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Ann Otol Rhinol Laryngol. 2000 Oct;109(10 Pt 1):921-8.
Effects of intralaryngeal carbon dioxide and acetazolamide on the laryngeal chemoreflex.

Heman-Ackah YD, Goding GS Jr.

Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Hennepin County Medical Center, Minneapolis 55455, USA.

Sudden infant death syndrome is the leading cause of death in infants in the United States. The laryngeal chemoreflex (LCR) is thought to contribute to its pathogenesis. In adult animals, increasing levels of intralaryngeal CO2 result in a decrease in ventilatory activity. Intravenous acetazolamide (AZ) abolishes this response. The purpose of this study was to determine the effects of intralaryngeal CO2 and AZ on the LCR and respiratory physiology of piglets under normoxic and hypoxic conditions. We applied 0% or 10% CO2 in a randomized order to the larynx of 26 piglets. Intubation via tracheotomy prevented inhalation of the gas mixtures. Laryngeal stimulation was performed under normoxic conditions (PaO2 of >70 mm Hg) in 15 animals and under hypoxic conditions (PaO2 of 50 to 65 mm Hg) in 11 animals both with and without intravenous AZ (5 mg/kg). Respiratory and cardiovascular response data were recorded. Ten percent intralaryngeal CO2 has no significant effect on mean baseline respiratory rate, systemic PaCO2 or PaO2 levels, or apnea duration (p > .05). The use of AZ (versus no AZ) resulted in significantly higher baseline respiratory rates (64 versus 51 breaths per minute; p = .016), a decreased baseline systemic PaCO2 level (38.8 versus 45.9 mm Hg; p < .001), a higher baseline PaO2 level (97.9 versus 82.8 mm Hg; p < .001), shorter mean apnea durations (15.5 versus 24.8 seconds; p = .001), a higher lowest O2 saturation level after the stimulus (78.0% versus 68.4%; p = .003), and fewer profound apneas (10 of 90 versus 41 of 90 trials; p < .001). We conclude that 10% intralaryngeal CO2 does not decrease ventilatory activity in piglets and has no significant effect on the LCR. Acetazolamide, however, appears to have a protective effect against the LCR, resulting in shorter and less severe apneas. The protective effect of AZ against the LCR appears to be related to its ability to stimulate the respiratory drive and increase oxygenation at baseline.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11051432&dopt=Abstract

Ann Chir. 2000 Sep;125(7):648-53.
[Abdominal aortic aneurysm and autosomal dominant polycystic kidney disease]

[Article in French]

Lacombe M.

Hopital Beaujon, Clichy, France.

AIM: The aim of this study was to report a series of patients with autosomal dominant polycystic kidney disease operated for abdominal aortic aneurysm. PATIENTS AND METHODS: From 1986 to 1999, seven patients with this pathologic association were operated for aneurysm by the same surgeon. All were males, 47 to 69 years old (mean: 57.7). All were hypertensive and heavy smokers. Four were treated by hemodialysis. In five patients, the aneurysm was an incidental discovery, while two patients presented signs of obstructive arterial disease of the lower limbs. Ultrasound was the routine screening investigation, completed by aortography in all patients and by computed tomography in 2 patients. Surgical treatment consisted of intrasaccular repair of the aneurysm with a straight aortic tube (n = 5), a bifurcated prosthesis from the aorta to both common iliac arteries (n = 1) and a bifurcated prosthesis from the aorta to both common femoral arteries (n = 1). RESULTS: There was no postoperative mortality or morbidity. Two late deaths (at 5 and 8 years) occurred from myocardial infarction. Only one patient subsequently received a kidney transplant. Repairs were verified by postoperative angiography: anatomical results were satisfactory in all patients. Only nine similar cases have been published in the literature, including two deaths from ruptured aneurysm. CONCLUSIONS: The clinical diagnosis of aortic aneurysm is difficult in patients with polycystic kidneys due to renal volume. Ultrasound scan of the aorta is recommended to screen these patients for aneurysm. The data of our series show that the main cause of aortic aneurysms is atheroma and that a pathogenic link between this lesion and polycystic kidney disease is questionable. Elective aortic repair is recommended in order to avoid rupture of the aneurysm.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11051694&dopt=Abstract

Klin Med (Mosk). 2000;78(9):35-40.
[Some pathogenetic mechanisms of bacterial bronchial asthma in paecilomycosis]

[Article in Russian]

Akhunova AM.

