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PubMed2004

An experimental study on the utility of a 3-mm ultrasonically activated trocar system.

BACKGROUND/PURPOSE: A prototype of a 3-mm ultrasonically activated trocar system supplied by Olympus Corporation was evaluated experimentally in terms of its utility and safety. METHODS: Three piglets with an average weight of 12 kg were used. A pneumoperitoneum was created by Hasson's technique. Eleven punctures were made with a disposable conical 3-mm trocar (CT), 9 punctures with a 3-mm radially expanding trocar (ET), and 13 punctures with a 3-mm ultrasonically activated trocar (UT) under laparoscopic control. The authors recorded the time for abdominal penetration, the severity of the peritoneal tenting, the presence of elevated abdominal pressure of 5 mm Hg or more at the penetration, and the maximal force applied to the trocar to remove from the abdominal wall. RESULTS: The average times for penetration were 11.8, 9.4, and 3.8 seconds with CT, ET, and UT, respectively (P < .05, CT v. UT, ET v. UT). The average maximal forces at the trocar removal were 10.52, 21.17, and 21.24 N with CT, ET, and UT, respectively (P < .05, CT v. ET, CT v. UT). Elevation of abdominal pressure of 5 mm Hg or more was recorded in CT and ET but not in UT. Peritoneal tenting was the most severe in ET and minimal in UT. No complication related to the UT system was found. CONCLUSIONS: The 3-mm UT is a simple and safe device and is expected to become commercially available.

Animals↗

PubMed2002

Six-month angiographic and 12-month clinical follow-up of MultiLink long (25 to 35 mm) stents for long coronary narrowings in patients with angina pectoris.

There are limited prospective angiographic data on stent deployment for long coronary lesions. This multicenter prospective study enrolled 120 patients with a single de novo stenosis >20 mm in length, in a native vessel > or =3 mm diameter, suitable for a MultiLink stent 25 to 35 mm in length with additional stent deployment if required. Quantitative angiography before and immediately after stenting and at 6-month follow-up assessed restenosis for the complete lesion and for 5-mm segments of the stented and adjacent nonstented vessel. By 1 year, myocardial infarction had occurred in 3% and target vessel repeat revascularization in 12% of patients. The mean stented length (35.8 +/- 14.6 mm) closely matched mean lesion length (30.1 +/- 13.5 mm). Restenosis to > or =50% diameter loss occurred in 32% of patients, but to > or =70% in only 8%. Of the 147 segments (5 mm in length) with baseline stenosis <25%, only 3 patients (2%) developed restenosis of > or =50%, and only in 1 of these was it > or =70%. Stenting of long narrowings is associated with good clinical outcome and a low rate of severe restenosis. Mildly diseased segments of long lesions covered by a stent rarely became severely narrowed and had negligible influence on the overall restenosis rate. These data support a strategy of full lesion coverage by stent deployment.

Adult↗

PubMed1981

Clinical and hemodynamic evaluation of the 19 mm Björk-Shiley aortic valve prosthesis.

Between November, 1973, and March, 1980, 43 patients underwent isolated aortic valve replacement with 19 mm Björk-Shiley prostheses at the Johns Hopkins Hospital. There were 4 male and 39 female patients ranging from 12 to 75 years old (mean, 54.5 years). Average weight was 62 +/- 2 kg and average body surface area, 1.64 +/- 0.3 m2. Five patients died within thirty days of operation; however, since 1975, hospital mortality has been 5.9%. The 38 survivors have been followed up for as long as 85 months (mean, 40 months). There were 4 late deaths, and actuarial survival in patients discharged from the hospital was 81% at five years. All long-term survivors were in New York Heart Association Functional Class I (29 patients) or Class II (5 patients). Preoperative and postoperative echocardiograms in 17 patients demonstrated significant decreases in mean left ventricular wall thickness (12.9 +/- 1.8 mm vs 10.3 +/- 1.4 mm; p less than 0.001) and in left ventricular mass (262 +/- 95 gm vs 188 +/- 50 gm; p less than 0.02). Postoperative cardiac catheterization data were obtained from an additional 24 patients undergoing aortic valve replacement with the 19 mm Björk-Shiley prosthesis at the National Heart Institute. Average peak systolic gradient at rest was 16 mm Hg (range, 0 to 45 mm Hg) and was found to be directly related to body surface area (r = 0.60, p less than 0.002). Average effective valve orifice area was 1.06 cm2 (range, 0.63 to 2.02 cm2). For patients with small aortic roots, aortic valve replacement with the 19 mm Björk-Shiley valve is a satisfactory and, perhaps, preferable alternative to aortic annuloplasty to accommodate larger sized prostheses.

