中药复方护骨胶囊对糖皮质激素诱导骨质疏松大鼠骨密度和骨形态计量学的研究

目的 探讨中药复方护骨胶囊(主要由制何首乌、淫羊藿、熟地黄等多味中药加工而成的复方制剂)对糖皮质激素诱导骨质疏松大鼠骨丢失的影响。方法 3月龄SPF级雄性SD大鼠30只,随机平均分为3组：正常对照组(Nrm)、激素组(Met)和中药组(CH)。Met组：皮下注射甲强龙(Met)5 mg/kg/d,每周5次;CH组：在Met组基础上给予中药复方护骨胶囊(150mg/kg/d)灌胃,实验期12w。大鼠右侧股骨和L5行骨密度(BMD)测定,右侧胫骨行骨形态计量学分析。结果 Met组L5和股骨BMD显著低于Nrm组;CH组L5和股骨BMD显著高于Met组。Met组Tb.N、%Tb.Ar、MS/BS、MAR和BFRs显著低于Nrm组,Tb.Sp、ES/BS显著高于Nrm组;中药组Tb.N、%Tb.Ar、MS/BS、MAR和BFRs显著高于Met组,Tb.Sp,ES/BS显著低于Met组。结论 中药复方护骨胶囊在提高激素诱导骨质疏松大鼠的骨密度,促进骨形成,降低骨吸收,延缓骨丢失方面有积极作用,对继发性骨质疏松的预防和治疗有一定前景。     

雷奈酸锶对糖皮质激素诱导骨质疏松大鼠骨形态计量学的研究

目的观察雷奈酸锶对糖皮质激素诱导骨质疏松大鼠骨形态计量学的影响。方法 24只3.5月龄SPF级雄性SD大鼠适应性喂养1w后,随机等分为3组:Nrm组:正常对照组;Met组:皮下注射甲强龙(Met)5 mg/(kg.d),每周5次;SrR组:在Met组基础上给予雷奈酸锶900 mg/(kg.d)灌胃。实验期9w。第5腰椎(L5)和右侧股骨用于骨密度测定,右侧胫骨行骨形态计量学分析。结果 Met组L5和股骨BMD显著低于Nrm组;SrR组L5和股骨BMD显著高于Met组。Met组BV/TV,Tb.Th,Tb.N,%Ct.Ar显著低于Nrm组,Tb.Sp,%Ma.Ar,ES/BS显著高于Nrm组;SrR组BV/TV,Tb.Th,Tb.N,%Ct.Ar显著高于Met组;Tb.Sp,ES/BS显著低于Met组。结论给予大鼠SrR 900 mg/(kg.d)灌胃,在提高激素诱导骨质疏松大鼠的骨密度,促进骨形成,降低骨吸收,延缓骨量丢失方面有积极作用;对继发性骨质疏松的预防和治疗有一定前景。     

老年性髋部骨折骨密度与骨形态计量学的关系

目的通过老年髋部骨折患者骨密度的测定和骨组织形态计量分析,探讨骨质疏松性骨折骨密度与骨结构的关系。方法选择低、中能量创伤所致髋部骨折需要手术治疗的老年患者30例,分为2组,男性14例,女性16例。以双能X线吸收骨密度仪(DEXA)测量患者健侧股骨近端大转子BMD。手术中用切面积1cm×1cm的环钻于患侧股骨大转子间区松质骨按统一标准定位后,钻取骨柱,进行骨组织形态计量学观察与分析。结果根据BMD测定的结果男性患者能诊断为骨质疏松症的有9例(64.29%),女性患者能诊断为骨质疏松症的有12例(75.00%)。骨组织形态计量学结果提示老年男女骨结构参数差异不明显,无统计学意义。老年男、女性股骨大转子BMD均与%Tb.Ar、Tb.Th、Tb.N、N/F成正相关,与Tb.Sp成负相关(P<0.05)。结论老年人男女两个组的股骨近端转子间区骨组织形态计量参数无明显差异,股骨近端转子间区的BMD与骨结构有一定的相关性,骨形态计量学分析较BMD更可靠、更敏感、更真实地反映骨质疏松的情况。     

