Mild hypercapnia after uncomplicated heart surgery is not associated with hemodynamic compromise

OBJECTIVE: The aim of this study was to examine the effects of small changes in PaCO(2) on hemodynamic parameters after uncomplicated heart surgery with cardiopulmonary bypass. DESIGN: This was a prospective, randomized crossover study. SETTING: A large academic medical center. PARTICIPANTS: Twenty-four subjects who were scheduled for elective cardiac surgery were enrolled in this study. INTERVENTIONS: Each subject underwent the normal procedures that are associated with cardiac surgery. General anesthesia, including muscle relaxation, were continued in the immediate postoperative period. Measured tidal volumes and minute ventilation were kept constant for the duration of the study. Target PaCO(2) concentrations of 30, 40, and 50 mmHg were achieved by adding varying amounts of exogenous CO(2) gas to the inhaled oxygen. Various measurements were made at each target PaCO(2), including cardiac index, mixed venous oxygen saturation, blood pressure, heart rate, and pulmonary artery pressure. MEASUREMENTS AND MAIN RESULTS: Twenty-four patients were enrolled. Seven were withdrawn before commencement of the study. The cardiac index increased when the PaCO(2) was increased from 30 to 40 mmHg (p < 0.001) and remained unchanged between 40 and 50 mmHg. Mixed venous oxygen saturation increased (p < 0.001) with elevations in PaCO(2) up to 50 mmHg and decreased again when the PaCO(2) was returned to 30 mmHg. The blood pressure decreased (p < 0.001) with increasing PaCO(2). The pulmonary pressure increased (p < 0.001) with elevations in PaCO(2). No patient became hemodynamically unstable or had any arrhythmias. CONCLUSION: The findings of this study suggest that unless there is a specific contraindication to mild hypercapnia, such as pulmonary hypertension or hemodynamic instability, concerns about mild respiratory acidosis should not prevent weaning of sedation and mechanical ventilation after uncomplicated heart surgery.     

Intramural injection with botulinum toxin significantly elongates the pig esophagus

Background/Purpose

Surgical treatment of long-gap esophageal atresia (LGEA) is challenging. Methods which facilitate stretching of the esophageal pouches may allow primary anastomosis. Botulinum toxin type A (BTX-A) blocks acetylcholine release in neuromuscular junctions, thereby causing muscle relaxation. We hypothesized that intramural injections with BTX-A into the esophageal wall of piglets would significantly elongate the tissue upon stretch.

Methods

Twenty-four piglets were randomized to receive BTX-A of placebo (saline). After one hour, the esophagus was removed en bloc and tested in a stretch-tension device.

Results

The mean esophageal elongation was 84% (range 83–101) in the BTX-A-group and 65% (50–78) in the control group. The mean difference between the two groups was 18%, which was significant (p < 0.001).

Conclusion

Intramural injections with botulinum toxin type A elongate the esophagus significantly. Clinically, this could be a potential method to achieve primary anastomosis in LGEA. Additional clinical studies are necessary to evaluate the method before it can be generally recommended.     

Measurement of Quality of Life in Head and Neck Cancer Patients Utilizing the Quality of Life Radiation Therapy Questionnaire

BACKGROUND: Quality of life (QOL) measures give patients the possibility to express subjective changes in wellbeing. We aimed to translate the radiation specific quality of life questionnaire (QOL-RTI) and the companion head and neck module (H&N) questionnaire into German and to test its reliability, validity and sensitivity. PATIENTS AND METHODS: After translation and final revisions based on qualitative interviews with ten patients, 97 head and neck cancer patients were screened for eligibility. Patients answered the 38 items questionnaire at baseline and twice in week 4 of radiotherapy for test-retest reliability. Internal consistency was calculated using Chronbach's alpha. Patients also completed the functional assessment of cancer tool plus head and neck (FACT-G plus H&N) for concurrent validity. Item analyses were performed to test the sensitivity. RESULTS: Chronbach's alpha yielded alpha = 0.85 for the QOL-RTI and alpha = 0.80 for the H&N module, test-retest reliability scores were r = 0.87 and r = 0.83, respectively. The correlation of the QOL-RTI plus H&N and the FACT plus H&N was r = 0.79. Questionnaire sensitivity was supported by significant changes in the mean score of 45.8% of the QOL-RTI items and 78.6% of the H&N items between baseline and week 4 of radiotherapy. CONCLUSIONS: The German version of the QOL-RTI was shown to be a reliable, valid and sensitive tool to assess the quality of life of patients undergoing radiotherapy. The H&N module is useful for patients undergoing treatment for head and neck cancer.     

Dynamic,contrast-enhanced CT of human brain tumors: quantitative assessment of blood volume,blood flow,and microvascular permeability: report of two cases

We present two patients with metastatic brain tumors who underwent dynamic contrast-enhanced CT that yielded estimates of blood volume, blood flow, and microvascular permeability. For one patient, these CT-based quantifications were compared with contrast-enhanced MR-based assessments of fractional blood volume and permeability. Regional blood volume heterogeneity patterns were consistent between both CT- and MR imaging-based mapping. Permeability variations across the tumor, however, were less consistent, perhaps because of differences between ionic and non-ionic contrast agents. The advantages of dynamic contrast-enhanced CT in comparison with dynamic, contrast-enhanced MR imaging for microvascular quantifications are its availability and lower costs, applicability in the presence of MR imaging contraindications, and potentially more accurate analyses. The disadvantages are its limited anatomic coverage, radiation exposure, and the need for injection of a contrast agent.     

