Age, performance and sleep deprivation

Young subjects are frequently involved in sleep-related accidents. They could be more affected than older drivers by sleep loss and therefore worsen their driving skills quicker, or have a different perception of their level of impairment. To test these hypotheses we studied variations of reaction time (RT), a fundamental prerequisite for safe performing, as measured by lapses, i.e. responses > or = 500 ms and self-assessment of performance and sleepiness after a night awake and after a night asleep in a balanced crossover design in young versus older healthy subjects. Ten young (20-25 years old) and 10 older volunteers (52-63 years old) were tested with and without 24 h of sleep deprivation. Without sleep deprivation, RTs were slower in older subjects than in the younger ones. However, after sleep deprivation, the RTs of young subjects increased while that of the older subjects remained almost unaffected. Sleepiness and self-perception of performance were equally affected in both age groups showing different perception of performance in the age groups. Our findings are discussed in terms of vulnerability to sleep-related accidents.     

Phlebitis in peripheral catheters (I). Incidence and risk factors

The type of pathology and the current therapeutic tendencies justify that endovenous therapy is the most frequently selected one. Although it has multiple advantages, it bears with it a series of infectious type complications (bacterial infections, phlebitis and thrombophlebitis). Even though bacterial infections in peripheral intravascular vessels have a low occurrence rate, which some authors list as between 1 and 2%, in central intravascular vessels, their occurrence is usually higher. Phlebitis is one of the complications most frequently associated with the use of peripheral intravascular catheters.     

Comparison of cizolirtine citrate and metamizol sodium in the treatment of adult acute renal colic: a randomized, double-blind, clinical pilot study

BACKGROUND: Renal colic causes excruciating pain that provides a good clinical model of acute pain for the development of new analgesics. OBJECTIVE: The purpose of the study was to compare the analgesic efficacy and tolerability of cizolirtine citrate and metamizol sodium in adult acute renal colic. METHODS: This Phase II, randomized, double-blind, clinical pilot study was conducted in the emergency departments of 6 general hospitals in the Czech Republic between October 2000 and February 2001. Male and female patients aged 18 to 65 years and presenting with hematuria and moderate to severe pain due to suspected renal colic starting within the 24 hours before presentation were eligible. Patients were randomized to receive a single IV dose of cizolirtine 350 mg or metamizol 2,500 mg, administered by slow infusion over 15 minutes. Both doses were maximal for the respective drugs to attain adequate analgesia. Use of rescue medication with butorphanol was allowed 30 minutes after study drug administration. Pain intensity was assessed at various time points during the following 360 minutes using a 100-mm visual analog scale (VAS) and a verbal categoric scale. In addition, a specific verbal categoric scale was used to rank pain relief. Physical examinations, laboratory tests, and questioning for adverse events addressed drug tolerability. RESULTS: Sixty-four patients (50 men, 14 women; mean [SD] age, 44.21 [12.29] years; mean [SD] body mass index, 25.97 [3.38] kg/m(2)) were enrolled. Physical examination findings and mean VAS pain intensity scores at baseline (mean [SD], 79.42 [7.89] mm and 82.59 [10.50] mm in the cizolirtine and metamizol groups, respectively) were similar in both groups. After 30 minutes, the mean (SD) scores were 33.84 (25.15) mm and 25.41 (24.51) mm, respectively. This difference was not statistically significant, and the noninferiority of cizolirtine with respect to the comparator could not be established. However, the proportion of patients that showed satisfactory pain relief (ie, decrease of > or = 50% in VAS pain intensity score compared with baseline) at 30 minutes in the cizolirtine group was fairly high (64.5%), which means relevant analgesic activity. Both treatments were well tolerated; 6 adverse events were reported in 5 patients (7.8%), and all were considered as not treatment related. CONCLUSIONS: Although this limited pilot study did not include an internal measure of sensitivity, relevant pain reduction was shown in the population of patients with suspected renal colic undergoing treatment with cizolirtine, suggesting the presence of analgesic activity. However, the efficacy of cizolirtine was found to be similar to that of metamizol. Treatments were well tolerated.     

