatory action research with aboriginal Canadians. Using a recent qualitative study of non-insulin-dependent diabetes mellitus among the James Bay Cree, it outlines and discusses the methodology used to construct a form of action research that focused on what meaning the Cree gave to the rising incidence and prevalence of diabetes. In order to understand this perspective, the researchers recruited members of the Cree community as co-researchers in the study. This facilitated the development of a Cree perspective on diabetes and also allowed the Cree members of the study to acquire a grounding in the knowledge and skills necessary for forms of qualitative research that can inform both policy and practice in health care and related areas. In particular, the paper discusses how the study was constructed and what lessons can be drawn from this form of collaborative inquiry.

PURPOSE: To determine the magnitude and time course of changes in the volume of brain and intracranial cerebrospinal fluid (CSF) spaces in patients who have sustained traumatic brain injury and to assess the relationship between these findings and long-term cognitive traumatic outcome. METHODS: Axial intermediate and T2-weighted MR images of 123 patients with traumatic brain injury were quantified using a multispectral segmentation algorithm. Measurements were corrected for differences in age, sex, and head size using a previously reported normative database. Brain morphology was compared across groups formed on the basis of chronicity of injury. Cognitive functioning and severity of injury were statistically correlated with brain measurements. RESULTS: Time-dependent expansion of CSF spaces and decreases in brain volume were observed. Increases in ventricular CSF volume, particularly in the temporal horns and third ventricle, preceded subsequent changes in total brain and subarachnoid CSF. High and moderate correlation was observed between volume measures and cognitive outcome and injury severity. Particularly strong was the relation between the volume of the left temporal horn and verbal IQ scores. CONCLUSION: Predictable time-dependent atrophic changes occurring after traumatic brain injury can be quantified using MR volumetric studies. Our results suggest significant contributions by both diffuse and focal mechanisms of injury. In the postacute period (more than 70 days after injury), MR volumetric studies may be predictive of eventual cognitive outcome.

A case study is presented in which a patient received magnetic resonance (MR) imaging of the brain 3 months prior to a severe traumatic brain injury (TBI). The post-TBI MR findings are compared and contrasted with the pre-TBI MR images. The posttraumatic changes demonstrate a significant dilation of the ventricular system which reflects diffuse axonal injury and loss of brain substance. Correspondingly, the neuropsychological studies in this individual reflect global deficits which match the nonspecific, traumatically induced degenerative changes found in the postinjury MR scan. This case study is unique in that specific preinjury MR findings are available for direct comparison and quantitative analysis of TBI-associated changes in brain structure with neuropsychological outcome.

Surgical stress, but not anesthesia induction, produced a significant increase in plasma beta-endorphin immunoreactivity in eight patients undergoing abdominal surgery. This increase was closely correlated with a parallel increase in plasma cortisol. Post-operative morphine administered for pain relief was associated with a significant reduction in plasma levels of both beta-endorphin and cortisol. These results demonstrate the responsiveness of the endorphin system to acute stress in humans and provide additional evidence linking plasma beta-endorphin to the hypothalamic-pituitary-adrenal axis.

As part of a protocol of the National Cancer Institute, 21 selected patients were submitted to total body hyperthermia for treatment of metastatic carcinoma. Elevation body temperature up to 41.8°C for 2 h was achieved using a computer driven external heating system. Patients were sedated during treatment. To ensure the safety of the procedure, a battery of physiological parameters was monitored. Continuous EEG recordings were carried out in all patients. Analysis of the EEG included visual assessment, compressed spectral array and power spectrum. EEG data were compared mainly to body temperature, state of consciousness and drug administration. Consciousness during the treatment varied from very light sedation to light anesthesia, with some rare delirious episodes. No motor seizures were observed. All EEG recordings demonstrated major changes in both rhythmicity and amplitude (slower and lower) indicating a diffuse decrease of cortical activity during the hyperthermia period. All changes reversed themselves during the cooling period. Spectral power showed a statistically significant inverse relationship with temperature. At temperatures above 41°C, decrease in total EEG spectrum was not related to decrease in clinical reactivity. The degree of EEG slowing varied with the extent and duration of the hyperthermia, and was totally reversible within a few hours of cooling, without evidence of any EEG or neurological sequelae. However, at temperatures above 41.5°C, EEG changes compatible with metabolic or toxic encephalopathy were observed. Possible mechanisms are discussed.

