Comparison of intermediate vs subcutaneous cervical plexus block for carotid endarterectomy.

BACKGROUND: Carotid endarterectomy surgery can be performed under regional anaesthesia alone or under general anaesthesia. However, there are several types of regional block available and reported complication rates after superficial cervical plexus blocks are significantly lower than deep blocks. It is not known if subcutaneous and intermediate blocks are equally effective, although anatomical evidence suggests that the latter (where the injectate diffuses below the deep cervical fascia) might provide superior quality of intraoperative anaesthesia. METHODS: Forty-four patients were randomized to receive either subcutaneous or intermediate cervical plexus blocks for carotid endarterectomy. The primary endpoint was supplemental lidocaine requirement during surgery. Secondary outcome measures included: total amount of fentanyl administered during surgery, recall of pain scores during surgery, complications, and patient and surgeon satisfaction. RESULTS: There was no statistically significant difference for median (range) lidocaine supplementation between the subcutaneous and intermediate groups 65 (20-170) mg vs. 85 (30-345) mg, respectively; P=0.31. There were no statistical differences in the secondary outcome measures and no major complications during the study. CONCLUSIONS: Intermediate and subcutaneous cervical plexus blocks are equally effective for carotid endarterectomy. This study adds to the body of evidence supporting the safe use of superficial blocks for this type of surgery.

The onshore transport of an oil spill by internal waves.

Internal waves generated by tidal currents concentrated and transported an oil spill (liquid asphalt) onshore. Plankton net samples were collected in front of and behind a set of internal waves as well as in the convergence and divergence zones over the waves. Tar "balls" were most abundant (greater than 30-fold) in the samples from the convergence zone. Comparison of the abundance of tar balls in front of and behind the set of waves suggests that the internal waves "caught" about 68% of the asphalt encountered and concentrated and swept shoreward tar balls from almost 8 kilometers of ocean.

Marine snow: microplankton habitat and source of small-scale patchiness in pelagic populations.

In near-surface waters of the neritic zone, the fragile aggregate material called "marine snow" is enriched by a variety of planktonic organisms and detrital products of plankton. Here marine snow is a source of patchiness and taxonomic diversity for microplankton populations and is a likely food resource and recycling agent for fecal particles.

Estimation of infectious dose and viral shedding rates for infectious pancreatic necrosis virus in Atlantic salmon, Salmo salar L., post-smolts.

Infectious dose and shedding rates are important parameters to estimate in order to understand the transmission of infectious pancreatic necrosis virus (IPNV). Bath challenge of Atlantic salmon post-smolts was selected as the route of experimental infection as this mimics a major natural route of exposure to IPNV infection. Doses ranging from 10(2) to 10(-4) 50% end-point tissue culture infectious dose (TCID(50)) mL(-1) sea water were used to estimate the minimum infectious dose for a Scottish isolate of IPNV. The minimum dose required to induce infection in Atlantic salmon post-smolts was <10(-1) TCID(50) mL(-1) by bath immersion (4 h at 10 degrees C). The peak shedding rate for IPNV following intraperitoneal challenge using post-smolts was estimated to be 6.8 x 10(3) TCID(50) h(-1) kg(-1) and occurred 11 days post-challenge. This information may be incorporated into mathematical models to increase the understanding of the dispersal of IPNV from marine salmon sites.

Comparative susceptibility of turbot Scophthalmus maximus to different genotypes of viral haemorrhagic septicaemia virus.

Viral haemorrhagic septicaemia (VHS) disease has exerted a significant impact on the development of turbot aquaculture in the British Isles. The source of such outbreaks is believed to be naturally occurring marine isolates of viral haemorrhagic septicaemia virus (VHSV), which are endemic in the marine environment of Northern Europe. Genetic studies have classified these marine VHSV isolates into genotypes based on their geographic rather than host-species origin. This study set out to explore the hypothesis that susceptibility of turbot to VHSV might be genotype specific. Immersion infection of turbot with a range of isolates, selected according to genotype, identified significant differences between susceptibility and genotype. Viruses belonging to Genotypes Ib (Baltic marine isolates) and III (North Sea/E. Atlantic marine isolates) caused significantly higher mortality than isolates from Genotypes Ia (isolates associated with rainbow trout aquaculture) and II (Baltic marine isolates). This study serves to highlight the importance of thoroughly investigating the susceptibility of any given species to the range of pathogens to which they might be exposed prior to considering them resistant to any disease. Furthermore, it highlights different risk factors that might be associated with turbot aquaculture undertaken in different environments. Finally, an increased knowledge of the relative virulence of different isolates in turbot will assist in understanding virulence determinants, which could lead to advances in disease control.

