Changes in Vertebral Column Height (VCH) at Different Distance Intervals During a 3-Mile Walk.

BACKGROUND: The purpose of this study was to determine the changes in vertebral column height (VCH) of males and females, at every one-half mile, for a total walking distance of 3 miles. METHODS: Twenty males and twenty females between the ages of 21 and 40 years walked 3 miles on a treadmill maintaining a walking speed that the subject rated between 12 and 14 on Borg's rate of perceived exertion scale. Blood pressure, heart rate, and VCH measurements were taken initially and at each half-mile interval throughout the three-mile walk. Vertebral column height (VCH) was measured from the spinous process of C7 to S2 using a standard tape measure. RESULTS: Significant differences existed in vertebral column height according to sex (F = 16.18; p < .05) and significant differences in vertebral column height at the different distances (F = 65.02: p < .0001). Significant changes occurred in the VCH between half-mile intervals only between 0.5 miles and 1.0 mile and between 1.0 mile and 1.5 miles during the walk. As found with a regression analysis, curvilinear relationship exists between the distance walked and VCH; with VCH decreasing throughout the distance of the walk. CONCLUSIONS: Vertebral column height decreased in a curvilinear relationship throughout the distance of walking 3 miles in both males and females.

Dose-response effects of intravenous ranitidine on gastric pH and volume in outpatients.

The dose-response effects of intravenous ranitidine given 45 min to 5 h earlier on gastric pH and volume were evaluated in six groups of 25 outpatients, each undergoing elective surgery under general anesthesia. Patients in Group 1 received no ranitidine and served as controls. Patients in Groups 2-6 received ranitidine intravenously in incremental doses of 0.5 mg X kg-1 body weight from 0.5 mg to 2.5 mg (Group 2, 0.5 mg; Group 3, 1.0 mg; Group 4, 1.5 mg; Group 5, 2.0 mg; and Group 6, 2.5 mg). Ninety-six per cent of patients in the control group (Group 1) had gastric pH less than or equal to 2.5 while 36% of the patients had gastric content volumes greater than or equal to 25 ml with pH less than or equal to 2.5. Ranitidine, in incremental doses of 05.-2.5 mg X kg-1 body weight, caused a significant reduction of gastric acidity and volume. The ED50 of ranitidine producing a gastric pH greater than 2.5 was 0.36 mg X kg-1, and the ED95 was 0.98 mg X kg-1 body weight. The ED95 of ranitidine producing a gastric volume less than 25 ml was 1.96 mg X kg-1. At the dose of 1.5 mg X kg-1 of ranitidine, 100% of the patients had gastric contents with pH greater than 2.5. The proportion of patients with volume less than 25 ml was 68% with ranitidine, 0.5 mg X kg-1, and gradually increased to 100% with 2.5 mg X kg-1 body weight.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of ranitidine as an oral antacid in outpatient anesthesia.

We studied the effects of preanesthetic ranitidine on gastric contents in 60 outpatients scheduled for elective surgery, with random allocation into three groups of 20 patients each. Patients in group 1 did not receive ranitidine and served as controls. Patients in groups 2 and 3 received ranitidine orally, 150 and 300 mg, respectively, one to five hours before induction of anesthesia. In the control group, mean pH and volume of gastric contents were 1.90 and 27.7 ml respectively. Ninety percent of the control subjects had gastric pH less than or equal to 2.5, and 65% of the patients had pH less than or equal to 1.8; 65% of the patients had gastric volumes of 20 ml or greater. Ranitidine in 150 and 300 mg doses markedly raised mean gastric pH to 6.40 and 5.87 respectively and reduced the proportion of patients with gastric pH less than or equal to 2.5 to 10% in group 2 and 0% in group 3. Mean gastric volume and proportion of patients with volume greater than or equal to 20 ml were significantly reduced in both treatment groups. Proportions of patients with combination of pH less than or equal to 2.5 and volume greater than or equal to 20 ml were significantly low in both treatment groups, as there was only one patient in group 2 and none in group 3 with both low pH and high volume. With respect to reduction of gastric acidity and volume, 300 mg of ranitidine had no advantage over 150 mg.

