Efficacy of TachoSil? patches in controlling Dacron suture-hole bleeding after abdominal aortic aneurysm open repair

Purpose  

The aim of this study is evaluate the efficacy of TachoSil^? patches in controlling suture-hole bleeding after elective infrarenal abdominal aortic aneurysm (AAA) replacement with Dacron graft.     

The effect of intravenous glucose solutions on neonatal blood glucose levels after cesarean delivery

Purpose

Intravenous solutions are often administered to the mother on the day of a cesarean delivery to minimize the effect of preoperative fasting or to stabilize the hemodynamics. Different intravenous solutions contain varying amounts of glucose, and rapid administration may lead to hypoglycemia in the neonate. We conducted a study to compare blood glucose levels of the mother and the fetus/neonate after they were rapidly given a Ringer’s solution containing 0, 1, or 5 % glucose. The effect of the glucose load that these intravenous solutions impose during cesarean delivery has not been fully reported. Therefore, we compared the effect of 0 % (Group I, n = 15), 1 % (Group II, n = 15), and 5 % (Group III, n = 15) glucose acetated Ringer’s solutions on maternal and umbilical blood glucose levels to determine the optimal glucose concentration.

Methods

Once the patients were in the operating room, the intravenous solutions were administered before delivery. The primary endpoint was changes in umbilical blood glucose levels and minimum neonatal blood glucose levels, and the secondary endpoint was the proportion of neonates who received a glucose infusion.

Results

Maternal blood glucose levels before and after intravenous infusion were 79.2 ± 12.2 and 74.6 ± 4.6 in Group I, 81.2 ± 12.9 and 103.3 ± 11.2 in Group II (P < 0.001), and 82.3 ± 8.7 and 252.5 ± 41.8 in Group III (P < 0.001). Umbilical blood glucose levels were 53.9 ± 10.2 in Group I, 80.8 ± 13.7 in Group II, and 181.8 ± 22.2 in Group III (P < 0.01: Group I vs. Group II and P < 0.01: Group II vs. Group III) (P < 0.001: Group I vs. Group III). Minimum neonatal blood glucose levels measured up to 8 h after birth were 35.7 ± 9.6 in Group I, 49.8 ± 10.8 in Group II, and 29.2 ± 7.5 in Group III. Neonatal hypoglycemia requiring glucose before the first milk feeding occurred in 6 neonates whose mothers were in Group I, 3 in Group II, and 9 in Group III, indicating a trend towards less neonatal hypoglycemia in Group II.

Conclusions

The use of 1 % glucose acetated Ringer’s solution did not induce hyperglycemia in the mother and it was able to maintain appropriate blood glucose levels in the fetus.     

Postoperative patientcontrolled epidural analgesia with opioid bupivacaine mixtures

Purpose

To determine the efficacy and safety of patient-controlled epidural analgesia of morphine or fentanyl in combination with bupivacaine for postoperative pain relief.

Methods p]Forty ASA 1–11 patients scheduled for major abdominal surgery were studied. After insertion of a lumbar epidural catheter, patients were given a non-opioid general anaesthetic. After surgery patients complaining of pain, received a loading dose of 2 mg morphine (Group I) or 50 μg fentanyl (Group II). For continuing pain, 1 mg morphine in 4 ml bupivacaine 0.125% (0.25 mg·ml^?1 morphine and 1 mg·ml^?1 bupivacaine, Group I) or 20 μg fentanyl in 4 ml bupivacaine 0.125% (5 μg·ml^?1 fentanyl and 1 mg·ml^?1 bupivacaine Group II) were administered. Blood pressure, heart rate, respiratory rate and SpO₂ were monitored. Assessments of pain (VAS), nausea-vomiting, motor block, pruritus and sedation were recorded for 24 hr.

