Office-based surgery and anesthesia: Where are we now?

At the time of publication of this journal, the Center for Urinary Control in Memphis, Tennessee, has performed eight office-based surgical procedures using anesthesia. Patients were aged between 56 and 80 years, and all were ASA I–III class. The procedures involved either cystoscopy with collagen injection into the bladder neck or cystoscopy with indigo laser treatment of the prostate. All patients were prepared by the anesthesiologist prior to the day of surgery, and appropriate laboratory tests were ordered and evaluated. All patients did very well, the surgical field was quiet, and each procedure went very smoothly. Each patient tolerated anesthesia without any adverse effect, was recovered in an adjacent examination room, and was extremely satisfied upon discharge from the office. Anesthesia was induced with Propofol (Diprivan) and sublimaze, maintained with a Propofol infusion and oxygen. The surgeon performed a periprostatic block on the patient having the Indigo laser treatment.     

Respiratory syncytial virus infection and meningococcal disease.

Although viral respiratory tract infections may predispose to meningococcal disease, strong evidence that they do so exists only for influenza. Data on laboratory reported cases of respiratory syncytial virus (RSV) infections and meningococcal disease in England and Wales from mid-1989 to mid-1994 were analysed. Although the rise in RSV cases preceded the rise in meningococcal disease cases each winter, the interval between the rise and fall of the two diseases was inconsistent, no association was found between time series after removal of the seasonal component, and there was no evidence that more cases of meningococcal disease occurred in winters with more RSV disease. RSV may have less effect on the two most likely mechanisms whereby influenza predisposes to meningococcal disease, namely lowered immunity and impaired pharyngeal defences.     

Relative effect of surgery and radiotherapy on the internal jugular vein following functional neck dissection

We examined the internal jugular veins in three groups of patients who had undergone (1) a functional neck dissection and radiotherapy, (2) a functional neck dissection alone, or (3) radiotherapy alone, using a noninvasive color Doppler ultrasound scan. The internal jugular veins were ultrasonically bilaterally normal in 18% of patients who had undergone a functional neck dissection and radiotherapy, in 88% of patients who had undergone a functional neck dissection alone, and in 57% of patients who had undergone radiotherapy alone. The combination of a functional neck dissection and radiotherapy significantly affected the internal jugular vein when compared with a functional neck dissection alone.     

Relationship between numbers of beta adrenergic receptors in lymphocytes and disease severity in asthma

In order to assess the status of beta adrenergic receptors in bronchial asthma, binding studies using (−) [³H] dihydroalprenolol (DHA) were performed on lymphocytes of 10 control subjects and 11 stable asthmatic patients. Specific DHA binding was generally lower at all DHA concentrations in asthmatics. At 12 nM DHA concentration, specific DHA binding was 391 ± 40 fM/mg protein in controls and 263 ± 35 fM/mg protein for asthmatic subjects (p < 0.05). A highly statistically significant positive correlation between specific DHA binding (at 12 nM DHA) and FEV₁/FVC% was observed (r = 0.93, p < 0.01), with those asthmatic subjects with the more severe airway obstruction and disease severity showing lower DHA binding. The results of the study suggest that a lymphocyte beta adrenergic receptor defect may be present among some patients with asthma. The magnitude of the receptor abnormality appears to be related to disease severity and degree of airway obstruction as measured by FEV₁/FVC%. Documentation of drug consumption was made, and restriction of beta adrenergic agonists was attempted; theophylline and corticosteroids were the predominant drugs used in the study. Even with these precautions, it is possible that the differences in DHA binding observed among subjects are the results of greater drug (e.g., theophylline and corticosteroids) consumption by the clinically more severe patients. On the other hand, the lymphocyte receptor alteration noted may reflect a more general beta adrenergic receptor abnormality in bronchial asthma.     

The reproducibility of estimates of critical power and anaerobic work capacity in upper-body exercise

The purposes of this study were to apply the linear power versus inverse of time relationship to high-intensity upper-body exercise and to assess the repeatability of the parameters critical power (CP) and anaerobic working capacity (AWC), using limits of agreement (Bland and Altman 1986). Sixteen active male subjects (aged 20–34 years), performed two sets of five constant-power exercises on an adapted cycle ergometer. There were no significant differences between mean estimates of CP [96 (16) W and 95 (17) W] and AWC [7457 (2011) J and 7608 (1684) J] from the first and second sets of bouts. Despite the lack of systematic bias, there was evidence of large random error. Ratio limits of agreement for time to exhaustion during constant-power exercises suggested that a repeat measurement might be expected in 95% of cases to be between 0.64 and 1.59 times the original measurement. The 95% limits of agreement for CP were –15 W to +17 W. The ratio limits of agreement for AWC suggest that in 95% of cases a repeat measurement might be between 0.57 and 1.67 times the original estimate. The results of this study suggest a poor repeatability of constant-power upper-body exercises to exhaustion, which may contribute to a poor repeatability of CP and AWC determined from the linear power versus inverse of time model. Electronic Publication     

Laminin-5-enriched extracellular matrix accelerates angiogenesis and neovascularization in association with ePTFE

The performance of biomedical implant devices is often limited by inappropriate tissue responses associated with synthetic materials used in device construction. Adverse healing responses, in particular the lack of an extensive vascular supply in the peri-implant tissue, are believed to lead to the ultimate failure of many of these medical devices. Accelerated formation of new blood vessels in the peri-implant tissue and within porous polymeric implants is hypothesized to improve the performance of such biomedical implant devices. The current study evaluated the use of cell-mediated, extracellular matrix modification of expanded polytetrafluoroethylene (ePTFE) to increase vessel growth in peri-implant tissue and within the pores of the implants. Discs of ePTFE were modified through cell-mediated matrix deposition using epithelial and endothelial cell lines with variable deposition of collagen types, fibronectin, and laminin types. Cell matrix-modified discs, Matrigel-coated discs, and nonmodified discs were implanted in both the adipose and subcutaneous tissues of the rat. Following a 5-week implant period, samples were removed and evaluated histologically and morphometrically for the presence of blood vessels in the peri-implant tissue and within the pores of the polymer as well as for the presence of activated macrophages and monocytes. A significantly increased presence of activated macrophages and monocytes was associated only with the samples modified with the matrix from a human microvessel endothelial cell line. Increased vessel density was identified in association with those ePTFE samples modified with either the 804-G, HaCaT, or II-4 cell matrices, all of which have extracellular matrices enriched in the protein laminin-5.