Assessment of age-related acid aspiration risk factors in pediatric, adult, and geriatric patients.

One hundred inpatients scheduled for elective surgery were studied to determine the age-related risk of pulmonary aspiration as indicated by gastric acidity and volume. Twenty-five patients from 6 months to 12 years old were included in the pediatric age group, 50 patients from 18 to 64 years old were included in the adult age group, and 25 patients older than 65 years old were included in the geriatric group. Mean gastric pH was 1.99, 2.40, and 3.32 in the pediatric, adult, and geriatric age groups, respectively; the differences between the three groups were statistically significant. The proportions of patients with pH less than or equal to 2.50 were also significantly different among three groups: 92%, 76%, and 60% in the pediatric, adult, and geriatric age groups, respectively. Mean gastric volumes were 0.49, 0.37, and 0.24 ml/kg and proportions of patients with volumes greater than or equal to 0.40 ml/kg were 60, 32, and 12% in pediatric, adult, and geriatric patients, respectively. Gastric contents with both pH less than or equal to 2.5 and volume greater than or equal to 0.4 ml/kg were seen in 60, 28, and 12% in the three respective groups. Risk of acid aspiration pneumonitis theoretically is present in all age groups, with children being at greatest risk and geriatric patients with least risk. We have also noted a correlation between age and gastric contents because gastric acidity and volume both decreased as age increased. Increasing length of fasting period increased gastric acidity without significant effect on volume.

Ranitidine and metoclopramide for prophylaxis of aspiration pneumonitis in elective surgery.

The effects of preanesthetic oral ranitidine and metoclopramide on gastric contents were studied in 150 inpatients scheduled for elective surgery with random allocation into ten groups with fifteen patients in each group. Patients in group I served as controls. Group II patients received metoclopramide, 10 mg, in the morning. Patients in group III received ranitidine, 150 mg; while group IV patients received ranitidine, 150 mg, and metoclopramide, 10 mg, also in the morning. Group V patients received ranitidine, 150 mg, at bedtime and in the morning; while patients in group VI received ranitidine as in group V and, in addition, received metoclopramide, 10 mg, in the morning. Group VII patients received ranitidine, 300 mg, in the morning; while patients in group VIII received ranitidine, 300 mg, and metoclopramide, 10 mg, in the morning. Patients in group IX received ranitidine, 300 mg, at bedtime and in the morning; while group X patients received ranitidine as in group IX, and in addition, received metoclopramide, 10 mg, in the morning. Patients with gastric pH less than or equal to 2.5 or gastric content volume greater than or equal to 20 ml were defined to be at risk of pulmonary damage in the event of aspiration. Patients in group I had a mean gastric pH of 2.33 with 73% of the patients with pH less than or equal to 2.5, while 47% of the patients presented with a combination of pH less than or equal to 2.5 and volume greater than or equal to 20 ml. Ranitidine and metoclopramide independently and in combination significantly reduced risk factors.(ABSTRACT TRUNCATED AT 250 WORDS)

Preanesthetic cimetidine and metoclopramide for acid aspiration prophylaxis in elective surgery.

The effect of preanesthetic cimetidine and metoclopramide on gastric contents in inpatients undergoing elective surgery was studied. One hundred and fifty patients were allocated randomly into six groups with 25 patients in each group. Patients in Group 1 served as control. Group 2 patients received metoclopramide in the morning. Group 3 patients received cimetidine at bedtime and in the morning. Patients in Group 4 received cimetidine at bedtime and metoclopramide in the morning. Group 5 patients received cimetidine and metoclopramide in the morning, while patients in Group 6 received cimetidine at bedtime and metoclopramide and cimetidine in the morning. Cimetidine 300 mg and metoclopramide 10 mg were administered by mouth with a sip of water at bedtime or in the morning 1-4 h prior to the induction of anesthesia. Patients with gastric pH less than or equal to 25 or gastric content volume greater than or equal to 25 ml were defined to be at risk of pulmonary damage if aspiration should occur. In the control group the mean pH and volume of gastric contents were 2.89 and 22.3 ml, respectively, with 64% of patients with pH less than or equal to 2.5 and 32% of patients with volumes of greater than or equal to 25 ml. Cimetidine and metoclopramide favorably modified the risk factors in all the experimental groups. This study demonstrated that the three groups receiving cimetidine in the morning (Groups 3, 5, and 6) had significantly greater mean gastric pH than the other groups. Gastric volumes were significantly less in all experimental groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of pre-anaesthetic glycopyrrolate and cimetidine on gastric fluid acidity and volume in children.