Results

No difference in pain or sedation was observed between groups, The 24 hr postoperative opioid consumption was 15.50 ± 7.53 mg morphine and 555.10 ± 183.85μg fentanyl. Total bupivacaine 0.125% consumption was 58.00 ± 30.14 ml in Group I and 101.05 ± 36.77 ml in Group II. One patient in Group II complained of motor weakness in one leg. The incidence of nausea (Group I 45%, Group II 10%P < 0.05) and pruritus (Group I 30%, Group II 5%P < 0.05) was less in patients receiving fentanyl. Conclusion: Both methods were effective in the prevention of pain but, because of fewer side effects, fentanyl may be preferable to morphine.     

Simple preoperative parameters to assess technical difficulty during a radical perineal prostatectomy

Purpose

We aimed to propose a practical selection method predicting the easier radical perineal prostatectomy (RPP) cases before the operation.

Methods

Fifty sequential RPP cases were divided into two groups according to the estimated difficulty of the operation (Group I: Easier, Group II: Difficult) which was assessed by using a RPP difficulty scale, constituted by three parameters (operation time, blood loss, and the judgment of the surgeon) each ranging between 1 and 3 points. As the localization parameters, skin-to-prostatic apex (SPAD) and skin-to-prostatic base (SPBD) distances and distance between bilateral ischial tuberosities (ITD) were measured. During suprapubic ultrasonography, a probe-divergence angle (PDA) and prostate volumes (PV) were recorded. These parameters were compared between the groups.

Results

In Group I (n = 29) and Group II (n = 21), the difficulty scores were 4.37 (3–5) and 6.80 (6–9), respectively. Data of age, clinical stages, and findings of digital rectal examination were not different between groups. While SPBD, SPAD, and ITD values were found similar (p > 0.05), PDA and PV were significantly different. PDA was > 45 degree in 21 cases in Group I (72.4 %) and in 7 cases in Group II (33.3 %) (p = 0.011). The mean of PV was 37.4 (20–60) cc and 49.9 (30–75) cc in Group I and Group II, respectively (p = 0.001).

Conclusions

While planning RPP operations, by selecting the prostate cancer cases with a prostate of low volume and localized deeper in the pelvis during suprapubic ultrasonography, urologists may have a chance to perform this technique more easily during the learning period.     

Epidural analgesia for labour and delivery: fentanyl or sufentanil?

Purpose

The highly lipid soluble opioids, fentanyl and sufentanil, are used in combination with local anaesthetics with/ without epinephrine to provide epidural analgesia during labour and delivery. Our aim was to determine whether either opioid was superior when used with low dose local anaesthetic.

Methods

In a double-blind study patients were randomized to two epidural infusion groups: Group I (n = 50) fentanyl 2 μg · ml^?1 with bupivacaine 0.015% and epinephrine 2 μg · ml^?1, Group II (n = 50) sufentanil 1 μg · ml^?1 with bupivacaine 0.015% and epinephrine 2 μg · ml^?1. Following a 20 ml bolus of the study solution an infusion was started at 10 ml · h^?1. To achieve analgesia patients could receive two boluses of 5 ml of the study solution and if analgesia was still inadequate, a further 5 ml bupivacaine 0.25% was used. Pain and overall satisfaction were assessed with a 10-point visual scale. Plasma samples obtained from the mother at the time the infusion was discontinued and from the umbilical cord vein at delivery were assayed to determine opioid concentration.

Results

Pain scores were greater for Group I than for Group II patients throughout the first and second stages of labour (P = 0.002). More patients in Group I (42%) requested a dose of bupivacaine 0.25% than in Group II (6%) (P < 0.0001) and the total dose of bupivacaine given to Group I patients was greater than that of Group II, 26.0 ± 22.0 mg vs. 13.4 ± 12.6 mg, P = 0.005. There were no differences with respect to first or second stage duration, incidence of side effects, infusion duration, outcome of labour or neonatal Apgar scores. There was no opioid accumulation in either maternal or foetal blood.

Conclusion

Epidural opioid infusion with very low dose bupivacaine (0.015%) achieved an overall high level of patient satisfaction in both groups without serious maternal or neonatal side effects. At the fentanyl-to-sufentanil ratio used here patients receiving sufentanil had lower pain scores and substantially fewer patients required bupivacaine rescue.     

