Hydrophilic-coated catheters for intermittent catheterisation reduce urethral micro trauma: a prospective, randomised, participant-blinded, crossover study of three different types of catheters

OBJECTIVE: To compare two hydrophilic-coated (SpeediCath and LoFric and one uncoated gel-lubricated catheter (InCare Advance Plus) concerning withdrawal friction force and urethral micro trauma. METHODS: 49 healthy male volunteers participated in this prospective, randomised, blinded, crossover study of three different bladder catheters. The withdrawal friction force was measured, and urine analysis of blood, nitrite and leucocytes, microbiological analysis of urine cultures and subjective evaluation of the catheters were performed. RESULTS: 40 participants completed the study and were included in the analysis. SpeediCath exerted a significantly lower mean withdrawal friction force and work than the gel-lubricated uncoated catheter, whereas LoFric exerted a significantly higher mean friction force than both of the other catheters. The hydrophilic catheters caused less microscopic haematuria and less pain than the gel-lubricated uncoated catheter. Furthermore, 93% of the participants preferred the hydrophilic catheters. CONCLUSION: Hydrophilic-coated catheters perform better than uncoated catheters with regard to haematuria and preference. SpeediCath, but not LoFric, exerts less withdrawal friction force than InCare Advance Plus.     

Methods of management of flail chest

We have treated 30 patients with flail chest, with priority given to associated factors (pain, secretions retention, hemo-/pneumothorax and underlying pulmonary contusion). When this treatment was insufficient IMV+PEEP was instituted; in this group there was a 58.8% incidence of pneumonia, 47.5% of sepsis and 11.7 days average stay in the ICU. These were significantly different when compared to the patients controlled without mechanical ventilatory support (7.7% pneumonia, 0% sepsis, 3.2 days).Surgical fixation was limited to 4 patients who presented with multiple and greatly displaced rib fractures, which made fixation by mechanical ventilation unpredictable.     

Changes in femoral vein blood flow velocity by intermittent pneumatic compression: calf compression device versus plantar-calf sequential compression device

Intermittent pneumatic compression has become widely used to prevent deep venous thrombosis potentially causing fatal pulmonary embolism. Although uniform compression has been commonly applied, a new method of sequential compression from plantar to calf has recently been developed. In this report, changes in maximum blood flow velocity in the femoral vein were compared with compression of only the calf uniformly and compression from plantar to calf sequentially in 10 healthy adult volunteers. A compression pressure of 60mmHg was applied for 5min, and the velocity was measured before and after this treatment by ultrasound echography. There was no statistically significant difference in the change in maximum velocity between calf compression and plantar-calf sequential compression. The maximum velocity increased significantly with both compressions. However, plantar-calf sequential compression tended to have a greater effect. Although the results did not demonstrate an advantage of plantar-calf sequential compression compared with calf compression only, if the former compression is applied for a long time, it may have a greater effect.     

Influence of stressors on the rewarding effects of alcohol in Wistar rats: studies with alcohol deprivation and place conditioning

Rationale and objectives Studies on laboratory animals have provided conflicting results regarding the actions of stressors on the rewarding effects of alcohol. In the present study, we first examined the effects of footshock or social defeat, given during deprivation, on the alcohol deprivation effect (ADE). We then tested the effects of stressors on place conditioning to alcohol, another technique used to measure drug reward.Methods Male Wistar rats were trained to drink 10% alcohol in a 24 h access, free-choice design and received intermittent footshock or defeat 5 times during a 2-week alcohol deprivation period, followed by 2 weeks of free access to alcohol. There were three such cycles. In the place conditioning studies, animals received footshock, defeat, or no stress immediately prior to conditioning sessions where they received alcohol (0.6 or 1.0 g/kg, IP) or vehicle injections.Results Alcohol intake of footshock-treated animals was significantly higher than that of controls following the first and second, but not the third period of alcohol deprivation and stress exposure. Defeat caused a smaller increase in alcohol intake that was significant only after the first deprivation and stress cycle. In the place conditioning studies, we found that either stressor blocked the place aversion induced by 1.0 g/kg alcohol.Conclusions These results demonstrate that stressors can modify the rewarding and aversive properties of alcohol, measured using two different paradigms. Footshock and defeat produced transient, but significant increases in the magnitude of ADE, while exposure to either stressor reduced the aversive effects of a high dose of alcohol measured using the place conditioning paradigm.     

