Transesophageal echocardiography interpretation: a comparative analysis between cardiac anesthesiologists and primary echocardiographers.

Diagnostic interpretation of intraoperative transesophageal echocardiography (TEE) examinations may vary, particularly when the echocardiographer is also the anesthesiologist. We therefore evaluated the concordance of TEE interpretation as part of a process of continuous quality improvement (CQI). Ten cardiac anesthesiologists participating in a CQI program conducted 154 comprehensive TEE examinations, each consisting of 16 major fields describing cardiac anatomy and function. These examinations were subsequently interpreted off-line by two primary echocardiographers (a radiologist and a cardiologist). Agreement was assessed using the kappa coefficient and percent agreement. Overall kappa and percent agreement were 0.58 and 83% for anesthesiologists versus radiologist, 0.57 and 80% for anesthesiologists versus cardiologist, and 0.60 and 82% for radiologist versus cardiologist. Anesthesiologists with longer than 5 yr of TEE experience had higher levels of agreement with the radiologist when assessing the aorta, right atrium, pulmonary vein flow, transmitral flow, and fractional area change. Cardiac anesthesiologists supported by a CQI program interpret TEE examinations at a level comparable with physicians whose primary practice is echocardiography. Thus, the anesthesiologist and the intraoperative echocardiographer need not be mutually exclusive. IMPLICATIONS: Interpretation of intraoperative transesophageal echocardiograms can be reliably performed by cardiac anesthesiologists.     

The associations between peer and parental relationships and suicidal behaviours in early adolescents.

OBJECTIVE: To investigate associations between suicidal behaviours, including suicidal ideation and attempts, and poor peer and parental relationships in a nationally representative sample of Canadian adolescents aged 12 to 13 years. METHODS: We used Statistics Canada's National Longitudinal Survey of Children and Youth as the dataset. This cross-sectional sample included 1049 girls and 1041 boys aged 12 to 13 years. We obtained answers to self-report questionnaires that included measures of peer relationships, parental nurturance, and parental rejection, as well as information regarding suicidal ideation and attempts. Unadjusted and adjusted logistic regression models were used for the analysis. We included depression in the multiple logistic regression analysis. Analyses were run separately for boys and girls. RESULTS: The unadjusted logistic regression models found that, among early adolescent boys and girls, depression, poor peer relationships, decreased parental nurturance, and increased parental rejection were all significantly associated with suicidal ideation and attempts. However, after adjusting for all other variables in the multiple logistic regression models, poor peer relationships were no longer significantly associated with suicidal ideation among early adolescent boys and were only weakly associated among early adolescent girls. CONCLUSIONS: Poor parental relationships and depression were more powerfully associated with suicidal ideation and attempts than were peer relationships in a nationally representative sample of boys and girls aged 12 to 13 years, and these factors may be important early intervention targets.     

Acute pancreatitis in a low alcohol-consuming community

The case records 50 patients with abdominal pain and hyperamylasemia were studied in detail. Ten cases of gallstone induced hyperamylasemia, in which no evidence of pancreatitis was found at operation, were excluded. The etiological factors in the remaining group of forty cases of acute pancreatitis, in a community practicing alcohol abstinence, were reviewed. Both alcoholic and idiopathic pancreatitis were insignificant factors in the etiology of acute pancreatitis. Eighty percent of cases of acute pancreatitis were due to biliary tract disease. A younger age-group and female preponderance, as well as biochemical evidence of cholestasis, was observed in this group. An inverse relationship between preoperative serum amylase levels and the severity of the disease was noted. A more aggressive diagnostic work-up is, however, warranted to identify these cases, for which early surgery is advocated. There was no mortality in operated cases of biliary pancreatitis.     

Effect of surgery under general anaesthesia on antipyrine clearance.

1 The effect of surgery under general anaesthesia on drug metabolism was investigated in man. The activity of hepatic drug-metabolizing enzymes was evaluated by measurement of antipyrine clearance, before surgery and 3 days after surgery, in eighteen patients. 2 In those patients in whom the operation lasted 2 h or less, the postoperative clearance of antipyrine was significantly (P less than 0.05) increased by 48%; in those patients in whom the operation lasted 2--4 h, it was non-significantly decreased by 36%; in those patients in whom the operation lasted more than 4 h, it was significantly decreased by 47% (P less than 0.01). 3 It is concluded (a) that short operations are followed by increased activity of hepatic drug-metabolizing enzymes, whereas (b) protracted operations are followed by decreased activity. It is suggested (a) that the former effect may be a consequence of enzyme induction by drugs used for premedication and anaesthesia, whereas (b) the latter effect may be the result of major surgical trauma.     

Human leukocyte antigen in genodermatosis

ABSTRACT: Tissue typing performed on the lymphocytes of 41 Patients, including: 23 patients with ichthyosis (15 of autosomal dominant and 8 of the x-linded variety; 8 patients with tuberous sclerosis (epiloia); and 10 patients with acroder-matitis enteropathica (AEP). In adddition, tissue typing was performed for a control group of 80 healthy unrelated subjects of the same ethnic origin as the patients. A significant increase of A₂ antigen or its crossreacting antigen A₂₈ was detected among the three diseases studied. A significant increase of HLA-A₂ antigen was found in autosomal dominant ichthyosis, while the x-linked variety showed significant association with HLA-Cw2. A significant association with HLA-A₂₈ antigen was noticed in both epiloia and AEP. The suggested mechanisms of such association may be refferred to as incidental genetic linkage with mutants causing disease or deficiency.     

Xanthinol nicotinate in the management of leg ulcers associated with haemoglobinopathies

The therapeutic role of xanthinol nicotinate, with its potent action on the peripheral circulation, in promoting healing of leg ulcers when added to conservative measures of ulcer treatment in adult beta-thalassaemia major and sickle cell thalassaemia, was evaluated in a double-blind crossover trial in 16 patients suffering from multiple leg ulcers. Conservative measures of ulcer treatment were leg raising in horizontal position for 14 hours, bed-rest, local antiseptic dressings and antibiotics. Xanthinol nicotinate or placebo was administered in a daily dose of 8 tablets (2400 mg) for 10 weeks. Comparison of the treatment results of conservative measures plus xanthinol nicotinate and those of conservative measures plus placebo revealed a statistically significant higher rate of complete ulcer healing during xanthinol nicotinate therapy (p less than 0.01). Apart from a low incidence of generalized itching and flushing at the start of the trial, xanthinol nicotinate was well tolerated in the prescribed dose.