Multifocal haemorrhagic brain damage following hypoxia and blood pressure lability: case report and rat model.

AIMS: Haemorrhagic brain damage is frequently encountered as a complication of premature birth. Much less frequently, multifocal petechial haemorrhage is identified in asphyxiated term newborns. Our goal was to develop an experimental rat model to reproduce this pattern of brain damage. METHODS: Neonatal rat pups were exposed to a 24-h period of 10% or 8% hypoxia followed by a single dose of phenylephrine. Acute and subacute changes, as well as long-term outcomes, were investigated by histology, brain magnetic resonance imaging and behavioural assessment. Immunostaining for vascular endothelial growth factor and caveolin-1 was performed in the rat brains as well as in a 17-day human case. RESULTS: Small foci of haemorrhage were identified in almost all regions of the rat brain subjected to hypoxia plus phenylephrine, but not hypoxia alone. Exposure to 8% hypoxia was associated with more haemorrhagic foci than 10% hypoxia. With rare exceptions, the blood deposits were too small to be detected by magnetic resonance imaging. Altered immunohistochemical detection of vascular endothelial growth factor and caveolin-1 in the child and the rat model suggests a role for blood-brain barrier compromise. There were no clear behavioural changes and no residual morphological abnormalities in the 78-day follow-up of the rats. CONCLUSIONS: We conclude that transient hypoxia, in a dose-dependent manner, can weaken the vasculature and predispose to brain haemorrhage in the situation of labile blood pressure. Persistent hypoxia is likely to be important in the genesis of permanent severe brain damage.

The twelfth rib syndrome.

The twelfth rib syndrome appears to be a fairly common and underdiagnosed chronic pain syndrome. It is more common in women than men (3:1) and is usually described as a constant dull ache or sharp stabbing pain that may last from several hours to many weeks. Lateral flexion, rotation of the trunk, and rising from a sitting position classically aggravate the pain. Manipulation of the affected rib and its costal cartilage reproduces it exactly. The diagnosis of this syndrome is clinical, requires exclusion of specific etiologies, and should only be made when the patient's symptoms can be exactly reproduced by manipulation of the affected rib. If symptomatology is complicated, it may be necessary to use an image intensifier for accurate location of the pain locus. Patients with this syndrome can be overinvestigated and have even undergone surgical procedures when this diagnosis has been overlooked. To describe the varied presentation of this syndrome, we describe the clinical manifestations in six patients.

Hydrogen ion compartmentation during and following cerebral ischemia evaluated by 31P NMR spectroscopy.

Two peaks were observed in the inorganic phosphate region in 31P NMR spectra obtained during and shortly after incomplete forebrain ischemia induced in rats under normoglycemic conditions. Pre-ischemia, a single Pi peak was observed at a chemical shift of 2.5 ppm (pH 7.2). This peak shifted upfield to 1.6 ppm (pH 6.5) and, following reperfusion, returned to its pre-ischemia value. During ischemia and for a short time following reperfusion, a second, smaller peak was observed which we assigned to a second pool of inorganic phosphate. The data support the proposal by Kraig and coworkers of pH compartmentation between neurons and glia during and following transient forebrain ischemia.

Phosphorus metabolites of liver from mice infected with Hymenolepis microstoma.

31P NMR in vivo spectra of mouse livers infected with Hymenolepis microstoma for 130 or 265 days showed modifications in phosphorus-containing metabolite ratios when compared to those of normal liver. After 130 days of infection the metabolite ratio of inorganic phosphate (Pi)/beta ATP significantly increased whereas that of phosphocreatine (PCr)/beta ATP significantly decreased. In older, 265 day infections, the increase in Pi/beta ATP and decrease in PCr/beta ATP persisted. Changes in the group infected for 130 days were accompanied by lowered pH. Analysis of liver extracts from mice with 130-day-old. H. microstoma revealed significantly lower concentrations of Pi, ATP and ADP compounds. In those from mice infected for 265 days the concentration of Pi remained low whereas concentrations of ATP and ADP increased to levels in between those of controls and the 130-day-old infection. In addition, levels of phosphorylethanolamine (PE) and of an unknown metabolite significantly increased in this latter group. Worm extracts contained high levels of glycerophosphorylcholine (GPC), Pi, fructose 1,6-diphosphate (FDP), PE, diphosphodiesters (DPDE), phosphorylcholine (PC) and glycerolphosphorylethanolamine (GPE) in order of declining concentrations, respectively.