Actuarial Analysis↗

PubMedDate not supplied

Inflammatory response in the rabbit after phacoemulsification and intraocular lens implantation using a 5.2 or 11.0 mm incision.

PURPOSE: To study the effect of two incision sizes, 5.2 and 11.0 mm, on the inflammatory response in rabbit eyes after lens extraction with phacoemulsification. SETTING: S:t Erik's Eye Hospital, Stockholm, and Pharmacia, Uppsala, Sweden. METHODS: Bilateral endocapsular phacoemulsification was performed on 32 rabbits. The wound was enlarged to 5.2 mm, and a poly(methyl methacrylate) intraocular lens (IOL) was implanted in the capsular bag. In each rabbit, one eye was selected at random and the wound in that eye enlarged to 11.0 mm. In both eyes the wound was sutured with a 9-0 polypropylene continuous suture. The number of white blood cells (WBCs) and prostaglandin E2 (PGE2) in the aqueous humor were measured at days 1, 3, 7, and 28 postoperatively. Corneal thickness was also measured by pachymetry. RESULTS: The number of WBCs at day 3 and the PGE2 levels at days 1, 3, and 7 were significantly higher in eyes with 11.0 mm incisions than in eyes with 5.2 mm incisions. One week after surgery, the corneas in the eyes with 11.0 mm incisions were significantly thicker than in those with 5.2 mm incisions. CONCLUSION: The results indicate that incision size is an important factor in the inflammatory response following phacoemulsification and IOL implantation in the rabbit eye.

Animals↗

PubMed1999

Self-adapting washer system for lag screw fixation of mandibular fractures. Part II: In vitro mechanical characterization of 2.3 and 2.7 mm lag screw prototypes and in vivo removal torque after healing.

The aim of this study was to mechanically characterize self-tapping 2.3 and 2.7 mm titanium lag screw prototypes which are part of the newly developed 'self-adapting washer' maxillofacial lag screw osteosynthesis system. In vitro in a screw testing machine the insertion torque, maximum locking torque and axial force and the ultimate torsional strength were assessed. In vivo in six miniature pigs using a mandibular symphyseal fracture model, the removal torques after 3 and 6 months of healing were measured. Additionally the bone-metal contact (BMC) of the screws was assessed histometrically. The maximum insertion torque (0.185 Nm) was far below the mechanical limits of the screws (2.3 mm = 0.96 Nm, 2.7 mm = 1.6 Nm). A tightening of the 2.7 mm screw with an axial force of 1000 N and of the 2.3 mm screw with 500-550 N leaves a safety margin of approximately one-third on the ultimate torsional strength. Clinically these values permit the use of two 2.3 mm lag screws or one 2.7 mm lag screw in mandibular symphysis fractures since 1000 N tensile axial force are required in this indication. During screw removal after 6 months healing, torque levels close to the mechanical limits of the screws were recorded and screw failures were observed. This failure rate may have been due to the BMC of 49.8% which was in the range of titanium dental implants. Accordingly the screw heads were reinforced to prevent fractures.

Animals↗

PubMed1996

Reactions between tunichrome Mm-1, a tunicate blood pigment, and vanadium ions in acidic and neutral media.

