Subarachnoidal anesthesia: the limits of its potentials

A total of 250 subarachnoidal anesthesias (SA) have been performed in patients operated on the lower limbs, perineum, external genitals, pelvic organs, and anterior abdominal wall at department for plastic and reconstructive surgery. The efficacy and safety of SA in everyday practice has been evaluated. A total of simultaneous 228 SA with three hyperbaric solutions were carried out: 5% ultracaine, 0.75% bupivacaine, 0.5% marcaine, and one isobaric solution 0.5% bupivacaine. Prolonged SA was administered to 10 patients and combined spinal-epidural anesthesia (CSEA) to 19. The sensory block was assessed by the pin prick test and the motor blocking by Bromage score. Of the central segmentary blockades, SA has been preferred for the above-listed interventions in recent years. Hyperbaric and isobaric solutions caused analgesia of different duration, latent period, and dissemination of the anesthetic under different clinical situations. Prolonged SA is justified in patients with limited hemodynamic reserves, and CSEA should be preferred when the expected duration of the intervention is longer than the estimated duration of SA effects. SA is an effective and safe method for surgical anesthesia on condition of proper choice of the local anesthetic, use of high-quality kits, and strict adherence to the protocol of subarachnoidal puncture and injection.     

Internet and cardiovascular research: the present and its future potentials and limits

The Internet and the World Wide Web have been proposed as tools to improve medical and cardiovascular research. These new technologies have been mainly applied to large-scale clinical trials, with the development of clinical-trial websites. They include tools for the management of some aspects of clinical trials, such as the dissemination of information on trial progress; randomisation and the monitoring processes; the distribution and accountability of study drugs; and remote data-entry. Several clinical-trial websites have been developed in the cardiovascular field over the last few years, but few have been designed to conduct trials fully online. Advantages of such systems include greater interaction between the coordinating centre and investigators, availability of a clean database in a short time, and cost reduction. Website developers need to take care of security issues and to use security tools (data encryption, firewalls, passwords and electronic signatures) in order to prevent unauthorised users from accessing the system and patient data.     

Occupational therapy and obsessive-compulsive disorder

The Model of Human Occupation, used as a frame of reference in the assessment and treatment of obsessive-compulsive disorder, helped identify how major disruptions in habituation and volition can affect a person's ability to perform and adapt in his or her environment. Careful application of this model promoted a more holistic view of John's life-style and guided me, as his occupational therapist, in creating a purposeful and meaningful treatment plan.     

Resuscitation from clinical death: pathophysiologic limits and therapeutic potentials

Modern cardiopulmonary-cerebral resuscitation (CPCR) for the reversal of clinical death (i.e., prolonged cardiac arrest) is a sequence of basic, advanced and prolonged life-support steps. This system was initiated by research that started in the 1950s. Present community-wide results are encouraging, but suboptimal. Maximal benefit from CPCR will be achievable: a) by minimizing response times; and b) by extending reversible arrest times--the topic of this symposium. For reperfusion, closed chest CPR is more readily available than, but physiologically inferior to, open chest CPR and emergency cardiopulmonary bypass. To optimize outcome, four components of the postresuscitation syndrome are being investigated: a) perfusion failure; b) reoxygenation injury cascades; c) self-intoxication; and d) blood derangements. Results from animal outcome studies so far suggest significant but still inconsistent benefit from several special postarrest treatments. The longest normothermic no-flow time yet reversed to good functional survival of heart, brain and the entire organism appears to be not 5 min, but between 10 and 20 min. The following is recommended and in part has been initiated: a) simultaneous investigation of pathophysiologic limits, therapeutic potentials, and prognosticating measurements; b) simultaneous basic research at cellular, organ, and organism levels; c) increased communication and consensus on research models between research centers; d) use of short-term and long-term animal models for systematic mechanism-oriented and empirical outcome-oriented studies; e) development of etiology-specific combination treatments; and f) community-wide case registries combined with epidemiologic studies and randomized clinical treatment trials.     

Occupational therapy personnel and AIDS: attitudes, knowledge, and fears

This study explored the attitudes, knowledge, and fears of occupational therapists and certified occupational therapy assistants regarding AIDS and HIV. The 119 respondents' scores related to knowledge and fear revealed that many had significant fears about AIDS, which in turn may inhibit their willingness to care for persons with AIDS. The respondents also indicated a need for specific information about the condition, including current research data and information on infection control.