Flavonol and Flavone Intake and the Risk of Intermittent Claudication in Male Smokers

The objective of this study was to investigate the association between flavonol and flavone intake and the risk of intermittent claudication in male smokers. The study population consisted of participants of the Finnish alpha-Tocopherol, beta-Carotene Cancer Prevention (ATBC) Study, who were free of intermittent claudication at study entry. These 25,041 male smokers were 50-69 years old at baseline. Participants completed a validated dietary questionnaire at baseline. The occurrence of intermittent claudication was assessed by annual administration of the Rose questionnaire. During the median follow-up of 4.1 years, 2412 new cases of intermittent claudication were observed. Dietary intake of flavonols and flavones was inversely associated with the risk of intermittent claudication when adjusted for cardiovascular risk factors (relative risk, RR in the highest vs. lowest quintile of intake 0.86, 95% confidence interval, CI: 0.75-0.98, p for trend 0.007). However, after further adjustment for intakes of vitamins C and E and total carotenoids, the association was attenuated (RR: 0.93, 95% CI: 0.81-1.08, p for trend 0.12). The risk of intermittent claudication was lower among men in the highest quintile of vegetable consumption (RR: 0.78, 95% CI: 0.69-0.89, p for trend 0.0001) and among wine drinkers (RR: 0.63, 95% CI: 0.41-0.98). Adjustment for flavonol and flavone intake only marginally changed these associations. In conclusion, flavonol and flavone intake was not independently associated with the risk of intermittent claudication.     

Elimination of ventilator dead space during synchronized ventilation in premature infants

BACKGROUND: Mainstream airflow sensors used in neonatal ventilators to synchronize mechanical breaths with spontaneous inspiration and measure ventilation increase dead space and may impair carbon dioxide (CO(2)) elimination. OBJECTIVE: To evaluate a technique consisting of a continuous gas leakage at the endotracheal tube (ETT) adapter to wash out the airflow sensor for synchronization and ventilation monitoring without CO(2) rebreathing in preterm infants. DESIGN: Minute ventilation (V'(E)) by respiratory inductance plethysmography, end-inspiratory and end-expiratory CO(2) by side-stream microcapnography, and transcutaneous CO(2) tension (TcPCO(2)) were measured in 10 infants (body weight, 835+/-244 g; gestational age, 26+/-2 weeks; age, 19+/-9 days; weight, 856+/-206 g; ventilator rate, 21+/-6 beats/min; PIP, 16+/-1 centimeters of water (cmH(2)O); PEEP, 4.2+/-0.4 cmH(2)O; fraction of inspired oxygen (FIo(2)), 0.26+/-0.6). The measurements were made during four 30-minute periods in random order: IMV (without airflow sensor), IMV+Sensor, SIMV (with airflow sensor), and SIMV+Leak (ETT adapter continuous leakage). RESULTS: Airflow sensor presence during SIMV and IMV+Sensor periods resulted in higher end-inspiratory and end-expiratory CO(2), Tcpco(2), and spontaneous V'(E) compared with IMV. These effects were not observed during SIMV+Leak. CONCLUSIONS: The significant physiologic effects of airflow sensor dead space during synchronized ventilation in preterm infants can be effectively prevented by the ETT adapter continuous leakage technique.     

Spatial-temporal display of colour-flow ultrasound for the assessment of the effects of intermittent pneumatic compression in limbs

Colour-flow M-mode ultrasonography in three dimensions (two spatial, one temporal) was used to assess the effects of intermittent pneumatic compression on the blood flow velocities in the common femoral vein and artery. The linear array of a standard 3-D system was held in place over the vessels, to record while a calf and thigh cuff compressed to 60 mmHg. The data was reconstructed in 3-D and, subsequently, sliced in different planes. The technique effectively demonstrated the emptying of distal veins during compression, and hyperaemia in the artery on deflation, in the coronal and sagittal planes. Reconstructions of this type may be of use in visualising the distribution of flow changes within blood vessels. (E-mail: morrisrj@cf.ac.uk)     

Increased incidence of dyskinesias and other behavioral effects of re-exposure to neuroleptic treatment in social colonies of Cebus apella monkeys