Back injuries in competitive squash players.

BACKGROUND: The aim of this investigation was to examine the prevalence of back injuries in competitive squash players. EXPERIMENTAL DESIGN: a retrospective analysis was made using a cross-section of current competitive squash players (survivor population). SETTING/PARTICIPANTS: an attempt was made to distribute a questionnaire on back injuries to all competitive squash players registered in the Otago provincial area, New Zealand, (n = 1047), of which 495 questionnaires were returned (47.3% compliance). INTERVENTIONS: variables were cross-tabulated and analysed via descriptive statistics, paired t-tests, chi-analyses of trend and chi 2 tests of significance. MEASURES: the questionnaire obtained information on demographics, the level of play (ability), overall volume of play (average frequency and duration of all exposures), plus the occurrence and severity of back injury. RESULTS: Nearly 52% of the sample reported they had suffered back injury. Of these, 33.5% claimed squash initiated their injury, 20.6% claimed squash exacerbated a previous back injury and the remaining 45.9% felt that squash had no detrimental effect on their back injury. Significantly higher frequencies of back injury were observed in males (56.5% compared to 46.4% in females, p = 0.033), in players of higher grade (p = 0.006),and with increased frequency (p = 0.01), but not duration of play (p = 1.0). CONCLUSIONS: These results suggest that the greater activity and possible over-reaching for the ball associated with higher levels of play may increase the risk of back injury and provides tentative support for the notion that back injuries in squash players might be related to periods of relative over-use.

Gestational weight gain in insulin-resistant pregnancies.

OBJECTIVE: To examine the Institute of Medicine (IOM) guidelines for gestational weight gain (GWG) in insulin-resistant pregnancy. STUDY DESIGN: Secondary analysis of a prospective cohort of 435 women with type 2 or gestational diabetes from 2006 to 2010. The exposure was categorized as GWG less than, within or greater than the IOM recommendations for body mass index. The maternal outcome was a composite of preeclampsia, eclampsia, third- to fourth-degree laceration, readmission or wound infection. The neonatal outcome was a composite of preterm delivery, level 3 nursery admission, oxygen requirement >6 h, shoulder dystocia, 5-min Apgar3, umbilical cord arterial pH<7.1 or base excess <-12. Secondary outcomes were cesarean delivery (CD), macrosomia and small for gestational age (SGA). RESULT: Incidence of the maternal outcome did not differ with GWG (P=0.15). Women gaining more than recommended had an increased risk of CD (relative risk (RR) 1.31, 95% confidence interval (CI) 1.01 to 1.69) and the neonatal outcome (RR 1.40, 95% CI 1.01 to 1.95) compared with women gaining within the IOM recommendations. Women gaining less than recommended had an increased risk of SGA (RR 3.29, 95% CI 1.09 to 9.91) without a decrease in the risk of the maternal outcome (RR 0.93, 95% CI 0.49 to 1.78) or CD (RR 0.74, 95% CI 0.40 to 1.37) compared with women gaining within the IOM recommendations. CONCLUSION: Women with insulin resistance should be advised to gain within the current IOM guidelines.

Properties of genes involved in the control of isocitrate lyase production in Aspergillus nidulans.

The interaction between genes of Aspergillus nidulans conferring constitutive synthesis of isocitrate lyase (iclc A and iclcB) and fluoroacetate resistance (facB) has been investigated. Although facB mutants are unable to induce the glyoxylate cycle enzyme isocitrate lyase in response to acetate as sole carbon source, this phenotype was suppressed in recombinants of the type iclc;facB. The iclcA and iclcB mutations do not alter significantly the activities of eight enzymes of intermediary metabolism assayed. We conclude that the iclc genes are probably bona fide isocitrate lyase regulatory genes.

