Aminoglycoside-induced vestibular injury: maintaining a sense of balance.

Objective: To describe the mechanism and risk factors for the development of aminoglycoside-induced vestibular injury and discuss their implications for therapeutic monitoring of aminoglycoside antibiotics.

Data Sources: A MEDLINE search (1975-January 2008) was performed to identify literature on aminoglycoside-induced vestibular injury and risk factors associated with this outcome and their impact on therapeutic drug monitoring. Additional references were identified through review of bibliographies of identified articles.

General surgery in a district hospital in Tajikistan: clinical impact of a partnership between visiting volunteers and host specialists.

After the collapse of the Soviet Union and 5 years of civil war, health care services in Tajikistan are in disarray. Nongovernmental organizations are playing a key role in recovery programs. A group of volunteer physicians from the West went to Khorog General Hospital in the Pamiri mountains to establish a dialogue with their physician counterparts, recommend evidence-based best practice appropriate for local conditions, and reintroduce a culture of continuing medical education.

High-dose thiopentone for open-chamber cardiac surgery: a retrospective review.

Purpose: High-dose thiopentone has been reported to reduce the incidence of neurological dysfunction after open-chamber cardiac surgery. However, this technique delays tracheal extubation and increases requirements for inotropic support after cardiopulmonary bypass. As a quality assurance measure to determine the safety of high-dose thiopentone, we reviewed the records of all patients undergoing elective, open-chamber surgery at our institution between 1st March, 1987 and 31st Dec, 1989.

Comparison of sedative recovery time after midazolam versus diazepam administration.

Objective: To compare the sedative recovery rate pharmacology of intravenous midazolam vs. diazepam when used for short-term sedation.

Data Sources: English-language articles were identified through a search of the MEDLINE and InPharma databases.

Determination of oral temperature accuracy in adult critical care patients who are orally intubated.

Objective: To determine whether sublingual temperatures are accurate in adult critical care patients with an oral endotracheal tube in place.

Design: Repeated measures quasi-experimental.

Setting: University-affiliated tertiary care center in Western Canada.

Lack of in vitro inactivation of tobramycin by imipenem/cilastatin.

Objective: Inactivation of aminoglycosides by beta-lactam antimicrobials both in vitro and in vivo has been documented. Such an interaction has not previously been documented between carbapenems and aminoglycosides. Examination of serum concentrations of tobramycin in a patient receiving both agents suggested that this interaction might exist.

Hemodynamic and temperature changes after aortocoronary bypass grafting.

Perioperative hemodynamic and temperature changes were reviewed in 58 patients who underwent aortocoronary bypass grafting. Core temperature showed an immediate decline postoperatively, secondary to core temperature cooling during bypass. Subsequent rewarming occurred over the next 8 to 12 hours, with the temperature often increasing above normal.

Long-term multi-dimensional outcome following isolated traumatic brain injuries and traumatic brain injuries associated with multiple trauma.

We retrospectively investigated long-term, multi-dimensional quality-of-life outcomes in 68 male patients who suffered pure head injuries and 63 male head-injured patients with associated multiple trauma. Results indicated that patients sustaining associated multiple trauma were significantly younger and more deeply comatose on admission. Trends were found to suggest that patients sustaining associated multiple trauma also remain in coma longer, and experience more difficulties in social interaction and overall psychosocial functioning, but less difficulties in mobility compared with pure-head-injured patients.

Early metabolic and neurologic predictors of long-term quality of life after closed head injury.

Research has begun to identify early markers that predict survival after traumatic brain injury. In this study, trauma and biochemical indicators of severity were used to predict quality of life in 61 adults with traumatic brain injury and no damage to other organ systems. Severity markers available within 24 hours of injury were predictive of later psychosocial, behavioural and social role functioning.

Early determinants of outcome in blunt injury.

A critical set of 135 patients and a validation set of 202 patients who sustained blunt injury were examined for indices of outcome based on blood chemistry and the Glasgow coma scale. In both sets the nonsurvivors had significantly lower scores on the coma scale, higher levels of plasma glucose and increased leukocyte counts. Hypokalemia was also noted and a trend towards lower serum levels with increasing injury severity.

Aortocolic fistula: a rare cause of profuse rectal bleeding.

A 62-year-old man with multiple myeloma survived for 19 months following massive hemorrhage from an aortocolic fistula secondary to an aortoiliac aneurysm that was adherent to the sigmoid colon. The literature indicates that early death from multisystem failure is to be expected and that sepsis is an inevitable consequence of aortocolic fistula. However, in this case the patient did not die despite multisystem complications and his eventual death was unrelated to sepsis or graft complications.

Cholecystectomy with and without drainage.

The authors studied the effect of intraoperative drainage, presence of postoperative pyrexia, influence of appendectomy, chest complications and wound infection in 200 patients who had undergone routine uncomplicated cholecystectomy. One hundred patients in whom no drain was inserted were matched with 100 patients whose cholecystectomies, performed during the same period, included placement of a drain. There were 10 males and 90 females in each group; the mean age was 40.