Variability in the treatment of acute spinal cord injury in the United Kingdom: results of a national survey

The aim of this study was to examine how traumatic spinal cord injury is managed in the United Kingdom via a questionnaire survey of all neurosurgical units. We contacted consultant neurosurgeons and neuroanesthetists in all neurosurgical centers that manage patients with acute spinal cord injury. Two clinical scenarios-of complete and incomplete cervical spinal cord injuries-were given to determine local treatment policies. There were 175 responders from the 33 centers (36% response rate). We ascertained neurosurgical views on urgency of transfer, timing of surgery, nature and aim of surgery, as well as neuroanesthetic views on type of anesthetic, essential intraoperative monitoring, drug treatment, and intensive care management. Approximately 70% of neurosurgeons will admit patients with incomplete spinal cord injury immediately, but only 40% will admit patients with complete spinal cord injury immediately. There is no consensus on the timing or even the role of surgery for incomplete or complete injuries. Most (96%) neuroanesthetists avoid anesthetics known to elevate intracranial pressure. What was deemed essential intraoperative monitoring, however, varied widely. Many (22%) neuroanesthetists do not routinely measure arterial blood pressure invasively, central venous pressure (85%), or cardiac output (94%) during surgery. There is no consensus among neuroanesthetists on the optimal levels of arterial blood pressure, or oxygen and carbon dioxide partial arterial pressure. We report wide variability among U.K. neurosurgeons and neuroanesthetists in their treatment of acute traumatic spinal cord injury. Our findings reflect the lack of Class 1 evidence that early surgical decompression and intensive medical management of patients with spinal cord injury improves neurological outcome.     

Cardiovascular responses to the insertion of nasogastric tubes during general anaesthesia

Eighty female patients free of cardiovascular disease who were having excision of breast lesions were randomly allocated to one of two groups. In the first group a nasogastric tube was inserted blindly during the surgical procedure, while in the second group the tube was inserted under direct laryngoscopy, using Magill forceps. Both groups exhibited a significant increase in systolic blood pressure (SBP) (p less than 0.001) and heart rate (HR) (p less than 0.005). These increases declined during the following 3 minutes. Ventricular extrasystoles (more than 5 during the 3 min following the insertion of the nasogastric tube) occurred only in the group having the nasogastric tube with the aid of laryngoscopy (p less than 0.05).     

Impact of intraoperative hypotension on hospital stay in major abdominal surgery

Purpose  

Although the relationship between preoperative risk factors and outcomes has been extensively studied, the effect of intraoperative hemodynamic changes in a patient’s postoperative course has been less well defined.     

No change in serum melatonin, or plasma beta-endorphin levels after sevoflurane anesthesia

STUDY OBJECTIVE: To investigate the effect of sevoflurane as single anesthetic on melatonin and beta-endorphin plasma levels during the first 24 hours postoperatively. DESIGN: Prospective, open-cohort study. SETTING: University hospital. PATIENTS: 13 ASA physical status I and II, adults, scheduled for dilatation and curettage of the uterus, and 13 healthy volunteers. INTERVENTIONS: Patients received general anesthesia with sevoflurane. MEASUREMENTS: Melatonin and beta-endorphin plasma levels were determined before anesthesia, immediately after, and two, 4, 8, and 24 hours after the end of anesthesia. Melatonin and beta-endorphin were also measured in 13 healthy subjects (controls) not undergoing anesthesia at similar times during the day. Systolic and diastolic blood pressure, heart rate, bispectral index, and oxygen saturation via pulse oximeter (SpO(2)) were recorded before and after anesthesia. Quality of sleep postoperatively was also assessed. MAIN RESULTS: Melatonin levels (pg/mL) in the patients and controls were 8.2 +/- 7.9 versus 15.2 +/- 15.0 before anesthesia and 7.7 +/- 7.9 versus 11.1 +/- 7.0, 6.5 +/- 6.1 versus 15.6 +/- 16.3, and 19.5 +/- 17.9 versus 23.7 +/- 23.3 at the end of anesthesia and 4 and 24 hours after the end of anesthesia, respectively (P = 0.057). At the same time points, beta-endorphin plasma levels (pmol/L) in patients and controls were 5.2 +/- 2.0 versus 4.0 +/- 2.3, 5.4 +/- 3.3 versus 3.9 +/- 2.5, 4.9 +/- 1.2 versus 4.4 +/- 1.7, and 3.7 +/- 2.6 versus 4.2 +/- 1.8, respectively (P= 0.285). The quality of sleep assessed clinically was not altered. CONCLUSION: Sevoflurane as a single anesthetic for minor gynecological procedures did not influence significantly melatonin or beta-endorphin plasma levels. Sleep quality assessed clinically was not influenced.     

Downgrading BIRADS 3 to BIRADS 2 category using a computer-aided microcalcification analysis and risk assessment system for early breast cancer

This paper explores the potential of a computer-aided diagnosis system to discriminate the real benign microcalcifications among a specific subset of 109 patients with BIRADS 3 mammograms who had undergone biopsy, thus making it possible to downgrade them to BIRADS 2 category. The system detected and quantified critical features of microcalcifications and classified them on a risk percentage scale for malignancy. The system successfully detected all cancers. Nevertheless, it suggested biopsy for 11/15 atypical lesions. Finally, the system characterized as definitely benign (BIRADS 2) 29/88 benign lesions, previously assigned to BIRADS 3, and thus achieved a reduction of 33% in unnecessary biopsies.     

Effects of morning melatonin administration on electroencephalographic theta to alpha power ratio in reproductive versus postmenopausal healthy female volunteers

Objective: The aim of the present study was to investigate the effect of exogenous morning melatonin administration on the electroencephalogram of reproductive versus postmenopausal women. Methods: Twenty-six female, reproductive and postmenopausal healthy volunteers were randomly assigned to receive melatonin or placebo at 9:00 in the morning. Twelve electroencephalographic recording sessions were performed before the intake of melatonin or placebo and at 15, 30, 45, 60, 75, 90, 120, 150, 180, 240, and 300 min. Theta to alpha ratios for every subject, channel and session were mathematically processed to yield the logarithm (base 10) of the spectral (theta power)/(alpha power) ratio for the 12 electroencephalographic sessions, weighted to the baseline ratio (LwRs). The LwRs were compared between melatonin groups (reproductive versus postmenopausal women) and also between melatonin and control groups. Results: Data from 24 women were analyzed. The LwRs in the reproductive women were significantly lower than the LwRs in postmenopausal women at 60, 180, 240 and 300 min after melatonin consumption (p = 0.007, 0.041, 0.008 and 0.040 respectively). In reproductive women, the LwRs of subjects who received melatonin were significantly lower compared to their controls at 60, 240 and 300 min after melatonin or placebo intake (p = 0.005, 0.006 and 0.019 respectively). In postmenopausal women, no significant differences in the LwRs were calculated for any time point between melatonin and control groups. Conclusions: Our results show that morning melatonin administration produces no electroencephalographic changes in postmenopausal women. In contrast, electroencephalographic changes suggesting a possible awaking effect were observed in reproductive women.