RATIONALE: Typical neuroleptic medications are still administered to as many as 40% of patients receiving antipsychotic treatment in the US. Intermittent administration or interruption of long-term neuroleptic medication for schizophrenia may increase the incidence of human tardive dyskinesias, and similarly may produce increasingly marked motor side-effects, parkinsonism, and other behavioral pathologies in non-human primates. OBJECTIVES AND METHODS: Given these similarities, we addressed the issue of prolonged and intermittent typical neuroleptic treatment and dopaminergic function during a 5-year, multi-phase study with social colonies of Cebus apella monkeys. In the previously reported phase 1, we examined the effects of 48 weeks of exposure to, followed by withdrawal from, fluphenazine decanoate (FPZ). Phase 3 reported here examined the effects of 18 weeks of re-exposure to FPZ in these same monkeys, 91 weeks after discontinuation of their phase 1 FPZ treatment. RESULTS: Analysis of blood plasma FPZ indicated levels of 0.22+/-0.08 ng/ml for the six injections during the re-exposure period (n=54), comparable to the 0.24+/-0.07 ng/ml levels measured during our original treatment with this dose. Acute dyskinesias and dystonias increased by 300% upon re-exposure to FPZ; 15 of 18 FPZ-treated animals exhibited oral-buccal dyskinesias and all exhibited torticollis or retrocollis. Retreatment with FPZ was also associated with highly significant reductions in Self- and Environment-Directed Behavior and Directed Affiliation, effects similar to those seen during the original phase 1 FPZ treatment. Although FPZ re-treatment was associated with a significant reduction in Directed Aggression (an effect that was more robust than that observed during phase 1), in phase 3, we again observed an increase in Directed Aggression during early drug discontinuation when animals were in a stress-inducing situation. CONCLUSIONS: These results both support our phase 1 conclusion that typical neuroleptic medications may contribute to negative symptoms of schizophrenia and provide additional evidence for the possibility of increased aggression in stressful situations when medication is discontinued. Additionally, the results indicate that intermittent treatment with typical neuroleptics may dramatically increase the incidence of dystonias and dyskinesias.     

Oral vasoactive medication in intermittent claudication: utile or futile?

Objective: To evaluate the role of orally administered vasoactive medication in the management of intermittent claudication. Setting: We limited our study to the products on the market in Belgium: cinnarizine, cyclandelate, isoxsuprine, naftidrofuryl, pentoxifylline, xanthinol nicotinate and buflomedil. Data sources: We conducted a systematic literature search involving Medline, International Pharmaceutical Abstracts, the Cochrane Library, direct contact with marketing companies and key authors, snowballing and Science Citation Index search. We looked for randomised placebo-controlled trials (RCTs) in patients with Fontaine stage II, in which pain-free and/or maximal walking distance were measured using a standardised exercise test. For isoxsuprine and xanthinol nicotinate, no trials conforming to these criteria were found. Thirty-six trials on cinnarizine, cyclandelate, buflomedil, naftidrofuryl and pentoxifylline met our inclusion criteria. Study selection: After quality assessment, 26 trials were excluded, mainly because of short trial duration (less than 12 weeks), small sample size (less than 30 patients) and/or failure to report details on variability (standard deviation or confidence limits). For cinnarizine and cyclandelate, none of the three selected RCTs was included. Data extraction: For buflomedil, of six published RCTs, two were included after quality assessment, each showing a marginally positive effect of buflomedil versus placebo. For naftidrofuryl, nine RCTs were selected; six were included of which five showed a significant positive result. The likelihood of publication bias and the heterogeneity of the results within and between trials precluded a meta-analysis. For pentoxifylline, of the 18 selected RCTs, only two could be included, both with inconclusive results. Conclusion: A national consensus conference, based on this review, concluded that health resources should be allocated to prevention and rehabilitation of intermittent claudication rather than to reimbursement of these products with doubtful efficacy. Received: 11 November 1999 / Accepted in revised form: 10 February 2000     

RESPIRATORY INSUFFICIENCY SYNDROME (RIS) IN PRETERM INFANTS WITH GESTATIONAL AGE OF 32 WEEKS AND LESS

ABSTRACT: Carlsson, J. and Svenningsen, N. W. (Department of Paediatrics, University Hospital, Lund, Sweden). Respiratory insufficiency syndrome (RIS) in preterm infants with gestational age of 32 weeks and less. Neonatal management and follow-up study. Acta Paediatr Scand, 64: 813, 1975.–The clinical entity of respiratory insufficiency syndrome (RIS), i.e. irregular breathing leading to recurrent apnea and bradycardia in an otherwise healthy preterm infant, has been studied in respect of symptomathology and management with intensive case including ventilatory support. During a 4-year period 26 of 103 infants with gestational age 32 weeks and mean birth weight 1304 g (range 710 to 1830 g) developed RIS. In most infants the initial apnea occurred after 2 and before 72 hours post delivery but in some infants later. Because of progressive hypoxemia and acidosis IS of the 26 RIS infants required IPPV treatment. The 76 % survival rate of RIS infants seems to justify intensive care with ventilatory support even in the smallest preterm infants with RIS, especially as the follow-up study performed at 15 months to 3 ½ years of age showed neurological sequelae in only 3 of 20 surviving babies, i.e. 15 % sequelae rate.