Ulinastatin reduces elevation of cytokines and soluble adhesion molecules during cardiac surgery

Purpose

To investigate whether ulinastatin pretreatment (6000 U · kg^?1 before CPB and before declamping of aorta) influenced the production of cytokines and adhesion molecules in the peripheral circulation.

Methods

This prospective randomized study was performed in 22 patients undergoing cardiac surgery. They were divided into two groups. Patients in Group I were untreated and in Group II treated with ulinastatin. The soluble intercellular adhesion molecule-1 (S-ICAM-1), soluble endothelial leukocyte adhesion molecule-1 (S-ELAM-1), interleukin8 and 6 (IL-8, 6) were measured using ELISA kits.

Results

Serum S-ICAM-1 concentration in Group I increased from the preoperative value of 297 ± 27 ng · kg^?1 to 418 ± 106 ng · kg^?1 at 60 min after declamping of the aorta (P < 0.01) but did not change in Group II. Serum S-ELAM-1 concentration did not change in either group. Serum concentration of IL-8 and IL-6 in Group I (37 ± 44 pg · kg^?1, and 59 ± 59 pg · kg^?1, preoperatively) increased to 169 ± 86 pg · kg^?1 and 436 ± 143 pg · kg^?1 at 60 min after declamping of the aorta (P < 0.001, P < 0.001). The increases were greater than those from 25 ± 6 pg · kg^?1 and 30 ± 26 pg · kg^?1 to 56 ± 36 pg · kg^?1 and 132 ± 78 pg · kg^?1 in Group II (P < 0.001, P < 0.001). The levels of S-ICAM-1 correlated with those of IL-8 (r = 0.5, P < 0.001).

Conclusion

These results suggest that ulinastatin may suppress the increase in IL-8 production and the expression of ICAM-1 during cardiac surgery.     

The feasibility of solo-surgeon living donor nephrectomy: initial experience using video-assisted minilaparotomy surgery

Background

Today, many kinds of surgery are being conducted without human assistants. Living donor nephrectomy (LDN) using video-assisted minilaparotomy surgery (VAM) has been performed by solo-surgeon using Unitrac^® (Aesculap Surgical Instrument, Germany). We examined the results from VAM–solo-surgeon living donor nephrectomy (SLDN) and conventional VAM–human-assisted living donor nephrectomy (HLDN).

Methods

Between July 2007 and April 2008, 82 cases of VAM–LDN were performed by two surgeons. From these cases, we randomly assigned 35 cases to undergo solo-surgery (group I) and the other 47 cases to undergo surgery with one human assistant (group II). All VAM–LDN procedures were performed in the same manner. Only the roles of a first assistant were substituted by the Unitrac^® in group I. We compared the perioperative and postoperative data, including operative time, estimated blood loss, and hospital stay, between the two groups. We also investigated cases that developed complications.

Results

There were no significant differences in the patient demographic data between the two groups (P > 0.05). The mean operative time was 201.9 ± 32.9 min in group I and 202.4 ± 48.3 min in group II (P = 0.954), whereas mean blood loss was 209.7 ± 167.3 ml in group I and 179.6 ± 87.8 ml in group II (P = 0.294). Postoperative hospital stay were 5.4 ± 1.1 days in group I and 5.5 ± 1.6 days in group II (P = 0.813). The incidence of perioperative complications was not significantly different between the two groups.

Conclusions

Our study demonstrates that VAM–SLDN can be performed safely, is economically beneficial, and is comparable to VAM–HLDN in terms of postoperative outcomes.     

Anaesthesia Equipment Patient controlled oral analgesia with morphine

Purpose

When using strong oral opioids for postoperative pain management, demand titration is desirable. A device for patient controlled oral analgesia (PCORA) and first results of its use for oral titration of morphine are presented.