Mannitol does not affect energy metabolism in forebrain ischemia.

Mannitol has a beneficial effect on ischemic injury following a short-duration forebrain ischemic insult in rats. Using the same animal model, we attempted to show that this effect of mannitol could be traced (via an improvement in cerebral blood flow) to a tempering of the collapse in the high-energy phosphates that occurs during the insult. A 10 min ischemic insult was induced by bilateral carotid artery occlusion followed by a reduction of the blood pressure to 50 mmHg through removal of blood via a tail catheter. 31P NMR spectroscopy was used to monitor the energy state and the pH prior to, during, and after the insult. The studies show that mannitol administered in doses of 0.25 g kg-1 or 1.0 g kg-1 prior to the insult has no significant effect on the high-energy phosphate levels or on the cerebral pH during ischemia, or on their post-ischemia recovery.

High frequency jet ventilation: use of the Bain system for entrainment.

The use of a Bain system to convey anaesthetic gases for entrainment during high frequency jet ventilation (HFJV) was evaluated by examining the effect of varying the fresh gas flow (Vf) on the end-tidal carbon dioxide (PECO2) in 46 ASA physical status I and II patients undergoing extracorporeal shock-wave lithotripsy (ESWL). Anaesthesia was induced with methohexitone (1-2 mg.kg-1), fentanyl (1-1.5 micrograms.kg-1) and vecuronium (0.1 mg.kg-1). After endotracheal intubation with a Mallinckrodt Hi-Lo Jet cuffed endotracheal tube, the patient was immersed in a water bath and HFJV at 150 breaths per minute was instituted with an Acutronic AMS 1000 jet ventilator attached to the side channel of the Hi-Lo tube. A Bain system was attached to the proximal end of the endotracheal tube to provide gases for entrainment. Anaesthesia was maintained with an intravenous infusion of methohexitone (5 mg.kg-1.h-1) and 50% nitrous oxide in oxygen for both the jetted and entrained gases. PECO2 was determined at 5-min intervals by a single-breath technique using a calibrated Engstrom Eliza capnograph. Thirty patients were randomly allocated to receive Vf's of 50 (Group 1), 75 (Group 2) and 100 (Group 3) ml.kg-1.min-1, respectively. A further eight patients (Group 4) received a Vf of 100 ml.kg-1.min-1 for 15 min, 75 ml.kg-1.min-1 for the next 15 min and 50 ml.kg-1.min-1 thereafter. In a further group of eight patients (Group 5), Vf was initially 25 ml.kg-1.min-1 for 10 min and was then switched off for the remainder of the procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

Encapsulated liquid crystals as probes for remote thermometry.

A temperature probe based on the magnetic resonance properties of an encapsulated liquid crystal has been investigated. Large changes in magnetic resonance signals occur as the liquid crystal undergoes a phase transition from an anisotropic (nematic) state to the isotropic liquid. The low latent heat of such phase transitions allows for rapid phase changes during a hyperthermia treatment. Transition temperatures can be tailored by adding suitable compounds such as analogues of the liquid crystal or various solvents. Encapsulation is required to maintain the integrity of the liquid crystal, particularly for applications in vivo. Results of preliminary studies designed to demonstrate the technical feasibility of the concept are presented.

Identification of lactate, threonine and alanine in rat thymus and tumorigenic lymphoid cells using 1H 2-D COSY NMR spectroscopy.

