Management of the patient at high risk for postoperative nausea and vomiting

Postoperative nausea and vomiting continue to be problematic areas in anesthesia as evidenced by frequent reports of therapies in the literature. No single therapy has been proven curative for all cases, in part because of the several emetic centers, all of which may be blocked by different classes of drugs and the diverse risk factors which act alone or in combination to cause vomiting. Identification of the patient most at risk allows for cost effective prophylactic management. An appropriate anesthetic technique can be planned that, relying on evidence based medicine, will decrease if not prevent the incidence of this most troubling complication.     

Epidemiology of hospitalizations due to Syphilis in large urban areas in Spain between 1997 and 2006

ObjectiveTo describe the epidemiology and trends of hospitalizations due to syphilis over a ten-year period (1997–2006) in Madrid, Spain.MethodsRetrospective study using data provided by the National Epidemiology Surveillance System for Hospital Data (Conjunto Mínimo Básico de Datos; CMBD). Hospitalized patients suffering from syphilis were identified through the corresponding ICD-9-CM codes (090–097).ResultsBetween 1997 and 2006, 1265 hospitalizations related to syphilis were recorded in Madrid. The annual hospitalization rate was 2.3 per 100,000 inhabitants, the mortality rate was 0.09 per 100,000 inhabitants, and the case fatality rate was 4.03%. The rate of hospitalization and the case fatality rate were significantly higher among men and patients over the age of 80 years.ConclusionWe found a significant increase in hospitalization rates during study period. Syphilis continues to be an important public health problem in Madrid, especially among men. Policies designed to control the course and transmission of sexually transmitted diseases needs to be improved.     

Vasodilator agents and supracollicular transection fail to inhibit cortical spreading depression in the cat

It remains an open question as to whether cortical spreading depression (CSD) is the pathophysiological correlate of the neurological symptoms in migraine with aura. In the experimental animal, CSD is an electrophysiological phenomenon mainly mediated via NMDA receptors. However, according to case reports in humans, visual aura in migraine can be alleviated by vasodilator substances, such as amyl nitrite and isoprenaline. There is also circumstantial evidence that brainstem nuclei (dorsal raphe nucleus and locus coeruleus) may play a pivotal role in the initiation of aura. In this study, CSD was elicited in alpha-chloralose anesthetized cats by cortical needle stab injury and monitored by means of laser Doppler flowmetry. Topical application of isoprenaline (0.1-1%) and amyl nitrite (0.05%) onto the exposed cortex had no effect on the elicitation or propagation of CSD. Also, after supracollicular transection, subsequent CSDs showed no differences in the speed of propagation and associated flow changes. We conclude from these data that--given CSD probably exists in humans during migraine--spreading neurological deficits during migraine aura are independent of brainstem influence and have a primarily neuronal rather than vascular mechanism of generation.     

Effect of cortical spreading depression on activity of trigeminovascular sensory neurons.

The effect of cortical spreading depression, a proposed initiating event for migraine pain, on cortical blood flow (laser Doppler method) and on the spontaneous firing rate and stimulus-evoked responses of trigemino-cervical neurons with craniovascular input was studied in 17 neurons in 8 cats anesthetized with chloralose. Cortical spreading depression, induced via cortical pinprick injury, produced an initial wave of cortical hyperemia (243+/-57% of control) and a later and smaller phase of oligemia (96+/-4% of control). Neither the basal discharge rate (6.7+/-1.7 sec(-1)) nor the evoked responses to electrical stimulation of the superior sagittal sinus (4.1+/-0.8 discharges per stimulus) of upper cervical spinal cord neurons was altered over periods of up to 2 h following one, two, or three waves of spreading cortical depression. We conclude that a small number of episodes of cortical spreading depression is not capable of activating C2 cervical spinal cord craniovascular sensory neurons in the cat.     

A CTSA‐Sponsored Program for Clinical Research Coordination: Networking,Education, and Mentoring

Upon receipt of the National Institutes of Health Clinical and Translational Science Award, the University of Iowa’s Institute for Clinical and Translational Science committed to develop an infrastructure for research professionals. Three goals were established: (1) identification of research professionals within the University of Iowa, (2) development of an educational series, including orientation and continuing education, and (3) development of a mentoring system. The purpose of this paper is to describe the process of development, initiation, and outcomes of a successful networking, educational, and mentoring system crafted for research professionals at the University of Iowa. Clin Trans Sci 2011; Volume 4: 42–47