Influência da dose de propofol e dos componentes sanguíneos na duração das convulsões elétricas em eletroconvulsoterapia

Background and objectives

Propofol is commonly employed as a hypnotic agent to perform electroconvulsive therapy, but it exhibits also anticonvulsant properties. The main objective was to study the effect of the weight‐adjusted dose of propofol on duration of the electrical seizure. Secondary objectives were to study the effect of absolute dose of propofol on duration of electrical seizure, the effect of both absolute and weight‐adjusted doses on values of bispectral index, and the influence of blood chemistry on anticonvulsant effect.

Defecatory disorders,anorectal and pelvic floor dysfunction: a polygamy?

A consecutive series of 41 patients with defecatory disorders was prospectively studied by anal manometry and evacuation proctography to determine the relationship between abnormalities and symptoms. The patients (29 female, 12 male, aged 41±2.3 years) all complained of difficulty in evacuation. All had normal colonoscopy and biochemistry. There was no evidence of megacolon or megarectum, and no symptoms had been previously treated by pelvic floor surgery. All subjects completed detailed questionnaires related to gastrointestinal symptoms with special reference to excessive straining and discomfort, digital manipulations during defecation, a sense of pelvic heaviness and incomplete evacuation. Each patient underwent clinical examination, anal manometry and defecography during a single outpatient visit. Rectocele (16 patients) was significantly associated with vaginal digitation, lower stool frequency, delayed rectal emptying and decreased rectal sensation to distension. Increased anal pressure on straining (14 patients) was also related to a poor rectal emptying in 13 patients. Neither perineal descent (24 patients) nor external rectal prolapse (12 patients) was related to objective obstruction. Nevertheless there was an association with pelvic heaviness and lower anal manometric recordings. Five among 16 patients with rectocele had manometric anismus. Forty percent of patients with intussusception also had a paradoxical sphincter response during defaecation. Furthermore, associated abnormalities were extremely common (34 of 41 patients), accurate interpretation of which was necessary for planning effective therapy.

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Résumé Une série de 41 patients consécutifs avec des désordres défécatoires a été étudiée prospectivement par manométrie anale et défécographie pour rechercher les relations entre les anomalies et les symptomes. Tous les patients (29 femmes, 12 hommes âgés de 41±2,3 ans) se plaignaient de difficulté à l'évacuation. Tous avaient une coloscopie et une biologie normales. Il n'y avait aucune évidence de mégacolon ou de mégarectum et aucun n'avait été préabablement traité par une chirurgie pelvienne. Tous les sujets ont rempli un questionnaire détaillé portant sur les symptomes gastro-intestinaux avec un intérêt particulier aux efforts de poussée, à la gêne et aux manipulations digitales durant la défécation, aux sensations de pesanteurs pelviennes et d'évacuation incomplète. Chaque patient a eu un examen clinique, une manométrie anale et une défécographie au cours d'une simple consultation. La rectocèle (16 patients) était significativement associée à des manoeuvres endovaginales, à une diminution de la fréquence des selles, à une vidange rectale retardée et à une diminution de la sensation rectale à la distension. Une augmentation de la pression anale à l'effort (14 patients) était aussi en relation avec une vidange rectale insuffisante chez 13 malades. Ni la descente périnéale (24 malades) ni le prolapsus rectale externe (12 malades) n'étaient en relation avec une obstruction objective. Néanmoins, ces troubles étaient associés aux pesanteurs pelviennes et à des pressions anales plus basses. Cinq des 16 malades avec rectocèle avaient un anisme en manométrie. 40% des patients avec une procidence interne avaient aussi une réponse paradoxale du sphincter durant la défécation. De plus, des anomalies associées étaient extrèmement fréquentes (34 de 41 malades), nécessiant une interprétation prudent d'envisager un traitement effectif.

     

Late life disability and experienced wellbeing: Are economic resources a buffer?

