Epidural analgesia during labour with a singleton alive fetus at term

OBJECTIVE: Whether epidural analgesia (e.a.) have influence on the way of delivery, indications to cesarean section (c.s.) and neonatal outcome. MATERIAL AND METHODS: We have analysed 8784 deliveries. We excluded women with plural pregnancy, pre-term parturitions, elective c.s., still births. Finally we studied 339 parturitions with e.a. versus 6868 the others and theirs newborns. RESULTS: More frequent c.s. was in women with e.a. (18.6% vs 7.9%; p < 0.001) or forceps (f.d.) (7.7% vs 3.5%; p < 0.005). Among those with e.a. the most frequent indications to c.s. were labour with no progression (23.4% vs 4.0%; p < 0.001) and the others as hypoxia fetus (68.7% vs 82.6%; p < 0.01). The lost of blood with oblique to transfusion was more frequent at f.d. at comparison to c.s. and spontaneous delivery (26.9% vs 3.2% and 6.8%; p < 0.001). The condition of neonates at 1 min. according Apgar score was the worse after f.d. in comparison to spontaneous delivery (7.38 +/- 2.22 vs 8.79 +/- 1.41 points; p < 0.005) and after c.s. (7.38 +/- 2.22 vs 8.55 points; p < 0.05). In comparison the state at 5 min. was the similar after f.d. (9.11 +/- 1.24 vs 9.53 +/- 0.81 points; p = 0.05) and (9.11 +/- 1.24 vs 9.48 +/- 0.83 points; p = 0.09). CONCLUSIONS: Women with epidural analgesia more frequent were ending the delivery by cesarean section or forceps. The forceps delivery was related with worse neonatal outcome at first minutes of live, and bigger lost of blood during labour. Epidural analgesia predisposed to cesarean section delivery caused of partus without progress and relatively deminished caused by fetus hypoxia.     

Autoregulation of the retinal circulatory system

Autoregulation plays an important role in the structures of high metabolism, like the brain or the retina. It protects these organs against damaging effects of abnormal blood flow. Specific anatomical and physiological features of these organs play a role in this process. In the retinal autoregulation most important are: 1) endothelium of the capillary vessels and 2) the contractile elements of the vessels' walls. Substances that are secreted by the endothelium can directly modify the function of the local circulation. One of the most important is the endothelium derive relaxing factor (EDRF), which has been identified as endogenous nitrous oxide (NO). We have attempted to systematize current knowledge about the autoregulatory processes in the retina.     

Early brain natriuretic peptide increase reflects acute myocardial ischemia in patients with ongoing chest pain

BACKGROUND: Plasma brain natriuretic peptide levels increase during acute ischemic events. In this study we tested the diagnostic performance of brain natriuretic peptide measurements in the detection of acute myocardial ischemia. METHODS: Blood brain natriuretic peptide was measured in 101 patients with ongoing chest pain but no heart failure or an ST-segment elevation myocardial infarction on arrival at the emergency department (baseline) and at 2 and 6 h later. After diagnostic testing and 1-month follow-up for ischemia, patients were classified as either ischemic or non-ischemic. RESULTS: In the ischemic group median (25th, 75th percentiles) brain natriuretic peptide values (pg/ml) were 122 (20, 349) at baseline, 116 (36, 347) at 2 h, increasing to 148 (52, 428) at 6 h (p<0.001 vs. baseline). Non-ischemic patients had 12 (5, 32) at baseline, 9 (6, 30) at 2 h, and 13 (5, 29) at 6 h (p<0.001 vs. corresponding values of the ischemic group). Receiver operator characteristic curves were constructed for brain natriuretic peptide values at baseline 2 and 6 h and for the increase of peptide levels from baseline to 6 h. All areas under curve indicated a significant diagnostic ability for the detection of ischemia. The 6-h measurement had better diagnostic performance than baseline and 2-h measurements. The subgroup of ischemic patients without myocardial necrosis also had higher brain natriuretic peptide values and could thus be discriminated from non-ischemic subjects. CONCLUSIONS: Brain natriuretic peptide values may detect acute myocardial ischemia in patients with ongoing chest pain but without ST-segment elevation, and distinguish ischemic patients from those with pain of non-ischemic origin.     

