Caudal clonidine and bupivacaine for combined epidural and general anaesthesia in children.

Background: Clonidine produces analgesia by actions on alpha 2-adrenoceptors and enhances both sensory and motor blockade from epidural injection of local anaesthetics. Low-dose clonidine has been used so far for caudal injection in children. Our aim was to study the perioperative effects of high-dose caudal clonidine when added to low concentration of bupivacaine for combined epidural and general anaesthesia in children.

Alternative techniques for measuring nutrient digestion in ruminants.

Because in vivo measurement of nutrient digestion in the rumen and small intestine requires ruminally and intestinally cannulated animals that are expensive, labor-intensive, and subject to error associated with markers and inherent animal variation, alternative techniques have been developed. Researchers have proposed various in situ or in vitro procedures for estimating ruminal and small intestinal nutrient digestion. This review summarizes these alternative techniques.

CT in searching for abscess after abdominal or pelvic surgery in patients with neoplasia: do abdomen and pelvis both need to be scanned?

Purpose: This prospective study was undertaken to determine the incremental yield of combined abdominal and pelvic CT in searching for clinically suspected postoperative abscess in oncologic patients.

Method: One hundred seventeen oncologic patients underwent CT to exclude a clinically suspected abscess within 30 days of abdominal or pelvic surgery during an 8 month period. Scans were evaluated for the presence of ascites, loculated fluid collections, or other possible sources of fever.

Grading of severity of postdural puncture headache after 27-gauge Quincke and Whitacre needles.

Background: Small-gauge needles are reported to have a low incidence of complications. Pencil-point needles are associated with a lower frequency of postdural puncture headache (PDPH), but a higher failure rate than Quincke needles.

Methods: The incidence of PDPH was investigated in 200 patients under the age of 45, undergoing day-care surgery, after spinal anaesthesia with either 27-gauge Quincke or Whitacre needle.

Cholangiocarcinoma at the hepatic hilus: sonographic findings.

Objective: This study was performed to characterize sonographic findings in patients with cholangiocarcinoma at the hepatic hilus and to compare those sonographic findings with surgical and pathologic findings.

Materials And Methods: Thirty-nine consecutive patients with hilar cholangiocarcinoma (Klatskin tumor) had preoperative color and spectral Doppler sonography and had surgical-pathologic correlation. Biliary drainage catheters were present in 24 patients (62%).

Gastric intramucosal pH: a predictor of survival in cardiac surgery patients with low cardiac output?

Objective: To assess the value of gastric intramucosal pH measurement in patients with low output after cardiac surgery.

Design: Prospective clinical study.

Setting: University hospital.

Continuous versus intermittent thermodilution cardiac output measurement during orthotopic liver transplantation.

We evaluated intermittent and continuous thermodilution cardiac output data in 12 patients undergoing orthotopic liver transplantation. Measurements were performed at 16 predefined time points between induction of anaesthesia and 3 h after reperfusion of the liver graft. Cardiac output measurements yielded 192 data pairs (intermittent cardiac output range: 1.

In-use contamination of propofol. A clinical study.

Reports about post-operative infections associated with the use of propofol prompted us to investigate the in-use contamination of lipid-formulated intravenous (i.v.) anaesthetics used for general anaesthesia or for sedation of intensive care patients in this department.

Effect of the 21-aminosteroid tirilazad mesylate on leukocyte adhesion and macromolecular leakage during endotoxemia.

Background: Interstitial accumulation of leukocytes has been related to the development of multiple organ failure after sepsis. Oxygen radicals are involved in the process of leukocyte adherence to the microvascular wall. This study investigates the effects of the oxygen radical scavenger tirilazad mesylate on leukocyte-endothelial interactions, macromolecular leakage, and microhemodynamics in mesenteric venules during endotoxemia.

Epidural abscess after combined spinal-epidural block.

Purpose: We report the first case of abscess formation after combined spinal-epidural block (CSE). Penetration of the dura in CSE may constitute an additional risk of subarachnoid spread of bacteria when post-puncture epidural infection is present.

Clinical Features: The combination of a spinal and a continuous epidural block (CSE) using a needle through needle technique was used in a 72-yr-old man for reconstructive vascular surgery of the lower limb.

Expression of the immunoglobulin superfamily cell adhesion molecule F3 by oligodendrocyte-lineage cells.

We have analysed the expression of glycosylphosphatidylinositol (GPI)-anchored proteins by oligodendrocyte-lineage cells. Biosynthetic labeling of mouse oligodendroglial primary cultures and an oligodendroglial precursor cell line demonstrated that these cells synthesise a variety of different GPI-anchored proteins. GPI-anchored proteins were isolated as a bulk preparation from the precursor cell line, and the individual proteins separated by 2D gel electrophoresis and analysed by microsequencing after tryptic digestion of the separated components.