BackgroundDisablement has been linked to compromised wellbeing in later life, but whether material resources buffer these negative effects is unclear.ObjectiveDrawing upon conceptual models of stress and coping, we analyze experienced wellbeing data from time diary interviews with adults ages 60 and older. We expect that experienced wellbeing will be influenced by each stage of the disablement process and that higher income and wealth will buffer the negative effects of disability on experienced wellbeing. Because income is a better reflection of one's liquid resources while assets reflect lifetime accumulation, we expect income to be a more substantial buffer than assets.MethodsWe use the Disability and Use of Time Supplement to the Panel Study of Income Dynamics (N = 1607). We consider several measures of the disablement process (activity limitations, impairment severity, duration of limiting condition) and history of work limitation and evaluate both pre-tax income and net worth quartiles. We estimate a series of multi-level regression models that account for clustering of individuals within couples. We calculate the marginal effects of disability on wellbeing at different quartiles of economic resources.ResultsWe find that impairment severity is associated with worse experienced wellbeing before and after adjusting for covariates, and income buffers these negative effects for those in the middle-income quartiles.ConclusionsFuture research should further explore the mechanisms through which income buffers the negative effects of impairment severity and specify the accommodations that enable economically disadvantaged and advantaged older adults alike to withstand physical declines while maintaining wellbeing.     

Restaging laparotomy and ovarian cancer

We retrospectively reviewed the records of 41 patients who had restaging laparotomy after initial surgery and chemotherapy for ovarian cancer. In 37 of them, the cancer was epithelial. Stage and amount of residual disease after initial cytoreductive surgery correlated with laparotomy outcome. There were no operative deaths, and perioperative morbidity was relatively minor. Of the 25 patients with residual disease after initial cytoreductive surgery ten had a complete response, eight had a partial response, two had stable disease, and five had progression. Three patients (11.5%) had recurrent disease after a negative restaging laparotomy. We discuss salvage therapy and the value of restaging laparotomy in ovarian cancer.     

Incidencia de infección de herida quirúrgica en cirugía renal. Efecto de la adecuación de la profilaxis antibiótica. Estudio de cohortes prospectivo

Objective

To assess compliance with the antibiotic prophylaxis protocol for patients who underwent renal surgery and its effect on the incidence of surgical wound infection.

The Wheelchair Circuit: Construct validity and responsiveness of a test to assess manual wheelchair mobility in persons with spinal cord injury

OBJECTIVE: To assess the validity and responsiveness of the Wheelchair Circuit, a test to assess manual wheelchair mobility in persons with spinal cord injury (SCI). DESIGN: Longitudinal. Subjects performed the Wheelchair Circuit at the start (T1) and at the end (T3) of inpatient functional rehabilitation. Construct validity and responsiveness were assessed. SETTING: Eight rehabilitation centers in the Netherlands. PARTICIPANTS: Seventy-four subjects with SCI admitted for inpatient rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Wheelchair Circuit consists of 8 wheelchair skills and results in 3 test scores: ability, performance time, and physical strain. The construct validity of the Wheelchair Circuit was assessed by testing whether the test scores were significantly related to the subjects' functional status, physical capacity, lesion level, motor completeness of the lesion, and age. To prove the test's responsiveness, it was assessed whether the test scores had significantly improved between T1 and T3. RESULTS: For construct validity, 4 of the 5 hypotheses were confirmed. For test responsiveness, all 3 test scores had significantly improved during rehabilitation, and the standardized response mean values ranged from 0.6 to 0.9. CONCLUSIONS: The Wheelchair Circuit is a valid and responsive instrument with which to measure manual wheelchair mobility in subjects with SCI.     

Bayesian analysis, pattern analysis, and data mining in health care

PURPOSE OF REVIEW: To discuss the current role of data mining and Bayesian methods in biomedicine and heath care, in particular critical care. RECENT FINDINGS: Bayesian networks and other probabilistic graphical models are beginning to emerge as methods for discovering patterns in biomedical data and also as a basis for the representation of the uncertainties underlying clinical decision-making. At the same time, techniques from machine learning are being used to solve biomedical and health-care problems. SUMMARY: With the increasing availability of biomedical and health-care data with a wide range of characteristics there is an increasing need to use methods which allow modeling the uncertainties that come with the problem, are capable of dealing with missing data, allow integrating data from various sources, explicitly indicate statistical dependence and independence, and allow integrating biomedical and clinical background knowledge. These requirements have given rise to an influx of new methods into the field of data analysis in health care, in particular from the fields of machine learning and probabilistic graphical models.