Methods

The PCORA-device is a modified Baxter-PCA-on-demand system (maximum bolus volume: 0.5 ml; flow rate for filling bolus volume: 0.5 ml · hr^?1). The demand PCORA-volumes were measured at specific time intervals and PCORA was compared with customarily prescribed pain therapy (CPPT) for postoperative pain management. On the first post-operative day, 20 orthopaedic ASA I or II patients received, in a randomised, cross-over trial, either PCORA (300 min) followed by CPPT (300 min) (Group I) or vice versa (Group II). The PCORA-device permitted a maximum dose of 15 mg morphine per 60 min and CPPT was performed by the ward doctor or nurse. Pain intensity (101-point numerical rating scale) and side effects were evaluated at 30 min intervals.

Results

The accuracy of the bolus volume delivered by the PCORA-device was 89.2 ± 0.85% (mean ± SEM), of manufacturer’s specifications. PCORA pain intensity decreased over time whereas CPPT pain intensity did not (P < 0.001). PCORA-morphine requirements were 61.5 ± 5.2 mg (Group I) and 52.5 ± 8.5 mg (Croup II) (NS; mean ± SEM). The handling of the PCORA-device presented no problem to any patient.

Conclusion

Patient controlled oral analgesia is an effective and non-invasive mode of postoperative pain management. The PCORA-device is reliable and easy to use.     

Implant Design Influences Tibial Post Wear Damage in Posterior-stabilized Knees

Background

The tibial post in posterior-stabilized total knees is a potential source of polyethylene wear debris, but the relationship between the shape and location of the tibial post in relation to the tibiofemoral bearing surfaces and the subsequent wear damage patterns remains unknown.

Questions/purposes

We used observations made on retrieved implant components from three contemporary posterior-stabilized knee designs to examine how differences in tibial post design affected wear damage on the post.

Methods

We examined 113 retrieved Zimmer NexGen^®, 103 Exactech Optetrak^®, and 58 Smith and Nephew Genesis^® II posterior-stabilized inserts using a subjective scale to grade post damage.

Results

All 274 inserts demonstrated wear damage. Total wear scores and scores for wear damage on the anterior post differed among designs: Optetrak^® 20 ± 4 and 5 ± 1, NexGen^® 13 ± 4 and 3 ± 1, and Genesis^® II 8 ± 3 and 1 ± 1, respectively. The Optetrak^® had predominantly anterior wear damage, the NexGen^® had more global wear damage, and the Genesis^® II had predominantly posterior wear damage. Tibial post wear damage and anterior post wear damage were primarily determined by implant design and to a lesser extent by length of implantation and revision diagnosis.

Conclusions

Although tibial post wear damage is multifactorial, the primary determinant of wear damage, and specifically anterior wear damage, is implant design.

Clinical Relevance

The constraint provided by the posterior-stabilized post-cam contact in modern knee arthroplasties is reflected in the wear damage patterns that occur during in vivo use. Unintended constraint such as anterior impingement should be addressed through design modifications for future posterior-stabilized knee arthroplasties.     

Somatic paravertebral block decreases opioid requirements in children undergoing appendectomy

Purpose

Somatic paravertebral block (SPVB) appears to provide effective and prolonged nerve block in children; however, study of its use in this population is limited. We compared SPVB with no block in children undergoing appendectomy.

Methods

Thirty-six children aged 3-16 yr undergoing open appendectomy were involved in this prospective randomized controlled study. Anesthesia was induced with propofol and maintained with isoflurane in N₂O/oxygen. All subjects received fentanyl, acetaminophen and ketorolac during anesthesia. Group I (SPVB) subjects received a right SPVB at T₁₁, T₁₂, and L₁ using 0.2% ropivacaine 0.25 mL·kg^?1 with epinephrine 1:200,000 preoperatively. Group II (Control) had only bandaids applied to skin. Both groups were given morphine 0.05 mg·kg^?1 iv every 2 hr if pain scores reached 5/10 on a visual analogue scale. Acetaminophen was administered postoperatively every 6 hr to both groups. Time to first dose of morphine, total dose of morphine in 24 hr, and any adverse effects up to 24 hr after surgery were recorded.

