Articles: function.
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Anesthesia and analgesia · Apr 2014
Topical combinations to treat microvascular dysfunction of chronic postischemia pain.
Growing evidence indicates that patients with complex regional pain syndrome (CRPS) exhibit tissue abnormalities caused by microvascular dysfunction in the blood vessels of skin, muscle, and nerve. We tested whether topical combinations aimed at improving microvascular function would relieve allodynia in an animal model of CRPS. We hypothesized that topical administration of either α2-adrenergic (α2A) receptor agonists or nitric oxide (NO) donors given to increase arterial blood flow, combined with either phosphatidic acid (PA) or phosphodiesterase (PDE) inhibitors to increase capillary blood flow, would effectively reduce allodynia and signs of microvascular dysfunction in the animal model of chronic pain. ⋯ The present results support the hypothesis that allodynia in an animal model of CRPS is effectively relieved by topical combinations of α2A receptor agonists or NO donors with PA or PDE inhibitors. This suggests that topical treatments aimed at improving microvascular function by increasing both arterial and capillary blood flow produce effective analgesia for CRPS.
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COPD is characterized by chronic inflammation. CD8+ T cells and CD4+ T cells have both been implicated in the inflammatory response. We investigated whether the lymphocyte and T-cell subpopulations in BAL differ between patients with COPD who are current smokers and those who are ex-smokers. ⋯ Current smoking status has a greater impact than airway obstruction on the distribution of T-cell subsets in BAL of patients with mild to moderate COPD. This fact must be considered when the role of T cells in COPD is evaluated. Our results stress the importance of subgrouping patients with COPD in terms of smoking.
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Douglas B. Craig, W.M. Wahba, Hillary Don ⋯ The work of Drs. D. Craig et al. published in the Journal more than 40 years ago was seminal to our understanding of how patient positioning has an important influence on lung volumes and on the age-related relationship between FRC and CV.
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Recent studies in healthy mice and rats have reported that positive pressure ventilation delivered with physiological tidal volumes at normal end-expiratory volume worsens lung mechanics and induces cytokine release, thus suggesting that detrimental effects are due to positive pressure ventilation per se. The aim of this study in healthy animals is to assess whether these adverse outcomes depend on the mode of mechanical ventilation. ⋯ Both positive and negative pressure ventilation performed with tidal volumes and timing of spontaneous, quiet breathing neither elicit an inflammatory response nor cause morpho-functional alterations in normal animals, thus supporting the notion of the presence of a critical volume threshold above which acute lung injury ensues. Distortion of lung parenchyma can induce an inflammatory response, even in the absence of volotrauma.
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A case of delivery of a hypoxic gas mixture to a patient during total intravenous anesthesia is described. A progressive fall in inspiratory oxygen concentration followed by a drop in oxygen saturation below 90 % occurred during the advanced stages of a hitherto uneventful general anesthesia of a female patient undergoing anterior cervical fusion surgery. A malfunctioning defective rubber seal of a vaporizer manifold was identified as the cause of the gas leak. ⋯ The problem of hypoxic gas mixtures and uncommon leaks in modern anesthesia equipment is discussed. The importance of locating a leak in the high or low pressure circuits is explained. An algorithm for the management of an unexpected decrease of inspiratory oxygen concentration or any other manifestation of a gas leak along with a systematic approach to locating the source of a gas leak is presented.