复方贞术调脂胶囊对糖皮质激素诱导骨质疏松大鼠股骨和腰椎骨密度及生物力学特性的研究

目的观察复方贞术调脂胶囊(FTZ)对糖皮质激素诱导骨质疏松大鼠股骨和腰椎骨密度及生物力学特性的影响。方法SPF级雄性SD大鼠32只,随机等分为4组:Nrm组为正常对照组,Met组为皮下注射甲强龙(Met)5 mg/(kg·d),每周5次,FTZL组和FTZH组在Met组基础上每日分别给予低剂量FTZ(1.5g/kg)和高剂量FTZ(6g/kg)灌胃,实验期为12w。QDR4500A型双能X线骨密度测定仪测定股骨和腰椎骨密度,MTS-858型生物力学实验机测定股骨和腰椎生物力学性能。结果Met组大鼠股骨和腰椎的骨密度、最大载荷、刚度、弹性模量、皮质骨厚度、股骨中段截面面积和椎体横断面面积均显著低于Nrm组相应指标(P0.001,P0.01),股骨骨髓腔面积显著高于Nrm组(P0.01);FTZL组大鼠的股骨骨密度,最大载荷、刚度、弹性模量、皮质骨厚度、股骨中段截面面积和椎体横断面面积较Met组有升高趋势,股骨骨髓腔面积较Met组减少,但两组间各指标均无显著性差异(P0.05);FTZH组大鼠股骨和腰椎的骨密度、最大载荷、刚度、弹性模量、皮质骨厚度和椎体横断面面积显著高于Met组相应指标(P0.01,P0.05),股骨骨髓腔面积显著低于Met组(P0.05),股骨中段截面面积较Met组有增加趋势,但无显著性差异(P0.05),FTZH组腰椎的骨密度和最大荷载显著高于FTZL组(P0.05),余各项指标间无显著性差异(P0.05)。结论高剂量FTZ对改善糖皮质激素诱导骨质疏松大鼠股骨和腰椎的骨密度及生物力学特性效果显著。     

左归丸防治去卵巢大鼠骨质疏松症的实验研究

目的探讨左归丸对去卵巢所致骨质疏松大鼠的防治作用。方法 手术切除大鼠双侧卵巢建立绝经后骨质疏松大鼠模型,用左归丸(高、中、低剂量)进行灌胃,120 d后,取大鼠左后肢股骨远端1/3做病理切片,光镜下观察骨组织形态学变化,测定骨小梁面积百分比(%Tb.Ar)、骨小梁厚度(Tb.Th)、骨小梁分离度(Tb.Sp);采用双能X线骨密度仪测定右后肢离体股骨近端1/3骨密度(BMD);采用酶联免疫吸附法(ELISA)检测大鼠血清骨钙素(BGP),用比色法测定血清抗酒石酸酸性磷酸酶(TRAP)。结果切除大鼠双侧卵巢后,骨小梁明显紊乱,变细且较稀疏,缺少连接,断端增多,%Tb.Ar、Tb.Th显著降低,Tb.Sp明显升高,BMD下降,血清BGP及TRAP水平显著升高,统计学显示有显著性差异(P0.01);去卵巢大鼠灌服左归丸后,与模型空白组比较,左归丸各剂量组均能不同程度地改善骨小梁变化,增加BMD,降低血清BGP及TRAP,统计学显示有显著性差异(P0.01),各用药组之间比较无显著性差异(P0.05)。结论 左归丸对去卵巢所致绝经后骨质疏松大鼠有一定的防治作用。     

PM2.5对去势后雌性SD大鼠骨微结构micro-CT的影响

目的探讨不同浓度的PM_(2.5)暴露对去势SD雌性大鼠骨微结构的影响。方法用不同浓度(35、70、150μg/m3)的PM_(2.5)对SD大鼠进行气道滴注,随机分为低剂量组、中剂量组和高剂量组,滴注后5个月末行去势手术;滴注后9个月末取股骨、胫骨、腰椎,运用显微计算机断层扫描术(micro-CT)分别检测三者骨微结构。结果与对照组相比,PM_(2.5)暴露组胫骨、股骨、腰椎的骨小梁骨密度(Tb.BMD)减小、骨体积分数(BV/TV)减小、结构模型指数(SMI)增大、骨小梁厚度(Tb.Th)减小、骨小梁数量(Tb.N)减少、骨小梁分离度(Tb.Sp)增加; PM_(2.5)暴露组中,胫骨骨小梁的BV/TV、Tb.Th、Tb.N、Tb.Sp指标改变与对照组比较差异有统计学意义(P0.05),股骨骨小梁的Tb.BMD、BV/TV、SMI、Tb.N、Tb.Sp指标改变与对照组比较差异有统计学意义(P0.05),腰椎骨小梁的SMI、Tb.Th、Tb.N、Tb.Sp指标改变与对照组比较差异有统计学意义(P0.05)。从micro-CT三维重建图结果看,与对照组比较,PM_(2.5)暴露组胫骨骨髓腔内明显空虚,骨小梁缺如;股骨Ward三角区骨小梁数量稀疏、间隙变大;腰椎骨小梁结构的完整性被破坏,杆状结构增多。结论表明PM_(2.5)暴露可使去势后雌性SD大鼠胫骨、股骨、腰椎骨小梁结构遭到破坏,数量减少,由片状结构转为杆状结构,由此可见PM_(2.5)暴露可加重绝经后骨量丢失。     