Results

Group I (SPVB) subjects required significantly less morphine than Group II (Control) patients (0.12 ± 0.07 vs 0.34 ± 0.15 mg·kg^?1, respectively; P < 0.001), and time to their first dose was significantly longer (7.1 ± 4.4 vs 2.5 ± 1.6 hr, respectively; P < 0.001). Incidence of vomiting was 11% with Group I and 27% with Group II (P = 0.21). No other adverse effects were observed in either group.

Conclusions

In children undergoing appendectomy, SPVB provides better pain relief than no block and reduces opioid requirements. Side effects were not statistically different between groups.     

Epidural administered buprenorphine in the perioperative period

Purpose

To study the effect of epidural buprenorphine on minimum alveolar concentration (MAC) of volatile anaesthetics, duration of analgesia and respiratory function in the perioperative period.

Methods

One hundred and twenty patients, ASA I–II undergoing gynaecological surgery were randomly divided into three studies. The forty patients in each study were randomly divided into four groups depending on the dosage; Group I (control), Group II (80 μg · kg^?1 morphine), Group III (4 μg · kg^?1 buprenorphine), Group IV (8 μg · kg^?1 buprenorphine). The MAC of halothane was measured following epidural administration of the agents in each group. The duration of analgesia was assessed by the first request for pentazocine. Postoperative analgesic effects were assessed by the total dosage of pentazocine required for the 48 hr after surgery. Respiratory rate (RR), minute volume (MV), and PaCO₂ were measured during surgery and the postoperative period. The MAC of halothane was reduced in Group IV (P < 0.01). The duration of analgesia was 10.0 ± 5.1 hr (Mean ± SE) in Group 1, 37.7 ± 4.7 hr in Group II, 27.1 ± 7.1 hr in Group III, and 44.4 ± 4.1 hr in Group IV. Total dosage of pentazocine was lower in Group IV (P < 0.05) than in the other groups. The decrease of RR, MV and the increase of PaCO₂ were observed within 60 min in Group III and IV dose dependently.

Conclusion

Epidural buprenorphine administered in a dose of 4 or 8 μg · kg^?1 provides postoperative analgesia that is no less effective than that of morphine.     

Exakte Messung des Volumeneffektes von 6%iger Hydroxyethylstärke 130/0,4 (Voluven®) während präoperativer akuter normovolämer Hämodilution

Background

What is the effect of preoperative acute normovolemic hemodilution (ANH) with 6% hydroxyethyl starch (HES) 130/0.4 (Voluven^®) on blood volume?

Methods

In 10 patients undergoing radical hysterectomy, ANH was performed to a hematocrit of 21% using 6% HES 130/0.4 (Voluven^®) whereby a replacement of blood with 115% of colloid was planned. Plasma volume (indocyanine green dilution technique) and hematocrit were determined before, 30 and 60 min after ANH. Red cell volume (labelling erythrocytes with fluorescein) was determined before and 30 min after ANH.

Results

After removal of 1,431±388 ml of blood and simultaneous replacement with 1,686±437 ml of colloid, blood volumes were 218±174 ml higher than before (at 105±4%). The volume effect was 98±12%, 30 min after ANH. Even 60 min after ANH, mean blood volumes were with 4,228±986 ml slightly higher than before ANH (102±5%). The hematocrit decreased disproportionally in relation to the residual intravascular volume. Consequently, estimating the volume effect from the changes in hematocrit led to an overestimation (about +30%).

Conclusion

Double label measurements of blood volume demonstrated that the volume effect of 6% HES 130/0.4 (Voluven^®) is about 100% in the course of ANH. The reason for the disproportionally large decrease in hematocrits could be the mobilization of a fraction of the plasma volume which was retained within the endothelial glycocalyx.     

Comparison of hemostasis using bipolar hemostatic forceps with hemostasis by endoscopic hemoclipping for nonvariceal upper gastrointestinal bleeding in a prospective non-randomized trial

Background

We previously reported on the safety and efficacy of bipolar hemostatic forceps for treating nonvariceal upper gastrointestinal (UGI) bleeding. However, no prospective or randomized studies have evaluated the efficacy of bipolar hemostatic forceps. The aim of this study was to evaluate the hemostatic efficacy of using bipolar hemostatic forceps compared with the hemostatic efficacy of the commonly used method of endoscopic hemoclipping for treating nonvariceal UGI bleeding.

