Addition of sodium bicarbonate to lidocaine decreases the duration of peripheral nerve block in the rat

BACKGROUND: Adding sodium bicarbonate to lidocaine to enhance its efficacy during peripheral nerve block is controversial. The authors studied the effect of adding sodium bicarbonate to lidocaine with and without epinephrine versus equivalent alkalinization by sodium hydroxide (NaOH) on onset, degree, and duration of peripheral nerve block. METHODS: Part I examined alkalinization by sodium bicarbonate versus NaOH to pH 7.8 on 0.5% lidocaine, with and without epinephrine (1:100,000), prepared from crystalline salt. Part II examined 0.5% and 1.0% commercial lidocaine solutions, with and without epinephrine, either unalkalinized or alkalinized with sodium bicarbonate or NaOH. With NaOH, pH was adjusted to 7.8, but with sodium bicarbonate, no pH adjustments were made to simulate clinical conditions. RESULTS: In part I, addition of either NaOH or sodium bicarbonate to 0.5% lidocaine without epinephrine produced a faster onset than did unalkalinized lidocaine, without effecting degree or duration of block. In solutions with epinephrine there were no differences in onset, degree, or duration between lidocaine alkalinized with sodium bicarbonate versus NaOH. In part II, addition of sodium bicarbonate or NaOH to 1.0% commercial lidocaine without epinephrine did not accelerate onset compared with the unalkalinized solution. However, adding sodium bicarbonate decreased the degree and duration of block by 25% and more than 50%, respectively, compared with lidocaine unalkalinized and alkalinized with NaOH. With epinephrine, sodium bicarbonate hastened onset without effecting degree and duration compared with the unalkalinized solution. CONCLUSIONS: With 1% commercial lidocaine without epinephrine, sodium bicarbonate decreases the degree and duration of block. However, in solutions with epinephrine, sodium bicarbonate hastens onset, without effecting degree or duration.     

Perinatal complications and three-year follow up of infants of diabetic mothers with diabetic nephropathy stage IV

The objective of the study was to evaluate differences in the perinatal complications and in the 3-year follow up of infants of diabetic mothers with and without diabetic nephropathy stage IV. We compared the fetal and maternal complications and the early postpartal development until 3 years after delivery in 10 children of nephropathic diabetic mothers and 30 children of diabetic mothers without nephropathy. The mean (+/-SD) birthweight of the infants of nephropathic women was 2,250 +/- 496 g versus 3,544 +/- 435 g in the women without nephoropathy (p < 0.01). Births were premature in six pregnancies (60%) of the nephrotic women but in none of the women without nephropathy (p < 0.01). Three infants (30%) of the women with nephropathy showed respiratory distress syndrome in contrast to two babies (6%) of the women without nephropathy. Pre-eclampsia or eclampsia occurred in 6 (60%) pregnant women with and in two women (6%) without diabetic nephropathy (p < 0.01). Nephrotic syndrome was observed in 7 nephrotic women (70%) in contrast to none women without nephropathy. Three years postpartum, six of the children (60%) of nephropathic women had a body weight < the 50th percentile but none of the children of the women without nephropathy did so (p < 0.01). In addition, the children of nephropathic mothers started to speak significantly later (15 +/- 3 versus 12 +/- 13 months postpartum, p < 0.05) and had infectious diseases more commonly (60% versus 6%, p < 0.01) than the children of women without nephropathy. It can be concluded that in pregnancies of diabetic women the birth weights of the infants are significantly smaller and the fetal as well as maternal complication-rates significantly higher than in those of women without nephropathy. Also 3 years after delivery, the body weight of the children of nephropathic diabetic women is significantly lower than that of children of diabetic women without nephropathy. Additionally, children of nephropathic women are retarded in terms of linguistic development and their resistance to infections is reduced.     