Surgical treatment of urinary stress incontinence using a method for postoperative adjustment of sling tension (Remeex System)

We present a technique that allows postoperative adjustment of the sling tension in female patients with urinary stress incontinence (USI). Twenty-one female patients with urodynamically proven USI were prospectively evaluated. Subjective and objective evaluation was made preoperatively, 6 months postoperatively and yearly thereafter. Mean age was 63.5; mean parity was 2.3. All patients were postmenopausal and 13 (62%) had had previous surgery for USI. The operating time was 32 minutes (range 25–45). At a mean follow-up of 12 months (6–25), 19 patients (90.5%) were very satisfied. Two patients (9.5%) were considered failures but subjectively were satisfied and refused readjustment. One patient (4.7%) developed 'de novo' detrusor instability. In conclusion, this is a sling procedure for patients with previous failed surgery and those with intrinsic sphincter deficiency (ISD) with the peculiarity that the sling tension can be regulated postoperatively. The readjustment can be made in the office, months or even years after the procedure.Abbreviations USI Urinary stress incontinence - ISD Intrinsic sphincter deficiency - MUCP Maximum urethral closure pressure - VLPP Valsalva leak-point pressureEditorial Comment: Adjusting the sling tension of a bladder neck sling at the time of surgery is diffucult and not very scientific. Slings that are too tight are associated with voiding dysfunction and De Novo urge incontinence. Slings that are too loose may still allow stress incontinence. This sling system allows the surgeon to leave very loose at the time of surgery with the ability to tighten or loosen the sling easily in the post-operative period to achieve continence and still maintain adequate voiding function. Data on long term success or need for surgical removal is not available. The ability to tighten or, more importantly, loosen this sling at a later time in the post-operative period when scarring has occured is not known at present.     

Lateral parabrachial lesions impair lithium chloride-induced aversive responses but not saccharin-induced flavor preference

Behavioral taste-guided experiments, as well as molecular studies employing c-FLI expression in response to aversive/appetitive unconditioned stimulus, have strongly suggested a visceral role for the lateral parabrachial subnuclei (lPB). The main objective in the present study was to further evaluate the functional role of the lPB in lithium chloride-induced behavioral/physiological responses. We employed a lesion/behavioral experimental strategy combining a lithium chloride-induced place aversion procedure together with the simultaneous evaluation of behavioral (“Lying on Belly”, “LOB”) and physiological (body temperature) responses elicited by the toxin. Data showed that lPB-lesioned animals failed to avoid the chamber previously paired with lithium chloride. Moreover, “LOB”, and not hypothermia, in response to lithium chloride was impaired in parabrachial lesioned animals. Finally, all the animals were tested in a free discriminative flavor-preference task induced by saccharin, a non-caloric reinforcer, which precludes visceral feedback as essential in acquiring the learned response. As expected, both control and lesioned animals developed a clear flavor-preference to the flavor previously paired with saccharin, which shows normal gustatory and associative processing in lPB-lesioned animals. This study extends previous results on the functional visceral role of lPB subnuclei by providing alternative behavioral evidence other than taste-guided behavior, that the lPB is pivotal in visceral processing. Present data are discussed in the context of the visceral hypothesis that holds that the lPB is critically involved in processing post-oral visceral feedback.     

Synthesis of Poly(ester amide)s Derived from Glycolic Acid and the Amino Acids: β‐Alanine or 4‐Aminobutyric Acid

The polymerization of metal salts of N‐chloroacetyl‐β‐alanine and N‐chloroacetyl‐4‐aminobutyric acid was investigated. The former gives a mixture of polymer and a seven‐membered cyclic compound constituted of glycolic and β‐alanine units, and its reaction proceeds in the solid state. However, liquefaction is observed in the second case giving rise to a polymer with a moderate molecular weight. Condensation kinetics of both sodium and silver salts of N‐chloroacetyl‐β‐alanine have been studied by differential scanning calorimetry. Copolymers of glycolic acid and β‐alanine with a molar ratio of glycolic acid/β‐alanine varying from 0.5 to 1.0 have been synthesized by thermal reaction of co‐precipitated crystals of the sodium salts of chloroacetic acid and N‐chloroacetyl‐β‐alanine. NMR spectroscopy indicates that copolymers tend to have a random distribution. The resulting new poly(ester amide)s have been characterized by spectroscopy and thermal analysis.

DSC heating runs corresponding to different mixtures of the sodium salts of chloroacetic acid and chloroacetyl‐β‐alanine.     

External ventricular drainage. Nursing care

The authors review the anatomy of the ventricular system, Intracranial Pressure and the alteration of ventricular function which leads to the temporary installation of an external drainage system, the complications derived from the installation and maintenance of that system, as well as the care which will be provided to the patient.