Methods

A total of 50 patients who required endoscopic hemostasis for UGI bleeding were divided into two groups: those who underwent endoscopic hemostasis using bipolar hemostatic forceps (Group I) and those who underwent endoscopic hemostasis by endoscopic hemoclipping (Group II). We compared the two groups in terms of hemostasis success rate and time required to achieve hemostasis and stop recurrent bleeding.

Results

All (100 %) of 27 patients in Group I and 18 (78.2 %) of 23 patients in Group II were successfully treated using bipolar hemostatic forceps or by endoscopic hemoclipping alone, respectively, indicating a significantly higher success rate for Group I than for Group II (p < 0.05). The time required to achieve hemostasis was 6.8 ± 13.4 min for Group I and 15.4 ± 17.0 min for Group II. One patient in Group I (3.7 %) and four patients in Group II (22.2 %) experienced recurrent bleeding.

Conclusion

Bipolar hemostatic forceps was more effective than endoscopic hemoclipping for treating nonvariceal UGI bleeding.     

Heparin and protamine titration do not improve haemostasis in cardiac surgical patients

Purpose

Weight-based heparin and protamine dosing strategies for cardiopulmonary bypass (CPB) do not take into account interpatient variability in drug sensitivity and may result in bleeding complications. We compared the Hemochron® RxDx heparin and protamine titration system with standard weight based management with regard to heparin dose, protamine dose, and perioperative bleeding.

Methods

One hundred and thirty-five cardiac surgical patients were randomised into four groups. Group I received standard heparin and protamine management: Group 2 received heparin and protamine byin vitro titration. Group 3 had the heparin dose titrated, and group 4 had the protamine dose titrated. Coagulation tests, bleeding, and transfusion requirements were measured.

Results

The initial heparin bolus predicted by the titration was < 300 U· kg^?1 in all patients. Group 2 received a lower heparin bolus for the initiation of bypass but total heparin doses were not different among groups (group 1 = 365 ± 43, group 2= 348 ± 73 U · kg^?1, group 3= 394 ± 86 U · kg^?1, group 4= 376 ± 60; P = 0.06). Groups 2 and 4 received a lower initial and a lower total protamine dose (total dose group 1 = 4.03 ± 0.65 mg · kg^?1, group 2 = 3.56 ±1.11 mg · kg^?1, group 3= 4.22 ± 0.90 mg · kg^?1, group 4= 3.38 ± 0.98 mg· kg^?1,P = 0.001). The incidences of incomplete heparin neutralisation (P = 0.14) and heparin rebound (P = 0.1) were not different among groups. Postoperative bleeding and transfusion requirements did not differ.

Conclusion

In cardiac surgical patients, heparin and protamine titration did predict a lower protamine dose but did not result in a measurable improvement in haemostasis during the perioperative period.     

Changes in number of water-filled vesicles of choroid plexus in early and late phase of experimental rabbit subarachnoid hemorrhage model; the role of petrous ganglion of glossopharyngeal nerve

Background

Cerebrospinal fluid (CSF) secretion may be increased in the early phases of subarachnoid hemorrhage (SAH), possibly via ischemic glossopharyngeal nerve discharges, and decreased due to glossopharyngeal nerve degeneration in the late phase of SAH; but this reflex pathway has not been definitively investigated. We studied the relationship between petrous ganglion of the glossopharyngeal nerve (GPN) and water vesicles of the choroid plexus (CP) in the early and late phases of SAH.

Methods

This study was conducted on 30 rabbits, divided into four groups, with five rabbits in the control group (group I), five rabbits in the sham group (Group II), and 20 rabbits in the SAH group. In the SAH group, five of the animals were decapitated after 4 days of cisternal blood injections (Group III), and the other 15 animals were decapitated after 20 days of injections (Group IV). The Petrous Ganglia and CPs of lateral ventricles were removed and stained for stereological analysis.

