Effect of total intravenous anaesthesia and balanced anaesthesia on the frequency of coughing during emergence from the anaesthesia

BACKGROUND

The effects of total intravenous anaesthesia (TIVA) and balanced anaesthesia (BAL) on coughing during emergence from the general anaesthesia have not yet been compared.

METHODS

Fifty patients, aged 18-60 yr, undergoing elective lumbar disk surgery were randomly allocated to undergo TIVA (propofol-remifentanil) or BAL (fentanyl-nitrous oxide-sevoflurane). Extubation was performed in the knee-elbow position, documented on video, and subsequently evaluated by blinded examiners.

RESULTS

There was no difference between TIVA and BAL patients with respect to patient characteristics, proportion of smokers, surgical time, or time of emergence. The median number of coughs was significantly lower in the TIVA group (1, range 0-9) than in the BAL group (4, range 0-20, P = 0.007). Mean maximal heart rate and mean maximal arterial pressure measured during emergence were also significantly lower in the TIVA group (P = 0.009 and P = 0.006, respectively).

CONCLUSIONS

During emergence from anaesthesia in the knee-elbow position, TIVA is associated with significantly less coughing and reduced haemodynamic response when compared with BAL.

Oral mucositis in myeloma patients undergoing melphalan-based autologous stem cell transplantation: incidence, risk factors and a severity predictive model

Melphalan-based autologous stem cell transplant (Mel-ASCT) is a standard therapy for multiple myeloma, but is associated with severe oral mucositis (OM). To identify predictors for severe OM, we studied 381 consecutive newly diagnosed myeloma patients who received Mel-ASCT. Melphalan was given at 200 mg/m2 body surface area (BSA), reduced to 140 mg/m2 for serum creatinine >3 mg/dl. Potential covariates included demographics, pre-transplant serum albumin and renal and liver function tests, and mg/kg melphalan dose received. The BSA dosing resulted in a wide range of melphalan doses given (2.4-6.2 mg/kg). OM developed in 75% of patients and was severe in 21%. Predictors of severe OM in multiple logistic regression analyses were high serum creatinine (odds ratio (OR)=1.581; 95% confidence interval (CI): 1.080-2.313; P=0.018) and high mg/kg melphalan (OR=1.595; 95% CI: 1.065-2.389; P=0.023). An OM prediction model was developed based on these variables. We concluded that BSA dosing of melphalan results in wide variations in the mg/kg dose, and that patients with renal dysfunction who are scheduled to receive a high mg/kg melphalan dose have the greatest risk for severe OM following Mel-ASCT. Pharmacogenomic and pharmacokinetic studies are needed to better understand interpatient variability of melphalan exposure and toxicity.

MRI with mangafodipir trisodium in the detection of pancreatic tumours: comparison with helical CT

The aim was to compare spiral CT and MRI enhanced with mangafodipir trisodium (Mn-DPDP) in the detection and staging of pancreatic lesions. 20 patients with suspected pancreatic cancer were included in a phase III study. Triphasic spiral CT (4 ml s-1) and MRI (axial T1 weighted turbo spin echo with and without fat suppression, T1 weighted gradient echo and T2 weighted turbo spin echo at 1.5 T) were performed. All sequences were repeated following contrast medium using the same instrument settings as in the unenhanced sequences. Mn-DPDP was administered by slow injection of 5 mumol kg-1 body weight. Imaging results were correlated with surgery, laparoscopy, biopsy and/or follow-up. Eight pancreatic adenocarcinomas were present. Ten patients had chronic pancreatitis, and two showed a stenosing papillitis. CT detected eight malignant lesions and MRI detected seven. One pancreatic cancer was not detected with MRI. CT and MRI excluded malignancy in nine patients. MRI and CT returned three false positive results. Mn-DPDP improved delineation of the lesion, resulting in a higher level of diagnostic confidence. Differentiation between pseudotumorous lesions in chronic pancreatitis and pancreatic carcinoma was difficult due to similar slight contrast enhancement. Owing to better delineation of the lesion and the higher confidence in diagnosis, MRI with Mn-DPDP may have the potential to improve the detection rate and the staging accuracy of focal pancreatic lesions. These results need to be confirmed in a larger patient trial.

