A novel way of distributing medical practice guidelines using Personal Digital Assistants (PDA).

With the rapid growth in medical knowledge, physicians' ability to keep up to date has become increasingly difficult. Although the Internet brought significant improvements in access to medical knowledge, there are still problems remaining, particularly for the mobile physician who is unable to perform time-consuming on-line searches, even with wireless access to the Internet. The goal of this project was to develop a novel way of distributing medical knowledge from the Internet to health professionals' Personal Digital Assistants (PDAs).

The site of action of epidural fentanyl infusions in the presence of local anesthetics: a minimum local analgesic concentration infusion study in nulliparous labor.

Unlabelled: We have previously demonstrated that continuous epidural infusions of fentanyl without local anesthetics elicit analgesia by a systemic mechanism. In this study, we examined the hypothesis that, in the presence of epidural bupivacaine, continuous infusions of epidural fentanyl elicit analgesia by a spinal mechanism. Forty-eight nulliparous women in active labor participated in this prospective, randomized, double-blinded study.

A comparison of the 24-gauge Sprotte and Gertie Marx spinal needles for combined spinal-epidural analgesia during labor.

Background: Prior experience with the combined spinal-epidural technique (CSE) for labor analgesia demonstrated a high (up to 14%) failure rate because of failure to obtain cerebrospinal fluid (CSF) or lack of response to appropriate doses of intrathecal sufentanil. The current study was designed to test whether a longer needle with a shorter side port (Gertie Marx needle; 127 mm long) would eliminate failures to obtain CSF compared with the needle we had used previously (Sprotte needle; 120 mm long).

Methods: Seventy-three parturients were randomly assigned to have a CSE performed with one of these two needles.

Pregnancy complicated by severe osteogenesis imperfecta: a report of two cases.

This case report discusses the anesthetic management of two parturients with severe osteogenesis imperfecta who presented for cesarean delivery. Although the anesthetic management for milder forms of the disease has been previously reported, anesthetic options for cases of this severity have not.

Death at home following a targeted advance-care planning process at home: the kitchen table discussion.

Objective: To determine whether home health agency patients' preferences to die at home can be honored following a structured, professionally facilitated advance-care planning (ACP) process provided in the home.

Design: A case series of patients who were identified by their home health agency nurses as having a life-limiting illness and then referred for social service assessment, followed for at least 6 months, with median follow-up of 191 days.

Setting: A large, urban, home health agency owned by a not-for-profit integrated healthcare system.

Evaluation of the number of agonist molecules needed to activate a ligand-gated channel from the current rising phase.

We propose a new method for calculating the number of agonist binding sites (n) in ligand-gated receptor channels from the initial phase of the current. This method is based on the fact that the relation between the current (I) and its first-time derivative (I') at the beginning of the current reflects the number of transitions that lead to channel opening. We show that, for constant agonist concentration, the above relationship at t --> 0 provides the number of steps leading to channel opening.

Early discharge with home health care in the coronary artery bypass patient.

Early hospital discharge after coronary artery bypass graft surgery has been the standard of practice throughout the United States. This study compared outcomes, readmissions, and costs for patients discharged early with home health care with those of patients discharged a day or more later without home health care. Discharging open-heart surgery patients on postoperative day 4 with home health care was found to be safe and cost-effective.

Block of quantal end-plate currents of mouse muscle by physostigmine and procaine.

of quantal end-plate currents of mouse muscle by physostigmine and procaine. Quantal endplate currents (qEPCs) were recorded from hemidiaphragms of mice by means of a macro-patch-clamp electrode. Excitation was blocked with tetrodotoxin, and quantal release was elicited by depolarizing pulses through the electrode.

Percutaneous lumbar sympathetic plexus catheter placement for short- and long-term pain relief: CT technique and results.

Purpose: The purpose of this work was to evaluate the use of percutaneously placed lumbar sympathetic plexus catheter placement under CT guidance in patients with complex regional pain syndrome (CRPS) or nonspecified neuropathic pain (NP) of the lower extremity.

Method: Sixteen lumbar sympathetic plexus catheter placements were performed in seven patients with CRPS and seven patients with NP. A 19 gauge epidural catheter was placed anterior to the psoas muscle at the L2-3 level.

Intrathecal sufentanil for labor analgesia: do sensory changes predict better analgesia and greater hypotension?

Sensory changes and hypotension occur after intrathecal sufentanil (ITS) is given during labor. The goal of this study was to determine whether sensory changes are predictive of hemodynamic changes or duration of pain relief. We also examined whether sensory and hemodynamic changes relate to the concentration of ITS administered.

Comparison of binding of 3H-desmethoxyverapamil and 3H-mibefradil in vascular smooth muscle and heart membranes. Possible binding of mibefradil to a site distinct from the phenylalkylamine-binding site.

Binding of 3H-mibefradil (Ro-40-5967, CAS 116666-63-8) and 3H-desmethoxyverapamil (CAS 67018-79-5) to membranes of vascular smooth muscle cells (VSMC) and heart was studied. Direct binding studies in VSM demonstrated the presence of significantly higher amounts of binding sites for mibefradil as compared to those for verampamil. In competition experiments both unlabelled drugs displaced 3H-desmethoxyverapamil with the same affinity.

Decreased heart rate variability in transgenic mice overexpressing atrial beta 1-adrenoceptors.

Heart rate variability (HRV) depends on various reflexes, including the baroreflex or respiratory reflex. Experimental studies have suggested that the sinoatrial node density in G protein-linked receptors may be involved. Transgenic mice, with a specific eightfold atrial overexpression of human beta 1-adrenoceptor (beta 1-AR), have been generated to evaluate the role of the atrial beta 1-AR density on HRV.

Smoking and idiopathic congestive cardiomyopathy.

Two case control studies were performed to evaluate whether smoking may affect myocardial function. Cardiomyopathy subjects had a greater pack year smoking history than 52 control subjects with no CAD (p < 0.02) and were more likely to have diabetes (p < 0.

Ketorolac and spinal morphine for postcesarean analgesia.

This study was designed to compare spinal morphine (SM), ketorolac (K), and a combination of the two drugs with respect to analgesic efficacy and side effects in postcesarean patients. Forty-eight parturients having bupivacaine spinal anesthesia for cesarean delivery randomly received in a double-blind manner either: SM: 0.1 mg or SM: 0.

[Characteristics of some Arctic cities according to data of physiologic and hygienic evaluation of the influence of weather and climate on human thermoregulation].

The article presents an original approach to evaluation of climate and weather according to their influence of human heat state. Use of the approach is accompanied by climate characteristics of some Transpolar cities, the authors discuss application of those characteristics to solution of hygienic problems.