Effect of different doses of remifentanil on the cardiovascular response after endotracheal intubation: a randomized double-blind study.

OBJECTIVE: Laryngoscopy and endotracheal intubation (EI) often provoke a marked sympathetic response, which leads to tachycardia and hypertension. The aim of this study was to investigate the effect of different doses of remifentanil on the cardiovascular response to laryngoscopy and EI. PATIENTS AND METHODS: 100 patients were included in this randomized study. The participants were divided into four groups of 25 patients each. The patients in the control group did not receive remifentanil. The patients from other three groups received remifentanil prior to induction of anesthesia at doses of 0.5 µg/kg, 1 µg/kg, and 1.5 µg/kg. Hemodynamic parameters were measured before and after administration of remifentanil, after induction of anesthesia and one minute after EI. RESULTS: After administration of remifentanil and induction of anesthesia, a decrease in arterial pressure and heart rate occurred in most patients. After EI, an increase in arterial pressure and heart rate was observed in most patients. The largest increase was recorded in the group of patients who did not receive remifentanil. The best hemodynamic response was observed in patients who received 1 and 1.5 µg/kg of remifentanil. CONCLUSIONS: Remifentanil at the doses of 1-1.5 µg/kg is absolutely safe for co-induction of anesthesia with thiopental. Such dosing regimen provides optimal conditions for reducing hemodynamic response to laryngoscopy and EI.

Gut-associated lymphoid tissue, gut microbes and susceptibility to experimental autoimmune encephalomyelitis.

Gut microbiota and gut-associated lymphoid tissue have been increasingly appreciated as important players in pathogenesis of various autoimmune diseases, including multiple sclerosis. Experimental autoimmune encephalomyelitis (EAE) is an animal model of multiple sclerosis that can be induced with an injection of spinal cord homogenate emulsified in complete Freund's adjuvant in Dark Agouti (DA) rats, but not in Albino Oxford (AO) rats. In this study, mesenteric lymph nodes (MLN), Peyer's patches (PP) and gut microbiota were analysed in these two rat strains. There was higher proportion of CD4(+) T cells and regulatory T cells in non-immunised DA rats in comparison to AO rats. Also, DA rat MLN and PP cells were higher producers of pro-inflammatory cytokines interferon-γ and interleukin-17. Finally, microbial analyses showed that uncultivated species of Turicibacter and Atopostipes genus were exclusively present in AO rats, in faeces and intestinal tissue, respectively. Thus, it is clear that in comparison of an EAE-susceptible with an EAE-resistant strain of rats, various discrepancies at the level of gut associated lymphoid tissue, as well as at the level of gut microbiota can be observed. Future studies should determine if the differences have functional significance for EAE pathogenesis.

Perigastric vascular abnormalities and the impact on esophagogastrectomy.

The surgeon's ability to recognize abnormal vascular anatomy has greater importance than ever in modern esophagogastric surgical procedures. Some aberrations of vascular vessels around the stomach found during extensive surgery due to primary cancer of the stomach, cardia and lower esophagus are presented in this paper. The purpose of the prospective study is to evaluate and classify these variations with respect to their impact in visceral surgery. A total of 426 patients who underwent total or extensive gastrectomy and esophagectomy combined with lymphadenectomy, have been analyzed prospectively. For the period of 10 years some vascular aberrations have been found in 54/426 (12.67%) of the patients in the operative field during lymphadenectomy as single or combined anomalies. An arterial perigastric anatomy considered normal in textbooks was found in 372 (87.32%) cases. An accessory left hepatic artery arising from the left gastric artery was found in 19/54 (35.18%), and replaced type in 7/54 (12.96%). The replaced right hepatic artery branching from the superior mesenteric artery was found in 5/54 (7.40%) cases. Replaced and accessory left gastric artery branching from the aorta was found in 8/54 (14.8%); accessory posterior gastric artery was found in 25/54 (44.4%), and abnormalities of the splenic, and subphrenic arteries were found in 6/54 (11.11%). Combined anomalies of both left and right hepatic arteries and variations of the celiac trunk were found in 2/54 (3.70%) cases. Forty-nine cases were classified according to established Michels' typology system. Six cases presented with extremely rare variations and remain unclassified. Possible intraoperative problems concerning postoperative complications are also emphasized.

Autologous blood transfusion in total joint arthroplasty.

In 1974, an autologous blood transfusion program for total joint replacements was established at William Beaumont Hospital. From 1980 through 1984, 396 patients donated 1,619 units of blood. The patients' ages ranged from 23 to 89 years (median, 63 years) in men and 29 to 89 years (median, 67 years) in women. Blood was collected on a weekly basis, if the patient's hematocrit was greater than 34%. Blood collected within 49 days of surgery was maintained in a liquid state; otherwise, it was frozen. Patients with a history of cardiovascular disease received permission from their internist before donating blood. The cost per unit of frozen blood was much higher than that of liquid blood. Autologous blood transfusion is safe, there is no age limitation for blood donors, and blood can be collected at weekly intervals.

Orthopedic injuries in water-skiing: etiology and prevention.

The inherent danger of orthopedic injury is little recognized in the extremely popular sport of water-skiing. The water-skiing equipment, the speed at which the boat is driven and the experience of the skier play a major role in the severe injuries reported here.

Fractures in children treated with methotrexate for leukemia.

Multiple fractures occurred in 7 children treated with methotrexate for leukemia. Non-union or delayed union in spite of adequate immobilization also occurred in children on methotrexate. When the methotrexate was discontinued the fractures usually healed. Methotrexate appears to be a drug which inhibits osteogenesis, and may be promising in heterotopic ossification and related orthopedic conditions.

Congenital, irreducible, permanent lateral dislocation of the patella.

This is a report of 6 cases (one bilateral) of congenital irreducible, permanent lateral dislocation of the patella, ages 5 to 14; 2 patients were normal and 4 were mongoloid. The dislocation was reduced by means of a newly-devised surgical reconstruction of anterior attachments of nearly all of the para-articular bone and ligamentous structures. The 2-year follow-up results are satisfactory.