Influence of the hepatobiliary contrast agent mangafodipir trisodium (MN-DPDP) on the imaging properties of abdominal organs

To assess the influence of Mangafodipir Trisodium on the imaging properties of abdominal organs when using T1-weighted gradient-echo (GE) and T2-weighted turbo spin-echo (TSE) sequences, thirty patients with focal lesions in the liver were examined at a field strength of 1.5 T before and after intravenous administration of Mangafodipir Trisodium (dose: 5 micromol/kg of body weight). Administration of Mangafodipir Trisodium led to a significant increase in the signal intensity of the liver tissue (p < 0.001), the spleen (p < 0.01), the pancreas (p < 0.001), and the kidneys (p < 0.001) in the T1-weighted GE sequence, while there was no relevant enhancement in fatty tissue and the musculature. In the T2-weighted turbo spin-echo sequence, there was no relevant change in the signal following administration of a contrast agent. The contrast-to-noise ratio (C/N) between the lesions and the liver tissue increased significantly in the post-contrast T1-weighted GE sequence (p < 0.001), while there was no change in the contrast-to-noise ratio in the post-contrast T2-weighted turbo spin-echo sequence. The contrast-to-noise ratio of the plain T2-weighted TSE sequence was significantly higher than that in the post-contrast T1-weighted GE sequence (p < 0.001). Although Mangafodipir Trisodium was primarily developed as a hepatobiliary contrast agent for demonstration and differentiation of liver lesions, it also affects the signal levels in the pancreas, spleen, and kidneys in the T1-weighted image. Awareness of this effect on the extrahepatic tissue makes it easier to interpret pathological findings in magnetic resonance imaging (MRI) of the abdomen.

[Olivocerebellar atrophy of the Holmes type in 2 generations]

Dementia and social disintegration were the reasons for admittance of a patient to the psychiatric hospital. His disease is described considering the autoptic finding of a olivocerebellar atrophy type Holmes in his mother.

Efficacy studies in natural family planning: issues and management implications illustrated with data from five studies

Studies of method effectiveness must be carefully assessed for comparability of findings. Several parameters are identified that are important in the assurance of comparable results. This article discusses these issues with the use of data from previously published studies and emphasizes the management implications of use-effectiveness data.

Ovulation method use during breastfeeding: is there increased risk of unplanned pregnancy?

Data from two prospective studies of the ovulation method were used to assess pregnancy rates and users' fertility-related behaviors among breastfeeding women. The rate of unplanned pregnancy was less than 1% during the first 6 months of lactational amenorrhea. However, the unplanned pregnancy rate was elevated among breastfeeders during the months after menses return compared with the pregnancy rate during nonlactating cycles. Rates were also elevated at the time when infant feeding supplementation was started. This increase in unplanned pregnancies was not directly attributable to nonadherence to the ovulation method rules; there was some indication that adherence to the rules actually may be increased during those months. Therefore, special emphasis on both the need for improved breastfeeding support to delay menses return and the increased potential for method failure among new users during this period of time should be incorporated into ovulation method training and support programs.

Histopathology studies in human malignant melanomas of the choroid after unsuccessful treatment with 106Ru/106Rh ophthalmic applicators

Choroidal malignant melanomas were examined after unsuccessful brachytherapy with 106Ru/106Rh ophthalmic plaques. The histologic findings were compared with those obtained in non-irradiated melanomas similar in size and location. Both groups revealed no significant clinical difference apart from the lower average age of the irradiated patients. Some of the histologic features (scar formation, changes in the distribution of cell types, rate of mitosis) represented reactions to irradiation. No single histologic feature was strongly correlated to the irradiated group. The phenomenon of radioinsensitivity observed in some malignant melanomas cannot be fully elucidated using conventional histologic methods.