Tunichromes are yellow, polyphenolic tripeptides prevalent in blood cells of tunicates (suborders phlebobranchia and stolidobranchia). Spectrophotometric studies of reactions between tunichrome Mm-1 and VV or VIV ions were conducted in vitro in various media to crudely approximate cellular conditions: deionized water, aqueous methanol, and aqueous buffers at pH 2 and 7. Catechol was used in parallel studies for comparison to tunichrome and was found to be a good model for tunichrome reactivity. For VIV in pH 7 buffer, both catechol and Mm-1 formed complexes with VIV ions, and no redox products were found. For VV in pH 2 buffer, both catechol and Mm-1 were oxidized by VV ions. Room temperature EPR qualitatively showed that Mm-1 in pH 2 buffer reduced VV ions to free VIV ions. For VV in pH 7 buffer, Mm-1 was oxidized by VV ions and formed VIV complexes. At higher concentrations, the VIV complexes were observed by low temperature EPR [Grant, K. B. (1994) Dissertation, Columbia University; Grant, K. B., et al. (1996) J. Inorg. Biochem. (manuscript in preparation)]. Using a colorimetric assay for VIII, we found that reactions between Mm-1 and VV or VIV ions in pH 7 buffer clearly did not generate appreciable quantities of VIII products. Thus, the colorimetric VIII assay resolved the issue of VIII product formation raised in EPR studies of Mm-1 [cf. Ryan, D. E., et al. (1992) Biochemistry 35, 8651-8661]. Overall, the results provide insights into tunichrome-vanadium chemistry and identify conditions which promote complexation and/or redox reactions in vitro.

Animals↗

PubMed2003

MDS-type abnormalities within myeloma signature karyotype (MM-MDS): only 13% 1-year survival despite tandem transplants.

Cytogenetic abnormalities (CA), especially of chromosome 13, have been used to identify a subgroup of previously untreated multiple myeloma (MM) patients with very poor prognosis despite high-dose therapy (HDT). We examined the prognostic implications of CA in 1000 MM patients receiving melphalan-based tandem autotransplants (median follow-up, 5 years). Negative consequences for both overall survival (OS) and event-free survival (EFS) in the presence of any CA were confirmed, especially when detected within 3 months of HDT. In the context of standard prognostic factors (SPF), 'MM-MDS' (MM karyotype that contains, in addition, CA typical of MDS) imparted a poor OS and EFS, after adjusting for any CA and all individual CA. One-year mortality was also high, especially for the MM-MDS subgroup with trisomy 8 within a MM signature karyotype (87%vs 34% in its absence, P < 0.001). No patient remained event free 5 years post transplant in the presence of these baseline high-risk CA. However, certain trisomies (e.g. chromosomes 7 and 9) and del 20 had favourable clinical consequences. The higher risk that is associated with CA compared with SPF justifies routine cytogenetic studies in all patients with MM at diagnosis and whenever additional treatment decisions are considered, such as in planning HDT either for initial response consolidation, at the time of primary unresponsiveness to induction therapy, or at relapse.

Antineoplastic Agents, Alkylating↗

PubMedDate not supplied

Blood storage XXII. Improvement in red blood cell 2,3-DPG levels at six weeks by 20 mM PO4 in CPD-adenine-inosine.

Inorganic phosphate has been known to assist red blood cell maintenance of ATP and in the presence of inosine to assist in the maintenance of 2,3-DPG. High concentrations of phosphate, while helping ATP maintenance, were found to be deleterious to 2,3-DPG maintenance in CPD-adenine preservatives. However, in the presence of inosine, concentrations of phosphate as high as 10 mM were advantageous to 2,3-DPG maintenance. The present study extends the observations on ATP and 2,3-DPG maintenance in CPD-adenine-inosine preservatives from the previous 10 mM to 20 mM phosphate. A high phosphate (20 mM) effect has been seen as improved maintenance of 2,3-DPG levels during the fifth and sixth weeks of storage of whole blood at 4C. This supports the previously reported observation of improved maintenance of 2,3-DPG in a 10 mM phosphate preservative. This is ten times the 2 mM phosphate concentration in CPD-adenine. In the low phosphate preservative (2 mM), 2,3-DPG maintenance is less than that in all of the higher phosphate preservatives after the second week of storage. ATP concentrations in this experiment show good maintenance throughout six weeks of storage.

Adenine↗

PubMedDate not supplied

Pullout properties of 3.5-mm AO/ASIF self-tapping and cortex screws in a uniform synthetic material and in canine bone.

