Haemorrhagic shock, therapeutic management

The management of a patient in post-traumatic haemorrhagic shock will meet different logics that will apply from the prehospital setting. This implies that the patient has beneficiated from a "Play and Run" prehospital strategy and was sent to a centre adapted to his clinical condition capable of treating all haemorrhagic lesions. The therapeutic goals will be to control the bleeding by early use of tourniquet, pelvic girdle, haemostatic dressing, and after admission to the hospital, the implementation of surgical and/or radiological techniques, but also to address all the factors that will exacerbate bleeding. These factors include hypothermia, acidosis and coagulopathy. The treatment of these contributing factors will be associated to concepts of low-volume resuscitation and permissive hypotension into a strategy called "Damage Control Resuscitation". Thus, the objective in situation of haemorrhagic shock will be to not exceed a systolic blood pressure of 90 mmHg (in the absence of severe head trauma) until haemostasis is achieved.

Productivity of crops grown on raised beds on duplex soils prone to waterlogging in Western Australia

Waterlogging of duplex soils in Western Australia has long been recognised as a major constraint to the production of agricultural crops and pastures. The work described in this paper examines the application of raised beds to arable land that is frequently waterlogged for the production of crops such as wheat, barley, field peas, lupins and canola. Raised beds are 138 cm wide, seed beds separated by 45 cm wide furrows 183 cm apart. These beds were made with a commercial bed former. Seven sites were selected across the south-eastern wheat belt of Western Australia with the experimental areas varying in size from 10 to 57 ha. These large sites were used to accommodate commercial farm machinery. Each site had raised beds formed with a commercial bedformer. The production from the bedded areas was compared with crops grown conventionally on flat ground under minimum tillage as the control. The experiments were established in 1997 and 1998 and the sites were monitored for a maximum of 5 years. In 11 of the 28 site-years of the experiments, grain yields on the raised beds were statistically significantly higher than the yield from crops grown on the control, with an average yield increase of 0.48 t/ha. Across the whole dataset, growing crops on raised beds did not produce significantly lower yields. Below average rainfall was received for much of the experimental period at several sites. Growing season rainfall had a large effect on grain yield and high rainfall over a period of 40 days after seeding significantly increased the grain yield difference between the raised bed and the control. These data indicate that the use of raised beds lead to higher grain yields when seasonal conditions are appropriate.

Postoperative morbidity associated with cesarean delivery among human immunodeficiency virus-seropositive women

OBJECTIVE

The aim of this study was to compare the complication rates associated with cesarean delivery between human immunodeficiency virus-seropositive women with those among a matched group of human immunodeficiency virus-seronegative subjects.

STUDY DESIGN

We conducted a case-control study of 86 human immunodeficiency virus-seropositive women undergoing cesarean delivery between the years 1992 and 2000 at a large, urban teaching institution and a control group of 86 human immunodeficiency virus-seronegative women matched for age, race, year of delivery, and delivery indications. Data were analyzed with the chi2 test and odds ratios. Among human immunodeficiency virus-seropositive women, complications were further stratified according to maternal disease status and use of antiretroviral therapy.

RESULTS

Human immunodeficiency virus-seropositive women were significantly more likely than control women to have minor postoperative complications (66.3% vs 41.8%; odds ratio, 2.73; 95% confidence interval, 1.40-6.10), of which febrile morbidity was the most common (62.8% vs 42.7%; P =.003). There was no difference between the groups in the rate of major complications (9.3% vs 3.4%; odds ratio, 2.84; 95% confidence interval, 0.65-14.06). Zidovudine use was associated with a decrease in the maternal morbidity rate (odds ratio, 0.31; 95% confidence interval, 0.07-1.03).

CONCLUSION

Postoperative morbidity among human immunodeficiency virus-seropositive women undergoing cesarean delivery was not different from that in a matched control population.

Human papillomavirus and disease status following therapy for cervical cancer

We enrolled 85 patients with invasive cervical cancer and collected cervicovaginal lavage samples at each clinical visit for diagnosis, staging, treatment, and follow-up. Lavage samples were tested by L1 consensus polymerase chain reaction for human papillomavirus (HPV). Results were compared with HPV demonstrated in tumor tissue and the clinical status at time of sample collection. Sensitivity and specificity of the lavage for detection of tumor HPV, determined on the basis of results of tests on lavage samples collected prior to therapy, were found to be 56% and 76.9%, respectively. The proportion of lavage samples detecting tumor HPV decreased significantly with treatment, from 0.54 at diagnosis to 0.03 at complete response (P < .001). Local treatment failure was associated with increased detection of tumor HPV; however, no samples were positive prior to clinically detected treatment failure. These results suggest that cervicovaginal lavage is not an effective sampling method for epidemiological analysis of HPV in cervical tumors.

Effect of clenbuterol on athletic performance

Unlike inhaled beta 2-agonists, more studies need to be performed before the action of systemic beta 2-agonists on athletic performance can be assessed accurately. Experiments in animals with oral clenbuterol have shown augmentation in muscle bulk across numerous species, but human studies cannot confirm similar muscle mass enlargement in healthy men. Although the human studies demonstrate the potential for long-acting systemic beta 2-agonists to increase muscle strength in certain muscle fiber types, it is difficult to judge the drugs' effects on overall athletic performance, because athletic skill is more than strength, speed, and endurance. The effect of oral clenbuterol on athletic performance cannot be evaluated from its actions on muscle strength alone. However, as evidence stands now, sports regulatory agencies are correct to ban systemic beta 2-agonists until the following 2 points can be proven: (1) oral forms provide a therapeutic benefit that cannot be obtained with aerosol or inhaled forms; and (2) oral forms do not give any unfair advantage to the competitor in muscle strength, power output, or endurance. Provided they are administered as prescribed, aerosol or inhaled beta-agonists do not impart an unfair advantage or enhance athletic performance and can continue to be used in competition by athletes with EIA.

Differentiation of convulsive syncope and epilepsy with head-up tilt testing

OBJECTIVE

To evaluate the usefulness of head-upright tilt table testing in the differential diagnosis of convulsive syncope from epileptic seizures in patients with recurrent idiopathic seizure-like episodes.

DESIGN

Prospective, nonrandomized study.

SETTING

Electrophysiology laboratory of a university hospital.

PATIENTS

Fifteen patients (8 men and 7 women patients; mean age, 29 +/- 20 years) with recurrent unexplained seizure-like episodes, unresponsive to antiseizure medication.

MEASUREMENTS

Head-upright tilt table testing with or without isoproterenol infusion. Five patients who were initially tilt positive had a second tilt test with continuous electroencephalographic (EEG) recording.

MAIN RESULTS

Syncope associated with tonic-clonic seizure-like activity occurred in six patients (40%) during the baseline tilt and in four patients (27%) during isoproterenol infusion (total positive tests, 67%). The EEG showed diffuse brain wave slowing (not typical of epileptic seizures) in five of five patients during the convulsive episode. All patients who had positive test results eventually become tilt table negative after therapy, and over a mean follow-up period of 21 +/- 2 months, no further seizure-like episodes have occurred.

CONCLUSION

Upright tilt table testing combined with isoproterenol infusion may be useful to distinguish convulsive syncope from epileptic seizures.