Repetitive generalized seizure-like activity during emergence from sevoflurane anesthesia

PURPOSE: Sevoflurane-induced seizures are most often described during mask induction of anesthesia when high concentrations of the volatile agent are administered concomitant with alveolar hyperventilation. The occurrence of seizure-like activity during emergence from sevoflurane anesthesia has been rarely reported. CLINICAL FEATURES: We describe a patient who developed several episodes of generalized tonic-clonic seizure-like activity during and immediately after emergence from sevoflurane anesthesia and discuss the potential factors that contributed to this unusual complication. The patient was treated with intravenous propofol, midazolam, and phenytoin and required intensive care management before his neurologic status stabilized. CONCLUSION: The report emphasizes that sevoflurane is capable of producing excitatory central nervous system (CNS) phenomena in spite of causing primarily CNS depressant effects.     

Primary aortoduodenal fistula. Diagnosis by computed tomography

A primary fistula between the abdominal aorta and the duodenum is rare and usually fatal. Computed tomography in a symptomatic but stable patient enabled preoperative evaluation and even diagnosis of abnormal communications, real or incipient, between the vascular and enteric system. This case demonstrated the effectiveness, ease, and low cost of documenting a primary aortoduodenal fistula. Surgical results were ultimately improved by initiating early intervention and aggressive management. Therapeutic principles included early intervention with aneurysmectomy, duodenorrhaphy, and extra-anatomic bypass. Anatomic graft placement may be acceptable in selected cases.     

Analysis of factors influencing patency of polytetrafluoroethylene prostheses for limb salvage

This clinical review of 70 polytetrafluoroethylene femoropopliteal and femoral-distal (tibial or peroneal) bypasses for limb salvage analyzes factors that influence graft patency. Patients with “good” angiographic run-off (n = 26) had a significantly better (P < 0.01) cumulative patency rate when compared to patients with “poor” (n = 43) angiographic run-off. Other factors which had a significant influence on graft patency over the 2-year follow-up included site of distal anastomosis (femoropopliteal versus femoral-distal), and previously failed femoropopliteal bypass. Patients with a preoperative ankle/brachial Doppler pressure index of less than 0.2 had a 67% occlusion rate during the first postoperative month. Thrombectomy and distal revisions (patch or jump graft) following graft occlusion did not significantly prolong graft patency.     

Nitrogen metabolism in growth hormone-deficient children receiving oxandrolone and human growth hormone

Five prepubertal growth hormone-deficient children were treated with oxandrolone (0.1 mg/kg/day) and human growth hormone (HGH) 2 mg three times weekly alone and in combination. Average nitrogen retained (mg/kg/day) was calculated from 9-day balance data obtained at the beginning and end of each 6-mo treatment period. Oxandrolone increased the range of nitrogen retention from control values of 2.5–50 to 20.4–107.1, which was statistically significant. Persistently increased nitrogen retention was demonstrable at the end of 6 mo of oxandrolone therapy. Addition of HGH further enhanced the anabolic effect (67.7–139.3), which also was statistically significant and persistent to the end of 6 mo of combination therapy (57.4–114.3). Despite continued HGH treatment with-drawal of oxandrolone was associated with a drop to pretreatment values by the end of 6 mo (0.8–38.4). Oxandrolone and HGH have synergistic anabolic effects which probably involve different mechanisms. During some balance periods, nitrogen retention was calculated by determination of ¹⁵N excretion after oral administration of labeled glycine. Results were similar but lacked statistical significance. The smallest increment in height for 1-yr advancement in bone age while receiving oxandrolone was 2.17 inches.     

Standards for palliative care delivery in oncology settings

This review aims to describe available standards for delivery of palliative and supportive care for cancer patients and discuss to what extent these guidelines have been evaluated and disseminated into standard care. Ovid searches were conducted to identify relevant guidelines, randomized studies comparing guideline-based care to usual care, and articles describing the use of guidelines in the usual care setting. Published guidelines address specific issues related to symptom management. Broader consensus statements have presented a framework for the delivery of palliative care for cancer patients. Dissemination of guidelines into standard care has been limited. Limited data suggest that implementation of palliative and supportive care guidelines can improve patient outcomes. Clinical trial publications rarely address supportive care in detail. Guideline efficacy has not been evaluated, and their dissemination into standard care has been poor. A conceptual framework for better implementation of existing guidelines might improve usage and outcomes.     

Anthelmintic Activity of Vernonia anthelmintica. Seeds Against Trichostrongylid Nematodes of Sheep

Abstract

This paper describes comparative in vitro. and in vivo. anthelmintic activities of Vernonia anthelmintica. (L.) Willd. (Compositae) seeds and levamisole. In vitro. studies revealed higher anthelmintic effects (p ≥ 0.05) of crude methanol extract (CME) as compared with crude aqueous extract (CAE) of V. anthelmintica. seeds on live Haemonchus. contortus. as evident from their mortality. For in vivo. studies, seeds of V. anthelmintica. were administered as crude powder (CP), CAE, and CME to sheep naturally infected with mixed species of gastrointestinal nematodes. In vivo., maximum reduction (73.9%) in fecal egg counts per gram (EPG) was recorded in sheep treated with V. anthelmintica. CAE at 3 g kg^?1 body weight on day 5 post-treatment (PT) followed by CP at 3 g kg^?1 (55.6%) on day 3 PT. However, CME did not exhibit anthelmintic activity in vivo.. It was found that whereas V. anthelmintica. seeds possess anthelmintic activity against nematodes, it was not comparable to levamisole (97.8% to 100% reduction in EPG). It may be suggested that further research on a large scale be carried out with a large number of animals on higher doses than those used in the current study; for the identification of active principles; and for standardization of the doses and toxicity studies for drug development.