Quantitative evaluation of tourniquet leak during i.v. regional anaesthesia of the upper and lower limbs in human volunteers

Although it is accepted that during i.v. regional anaesthesia (IVRA) local anaesthetic can leak under the tourniquet into the systemic circulation, no published study has evaluated this leak quantitatively. In volunteers, during two random sessions, we have simulated IVRA using standard techniques with a radiolabelled compound which is chemically similar to lignocaine and has comparable tissue distribution (0.1 mg of HIDA labelled with 100 muCi of 99mTc in 40 ml of saline). The decrease in radioactivity was measured with a gamma camera for the 20 min of tourniquet inflation and for the 20 min of washout after cuff deflation. While the tourniquet was inflated, the leak for the lower limb (mean 29 (SD 8) %) was significantly greater (P < 0.004) than the leak for the upper limb (15 (5) %). Moreover, in each of 10 volunteers, the leak was always greater for the lower than the upper limb. During the first 3 min after tourniquet deflation the loss of radioactivity was 58 (8) % of the maximal amount for the upper limb and 39 (8) % for the lower limb (P < 0.001). As the leak under the tourniquet was significantly greater for the lower than the upper limb, we conclude that IVRA for the lower limb can be associated more frequently with a shorter duration of successful anaesthesia and/or failure.      

Technique of intraoperative laparoscopic cholangiography]

Since laparoscopic cholecystectomy has been established at our institution, the routine use of intraoperative cholangiography was abandoned but preoperative intravenous cholangiography and sonography are mandatory. However, these investigations are not always conclusive and in some cases not applicable. We have therefore started to use selective intraoperative laparoscopic cholangiography for laparoscopic cholecystectomy. Our technique and the materials required for this peroperative investigation are described in the present article.     

Does Physical Exercise Influence Bowel Transit Time in Healthy Young Men?

An examination was performed on 20 healthy men, who had a specific diet, to test the influence of moderate physical activity on bowel transit. During a 3-day pause and a 3-day phase of easy sports activity (jogging), oro-anal transit was measured with the help of radiopaque markers (Hinton method). While the subject was under exertion, the entire weight of stool rose significantly (743 vs. 600 g), whereas we found no significant influence on the oro-anal transit time (39 vs. 48 h) or on stool frequency (1.3 vs. 1.3 per day). Moderate physical activity had no effect on bowel transit time of healthy men under a constant diet. The effect of the so often recommended increase of physical activity on constipation remains to be elucidated.     

The use of UW solution in clinical transplantation. A 4-year experience.

The development of the University of Wisconsin (UW) cold storage solution has extended safe preservation of the liver and pancreas from 6 to 24 hours or more. From May 1987 until November 1991, 288 livers and 163 simultaneous pancreas/kidney transplants were performed using UW solution. The mean preservation times were: liver, 12.7 +/- 4.4 hours, pancreas 17.2 +/- 4.4 hours, and kidney, 19.2 +/- 4.3 hours. Included in this series were 35 reduced-sized liver transplants, 7 cluster transplants, and 132 combined liver/pancreas retrievals. No differences in allograft function or graft-related complications were seen in organs preserved for less than or longer than 12 hours or in grafts from combined liver/pancreas retrievals. All pancreas/kidney transplants and most liver transplants were performed semi-electively. Actuarial 1-month patient and graft survival after liver transplantation was 91.4% and 80.2%, and at 4 years was 74.0% and 62.0%, respectively. After pancreas/kidney transplantation, the actuarial patient survival at 1 month and 4 years was 99.4% and 90.5%, respectively, whereas pancreatic and renal allograft survival at 1 month was 97.5% and 96.8%, and at 4 years was 83.0% and 83.4%, respectively. The ability to extend preservation times with UW solution has many advantages; however, the most important contribution of UW solution to clinical transplantation has been the increased utilization of scarce donor organs for more recipients because the previously imposed constraints on preservation time have been removed.     

Bioavailability of tobacco-specific N-nitrosamines to the snuff dipper.

Use of supercritical carbon dioxide extraction in the analysis of smokeless tobacco for tobacco-specific N-nitrosamines revealed the presence of higher levels of 4-(methylnitros-amino)-1-(3-pyridyl)-1-butanone (NNK) than had been determined with conventional methods. Whether human saliva may be similarly capable of releasing apparently bound NNK during chewing or snuff dipping was tested by incubating smokeless tobacco with enzymatically active saliva and with heat-treated saliva respectively. Enzymatically active human saliva was found to liberate up to twice the amount of the highly carcinogenic NNK than did heat-treated saliva. This is of major consequence for the cancer risk assessment of snuff dippers and tobacco chewers.