Infusion phlebitis in post-operative patients: when and why

BACKGROUND: The most common complication of intravenous therapy is infusion phlebitis. This study was done to prospectively assess its frequency in a series of consecutive patients who will undergo surgery, and to identify which variables may predict an increased risk for phlebitis. PATIENTS AND METHODS: 400 consecutive patients who will undergo surgery in a general surgery department were included. Only the first catheter, inserted the day before surgery, was taken into account. Eighteen variables (from the infusion, the catheter and from the patient) were prospectively evaluated for their contribution to the occurrence of phlebitis. RESULTS: 60/400 patients (15%) developed phlebitis, and most of them needed insertion of a further catheter. The univariate analysis showed that patients who developed phlebitis were older, and their pre-operative levels of both blood haemoglobin and neutrophil cound were significantly higher than those in patients who did not develop phlebitis. However, the multivariate analysis only confirmed the association with blood haemoglobin levels: the risk of phlebitis sharply increased in the patients with the highest haemoglobin levels. As to the influence of time on phlebitis development, there was a significant decrease in the day-specific risk, from the 5th day on. COMMENTS: In our series, blood haemoglobin levels were found to be the only variable associated to a higher risk of phlebitis. Besides, in contrast with the recommendations by the Centers for Disease Control, no significant increase in the day-specific risk of phlebitis was found. Thus, a guideline to select the type of catheter to be inserted in an individual patient is suggested.     

Effect of statin therapy on restenosis after coronary stent implantation

The effect of statins on the development of restenosis and clinical outcome after coronary stent implantation was assessed in a retrospective analysis of 525 consecutive patients. Baseline clinical, angiographic, and procedural characteristics did not differ between 258 patients with and 267 patients without statin therapy. Statin therapy was associated with a significantly (p<0.04) improved survival free of myocardial infarction and a significant reduction in repeat target vessel revascularization procedures (27.9% vs. 36.7%, p<0.05) during 6-month follow-up. Minimal lumen diameter was significantly larger (1.98+/-0.88 vs. 1.78+/-0.88 mm, p = 0.01), late lumen loss was significantly less (0.64+/-0.8 vs. 0.8+/-0.8 mm, p = 0.032), and net gain significantly increased (1.2+/-0.88 vs. 0.98+/- 0.92 mm, p = 0. 009) in patients receiving statin therapy. Dichotomous angiographic restenosis (> or =50%) rates were significantly lower, with 25.4% in the statin group compared with 38% in the no-statin group (p<0.005). Multivariate analysis identified statin therapy (p = 0.005), minimal lumen diameter immediately after stenting (p = 0.02), and stent length (p = 0.02) as independent predictors for subsequent restenosis development. Thus, statin therapy is associated with reduced recurrence rates and improved clinical outcome after coronary stent implantation.     

Surgery for ischaemic heart disease in the patient aged 40 and younger

A group of 128 patients with a mean age of 36 years, operated on between 1971 and 1986, were followed up over a period of up to 15 years. Their five-year survival was 90%, and 10-year survival 60%. The main cause of death was progression of ischaemic heart disease. The only factor affecting long-term survival is resection of a left ventricular aneurysm: patients who undergo this procedure exhibit a shorter survival (p less than 0.05). The number of vessels involved, performance of complete or incomplete revascularization, or ejection fraction data had no effect on patient survival. To improve the results of 10-year and longer follow-up, the patient must comply with the principles of secondary prevention of atherosclerosis, and the internal mammary artery should be used for reconstruction.     

Stepwise biosynthesis in vitro of globin genes from globin mRNA by DNA polymerase of avian myeloblastosis virus.

Two approaches have been explored for the synthesis of double-stranded DNA from single-stranded DNA template complementary to rabbit 9S globin mRNA (cDNA). (i) cDNA was elongated with dCMP or dTMP homopolymeric tracts using terminal deoxynucleotidyltransferase (EC 2.7.7.31; nucleosidetriphosphate:DNA deoxynucleotidylexotransferase). cDNA-dC, in the presence of an oligo(dG)10 primer, was an efficient template with either DNA polymerase of Escherichia coli (EC 2.7.7.7; deoxynucleosidetriphosphate:DNA deoxynucleotidyltransferase) or RNA-directed DNA polymerase of avian myeloblastosis virus. cDNA-dT [ with an oligo(dA)10 primer] functioned as template only with E. coli polymerase. (ii) cDNA, without homopolymeric tails, was also efficiently copied in the absence of oligonucleotide primer, by DNA polymerase of avian myeloblastosis virus or of E. coli. The product of the reaction consisted of long hairpin molecules which could be converted into DNA duplex (melting temperature, 93 degrees) by digestion with single-strand nuclease S1. The data indicate that a loop structure on the 3' end of cDNA allowed DNA synthesis to take place by a "self-priming" mechanism. Some of the double-stranded DNA synthesized corresponded to the entire sequence of the 9S mRNA template. The synthesis of full-length double-stranded DNA from mouse globin mRNA and immunoglobulin light chain mRNA is also discussed.     

