Anesthesia and myotonic dystrophy (Steinert's syndrome). The role of total intravenous anesthesia with propofol, cisatracurium and remifentanyl. Case report.

Anesthesia for patients with Steinert's syndrome (myotonic dystrophy, MD) is a challenge for the anaesthetist. MD is a multisystemic disease and the neuromuscular symptoms can be associated with sleep apnea, endocrine disorders (diabetes, hypogonadism, hypothyroidism), cardiac, gastroenteric or cognitive disorders (mental deficiency, attention disorders). The diagnosis is facilitated when one or more of these symptoms are associated with the neuromuscular symptoms; however, the latter are not always present at the onset, which makes the diagnosis of MD a difficult and often late one. The choice of drugs and the choice of anesthesia in these patients can be very challenging for many reasons. A myotonic crisis can be triggered by several factors including hypothermia, shivering and mechanical or electrical stimulation. These patients are very sensitive to the usual anesthetics such as hypnotics and paralyzing agents (both depolarizing and nondepolarizing). The following case report describes pathophysiological considerations and a technique for anaesthesia during thoracic surgery that has been able to assure hemodynamic peroperative stability, early extubation and prolonged respiratory autonomy in a patient affected by this genetic disorder.

Start up of deammonification process in one single SBR system.

A process for autotrophic nitrogen removal named aerobic/anoxic deammonification wherein NH4+ is oxidized by nearly 50% to NO2- and subsequently the ammonia is converted together with the nitrite to molecular nitrogen (N2 gas), has come to full-scale application within the last few years. In this research, sludge from a biological rotation disk located at a landfill leachate plant at Mechernich, Germany, which is capable of performing the deammonification process, was used as seed sludge for acclimating deammonification activities in laboratory scale batch-reactors. In parallel, the same tests were performed with normal activated sludge. Research results indicated that deammonification activities could be obtained from the seeded reactor and also, with limited performance, from normal activated sludge in a single SBR system after several months acclimation. It was also seen that oxygen is an important factor that influences the deammonification from both the acclimatization process and process running. Further results were approved that report an impact of nitrite as a process intermediate on the closely related process of anaerobic ammonia oxidation ("Anammox"). However, limiting concentrations on a bacteria population performing deammonification were found to be different to those reported for a pure Anammox-culture. Also the influence of another intermediate, hydrazine, was tested for speeding up the acclimating process by inducing the deammonification activities and recovering the activities of deammonification from nitrite inhibition.

Evaluation of two anesthetic techniques for hemodynamic control during carotid surgery. Preliminary results.

BACKGROUND: To evaluate two anesthetic techniques for hemodynamic control during carotid TEA surgery and early post-surgery. METHODS: Two study groups treated by carotid surgery were compared; the Fentanyl group consisted of 7 patients in ASA class 3, the Remifentanil-Sevoflorane group included 12 patients in ASA class 3. The double product was monitored on entry to the operating room, at 5, 15, 30 min after induction of anesthesia and tracheal intubation, and at 30 min after extubation. Time of extubation, re-awakening and attention levels during early post-surgery, and myocardial ischemia markers were monitored for 48 h after surgery in the Remifentanil group. RESULTS: Statistical analysis using Student's "t"-test for paired data showed that the double product indicated better hemodynamic stability in the patients who received Remifentanil-Sevoflorane than in those who received Fentanyl. CONCLUSIONS: Compared with anesthesia using Fentanyl and with locoregional techniques, anesthesia with Remifentanil-Sevoflorane in carotid surgery provides a valuable alternative and secures good hemodynamic stability.

[Observation of anterior chamber angle after phacoemulsification and extra capsule cataract extraction and intraocular lens implantation].

