Major complications after 400 continuous popliteal sciatic nerve blocks for post‐operative analgesia

Background: A continuous popliteal sciatic nerve block (CPSNB) has been performed with increasing frequency for post‐operative analgesia after foot surgery. Major complications associated with the placement of a perineural catheter remain rarely studied. The aim of this study was to prospectively determine the incidence of major complications (neurological and infectious) in post‐operative adult patients with a continuous popliteal catheter inserted by the anatomical posterior approach for analgesia after foot surgery. Methods: All popliteal catheters were placed pre‐operatively under sterile conditions with the aid of a nerve stimulator technique. The primary outcome measure was the incidence of major complications including infection and neuropathy. As a secondary outcome, adverse effects as well as other complications were also evaluated. Data were expressed as median [25th–75th percentiles]. Results: A total of 400 patients were included in the study during a 2‐year period. The median time the catheter remained indwelling was 47 h [23, 54]. Major complications included three events (0.75%) with one infection (0.25%) and two neuropathies (0.50%). Three blocks were unsuccessful and the catheter insertion was difficult in 12 patients (3%). During the CPSNB procedure, one patient reported slight paraesthesia during stimulation. Patient satisfaction was scored at 4 for 89%, 3 for 6% and 2 for 5% on the analogue scale. Conclusions: Major complications after the use of CPSN are not in fact rare. The incidence of severe neuropathy or infection complications is, respectively, 0.50% and 0.25%. However, the insertion of CPSN could be considered effective and is associated with only a few minor complications.     

The role of octreotide versus placebo in the prevention of post-ERCP pancreatitis

BACKGROUND/AIMS: To evaluate the effectiveness of a single administration of intravenous octreotide infusion in preventing post-ERCP pancreatitis and progressing hyperamylasemia. METHODOLOGY: One hundred and twenty (71 female, 59 male) patients who had been diagnosed with pancreaticobiliary pathology were included in this study. 100 microgram (0.1 mg) octreotide diluted in 60 mL normal saline solution administered intravenously 60 minutes prior to the procedure and continued during the procedure and after the procedure. Placebo was given in 87 patients. Patients were assessed clinically and serum amylase level was also measured before the procedure and 3, 12, and 24 hours after the procedure. We define clinical pancreatitis as serum amylase level greater than 4-5 times in conjunction with clinical assessment. RESULTS: Hyperamylasemia was assessed in 14 of 33 (42.4%) administered octreotide patients. Clinical findings of pancreatitis were observed in 5 of these 14 (11.5%) patients. Hyperamylasemia was also assessed in 41 of 87 (47.1%) administered placebo patients. Clinical findings of pancreatitis were observed in 10 of these 41 (11.5) patients. There were no significant differences between the groups, statistically (p > 0.05) (Pearson chi-square test). CONCLUSIONS: The results of this trial indicate that a single administration of intravenous octreotide infusion does not prevent ERCP-induced pancreatitis and effect serum amylase level.     

The Longitudinal Examination of Arthritis Pain (LEAP) study: relationships between weekly fluctuations in patient-rated joint pain and other health outcomes

OBJECTIVE: To examine relationships between weekly fluctuations in self-rated joint pain and other health outcomes among adults with osteoarthritis (OA). METHODS: In this observational study, 287 adults (aged > or = 50 yrs) with hip or knee OA were recruited from 16 medical practices across the United States. Patients were telephoned weekly for 12 weeks to assess pain/stiffness, daily activities/function, productivity, emotional well-being, quality of life, and healthcare utilization. Associations between changes in joint pain levels and other health outcomes were evaluated using a generalized estimating equation model. RESULTS: The mean (SD) pain score at Week 1 was 4.2 (2.1) on the Western Ontario and McMaster Universities OA index (WOMAC) pain subscale (0 = no pain, 10 = extreme pain); during the study, 49% of patients reported a between-week fluctuation of > or = 2 points. A 2-point decrease in WOMAC pain subscale score was associated with a 22% decrease in number of days of limited activity/week (beta = -0.107; 95% confidence interval -0.163, -0.051); a 48% decrease in number of days of missed work/week (beta = -0.217; 95% CI -0.395, -0.039); a 14% decrease in number of nights with pain-related sleep interference/week (beta = -0.068; 95% CI -0.109, -0.027). Patients were 1.6 times more likely to contact a healthcare provider when their pain changed from "acceptable" to "unacceptable." CONCLUSION:Weekly fluctuations in pain levels and other health outcomes were identified among adults with OA. Decreases in patient-reported pain were associated with improvements in daily activities/functioning and decreases in work absenteeism, sleep interference, and healthcare resource use.     

三维适形放疗结合252锎中子腔内后装照射治疗中晚期食管癌的临床研究

目的：探讨三维适形放疗结合锎（252Cf）中子腔内后装照射治疗中晚期食管癌的疗效、不良反应及晚期并发症。方法：92例中晚期食管癌患者全部采用三维适形放疗结合锎（252Cf）中子腔内后装照射治疗。三维适形放疗总剂量为45Gy-54Gy,分25-30次,5-6周完成;腔内照射3-4Gy/次,1次/周,共2-4次,总吸收剂量10Gy-16Gy。结果：治疗结束3个月进食梗阻缓解率为95%。近期疗效：完全缓解（CR）27%,部分缓解（PR）69.6%。1、2、3年局部控制率分别为82%、51%、32%;1、2、3年生存率分别为：78%、35%、18%;急性放射性食管炎发生率为54%;晚期食管狭窄发生率9%;食管穿孔发生率2%。结论：中晚期食管癌采用三维适形放疗结合锎（252Cf）中子腔内后装照射能够迅速而持久地缓解进食梗阻症状,提高局部控制率及生活质量,近期疗效显著,放疗不良反应未见明显增加。     

广西鼠疫指示动物犬血清IHA、ELISA检测鼠疫F1抗体的一致性研究

目的 了解应用IHA、ELISA检测鼠疫F1抗体的一致性,评价方法的优劣,以便更好地制订鼠疫监测的方法及防治策略.方法 对广西鼠疫监测点隆林、西林县的犬血清使用IHA及ELISA两种试验方法,并进行一致性研究,评价IHA与ELISA方法的可靠性.结果 IHA检测鼠疫F1抗体阳性率为0,ELISA检测鼠疫F1抗体的总阳性率为4.4%(12/273);IHA与ELISA之间的一致性为95.6%,其Kappa值等于0,呈轻度一致.结论 间接血凝试验方法特异、操作简便是传统的鼠疫监测手段之一;酶联免疫吸附试验具有敏感性高、特异性强、操作简便等特点,且与间接血凝试验有轻度一致性,适宜在鼠疫监测中推广应用.     

Parentage analysis by endonuclease shattering of hypervariable DNA

Single-locus DNA probes for tandem repeat sequences are now used in conjunction with particular endonucleases to characterize heritable restriction fragment lengths in parentage tests. Southern blots of this type, however, demonstrate only two attributes of an allele: its length and the presence of nucleotide sequences that are complementary to the probe. Not all restriction fragments of the same apparent length that react with the same probe are identical. Differences between comigrating fragments can be detected by the selection of a restriction enzyme that recognizes sites in a subset of the repeat sequences, and the information content of these loci is therefore increased. This report describes a paternity case in which two brothers appeared, after DNA phenotyping using Hinf I, to be the father. A second phenotyping using Hae III excluded one of the brothers.     

Intra oral suturing by slip knot

A surgical method of intra oral Suturing by slip knot is reported.