Increased hepatic microsomal enzyme activity after surgery under halothane or spinal anesthesia

Thirty-two fit patients scheduled for explorative arthrotomy of the knee were allocated randomly to either halothane/oxygen anesthesia or spinal anesthesia with bupivacaine 0.25 mg X kg-1. The day before and 1, 10, and 21 days after surgery, the aminopyrine breath test (ABT) was performed. The day before and 5, 10, and 21 days after surgery, the antipyrine clearance (APcl) was measured by the single sample saliva technique. The ABT as well as the APcl were increased significantly postoperatively (P less than 0.01). The day after surgery the ABT was increased by 13 +/- 21% in the spinal anesthesia group only, whereas a late increase by 14 +/- 31% was found in the halothane group. Five days after surgery, the APcl was increased by 36 +/- 45% in the spinal anesthesia group and by 21 +/- 28% in the halothane group. Both tests returned to base line values within 3 weeks postoperatively. In five volunteers following the same sampling scheme but receiving bupivacaine 0.25 mg X kg-1 im without surgery, no change in the ABT or the APcl was observed. The authors conclude that surgery may cause microsomal enzyme induction regardless of the anesthetic agent or technique used. The mechanism of this induction remains to be elucidated.     

Ultrasonography of the undescended testis

Sixty prospective sonographic preoperative examinations were performed on 57 boys, 3 to 12 years of age (mean 6 2/3), in order to investigate the accuracy of the method for localizing undescended or non-palpable testes in the anteperitoneal region, i.e. the inguinal canal. Sonographic results agreed with the findings at surgical exploration in 53 (88%) of the 60 examinations performed which was regarded as a satisfactory result. The method is convenient and valuable for the planning of surgery. Sonograms of patients earlier operated upon were difficult to interpret and accounted for some misinterpretations as did examinations in some patients with divergent anatomy.     

Guided tissue regeneration in the treatment of human infrabony defects Clinical, radiographical and microbiological results: a pilot study

Abstract. The aim of the study was to evaluate the clinical, radiographical and microbiological outcome after using guided tissue regeneration (GTR) with a bioabsorbable membrance, Resolut^$$. Subjects with bilateral infrabony defects at single rooted teeth were selected. A total of 22 teeth, 2 in each 1 of 7 patients and 4 in 2 patients, with probing pocket depth ≥5 mm, 3 months after scaling, participated. At baseline, assessments of plaque and gingival indices, bleeding on probing, probing pocket depth and probing attachment level were recorded and reproducible radiographs for computer-based bone level measurements were taken. Bacterial samples were collected to investigate the presence of periodontitts-assoctated bacteria, e.g., Porphyrnmonas$$Prevotella -and Fusobactrium -like micro-organisms. One tooth was randomly treated with GTR and the contralateral With an open debridement procedure as a control. Clinical, radiographical and microbiological examinations were repeated 6 and 12 months postoperatively. Both procedures demonstrated a siatistically significant improvement of gingival conditions, reduction of pocket depths and gain of attachment. When evaluating the differences between test and control teeth, none of the clinical parameters yielded statistical differerence. Computer-based bone-level measurements showed only small differences in the majority of both test and control sites. The differences were not significant. Periodontitis-associated bacteria were present at baseline, but the appearance was not related to any specific site or patient and did not demonstrate and unwanted change in the 6- and 12- month samples. The findings suggest that the clinical, radiographical and microbiological improvements were not significantly enhanced with the GTR therapy.     

Behavioural and neuropsychological problems in refractory paediatric epilepsies

The associated behavioural and neuropsychological profiles were studied in 573 children with refractory epilepsy, admitted in our residential Rehabilitation and Epilepsy Unit during the period 1984-2000. The aim of this study was to look for possible correlations between epileptic categories and behavioural profiles. The most frequent neuro-behavioural correlates in the different epilepsy categories were pervasive disorders (48/573=8%), attentional problems (43/573=7.5%), loss of self-esteem (n=49 or 9%) and self-induction of seizures (n=34 or 7%). Pervasive disorders were significantly more frequent in secondary generalised epilepsies. In 86/573 children (15%), mental decline due to epileptic process itself was observed. As expected this was seen in all patients with Lennox-Gastaut syndrome, West syndrome, severe myoclonic epilepsy of infancy and in continuous spikes and slow waves during slow wave sleep. The only behavioural problem that was more frequent in females was self-induction of seizures.     

Modelling the normal retinal nerve fibre layer thickness as measured by Stratus optical coherence tomography

Background The variation in retinal nerve fibre layer thickness (RNFLT) as measured by Stratus optical coherence tomography (OCT) in healthy subjects may be reduced when the effect on RNFLT measurements of factors other than disease is corrected for, and this may improve the diagnostic accuracy in glaucoma. With this perspective we evaluated the isolated and combined effects of factors potentially affecting the Stratus OCT RNFLT measurements in healthy subjects.Methods We included 178 healthy eyes of 178 subjects between 20 and 80 years of age. Participants underwent an extensive eye examination. Stratus OCT RNFLT was measured by three standard protocols, two with high and one with standard image resolution. Effects on RNFLT of age, gender, refractive error, axial length, lens nuclear colour and opalescence, intra-ocular pressure (IOP), and optic disc size were examined by univariate and multivariate analyses.Results Age, refractive error, axial length, and lens nuclear colour and opalescence affected RNFLT in univariate analyses, whereas gender, IOP, and optic disc size had no significant effect. In multivariate analyses only age in combination with refractive error, or with axial length, was significant and explained 14.7–17.6% (R ²) of the total variation of RNFLT, approximately 50% more than age alone. RNFLT decreased by 2.6–2.9 μm per increasing decade of age and increased by 1.5–1.8 μm per more positive diopter of spherical equivalent using full-circle measurements of the three standard protocols. These effects varied between measurement sectors.Conclusions RNFLT as measured by Stratus OCT standard protocols was significantly affected by age and refractive status. The effect on global RNFLT of a difference in refractive error of 10 diopters corresponded to the effect of a difference in age of 60 years. Theoretically, the effect of refractive status may be explained by artefacts of RNFLT measurement circle placement. The results suggest that the diagnostic accuracy of Stratus OCT may be improved by considering refractive status in addition to age when RNFLT is measured. For this purpose spherical equivalent seems as effective as axial length.     