Identification of glycoprotein Ib as a target for autoantibody in idiopathic (autoimmune) thrombocytopenic purpura

An antibody (DIL) from a patient with idiopathic thrombocytopenic purpura (ITP) was shown to have autospecificity on the basis of reactions with autologous platelets that were identical to those obtained with platelets from normal subjects. DIL antibody also reacted strongly in an immunofluorescence test with platelets from a patient with Glanzmann's thrombasthenia, but failed to react with platelets from a patient with the Bernard-Soulier syndrome who was known to be deficient in glycoprotein Ib (GPIb). Purified GPIb and control platelets, but not Bernard-Soulier platelets, inhibited the lytic activity of DIL. Using the GPIb-specific monoclonal antibody AP1 and one-dimensional rocket electrophoresis into gels containing rabbit antihuman platelet membrane antibody, it was shown that staphylococcal protein A-Sepharose beads coated with DIL antibody selectively remove GPIb from solubilized platelet preparations. By crossed immunoelectrophoresis it was found that DIL recognizes a determinant on GPIb on the membrane side of the cleavage site of the platelet calcium- activated protease (calpain). These studies provide direct evidence for binding of a platelet autoantibody to a determinant on GPIb relatively close to the site of insertion of this protein into the platelet membrane.     

Klinischer Stellenwert von Monointoxikationen mit Ibuprofen, Diclofenac und Metamizol

Zusammenfassung Fragestellung Aufgrund der steigenden Anzahl suizidaler und parasuizidaler Intoxikationen mit Schmerzmitteln, soll die Häufigkeit und der klinische Stellenwert von Monointoxikationen der drei häufigsten Generika der Gruppe der nichtsteroidalen und steroidalen Antirheumatika/Analgetika (ohne Berücksichtigung der Acetylsalicylsäure), Diclofenac, Ibuprofen und Metamizol, untersucht werden und eruiert werden, ab welcher Dosierung eine intensivmedizinische Überwachung nötig erscheint. Patienten und Methodik Im Untersuchungszeitraum vom 1. Januar 1995 bis 31. Dezember 2001 wurden alle beim Giftinformationszentrum Mainz dokumentierten Monointoxikationen o. g. Generika mittels des Datenverarbeitungsprogramms ADAM-Dok/-Aus (basierend auf Microsoft^®Access^®) ausgewertet. Die Feststellung des Schweregrades erfolgte mittels des Poison Severity Scores. Zur speziellen Betrachtung gelangten nur die nichtsteroidalen Antirheumatika/Analgetika. Ergebnisse Im o. g. Zeitraum kam es zu 1281 Monointoxikationen mit NSAR und SAR, davon 40% Ibuprofen, 31% Diclofenac und 13% Metamizol. Bei Monointoxikationen mit Ibuprofen kam es erst ab einer Dosierung von 300 mg/kg KG zu schwerwiegenden, lebensbedrohlichen Vergiftungserscheinungen. Bei Diclofenac und Metamizol zeigten sich komplett unterschiedliche klinische Verläufe (Hypotonie, Herzrhythmusstörung und Niereninsuffizienz bei niedriger Dosierung, Symptomfreiheit bei hoher Dosierung). Zusammenfassung Bei Monointoxikationen mit Ibuprofen sollte erst ab einer Dosierung von 300 mg/ kg KG eine intensivmedizinische Überwachung angestrebt werden. Aufgrund komplett unterschiedlicher klinischer Verläufe (schwere Symptome bei niedriger Dosierung und keine Symptome bei hoher Dosierung) ist bezüglich der Festlegung einer kritischen Dosierung bei Monointoxikationen mit Diclofenac und Metamizol zur Zeit keine klare Aussage möglich. Hierzu sollten weitere Untersuchungen folgen. Bei jeder Art von Intoxikation empfehlen wir die Rücksprache mit einem Giftinformationszentrum, z. B. 06131/19240.