OBJECTIVES--To compare the pullout properties of 3.5-mm AO/ASIF self-tapping screws (STS) to corresponding standard cortex screws (CS) in a uniform synthetic test material and in canine femoral bone. The influence of screw-insertion technique, test material, and test-material thickness were also assessed. STUDY DESIGN--In vitro experimental study. SAMPLE POPULATION--Two independent studies: a uniform synthetic test material and paired femurs from mature dogs. METHODS-Mechanical testing was performed in accordance with standards established by the American Society for Testing and Materials for determination of axial pullout strength of medical bone screws. Completely inserted STS, completely inserted CS, and incompletely inserted STS were tested in 3 groups of 10 test specimens each in 4.96-mm and 6.8-mm thick sheets of synthetic material. In the bone study, group 1 consisted of 24 completely inserted STS compared with 24 completely inserted CS, and group 2 consisted of 24 incompletely inserted STS versus 24 completely inserted CS. Comparisons were made between paired femurs at corresponding insertion sites. Pullout data were normalized, thereby eliminating the effect of test-material thickness on pullout properties. Mean values were compared using 2-way ANOVA. Statistical significance was set at P <.05. RESULTS--In both the 4.96-mm and 6.8-mm synthetic material, pullout testing of the completely inserted STS demonstrated significantly greater yield strength and ultimate strength than completely inserted CS. There was no significant difference between incompletely inserted STS and completely inserted STS. The 6.8-mm test material significantly increased yield strength and ultimate strength for all test groups compared with the 4.96-mm test material. In canine bone, there was no significant difference in yield strength of completely inserted STS and completely inserted CS. Yield strength of completely inserted STS and completely inserted CS were significantly greater than incompletely inserted STS. CONCLUSIONS--Pullout properties of completely inserted STS were significantly greater than corresponding CS in a uniform test material. In canine bone, the pullout strength of STS and CS were not different. Incomplete STS insertion resulted in an 18% reduction in holding power as compared with completely inserted CS and STS in canine bone. CLINICAL RELEVANCE--The length of STS used in canine bone should be such that the cutting flutes extend beyond the trans cortex to maximize pullout strength.

Animals↗

PubMed2003

Utility of dual skin tests to evaluate tuberculin skin test reactions of 10 to 14 mm in healthcare workers.

OBJECTIVE: To define the utility of 10- to 14-mm reactions to a Mycobacterium tuberculosis purified protein derivative (PPD) skin test for healthcare workers (HCWs). DESIGN: Blinded dual skin testing, using PPD and M. avium sensitin, of HCWs at a single medical center who had a 10- to 14-mm reaction to PPD when tested by personnel from the Occupational Health Department as part of routine annual screening. SETTING: A single tertiary-care academic medical center. PARTICIPANTS: Employees of the medical center who underwent routine annual PPD screening and were identified by the Occupational Health Department as having a reaction of 10 to 14 mm to PPD. RESULTS: Nineteen employees were identified as candidates and 11 underwent dual skin testing. Only 4 (36%) had repeat results for PPD in the 10- to 14-mm range, whether read by Occupational Health Department personnel or study investigators. For only 5 (45%) of the subjects did the Occupational Health Department personnel and study investigators concur (+/- 3 mm) on the size of the PPD reaction. Two of the 4 subjects with reactions of 10 to 14 mm as measured by the study investigators were M. avium sensitin dominant, 1 was PPD dominant, and 1 was nondominant. CONCLUSION: A reaction of 10 to 14 mm to PPD should not be used as an indication for the treatment of latent tuberculosis (TB) infection in healthy HCWs born in the United States with no known exposure to TB.

Hospitals, University↗

PubMed2002

Transperitoneal laparoscopic renal surgery using blunt 12-mm trocar without fascial closure.