甲状旁腺激素通过增加血管及骨的形成防治骨质疏松

目的探索甲状旁腺激素(PTH)对去势大鼠骨质疏松的防治作用。方法 30只健康雌性SD大鼠随机行假手术(Sham,N=10)和双侧卵巢(OVX,N=20)切除手术后,所有OVX组大鼠随机的分成2组:OVX组、PTH+OVX组。术后第一天开始给予药物治疗,PTH+OVX组:PTH皮下注射(剂量60μg/kg,每周3次),直至手术后12周为止,实验截止时间之前所有大鼠注射碘海醇后处死取股骨行Micro-CT检测。结果与OVX组比较,PTH+OVX组股骨远端有较高的BMD、BV/TV、Tb.Th、Tb.N、Conn.D、血管体积分数和较低的Tb.Sp,其中Sham组大鼠股骨远端有最高的BMD、BV/TV、Tb.Th、Tb.N、Conn.D、血管体积分数和最低Tb.Sp。结论甲状旁腺激素通过促进血管形成及骨量增加来防治去势大鼠骨质疏松。     

中药骨康对去卵巢大鼠腰椎骨形态计量学的影响

目的 探讨中药骨康对卵巢切除大鼠骨质疏松症的治疗作用。方法 选择6m龄SD大鼠48只。随机分为假手术模型组（Sham）、手术模型组（OVX）、尼尔雌醇组（E2）、中药骨康组。切除大鼠卵巢3m后。大鼠骨质疏松症模型制备成功，分别给予尼尔雌醇、中药骨康灌胃治疗，并与Sham组和OVX组对照。治疗3m后，体内双荧光标记，取第2腰椎包埋切片。全自动图像分析及松质骨骨形态计量学软件处理。观察中药对骨形态计量学参数的影响。结果 卵巢切除后大鼠骨小梁面积百分数（％Tb．Ar）下降35．84％，骨小梁数量（Tb．N）下降16．60％，骨小梁宽度（Tb．Th）下降25．79％，表明绝经后骨质疏松症动物模型成立。骨康治疗3个月后，与OVX组相比，Oc．N／mm^2下降42．80％，有显著性差异（P〈0．01）；％Tb．Ar、Tb．Th、Tb．N和MAR有上升趋势（P〉0．05）；15．Sp，％L．Pm、BFR／BS、BFR／TV和Oc．N／mm，BFR／BV有下降趋势（P〉0．05）。结论 中药骨康具有降低骨转换以及促进骨形成和抑制骨吸收的双重作用，说明中药骨康对骨质疏松有明显的治疗作用。     

福善美调控软骨下骨骨重塑保护关节软骨的机制研究

目的 探讨福善美调控软骨下骨骨重塑保护关节软骨的机制.方法 以清洁级健康雌性SD大鼠为动物模型,分为Sham组、模型组和福善美组.通过切除双侧卵巢并切断右侧膝交叉韧带建立骨关节炎动物模型,术后第4周开始灌服福善美,模型组、Sham组灌服等量的生理盐水,分别于术后8、12、16周取材,采用骨关节炎软骨病理变化评价系统(OARSI)评价关节软骨的病变,对软骨下骨进行骨形态计量学分析.结果 术后8、12、16周,模型组较Sham组OARSI评分差异有显著意义(P＜0.01),福善美组较模型组OARSI评分差异有显著意义(P＜0.05).软骨下骨组织形态计量学参数测量显示模型组较Sham组骨小梁面积百分数(%Tb.Ar)、骨小梁宽度(Tb.Th)、骨小梁数量(Tb.N)、骨小梁分离度(Tb.Sp)、每毫米破骨细胞数(Oc.N/mm)差异有显著性(P＜0.01);模型组荧光周长百分率(%L.Pm)、矿化沉积率(MAR)、骨形成率(BFR/BV)、骨形成率(BFR/BS)低于Sham组,差异有显著性(P＜0.05).结论 软骨下骨在骨关节炎发生发展中起重要作用,骨吸收抑制剂福善美可作为治疗骨关节炎有潜力的药物.     

