Interactive cardiovascular effects between isoflurane and peroperative events

Abstract. The objective of this five–part (IV) study was to evaluate cardiovascular interactions between isoflurane and some pathophysiological and pharmacological interventions, likely to occur peroperatively. Specific aims were to investigate:

• a. Interactive responses between hemorrhage–induced hypovolemia and isoflurane in the intestinal circulations.
• b. Interactive response between regional hypothermia (28°C) and isoflurane in the intestinal circulation.
• c. Interactive responses between amrinone and isoflurane in the intestinal and renal circulations.
• d. Modulation by dopamine of the cardiovascular responses to isoflurane.
• e. Modulation by dopamine of the cardiovascular responses to thoracic epidural blockade concurrent with isoflurane administration

Intestinal (I–III) and renal (III) blood circulations were studied by optic flowmetry in cat models, with regional perfusion pressures controlled either by an extracorporeal pumpassisted circuit (I, II) or by adjustable abdominal aortic occlusion (III). Central hemodynamics were assessed in cat and dog models (III–V). Isoflurane was found to depress cardiac function in a doserelated fashion. In the regional circulation, isoflurane dose dependently produced vasodilation in the small intestine and in the kidney. The net response from these cardiac and vascular effects of isoflurane was a decrease in arterial pressure. In the small intestine, reflex vasoconstriction, induced by hemorrhage, was overruled by the vasodilator effects of isoflurane. Regional hypothermia in the small intestine attenuated the local vasodilator effects of isoflurane. The phosphor diesterase III inhibitor amrinone induced intestinal and renal responses, which added to the vasodilations induced by a moderate dose of isoflurane. The depressor effect of isoflurane could effectively be controlled by exogenous dopamine through counter–directed actions on cardiac function and through increased systemic vascular tone. The combination of isoflurane and thoracic epidural blockade was associated with depressed cardiac function. Exogenous dopamine effectively countered such actions and, in this situation, increased vascular tone to a greater extent than in control situations.     

Longitudinal person-centered measurement: A psychometric evaluation of the Preparedness for Colorectal Cancer Surgery Questionnaire (PCSQ)

ObjectiveThe Preparedness for Colorectal Cancer Surgery Questionnaire (PCSQ) was previously developed in Swedish to assess patients’ knowledge seeking and sense making capabilities. Aiming to measure preparedness at different phases during the pre-surgery and recovery period, the objectives were to (a) evaluate psychometric properties of the longitudinal PCSQ, (b) establish measurement invariance over time, and (c) describe change in preparedness.MethodsElective colorectal cancer surgery patients completed a questionnaire at five time points from pre-surgery until 6 months post-surgery (n = 250). The longitudinal PCSQ consists of 23 items measuring four domains: Searching for and making use of information, Understanding and involvement in care, Making sense of recovery, Support and access to care. Psychometric analyses, including confirmatory factor analysis, were applied to evaluate internal consistency reliability and ascertain invariance over time of the measurement structure and parameters.ResultsThe psychometric analyses revealed good fit of the measurement models, high internal consistency reliability (≥.94), and support for configural, metric and scalar measurement invariance of the four PCSQ domains. Patients reported lower levels of preparedness after surgery than pre-surgery.ConclusionThe adapted version of the PCSQ can be used for longitudinal analyses.Practice implicationsThe measurement of preparedness is important for evaluating person-centred outcomes before and during recovery from colorectal cancer surgery.     

Dumping the information bucket: A qualitative study of clinicians caring for patients with early stage non-small cell lung cancer

ObjectiveTo evaluate the quality of patient-clinician communication and shared decision making (SDM) when two disparate treatments for early stage non-small cell lung cancer (NSCLC) are discussed.MethodsWe conducted a qualitative study to evaluate the experiences of 20 clinicians caring for patients with clinical Stage I NSCLC prior to treatment, focusing on communication practices. We used directed content analysis and a patient-centered communication theoretical model to guide understanding of communication strategies.ResultsAll clinicians expressed the importance of providing information, especially for mitigating patient worry, despite recognition that patients recall only a small amount of the information given. When patients expressed distress, clinicians exhibited empathy but preferred to provide more information in order to address patient concerns. Most clinicians reported practicing SDM, however, they also reported not clearly eliciting patient preferences and values, a key part of SDM.ConclusionCommunication with patients about treatment options for early stage NSCLC primary includes information giving. We found that only a few communication domains associated with SDM occurred regularly, and SDM may not be necessary in this clinical context.Practice implicationsClinicians may need to incorporate nurse navigators or more written materials for effectively discussing potentially equivalent treatment options with their patients.     

