The effect of iso-oncotic plasma substitutes: gelatine, dextran 40 (50 g/l) and the effect of Ringer's lactate on the plasma volume in healthy subjects.

82 healthy subjects undergoing Extra-corporeal Shock Wave Lithotripsy (ESWL) under epidural anesthesia were given 1000 ml of either gelatine (Geloplasme), dextran 40, 50 g/l (Isodex) or Ringer's lactate. The purpose of the study was to determine the efficacy of the three described solutions in respect to blood volume changes. A clear differentiation is only possible under absolutely defined physiological conditions and therefore in contrast to other studies, none of these patients was suffering from any shock syndrome or had any blood loss, so no capillary leakage or transcapillary refill problem was present. Plasma volume (PV), colloid oncotic pressure (COP) and hematocrit (Hct) were measured before and 15, 120 and 240 min. after infusion. PV increased both in the gelatine and dextran groups with a higher initial increase in the dextran group. COP increased after 15 min. and Hct decreased after 15 min. in the gelatine and dextran groups. With regard to absolute contraindications this study suggests that dextran 40 can be recommended as plasma substitute due to its higher initial increase in PV, its moderate duration of effect and its low incidence of anaphylactic reaction after a preceding infusion of 20 ml dextran Mw 1000 (Promiten).

Epidural sufentanil for intra- and postoperative analgesia in thoracic surgery: a comparative study with intravenous sufentanil.

A comparative study was undertaken to evaluate the effectiveness of epidural sufentanil in providing intra- and postoperative analgesia during thoracic surgery. Sufentanil was chosen on the basis of its high lipid solubility and its potent opiate receptor binding. Epidural sufentanil was compared with intravenous sufentanil as the major intraoperative analgetic agent in an anesthesia regimen with midazolam and nitrous oxide. Epidural sufentanil significantly decreased the need for supplementary intravenous analgesia. In the epidural sufentanil group the immediate postoperative analgesia was found to be better, with a longer duration of action, compared with the intravenous sufentanil group. Postoperatively epidural sufentanil was compared with epidural morphine. Sufentanil provided good analgesia with a very fast onset and a mean duration of almost 7 h. Severe respiratory depression was observed in one patient within 1 h of extubation, probably due to the combined effects of the narcotic administration and residual midazolam. It is concluded that 50 micrograms of sufentanil administered in the thoracic epidural space provides valuable intraoperative analgesia which can easily be extended into the postoperative period, although all necessary precautions for epidural opiate administration should be taken.

Epidemiology of alpha 1-antitrypsin deficiency in the Netherlands.

During a 3-year period, newborns in the eastern part of the Netherlands were investigated for alpha 1-antitrypsin deficiency. Electroimmunoassay was used for screening, followed by Pi typing in suspected cases. In all 95 033 newborns were screened, and a mean frequency of deficiency (phenotypes Pi Z, Pi SZ, and Pi S) of 8.00 in 10 000 was found. The distribution of deficient Pi types over the area was remarkably uneven, Pi type Z being more predominant north and Pi type S south of the Rhine. Cluster areas of alpha 1-antitrypsin deficiency, with frequencies of up to 59.6 in 10 000 live births, occurred mainly in small rural communities. In urbanized areas the frequency of deficiency was lower than the mean.

Automated determination of the antitrypsin activity of serum.

An automated determination of the serum antitrypsin activity is described in which all reaction parameters have been optimized. The determination is carried out by measuring the difference between the activity of a standard amount of trypsin with and without addition of serum. Trypsin activity is measured using N-alpha-benzoyl-L-arginine-p-nitroanilide as a substrate. The assay is performed by means of an automatic enzyme reaction rate analyser the Vitatron AKES. The antitrypsin activity is expressed in Inhibitor Units making standardization of the trypsin preparation superfluous. Normal values of the antitrypsin activity for some of the most frequently occurring genetic variants of alpha1-antitrypsin are given.

A new, high frequency variant of alpha1-antitrypsin.

A new variant of alpha1-antitrypsin has been detected with the aid of isoelectric focusing on polyacrylamide slab gels. In contrast with many other variants this new alpha1-antitrypsin allele is found in 10-15% of the phenotypes examined. The electrophoretic properties of the new alpha1-antitrypsin variant in isofocusing polyacrylamide gels differ only slightly from the most common alpha1-antitrypsin allele M. On the basis of its electroforetic behaviour we propose the term MN to indicate this new protease inhibitor variant. The isofocusing technique employed, provides an easy to handle, very reproducible method for determining the alpha1-antitrypsin phenotype and can be employed for large scale screening.

Distribution of alpha-1-antitrypsin phenotypes in two Dutch population groups.

The alpha1-antitrypsin phenotypes of two Dutch population groups (consisting of 672 and 802 individuals) were determined by the isoelectric focusing technique, which due to its recent development, has been used for the first time in large-scale phenotyping. As in other population studies on the alpha1-antitrypsin phenotype distribution, Pi M is the most frequently occurring allele. The two investigated groups exhibit remarkable differences, both to other studied groups as well as to each other. The most interesting results are probably the high frequencies of the alleles Pi- and of the recently discovered Pi MN. Comparison with phenotype studies carried out in other populations is also presented.