BACKGROUND AND PURPOSE: Conical blunt trocar insertion may eliminate the need for fascial closure (FC) in transperitoneal laparoscopic renal surgery. This concept applies to 12-mm blunt trocar placement through muscular parts of the abdominal wall, relying on muscle splitting and eventual muscle retraction when the trocar is removed. We retrospectively assessed the safety of fascial nonclosure (FNC) after 12-mm blunt port insertion. PATIENTS AND METHODS: Ninety transperitoneal laparoscopic renal procedures were performed between August 1999 and May 2000. Four ports (two 12 mm and two 5 mm) were usually used except for 30 donor nephrectomies, where an additional 5-mm port was used. The 12-mm trocars were inserted at the lateral border of the rectus muscle 5 cm below the costal margin and in the anterior axillary line 8 cm below the costal margin. Fascial closure was performed in 62 patients and nonclosure in 28 patients. Exclusion criteria for FNC included midline location, malnutrition, renal failure, and chronic use of steroids. Postoperative outcomes were compared in 20 patients with FNC matched with 20 patients with FC. RESULTS: At an average of 4.8 months of follow-up, none of the patients developed a trocar site hernia. No significant statistical differences were observed between the groups with regard to intraoperative and postoperative data. CONCLUSIONS: These two approaches appear to be equivalent in terms of patient morbidity and postoperative hospital stay. Fascial nonclosure after transperitoneal 12-mm blunt trocar insertion, through muscular parts of the abdominal wall may be safe and efficacious and eliminates the last step in transperitoneal laparoscopic renal surgery.

Adult↗

PubMed2006

Clinical relevance of melanoma micrometastases (<0.1 mm) in sentinel nodes: are these nodes to be considered negative?

As only about 20% of sentinel node (SN) positive melanoma patients have additional non-SN lymph node involvement in the Completion Lymph Node Dissection (CLND) specimen, we tried to identify a SN positive patient group, which can be spared CLND. Micro anatomic analyses of metastatic SNs were performed to identify patient/tumor and/or SN factors predicting additional non-SN positivity as well as disease-free and overall survival. SN positivity was found in 77 of 262 stage I/II patients, included into a prospective database (10/97-5/04). Of 74 patients pathology material was available for re-evaluation. Micro anatomic analyses categorized topography of SN-metastases, Starz classification and amount of SN tumor burden. Additional non-SN positivity, DFS, OS and was calculated for all analyses. Mean Breslow thickness was 3.5 mm (0.8-12.0); mean FU was 35 (6-81) months. There was no additional non-SN positivity for SN-micrometastases <0.1 mm. Topography of SN involvement had no impact on OS. Estimated 5-year OS rates for the different groups of <0.1 mm, 0.1-1.0 mm and >1.0 mm SN tumor burden were 100%, 63% and 35% respectively. Distant metastases were exceedingly rare (1/16 = 6.3%) in <0.1 mm SN-positive patients. On multivariate analysis the SN tumor burden was the most important prognostic factor for DFS (P = 0.005) and OS (P = 0.03). Distant metastasis-free survival was identical (91%) to the 5-yr OS of SN negative patients, the estimated 5-yr OS was 100% for these patients and additional non-SN positivity was not observed. Therefore, our data suggest that patients with sub-micrometastases (<0.1 mm) in the SN may be judged as SN negative, as non-stage III, and are highly unlikely to benefit from CLND, which we no longer recommend.

Adolescent↗

PubMed1997

Functional interrelationships between follicles greater than 4 mm and the follicle-stimulating hormone surge in heifers.

