Ketamine as an Anesthetic for Patients with Acute Brain Injury: A Systematic Review

Neurocritical Care - For years, the use of ketamine as an anesthetic to patients suffering from acute brain injury has been debated because of its possible deleterious effects on the cerebral...     

Sagittal abdominal diameter and waist circumference appear to be equally good as identifiers of cardiometabolic risk

Background and aimsBody mass index (BMI) and waist circumference (WC) are commonly used markers of cardiometabolic risk. However, sagittal abdominal diameter (SAD) has been proposed as a possibly more sensitive marker of intra-abdominal obesity. We investigated differences in how SAD, WC, and BMI were correlated with cardiometabolic risk markers.Methods and resultsThis cross-sectional study investigated anthropometric and metabolic baseline measurements of individuals from six trials. Multiple linear regression and (partial) correlation coefficients were used to investigate associations between SAD, WC, and BMI and cardiometabolic risk markers, including components of the metabolic syndrome as well as insulin resistance, blood lipids, and lowgrade inflammation.In total 1516 mostly overweight or obese individuals were included in the study. SAD was significantly more correlated with TG than WC for all studies, and overall increase in correlation was 0.05 (95% CI (0.02; 0.08). SAD was significantly more correlated with the markers TG and DBP 0.11 (95% CI (0.08, 0.14)) and 0.04 (95% CI (0.006, 0.07), respectively compared to BMI across all or most studies.ConclusionThis study showed that no single anthropometric indicator was consistently more strongly correlated across all markers of cardiometabolic risk. However, SAD was significantly more strongly correlated with TG than WC and significantly more strongly correlated with DBP and TG than BMI.     

Prenatal diagnosis of distal arthrogryposis type I by ultrasonography.

Two consecutive pregnancies in a woman with initially undiagnosed type I distal arthrogryposis (DA) are reported. A prenatal diagnosis of the condition was made by ultrasound in the 17th week of gestation in one of the pregnancies, whereas in the subsequent pregnancy the disorder was excluded as early as 13 weeks' gestation. The diagnoses were verified at birth. The feasibility of prenatal diagnosis of DA type I in the second trimester is thus confirmed and its possibility in the late first trimester is suggested.     

Ultraviolet Light and Non-Hodgkin's Lymphoma

In the beginning of this century, a Danish dermatologist, Professor Niels Finsen, received the Nobel Prize for his showing of the beneficial effects of UV-light on certain skin diseases. We have subsequently learned that UV-light is far from being only beneficial to our health. UV-light is an important risk factor for malignant melanoma and squamous cell carcinoma of the skin (1). Furthermore, UV-light appears to have immunosuppressive effects, not only on the local skin, but on the immune system in general (2-4). Recently, it was suggested that UV-light may also increase the risk of non-Hodgkin's lymphoma (NHL) (5, 6).     

Cultures of thoracotomy specimens confirm usefulness of sputum cultures in cystic fibrosis

Bacteriologic cultures of sputum and specimens obtained at thoracotomy from 17 patients with cystic fibrosis were compared. All organisms found in the surgical specimens were found in the sputum. Only two surgical specimens failed to yield any organisms. The most frequently isolated organisms were Pseudomonas aeruginosa (41%) and Pseudomonas cepacia (35%). Serotypes of P. aeruginosa and antibiogram results on both P. aeruginosa and P. cepacia further supported the concordance of the isolates from the two sources. In addition, anaerobic cultures were obtained in specimens from 10 patients with CF and revealed two patients with anaerobic colonization of the lower respiratory tract. These findings also correlated well with the sputum cultures. The correlation of sputum and lung specimen culture results supports the value of sputum culture in the management of lung disease in CF.     