Effects of transcutaneous neuromodulation (TENS) on overactive bladder symptoms in children: A randomized controlled trial

BackgroundThe aim of the present study was to investigate whether addition of transcutaneous electrical nerve stimulation (TENS) treatment improves the results of standard urotherapy in children with overactive bladder (OAB) symptoms.Material and methodsSixty-two children with symptoms of OAB and incontinence were included. The children were randomized either to standard urotherapy treatment alone or a combination of standard urotherapy and TENS. The effect variables were taken from a voiding–drinking diary: number of voiding, number of incontinence episodes, and maximum voided volume.ResultsBoth treatment groups had good treatment results, with no significant difference between the groups. In the standard treatment group 13/28 (46%) were completely dry and 11/28 (40%) had a decrease in incontinence episodes, compared to 16/24 (67%) and 3/24 (13%), respectively, in the standard + TENS group (p = 0.303). The number of voiding decreased in two-thirds of the patients in both groups. However, maximal voided volume only increased in the standard treatment group. Subjectively 72% and 80% considered themselves significantly improved or free of symptoms. Previous treatment was registered in 15/55 (27%). All efficacy variables decreased in those with previous treatment, but with no difference between the standard and standard + TENS treatment groups. The only difference noted was when comparing the children without previous treatment in the groups: a significantly higher proportion were completely dry in the TENS group (12/18 [71%] versus 10/22 [48%], p = 0.05).ConclusionOur results showed no significant difference overall in treatment response to OAB symptoms between urotherapy only and urotherapy + TENS, whereas a tendency to difference was found in children without previous treatment. Thus with good urotherapy support, TENS only seems to have marginal additional effects on OAB symptoms.     

A case of Kearns-Sayre syndrome with metaphyseal dysplasia

A case of mitochondrial encephalomyopathy (Kearns-Sayre syndrome) demonstrating bilateral symmetric metaphyseal dysplasia is reported. This represents a new association with the syndrome.     

A cluster of genes located in 1p36 are down-regulated in neuroblastomas with poor prognosis,but not due to CpG island methylation

Background  

A common feature of neuroblastoma tumours are partial deletions of the short arm of chromosome 1 (1p-deletions). This is indicative of a neuroblastoma tumour suppressor gene being located in the region. Several groups including our have been studying candidate neuroblastoma genes in the region, but no gene/genes have yet been found that fulfil the criteria for being a neuroblastoma tumour suppressor. Since frequent mutations have not been detected, we have now analyzed the expression and promoter CpG island methylation status of the genes UBE4B, KIF1B, PGD, APITD1, DFFA and PEX14 in the 1p36.22 region in order to find an explanation for a possible down-regulation of this region.     

Clinical,pathogenetic and neuropathological correlates in dystonic cerebral palsy

Studies were made of three autopsied cases of dystonic (changing tone) cerebral palsy with the aim of correlating the clinical characteristics and pathogenetic factors with the neuropathological lesions.Clinically all three patients were small-for-dates and born at gestational ages of 31–34 weeks. They sustained either severe birth asphyxia or repeated hypoxic episodes with respiratory arrest, and all three had moderate hyperbilirubinemia during the perinatal period. All of them developed an identical non-progressive extrapyramidal cerebral palsy syndrome. Mental capacity was less affected than motor performance, which remained at a neonatal level.From the pathogenetic point of view, prenatal malnutrition, preterm birth, pre- and perinatal hypoxia, acidosis and icterus were considered to be cumulative brain-damaging factors in each of the three patients. The pattern of combined partial and total asphyxia could be discerned in all the cases.The outstanding neuropathological correlate was selective bilateral sclerosis of the globus pallidus.It is proposed that the time of operation of the above factors in relation to the developmental stage of the globus pallidus determined the site of the cerebral damage. This hypothesis finds support in recent experiments with graded asphyxia in Rhesus monkeys.Supported by¹ the Swedish Medical Research Council, and² the Norrbacka-Eugenia Foundation and the newspaper Expressen's Prenatal Research Foundation