Wachstumsretardierung durch A.-iliaca-Verschluss nach Herzkatheteruntersuchung

Cardiac catheterisations in newborns and infants are being performed routinely in increasing numbers for diagnostic and therapeutic purposes. Rarely, the femoral artery or the iliac artery will be completely occluded after such a procedure, and growth retardation of the lower extremity can result. We report on a case of iliofemoral artery occlusion following cardiac catheterisation in an infant. Twelve years later, a difference of 5.5 cm in leg length was noted, as well as a difference in shoe size and intermittent claudication. Following operative reconstruction, the child’s leg pain ceased. Two years after surgery, differences in leg lengths and shoe sizes are no longer significant. Vascular complications should not be underestimated despite the juvenile potential for collateral vessels. Even in the absence of signs of ischaemia, these complications necessitate further investigation and adequate treatment in due course.     

Data sources for measuring colorectal endoscopy use among Medicare enrollees.

BACKGROUND: Estimates of colorectal cancer test use vary widely by data source. Medicare claims offer one source for monitoring test use, but their utility has not been validated. We compared ascertainment of sigmoidoscopy and colonoscopy between three data sources: self reports, Medicare claims, and medical records. MATERIALS AND METHODS: The study population included Medicare enrollees residing in North Carolina (n = 561) who had participated in a telephone survey on colorectal cancer tests. Medicare claims were obtained for the 5 years preceding the survey (January 1, 1998 to December 31, 2002). Information about sigmoidoscopy and colonoscopy procedures conducted in physician offices were abstracted from medical records. Sensitivity, specificity, positive predictive value, negative predictive value, agreement, and kappa statistics were calculated using the medical record as the gold standard. Agreement on specific procedure type and purpose was also assessed. RESULTS: Agreement between claim and medical record regarding whether an endoscopic procedure had been done was high (over 90%). Agreement between self report and medical record and between self report and claim was good (79% and 74%, respectively). All three data sources adequately distinguished the type of procedure done. None of the data sources showed reliable levels of agreement regarding procedure purpose (screening or diagnostic). CONCLUSION: Medicare claims can provide accurate information on whether a patient has undergone colorectal endoscopy and may be more complete than physician medical records. Medicare claims cannot be used to distinguish screening from diagnostic tests. Recognizing this limitation, researchers who use Medicare claims to assess rates of colorectal testing should include both screening and diagnostic endoscopy procedures in their analyses.     

Gastric contents and pH after oral premedication

Forty women, aged 26-40 years, were investigated with regard to gastric contents and pH before general anaesthesia. The patients were divided into two groups (20 in each). Group 100 received 0.3 mg kg-1 diazepam orally with 100 ml of water 2 h before surgery. Group 50 received 0.3 mg kg-1 diazepam with 50 ml of water 2 h before surgery. The amount of gastric content was significantly greater in Group 100 than in Group 50 (P less than 0.05). There was no statistical difference in pH values between the groups. The number of patients with both gastric pH less than 2.5 and gastric volume greater than 25 ml was significantly higher in Group 100 compared to Group 50 (P less than 0.05). We cannot recommend the use of oral premedication using these amounts of water, considering the increased risk of aspiration of gastric contents.     

Mitigation of hearing loss from semi-circular canal transection in pseudomonas otitis media with ciprofloxacin-dexamethasone irrigation.

HYPOTHESIS: Irrigation of the mastoid with a quinolone antibiotic-steroid solution may mitigate hearing loss caused by iatrogenic semicircular canal injury in the presence of Pseudomonas aeruginosa (PA) otitis media (OM). BACKGROUND: Studies have shown the cochlea to be more vulnerable to semicircular canal transection (SCT)-related hearing loss in the presence of PA OM. Prophylactic systemic antibiotics and steroids may decrease this hearing loss, but SCT is usually not planned. The aim of this study was to determine if irrigation with ciprofloxacin-dexamethasone (cipro-dex) could improve hearing outcomes following SCT in PA OM. METHODS: PA OM was induced in 28 animals. After three to five days, unilateral SCT was performed in each animal, with sham SCT on the contralateral ear. At surgery, half of the animals (n = 14) underwent irrigation of the both mastoid bullae with cipro-dex; the second group of animals (n = 14) underwent irrigation of the bullae with sterile saline. Auditory thresholds were obtained immediately prior to SCT and 7-10 days after SCT. RESULTS: SCT ears treated with cipro-dex showed a mean click threshold improvement of 4.6 dB from pre-transection to 7-10 days post-transection, whereas thresholds in the SCT ears treated with saline worsened by 7.5 dB (p = 0.15). CONCLUSION: Irrigation of the guinea pig bulla with cipro-dex following SCT in the setting of PA OM appears safe and may yield beneficial effects on hearing.