Continuous laser radiation effect at 1.06 microns on gastrointestinal tract

The thermal effect of 1.06 microns YAG:Nd laser irradiation at temperature conditions up to 100 degrees C without crater formation on gastrointestinal (GI) tissue samples was investigated. The theoretical and experimental data show that at an intensity of 160-400 W/cm2 laser-induced heating of the tissue with an initial temperature of 20 degrees C leads to coagulation lesions at a temperature no less than 60 degrees C and at a depth of 1.7-2.1 mm.     

Pharmacokinetics of ciprofloxacin and vancomycin in patients with acute renal failure treated by continuous haemodialysis.

To determine appropriate doses of ciprofloxacin and vancomycin for septic patients with acute renal failure (ARF) treated by continuous arteriovenous and venovenous haemodialysis, (CAVHD/CVVHD), we performed pharmacokinetic studies in patients receiving these antibiotics. All patients were treated by CAVHD/CVVHD using Hospal AN69S 0.43 m2 filters and Fresenius 1.5% peritoneal dialysis fluid at dialysate flow rates (Qd) of 1 and 2 l/h. Patients received ciprofloxacin 200 mg i.v. 12-hourly (n = 6) or 8-hourly (n = 5); vancomycin 1 g i.v. was administered to 10 patients approximately every 48 h to maintain therapeutic plasma levels. For ciprofloxacin, volume of distribution (Vdarea) was 136.5 +/- 9.81, terminal elimination half-life (t1/2) 6.4 +/- 0.8 h, and total body clearance (TBC) 264.3 +/- 22.9 ml/min (mean +/- SEM). Mean sieving coefficient (S/C) was 0.76 +/- 0.05 and filter clearances at Qd 1 and 2 l/h were 16.2 +/- 1.9 and 19.9 +/- 1.1 ml/min respectively. For vancomycin, Vdarea was 60.7 +/- 5.11, t1/2 24.7 +/- 2.6 h and TBC 31.0 +/- 4.6 ml/min. Mean S/C was 0.66 +/- 0.08 and filter clearances at Qd 1 and 2 l/h 12.1 +/- 2.0 and 16.6 +/- 2.0 ml/min. These data suggest that patients with ARF treated by CAVHD/CVVHD should be given ciprofloxacin 200 mg i.v. 8-12-hourly and vancomycin every 48 h.     

Bilateral complete discoid medial meniscus combined with posterior cyst formation

Bilateral discoid medial menisci is an extremely rare condition of the knee and it can be associated to other pathological findings, including anterior portion cyst formation. We report on the clinical features, radiographic findings, treatment and results of one patient who presented a bilateral medial discoid meniscus combined with posterior portion cyst of the left knee. To the best of the author’s knowledge, this is the first case of bilateral medial discoid meniscus associated with posterior portion cyst formation.     

RESEARCH ON A REAL-TIME CONTROL SYSTEM OF LOW POWER DISSIPATION FOR CONTINUOUS CYCLIC PERITONEAL DIALYSIS(CCPD) CYCLER

FOREWORDPeritonealdialysisrepresentssoluteandfluidexchangemainlybetweenperitonealcapillarybloodanddialysissolutionintheperitonealcavity'CombinedwithhemodialySisandrenaltransplantation,peritonealdialysisisusedmainlyforthetreatmentofrenalfailure,particularlyforchronicfailure'In1976,Prof'Popovichdevelopedcontinuousambulatoryperitonealdialysis(CAPD)basingontheconceptofcontinuousequilibrationdialysis('1'Fromthenon,peritonealdialysisfounditsclinicaluse'Continuouscyclicperitonealdialysis(CCPD…     

Posterior segment eye-surgery in day care?

