Effect of propofol and clonidine on cerebral blood flow velocity and carbon dioxide reactivity in the middle cerebral artery

This study was designed to evaluate the effects of propofol alone and propofol-clonidine combination on human middle cerebral artery blood flow velocity (Vmca) and cerebrovascular carbon dioxide (CO2) response by using transcranial Doppler ultrasonography. Mean Vmca in response to changes in arterial partial pressure of CO2 (Paco2) was determined under the following conditions: awake (group 1), propofol anesthesia (group 2), and combined propofol-clonidine anesthesia (group 3). Normocapnic, hypercapnic, and hypocapnic values of heart rate, mean arterial pressure, partial end-tidal CO2 pressure, Paco2, and Vmca were obtained. The mean Vmca in groups 2 and 3 was significantly lower than that in group 1 at each level of Paco2. The calculated Vmca at each level of Paco2 was not different between groups 2 and 3. There was a correlation between Paco2 and Vmca in all groups, but in the anesthetized groups the effect of Paco2 on Vmca was attenuated. The present data demonstrated that clonidine-propofol does not change CO2 reactivity compared with propofol alone, but both anesthetics attenuate cerebral blood flow compared with awake controls.     

Erythropoietin against cisplatin-induced peripheral neurotoxicity in rats

Cisplatin (CDDP) is a potent anticancer drug, and neurotoxicity is one of its most important dose-limiting toxicities. In this study we investigated the role of recombinant human erythropoietin (rhuEPO) for protection against CDDP-induced neurotoxicity. All experiments were conducted on female Wistar-albino rats. Animals were randomly assigned to three groups. Group A received only CDDP, group B received CDDP plus rhuEPO, and group C received only rhuEPO. Electroneurography (ENG) was done in the beginning and at the end of 7 wk, then the rats were sacrificed and the sciatic nerve was removed for histopathological examination. The mean initial latency was 2.7438 ms in group A, 2.4875 ms in group B, and 2.62 ms in group C. After 7 wk of treatment, the latency was 2.4938, 2.6313, and 2.3900 ms, respectively. The difference in latencies was not statistically significant. The amplitude of compound muscle action potential (CMAP) was 12.8125 mV, 14.3875 mV, and 14.5600 mV before the treatment and 8.4875, 12.8250, and, 13.0800 mV after treatment, respectively. Amplitude of CMAP was significantly greater in rhuEPO-treated groups (groups B and C) compared to cisplatin only Group A. The mean area of CMAP was 12.2625, 12.3500, and, 12.2800 mV s before the treatment and 5.7125, 10.6463, and 9.1600 mV s after the treatment, respectively. The area of CMAP was significantly larger in rhuEPO-treated groups. In histopathological studies thick, thin, and total number of nerve fibers were 4053, 5050, and 9103, in group A, 5100, 8231, and 13331, in group B, and 5264, 6010, and 11274, in group C respectively. In the microscopic examination active myelinization process was observed in rhuEPO-treated groups. We concluded that at the given dose and schedule CDDP-induced motor neuropathy and rhuEPO prevented this neuropathy by sparing the number of normal nerve fibers and by protecting the amplitude and area of CMAP. We concluded that rhuEPO may also play a role in active myelinization and it is an active agent in protection against CDDP-induced peripheral neuropathy, warranting further clinical studies.     

Cardiac hydatic cyst causing cerebral emboli in a child

Cardiac hydatic cyst is rarely encountered. In this article, a case of hydatid cyst localized in the left ventricle causing cerebral emboli is reported.     

Effect of timing of chest tube removal on development of pericardial effusion following cardiac surgery

BACKGROUND: There are no standard criteria for the timing of drain removal. The objective of this study was to determine whether the macroscopic appearance of chest tube drainage fluid to serosanguineous may be used as a criteria for drain removal. METHODS: 2,359 patients were assessed retrospectively and 80 randomized patients were followed prospectively who underwent cardiac surgery. In both parts of the study, patients were divided into two groups according to the timing of drain removal. Group I consisted of patients whose chest tubes were removed as soon as the macroscopic appearance of the drainage fluid turned to serosanguineous. Group II consisted of patients whose chest tubes were removed at the second postoperative day when the drainage output declined to less than 50 mL in a five-hour period. In the retrospective part, cases of hemodynamically significant pericardial effusion observed within seven days postoperatively were reviewed. In the prospective part, just before the drain removal, the fluid sample hematocrit obtained from the drain lines and patients' blood hematocrit were measured and recorded. Patients were evaluated with echocardiography for pericardial effusion. RESULTS: No statistically significant difference was detected in the frequency of hemodynamically significant pericardial effusion and incidence or amount of pericardial effusion between the two study groups. The drain hematocrit to blood hematocrit ratios before drain removal showed a significant correlation with pericardial effusion.The strength of correlation between the drain hematocrit to blood hematocrit ratios before drain removal and pericardial effusion was also studied using receiver operating characteristic curve, which suggests that a drain hematocrit to blood hematocrit ratio of < or = 0.3 is strongly predictive that pericardial effusion would be absent or mild between the fifth and seventh postoperative days. CONCLUSIONS: It is safe to remove the chest tubes as soon as the macroscopic appearance of the drainage fluid turns to serosanguineous since this practically indicates cessation of active bleeding.     