The interrelationships between the FSH surge that initiates a follicular wave and the follicles in the wave were examined in heifers. In experiment 1, > or = 5-mm follicles were ablated 5 days after ovulation and heifers (n = 6/group) received a total dosage of 0, 37.5, 75, or 150 units of porcine FSH. Half of the FSH dosage was administered 24 h after ablation followed by the other half 12 h later. Blood samples were taken after the initial FSH injection for FSH assay, and ovaries were examined daily with ultrasound to monitor follicle growth. There were progressively higher FSH concentrations at the mean peak (8 h after initial injection in all groups) as the dosage increased (interaction of dose and time; p < 0.001). Compared to values in controls, the highest dosage (150 units) approximately doubled the number of 5- and 6-mm follicles; this then progressed into a 4- to 7-fold increase in the number of 7- and 8-mm follicles. In experiment 2, either all (controls; n = 6), two (n = 11), one (n = 6), or zero (n = 6) follicles of the first wave of an estrous cycle were retained and the remaining were ablated upon reaching 5 mm. Scanning and blood sampling were performed every 8 h for 72 h after the initial ablation. Mean FSH concentrations during 0 to 72 h decreased (p < 0.004) as the number of retained follicles increased. In heifers in the one-follicle group, the randomly chosen 5-mm follicle developed the characteristics of a dominant follicle. The following conclusions were made: 1) the number of follicles that advanced into a follicular wave was increased by exaggerating the height of the FSH surge, 2) all > or = 5-mm follicles of a wave contributed to the declining portion of the FSH surge, and 3) any 5-mm follicles at the emergence of a wave were capable of becoming the dominant follicle.

Animals↗

PubMed1997

Safe epidural analgesia in thirty parturients with platelet counts between 69,000 and 98,000 mm(-3).

Regional anesthesia is a popular form of pain relief for the management of labor and delivery. Thrombocytopenia is considered a relative contraindication to the administration of regional anesthesia. Some authorities have recommended that an epidural anesthetic be withheld if the platelet count is <100,000 mm(-3). For the period of March 1993 through February 1996, we reviewed the charts of all parturients who had a platelet count <100,000 mm(-3) during the peripartum period. Eighty women met this criterion. Of these 80, 30 had an epidural anesthetic placed when the platelet count was <100,000 mm(-3) (range 69,000-98,000 mm(-3)), 22 had an epidural anesthetic placed with a platelet count >100,000 mm(-3) that subsequently decreased below 100,000 mm(-3), and 28 did not receive a regional anesthetic. We found no documentation of any neurologic complications in the medical records. We conclude that regional anesthesia should not necessarily be withheld when the platelet count is <100,000 mm(-3).

Analgesia, Epidural↗

PubMed1985

Thin (less than or equal to 1 mm) melanomas of the extremities are biologically favorable lesions not influenced by regression.

Although a thickness of less than or equal to 0.76 mm has been used to define biologically favorable (thin) melanoma, there is evidence that 1 mm may be a reasonable cutoff to categorize favorable extremity melanomas. This is tempered, however, by the claim that histologic regression in thin melanomas is associated with an increased metastatic rate. We have therefore addressed the following questions: Is 1 mm an appropriate cutoff point to define thin melanoma on the extremities? Does regression in a thin lesion truly signify a poor prognosis? Is the width of excision (narrow vs. wide) related to recurrence rates in these lesions? To address these issues we reviewed 48 patients with extremity melanomas, less than or equal to 1 mm in maximum thickness, treated at this institution during a 20-year period. Pathologic features included histologic type: superficial spreading (90%), nodular (6%), and not classified (4%); thickness: less than 0.76 mm (61%) and 0.76 to 1 mm (39%); and Clark's level: II (33%), III (63%), and IV (4%). A moderate or marked lymphoid infiltrate occurred in 75%, and histologic tumor regression was found in 50%. The median margin of excision, as stated by the surgeon, was 4 cm. The median margin measured by the pathologist in unfixed specimens was 3.5 cm. Although 13% had atypical melanocytic hyperplasia in the initial excisional biopsy margin, all reexcisions were clear. Of 21 patients having node dissections, none had nodal metastases. There were no recurrences or deaths due to melanoma (median follow-up: 90 months). We conclude that melanomas less than or equal to 1 mm in thickness on the extremities can be defined as biologically highly favorable, "thin" lesions. Foci of regression do not alter their behavior. Their favorable prognosis justifies conservative excision in most cases.

Adult↗

PubMed2004

An "all 5-mm ports" selective approach to laparoscopic cholecystectomy, appendectomy, and anti-reflux surgery.