仙灵骨葆对卵巢切除小鼠骨质疏松症的影响

目的 利用卵巢切除骨质疏松症小鼠模型,研究仙灵骨葆抗骨质疏松症的疗效.方法 30只129SV品系雌性小鼠随机分为三组:卵巢假切+安慰剂组(SHAM+NS,0.2 ml·d-1);卵巢切除+安慰剂组(OVX+NS,0.2 ml·d-1),卵巢切除+仙灵骨葆组(OVX+XLGB,500 mg·kg-1·d-1),持续治疗12周后取材,应用Micro-CT检测骨密度(BMD)和骨小梁结构、组织病理切片观察骨形态、三点弯曲试验和压缩试验检测骨生物力学指标.结果 Micro-CT 检测股骨BMD,OVX+NS组BMD(498.6±13.0 mg/cm2)较SHAM+NS组(636.5±12.4 mg/cm2)下降22%(P＜0.01),OVX+XLGB组BMD (561.0±18.6 mg/cm2) 与OVX+NS组相比提高了13%(P＜0.05).Micro-CT检测小鼠腰椎(L2-5)骨小梁结构显示:OVX+NS组骨小梁BV/TV、Tb.Th 分别低于SHAM+NS组22%、35%,Tb.Sp高于SHAM+NS组11%,差异有统计学意义(P＜0.05).给予仙灵骨葆治疗后,腰椎BV/TV及Tb.Th分别高于OVX+NS组15%、16%,Tb.Sp低于OVX+NS组9%,具有显著性差异(P＜0.05).三点弯曲和压缩试验检测OVX+NS组股骨和腰椎的最大载荷和最大应力,股骨最大载荷和最大应力较SHAM+NS组显著降低42%、49%,腰椎最大载荷和最大应力显著降低42%、43%(P＜0.05).仙灵骨葆治疗后,股骨和腰椎的最大载荷分别提高了75%和47%,最大应力分别提高了47%和47%,差异有统计学意义(P＜0.05).结论 仙灵骨葆能够显著提高卵巢切除引起的骨密度,改善骨微结构破坏,提高骨生物力学参数,表明仙灵骨葆具有良好的抗骨质疏松症疗效.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

The analgesic effect of racemic ketamine in patients with chronic ischemic pain due to lower extremity arteriosclerosis obliterans

Background : Ketamine in sub-dissociative doses has been shown to have analgesic and phantom-Limb pain, where conventional treatment has often failed. Chronic ischemic pain due to lower extremity arteriosclerosis obliterans often responds poorly to analgesics, and the pain-generating mechanisms are not well understood.
Methods : Eight patients with rest pain in the lower extremity due to arteriosclerosis obliterans were given sub-dissociative doses of 0.15, 0.30, or 0.45 mg/kg racemic ketamine and morphine 10 mg as a 5-min infusion on four separate days in a cross-over, double-blind, randomised protocol. Plasma levels of (S)- and (R)-ketamine and their nor-metabolites were analysed with an enantioselective high-performance liquid chromatography (HPLC) method. Pain levels were evaluated with a visual analogue scale (VAS).
Results : Individual pain levels were highly variable during and after all the infusions but the pooled pain levels showed a dose-dependent analgesic effect of ketamine with a transient but complete pain relief in all patients at the highest dose (0.45 mg/ kg). Side-effects, mainly disturbed cognition and perception, were pronounced and dose-dependent. Morphine 10 mg had an analgesic peak at 20 min and 5/8 patients had complete pain relief. The remaining 3 patients also had high baseline pain scores, indicating a higher analgesic potency for the 0.30 and 0.45 mg/ kg ketamine doses than for morphine 10 mg.
Conclusion : We have demonstrated a potent dose-dependent analgesic effect of racemic ketamine in clinical ischemic pain. Due to a narrow therapeutic window, this analgesic effect is probably best utilised in combination with other analgesics.     