Gender-specific differences of the foot during the first year of walking

BACKGROUND: It is is well established that gender-specific differences in foot shape exist in adults. However, no information is available whether these differences are present already in children's feet and at what stage in the development these changes become evident. METHODS: Plantar pressure patterns and footprints of 42 healthy infants (20 male, 22 female) were evaluated over the course of one year and compared regarding gender-specific differences. The age at initial evaluation of the children was 16.1 months, and they were evaluated every 3 months. Anthropometric data, foot shape, and foot loading parameters for the whole foot, as well as for selected regions of interest, were evaluated. RESULTS: Significant differences in the foot shape and dynamic foot loading parameters were noted between boys and girls already at this young age. Boys demonstrated a broader midfoot, indicating a lower arch. Girls showed a more pronounced dynamic loading, especially in the heel and forefoot regions. CONCLUSIONS: The differences seen in this study should be taken into account by the shoe industry responsible for the design of children's shoes to support healthy development of the growing foot. Foot disorders are not only caused by hereditary factors but may be due to disturbances during foot growth and development. Since today's society is dependent on wearing shoes for foot protection, shoes should be designed not only according to the fashion demands of the customers but also to the biomechanical needs. Therefore, it is important to ensure that shoes fit the shape of the feet, which is different for boys and girls already when walking begins.     

Sexual activity and function in women with and without pelvic floor disorders

Introduction and hypothesis

We describe differences in sexual activity and function in women with and without pelvic floor disorders (PFDs).

Methods

Heterosexual women ≥40 years of age who presented to either urogynecology or general gynecology clinics at 11 clinical sites were recruited. Women were asked if they were sexually active with a male partner. Validated questionnaires and Pelvic Organ Prolapse Quantification (POP-Q) examinations assessed urinary incontinence (UI), fecal incontinence (FI), and/or pelvic organ prolapse (POP). Sexual activity and function was measured by the Female Sexual Function Index (FSFI). Student’s t test was used to assess continuous variables; categorical variables were assessed with Fisher’s exact test and logistic regression. Univariate and multivariate analyses were used to assess the impact of pelvic floor disorders (PFDs) on FSFI total and domain scores.

Results

Five hundred and five women met eligibility requirements and gave consent for participation. Women with and without PFDs did not differ in race, body mass index (BMI), comorbid medical conditions, or hormone use. Women with PFDs were slightly older than women without PFDs (55.6?+?10.8 vs. 51.6?+?8.3 years, P <0.001); all analyses were controlled for age. Women with PFDs were as likely to be sexually active as women without PFDs (61.6 vs. 75.5 %, P?=?0.09). There was no difference in total FSFI scores between cohorts (23.2?+?8.5 vs. 24.4?+?9.2, P?=?0.23) or FSFI domain scores (all P?=?NS).

Conclusion

Rates of sexual activity and function are not different between women with and without PFDs.     

Telerehabilitation of anomia in primary progressive aphasia

Background: The efficacy of telerehabilitation-based treatment for anomia has been demonstrated in post-stroke aphasia, but the efficacy of this method of anomia treatment delivery has not been established within the context of degenerative illness.

Aims: The current study evaluated the feasibility and efficacy of a telerehabilitation-based approach to anomia treatment within the three subtypes of primary progressive aphasia (PPA).

Methods & Procedures: Each of the three telerehabilitation participants represented a distinct subtype of PPA. Following a baseline evaluation of language and cognition, a phonological treatment and an orthographic treatment were administered to all participants over the course of 6 months. One month after the end of treatment, a post-treatment evaluation began. All treatment sessions and the majority of the evaluation sessions were administered via telerehabilitation. Treatment effects were examined within each subject, and treatment effects were also compared between each telerehabilitation participant and a group of in-person participants who had the same subtype of PPA.

Outcomes & Results: All three telerehabilitation participants exhibited positive treatment effects. CGR (nonfluent/agrammatic variant PPA) and WCH (logopenic variant PPA) showed maintenance of naming for prophylaxis items under both treatment conditions, while ACR (semantic variant PPA) demonstrated increased naming of remediation items under the phonological treatment condition. Compared to in-person participants with the same subtype of PPA, each of the telerehabilitation participants typically showed effects that were either within the expected range or larger than expected.

Conclusions: Telerehabilitation-based anomia treatment is feasible and effective in all three subtypes of PPA.     

Self-harm as a risk factor for inpatient aggression among women admitted to forensic psychiatric care

Background: Inpatient aggression among female forensic psychiatric patients has been shown to be associated with self-harm, that is considered to be a historical risk factor for violence. Research on associations between previous or current self-harm and different types of inpatient aggression is missing.

Aim: The aim of this register study was to investigate the prevalence of self-harm and the type of inpatient aggression among female forensic psychiatric inpatients, and to study whether the patients’ self-harm before and/or during forensic psychiatric care is a risk factor for inpatient aggression.

Methods: Female forensic psychiatric patients (n?=?130) from a high security hospital were included.

Results: The results showed that 88% of the female patients had self-harmed at least once during their life and 57% had been physically and/or verbally aggressive towards staff or other patients while in care at the hospital. Self-harm before admission to the current forensic psychiatric care or repeated self-harm were not significantly associated with inpatient aggression, whereas self-harm during care was significantly associated with physical and verbal aggression directed at staff.

Conclusions: These results pointed towards self-harm being a dynamic risk factor rather than a historical risk factor for inpatient aggression among female forensic psychiatric patients. Whether self-harm is an individual risk factor or a part of the clinical risk factor ‘Symptom of major mental illness’ within the HCR-20V3 must be further explored among women. Thus, addressing self-harm committed by female patients during forensic psychiatric care seems to be important in risk assessments and the management of violence, especially in reducing violence against staff in high-security forensic psychiatric services.