Diazepam as an oral hypnotic increases nocturnal blood pressure in the elderly.

BACKGROUND: No study has evaluated the cardiovascular effects of diazepam in elderly subjects that assume diazepam to induce sleep. PURPOSE: The present study was carried out in order to evaluate the effects of chronic administration of diazepam as hypnotic drug on blood pressure (BP) and heart rate (HR) in healthy elderly subjects. PATIENTS AND METHODS: Healthy, elderly subjects, aged 65-74 years, were treated with diazepam 5 mg or placebo-both administered once a day in the evening-for 4 weeks in two cross-over periods, each separated by a 2-week placebo period, according to a randomized, double-blind, cross-over design. At the end of each study period, clinical as well as 24-h ambulatory BP and HR were evaluated. RESULTS: A total of 25 subjects were included in the analysis. At the end of a 4-week diazepam treatment, clinical as well 24-h BP and HR mean values were not significantly affected. Analysis of sub-periods showed that during night-time, systolic BP (SBP) values under diazepam were 7.6% higher than under placebo, with a mean difference of 7.9 mmHg (p < 0.01), diastolic BP (DBP) values were 5.8% higher, with a mean difference of 3.7 mmHg (p < 0.05 vs placebo) and HR values were 6.6% higher with a mean difference of 4.2 b/min (p < 0.05). The HR increase observed with diazepam persisted during the morning hours, whereas during the afternoon and evening hours SBP, DBP and HR values were similar in the two treatment groups. CONCLUSIONS: In elderly subjects chronic assumption of diazepam as hypnotic agent produced an increase in BP, in particular SBP, during night-time and of HR during night-time and morning hours. These effects, which probably depend on a diazepam-mediated increase in sympathetic drive and decrease in vagal tone, might be of clinical relevance due to the role of increased BP and HR as independent predictors of cardiovascular morbidity and mortality.

The pie-crust surgical technique for medial collateral ligament release: enhancing visualization of the medial compartment in knee arthroscopy.

This study presents a comprehensive surgical technique for performing a 'pie-crust' release of the medial collateral ligament (MCL) to enhance visualization of the medial compartment during arthroscopic knee procedures. The primary objective of this research is to improve the precision of diagnosis and treatment for injuries specifically affecting the posterior horn and posterior root of the medial meniscus. Arthroscopic knee procedures have become increasingly common in orthopedic surgery, offering the advantage of minimally invasive techniques for treating a wide range of knee conditions. However, accessing and visualizing the posterior structures within the medial compartment can be challenging. To overcome this limitation, the surgical technique presented in this study offers a systematic approach that includes patient positioning, precise identification of anatomical landmarks, and a detailed, step-by-step procedural description. The process begins with meticulous marking of anatomical landmarks to provide reference points. Precisely identifying the location for the MCL release is of utmost importance. This involves making needle punctures with guidance from arthroscopic visualization and applying valgus strain to the knee as necessary. One of the key advantages of this described surgical technique is its focus on safety and efficacy. Surgeons can work more confidently and precisely by reducing the risk of iatrogenic cartilage damage and facilitating access to the posterior structures within the medial compartment. Clinical outcomes from this approach have demonstrated consistently favorable results, leading to improved patient recovery and reduced complications. Furthermore, it is noteworthy that the postoperative use of a brace is not mandatory, adding to the appeal of this technique for both patients and surgeons. This surgical technique's enhanced visualization and optimized treatment outcomes make it a valuable tool in the arsenal of orthopedic surgeons specializing in knee arthroscopy. In conclusion, this study's surgical technique has the potential to significantly improve the diagnosis and treatment of patients with meniscal injuries in the medial compartment, ultimately leading to better clinical outcomes and patient satisfaction.

Lateral Extra-articular Tenodesis With Cortical Suspensory Femoral Fixation and Suture Tape Augmentation.

This article aims to provide a new surgical technique for rotational instability in the setting of anterior cruciate ligament rupture. Two main groups of surgical procedures can be identified in the treatment of anterolateral knee instability: lateral extra-articular tenodesis and anterolateral ligament reconstruction. Although the importance of anterior cruciate ligament reconstruction in anterolateral complex injuries is well known, the superiority of lateral extra-articular tenodesis over anterolateral ligament reconstruction or vice versa has not yet been shown. Both techniques show improved outcomes and reduced graft failure rates. The presented procedure can be considered a modification of the technique first described by Lemaire. Better tensioning can be achieved through cortical suspension by identifying the anisometric point on the lateral femur and performing a medial pullout on the femoral side. The advantages of this technique are better fine-tuning and tensioning, less invasiveness, and adjustable cortical fixation, which allows for a precise, incremental tensioning of the graft, ensuring circumferential healing of the graft within the socket and reducing the risk of graft laceration, which may happen with interference screws. Internal bracing provides excellent contact pressure between the femoral button and femoral cortex, ensuring that adequate tensioning is applied to the graft.

Phase-contrast neutron imaging compared with wave propagation and McStas simulations.

Propagation-based phase contrast, for example in the form of edge enhancement contrast, is well established within X-ray imaging but is not widely used in neutron imaging. This technique can help increase the contrast of low-attenuation samples but may confuse quantitative absorption measurements. Therefore, it is important to understand the experimental parameters that cause and amplify or dampen this effect in order to optimize future experiments properly. Two simulation approaches have been investigated, a wave-based simulation and a particle-based simulation conducted in McStas [Willendrup & Lefmann (2020). J. Neutron Res. 22, 1-16], and they are compared with experimental data. The experiment was done on a sample of metal foils with weakly and strongly neutron absorbing layers, which were measured while varying the rotation angle and propagation distance from the sample. The experimental data show multiple signals: attenuation, phase contrast and reflection. The wave model reproduces the sample attenuation and the phase peaks but it does not reproduce the behavior of these peaks as a function of rotation angle. The McStas simulation agrees better with the experimental data, as it reproduces attenuation, phase peaks and reflection, as well as the change in these signals as a function of rotation angle and distance. This suggests that the McStas simulation approach, where the particle description of the neutron facilitates the incorporation of multiple effects, is the most convenient way of modeling edge enhancement in neutron imaging.