Jacques Daviel--the inventor of the extracapsular cataract extraction surgery

On April 8, 1747, Jacques Daviel called to operate on M. Garion, a master wigmaker, whose cataracts appeared very favorable for surgery. Nevertheless, the expert Daviel was unable to depress lens. At that moment, he decided on a deliberate extraction. After widely opening the right cornea, he passed a small spatula through the pupil and extracted from the posterior chamber the lens. Thus was initiated the first significant advance in cataract surgery since the invention of couching in ancient India.     

Problems of perioperative period in patients with Steinert's myotonic dystrophy operated due to cataract

Steinert's myotonic dystrophy is a genetically conditioned systemic disease with symptoms related to circulatory, respiratory, muscular, endocrine and mental disturbances. Most if not all of these patients develop lens opacification as a presenting symptom and need to undergo cataract surgery. Nevertheless, selection of a type of anaesthesia can arise to a problem in these patients because local anaesthesia can be insufficient whereas general endotracheal anaesthesia is known, to potentially provoke serious postoperative complications. In this contribution we discuss problems we faced during cataract surgery in three siblings affected by Steinert's myotonic dystrophy. Two of them were operated on in local anaesthesia and developed intraoperative problems related to sudden increase of intraocular pressure, bleeding and vitreous efflux. After receiving a thorough examination the youngest of the three was operated on under short acting general intravenous anaesthesia (propofol and/or benzodiazepines, piperidine derived opioids, non-polarizing paralytics). We conclude that short acting general intravenous anaesthesia can help in avoiding both, local ocular complications during surgery and problems in the postoperative period.     

Risk factors of massive suprachoroidal hemorrhage during extracapsular cataract extraction surgery

PURPOSE: To estimate retrospectively the incidence, predisposing factors, and possible mechanisms precipitating massive suprachoroidal hemorrhage (MSCH) development during cataract extraction surgery. METHODS: The study was conducted on 6639 consecutive cataract extractions performed between 1994 and 2002. All of the procedures were carried out using traditional nucleus expression methods. The study cases comprised 19 patients who developed intraoperative MSCH. The remaining 6620 patients served as the control group. Baseline systemic and ocular characteristics, as well as intraoperative factors, were analyzed. Categorical variables were analyzed using the chi-square test and the Fisher exact test. RESULTS: The incidence of MSCH during cataract surgery was 0.28%. Highly significant risk factors included high myopia, glaucoma, and diabetes (p<0.01). Atherosclerotic vascular diseases and/or hypertension were less significantly related to the condition (p<0.05). There was no significant relationship between MSCH formation and age, sex, side of the cataract, history of ocular trauma, or inflammation. The incidence of MSCH did not differ between patients operated on with extracapsular or intracapsular cataract extraction. CONCLUSIONS: Attention to multiple preoperative and intraoperative ocular and systemic variables may allow the identification of, and prophylaxis for, patients at greater risk for MSCH.     

Internal ophthalmoplegia as a direct consequence of head injury. Report on 2 cases]

The authors describe two cases admitted following head injury and presenting with a dilated, stiff pupil. CT scan of the head revealed no intracranial mass lesion. The symptoms persisted over a year in one case, whereas in the other one they faded away within a few weeks. The symptoms are believed to arise due to a downward shift of the brainstem which is known to occur at the moment of head injury. The oculomotor nerve is ++over-stretched and is supposed to be partially damaged at the posterior petroclinoid ligament. The roots of the pupillomotor fibers may also be supposedly torn at the site where they leave the brainstem.     

Gastrogastric intussuscepting leiomyomas

Two cases of gastrogastric intussusception sof leiomyomas are presented. Intussusception of a fundal mass into the gastric antrum can cause a confusing appearance on the double-contrast barium study. Intermittent intussusception was seen on fluoroscopy in 1 case.     

Ex vivo perfusion of a tumor-containing colon with monoclonal antibody

We describe a model for the evaluation of anti-tumor antibody specificity using a colonic adenocarcinoma-containing specimen, freshly resected from a patient. The colonic segment was perfused for 1 hr through the mesenteric vessels with a perfusate solution containing an ACRC antibody known to bind specifically to cells of human colorectal carcinoma. Differential binding of a monoclonal ACRC antibody to cells of the adenocarcinoma and not to those of normal colonic mucosa was observed in three patients, whereas in two patients such differences in preferential binding were not observed. No antibody binding to any tissues was observed in the sixth patient. These results warrant further trial of in vivo evaluation of the specificity of ACRC antibody for diagnosis and therapy of human malignancy.