混合痔术后肛门水肿原因分析

为分析混合痔术后肛门水肿的原因,总结经验,做好预防,以降低术后肛门水肿发生牢。将207例混合痔术后肛门水肿患者随机分为3组,以术前是否灌肠、术中是否行肛门内括约肌切断、术后是否坐浴进行分别对比。结果显示,术前不灌肠、术中不加行肛门内括约肌切断、术后早期坐浴者肛门易水肿。结果表明,针对混合痔术后肛门水肿的原因,积极有效的预防,可明显减轻肛门水肿、疼痛,促进创面愈合。     

Anomalous arrangement of the pancreaticobiliary ductal system without dilatation of the biliary tract

A rare case of anomalous arrangement of the pancreaticobiliary ductal system without dilatation of the biliary tract (AAPBDS without DBT) associated with mucosal dysplasia of the biliary duct is described herein. A 53 year old male with a long history of diarrhea and right upper abdominal pain was diagnosed as having AAPBDS without DBT by endoscopic retrograde cholangiopancreatography and other examinations. Excision of the gallbladder and biliary duct with a Roux-en-Y hepatico-jejunostomy was performed and subsequent pathological examination of the surgical specimens showed mucosal hyperplasia of the gall-bladder and mucosal dysplasia of the biliary duct. Considering the dysplastic changes of the biliary duct as seen in our case, and the high incidence of AAPBDS without DBT developing into carcinoma of the biliary duct, being 12.2 per cent, we suggest that pancreaticobiliary ductal diversion with excision of the gall-bladder and biliary duct should also be performed for AAPBDS without DBT. However, further pathological investigations concerning the excised biliary duct in AAPBDS without DBT will be need to be carried out.     

The effects of treatment of renal trauma on renal function

Renal function studies were performed in 275 severely injured patients with hemorrhagic shock and massive transfusion. There were 230 patients without renal injury and 45 patients with renal injury treated without exploration of the kidney in 17 patients, with exploration and renorrhaphy in nine patients, and with partial or total nephrectomy in 19 patients. In addition, 45 patients without renal injury were randomly matched by computer to the 45 patients with renal injury based on the number of blood transfusions and severity of shock as indicators of physiologic insult. Renal function was adversely affected by partial or total nephrectomy in patients with renal injury. Significant decreases in renal filtration and excretion were seen when the nephrectomy group was compared to the patients without renal injury matched for injury insult. Creatinine clearance decreased from 103 ml/min to 55 ml/min, inulin clearance from 106 ml/min to 63 ml/min, and osmolar clearance from 4.8 ml/min to 3.3 ml/min. The 230 patients without renal injury had an incidence of renal failure of 7.4% and a mortality rate of 8.2% compared to 11.4% and 15.6%, respectively, in the 45 patients with renal injury. Death and renal failure occurred in 13 of the 230 patients without renal injury (5.6%) and in two of the 45 renal injury patients (4.4%). The incidence of renal failure in the 19 patients without renal injury who died was 68% versus 29% in the seven renal injury patients who died. Preservation of renal parenchyma is recommended to provide maximal renal function in severely injured patients.     

PLIF和ALIF对相邻节段生物力学影响的比较

目的比较PLIF和ALIF及附加椎弓根螺钉后相邻节段的力学性能。方法采用10具小牛腰椎标本,随机选5具为对照组,将10具标本分为L4/L5PLIF和ALIF单纯融合组及附加内固定组,比较L3/L4节段的应变、强度和位移。结果两种融合方法在附加内固定前后比对照组,应变和位移都增加,强度降低(P<0.01),两组间以ALIF组变化最大,PLIF最小(P<0.05);在内固定前后配对比较,附加内固定后应变、位移增加,强度降低(P<0.05)。结论PLIF和ALIF单纯融合及附加内固定有增加上位节段退变的趋势,以ALIF较为明显。附加内固定后比单纯融合有增加退变的趋势。     

Intravesical prostatic protrusion is better than prostate volume in predicting the outcome of trial without catheter in white men presenting with acute urinary retention: a prospective clinical study