When the common femoral vein is revealed as flattened on spectral Doppler sonography: is it a reliable sign for diagnosis of proximal venous obstruction?

Objective: The purpose of the study was to determine if a monophasic waveform with no response to Valsalva's maneuver in the common femoral vein on spectral Doppler sonography is reliable for the diagnosis of proximal venous obstruction.

Subjects And Methods: In a prospective study from January 1993 through October 1995, 37 of 2138 cancer patients examined with duplex Doppler sonography exhibited monophasic flow in the common femoral vein on spectral Doppler imaging and no response to Valsalva's maneuver. These 37 patients were further evaluated with an abdominal and pelvic CT scan with IV contrast medium (n = 23), with sonography (n = 8), with MR imaging (n = 4), with venography (n = 1), or by both venography and CT (n = 1) to determine the cause of monophasic flow in the common femoral vein and lack of response to Valsalva's maneuver.

Endometrial thickness in tamoxifen-treated patients: correlation with clinical and pathologic findings.

Objective: This study was performed to evaluate sonographic measurements of endometrial thickness in postmenopausal breast cancer patients being treated with tamoxifen and to correlate endometrial thickness with pathology, symptoms, and duration of tamoxifen treatment.

Materials And Methods: Pelvic sonograms and medical records of 91 postmenopausal breast cancer patients being treated with tamoxifen were retrospectively reviewed. Histologic results were available in 46 patients (51%).

Semiquantitative analysis of intrahepatic cytokine mRNAs in chronic hepatitis C.

In order to characterize intrahepatic cytokine production, the mRNA levels of interleukin (IL)-2, -4, and -10 and interferon (IFN)-gamma were semiquantitatively determined by reverse-transcription competitive polymerase chain reaction in liver specimens from patients with chronic hepatitis C (n = 23), chronic hepatitis B (n = 9), or primary biliary cirrhosis (n = 12) and normal liver (control) specimens (n = 12). IL-4 mRNA was undetectable. Similar IL-10 mRNA levels were detected in all samples studied, including the controls.

[Economic aspects of modern inhalation anesthetics with sevoflurane as an example].

The economic impact of the new German health care laws requires an awareness of cost-effectiveness when using newer drugs. The main goal in patient care, i.e.

Assessment of vitamin K status in human subjects administered "minidose" warfarin.

Vitamin K is required to convert specific glutamyl residues in a limited number of proteins to gamma-carboxyglutamyl residues. The response of various measures of vitamin K insufficiency to the administration of 1 mg/d of the vitamin K antagonist warfarin was studied in two groups of nine older (55-75 y) or younger (20-28 y) subjects. The most consistent and extensive alteration was an increase in the concentration of serum under-gamma-carboxylated osteocalcin followed by increased immunochemical detection of plasma under-gamma-carboxylated prothrombin (PIVKA-II), and by a decreased urinary excretion of gamma-carboxyglutamic acid.

Infectious risks associated with the use of propofol.

Background: Investigations of the Centers for Disease Control into postoperative infections have implicated extrinsically contaminated propofol.

Methods: To evaluate the infectious risk associated with intravenous anaesthetic agents, we surveyed the literature from 1971 to 1995 using the Medline database. Papers covering infections related to intravenous anaesthetic agents were included.

Retention of the antibiotic teicoplanin on a hydromer-coated central venous catheter to prevent bacterial colonization in postoperative surgical patients.

Objective: Antibiotic-coated intravascular catheters may be an effective means of decreasing bacterial colonization and subsequent catheter-related infection. The present study was designed to investigate the retention of the antibiotic teicoplanin on a hydromer-coated intravenous catheter and the effect of this antibiotic coating on catheter bacterial colonization.

Design: A prospective, randomized pilot study.

Hepatic lobar atrophy: association with ipsilateral portal vein obstruction.

Objective: This study was performed to evaluate the association between hepatic lobar atrophy, bile duct obstruction, and portal vein obstruction.

Materials And Methods: Thirty cases of hepatic lobar atrophy identified on angiography with CT during arterial portography from August 1992 to March 1995 were retrospectively reviewed by two independent observers. Cases were evaluated for vascular patency and bile duct obstruction.

Portal vein evaluation with US: comparison to angiography combined with CT arterial portography.

Purpose: To compare ultrasound (US) to angiography combined with computed tomography during arterial portography (CTAP) in the preoperative evaluation of the portal vein.

Materials And Methods: Sixty-three consecutive patients being considered for hepatic resection underwent color and spectral Doppler US and angiography with CTAP before surgery. The main, right, and left portal veins were evaluated separately.

Dopexamine maintains intestinal villus blood flow during endotoxemia in rats.

Objective: To determine the influence of dopexamine, a synthetic catecholamine ligand for dopaminergic and beta 2-adrenergic receptors, on alterations of the intestinal villus microcirculation in a model of normotensive endotoxemia.

Design: Randomized, controlled trial.

Setting: Experimental laboratory.