Epidemiology and morbidity of regional anesthesia in children: a follow-up one-year prospective survey of the French-Language Society of Paediatric Anaesthesiologists (ADARPEF)

Background: The French‐Language Society of Paediatric Anaesthesiologists (ADARPEF) designed a 1‐year prospective, multicenter and anonymous study to update both epidemiology and morbidity of regional anesthesia in children. Methods: From November 2005 to October 2006, data from participating hospitals were recorded using an identification form, a data recording form, and a complication form. Information collected included the characteristics of the hospitals, the number and type of regional anesthetics (RA), the age of the involved children as well as the incidence, and type of complications. Results: Data collected in 47 institutions included 104 612 pure general anesthesias (GAs), 29 870 GAs associated with regional blocks, and 1262 pure regional blocks. Central blocks accounted for 34% of all RA. Peripheral blocks (66%) were upper or lower limb blocks (29% of peripheral blocks), trunk blocks, and face blocks (71%). In children aged ≤3 years, the percentage of central blocks was similar to the peripheral ones (45% vs 55), while in older children, peripheral blocks were more than four times used than central ones. Complications (41 involving 40 patients) were rare and usually minor. They did not result in any sequelae. The study revealed an overall rate of complication of 0.12%; CI 95% [0.09–0.17], significantly six times higher for central than for peripheral blocks. Conclusions: As a result of the low rate of complications, RA techniques have a good safety profile and can be used to provide postoperative analgesia. In addition, the results should encourage anesthesiologists to continue to use peripheral instead of central (including caudal) blocks as often as possible when appropriate.     

Identification of Neospora antigens recognized by CD4+ T cells and immune sera from experimentally infected cattle

Neospora caninum is recognized as a major cause of infectious abortion in cattle. Very little is known about immunity to Neospora . Cell mediated responses have previously been shown to be important in the development of protective immunity to the closely related parasite Toxoplasma gondii , and may therefore be an important component in the immune response to Neospora . In this paper we report that a group of low molecular weight NC1 strain tachyzoite antigens (≤ 30 kDa) separated by SDS PAGE and bound to nitrocellulose membrane stimulated proliferation in vitro of CD4+ T cells from calves experimentally infected with N. caninum . Proliferation was accompanied by production of high concentrations of IFNγ. Several of these antigens were also recognized by antibody produced in these animals. As the most effective vaccines require the stimulation of both humoral and cell mediated immune responses, these antigens may be important in the development of a vaccine against neosporosis.     

Angiographic and Histologic Course after Implantation of Balloon Expandable Intravascular Stents in Miniswine Coronary Arteries: Short- and Mid-Term Observations

Sixteen balloon expandable Medtronic Wiktor tantalum stents were implanted in the major coronary arteries of six minipigs, which were maintained on a normal diet and given 500 mg aspirin per day. Angiographic and histologic examinations were performed 6 and 26 weeks after implantation. Angiographically reviewed, stenting increased the inner diameter of the coronary arteries from 2.61 ± 0.44 to 3.02 ± 0.34 mm (n = 16, P ≤ 0.001). Six weeks later, this value was reduced from 2.98 ± 0.35 to 2.33 ± 0.46 mm (n = 9, P ≤ 0.05), and between 6 and 26 weeks, an increase from 2.17 ± 0.44 to 2.93 ± 0.40 mm occurred (n = 6, P ≤ 0.05). Histologic evaluation at 26 weeks after stent implantation revealed an increase of the cross-sectional area of the total vessel from 4.30 ± 1.09 to 5.50 ± 1.67 mm² (n = 9; P ≤ 0.01). This was due to widening of the total vessel and intimal proliferation, which amounted to 1.19 ± 0.46 mm² within the stented segment, as compared to 0.03 ± 0.03 mm² in control sections (P ≤ 0.01). The areas of free vessel lumen, media muscularis, and adventitia remained unchanged. In 15 of the 16 hislologically examined coronary arteries, the internal elastica was fractured at the site of stent implantation. Twelve stents had also penetrated through the external elastica without evidence of wall hemorrhage. Thirteen out of 16 stents were angiographically followed, of which 12 were patent at the final reangiography. In one animal, acute thrombosis of the stented vessel after guidewire induced coronary artery spasm caused chronic right heart failure due to right ventricular myocardial infarction. Sudden death occurred in another pig 2 hours after successful implantation of three grossly oversized stents (inner vessel diameter: 2.4 ± 0.2 mm, stent diameter 3.2 ± 0.5 mm). Autopsy revealed extensive dissections of the media with subsequent vessel occlusion. It is concluded that Medtronic Wiktor stents can be placed easily, even in more distal or curved coronary arteries. Despite antiaggregational medication, intimal proliferation is observed early after implantation, reaches a maximum at about 6 weeks, and is followed by a regression 26 weeks poststenting. At 26 weeks follow-up, the free vessel lumen at the stent site was not significantly reduced as compared to control segments. Proper adjustment of internal vessel diameter and stent diameter is necessary to prevent major dissections and thrombotic occlusions.     