PURPOSE: Trial without catheter after a short course of an alpha-blocker in men presenting with acute urinary retention is successful in up to 50% of cases. The ability to better predict outcome could avoid a trial without catheter for some men. Intravesical prostatic protrusion and not prostate volume has been shown to predict trial without catheter outcome in an Asian cohort. We investigated the relationship between the outcome of trial without catheter and prostate volume and intravesical prostatic protrusion in white men given alpha-blockers before a trial without catheter. MATERIALS AND METHODS: Consecutive men 50 years old or older presenting with acute urinary retention were prospectively recruited based on strict selection criteria. At presentation factors thought to precipitate acute urinary retention were treated, alpha-blocker therapy started and the patient brought back for a trial without catheter after 2 weeks. Prostate volume and intravesical prostatic protrusion were measured by standard transrectal ultrasonography. RESULTS: Of 121 men presenting with acute urinary retention 57 fulfilled the study selection criteria. Mean (+/- SD) age, prostate volume and intravesical prostatic protrusion of recruited men were 70 +/- 9.2 years, 69.7 +/- 36.3 ml and 12.8 +/- 10.1 mm, respectively. A total of 25 men (43.9%) had a successful trial without catheter. Mean intravesical prostatic protrusion was significantly smaller in those who had a successful trial without catheter (7.2 vs 16.5 mm, 95% CI 4.5-14, p <0.001). With intravesical prostatic protrusion correlating well with prostate volume (r = 0.588), mean prostate volume was also smaller in men with a successful trial without catheter, albeit with a smaller effect size. Men with an intravesical prostatic protrusion of 10 mm or less, compared to those with a larger intravesical prostatic protrusion, were 6 times more likely to have a successful trial without catheter. CONCLUSIONS: In this cohort presenting with acute urinary retention related to benign prostatic hyperplasia and receiving alpha-blockers before a trial without catheter, intravesical prostatic protrusion appears to strongly predict the outcome of a trial without catheter. A trial without catheter is more likely to fail in patients with intravesical prostatic protrusion larger than 10 mm.     

Five to nine years' results of selective proximal vagotomy with and without pyloroplasty for duodenal ulcer.

In a retrospective study the clinical and secretory results of 118 patients operated upon with selective proximal vagotomy (SPV) with or without pyloroplasty for duodenal ulcer were examined. The results of surgery in the two groups, with pyloroplasty or without pyloroplasty, were compared. The recurrence rate was higher, although statistically not significant, for patients operated upon without pyloroplasty (19.2%) than for patients operated upon with pyloroplasty (10.6%). Dumping was significantly more common and more severe after SPV with pyloroplasty than after SPV without pyloroplasty. The acid response to histalog stimulation at follow-up was significantly higher for patients operated upon without pyloroplasty. This study indicates that SPV without pyloroplasty results in less dumping but gives a poorer protection against recurrent ulceration than does SPV with pyloroplasty. Further long-term studies appear to be necessary, however.     

PCNL术中人工肾积水临床体会与技术改进

目的 探讨PCNL术中超声定位下经皮肾穿刺时人工肾积水的必要性.方法 回顾本院无人工肾积水时采用超声定位行上尿路结石PCNL术196例临床病例的治疗情况.结果 本组中重度肾积水共114例患者均未人工肾积水,直接穿刺成功;轻度肾积水患者中62例直接穿刺成功,3例经人工肾积水辅助下穿刺成功;17例无明显肾积水患者中1 1例直接穿刺成功,6例行人工肾积水后穿刺成功.结论 多数患者可以不需要行人工肾积水而直接经皮肾穿刺造瘘.     

改良式无钛夹小操作孔腹腔镜阑尾切除术

目的：探讨改良式无钛夹小操作孔腹腔镜阑尾切除术的操作技巧。方法：手术操作孔均用5mm套管,阑尾系膜用电凝法,无需钛夹。结果：32例均顺利完成腹腔镜下手术,无中转开腹。平均手术时间46.5min。术后无出血及切口感染等并发症发生。结论：改良式无钛夹小操作孔腹腔镜阑尾切除术治疗费用低,术后疤痕小,安全可靠。     

Results of cholecystectomy without intraoperative cholangiography.

BACKGROUND: To determine if cholecystectomy can be performed satisfactorily without the use of adjunctive intraoperative cholangiography (IOC), we planned a retrospective analysis at a Canadian university teaching hospital. METHODS: General operative morbidity and mortality (in particular, occurrences and complications of missed choledocholithiasis and reoperations for same, and occurrences of bile duct injuries and bile leaks) were noted and analyzed for a consecutive series of cholecystectomies from a single practice, carried out without IOC. MAIN RESULTS: In general, choledocholithiasis could be identified and treated before the operation; missed cases were infrequent and were treatable without reoperation. No major injuries to the bile duct were encountered. CONCLUSIONS: IOC appears to be optional with cholecystectomy; cholecystectomy can be performed without IOC safely in the defined setting, without related major complications from missed choledocholithiasis or excess occurrence of bile-duct injury.     