OBJECTIVE: To observe and compare the difference of anterior chamber angle after Phacoemulsification and Intraocular Lens Implantation (Phaco & IOL) through a tunnel incision and Extra Capsule Cataract Extraction and Intraocular Lens Implantation (ECCE & IOL). METHODS: The changes of internal incision, the peripheral iris and the fixation of lens intracapsular of 36 eyes were individually observed after the operation. RESULTS: Desemet's membrane detachments occurred in three eyes (8.35%) in the group of Phaco & IOL and four eyes (11.1%) in the group of ECCE & IOL. The difference was not significant. (P > 0.05) Peripheral anterior synechiae occured in three eyes (8.35%) of Phaco & IOL group and in 17 eyes (47.27%) of ECCE & IOL group. The difference was significant (P < 0.05). Intracapsular lens account for 31 eyes (86.1%) of Phaco & IOL group and ten eyes (22.5%) in ECCE & IOL group. The difference was statistically significant. (P < 0.05) CONCLUSION: Phaco & IOL can decrease the incidence of peripheral iris anterior synechiae and increase the chance of intracapsular placement of IOL.

Clinical epidemiologic characteristics of 430 cases of gallbladder cancer.

OBJECTIVE: To make clear the incidence, clinical characteristics and possible regional difference of gallbladder cancer in China. METHODS: A total of 430 cases of gallbladder cancer from 28 hospitals between 1986-1996 were reviewed, according to a standard protocol called "the clinical epidemiological list of gallbladder cancer". RESULTS: The incidence of gallbladder cancer was higher in the females than in the males. There was significant difference in the incidence between the north and south of China, and between the mountain area and flatlands. Gallbladder cancer accounted for 1.6% of bile tract disease in the same period. Gallstones were found in about 50% of the cases of gallbladder cancer. The clinical symptoms included abdominal pain, ictus, etc. The major pathohistologic type was adenocarcinoma, and 58% of tumors were localized in the whole gallbladder. Metastasis occurred mainly along the biliary tract or directly to the bed of gallbladder and liver. Ultrasonography and CT were useful to diagnosis. The positive imaging diagnostic rate was higher in 1991-1996 than in 1986-1990 P < 0.05) [corrected]. The rate of operative resection was 100% for stage I and II disease, 75% for stage III and IV, and significantly lower for stage V (P < 0.05). The 3-year survival rate in patients with stage I or II disease was significantly higher than that in those with terminal cancer (P < 0.05). CONCLUSIONS: There is specific populational, time and regional difference in the distribution of gallbladder cancer. Ultrasonography and CT are the most important diagnostic methods. Early diagnosis and early radical resection are the key to increasing the 5-year survival rate.

Noninvasive diagnosis of latent pulmonary hypertension in COPD by exercise-load impedance rheopneumogram: a comparative study with right heart catheterization.

Impedance rheopneumogram (IRP) and right heart Swan-Ganz catheter examinations were simultaneously carried out in 63 patients. Two equations for calculating after-exercise-pulmonary-pressure (PAPm) were obtained by stepwise regression analysis: 1) PAPm (kPa) = -1.40-0.88.InHs+8.30.(B-F)+5.78.Q-B/B-Y (r = 0.730, IRP is measured at rest); 2) PAPm(kPa) = 6.46-5.04.Hs/square root of R-R +4.35.Q-B/B-Y-19.34.(Q-C) (r = 0.648, IRP is measured after exercise). This is a new method for diagnosing latent pulmonary hypertension noninvasively.

[Hemodynamic changes and their relationship with the renin-angiotensin-aldosterone system in chronic obstructive pulmonary disease].

The hemodynamic changes and plasma renin activity (PRA), angiotensin II (ATII), aldosterone (Ald) levels in 38 COPD patients with or without pulmonary hypertension were studied. We found that the right ventricular pressure (RVP), pulmonary artery pressure (PAP), pulmonary vascular resistance (PVR) and the levels of PRA, ATII, Ald increased significantly in patients with pulmonary hypertension when compared with those not accompanied by pulmonary hypertension. In addition, a close correlation was found between PRA, ATII, Ald and RVP, PAP, PVR. The relationship between ATII and PAP was very remarkable (r = 0.67, P less than 0.001). These findings suggest that the activation of renin-angiotensin-aldosterone system (RAAS) increases in COPD patients with pulmonary hypertension, and may involve in the development of pulmonary hemodynamic changes.