The Imugard IG 500 cotton wool filter and the Cellselect cellulose acetate filter were adapted for filtration of leucocytes from packed cell transfusions at the bedside. Sixty five transfusions were given via the Imugard IG 500 filter and 54 transfusions were given via the Cellselect filter. Packed red cell concentrates from the National Blood Transfusion Service provided for routine blood transfusions were used in all cases. No patient in either group of multitransfused patients experienced a febrile blood transfusion reaction during the study. The Imugard IG 500 removed 91% +/- 9 (SEM) leucocytes; the Cellselect removed 96% +/- 7 (SEM) leucocytes. In the Imugard IG 500 group one patient received greater than 0.5 X 10(9) leucocytes. In the Imugard IG 500 group one patient received greater than 0.5 X 10(9) leucocytes, but no patient in the Cellselect group received greater than 0.5 X 10(9) leucocytes in any single transfusion. This is a safe method of providing leucocyte poor blood at the bedside.

Two hundred twenty-two spinal anesthesias were administered with 10 mg. of tetracaine and 1 ml. of 10 percent dextrose to investigate the effects of vasopressors, patients age, and pH of cerebrospinal fluid on the onset and duration of spinal anesthesia. Neither the differences in overall age, cerebrospinal fluid pH, nor the addition of vasopressors had any significant effect on onset. Duration, however, was significantly prolonged by the addition of vasopressors, 53 percent prolongation by 0.2 mg. of epinephrine and 72 percent prolongation by 2 mg. of phenylephrine.

After the abandonment of the Iron Age settlement during the third quarter of the seventh century, the area of Parco San Stefano was used as a cemetery. As has been described above, in the course of the bulldozing undertaken prior to the extension of the quarry, burials were found and this led to the rescue excavation of 1970. Supervision began after the bulldozer had stripped some of the area and, later, burials were often seen only after they had been exposed by the bulldozer. No accurate plans of the tombs could be made but identified burials were plotted on the plan and the finds recorded, as far as was possible in tomb groups. Tombs IV, V, VII, IX, X, XI, XII, XIV–XVI, XVIII–XXI were recorded by Jonathan Boutelle, while Signor Losindaco rescued the finds from Tombs I, II, III, VI, VIII, XIII, XVII.Many tombs, particularly those found after the end of the excavation, were too destroyed by the bulldozer to warrant detailed description; tombs seen by Mr. Boutelle are described below. In the following report, the tombs have been arranged under tomb types and, as far as is possible, in their chronological sequence.

In volume xxxiv of the Papers, pp. 131–50 (hereafter cited as ‘PBSR (1966)’), a short account was given of the site of Botromagno, overlooking the town of Gravina, on the western borders of the modern Apulia, and of the trial excavations which the British School conducted there in 1966 on behalf of the Superintendency of Antiquities for Apulia. As will have been evident from that account, the results were sufficiently promising to justify an extension of the work, and the report which follows gives some details of the three further seasons of work which were undertaken in 1967 and 1968 jointly by the British School, the University of Alberta and the Institute of Archaeology, London University. The first of these, covering five weeks in May-June of 1967, was directed by Dr. M. Aylwin Cotton and Mr. Halstead B. Vander Poel. The second and third seasons, both of five weeks, took place in August-September of 1967 and 1968 respectively, and were in both cases directed by Miss Joan du Plat Taylor of the Institute of Archaeology, London University.

The celiac plexus block has been "rediscovered" by the modern multidisciplinary pain clinic. Local anesthetic blocks aid in diagnosing unusual syndromes of abdominal pain. Neurolytic blocks are important in the management of intractable pain from abdominal cancer. Therapeutic use of celiac plexus block in managing the pain of chronic pancreatitis has been expanded by the use of intraplexus steroids. This treatment carries less morbidity than surgical interventions and affords long-term pain relief.

The authors report a case of acute renal failure with hyperoxaluria and intratubular deposits of oxalate crystals, following a massive ingestion of piridoxilate. Cases of calciumoxalate urolithiasis have also been reported after chronic administration of piridoxilate.