Laparoscopic appendectomy, cholecystectomy, or anti-reflux procedures are conventionally performed with the use of one and often two 10/12-mm ports. While needlescopic or micropuncture laparoscopic procedures reduce postoperative pain, they invariably involve the use of one 10/12-mm port and the instruments applied have their ergo-dynamic shortcomings. Between September 2002 and March 2003, we have attempted an "all 5-mm ports" approach in 49 laparoscopic procedures, which included 18 of 59 laparoscopic cholecystectomies (31%), 26 diagnostic laparoscopies for suspected appendicitis (of which we proceeded to a laparoscopic appendectomy in 17 patients), and in the last 5 of 9 laparoscopic Nissen fundoplications. Conversion of one of the 5-mm ports to a 10-mm port was required in 5 of the 18 (28%) laparoscopic cholecystectomies and in 6 of the 17 (35%) laparoscopic appendectomies to facilitate organ retrieval in patients with large gallstones (>5 mm in diameter) and in obese patients with fatty mesoappendix. There were no conversions to open surgery. No significant differences in the operating time between the laparoscopic procedures performed by the all 5-mm ports approach or the conventional approach were observed. No intraoperative or postoperative complications occurred in this series. The "all 5-mm ports" approach to laparoscopic cholecystectomy and appendectomy in selected patients and to laparoscopic fundoplication appears feasible and safe. A randomised comparison between this approach and the conventional laparoscopic approach to elective cholecystectomy and fundoplication in which two of the ports employed are of the 10-mm diameter is warranted.

Appendectomy↗

PubMed2004

Comparison of 27-gauge (0.41-mm) Whitacre and Quincke spinal needles with respect to post-dural puncture headache and non-dural puncture headache.

BACKGROUND: The incidence of headache after spinal anaesthesia has varied greatly between studies. We compared the incidence of postoperative headache in general and postdural puncture headache (PDPH) when using 27-gauge (G) (outer diameter 0.41 mm) Quincke and Whitacre spinal needles in ambulatory surgery performed under spinal anaesthesia. METHODS: In a prospective, randomized study, 676 ASA physical status I-II day-case outpatients were given a spinal anaesthetic through either a 27-G (0.41 mm) Quincke or a 27-G (0.41 mm) Whitacre spinal needle. The incidence of any type of postoperative headache was assessed and the type of headache defined using a standardized questionnaire including PDPH criteria. The severity of the headache was defined using a 100-mm visual analogue scale. RESULTS: For the final analysis, 529 patients were available (259 patients in the Quincke group and 270 patients in the Whitacre group). The overall incidence of postoperative headache was 20.0%, but the incidence of true PDPH was very low (1.51%). The incidence of PDPH in the Quincke group was 2.70%, while in the Whitacre group it was only 0.37% (P < 0.05). The overall incidence of non-dural puncture headache was 18.5% and did not differ between the study groups. CONCLUSIONS: True PDPH seldom occurs when a 27-G (0.41 mm) spinal needle is used, although postoperatively a non-specific headache is common. Using the 27-G (0.41 mm) Whitacre spinal needle further reduced the incidence of PDPH. Thus, we recommend routine use of the 27-G (0.41 mm) Whitacre spinal needle when performing spinal anaesthesia.

Adult↗

PubMed2006

Attempted forced titration of blood pressure to <130/85 mm Hg in type 2 diabetic hypertensive patients in clinical practice: the diastolic cost.

The authors assessed the practicality and results of forced titrating of blood pressure to <130/85 mm Hg based on guidelines of the sixth Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure in the setting of a clinical practice in 257 diabetic, hypertensive patients. Goal diastolic pressure was achieved in 90% of the patients, but goal systolic pressure was achieved in only 33%. In 57% of the patients, the attained diastolic pressure was < or =70 mm Hg, and in 20% of the cohort diastolic pressure was reduced to <70 mm Hg (mean, 60+/-1 mm Hg). Patients with final diastolic pressure <70 mm Hg were older, had a higher prevalence of coronary artery disease, and higher initial systolic and pulse pressures compared with patients with final diastolic pressure of 71-85 mm Hg. Thus, attempted lowering of blood pressure to <130/85 mm Hg is associated with excessive lowering of diastolic pressure in a significant number of patients. Whether the benefits of tight systolic control outweigh the risks of excessive diastolic reduction requires further prospective assessment.

Aged↗