Addition of Sodium Bicarbonate to Lidocaine Decreases the Duration of Peripheral Nerve Block in the Rat

Background: Adding sodium bicarbonate to lidocaine to enhance its efficacy during peripheral nerve block is controversial. The authors studied the effect of adding sodium bicarbonate to lidocaine with and without epinephrine versus equivalent alkalinization by sodium hydroxide (NaOH) on onset, degree, and duration of peripheral nerve block.

Methods: Part I examined alkalinization by sodium bicarbonate versus NaOH to pH 7.8 on 0.5% lidocaine, with and without epinephrine (1:100,000), prepared from crystalline salt. Part II examined 0.5% and 1.0% commercial lidocaine solutions, with and without epinephrine, either unalkalinized or alkalinized with sodium bicarbonate or NaOH. With NaOH, pH was adjusted to 7.8, but with sodium bicarbonate, no pH adjustments were made to simulate clinical conditions.

Results: In part I, addition of either NaOH or sodium bicarbonate to 0.5% lidocaine without epinephrine produced a faster onset than did unalkalinized lidocaine, without effecting degree or duration of block. In solutions with epinephrine there were no differences in onset, degree, or duration between lidocaine alkalinized with sodium bicarbonate versus NaOH. In part II, addition of sodium bicarbonate or NaOH to 1.0% commercial lidocaine without epinephrine did not accelerate onset compared with the unalkalinized solution. However, adding sodium bicarbonate decreased the degree and duration of block by 25% and more than 50%, respectively, compared with lidocaine unalkalinized and alkalinized with NaOH. With epinephrine, sodium bicarbonate hastened onset without effecting degree and duration compared with the unalkalinized solution.     

两孔法无钛夹腹腔镜阑尾切除术的体会

目的:探讨两孔法无钛夹腹腔镜阑尾切除术(laparoscopic appendectomy,LA)的可行性。方法:回顾分析2008年10月至2010年10月为23例阑尾炎患者行LA的临床资料。选择两孔法,采用"防波堤"技术处理阑尾系膜,阑尾根部套扎。结果:23例均顺利完成两孔法无钛夹LA,无一例中转开腹。术后均恢复良好。结论:两孔法无钛夹LA术后切口疤痕更少,腹腔内无金属异物存留,无需使用昂贵手术器械,方法简单易行,值得推广应用。     

Comparison of Müller Total Hip Replacement with and without Trochanteric Osteotomy: Kinesiologic Measurements of 82 Cases 2 Years After Surgery

Function of 37 patients with osteotomy of the greater trochanter during total hip replacement (41 hips) is compared to function of 38 patients (41 hips) without osteotomy. Subjective assessments and cane force measurements were slightly more favorable in the group without osteotomy. Objective measurements of hip motion, hip abductor and adductor muscle strength, weight distribution during standing, and multiple components of free-speed and fast walking showed no statistically significant differences between performance of the groups with and without osteotomy before surgery or 6 months or 2 years after. This suggests that osteotomy provides no functional advantages to the patient beyond those obtained in total hip replacements without osteotomy.     

A case of epidermoid cyst of the testis role of conservative surgery.

We report one case of an epidermoid cyst of the testis in a 15 year-old boy. Pre-operative testicular ultrasound may help to establish the diagnosis without resorting to orchiectomy. In such a selected case local excision alone should be considered adequate without violating accepted surgical principles.     

Management of caustic ingestion in adults

The treatment of 484 adults with caustic ingestion injury is discussed. Signs and symptoms are an unreliable guide to injury and a chest X-ray and fibreoptic endoscopy should be performed as soon as possible. All of the 250 patients who developed superficial lesions of the oesophagus, stomach or duodenum experienced healing without sequelae. Forty-four patients required emergency surgery of whom twenty-four died and oesophagectomy without thoracotomy is now advocated for this group, followed by interval surgery to restore continuity. The remaining 190 patients suffered gastric or oesophageal ulceration without necrosis: 92 recovered without complication, 3 succumbed to aorto-oesophageal fistula, 12 survived following delayed surgery for complications and 83 developed oesophageal and/or gastric stenosis which subsequently required endoscopic or surgical treatment.     