One- and two-dimensional 1H NMR spectra were obtained for normal murine thymus and malignant lymphoma tissue, as well as for the supernatant fractions from high speed centrifugal separations. Crosspeaks in the two-dimensional spectra resembled those reported by others for adenocarcinoma and leukemic lymphoblast cells, assigned tentatively to the carbohydrate fucose. However, for the present systems, spectral analysis and the spectral response to addition of known compounds led to assignment of the crosspeaks as follows: 1.33-4.12 ppm, lactate anion; 1.33-4.26 ppm, threonine; 1.48-3.78 ppm, alanine. Differences between the NMR data for the normal and malignant specimens were only in the relative intensities of the peaks. No peaks characteristic of fucose were found in spectra of cytosol, tissue or membrane lipids. Thus, the NMR data for malignant lymphoma cells are significantly different from those for adenocarcinoma and leukemic lymphoblasts. The NMR characteristics of different types of cancer cell must be individually determined.

23Na and flame photometric studies of the NMR visibility of sodium in rat muscle.

23Na nuclear magnetic resonance spectroscopy (NMR) is increasingly being used to study Na+ gradients and fluxes in biological tissues. However, the quantitative aspects of 23Na NMR applied to living systems remain controversial. This paper compares sodium concentrations determined by 23Na NMR in intact rat hindlimb (n = 8) and excised rat gastrocnemius muscle (n = 4) with those obtained by flame photometric methods. In both types of samples, 90% of the sodium measured by flame photometry was found to be NMR-visible. This is much higher than previously reported values. The NMR measurements for intact hindlimb correlated linearly with the flame photometric measurements, implying that one pool of sodium, predominantly extracellular, is 100% visible. From measurements on excised muscle, in which extracellular space is more clearly defined, the NMR visibility of intracellular Na+ was calculated to be 70%, assuming an extracellular space of 12% of the total tissue water volume and an extracellular NMR visibility of 100%. 23Na transverse relaxation measurements were carried out using a Hahn spin echo on both intact hindlimb (n = 1) and excised muscle (n = 2) samples. These showed relaxation curves that could each be described adequately using two relaxation times. The rapidly relaxing component showed a T2 value of 3-4 ms and the slowly relaxing component a T2 of 21-37 ms. A spin lattice relaxation (T1) measurement on intact hindlimb yielded a value of 51 ms. These relatively long relaxation times show that the quadrupolar relaxation effect of Na+ complexing to large macromolecules or being otherwise motionally restricted is relatively weak. This is consistent with the high NMR visibilities reported here.

Echinococcus multilocularis--a model for imaging research.

Magnetic resonance images of transverse, sagittal, and coronal sections of Meriones unguiculatus abdomens experimentally infected with Echinococcus multilocularis revealed alveolar cyst masses that were especially prominent in the late phase of infection.

An unusual cause of obstructive emphysema.

A 6-month-old child presented with a history, physical signs and radiographic findings suggestive of the presence of a foreign body in the tracheobronchial tree. However, further investigation revealed extrinsic compression of the left main bronchus by a grossly enlarged left atrium. Treatment of the patient's heart failure resulted in resolution of the signs. Anomalous origin of the left coronary artery was found to be the cause.

A survey of the practice of regional anaesthesia.

A questionnaire designed to elucidate the popularity and practice of regional anaesthesia was circulated to all anaesthetists in the South East Thames Region. Two hundred and eleven completed questionnaires were received and subsequently analysed, a response rate of 65%. Regional anaesthesia was employed at least once per week by 83% of respondents usually in combination with general anaesthesia (77% of respondents). The provision of postoperative analgesia was cited as the main advantage by 86% of anaesthetists.

Pulse oximetry and postoperative hypothermia. An evaluation of the Nellcor N-100 in a cardiac surgical intensive care unit.

The accuracy of the Nellcor N-100 pulse oximeter was evaluated in hypothermic patients (core temperature less than or equal to 35.0 degrees C) after cardiac surgery. The pulse oximeter overestimated oxygen saturation in comparison to values obtained by direct in vitro oximetry with a mean bias of 0.6% saturation. The 95% predictability limits for individual measurements were +/- 3.9% oxygen saturation. No demonstrable loss of accuracy was caused by skin pigmentation, the concurrent administration of low doses of dopamine or vasodilators, or the intra-operative intravascular administration of Patent Blue V dye.