Results

The mean number of follicles per cubic millimeter was 5.3?±?1.2 the in control group (Group I), 4.5?±?0.9 in the sham group (Group II), 16.60?±?3.77 the in early decapitated group (Group III), and 4.30?±?0.84 in the late decapitated group (Group IV). The mean number of degenerated neuron density of petrous ganglions was 6?±?2, 50?±?6, 742?±?96, and 2.420?±?350 in the control (Group I), sham (Group II), early decapitated (Group III), and late decapitated group (Group IV), respectively. The mean number of water vesicles was statistically different after SAH between the early decapitated group (group III) and the late decapitated group (group IV) (P?<?0.05).

Conclusions

We studied the relationship between petrous ganglion cells of the GPN and water vesicles of CP in the early and late phases of SAH, and found that CP vesicles are increased in the early phase of SAH due to irritation of GPN, and decreased in the late phase due to ischemic insult of the petrous ganglion and parasympathetic innervation of the CP.     

Refractory and new-onset diabetes more than 5?years after gastric bypass for morbid obesity

Background

Few studies about long-term glucose homeostasis in bariatric patients are available. In a prospective protocol that included retrospective information, outcome of patients with both impaired and normal fasting blood glucose (FBG) was monitored to assess frequencies and correlates.

Methods

Patients submitted to Roux-en-Y gastric bypass were classified as group I, elevated FBG, and group II, normal controls. Those in group I with improvement in FBG were defined as responsive and the others as refractory. Group II participants progressing to new-onset diabetes (NOD) or prediabetes represented NOD cases; the remaining were listed as stable controls. FBG was the main endpoint, but HbA1c results were considered, along with diet composition and general biochemical profile.

Results

Among 97 selected patients, 51 belonged to group I (52.4?±?10.5?years, 29.6?% males, initial body mass index (BMI) 58.4?±?13.4, current BMI 35.1?±?8.4?kg/m²) and 46 to group II (48.2?±?10.5?years, 19.6?% males, initial BMI 55.5?±?8.8, current BMI 33.9?±?6.9?kg/m²). Follow-up was 7–9?years, and 31.4?% (16/51) of group I were classified as refractory, whereas 15.2?% (7/46) of the controls converted to NOD. Multivariate analysis pointed out higher current BMI, older age, consumption of antidiabetic drugs, and male gender as features of refractory cases, whereas NOD participants were not significantly different from non-progressing controls.

Conclusions

This is the first investigation, to the best of our knowledge, to underscore the correlates of refractory and NOD within the bariatric context. Further studies are recommended as such information could be valuable for patient selection, prognostic scoring, and outcome monitoring.     

Heart rate changes in cardiac transplant patients and in the denervated cat heart after edrophonium

Purpose

The effect of edrophonium on heart rate in cardiac transplant patients and in an animal model of acute cardiac denervation were studied, to evaluate the functional state of the peripheral parasympathetic pathway fol lowing cardiac denervation.

Methods

Edrophonium was studied in patients with normally innervated hearts (controls) and m cardiac trans plants. Edrophonium was also studied in vagotomized. beta-blocked cats. In Group I animals, the vagus nerve was not stimulated. In Groups 2 & 3 the right vagus nerve was electrically stimulated to produce approximately 20% and 40% reductions in baseline heart rate, respectively.

Results

Maximum heart rate reduction in transplants (7.3 ± 0.8 beats·min^?1 with 0.6 ± 0.08 mg·kg^?1) was less than in controls (13.3 ± 1.6 beatsmm with 0.4 + 0.05 mg·kg^?1, P < 0.01). In Group I animals heart rate decreased maximally by 20.9 ± 2.5 beats·min^?1 with 9.0 ± 1.9 mg·kg^?1. In Groups 2 and 3, with doses < 15 mg·kg^?1, reduc tions m heart rate were greater than in Group I and maximual reductions were obtained with lower doses (Group 2: maximum reduction by 20.3 ± 2.8 beats·min^?1 with 1.3 ± 0.1 mg·kg^?1: Group 3: 22.6 ± 4.0 beats·min^?1 with 0.8±0.2 mg·kg^?1, P < 0.001) Doses > 1.5 mg·kg^?1 in Groups 2 and 3 produced increases in heart rate.