Invasive ductal breast carcinoma response to neoadjuvant chemotherapy: noninvasive monitoring with functional MR imaging pilot study

PURPOSE: To investigate if the extraction flow product (EFP), as determined on dynamic contrast material-enhanced magnetic resonance (MR) images, could be a potential marker of tumor response to neoadjuvant chemotherapy in patients with locally advanced breast cancer. MATERIALS AND METHODS: Fourteen women with proven breast cancer underwent MR imaging prior to and following neoadjuvant chemotherapy. Dynamic gradient-echo and echo-planar MR images were acquired before and after injection of gadopentetate dimeglumine. Precontrast T1s were measured before EFP maps were calculated by using a multicompartmental model. Mean EFP (EFPmean) and distribution analysis of EFP (EFPcount) were measured in tumors before and after neoadjuvant chemotherapy and were compared with tumor response at MR imaging. The significance of the difference in EFP values between the responders and nonresponders was calculated with a two-tailed Student t test. RESULTS: EFPmean after neoadjuvant chemotherapy in partial responders and nonresponders was 33 mL x 100 g-1 x min-1 +/- 9.8 and 54.2 mL x 100 g-1 x min-1 +/- 10.3, respectively (P <.005). EFPmean decreased after neoadjuvant chemotherapy in the responders and nonresponders by 37% +/- 30 and -5% +/- 35, respectively (P >.05). An increase in EFPmean values was observed only in nonresponders who received taxanes. For regimens without taxanes, EFPmean decreased regardless of the morphologic response. EFPcount decreased for all the responders by 77% +/- 33 and increased for all the nonresponders by 45% +/- 68 (P <.02). CONCLUSION: EFPcount appears to provide functional information regarding changes in tumor angiogenesis due to neoadjuvant chemotherapy. Functional MR imaging of the breast may be useful in monitoring tumor response to neoadjuvant chemotherapy.     

The role of a posteriorly positioned fibula in ankle sprain

BACKGROUND: Specific anatomic variations of the ankle mortise may predispose people to ankle sprains. HYPOTHESIS: There is a correlation between a higher malleolar index (posteriorly positioned fibula) and incidence of ankle sprain. STUDY DESIGN: Prospective case control study. METHODS: We compared the malleolar index (transverse plane of the talus) on computerized axial tomographic images of 61 patients with ankle sprain with that of 101 normal controls. A positive number for the malleolar index meant that the lateral malleolus was posterior to the plane of the medial malleolus. A negative number meant that the lateral malleolus was actually anterior to the plane of the medial malleolus. RESULTS: The average malleolar index of the patients with ankle sprain was +11.5 degrees with a standard deviation of 7 degrees. Malleolar relationships varied from -6 degrees to +39 degrees, a range of 45 degrees. The average malleolar index in the control group was +5.85 degrees with a standard deviation of 4.9 degrees, which varied from -8 degrees to +16 degrees. However, there was no correlation between recurrence of sprains and malleolar index values. CONCLUSION: Patients with an ankle sprain were more likely to have a posteriorly positioned fibula, possibly predisposing them to ankle sprain.     

Confirmation of alleged falanga torture by bone scintigraphy—Case report

Any objective persisting signs of previous torture would be very valuable in the late assessment of the individual claiming such abuse of human rights. We present the case of a 32-year-old man referred to our hospital for an opinion on alleged torture by the falanga method. Magnetic resonance imaging and bone scintigraphy were evaluated and compared as methods of confirming such torture.     

Accuracy of cartilage and subchondral bone spatial thickness distribution from MRI

PURPOSE: To assess three-dimensional measurement accuracy of articular cartilage (AC) and subchondral bone (SB) thickness from MRI. MATERIALS AND METHODS: A computer program was used to calculate AC and SB thickness from MRI (three-dimensional spoiled gradient echo (SPGR),.31-mm resolution, 1-mm slice thickness) of six adult femoral heads. Specimens were imaged in five anatomical planes ranging between +30 degrees to -30 degrees from neutral and cut into 2-mm thick sections along the five anatomical planes. Faxitron x-ray was used to produce microradiographic (.05-mm resolution) images of the sections. RESULTS: In-plane measurement accuracy was.165 +/-.108 mm for AC thickness and.387 +/-.174 mm for SB thickness. Taking into account chemical-shift misregistration in SB thickness, accuracy of measurements improved to.213 +/- 128 mm. Out-of-plane (three-dimensional) thickness accuracy of the model, assessed by numerical simulation, was.015 mm. However, three-dimensional thickness errors in specimens were.319 +/-.256 mm for AC and.253 +/-.183 mm for SB thickness. CONCLUSION: Errors in three-dimensional AC thickness were attributed to volume-averaging effects caused by oblique intersection of the image plane with the joint surface. Errors in three-dimensional SB thickness were attributed to chemical-shift artifact. We conclude that accuracy of AC thickness is within clinically acceptable standards but that more sophisticated pulse sequences are needed to improve the measurement of SB thickness.