The effects of pre-anaesthetic glycopyrrolate and cimetidine on gastric fluid pH and volume were studied in 96 paediatric patients from ages 6 months to 12 years undergoing elective surgery. They were randomly allocated into six groups with 16 patients in each group. Patients in group I received neither glycopyrrolate nor cimetidine and served as controls. Group II patients received glycopyrrolate, 5 micrograms kg-1 intramuscularly in a.m. Patients in group III received cimetidine 5 mg kg-1 orally in a.m. Group IV patients received cimetidine 5 5 mg kg-1 orally in a.m. and glycopyrrolate 5 micrograms kg-1 in a.m. Patients in group V received cimetidine 5 mg kg-1 orally h.s. and a.m. Group VI patients received cimetidine as in group V and also received glycopyrrolate as in group II. Patients with gastric pH 2.5 or less and volume of gastric contents 0.4 ml kg-1 or greater were defined to be at risk of pulmonary damage if aspiration should occur. The patients in the control group had a mean gastric pH of 1.91 +/- 0.074 and mean gastric volumes of 0.52 +/- 0.06 ml kg-1. Ninety-four per cent of patients in this group had gastric pH less than or equal to 2.5 and 69% of patients had gastric volumes greater than or equal to 0.4 ml kg-1. Glycopyrrolate (group II) reduced patients with pH less than or equal to 2.5 to 50% and volumes greater than or equal to 0.4 ml kg-1 to 44%. Cimetidine markedly reduced both gastric acidity (gastric pH less than or equal to 2.5 in 0-13% of patients in groups III-VI) and gastric volume (greater than or equal to 0.4 ml kg-1 in 19-38% of patients in groups III-VI). Only a maximum of 13% of the patients presented with combination of both risk factors in groups III-VI.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of preanesthetic glycopyrrolate and cimetidine on gastric fluid pH and volume in outpatients.

The effects of preanesthetic glycopyrrolate and cimetidine on gastric fluid pH and volume were studied in outpatients. One hundred outpatients scheduled for elective surgery were randomly allocated into four groups with 25 patients in each group. Patients in group I were given neither glycopyrrolate nor cimetidine and served as controls. Group II patients received 4-5 micrograms/kg of glycopyrrolate intramuscularly 45-90 min before induction of anesthesia. Patients in group III received 300 mg of cimetidine orally with a sip of water 1-4 hr before induction of anesthesia. Group IV patients received cimetidine, as in group III, and glycopyrrolate as in group II. Twenty-five inpatients undergoing elective surgery also were studied for comparison. Patients in group I (control) served as the basis for comparison with inpatients. Patients with gastric pH less than or equal to 2.5 or volume of gastric contents greater than or equal to 20 ml were defined to be at risk of pulmonary damage in the event of aspiration. Patients in group I had a mean gastric pH of 2.34 +/- 0.30 with a mean gastric volume of 25.6 +/- 4.1 ml. Seventy-six % of the patients in the control group had gastric contents with a pH less than or equal to 2.5 and 52% had volumes greater than or equal to 20 ml. Glycopyrrolate (group II) failed to increase gastric pH or to reduce gastric volume. In contrast, cimetidine in groups III and IV with or without glycopyrrolate significantly reduced the number of patients at risk of aspiration, by increasing the pH and reducing the volume of gastric contents.(ABSTRACT TRUNCATED AT 250 WORDS)

Pathologic features of the eye in Down's syndrome with relationship to other chromosomal anomalies.

A 2,990-g newborn female mongoloid had narrow palpebral fissures with a mongoloid slant and Brushfield's spots. Pathologic ocular findings resembled those found in patients with trisomy 21 syndrome. Many lesions reflected excessive genetic material and qualitatively resembled those lesions in trisomy 13 and 18 syndromes.