Chronic pain in land mine accident survivors in Cambodia and Kurdistan

The aims of the study were to study chronic pain in land mine accident survivors, and to study the impact of trauma and trauma care parameters on chronic pain. The level of chronic pain was registered (patient-rated and by clinical examination) in 57 severely injured adult land mine accident survivors in Cambodia and Northern Iraq more than one year after the accident. As all study patients had been managed by a standardized trauma system, we could assess the impact of injury severity and primary trauma care on chronic pain. 64% of the study patients (n=36) had chronic pain syndromes (non-significant difference between the two countries). 68% of the amputees (19 out of 28) had phantom limb pain. Pre-injury trauma exposure, the severity of the actual trauma, and the quality of trauma care had no impact on end point chronic pain. In 85% of cases (n=48), the economic standing of the patients' family had deteriorated after the accident. Patient-rated loss of income correlated with the rate of chronic pain syndromes.     

Serum cystatin C as a marker of the renal function in patients with spinal cord injury

OBJECTIVE: To investigate the relationship between serum cystatin C, serum creatinine, and (51)Cr-EDTA-clearance in patients with spinal cord injury. SETTING: The Spinal Cord Unit, Viborg-Kjellerup County Hospital. METHODS: Twenty-four men and seven women aged 20.3 to 68.0 years with motor complete spinal cord injury (ASIA A or B) were included. Serum cystatin C was measured by an automated particle-enhanced nephelometric immunoassay (Dade Behring), serum creatinine by an enzymatic method (Vitros 950), and (51)Cr-EDTA-clearance by a multiple plasma sample method. RESULTS: A linear relationship was found between (51)Cr-EDTA-clearance and the reciprocal values of cystatin C and creatinine. The correlation coefficient between (51)Cr-EDTA-clearance and 1/cystatin C was 0.72 compared to the correlation coefficient between (51)Cr-EDTA-clearance and 1/creatinine being 0.26. Comparison of the area under the curves in the non-parametric receiver operating characteristics (ROC) plots for serum cystatin C (area under the curve (AUC)=0.912; SE=0.065), and serum creatinine (AUC=0.507; SE=0.115) revealed significant differences (P-values=0.0005). CONCLUSION: In patients with spinal cord injury serum cystatin C is a better marker of the renal function compared to serum creatinine.     

Accuracy and repeatability of prostate volume measurements by transrectal ultrasound

We evaluated six alternative methods of prostate volume determination by transrectal ultrasound, three based on planimetry and three based on measurement of prostate diameters. Prostate volume measurements were made on an average of 6.5 occasions over a 3 y period on 41 patients with benign prostatic hyperplasia, using standard techniques. We defined the average of multiple planimetries as the prostate reference volume. Agreement with the reference volume and reproducibility at repeat testing was in the same range for single planimetry and volume determinations based on the formulas height (H) x width (W) x length (L) x pi/6 and W x W x H x pi/6, but was poorer using the formula W x W x W x pi/6. Using the average result of two successive planimetry measurements increased the reproducibility of planimetry, being statistically significantly better than for one single planimetry (P=0.024) or for the formula W x W x H x pi/6 (P=0.048). Our study suggests that the simple formula based methods of prostate volume determination provide results that are only marginally inferior to one single planimetry, but results are improved by performing two planimetry measurements.     

Long-and Short-Term Mortality Rates in Patients who Primarily Survive Cardiac Arrest Compared with a Normal Population

This is a follow-up study of 180 survivors after cardiac arrest outside intensive care and coronary care units. The follow-up extended over 0.5 to 8.5 years (averaged 4.3 years) after the primary cardiac arrest. Of the patients, 72 (40%) were discharged from hospital, 13 with anoxic brain damage. Thirty-ourred in 43% after 2 years, and in 50% after 3 years. After that time, the mortality was similar to that of a comparable normal population. At the end of the study, 34 patients were still alive, including eight with neurological sequelae. Their present cardiac function was satisfactory in the majority (59%) of the patients falling into group I or II of the American Heart Association classification. Their social situation, however, left much to be desired, as only 50% had fully or partly regained their previous level of activity.