Prolonged neuromuscular blockade following vecuronium. A case report.

Vecuronium was used to provide muscle relaxation in a patient who subsequently developed prolonged neuromuscular blockade (8 h) after anaesthesia. The aetiology of this condition, and the possible role of vecuronium, are discussed.

Some effects of vitamin E and selenium deprivation on tissue enzyme levels and indices of tissue peroxidation in rainbow trout (Salmo gairdneri).

Duplicate groups of rainbow trout (Salmo gairdneri) (mean weight 11 g) were given for 40 weeks one of four partially purified diets that were either adequate or low in selenium or vitamin E or both. Weight gains of trout given the dually deficient diet were significantly lower than those of trout given a complete diet or a diet deficient in Se. No mortalities occurred and the only pathology seen was exudative diathesis in the dually deficient trout. There was significant interaction between the two nutrients both with respect to packed cell volume and to malondialdehyde formation in the in vitro NADPH-dependent microsomal lipid peroxidation system. Tissue levels of vitamin E and Se decreased to very low levels in trout given diets lacking these nutrients. For plasma there was a significant effect of dietary vitamin E on Se concentration. Glutathione (GSH) peroxidase (EC 1.11.1.9) activity in liver and plasma was significantly lower in trout receiving low dietary Se but was independent of vitamin E intake. The ratios of hepatic GSH peroxidase activity measured with cumene hydroperoxide and hydrogen peroxide were the same for all treatments. This confirms the absence of a Se-independent GSH peroxidase activity in trout liver. Se deficiency did not lead to any compensatory increase in hepatic GSH transferase (EC 2.5.1.18) activity; values were essentially the same in all treatments. Plasma pyruvate kinase (EC 2.7.1.40) activity increased significantly in the trout deficient in both nutrients. This was thought to be due to leakage of the enzyme from the muscle and may be indicative of incipient (subclinical) muscle damage.

Control of blood gas measurements in intensive-care units.

The frequency of blood gas measurement in two adult intensive-care units was assessed for 7 months before and 12 months after introduction of a protocol of indications for such investigation. Demographic, diagnostic, outcome, and intervention data were collected prospectively. There were no differences in demographic characteristics, severity or type of illness, survival, or frequency of arterial or pulmonary artery catheter use between the two observation periods, but the frequency of blood gas analysis fell by 44% (p less than 0.001) after the protocol was introduced.

High-dose thiopentone for open-chamber cardiac surgery: a retrospective review.

PURPOSE: High-dose thiopentone has been reported to reduce the incidence of neurological dysfunction after open-chamber cardiac surgery. However, this technique delays tracheal extubation and increases requirements for inotropic support after cardiopulmonary bypass. As a quality assurance measure to determine the safety of high-dose thiopentone, we reviewed the records of all patients undergoing elective, open-chamber surgery at our institution between 1st March, 1987 and 31st Dec, 1989. METHODS: The charts of 236 patients were reviewed retrospectively, and 227 met our inclusion criteria. The perioperative characteristics of patients anaesthetized with thiopentone (Group T, n = 80) were compared with those of patients anaesthetized with opioids (Group O, n = 147). RESULTS: Anaesthetic technique was chosen by the attending anaesthetist. in Group T (n = 80) thiopentone 38.1 +/- 11.8 mg.kg-1 was infused to produce electroencephalographic burst-suppression during bypass. Moderate hypothermia and arterial line filtration were used during bypass. The groups did not differ with respect to demographics, type of surgery, or conduct of bypass. There were no strokes in Group T and 4 in Group O (P = NS). The time to extubation was prolonged in Group T compared with Group O (39 +/- 51 vs 27 +/- 24 h, P = 0.014), as was the duration of stay in intensive care (66 +/- 56 vs 51 +/- 29 h, P = 0.010). Thiopentone did not increase the need for inotropic or mechanical support after bypass. In-hospital mortality was lower in Group T than in Group O (1.2% vs 9.5%, P = 0.034). CONCLUSION: High-dose thiopentone delays extubation after open-chamber procedures. However, the technique appears safe, and further prospective investigation is justifiable.