In the intact canine heart a gradient of systolic intramyocardial pressure from a minimum at the epicardial region to a maximum at the endocardial region is well established. No information is, however, available regarding the effects of various anaesthetic agents on this gradient. In the present study the effects of halothane on intramyocardial pressure recorded from subendocardial and subepicardial layers of the canine left ventricular free wall were assessed. Experiments were performed on seven anaesthetised mongrel dogs ventilated with 100% oxygen. Intramyocardial pressure was recorded simultaneously from the inner and outer regions of the myocardium using two Mikro-tip pressure transducers. Halothane concentration in the inspired gas varied from 0% to 2%. In the pentobarbital anaesthetised dog halothane does not significantly change the heart rate. With increasing concentrations of halothane in inspired gas systolic intramyocardial pressure at both endocardium and epicardium decreased significantly from control values. As the halothane concentration increased, the normal differential between systolic left ventricular pressure and endocardial intramyocardial pressure was abolished. The intramyocardial pressure gradient from endocardium to epicardium, however, persisted during systole. During diastole the pressure gradient was reversed, becoming maximum in the epicardial region and minimum in the endocardial region in both control and halothane treated animals. Over the range of 0-2% halothane concentration there was no significant effect on the diastolic intramyocardial pressure gradient. These results suggest that halothane affects the myocardial tissue pressure non-uniformly across the left ventricular free wall and therefore influences the transmural distribution of coronary blood flow. Compared with control animals, halothane treated animals generated an equivalent systolic left ventricular pressure with a lower endocardial intramyocardial pressure, suggesting a beneficial effect on myocardial mechanics during systole.

Noncardiogenic pulmonary edema occurred in an anesthetized patient during an otherwise uneventful laparotomy. Following transfusion of an individual unit of whole blood, routine intraoperative monitoring detected sudden major pulmonary shunting (increased alveolar-arterial oxygen gradient) and an increased physiological alveolar dead space (increased arterial-alveolar carbon dioxide gradient). The noncardiac pulmonary edema probably resulted from the presence of a leukoagglutinin against the patient's granulocytes in the donor's plasma. This antibody had no apparent specificity for known HLA, neutrophil, or blood group antigens. The acute respiratory failure was transient, resolving in 72 hours with respiratory support. The presence of otherwise unexplained noncardiogenic pulmonary edema during or soon after a blood transfusion should suggest the possible diagnosis of a leukoagglutinin reaction.

Disposable liquid-crystal temperature-trend indicators were evaluated under clinical conditions that simulated the development of intraoperative hyperthermia during anesthesia. Comparison was made to forehead thermistors for rapidity, accuracy, and linearity of response as well as correlation with esophageal and rectal thermistor recordings. The liquid-crystal monitors were comparable to the forehead thermistors in both rapidity and linearity or response, but not in accuracy. A linear correlation existed with the esophageal thermistor temperatures. Correlation with the rectal temperatures was not as exact. It is concluded that liquid-crystal thermometers may adequately serve as screening devices for intraoperative hyperthermia.

Sensory level of anesthesia following the injection of 20 ml of 1.5% lidocaine with epinephrine (1:200,000) in 238 adult males averaged T7.7, T5.6, and T5.1 at 10, 20, and 30 minutes, respectively. Patient age had no significant effect on local anesthetic requirements per spinal segment per unit height until age 40 years, which age the calculated amount of local anesthetic decreased significantly to 0.62 ml from 0.69 ml/segment/meter of height. Above age 40 there was no further decrease in epidural anesthetic requirement with advancing age. Patient height was inversely related to sensory level (p0.001). Time required for anesthesia ro recede to T12 averaged 164 minutes and was slightly but significantly (p0.05) prolonged with advancing age.

We evaluated the effect of halothane on the balance of subendocardial oxygen supply and demand in six dogs by estimating the endocardial viability ratio (EVR) based on the pressure generated within the subendocardium (ENDO-IMP). Concurrently, the conventional EVR based on left ventricular pressure (LVP) was estimated and compared with the EVR based on ENDO-IMP. The subendocardial oxygen supply-demand ratio based on ENDO-IMP (IMP-EVR) was significantly less than EVR based on LVP (LVP-EVR) (0.87 +/- 0.03 vs 1.07 +/- 0.06, P less than 0.05) during the control period. With 0.5% halothane administration, IMP-EVR improved significantly (1.04 +/- 0.07, P less than 0.05) while LVP-EVR remained unchanged (1.08 +/- 0.09). No further changes in EVR (either IMP-EVR or LVP-EVR) were observed with increasing halothane concentrations up to 2%. The relationship between the two indices was weak (r2 = 0.44, P less than 0.001) but statistically significant. Because an estimate of EVR based on direct measurement of subendocardial tissue pressure (IMP-EVR) would reflect more accurately the oxygen supply-demand balance of this region than the LVP-EVR, our results suggest that the oxygen balance of the subendocardium improves with halothane administration. The use of LVP-EVR as a hemodynamic index of subendocardial oxygen balance during halothane anesthesia, therefore, is questionable.