Hypoxaemia after lower abdominal surgery: Comparison of tramadol and morphine

This prospective, double-blind, randomised study measured postoperative arterial oxygen saturation (SpO₂) in 27 female patients (aged 28–68 years; ASA I–III) allocated to receive parenteral tramadol or morphine in equianalgesic doses following an abdominal (Pfannenstiel) incision. Benzodiazepine premedication was followed by a standardised general anaesthetic, including fentanyl intra-operatively. The first dose of study analgesic medication was administered postoperatively more than one hour after the last increment of fentanyl. Pain was measured during the first eight hours using a four-point verbal rating scale. An overall opinion of the analgesia (using a five-point verbal rating scale) was noted at 24 hours post surgery. SpO₂ while breathing air was recorded every 30 seconds up to 24 hours postoperatively.Patient characteristics, pain scores and overall patient satisfaction were similar. Patients in the tramadol group spent significantly more time with normal saturation (SpO₂ > 94%, p=0.035): five of 12 patients in the morphine group were mildly hypoxaemic for more than 50% of study time (SpO₂ 90–94%) compared to only two of the 13 patients in the tramadol group. The incidence of moderate hypoxaemia (SpO₂ 85–89%) was higher in the morphine group. Severe hypoxaemia (SpO₂ < 85%) was infrequent in both groups, but of greater incidence in the morphine group. Tramadol produced a significantly lower incidence of arterial hypoxaemia than morphine.     

Evidence for genetic correlation between human cerebral white matter microstructure and inflammation

White matter microstructure is affected by immune system activity via the actions of circulating pro‐inflammatory cytokines. Although white matter microstructure and inflammatory measures are significantly heritable, it is unclear if overlapping genetic factors influence these traits in humans. We conducted genetic correlation analyses of these traits using randomly ascertained extended pedigrees from the Genetics of Brain Structure and Function Study (N = 1862, 59% females, ages 18–97 years; 42 ± 15.7). White matter microstructure was assessed using fractional anisotropy (FA) calculated from diffusion tensor imaging (DTI). Circulating levels (pg/mL) of pro‐inflammatory cytokines (IL‐6, IL‐8, and TNFα) phenotypically associated with white matter microstructure were quantified from blood serum. All traits were significantly heritable (h² ranging from 0.41 to 0.66 for DTI measures and from 0.18 to 0.30 for inflammatory markers). Phenotypically, higher levels of circulating inflammatory markers were associated with lower FA values across the brain (r = ?.03 to r = ?.17). There were significant negative genetic correlations between most DTI measures and IL‐8 and TNFα, although effects for TNFα were no longer significant when covarying for body mass index. Genetic correlations between DTI measures and IL‐6 were not significant. Understanding the genetic correlation between specific inflammatory markers and DTI measures may help researchers focus questions related to inflammatory processes and brain structure.     

低频超声波对人外周血造血干细胞作用的研究

目的观察低频超声波对人外周血造血干细胞的作用。方法正常人经外周血动员后Baxter CS-3000血细胞分离机采取外周血造血干细胞，分成照射组和对照组。分别于照射后6h，24h，48h用台盼蓝拒染法检测细胞存活率，流式细胞仪检测细胞凋亡，瑞氏染色光镜下观察细胞照射后有无出现凋亡，透射电镜观察照射后细胞的超微结构。结果台盼蓝拒染法结果为不同照射强度和不同照射时间组之间数值差异不显著；流式细胞仪未检测到明显凋亡；瑞氏染色光镜下未观察到细胞凋亡；透射电镜观察结果为照射后细胞的超微结构无明显改变。结论低频低强度超声波对人外周血造血干细胞的生长无明显影响。     

Fluid resuscitation in infantile hypertrophic pyloric stenosis

The purpose of this analysis was to investigate biochemical disturbances at presentation and initial fluid resuscitation before surgery in infantile pyloric stenosis. The charts of 139 consecutive infants (113 boys and 26 girls) between 7 d and 20 wk of age with hypertrophic pyloric stenosis were reviewed. The infants were treated at the Department of Pediatric Surgery, University of Bern, Switzerland, in the period between 1987 and 1997. A trend towards hypokalaemia (13 of the 139 patients), hypochloraemia (39 patients) and especially metabolic alkalosis (98 patients) was frequently noted on admission. In 84 patients, data on fluid management and on circulating sodium, potassium, chloride and the acid-base balance immediately before surgery were also available. In these patients a significant correlation was found between the parenteral chloride dose given for fluid repair (y = 0.310 x; r = 0.54; p < 0.001) and the changes in plasma bicarbonate. The equation indicates that a chloride dose of 10 mmol/kg body weight is required to reduce plasma bicarbonate on average by 3 mmol/. CONCLUSION: Since assessment of the fluid volume stated by physical examination and history is inaccurate in infants with vomiting, the severity of metabolic alkalosis helps to define the amount of fluid required for repair.     

LEGIONNAIRES' DISEASE — A POTENTIAL HAZARD OF RATIONALISATION

SUMMARY The cases of two elderly patients who complained of general malaise after they had undergone ward transfer (due to rationalisation of the rehabilitation service) are discussed. Both were pyrexial and had signs of pneumonic consolidation. Subsequent investigation revealed that their symptoms were due to infection with Legionella pneumophila. Their cases highlight the problems sssociated with ward closures and the hazards of stagnant water.     

Suprasellar lesions: evaluation with MR imaging

The authors retrospectively evaluated the characteristics on magnetic resonance (MR) images of 59 suprasellar lesions and compared them with computed tomography (CT) scans in 55 of the cases in which CT was performed. A diverse number of lesions were included: 17 pituitary adenomas; eight optic or hypothalamic gliomas; six craniopharyngiomas; six vascular anomalies; four lesions with extension into the suprasellar space; three metastases; two each of meningioma, hamartoma, germinoma, sarcoid granuloma, and teratoma; and one each of lymphoma, optic tract hematoma, cerebrospinal fluid-borne metastasis, pituitary hyperplasia, and sphenoid sinus mucocele. MR enabled characterization of lesions containing hemorrhage, fat, flowing blood, mucus, and cyst and allowed more specific diagnoses than CT in 6% of cases. MR was equivalent to CT in allowing lesions to be detected and in 20% of cases more accurately defined altered perisellar anatomy. Vascular abnormalities can be better evaluated with MR, and use of angiography can be avoided in some cases.     

Sunscreens – what's important to know

The popularity of sunscreens dramatically increased since ultraviolet irradiation was implicated in the pathogenesis of skin cancer and skin ageing. The absorption properties, safety, photostability of different organic and inorganic filters are reviewed: para -aminobenzoic acid, salicylates, cinnamates, benzophenones, butylmethoxydibenzoylmethane (Parsol 1789), drometrizole trisulphonic (Mexoryl XL), terephthalydene dicamphor sulphonic acid (Mexoryl SX), methylene bisbenzotriazol tetramethylbutylphenol (Tinasorb M), anisotriazine (Tinasorb S), titanium dioxide and zinc oxide. Furthermore, this review discusses the optimal methods for measuring the protection that a sunscreen offers, the role of sunscreen use in melanoma prevention and future trends in sunscreen filters development.     

Ocular toxocariasis studied by CT scanning

Ocular Toxocara canis infection causing larval granulomatosis and leading to chronic endophthalmitis and retinal detachment is a well-defined cause of unilateral leukokoria in children. The computed tomographic (CT) scan revealed a diffuse, nonenhancing, well-defined hyperdense lesion occupying most of the globe. The CT findings do not definitively differentiate the diffuse endophthalmitis of larval granulomatosis from retinoblastoma or other pseudogliomas.