Ultrasound Examination and Localization of the Sciatic Nerve: A Volunteer Study

Background: Few studies have examined the use of ultrasound for sciatic nerve localization. The authors evaluated the usefulness of low-frequency ultrasound in identifying the sciatic nerve at three locations in the lower extremity and in guiding needle advancement to target before nerve stimulation.

Methods: In this prospective observational study, 15 volunteers underwent sciatic nerve examination using a curved ultrasound probe in the range of 2-5 MHz and a Philips-ATL 5000 unit (ATL Ultrasound, Bothell, WA) in the gluteal, infragluteal, and proximal thigh regions. Thereafter, an insulated block needle was advanced inline with the ultrasound beam to reach the nerve target, which was further confirmed by electrical stimulation. The quality of sciatic nerve images, ease of needle to nerve contact, threshold stimulating current, and resultant motor response were recorded.

Results: The sciatic nerve was successfully identified in the transverse view as a solitary predominantly hyperechoic structure on ultrasound in all of the three regions examined. The target nerve was visualized easily in 87% and localized within two needle attempts in all patients. Nerve stimulation was successful in 100% after two attempts with a threshold current of 0.42 +/- 0.12 (mean +/- SD) eliciting foot plantarflexion or dorsiflexion.     

Psychotropic prescribing patterns of nonpsychiatric residents in a general hospital in 1973 and 1982

The findings of a study of the frequency and type of psychotropic drugs that nonpsychiatric residents prescribed for nonpsychiatric patients in a teaching hospital in 1982 were compared with the findings of a similar study in the same hospital nine years earlier. The overall percentage of patients receiving psychotropic drugs remained almost the same, at less than 10 percent. However, in 1982 residents prescribed antidepressants almost four times as often as in 1973, and the use of antianxiety agents decreased. Deficiencies in chart documentation of psychotropic prescribing and the tendency to use conservative dosages remained unchanged from the earlier study.     

Does the establishment of a Vascular Unit reduce the prevalence of ruptured aortic aneurysms?

AIM: The aim of this study was to assess the effect of a specialised Vascular Unit upon the prevalence of ruptured aortic aneurysms in the same population catchments' area and associated mortality rates. METHODS: Setting: prospective computerised data collection from 1997 to today, retrospective from 1990-1996. Subjects: 108 aneurysms were operated upon from 1990-1996, compared to 317 from 1997 to Aug 2002. Main outcome measures: statistical analysis was done using SPSS statistics with Kaplan Meier life table curves and compared by the log rank test while the Mann Whitney test was used for comparison of mortality. RESULTS: The median values for ruptured aneurysms per year were 5 for the early period, compared to 10 for the recent years, while the median values for both urgent and ruptured were 7 and 18.5 cases annually, respectively. The number of scheduled procedures increased by 500% in the second period, with median values of 7 and 36.5, respectively. In-hospital mortality according to category was 21% for scheduled, 31% for urgent and 69% for ruptured aneurysms in the early period, compared to 3.7%, 16% and 29% respectively, following the establishment of the Vascular Unit. CONCLUSION: Despite the five-fold increase in the total number of aortic aneurysm repairs (as expected), the number of ruptured aneurysms operated upon increased as well. There was just a trend for a reduction in the absolute numbers of ruptured aneurysms operated upon in the last 2 years. Mortality, on the other hand, decreased dramatically in all categories, with the overall 30-day mortality decreasing more than four-fold, from 40% to 9.3%, while the respective mortalities according to the category of intervention were 3.7% vs 21% for scheduled, 16% vs 35% for urgent and 29% vs 69% for ruptured aneurysms, with a P value of less than 0.01. However, there was no difference in the numbers of patients with ruptured aneurysm reaching the hospital (operated or not) between the two periods (median values of 11 and 10.5 annually). The presence of a Vascular Unit, although it achieves dramatically better results, is not associated with a reduction in the number of emergency proceduresaeat least in the intermediate termaedespite an expansion in the indications for surgery, increased awareness and prompt referrals (centralisation).     

Gastro-oesophageal reflux disease: Medical or surgical treatment? Report of an interactive workshop

Gastroesophageal reflux disease (GERD) is the most common disease of the upper gastrointestinal tract. With the introduction of proton pump inhibitors medical treatment of GERD has been significantly improved. However, the development of laparoscopic antireflux surgery resulted in an increasing interest of surgeons in this disease. An interactive meeting was organized in order to develop an agreement between gastoenterologists and surgeons regarding therapeutic decisions and this is the main topic of this paper.     

AgNOR counts in conjunctival malignant melanoma lack prognostic value.

Using a silver staining technique, argyrophilic nucleolar organiser region-associated proteins (AgNORs) have been studied in routinely processed paraffin sections of 46 invasive malignant melanomas (MM) of the conjunctiva. The aim of this retrospective study was to assess the value of the AgNOR method as a prognostic indicator for this neoplasm. The 46 cases were divided into two groups: (A) 14 cases of MM that metastasised and caused death of the patient within 5 years of (histological) diagnosis, and (B) 32 cases of MM that did not metastasise and in which patients survived beyond 5 years. The mean of the AgNOR counts per nucleus was 7.03 (95% CI: 5.81-8.24) in group A, and 7.15 (95% CI: 6.53-7.77) in group B. A comparison using a multifactor analysis of variance (ANOVA) model, which corrected for possible confounding effect of tumour thickness, site, and cell type showed no significant difference in AgNOR counts between groups A and B (p = 0.8). Analysis by the Cox proportional hazards regression model showed that survival was not influenced significantly by the mean AgNOR number (hazard ratio: 0.92). Whereas the AgNOR technique may be used to distinguish benign from malignant melanocytic lesions of the conjunctiva, we conclude it has no value in predicting the outcome for patients with conjunctival MM.