We have studied the effects of preoperative administration of diclofenac on suxamethonium-induced myalgia, plasma met-enkephalin-like activity (E-LA), prostaglandin E2-like activity (PGE2-LA), ...leukotriene C4-like activity (LTC4-LA) and histamine-like activity (H-LA). Thirty-four ASA I patients undergoing elective ophthalmic surgery were allocated randomly to two groups to receive either saline placebo or diclofenac 75 mg i.m. 20 min before operation, in a double-blind design. Anaesthesia was induced with thiopentone 5-7 mg kg-1 followed by suxamethonium 1.5 mg kg-1 and maintained with 67% nitrous oxide and halothane in oxygen. Plasma PGE2-LA, LTC4-LA, H-LA and E-LA were measured before premedication, 1 min after the administration of suxamethonium and 24 h after operation. Muscle fasciculations, intubation conditions and postoperative myalgia were graded numerically. Postoperative myalgia in the diclofenac group was significantly (P < 0.05) less (47.1%) than in the control group (76.5%). Post-suxamethonium and 24-h concentrations of plasma PGE2-LA and LTC4-LA were also significantly (P < 0.05) greater than baseline in the control group. Plasma H-LA was increased in both groups after suxamethonium and this increase was significant (P < 0.05) in the control group. We conclude that diclofenac reduces significantly the incidence and intensity of suxamethonium-induced myalgia.
BACKGROUND:Data on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) guide therapy in severe traumatic brain injury (TBI), but current linear analytic methods are insufficiently ...sensitive and specific for prognosis in dynamic situations over time.
METHODS:We have developed algorithms incorporating continuous, automated, digital ICP and CPP monitoring data into a pressure times time “dose” function. In this study, we calculated cumulative doses using thresholds of ICP >20 mm Hg and CPP <60 mm Hg and graphed these as a Brain Trauma Index (BTI or CPP/ICP). Using receiver operator characteristics analysis, we examined BTI <3 and BTI <2 and various threshold levels of pressure times time doses of ICP and CPP as predictors of 30-day mortality and Extended Glasgow Outcome Scale (GOSE) <5 at 6 months and 12 months. Using the data processing and analysis tools underlying this work, we are also piloting a real-time bedside and telemetric display system as a means of indentifying and monitoring critical changes in physiologic metrics, including BTI, CPP, and ICP.
RESULTS:Sixty subjects yielded 8678.1 hours of data (5,206,860 data points). BTI <2 was better than CPP <60 mm Hg in predicting unfavorable Extended Glasgow Outcome Scale at 6 months (p <0.05). An example of linear and graphically processed BTI, CPP, and ICP data from a representative TBI patient is provided.
CONCLUSION:Calculation of a BTI from continuous digital data predicts outcome in severe TBI and has potential for the design of real-time bedside early warning systems.
To report the pregnancy outcome after transabdominal multifetal pregnancy reduction in multiple pregnancies achieved by intracytoplasmic sperm injection.
One twin and 13 triplet pregnancies obtained ...by intracytoplasmic sperm injection underwent pregnancy reduction. Pregnancies were achieved with ejaculated sperm in 8, testicular sperm in 3, and epididymal sperm in 2 of these cases. All triplet pregnancies were reduced to twins at 10-12 weeks' gestation by transabdominal potassium chloride injection. A twin pregnancy with spina bifida affecting 1 fetus was reduced to singleton at 18 weeks of pregnancy.
There was no failed procedure and no pregnancy loss within the first 4 weeks after the procedure. A complete miscarriage (7.1%) developed in 1 case at 17 weeks' gestation which was due most probably to the incompetent cervix. In utero fetal death occurred in 1 fetus of another reduced pregnancy. Three of the reduced pregnancies delivered at term, after 37 completed weeks, four premature deliveries occurred between 31 and 35 gestational weeks, and four pregnancies were ongoing beyond 25 weeks' gestation. A total of 16 fetuses, from seven twin and two singleton pregnancies, were delivered without perinatal mortality.
Although the sample size was small, our experience indicates that the reduction of triplets obtained by sophisticated infertility treatments such as intracytoplasmic sperm injection using testicular or epididymal sperm seems to be a safe method and can be effectively used.
Kahraman et al investigate the relations between the penetration rate of percussive drills and both coarseness index (CI) and median particle size (MPS) values. It is shown that CI and MPS values ...strongly correlate with penetration rates of percussive drills. Therefore, CI and MPS may be a representative measure of penetration rate of percussive drills.
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