Studies in the radiobiology of osteoradionecrosis and their clinical significance

The radiobiology of osteoradionecrosis is a complex of cellular death and cellular functional impairments from radiation energy transfers. Four studies of irradiated patients and a data base from 536 patients with osteoradionecrosis revealed separate pathophysiologic conditions for osteoradionecrosis induced by early trauma, osteoradionecrosis induced by late trauma, and spontaneous osteoradionecrosis. A large body of data suggested useful clinical guidelines for the management of irradiated patients. The guidelines, in part, include a recommendation for deferring radiation treatment for 21 days after tissue wounding, if possible; a relative contraindication to wounding tissue during a radiation course; a recommendation for the use of hyperbaric oxygen before wounding; and a strong recommendation to provide comprehensive dental care to the irradiated patient.     

Analysis of a protocol for an autologous blood transfusion program for total joint replacement surgery

This retrospective study analysed an autologous blood transfusion program for total joint replacement surgery. A group of 99 patients receiving autologous blood transfusion was compared with a control group of 55 patients. One-unit phlebotomies were done 14 and 7 days before surgery. The whole blood was transfused intraoperatively. Preoperative hemoglobin values were within the normal range for all patient groups except the female autologous blood group for which the mean value was 122 +/- 11.3 g/L. Due to perioperative hemodilution, the postoperative hemoglobin values were substantially lower than preoperative values for all groups. Mean intraoperative blood loss was similar for the autologous and control groups (650 to 750 ml). No adverse reactions were associated with the autologous transfusions and 74% of the autologous group received autologous blood only. From this analysis a 3-week, three-unit preoperative collection was proposed for future use. A standardized protocol will allow logistical ease and implementation of the program for various surgical procedures.     

Élaboration d’un guide d’information SOR SAVOIR PATIENT à l’usage des personnes malades et de leurs proches sur la vie intime et sexuelle pendant et après un cancer : l’étape d’état des lieux

Since 1998, the French National Federation of Comprehensive Cancer Centres (FNCLCC) has led an information program dedicated to patients and their relatives: the SOR SAVOIR PATIENT (SSP) program. The program is provided by the FNCLCC, the twenty French regional cancer centres (CLCC), the National League Against Cancer (LCC), the French National Cancer Institute (INCa), the French Hospital Federation (FHF), the National Oncology Federation of Regional and University Hospitals (FNCCHRU), the French Oncology Federation of General Hospitals (FFCHG), the National Private Hospital Union for Oncology (UNHPC), the International Union Against Cancer (UICC) and a large number of learned societies. The methodology of the program adheres to the quality criteria established for publishing documents containing information for patients. Issues related to the sexual health of cancer patients and their partners too often remain underestimated and even completely neglected by health professionals, although healthcare providers are increasingly interested in this area and patients frequently confront them with questions about this aspect of their lives. The development of an SOR SAVOIR PATIENT informational guide on the various issues related to sexuality during and after cancer treatment constitutes a first step in addressing the needs of cancer patients and others concerned. This article describes the first stage in the development of a specific SOR SAVOIR PATIENT guide that focuses on the general availability of informational material in French on the sexual health of patients and their partners during and after cancer treatment.     

Tricyclic antidepressant overdose. A review

Significant advances in diagnosis and management of tricyclic antidepressant overdose have occurred in recent years. This article reviews epidemiologic, pharmacologic, and therapeutic information to provide a systematic approach to these potentially life-threatening overdoses. The tricyclics are discussed as a group, with individual drugs specified when established differences exist.     

The effects of various indwelling ureteral catheter materials on the normal canine ureter

In an attempt to objectively evaluate the biocompatibility of materials commonly used for ureteral stenting, stent-catheters made of four different materials were placed randomly in 31 ureters of 19 mongrel dogs. Animals underwent urography at four weeks and were sacrificed at six weeks. Mild hydronephrosis was noted in eight instances, essentially unrelated to specific material. Silicone, C-flex and polyurethane stents caused a similar, mild degree of ureteral edema, but ureters stented with Silitek demonstrated fairly marked edema. Epithelial ulceration and erosion, often severe, occurred with all polyurethane stents, and rarely with the three other materials. All materials differed statistically from controls, and C-flex caused less reaction overall than polyurethane, indicating differences in biocompatibility of the various materials which may be relevant to their use in patients undergoing long-term ureteral stenting. In practical terms, these suggest that certain materials, notably silicone and C-flex, are more suitable for ureteral stenting than others.     

Can a clinician predict the technical equipment a patient will need during intensive care unit treatment? An approach to standardize and redesign the intensive care unit workstation

The technical equipment of today's intensive care unit (ICU) workstation has been characterized by a gradual, incremental accumulation of individual devices, whose presence is dictated by patient needs. These devices usually present differently designed controls, operate under different alarm philosophies, and cannot communicate with each other. By contrast, ICU workstations could be equipped permanently and in a standardized manner with electronically linked modules if the attending physicians could reliably predict, at the time of admission, the patient's equipment needs. Over a period of 3 1/2 months, the doctors working in our 20-bed surgical ICU made 1,000 predictions concerning outcome, equipment need, duration of artificial ventilation, and duration of hospitalization for 300 recently admitted patients. The interviews were made within the first 24 hours after admission. The doctors being interviewed were usually (i.e., in over 90% of cases) unfamiliar with the patient. Information concerning the patient's general state of health, special pre-ICU events, and complications was offered to the interviewed clinician because this information represents standard admission data. It was found that the equipment need (represented by two different setups, high tech and low tech) could be predicted most reliably (96.4% correct predictions) compared with a prediction on outcome of ICU treatment (94.5%), on duration of artificial ventilation (75.4%), and on duration of stay (43.4%). There was no significant (p>0.05) difference in the reliability of predictions between residents and consultants. Factors influencing the postoperative equipment need varied with surgical specialty. The general state of health, as indicated by the ASA classification (p<0.001), and the specific intervention (all multiple-valve replacements needed the high-level equipment standard) appeared to be most important in cardiac surgery, while a state of septicemia was important in general surgery (p<0.001). Our findings suggest that ICU workstations may be standardized into at least two types.