Day care is generally accepted in anterior segment eye-surgery. In the Rotterdam Eye Hospital this option was also considered for posterior segment surgery. We were interested in the opinion, of patients on this matter and therefore asked patients, who were admitted for posterior segment eye-surgery, to answer a questionnaire. The major question was: ‘If your physician had given his permission, do you think it would have been possible for you to go home on the evening after surgery?’. Other questions evaluated problems in organising assistance at home and transportation to the out-patient clinic as well as circumstances after the operation, such as pain, nausea, dizziness and anxiety. Eighty-one out of 87 patients responded: 56% answered ‘eyes’ and 44% ‘no’ to the major question. Relating the answer to the major question to medical data and to answers to the other questions, we found organizational problems at home and anxiety to have a statistical significant relation with a negative answer. Clinical factors like age, American Society of Anesthesiologists (ASA)-class, diabetes mellitus (including insulin-dependant), type of anesthesia, time of the day the surgery was finished, duration of surgery, pain, nausea or dizziness were not signficantly related. The number of patients involved in this study, however, is too small to draw conclusions on specific subgroups of patients.     

Effects of calcium in continuous cardioplegia on myocardial protection

The effects of calcium (Ca) on a hyperkalemic cardioplegic solution for continuous cardioplegia were examined in an isolated perfused working rat heart model. The coronary arteries were perfused with a modified Krebs-Henseleit bicarbonate buffer (K-H) solution, containing various concentrations of Ca(0.1, 0.6, 1.2, and 2.5 mmol/l) and a high concentration of potassium (20 mmol/l), for 180 min, after which cardiac arrest was induced at 37°C for 180 min. Cardiac function and creatine kinase (CK) were measured. In the control group, K-H solution was infused in place of the cardioplegic solution, and cardiac arrest was not induced. No significant differences were observed between the groups infused with the K-H solution containing Ca concentrations of 0.6, 1.2, and 2.5 mmol/l in the percent recovery of aortic flow (82.1±2.9%, 80.6±2.0%, and 71.5±3.7% (mean±SEM) respectively) or in the recovery of other indices of cardiac function, or in CK leakage. There were also no significant differences in the recovery of cardiac function and CK leakage between these groups and the control group. In the Ca 0.1 mmol/l group, however, the characteristic Ca paradox was observed. These findings suggest that if the Ca concentration in a cardioplegic solution is higher than 0.6 mmol/l during continuous cardioplegia, excellent cardioprotective effects will be achieved.     

Comparison of the biomechanical effect of posterior condylar offset and kinematics between posterior cruciate-retaining and posterior-stabilized total knee arthroplasty

Background

The effect of the changes in the femoral posterior condylar offset (PCO) on anterior–posterior (AP) translation and internal–external (IE) rotation in cruciate-retaining (CR) and posterior-stabilized (PS) total knee arthroplasty (TKA) remains unknown. The purpose of this study was to compare the kinematics in CR and PS TKA with respect to the difference in prosthetic design and PCO change through a computational simulation.

The middle collateral artery: anatomic basis for the “extreme” lateral arm flap

The vascularization of the posterolateral area of the arm is supplied by the terminal branches of the deep brachial artery [middle collateral artery (MCA) and posterior radial collateral artery]. Their anatomy has been a field of confusion for a long time. An extended lateral arm flap, named the extreme lateral arm flap, supplied by these branches and dissected as a retrograde island flap has been proposed as an alternative for large compound defects of the distal forearm. We carried out an extensive anatomic study of the extreme lateral arm flap on 69 upper limbs: 54 fresh injected with colored latex, 10 embalmed and 5 radiographed after Micropaque injection. Two origin levels of the MCA were found: a proximal one (37%) above the radial groove, and a distal one (63%) at the level of the groove. The deep brachial artery always bifurcated after the origin of the MCA into a posterior radial collateral artery (PRCA) and anterior radial collateral artery (ARCA). Indeed in our dissections, after the origin of the MCA from the deep brachial artery, there was always a common trunk named the radial collateral artery (RCA) which bifurcated into the ARCA and PRCA. In all dissected arms we always found the MCA anastomosed in a transverse pattern with the inferior ulnar collateral artery (IUCA), contributing to the anastomotic circle of the elbow. This circle represents the unique vascularization source of the reverse extreme lateral arm flap.