Conclusion

Edrophonium produced bradycardia in cardiac transplants suggesting spontaneous release of acetylcholinee from parasympathetic postganglionic neurons m the transplanted heart. The magnitude of the brady cardia was less in transplant than in control patients. Findings from animal studies suggest that the reduction in transplants can be attributed to diminution or absence of tonic cardiac parasympathetic drive. At high doses, edrophonium may interfere with parasympathetic neuron activation.     

Is lidocaine-prilocaine cream (EMLA®) always useful for venous puncture in preoperative autologous blood donation ?

Purpose

The goal of the present study was to evaluate in adults the benefit of the Eutectic Mixture of Local Anesthetics (EMLA®) for preoperative autologous blood donation.

Methods

Twenty-six adult patients requiring three blood samples were studied. The pain of venipuncture was assessed by the patient using a 100 mm Visual Analogue Scale (VAS) and a four-category Verbal Rating Scale (VRS). The first puncture was performed without anaesthesia, as a “reference puncture.” The second and third punctures were performed with EMLA® and placebo in a double-blind cross-over randomization. For statistical analysis, the patients were allocated to two groups according to the VAS scores of the reference puncture: (Group 1) VAS_ref < 20 mm; (Group 2) VAS_ref≥20 mm.

Results

For the whole 26 patients, the VAS and the VRS pain scores were lower for EMLA® puncture than for both the placebo and reference punctures (P < 0.05). Twenty patients had a VAS_ref < 20 mm and six patients a VAS_ref ≥ 20 mm. In Group 1, there was no difference between EMLA® and placebo for both the VAS and VRS scores. In contrast, in Group 2, the VAS score was lower for EMLA® than for both the placebo and the reference punctures (respectively 11 ± 7.1, 28.9 ±7.9, 29.1 ± 6.4; P < 0.01); the VRS score was also lower for EMLA® puncture than for placebo puncture (P < 0.05).

Conclusion

In adults requiring repeated venous punctures, pain from cannulation may be evaluated at the first puncture with a Visual Analogue Scale, thus indicating or not the need for EMLA®.     

Is closed-suction drainage necessary after intradural primary spinal cord tumor surgery?

Purpose

The efficacy of closed-suction drainage in primary intradural spinal cord tumor surgery has not been addressed. We investigated whether closed-suction drainage is essential after primary intradural spinal cord tumor surgery.

Methods

From January 2003 to October 2011, 169 consecutive patients with primary intradural spinal cord tumors operated by a single surgeon were selected. Closed-suction drainage was inserted in patients before August 2007, but was not used after August 2007. After removal of tumor and meticulous hemostasis, the opened dura was closed and made watertight using 4-0 silk with interrupt suture and 1.0 cm³ of surgical glue was applied in common. Closed-suction drainage was inserted below the muscular fascia in 75 patients (group I, M:F = 39:36; 46.20 ± 15.63 years) and was not inserted in 94 patients (group II, M:F = 46:48; 51.05 ± 14.89 years).

Results

Neurological deficit precluding ambulation did not occur in all patients. Between group I and II, there were no significant differences in body mass index (22.75 ± 3.16 vs. 23.51 ± 3.22 kg/m²; p = 0.13), laminectomy level (2.45 ± 1.46 vs. 2.33 ± 1.91; p = 0.65), operation time (260.65 ± 109.08 vs. 231.52 ± 90.08 min; p = 0.06), estimated intraoperative blood loss (456.93 ± 406.62 vs. 383.94 ± 257.25 cm³; p = 0.18), and hospital stay period (9.25 ± 5.01 vs. 9.35 ± 5.75 days; p = 0.91). Two patients in group I underwent revision surgery due to wound problems, while revision surgery was not performed in group II (p = 0.20).

Conclusion

Closed-suction drainage may not be essential after primary intradural spinal cord tumor surgery.