A consideration of neonatal resuscitation

There are currently two major areas of resuscitation of the newborn which have come into question: the use of intermittent positive pressure ventilation and the use of oxygen. There is evolving evidence that volutrauma associated with IPPV, especially in the premature infant, may induce changes in the lung which can lead to chronic lung disease. There is reason to believe that the use of continuous positive airway pressure in premature infants who are making respiratory efforts may be less harmful than the use of IPPV. With regard to the use of oxygen, it is clear that most infants can be successfully resuscitated with room air. Although we can identify markers for oxidative stress in newborns when resuscitated with 100% oxygen, the clinical importance of these markers remain an open issue. If the presence of these markers after resuscitation is shown to relate to clinical problems, then the use of oxygen may need to be considered.     

Evoked potentials elicited by stimulation of the lateral and anterior femoral cutaneous nerves in meralgia paresthetica

Seventy-five consecutive patients with clinical symptoms and signs of meralgia paresthetica underwent bilateral somatosensory evoked potential (SEP) studies involving stimulation of skin areas innervated by the lateral and anterior femoral cutaneous nerves of the thighs. The most common abnormality was an absolute lateral femoral cutaneous SEP latency > 40 ms in 35 patients (47%), followed by an absent response in 14 patients (19%), an absolute latency < 40 ms but amplitude reduction > 50% compared with the contralateral response in 8 patients (11%), and an absolute latency < 40 ms but > 5 ms interside latency difference in 5 patients (7%). Anterior femoral cutaneous SEPs were of value in distinguishing meralgia paresthetica from a proximal lumbar radiculopathy in an additional 4 patients and confirming bilateral meralgia paresthetica in 10 patients.     

Multinational study of reliability and validity of the King's Health Questionnaire in patients with overactive bladder

Objective: Overactive bladder (OAB) has substantial impact on health-related quality of life (HRQoL). The purpose of this research was to evaluate the psychometric properties of the King's Health Questionnaire (KHQ). Methods: The KHQ (n = 1284) was administered at baseline and 12 weeks post-treatment in a multinational, double-blind, randomized clinical trial of tolterodine for treatment of OAB. Country-specific psychometric analyses of HRQoL instruments were performed. Countries demonstrating marginal psychometric properties on the KHQ were pooled with same-language countries, re-evaluated, and aggregate analysis performed on the pooled data. Results: Internal consistency of the KHQ was high, item characteristics were good, most assumptions of summed scales were met, and it is externally valid and consistent. Few problems with the KHQ were noted although the performance of the personal relationships domain was complicated by the not applicable response category. Conclusions: Psychometric testing supports the reliability and validity of the KHQ as an OAB-specific measure of HRQoL.     

Quantitative features of the nucleus rotundus in the brain of pre- and post-hatch chicks

The nucleus rotundus (ROT) is a major relay station in the tectofugal pathway of the avian visual system. In this study, some quantitative features of ROT in developing chicks were analysed using new stereological methods. Total neuron number (N) and mean volume (V) of ROT were estimated by the optical fractionator method and by the Cavalieri principle, respectively. Neuronal density of neurons in ROT was calculated from these data. The eyes of the chick embryo are not normally stimulated by light until days E19/20. Therefore in this study, chicks at three developmental stages were investigated: on the 17th embryonic day (E17), that is before light stimulation of the visual system, at the time of hatch (0-day, stimulated by light) and 10 days after hatch (10-day). The results showed that N was reduced by 27% between E17 and 0-day, and 7.8% between 0- and 10-day while neuronal density was reduced by 15% and 32% over the same periods. It is concluded that the reduction of neuronal density during the pre-hatch period may be due to neuron loss, whereas the post-hatch decrease of neuronal density may be the result of an increase in ROT total volume. Cell loss was more prominent in the pre-hatch than in the post-hatch period. Estimates of neuronal density in the developing ROT are not useful indicators of developmental status, since they do not relate to total neuron number.     

Comparison of the Zeiss IOLMaster and applanation A-scan ultrasound: biometry for intraocular lens calculation

Purpose: A comparison of axial length estimates using applanation A‐scan ultrasound and the Zeiss IOLMaster was conducted. The accuracy in predicting postoperative refraction determined by each method was also compared. Methods: A cross‐sectional study was performed on 51 eyes in 46 patients presenting to clinical practice for cataract surgery assessment. Preoperative measurement of axial length was performed with applanation ultrasound and the IOLMaster. The IOLMaster measurements were used to determine the intraocular lens power based on the SRK/T formula. Postoperative refractive outcomes were obtained and spherical equivalent calculated and compared to the predicted refractive error with each biometric method. Results: On average the axial lengths measured by the IOLMaster were longer by 0.15 mm compared to ultrasound biometry (P < 0.01). Using the IOLMaster over applanation ultrasound biometry significantly improved the postoperative refractive outcome from 0.65 D to 0.42 D (P = 0.011). Conclusions: The IOLMaster provides an accurate axial length measurement and results in accurate intraocular lens power calculation based on the SRK/T formula. It is quick and easy to use and provides a non‐contact technique with no risk of infection or corneal abrasion.     

Peripheral neuropathy associated with polycythemia vera

Nerve conduction studies were performed on 26 patients with polycythemia vera, 11 of whom had sensory symptoms in the extremities and 3 of whom had clinical signs of peripheral neuropathy. There was significant impairment of sensory conduction in the ulnar and sural nerves and mild slowing of motor conduction in the lateral popliteal nerve. Sural nerve biopsies were performed on three patients. The pathological findings, including teased fiber studies, were consistent with mild chronic axonal degeneration. There is an association between polycythemia vera and peripheral neuropathy.     

Levosimendan for patients with impaired left ventricular function undergoing cardiac surgery

The efficacy of levosimendan treatment for a low cardiac output status following cardiac surgery has not been established. Here, we review our initial experiences of the perioperative use of levosimendan. This study is a retrospective uncontrolled trial. Nine patients who underwent cardiac surgery, and developed a low cardiac output status resistant to conventional inotropic support, were given levosimendan. The mean preoperative ejection fraction was 35.2+/-3.4%. All patients were on concomitant inotropic agents and had previously undergone intra-aortic balloon pumping. Cardiac index increased immediately from 2.14+/-0.33 l/min/m(2) at baseline to 2.41+/-0.31 (P=0.02) at 1 h, rising to 2.67+/-0.43 (P<0.001) at 4 h after the loading dose was started. Similarly, the systemic vascular resistance index decreased from 2350+/-525 dynes/s/cm(-5)/m(2) at baseline to 1774+/-360 (P=0.002) at 4 h. In the case of all but one of the patients, either the dose of the concomitant inotropic support or the balloon pumping could be weaned down within 24 h after completion of the levosimendan infusion. No withdrawal of levosimendan was required. Levosimendan could constitute a new therapeutic option for postoperative low cardiac output.