2-week to 18 year follow-up data are analysed for 190 patients aged 3 to 70 years (91 females and 99 males) with bronchial asthma in Paecilomyses infection. Paecilomyces fungi play the role of a specific agent responsible for development of bacterial asthma. The bronchial spasm was provoked, on the one side, by hypersensitivity with participation of IgE defending the organism from the fulgi persisting in the blood and pulmonary tissue, on the other side, by biologically active substances produced by fungal cells, exogenic phospholipase A2, in particular. Clinical characteristics, course and outcome of bacterial asthma in Paecilomyces infection depend on the resistance of immune system to hematogenic fungal infection and immune reactions running in elimination of the agent.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11051738&dopt=Abstract

Rinsho Byori. 2000 Jul;48(7):575-9.
[Current HIV therapy and its clinical problems]

[Article in Japanese]

Oka S.

AIDS Clinical Center, International Medical Center of Japan, Tokyo.

HIV-specific protease inhibitors(PI) have been available in Japan since 1997. Since then, highly active anti-retroviral therapy(HAART) including two reverse transcriptase inhibitors combined with PI became the main strategy of HIV treatment. After introducing HAART, incidence of most opportunistic infections dramatically decreased, resulted a steep decline of AIDS death in Japan as well as in the United States. However, several unexpected problems related to HAART have been coming up. One is a lipodystrophy syndrome(LDS) which is a novel side effect caused by PI. Lipid disposition was noted associated with hyperlipidemia and/or hyperglycemia. Ischemic heart diseases will emerge in patients with LDS in future. Another one is inflammatory reactions to some opportunistic pathogens, such as Mycobacteria, Pneumocystis carinii, cryptococcus, and so on, occurred during course of immune reconstitution after HAART. This reaction is sometimes too severe to continue HAART and corticosteroid is often required to control the reaction. How to diagnose and how to manage the reaction are to be determined in future.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11051780&dopt=Abstract

J Endotoxin Res. 2000;6(3):223-34.
Complement activation by Proteus mirabilis negatively charged lipopolysaccharides.

Kaca W, Literacka E, Sjoholm AG, Weintraub A.

Karolinska Institutet, Division of Clinical Bacteriology, Huddinge University Hospital, Sweden. wkacirus.cmiwpan.lodz.pl

Proteus mirabilis strains are human pathogens responsible for urinary tract infections and bacteremias and may be involved in rheumatoid arthritis. Lipopolysaccharide (LPS, bacterial endotoxin), the major component of the cell wall, is one of the virulence factors of Proteus. In the presented studies, we have investigated complement activation by LPSs isolated from P. mirabilis O10, O23, O30, and O43 strains, which differ in the number of negative COO- groups on their polysaccharide components. Four P. mirabilis strains studied were sensitive to complement-mediated killing, despite complement binding by their LPSs. The optimal complement binding by LPSs was detected in serum with functional assays for both the classical and alternative pathways. Complement activation in 80% serum by the smooth, uronic acid, and hexosamine containing P. mirabilis LPSs was not critically determined by the structure of their O-chain polysaccharides. One of four LPSs used as a model, P. mirabilis O10 LPS, fragmented C3 in an LPS dose- and time-dependent manner. It was detected by crossed-immunoelectrophoresis and capture ELISA with anti-C3c antibodies. The lower complement activation by 023 LPS correlates with its reduced C3 fragmentation, compared with three other Proteus LPSs studied. Rabbit anti-O antibodies enhanced the complement binding and factor C3 fragmentation by O10, O23, O30, and O43 P. mirabilis LPSs.

online pharmacy ref. source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11052177&dopt=Abstract

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