Cardiovascular responses to the insertion of nasogastric tubes during general anaesthesia

Eighty female patients free of cardiovascular disease who were having excision of breast lesions were randomly allocated to one of two groups. In the first group a nasogastric tube was inserted blindly during the surgical procedure, while in the second group the tube was inserted under direct laryngoscopy, using Magill forceps. Both groups exhibited a significant increase in systolic blood pressure (SBP) (p less than 0.001) and heart rate (HR) (p less than 0.005). These increases declined during the following 3 minutes. Ventricular extrasystoles (more than 5 during the 3 min following the insertion of the nasogastric tube) occurred only in the group having the nasogastric tube with the aid of laryngoscopy (p less than 0.05).     

Gabapentin attenuates late but not acute pain after abdominal hysterectomy

BACKGROUND AND OBJECTIVE: Gabapentin has been suggested to decrease acute postoperative pain. We evaluated the effect of gabapentin on pain after abdominal hysterectomy. METHODS: Sixty patients scheduled for abdominal hysterectomy were randomized to receive orally gabapentin 400 mg 6 hourly or placebo. Treatment started 18 h preoperatively and continued for 5 postoperative days. Pain (visual analogue score) and consumption of morphine for 48 h and of oral paracetamol/codeine were recorded after 2, 4, 8, 24 and 48 h and on days 3-5 postoperatively. After 1 month, patients were interviewed by phone for pain, and analgesic intake after hospital discharge. RESULTS: Morphine consumption (mean +/- SD) was 35 +/- 15.7 mg in the control and 28 +/- 12.1 mg in the gabapentin group (P = 0.21). Median number (range) of paracetamol 500 mg/codeine 30 mg tablets taken during days 3-5 was 1.0 (0-6) in the control and 2.0 (0-9) in the gabapentin group (P = 0.35). The visual analogue scores at rest and after cough did not differ between the two groups (F = 0.92, df = 1, P = 0.34 and F = 0.56, df = 1, P = 0.46, respectively). One month after surgery, 22/27 (81%) of the control group and 9/25 (36%) of the gabapentin group reported pain in the surgical area (chi(2) = 11.15, P = 0.002), while 11/27 (41%) of controls and 7/25 (28%) of gabapentin patients consumed analgesics for pain (chi(2) = 0.93, P = 0.39). The intensity of pain was decreased in the gabapentin group (chi(2) = 12.6, P = 0.003). CONCLUSIONS: Gabapentin has no effect on immediate pain after abdominal hysterectomy but decreases pain 1 month postoperatively.     

Brain volume perfusion CT performed with 128-detector row CT system in patients with cerebral gliomas: A feasibility study

Objectives  

Validation of the feasibility and efficacy of volume perfusion computed tomography (VPCT) in the preoperative assessment of cerebral gliomas by applying a 128-slice CT covering the entire tumour.     

Impact of intraoperative hypotension on hospital stay in major abdominal surgery

Purpose  

Although the relationship between preoperative risk factors and outcomes has been extensively studied, the effect of intraoperative hemodynamic changes in a patient’s postoperative course has been less well defined.     

No change in serum melatonin, or plasma beta-endorphin levels after sevoflurane anesthesia

STUDY OBJECTIVE: To investigate the effect of sevoflurane as single anesthetic on melatonin and beta-endorphin plasma levels during the first 24 hours postoperatively. DESIGN: Prospective, open-cohort study. SETTING: University hospital. PATIENTS: 13 ASA physical status I and II, adults, scheduled for dilatation and curettage of the uterus, and 13 healthy volunteers. INTERVENTIONS: Patients received general anesthesia with sevoflurane. MEASUREMENTS: Melatonin and beta-endorphin plasma levels were determined before anesthesia, immediately after, and two, 4, 8, and 24 hours after the end of anesthesia. Melatonin and beta-endorphin were also measured in 13 healthy subjects (controls) not undergoing anesthesia at similar times during the day. Systolic and diastolic blood pressure, heart rate, bispectral index, and oxygen saturation via pulse oximeter (SpO(2)) were recorded before and after anesthesia. Quality of sleep postoperatively was also assessed. MAIN RESULTS: Melatonin levels (pg/mL) in the patients and controls were 8.2 +/- 7.9 versus 15.2 +/- 15.0 before anesthesia and 7.7 +/- 7.9 versus 11.1 +/- 7.0, 6.5 +/- 6.1 versus 15.6 +/- 16.3, and 19.5 +/- 17.9 versus 23.7 +/- 23.3 at the end of anesthesia and 4 and 24 hours after the end of anesthesia, respectively (P = 0.057). At the same time points, beta-endorphin plasma levels (pmol/L) in patients and controls were 5.2 +/- 2.0 versus 4.0 +/- 2.3, 5.4 +/- 3.3 versus 3.9 +/- 2.5, 4.9 +/- 1.2 versus 4.4 +/- 1.7, and 3.7 +/- 2.6 versus 4.2 +/- 1.8, respectively (P= 0.285). The quality of sleep assessed clinically was not altered. CONCLUSION: Sevoflurane as a single anesthetic for minor gynecological procedures did not influence significantly melatonin or beta-endorphin plasma levels. Sleep quality assessed clinically was not influenced.     

Downgrading BIRADS 3 to BIRADS 2 category using a computer-aided microcalcification analysis and risk assessment system for early breast cancer

This paper explores the potential of a computer-aided diagnosis system to discriminate the real benign microcalcifications among a specific subset of 109 patients with BIRADS 3 mammograms who had undergone biopsy, thus making it possible to downgrade them to BIRADS 2 category. The system detected and quantified critical features of microcalcifications and classified them on a risk percentage scale for malignancy. The system successfully detected all cancers. Nevertheless, it suggested biopsy for 11/15 atypical lesions. Finally, the system characterized as definitely benign (BIRADS 2) 29/88 benign lesions, previously assigned to BIRADS 3, and thus achieved a reduction of 33% in unnecessary biopsies.     

Effects of morning melatonin administration on electroencephalographic theta to alpha power ratio in reproductive versus postmenopausal healthy female volunteers

Objective: The aim of the present study was to investigate the effect of exogenous morning melatonin administration on the electroencephalogram of reproductive versus postmenopausal women. Methods: Twenty-six female, reproductive and postmenopausal healthy volunteers were randomly assigned to receive melatonin or placebo at 9:00 in the morning. Twelve electroencephalographic recording sessions were performed before the intake of melatonin or placebo and at 15, 30, 45, 60, 75, 90, 120, 150, 180, 240, and 300 min. Theta to alpha ratios for every subject, channel and session were mathematically processed to yield the logarithm (base 10) of the spectral (theta power)/(alpha power) ratio for the 12 electroencephalographic sessions, weighted to the baseline ratio (LwRs). The LwRs were compared between melatonin groups (reproductive versus postmenopausal women) and also between melatonin and control groups. Results: Data from 24 women were analyzed. The LwRs in the reproductive women were significantly lower than the LwRs in postmenopausal women at 60, 180, 240 and 300 min after melatonin consumption (p = 0.007, 0.041, 0.008 and 0.040 respectively). In reproductive women, the LwRs of subjects who received melatonin were significantly lower compared to their controls at 60, 240 and 300 min after melatonin or placebo intake (p = 0.005, 0.006 and 0.019 respectively). In postmenopausal women, no significant differences in the LwRs were calculated for any time point between melatonin and control groups. Conclusions: Our results show that morning melatonin administration produces no electroencephalographic changes in postmenopausal women. In contrast, electroencephalographic changes suggesting a possible awaking effect were observed in reproductive women.