Effect of antibiotics on Oxalobacter formigenes colonization of human gastrointestinal tract

BACKGROUND AND PURPOSE: Oxalobacter formigenes is a bacterium residing in the human gastrointestinal tract that degrades oxalate and reduces its availability for absorption. This bacterium is assumed to be antibiotic sensitive, and repeated antibiotic therapies could eradicate it. The aim of the present study was to determine the differences in the colonization by O. formigenes of individuals who had been on antibiotics for at least 5 days at the time of sample collection and individuals who had not taken antibiotics for at least 3 months. PATIENTS AND METHODS: Stool samples were collected from 80 individuals without stone disease (35 with and 45 without antibiotic consumption) and 100 patients with stone disease (20 with and 80 without antibiotic consumption). Oxalobacter formigenes was detected by a polymerase chain reaction-based method, and the presence/absence of O. formigenes was correlated with urinary oxalate concentrations. RESULTS: Lower percentages of individuals without stone disease and with stone disease who were consuming antibiotics had O. formigenes colonization than individuals without antibiotic consumption. Urinary oxalate concentrations were higher in the individuals without O. formigenes than in colonized individuals. CONCLUSION: Our observations confirm a direct association between antibiotic consumption and absence of O. formigenes. Absence of intestinal O. formigenes could represent a pathogenic factor in calcium oxalate urolithiasis when antibiotics are prescribed generously.     

Evaluation of clinical effects of microsurgical subinguinal varicocelectomy with and without testicular delivery

The aim of this study was to access whether microsurgical subinguinal varicocelectomy (MSV) with testicular delivery has a better therapeutic effect than MSV without testicular delivery, including semen quality, serum testosterone (T) level and International Index of Erectile Function (IIEF)-5 score in infertility male patients with varicocele. In this prospective study, 181 patients were included and they chose the treatment by themselves. A total of 114 patients who received MSV without testicular delivery (TD) and 67 patients who received MSV with TD were followed-up 6 months after the operation. Semen parameters, serum T level and IIEF-5 scores were recorded before and 6 months after the operation. Results showed that MSV with or without TD could improve semen quality, serum T level and IIEF-5 score. For semen quality 6 months after the operation, there was no significant difference between patients received MSV with or without TD. But in patients with varicocele of grade III, MSV without testicular delivery improved the sperm concentration and motility more. And patients received MSV without TD have a higher T level 6 months after the operation, especially in patients ≤27 years. MSV with TD is not superior to that without, but this should be verified in more samples and a better designed randomised controlled study in the future.     

Screening, monitoring, and treatment of albuminuria: Public health perspectives

Microalbuminuria is an early sign of progressive cardiovascular and renal disease in individuals with and without diabetes. Despite compelling data, at present only a minority of patients with diabetes and rarely individuals without diabetes are screened for albuminuria in a systematic way. All of the criteria to implement systematic albuminuria screening are fulfilled in diabetes, and most are nearly fulfilled for microalbuminuria screening in individuals without diabetes. Because of the growing evidence that treatment of microalbuminuria in individuals without diabetes may offer a cost-effective benefit to prevent cardiovascular disease, nephrologists and other health care providers should pay more attention to the early detection and subsequent treatment of individuals with microalbuminuria.     

Small Airway Dysfunction Impairs Quality of Life Among Smokers With No Airflow Limitation

IntroductionSmall airway dysfunction (SAD) caused by smoking contributes to the early onset of airflow limitation (AFL), although its impact on patients’ perception of health is largely unknown. We aimed to evaluate the frequency of SAD in active smokers without AFL, and to compare health-related quality of life (HRQoL) of non-smokers, smokers without SAD, smokers with SAD, and smokers with AFL.MethodsA total of 53 active smokers without AFL, 20 smokers with AFL, and 20 non-smokers completed the SF-36 and EuroQoL questionnaires and performed impulse oscillometry and spirometry. Pulmonary parenchymal attenuation was determined in inspiration and expiration. SAD was determined to exist when resistance at 5 Hz (R5), the difference between R5 and R20, and reactance area (AX) exceeded the upper limit of normal.ResultsIn total, 35.8% of smokers without AFL had SAD. No differences were detected in spirometric parameters or pulmonary attenuation between smokers with or without AFL and non-smokers. However, smokers with SAD had worse scores on HRQoL questionnaires than smokers without SAD or non-smokers, and scores compared to smokers with AFL were intermediate. R5 and X5 were identified as independent determinants of HRQoL in smokers without AFL.ConclusionsSAD is common in smokers without AFL, affecting one third of this population, and independently affecting their perception of health.