How do patients experience consultations at an orthopaedic out-patient clinic?: Eighteen patients comment on video-taped consultations: a qualitative study

The purpose of this study is to describe experiences of communicationin medical consultations, obtained after patients have observedand commented on their own video recorded consultations. Eighteenpatients in an orthopaedic out-patient clinic were randomlyselected and, of these, 10 were men and 8 were women. Nine ofthe visits were first-time consultations and an equal numberwere follow-ups. We explained that we wanted to understand whattakes place between a doctor and patient, both when the experienceis satisfactory and when it is not. Approximately 1 week afterthe consultation, the patient was allowed to watch the videorecording. Prior to viewing this, the patient was instructedthat we were particularly interested in his/her viewpoints andspontaneous reactions. Every time a patient wished to say something,the videotape was stopped and the comments recorded. These commentswere later transcribed. The patients' negative comments (60%)described four kinds of experiences indicating aspects of poorcommunication: i) the patient had difficulty understanding whatthe physician asked, said or did, ii) the physician was insufficientlyprepared for the consultation, iii) the physician questionedthe findings of other doctors and iv) the physician showed alack of understanding.     

Bufuralol metabolism in human liver: a sensitive probe for the debrisoquine-type polymorphism of drug oxidation

The genetically controlled polymorphism causing decreased metabolism of debrisoquine is closely related to that of the metabolism of bufuralol and numerous other drugs and has important clinical consequences. A sensitive in vitro assay was developed which quantifies the production of 1'-hydroxy-bufuralol (carbinol) from bufuralol in human liver microsomes. Initial formation rates of carbinol suggested Michaelis-Menten kinetics with an apparent KM of 61 and 171 mumol l-1 and Vmax of 3.2 and 5.8 nmol mg-1 microsomal protein h-1 in two human liver samples. The Vmax in microsomes of thirty-two liver samples was 4.2 +/- 1.0 (SD) nmol carbinol mg-1 protein h-1. Metabolism of debrisoquine in vivo, as expressed by the 'metabolic ratio' of debrisoquine over 4-OH debrisoquine correlated (r = -0.65, P less than 0.01; n = 18) with carbinol production rate in microsomes in vitro. Microsomes of one individual identified as poor metabolizer of debrisoquine in vivo showed reduction of carbinol formation to 1.97 nmol mg-1 h-1. Mixing his microsomes with those of an extensive metabolizer resulted in additive formation of carbinol excluding mediation of the defect by a soluble inhibitor. These data support the concept of a primary defect in microsomal oxidation of bufuralol. The described assay offers a sensitive tool to investigate the molecular mechanism of the 'debrisoquine polymorphism'.     

Effect of dietary supplementation with eicosapentaenoic acid in the treatment of atopic dermatitis

The effects of a dietary supplement of n-3 fatty acids in patients with atopic dermatitis were investigated in a 12-week, double-blind study. The experimental group received 10 g of fish oil daily, of which about 1.8 g was eicosapentaenoic acid. This amount of eicosapentaenoic acid can be obtained from a daily intake of fat fish. The controls received an iso-energetic placebo supplement containing olive oil. Compliance was monitored by gas-chromatographic analysis of the fatty acid pattern in serum phospholipids. Results favoured the experimental group with regard to scale (P less than 0.05), itch (P less than 0.05) and overall subjective severity (P less than 0.02) as compared to the controls.