Accidental epidural administration of a high dose of sufentanil

Epidural sufentanil infusions are routinely used for post-operative analgesia after high-abdominal and thoracic surgery in our hospital. The erroneous administration of a bolus of 250 micrograms of sufentanil epidurally was followed by a 24 hour episode of deep analgesia and respiratory depression. The recovery from respiratory depression over a 27 hour period is described.     

Delayed hepatic CT scanning: increased confidence and improved detection of hepatic metastases

Fifty oncologic patients with suspected hepatic metastases were prospectively evaluated by dynamic sequential hepatic computed tomography (DSHCT) and by delayed iodine hepatic computed tomography (DICT) scanning. DICT scanning was performed 4-6 hours following administration of 60 g of intravenous iodine. Both techniques were evaluated for lesion definition relative to the adjacent hepatic parenchyma and for numbers of metastases detected. Metastases were detected by both techniques in 26 patients. Fifteen patients (58%) had lesions better defined by DICT. DICT scanning detected more metastases in seven of these 15 patients. In eight patients (31%), there was no difference between the two techniques in numbers of masses detected or lesion definition. In three cases (11%), metastases were more confidently identified on the initial or DSHCT scan. DICT scanning, as described, is useful in defining and detecting hepatic metastases, especially where there is questionable hepatic involvement or better quantification of size is necessary.     

Chronic Arsenic Poisoning From Burning High-Arsenic-Containing Coal In Guizhou, China

Optimization of a previously disclosed sorbitol dehydrogenase inhibitor (SDI, II) for potency and duration of action was achieved by replacing the metabolically labile N,N-dimethylsulfamoyl group with a variety of heterocycles. Specifically, this effort led to a series of novel, in vitro potent SDIs with longer serum half-lives and acceptable in vivo activity in acutely diabetic rats (e.g., 62, 67, and 69). However, the desired in vivo potency in chronically diabetic rats, ED90 less than or equal to 5 mg/kg/day, was achieved only through further modification of the piperazine linker. Several members of this family, including 86, showed better than the targeted potency with ED90 values of 1-2 mg/kg/day. Compound 86 was further profiled and found to be a selective inhibitor of sorbitol dehydrogenase, with excellent pharmacodynamic/pharmacokinetic properties, demonstrating normalization of sciatic nerve fructose in a chronically diabetic rat model for approximately 17 h, when administered orally at a single dose of 2 mg/kg/day.     

Effective dose equivalent to the operator in intra-oral dental radiography

The effective dose equivalent to the operator in intra-oral dental radiography has been determined. The exposure from a bitewing radiograph and periapical views of the left maxillary incisors and first molar was measured at nine heights and 16 positions, all 1 m from the patient. The effective dose equivalent was determined using data from ICRP 51 (International Commission on Radiological Protection: Data for Use in Protection Against External Radiation). The values presented are related to an exposure of 1 C kg-1 (3876 R) measured free in air at the tube-end. They thus constitute ratios which are not influenced by the sensitivity of the film or other detector used and form standard tables which permit the calculation of the effective dose equivalent in clinical situations.     

Hypotension during thoracic surgery under combined general and high thoracic epidural anesthesia

High thoracic epidural anesthesia (TEA) is increasingly often used in combination with general anesthesia for major thoracic and abdominal surgery. TEA leads to sympatholysis of cardiac efferences leading to improved myocardial oxygen balance, which is in part due to vasodilation of atherosclerotic coronary vessels. To provide the full benefit of TEA, it is important to extend it as patient-controlled epidural analgesia in the postoperative period. If adequate vascular volume is maintained, hypotension is less frequent after TEA than after lumbar epidural anesthesia. However, in combination with general anesthesia, it may be more frequent and more severe. Treatment of hypotension is sometimes difficult and may require the use of nonadrenergic vasoconstrictors (eg, vasopressin). Copyright © 2000 by W.B. Saunders Company     

The abdication of the role of health education by hospital nurses

As nurses are in a unique position to influence patients and so carry out health education to their'captive audience', it is pertinent to discuss why so many nurses appear to abdicate this role. Reasons are suggested that the nurses'own education has failed to equip her with the skills necessary for the fulfilment of this role. Even basic communication skills appear to be poorly developed, let alone the more complex and analytical skills required by the nurse in order to effectively deliver a planned programme of health education to either individual patients or groups. A Health Belief Model (HBM) has been discussed and is proposed as a useful framework around which the nurse can formulate her health teaching. Variables to be considered include motivation, value of illness threat reduction, probability that compliant behaviour will reduce the threat of illness, and modifying and enabling factors. The HBM should be incorporated into an individualized nursing care plan, so that health teaching is an integral part of the patient's planned care in hospital. The ward sister is the key figure in implementing such procedures, and it is to her that education should also be directed     

Cine and tagged magnetic resonance imaging in short-term stunned versus necrotic myocardium

We investigated the potential of Cine and 2D Tagged Cardiac Magnetic Resonance (CMR) Imaging to distinguish stunned from necrotic left ventricular (LV) myocardium in the early postischemic phase in an open-chest animal model (N=12). Reversible and permanent occlusion of the LAD coronary artery resulted in global LV dysfunction in both groups without significant differences. LAD perfused segments revealed significant higher values for end systolic wall thickening (ESWT) and percentual systolic wall thickening in animals with stunned myocardium. Analysis of strain parameters showed significant regional differences (maximal principal strain ₁, deviation angle ) between postischemic and remote myocardium within both groups, however results were not significantly different comparing animals with stunned myocardium to animals with myocardial necrosis. In conclusion, at rest neither global LV functional nor regional strain parameters derived from Cine and 2D Tagged CMR Imaging can distinguish animals with short-term stunned myocardium from respective animals with necrotic myocardium. Diagnostic value of ESWT is limited due to the spatial resolution of the gradient-echo sequence used.Supported by a grant from the Interdisciplinary Center of Clinical Research (IZKF; B1, BMBF-01KS 9604).