Intravenous endotoxin does not increase tissue extravasation of albumin in rats

Background : It is unclear whether activation of the inducible nitric oxide synthase (iNOS) increases or decreases the extravasation of plasma.
Methods : Chloralose anaesthetised male Wistar rats received E. coli lipopolysacharide (LPS), 3 mg kg^-1 i.v., or the corresponding volume of saline, 3 or 5 h before the end of the experiment. Mean arterial pressure (MAP) and heart rate (HR) were recorded. Tissue clearance of radio-labelled albumin, during the last 2 h of each experiment, was determined by a double-isotope method. In separate animals, the serum concentration of nitrite and nitrate was determined, 5 h after LPS or the solvent.
Main Results : LPS initially decreased MAP and lastingly increased HR. In the 3-h LPS animals (n=8), tissue plasma clearance was lower in the heart and calf muscle and increased only in diaphragm, compared to corresponding control animals (n=8). In the 5-h LPS rats, clearance was lowered (n=8) in the entire gastrointestinal tract and in testes, compared to controls (n=8). The serum nitrite/nitrate concentration was higher in animals given LPS (n=6) than in controls (n=6).
Conclusion : After LPS, tissue clearance of albumin was not increased in any major tissue, in spite of increased serum levels of NO end products. Apparently, after activation of iNOS, the augmented release of NO is not necessarily associated with increased albumin extravasation.     

Adrenaline markedly improves thoracic epidural analgesia produced by a low-dose infusion of bupivacaine, fentanyl and adrenaline after major surgery: A randomised, double-blind, cross-over study with and without adrenaline

Background: Basic pharmacological research indicates that there are synergistic antinociceptive effects at the spinal cord level between adrenaline, fentanyl and bupivacaine. Our clinical experience with such a mixture in a thoracic epidural infusion after major surgery confirms this. The objectives of the present study were to evaluate the effects on postoperative pain intensity, pain relief and side effects when removing adrenaline from this triple epidural mixture. Methods: A prospective, randomised, double-blind, cross-over study was carried out in 24 patients after major thoracic or abdominal surgery. Patients with only mild pain when coughing during a titrated thoracic epidural infusion of about 10 ml · h^?1 of bupivacaine 1 mg · ml^?1, fentanyl 2 μg · ml^?1, and adrenaline 2 μg · ml^?1 were included. On the 1^st and 2^nd postoperative days each patient was given a double-blind epidural infusion, at the same rate, with or without adrenaline. The effect was observed for 4 h or until pain when coughing became unacceptable in spite of a rescue analgesic procedure. Rescue analgesia consisted of up to two epidural bolus injections per hour and i.v. morphine if necessary. All patients received rectal paracetamol 1 g, every 8 h. Fentanyl serum concentrations were measured with a radioimmunoassay technique at the start and end of each study period. Main outcome measures were extent of sensory blockade and pain intensity at rest and when coughing, evaluated by a visual analogue scale, a verbal categorical rating scale, the Prince Henry Hospital pain score, and an overall quality of pain relief score. Results: The number of hypaesthetic dermatomal segments decreased (P <0.001) and pain intensity at rest and when coughing increased (P <0.001) when adrenaline was omitted from the triple epidural mixture. This change started within the first hour after removing adrenaline. After 3 h pain intensity when coughing had increased to unacceptable levels in spite of rescue analgesia (epidural bolus injections and i.v. morphine). Within 15–20 min after restarting the triple epidural mixture with adrenaline, pain intensity was again reduced to mild pain when coughing. Serum concentration of fentanyl doubled from 0.22 to 0.45 ng · ml^?1 (P <0.01), and there was more sedation during the period without adrenaline. Conclusions: Adrenaline increases sensory block and improves the pain-relieving effect of a mixture of bupivacaine and fentanyl infused epidurally at a thoracic level after major thoracic or abdominal surgery. Serum fentanyl concentrations doubled and sedation increased when adrenaline was removed from the epidural infusion, indicating more rapid vascular absorption and systemic effects of fentanyl.     

Utilisation des médicaments prokinétiques en réanimation : indications et limites ?

Enteral feeding is often limited by gastric and intestinal motility disturbances in critically ill patients, particularly in patients with shock. So, promotility agents are frequently used to improve tolerance to enteral nutrition. This review summaries the pathophysiology, presents the available pharmacological strategies, the clinical data, the counter-indications and the principal limits. The clinical data are poor. No study demonstrates a positive effect on clinical outcomes. Metoclopramide and erythromycin seems to be the more effective. Considering the risk of antibiotic resistance, the first line use of erythromycin should be avoided in favor of metoclopramide.     