Recognition of ovulatory/anovulatory cycle pattern in adolescents by mucus self-detection

The high frequency of anovulation during adolescence raises the question of whether a method for the recognition of ovulation by self-detection of cervical mucus patterns is useful in teenagers. We performed a secondary analysis of 1049 completely recorded cycles of 235 teen women 15-17 years of age with a gynecologic age from less than 1 to 7 years. These subjects had learned to monitor their fertility patterns using the Billings Ovulation Method. The cycles were analyzed by the length of the mucus and luteal phases and recorded "peak symptom." Ovulatory cycles were grouped by the length of the luteal phase, short (4-8 days) and average (8-18 days), and plotted against gynecologic age. The frequency of anovulatory cycles was comparable to Vollman's age-stratified monophasic cycle groups. Ovulatory patterns were found at gynecologic ages of 1 year, 49%; 2 years, 60%; 3 years, 72%; 4 years, 61%; 5 years, 86%; and 6 years, 71%. The study proved that teen-age women can distinguish patterns of ovulation and anovulation by self-detection of cervical mucus.

Characteristics of ovulation method acceptors: a cross-cultural assessment

Five programs of instruction in the ovulation method (OM) in diverse geographic and cultural settings are described, and characteristics of approximately 200 consecutive OM acceptors in each program are examined. Major findings include: the religious background and family size of acceptors are variable, as is the level of previous contraceptive use. Acceptors are drawn from a wide range of socioeconomic and religious backgrounds; however, family planning intention was similarly distributed in all five countries. In sum, the ovulation method is accepted by persons from a variety of backgrounds within and between cultural setting.

Factors related to ovulation method efficacy in three programs: Bangladesh, Kenya, and Korea

Sociodemographic and reproductive health data were gathered on approximately 200 acceptors in each of three programs offering the Ovulation Method of Natural Family Planning. The programs were located in Bangladesh, Kenya, and Korea. In addition, a one year follow-up was attempted to assess continuation and efficacy. Descriptive data show a variety of religious, educational, income, family, and family planning backgrounds among acceptors. Life table analyses of reported unplanned pregnancy occurrence among spacers and limiters combined was 15% at 12 months in Bangladesh, 11% in Kenya and 13% in Korea. The pregnancy rate at 12 months for all pregnancies, planned and unplanned, was 27.0, 26.0, and 23.7, respectively. In Bangladesh 37 of the 48 unplanned pregnancies were user-related as were all of the 14 unplanned pregnancies in Kenya and 17 of the 20 in Korea. Method failure was the reported cause of pregnancy in only 2 of the 83 unplanned pregnancies. A major aspect of this study was the assessment of higher risk population subgroups; increasing age, education, previous pill use and previous family planning are significantly associated with fewer unplanned pregnancies while religion, attendance as a couple, family planning intention, size and source of referral do not have a demonstrated impact on pregnancy occurrence. The time of entry into the data set in relation to time of initial NFP acceptance may be an important variable in assessing OM effectiveness.

Fertility awareness / natural family planning for adolescents and their families: report of multisite pilot project

Fertility awareness is experiential learning about cyclic fertility. This awareness, used as a family planning method, differs from contraception because it does not isolate the procreative capacity of either partner. The acceptability and effect of teaching fertility awareness on teen sexual activity and decision making was tested in a multisite pilot program which taught fertility awareness via the prospective marker of the cervical mucus (ovulation method of natural family planning). 200 US and 35 Guatemalan volunteer women ages 15-17 in a structured 1 year curriculum, monitored cycle charting and explored the implications of experiencing one's signs of fertility. Control subjects were recruited from the general population and from family planning clinics. 9% of the US study group were sexually active prior to entry. By cycle 12, 1/2 had discontinued activity. Conception rate was 0.0044. The continuation rate dropped from 90% at cycle 7 to 71% at cycle 8 due to scheduling constraints for 2 classes and to 57% at cycle 12. Postprogram follow-up of early leavers showed only 1/3 the expected rate of onset of sexual activity and pregnancy. Parent involvement correlated positively with postponement and/or discontinuation of sexual activity. Reported movement away from peer group pressure appeared 3 months after entry.

