Sevoflurane versus Halothane: Postoperative Maladaptive Behavioral Changes: A Randomized, Controlled Trial

Background: The authors conducted a double-blind, randomized, controlled trial to determine whether the use of sevoflurane in children undergoing anesthesia and surgery results in a higher incidence of postoperative maladaptive behavioral changes as compared with halothane.

Methods: Children and their parents (n = 102) were randomly assigned to either a halothane group (n = 50) or a sevoflurane group (n = 52). The intraoperative anesthetic protocol was strictly controlled, and the postoperative analgesic consumption and pain levels were recorded. The effect of the group assignment on emergence status and maladaptive postoperative behavioral changes was assessed both by validated psychological measures and physiologic instruments (actigraphy) on postoperative days 1-7. Anxiety of the parent and child was also assessed, as was the child's postoperative recovery (Recovery Inventory).

Results: There were no group differences in preoperative state anxiety, postoperative analgesic requirements, postoperative pain, or the incidence of emergence delirium (P = not significant). Two-way repeated-measures analysis of variance showed no group differences in the incidence of postoperative maladaptive behaviors (F4,72 = 0.60, P = 0.701) or actigraphic variables such as percent sleep, number of night awakenings, and night awakenings that lasted for more than 5 min (P = not significant).     

Physical and psychosocial adaptation of blacks on hemodialysis.

Roy's Adaptation Model was used to study problems and coping strategies reported by 102 blacks on hemodialysis. Although the most frequently identified problems were fatigue, muscle soreness, and physical limitations, food and fluid restrictions were most bothersome. Participants used multiple strategies to cope with the illness and its treatment. Putting trust in God was the most frequently identified strategy. These findings can be used to enhance the physical and psychosocial assessment of these patients and facilitate the ability of clinicians to intervene effectively in helping clients cope with the problems that are associated with the illness and its treatment.     

The relationship of schools to emotional health and bullying

Objectives:  

To examine the extent to which school climate and school pressure could predict other aspects of adolescents’ lives, most particularly their emotional health and bullying. Furthermore, the study sought to investigate if these relationships were consistent across countries.     

Detecting cumulative trauma disorders in workers performing repetitive tasks

On-site testing of 157 poultry processors disclosed that 50% had three or more abnormal upper extremity findings out of a total of 22 possibles. The average worker had five to six abnormal findings. Impaired pinch strength, decreased vibration sensitivity in the fingertips, and reports of current numbness were the most prevalent. Of workers with signs, 25% reported no symptoms, whereas only 8% of workers reported symptoms but had no signs. The investigators concluded that this measurement method has utility for assessments of worker populations to determine prevalence of CTDs and, potentially, for preclinical detection of these disorders to permit early intervention, reduce medical costs, and minimize disability. The need for accurate measurement to enhance early detection and prevention is discussed.     

Dural Tissue Trauma and Cerebrospinal Fluid Leak after Epidural Needle Puncture: Effect of Needle Design, Angle, and Bevel Orientation

Background: The effects of epidural needle design, angle, and bevel orientation on cerebrospinal fluid leak after puncture have not been reported. The impact of these factors on leak rate was examined using a dural sac model. Dural trauma was examined using scanning electron microscopy.

Methods: Human cadaveric dura, mounted on a cylindrical model, was punctured with epidural needles using a micromanipulator. Tissue was punctured at 15 cm H2O (left lateral decubitus) system pressure, and leak was measured at 25 cm H2O (semisitting) pressure. Leak rates and trauma were compared for the following: (1) six different epidural needles at 90[degrees], bevel parallel to the dural long axis; (2) 18-gauge Tuohy and 18-gauge Special Sprotte(R) epidural needles, 30[degrees]versus 90[degrees]; (3) 18-gauge Tuohy, bevel perpendicular versus parallel to the dural long axis.

Results: With the 90[degrees] puncture, bevel parallel, the greatest leak occurred with a 17-gauge Hustead (516 +/- 319 ml/15 min), and the smallest leak occurred with a 20-gauge Tuohy (100 +/- 112 ml/15 min; P = 0.0018). A 20-gauge Tuohy puncture led to statistically significant reductions in leak (P value range, 0.0001-0.0024) compared with all needles except the Special Sprotte(R). With the 30[degrees]versus 90[degrees] angle, 30[degrees] punctures with an 18-gauge Tuohy produced nonstatistically significant leak reductions compared with the 18-gauge Tuohy at 90[degrees]. The puncture angle made no difference for the Special Sprotte(R). Nonsignificant reductions were found for the Special Sprotte(R) compared with the Tuohy. With the 18-gauge Tuohy bevel orientation, perpendicular orientation produced nonstatistically significant reductions in leak compared with parallel orientation.     

Human papillomavirus detection: verification with cervical cytology.

OBJECTIVE: Thirteen specific types of human papillomavirus (HPV), classified as high-risk for the development of cervical cancer, have been reported in 99.7% of all cervical cancers. For this reason, and because of the reported lack of sensitivity of the Papanicolaou (Pap) smear for detecting HPV, some experts believe that the use of papillomavirus DNA testing may replace cytology for routine gynecological screening. Our goal was to validate a commercial assay, the Digene Hybrid Capture-2 for the detection of human papillomavirus by comparing the results to cytological detection of cervical abnormalities. DESIGN: Cytology results of concurrent liquid-based Papanicolaou smears were compared to the Hybrid Capture-2 results. Correlation was assessed and discordant cytology results were reviewed. SETTING: Louisiana State University Health Sciences Center at Shreveport, Department of Pathology, HPV Diagnostic Laboratory. PATIENTS: All liquid cytology specimens submitted for HPV testing between November 1, 2000 and April 1, 2001. RESULTS: Of the 291 cases tested by Hybrid Capture-2, 12% and 28% were positive with the low-risk and high-risk probes, respectively, and 265 had concurrent cytology results. Fourteen specimens testing positive only with the low-risk probe were not included in this comparison. Thus, the results for 251 of the 291 (86%) specimens tested for human papillomavirus DNA were compared to the original cytology report. Overall concordance between Hybrid Capture-2 and the original smear cytology result was 78%. Slide review reduced the number of discordant specimens from 22% to 12%. CONCLUSION: Based upon these data, we find the HPV assay to be useful as a routine screen for Human papillomavirus.