Anesthésie générale chez l’enfant : quid des pratiques en 2010 ?

Introduction

The practice of pediatric anesthesia requires a regular update of scientific knowledge and technical skills. To provide the most adequate Continuing Medical Education programs, it is necessary to assess the practices of pediatric anesthesiologists. Thus, the objective of this survey was to draw a picture of the current clinical practices of general anesthesia in children, in France.

Material and methods

One thousand one hundred and fifty questionnaires were given to anesthesiologists involved in pediatric cases. These questionnaires collected information on various aspects of clinical practice relative to induction, maintenance, recovery from general anaesthesia and also classical debated points such as children with Upper Respiratory Infection (URI), emergence agitation, epileptoid signs or anaesthetic management of adenoidectomy. Differences in practices between CHG (general hospital), CHU (teaching hospital), LIBERAL (private) and PSPH (semi-private) hospitals were investigated.

Results

There were 1025 questionnaires completed. Fifty-five percent of responders worked in public hospitals (CHG and CHU); 77% had a practice that was 25% or less of pediatric cases. In children from 3 to 10 years: 72% of respondents used always premedication and two thirds performed inhalation induction in more than 50% of cases. For induction, 53% used sevoflurane (SEVO) at 7 or 8%. Respondents from LIBERAL used higher SEVO concentrations. Tracheal intubation was performed with SEVO alone (37%), SEVO and propofol (55%) and SEVO with myorelaxant (8%), 93% of respondents used a bolus of opioid. For maintenance, the majority of respondents used SEVO associated with sufentanil; desflurane and remifentanil were more frequently used in CHU. Two thirds of respondents used N₂O. Depth of anesthesia was commonly assessed by hemodynamic changes (52%), end tidal concentration of halogenated (38%) or automated devices based on EEG (7%). In children with URI, 98% of respondents used SEVO for anesthesia. To control the airway 42% used a tracheal tube, 30% a laryngeal mask and 20% a facial mask. Emergence agitation was an important concern for two thirds of respondents, while epileptoid signs were considered as important by only 20%. Eighty-nine percent of respondents practiced anesthesia for adenoidectomy. Anesthesia was induced by inhalation of SEVO 7–8% (41%), 6% (39%) or 4% (12%), 66% put an intravenous line (less frequently in LIBERAL). 67% of the responders managed adenoidectomy without any device to control the airway (more frequently in LIBERAL), 32% administrated a bolus of opioid (less frequently in LIBERAL).

Discussion

This survey demonstrated that the practices regarding general anesthesia in children are relatively homogenous. Most of the differences appeared between LIBERAL and the others structures; the anaesthetic management for adenoidectomy illustrates these findings.     

Intérêt d’une rééducation précoce pour les patients neurologiques

Rehabilitation improves the functional prognosis of patients after a neurologic lesion, and tendency is to begin rehabilitation as soon as possible. This review focuses on the interest and the feasibility of very early rehabilitation, initiated from critical care units. It is necessary to precisely assess patients’ impairments and disabilities in order to define rehabilitation objectives. Valid and simple tools must support this evaluation. Rehabilitation will be directed to preventing decubitus complications and active rehabilitation. The sooner rehabilitation is started; the better functional prognosis seems to be.     

Risiko Schlaganfall — Öffentlichkeitsarbeit und Aufklärung dringend erforderlich

Zusammenfassung Das wesentliche — und zugleich noch wenig ausgeschöpfte — Potenzial der Schlaganfallmedizin liegt in der langfristigen Prophylaxe. Durch Beeinflussung von Lifestylefaktoren wie Ernährungsgewohnheiten, Zigarettenkonsum und körperlichem Training durch entsprechende Aufklärung ließe sich ein erheblicher Teil an zerebralen Ereignissen vermeiden. Ein weiterer in Deutschland noch zu wenig beachteter Faktor ist die konsequente Blutdruckeinstellung. Breitgestreute Aufklärung könnte außerdem potenziellen Patienten helfen, bereits auftretende Warnsymptome wie die transiente ischämische Attacke richtig einzuschätzen, um eine rechtzeitige Behandlung zu ermöglichen.