Effect of diets containing varying concentrations of essential fatty acids and triglycerides on renal function in uremic rats and NZB/NZW F1 mice

Influences of essential fatty acids (EFA) and triglycerides as reasons for the progression of chronic renal failure are still in debate. We studied the outcome of four diets containing different concentrations of triglycerides and EFA in 5/6 nephrectomized rats and in NZB/W mice up to 45 weeks. The results showed no significant differences in the outcome of survival rate, proteinuria, urea, and creatinine levels as well as histological findings in the different groups of both animal models. We conclude that diets containing EFA up to C18:2 or being free of EFA or that triglyceride-enriched diets have no influence on the natural course of the renal disease in these both experimental models.

Use-effectiveness and client satisfaction in six centers teaching the Billings Ovulation Method

Use-effectiveness of the Billings Ovulation Method (OM) is reported for 1139 clients from six centers who were followed for at least 24 months. Method failure rates were 1% when calculated by either Pearl formula or life table analysis. Combined method and user failure rates were 20% when calculated with the Pearl formula, and 16% at 12 months and 23% at 24 months by life table analysis. Pregnancy rates were higher for couples using OM alone, than for couples using OM in combination with additional fertility awareness methods or together with barrier methods. The difference was significant when estimated by the Pearl formula but not when analyzed by the life table. The emotional implications underlying the apparent contradiction between a desire to avoid pregnancy and the deliberate coital use of fertile days are reflected in the differences between method and user failure rates, the high client satisfaction levels reported with "user failure," and 56% continuation rate at 24 months. The will require in-depth exploration.

[Determination of aluminum in foods]

In connection with studies on the changes of functional properties of food constituents (e. g. solubility of proteins) by means of aluminium compounds, the elaboration of an appropriate method for the quantitative determination of aluminium has been necessary. The organic samples are mineralized with 80% perchloric acid; in case of fat-containing foods, after fat removal. After reaction with aluminon (ammonium salt of aurin tricarboxylic acid), aluminium is determined photometrically at 530 nm. The limit of detection lies between 1 and 2 ppm; the recovery rate is 103%; the standard deviation is +/- 10%. The determination (without mineralization) requires about 1 hours. The authors analyzed, inter alia, milk (1.2--1.7 ppm A1), fat cheese (9 ppm), micora (4 ppm), aluminium-stabilized protein texturates (300--1500 ppm).

Use-effectiveness and analysis of satisfaction levels with the Billings Ovulation Method: two-year pilot study

A 2-year study of 135 women using the Billings Ovulation Method as their method of family planning is reported. There were 1381 exposure cycles during the 1st year and 580 during the 2nd year. The total conception rates were 1.303 for the 1st year and 1.896 for the 2nd year. If one subtract the user failures from these rates, the biologic failure rates are 0.072 for the 1st year and 0.517 for the 2nd year. The continuation rate is 51.8%. An analysis of satisfaction levels is presented with a discussion of possible underlying emotional factors.

Norlestrin-induced pseudopregnancy in the baboon. Effects on blood coagulation and endocrine glands during attempted production of Sheehan's syndrome

Production of Sheehan's syndrome was attempted. As it was not possible to obtain pregnant baboons initially, pseudopregnancy was induced with norlestrin, 2.k mg., for 3 and 4 months, respectively. Sheehan's syndrome was not produced with massive hypovolemic shock but failure to obtain true pregnancy has given serendipitous information on the long-term action of norlestrin on the pituitary and its target organs. Unusual abundance of prolactin acidophils and decrease of growth hormone acidophils was found. Further studies will be necessary to show the possible significance of these findings. As fibrin degradation products did not appear in the serum, we can make no inference about the necessity of intravascular coagulation for the production of Sheehan's phenomenon. Finally one animal became pregnant. Sheehan's phenomenon was not produced in her despite induction of intrapartum hypovolemic shock. Histologic findings in her pituitary resemble those of the pseudopregnant animals.