A novel inhibitor of advanced glycation end-product formation inhibits mesenteric vascular hypertrophy in experimental diabetes

Aims/hypothesis. Previous studies in our laboratory have shown that the vascular changes in diabetes include hypertrophy of the mesenteric vasculature and that this process can be attenuated by the inhibition of advanced glycation with aminoguanidine. Since aminoguanidine can also act as an inhibitor of nitric oxide synthase, the effect of a novel inhibitor of advanced glycation end-products, formation that does not inhibit nitric oxide synthase, known as 2,3 diaminophenazine (2,3 DAP) was evaluated. Methods. Initially, in vitro assessment of the ability of 2,3 diaminophenazine to inhibit formation of advanced glycation products was performed. Subsequently, in vivo studies evaluating 2,3 diaminophenazine and aminoguanidine were carried out. Animals were followed for 3 weeks after induction of diabetes and randomised to no treatment, aminoguanidine or 2,3 diaminophenazine. Mesenteric vessels were weighed and advanced glycation end-products were measured by radioimmunoassay in vessel and kidney homogenates. In addition, these products were assessed in mesenteric vessels by immunohistochemistry. Results. When compared with control animals, diabetes was associated with an increase in mesenteric vascular weight. Treatment of diabetic rats with aminoguanidine or 2,3 diaminophenazine resulted in attenuation of vascular hypertrophy. Both aminoguanidine and 2,3 diaminophenazine reduced the formation of advanced glycation end-products as measured by radioimmunoassay and as assessed immunohistochemically in these vessels. This reduction was also observed in the kidney. Conclusion/interpretation. These data support the concept that the effects of aminoguanidine in reducing diabetes associated vascular hypertrophy are via inhibition of advanced glycation end-products dependent pathways. [Diabetologia (1999) 42: 472–479] Received: 20 July 1998 and in revised form: 2 November 1998     

‘How do we know if this is the best?’ Mental health‐care professionals' views on national guidelines for psychosocial interventions

National guidelines are released regularly, and professionals are expected to adopt and implement them. However, studies dealing with mental health‐care professionals' views about guidelines are sparse. The aim of the present study was to highlight mental health‐care staff's views on the Swedish national guidelines for ‘psychosocial interventions for schizophrenia or schizophrenia‐type symptoms’ and their implementation. The study took place in the southeast parts of Sweden, and data were collected through five group interviews consisting of 16 professionals working either in the county council or in the municipalities. The transcribed text was analysed by content analysis, revealing two categories. The first category ‘a challenge to the practice of care as known’ reflected that the release of guidelines could be perceived as a challenge to prevailing care and culture. The second category ‘anticipating change to come from above’ mirrored views on how staff expected the implementation process to flow from top to bottom. To facilitate working in accordance with guidelines, we suggest that future guidelines should be accompanied by an implementation plan, where the educational needs of frontline staff are taken into account. There is also a need for policy makers and managers to assume responsibility in supporting the implementation of evidence‐based practice.     

Understanding ‘the contaminated blood affair’: Lessons from cross-national comparisons

This extended review critically compares two edited texts which explore institutional and societal responses to the health risks posed by the presence of HIV infection in blood used for medical purposes. The review is used to raise more general issues about cross-national comparisons and regulatory responses to new risks. The texts reviewed are Bovens, 't Hart and Peters (2001 Bovens, M., 't Hart, P. and Peters, B. G., eds. 2001. Success and Failure in Public Governance. A Comparative Analysis, Cheltenham: Edward Elgar.  [Google Scholar]) Success and Failure in Public Governance. A Comparative Analysis and Feldman and Bayer (1999 Feldman, E. A. and Bayer, R., eds. 1999. Blood Feuds. AIDS, Blood and the Politics of Medical Disaster, New York and Oxford: Oxford University Press.  [Google Scholar]) Blood Feuds. AIDS, Blood and the Politics of Medical Disaster. The review draws a number of conclusions from analysis and comparison of these texts. First, ingrained assumptions (in this case, that transfused blood from unpaid donors is inherently safe) may impede responsiveness to new risks. Second, national political responses to adverse events (in this case HIV infection through medical use of blood products) are not directly related to the adequacy of the regulatory response. Third, the two texts come to somewhat different conclusions about the adequacy of the regulatory response to the contaminated blood crisis. This discrepancy is explained in terms of differences in approach to cross-national comparison.     

Acute coronary artery thrombosis and a giant coronary artery aneurysm: an atypical combination and an unconventional catheter-based intervention.

Coronary artery aneurysm is an unusual finding at coronary arteriography. We present a case of acute myocardial infarction and a giant aneurysm of the left circumflex coronary artery (CX) in a 70-year-old male with hypertension. The culprit lesion was a thrombus occupying the aneurysm and the distal CX. By an unconventional manoeuvre the thrombus was aspirated via the 7 French guiding catheter. After stent implantation in the distal CX a thrombolysis in myocardial infarction 3 flow was achieved and still present at 2-month follow-up. The patient was prescribed aspirin and clopidogrel as a life-long therapy.