Comparison of Tympanic, Esophageal and Blood Temperatures during Mild Hypothermic Cardiopulmonary Bypass: A Study using an Infrared Emission Detection Tympanic Thermometer

Objective. Tympanic temperature can be obtained instantaneously using an infrared emission detection (IRED) thermometer. Its accuracy has been documented in a variety of clinical settings, but its performance at low body temperatures is still unknown. In this study we evaluated its performance during coronary artery revascularization surgery in which mild hypothermic cardiopulmonary bypass (CPB) was used. Methods. Thirty adult patients undergoing coronary artery bypass graft surgery were enrolled in the study. Tympanic temperature obtained using IRED thermometry (Tt1) was compared with core temperatures from the esophagus (Te), and venous blood of CPB (Tv) before, during, and after CPB. We also measured tympanic temperature using a thermocouple probe (Tt2) in 16 of the 30 patients in order to study the agreement between the two methods. Values for correlation coefficients and limits of agreement were computed to assess the degree of agreement among the temperatures obtained. Results. The highest agreement with Tv during CPB was obtained from Tt1 (r = 0.94, 0.41 ± 1.73, limits of agreement) and from Te (0.91, 0.36 ± 2.46). Tt1 also showed good agreement with Tt2 during surgery. Conclusions. Infrared tympanic thermometry is a reliable, alternative method to measure tympanic temperature and may be useful to assess core temperature in both normothermic and mild hypothermic conditions.     

Isoflurane for removal of chest drains after cardiac surgery

Thirty-five patients who had undergone uncomplicated cardiac surgery were randomly allocated to receive either Entonox or isoflurane 0.25% in Entonox as inhalational analgesia for the removal of their two chest drains. The gases were presented premixed in high-pressure cylinders and were self-administered by means of a demand valve. The removal of the second drain was more painful than the first but that pain was better controlled by isoflurane 0.25% in Entonox than by Entonox alone.     

A comparative analysis of radiological and surgical placement of central venous catheters

Purpose To compare the differences in practice and outcome of all radiologically and surgically placed central venous catheters retrospectively over a 2-year period simultaneously, at a single institution. Methods A total of 253 Hickman catheters were inserted in 209 patients; 120 were placed radiologically in 102 patients and 133 were placed surgically in 107 patients. The indication was chemotherapy in 76% of radiological and in 47% of surgical cases; the remainder were for total parenteral nutrition and venous access. Results There were 6 (4.5%) primary surgical failures and a further 17 (13%) surgical cases requiring multiple placement attempts. Pneumothorax occurred once (0.8%) surgically and four times (3.3%) radiologically. There were no radiological primary misplacements but there were five (3.7%) surgical ones. Catheter or central vein thrombosis occurred in four (3.3%) radiological and five (3.7%) surgical cases. The rate of infection per 1000 catheter-days was 1.9 in radiologically placed catheters and 4.0 in surgically placed ones (p<0.001). Average catheter life-span was similar for the two placement methods (100±23 days). Conclusion Radiological placement is consistently more reliable than surgical placement. There are fewer placement complications and fewer catheter infections overall.     

心肌肌凝蛋白轻链—1的免疫组化研究

为了研究心肌肌凝蛋白轻链－１（ＣＭＬＣ－１）组织特异性的特点，并对其构型在心肌发育过程中的表达规律以及不同哺乳动物ＣＭＬＣ－１构型的生化规律进行探讨，应用抗人心室肌ＣＭＬＣ－１，单克隆抗体（ＭｃＡＢ）对成人和不同胎龄胎儿的心肌和其它组织，不同种属哺乳动物的心肌进行了免疫组织化学研究。结果发现：成人心室肌，慢性骨骼肌均发生强烈反应，成人心房，胎儿心室肌发生交叉反应，而其它组织加快骨骼肌，平滑肌以及肌     

超声心动图监测经导管心脏间隔缺损关闭术

应用超声心动图监测，经导管关闭先天性心脏间隔缺损９例。术中监测的主要内容有：（１）确定关闭器在心内的位置；（２）显示残余分流和瓣膜返流；（３）观察房间隔缺损球囊探测的过程。结果表明：超声心动图在显示心内结构、关闭器位置，残余分流和瓣膜流等方面有其独特性，同时可结合声学造影或术中需要进行多方面的监测。     

The Evolution of Abdominal Compression in Cardiopulmonary Resuscitation

Objective: To review the history of external abdominal compression as an adjunct to cardiopulmonary resuscitation (CPR), tracking the development of five major themes over the course of the 20th century: 1) augmentation of peripheral resistance by physical means, 2) risk of hepatic injury with abdominal compression, 3) counterpulsation vs sustained compression, 4) the abdominal pump mechanism, and 5) contact compression techniques.
Methods: Literature retrieved from successive MEDLINE English-language searches was reviewed with a special emphasis on work and concepts highlighted by participants at the First Purdue Conference on Interposed Abdominal Compression-CPR, September 1992.
Results: External abdominal compression of one form or another has been studied as a means of resuscitation by many investigators throughout the 20th century. Experimental and clinical studies have shown generally consistent evidence of hemodynamic augmentation by abdominal compression during various forms of CPR. Recent advances include a modified theoretical understanding of hemodynamic mechanisms and demonstration of clinical potential in humans. Inconsistencies in published results may be due to differences in mechanical techniques of abdominal compression. Based on these studies, a modified manual technique for "contact compression" of the abdominal aorta is recommended.
Conclusions: A technique for left-of-center, angled compression of the abdominal aorta against the crest of the spine is recommended. Further well-supervised and controlled clinical trials using this standardized technique are warranted as a prelude to more widespread clinical application of abdominal compression in CPR.     

Abdominal Pumping

This article reviews the author's experience with a form of interposed abdominal compression cardiopulmonary resuscitation (IAC-CPR) in the United Kingdom. The development of the technique based upon animal resuscitation, including the use of phasic compression (abdominal pumping) for the resuscitation of rats from 30 minutes of cardiac arrest due to hypothermia, is reviewed. A simple technique for clinical use is described. The technique uses a hard-covered book or bean-shaped board applied to the abdomen below the umbilicus and compressed alternately with cardiac massage while respiration is assisted. Anecdotal clinical results suggest that further controlled clinical investigation is warranted.     

Plant cardiac glycosides and digoxin Fab antibody

The potential application of the Digoxin Fab antibody (Wellcome Digibind) in the clinical management of plant poisoning was investigated. The cardiac glycoside contents of various Australian plants were studied using immunoassay techniques. The cross-reactions of the Fab antibody and two digoxin assay antibodies against extracts of these plants were also studied. Results obtained indicated that the Digibind antibody cross-reacted with a wide range of glycosides contained in Australian plants and therefore could be of use in the treatment of life-threatening plant poisoning.     

PET in cardiology: current status and clinical expectations

Summary. The development of positron emission tomography (PET) in the clinical environment along with the synthesis of biologically active molecules and tracer kinetic principles has provided a diagnostic tool for in vivo tissue characterization in humans. Moreover, based on the growing knowledge of cellular function on the molecular level of diseases PET biological imaging has stimulated the synthesis of numerous metabolic compounds labelled with the four primary positron-emitting radioisotopes C-ll, F-18, N-13 and 0–15. While the concept of biological imaging has gained attraction for probing both the central nervous system and neoplastic tissues, current diagnostic benefit from PET is probably best defined in cardiovascular medicine.