Vascular trauma at a university teaching hospital

Fifty-two patients with vascular trauma have been managed by the St Vincent's Hospital Vascular Surgical Unit during the 5 year period 1982-86. The mean age of the patients was 39.7 years; 81% were male. Penetrating, blunt and iatrogenic trauma were equally represented. Forty-nine of the patients underwent 63 operations performed by members of the unit. Twenty-five of the patients had significant non-vascular injuries, requiring 29 other operations. Pre-operative angiography was used rarely in urgent cases. All vascular reconstructions were noted to be patent during the follow-up period, with a mean of 20 months, except in one instance, where an amputation resulted from failed surgery. One patient died from a complication of the vascular surgery.     

The effect of lidocaine on bacterial growth in propofol

Extrinsically contaminated propofol has been associated with multiple infectious complications. Injection of propofol is associated with pain that is diminished by the addition of lidocaine. Lidocaine has antibacterial properties at high concentrations, but low concentrations of lidocaine (0.1%) have not been studied. We examined the growth rates of Staphylococcus aureus, Serratia marcescens, Pseudomonas aeruginosa, and Candida albicans in propofol containing disodium edeteate with and without added lidocaine 0.1% 2, 5, and 24 h after inoculation. There was no significant difference in the number of colony-forming units between propofol with and without added lidocaine at any time after inoculation. Implications: The addition of lidocaine to propofol in concentrations clinically effective in reducing pain on injection had no effect on microbial growth. Adherence to strict aseptic technique is further emphasized.     

Unintentional extraction of an endothelialized bare metal stent

The extraction of a previously endothelialized stent has been rarely reported in the literature. We report a case of a patient with unstable angina due to in-stent restenosis. During percutaneous coronary intervention, a stent was inadvertently dislodged in the ostium of the right coronary artery. Retrieval of the dislodged stent led to unintentional extraction of the previously endothelialized bare metal stent.     

Effects of female genital mutilation on birth outcomes in Switzerland

Objective  The primary aim of this study was to determine the desires and wishes of pregnant patients vis-à-vis their external genital anatomy after female genital mutilation (FGM) in the context of antenatal care and delivery in a teaching hospital setting in Switzerland.
Our secondary aim was to determine whether women with FGM and non-mutilated women have different fetal and maternal outcomes.
Design  A retrospective case–control study.
Setting  A teaching hospital.
Population  One hundred and twenty-two patients after FGM who gave consent to participate in this study and who delivered in the Department of Obstetrics and Gynaecology in the University Hospital of Berne and 110 controls.
Methods  Data for patients' wishes concerning their FGM management, their satisfaction with the postpartum outcome and intrapartum and postpartum maternal and fetal data. As a control group, we used a group of pregnant women without FGM who delivered at the same time and who were matched for maternal age.
Main outcome measures  Patients' satisfaction after delivery and defibulation after FGM, maternal and fetal delivery data and postpartum outcome measures.
Results  Six percent of patients wished to have their FGM defibulated antenatally, 43% requested a defibulation during labour, 34% desired a defibulation during labour only if considered necessary by the medical staff and 17% were unable to express their expectations. There were no differences for FGM patients and controls regarding fetal outcome, maternal blood loss or duration of delivery. FGM patients had significantly more often an emergency Caesarean section and third-degree vaginal tears, and significantly less first-degree and second-degree tears.
Conclusion  An interdisciplinary approach may support optimal antenatal and intrapartum management and also the prevention of FGM in newborn daughters.     

Extended endoscopic endonasal transsphenoidal approaches in skull base Surgery Article in Russian

The article deals with endoscopic endonasal transsphenoidal surgery, which has gained great interest among the modem trends of neurosurgery. Application of extended endoscopic endonasal transsphenoidal approaches significantly advances capabilities of transsphenoidal surgery. Pituitary adenomas and some other sellar tumors which traditionally require transcranial procedure now can be removed via endonasal route.     

ID3 Prescribing Patterns for Treatment of Upper Respiratory Infections

OBJECTIVE: This purpose of this study was to estimate the value of HIV prevention using the contingent valuation methodology.
METHODS: Two convenience samples of 452 high-risk individuals (homosexual) and 155 low-risk individuals (heterosexual) were collected from selected sites across the state of Missouri. Subjects completed a 60 item questionnaire on their knowledge, attitudes, beliefs, and sexual behaviors. A series of willingness to pay (WTP) questions were asked to estimate the value of 98% protection (i.e., condom use) and 100% protection (i.e., abstinence) from HIV infection. Additionally, two willingness to be paid (WTBP) questions were asked to estimate the cost of behavior change.
RESULTS: The results of the study showed high-risk individuals placed a greater value on the benefits of HIV prevention than did individuals at low-risk of HIV infection. The benefits of condom use against infection from HIV were valued at $261/month for subjects in the high-risk sample and $238/month for individuals in the low-risk sample. The average monetary benefits of abstinence against HIV infection were estimated at $305/month for high-risk individuals, compared to $249/month among individuals in the low-risk sample. Utility for each preventive behavior (condom use and abstinence) was calculated using a cost-to-benefit ratio (WTBP/WTP). Utilities were regressed on demographic and risk variables. a high-risk individual's utility for 98% protection was associated with greater exposure risk to HIV and knowledge of an AIDS-related death. The low-risk sample was not statistically significant, and no statistical relationships were found between independent variables.
CONCLUSIONS: While subject to methodological limitations, the results from this research provide estimates of the value of HIV prevention strategies. Further research in the area of WTP and HIV prevention is advocated.     

Dedicated radial ventriculography pigtail catheter

A new dedicated cardiac ventriculography catheter was specifically designed for radial and upper arm arterial access approach. Two catheter configurations have been developed to facilitate retrograde crossing of the aortic valve and to conform to various subclavian, ascending aortic and left ventricular anatomies. The “short” dedicated radial ventriculography catheter is suited for horizontal ascending aortas, obese body habitus, short stature and small ventricular cavities. The “long” dedicated radial ventriculography catheter is suited for vertical ascending aortas, thin body habitus, tall stature and larger ventricular cavities. This new design allows for improved performance, faster and simpler insertion in the left ventricle which can reduce procedure time, radiation exposure and propensity for radial artery spasm due to excessive catheter manipulation. Two different catheter configurations allow for optimal catheter selection in a broad range of patient anatomies. The catheter is exceptionally stable during contrast power injection and provides equivalent cavity opacification to traditional femoral ventriculography catheter designs.