Epidural pain relief versus systemic opioid-based pain relief for abdominal aortic surgery.

BACKGROUND: Epidural analgesia offers greater pain relief compared to systemic opioid-based medications, but its effect on morbidity and mortality is unclear. OBJECTIVES: To assess the benefits and harms of postoperative epidural analgesia in comparison with postoperative systemic opioid-based pain relief for adult patients who underwent elective abdominal aortic surgery. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials via OVID (CENTRAL) (The Cochrane Library, Issue 3, 2004); OVID MEDLINE (1966 to July 2004); and EMBASE (1980 to June 2004). We assessed non-English language reports and contacted researchers in the field. We did not seek unpublished data. SELECTION CRITERIA: We included all randomized controlled trials comparing postoperative epidural analgesia and postoperative systemic opioid-based analgesia for adult patients who underwent elective open abdominal aortic surgery. DATA COLLECTION AND ANALYSIS: Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information and data. MAIN RESULTS: Thirteen studies involving 1224 patients met our inclusion criteria; 597 patients received epidural analgesia and 627 received systemic opioid analgesia. The epidural analgesia group showed significantly lower visual analogue scale for pain on movement (up to postoperative day three), regardless of the site of epidural catheter and epidural formulation. Postoperative duration of tracheal intubation and mechanical ventilation was significantly shorter by about 20% in the epidural analgesia group. The overall incidence of cardiovascular complication; myocardial infarction; acute respiratory failure (defined as an extended need for mechanical ventilation); gastrointestinal complication; and renal insufficiency was significantly lower in the epidural analgesia group, especially in trials that used thoracic epidural analgesia. AUTHORS' CONCLUSIONS: Epidural analgesia provides better pain relief (especially during movement) for up to three postoperative days. It reduces the duration of postoperative tracheal intubation by roughly 20%. The occurrence of prolonged postoperative mechanical ventilation, overall cardiac complication, myocardial infarction, gastric complication and renal complication was also reduced by epidural analgesia, especially thoracic. However, current evidence does not confirm the beneficial effect of epidural analgesia on postoperative mortality and other types of complications.

Repair of chronic osteochondral defects in the rat. A bone marrow-stimulating procedure enhanced by cultured allogenic bone marrow mesenchymal stromal cells.

Bone marrow mesenchymal stromal cells were aspirated from immature male green fluorescent protein transgenic rats and cultured in a monolayer. Four weeks after the creation of the osteochondral defect, the rats were divided into three groups of 18: the control group, treated with an intra-articular injection of phosphate-buffered saline only; the drilling group, treated with an intra-articular injection of phosphate-buffered saline with a bone marrow-stimulating procedure; and the bone marrow mesenchymal stromal cells group, treated with an intra-articular injection of bone marrow mesenchymal stromal cells plus a bone marrow-stimulating procedure. The rats were then killed at 4, 8 and 12 weeks after treatment and examined. The histological scores were significantly better in the bone marrow mesenchymal stromal cells group than in the control and drilling groups at all time points (p < 0.05). The fluorescence of the green fluorescent protein-positive cells could be observed in specimens four weeks after treatment.

[Clinical observations with clarithromycin in pediatrics].

Clarithromycin (TE-031, A-56268) was given orally to 25 children with acute bacterial infections including 5 with bronchitis, 8 with pneumonia, 4 with Mycoplasma pneumonia, 2 with pertussis and 6 with Campylobacter enteritis. Good to excellent clinical responses were obtained in 22 patients with bacterial eradication of all 10 strains. No side effect was observed. From the above clinical results, it appears that TE-031 is a useful antibiotic for the treatment of pediatrics with various bacterial infections.

[Clinical studies on sultamicillin in pediatrics].

Sultamicillin (SBTPC) fine granule was given orally to 15 children with acute bacterial infections including 4 with acute pharyngitis, 5 with acute tonsillitis, 2 each with acute bronchitis and urinary tract infections, and 1 each with acute pneumonia and cervical purulent lymphadenitis. Good to excellent clinical responses were obtained in all of the 15 patients and bacterial eradication of all 4 strains found in these cases. Loose stool was observed in 1 case. From the above clinical results, it appears that SBTPC is a useful antibiotics for the treatment of pediatric patients with various bacterial infections.

[Clinical experience with sulbactam/ampicillin in the pediatric field].

Sulbactam/ampicillin (SBT/ABPC) was given intravenously to 20 children with the following acute bacterial infections; 14 cases of pneumonia, 2 cases of purulent cervical lymphadenitis and 1 case each of bronchitis, pyothorax, cellulitis, and purulent meningitis. Good clinical responses were obtained in 18 out of 20 patients, and bacteriologically, all of the 14 isolated strains were eradicated. No side effect was observed except 2 cases of eosinophilia, and 1 case each of loose stool and elevated thrombocyte. From the above clinical results, it is apparent that SBT/ABPC is a useful antibiotic for the treatment of pediatric patients with various kinds of bacterial infections.

[Clinical studies on cefpirome in pediatrics].

Cefpirome (CPR, HR 810) was given intravenously to 10 children with acute bacterial infections including 8 with acute pneumonia, 1 each with acute pleuritis and urinary tract infections. Good to excellent clinical responses were obtained in all of the 10 patients and bacterial eradication were obtained for all 8 strains found in these cases. Slight elevation of GOT, GPT and eosinophilia were observed in 1 case each. From the above clinical results, it appears that CPR is a useful antibiotic for treatment of pediatric patients with various bacterial infections.

[Clinical studies on cefprozil in pediatrics].

Cefprozil (CFPZ, BMY-28100) fine granules were given orally to 21 children with acute bacterial infections including 15 cases of acute tonsillitis and 3 each of acute bronchitis and urinary tract infections. Good to excellent clinical responses were obtained in 19 of the 21 patients and bacterial eradications were obtained for all 11 strains found in these cases. Loose stool and eosinophilia were observed in 1 case each. From the above clinical results, it appears that CFPZ is a useful antibiotic for the treatment of pediatric patients with various bacterial infections.

[Clinical experience with T-1982 (cefbuperazone) in the pediatric field].

T-1982 (cefbuperazone) was given intravenously to 21 children with the following acute bacterial infections; 13 cases of bronchopneumonia, 2 cases of urinary tract infection, 1 case of subcutaneous abscess, 1 case of cervical purulent lymphadenitis and acute tonsillitis, and 4 cases of acute bronchitis. Clinical effectiveness was obtained in 20 cases out of 21 cases and bacteriological effectiveness in 7 cases out of 8 cases. As for the side effects, 1 patient had asymptomatic eosinophilia, but no other laboratory abnormalities were observed. Above results suggest that T-1982 is a useful antibiotic for treating pediatric patients with various kinds of bacterial infections.

[Clinical experience with cefodizime in pediatric field].

Cefodizime (CDZM, THR-221) was given intravenously to 20 children with the following acute bacterial infections: 2 cases each of tonsillitis, bronchitis, purulent cervical lymphadenitis, and urinary tract infections and 12 cases of pneumonia. Good clinical responses were obtained in 18 patients out of the 20, and bacteriologically, all of the 5 strains identified were eradicated. No side effect was obtained except one case of eosinophilia. From the above clinical results, it is apparent that CDZM is a useful antibiotic for the treatment of pediatric patients with various kinds of bacterial infections.

[Propofol and sevoflurane--a comparison of anesthesia for laryngomicrosurgery].

Laryngomicrosurgery has some special characteristics. It is under much stress such as intubation and direct laryngoscopy during a short operation time. Therefore both adequate anesthesia and quick recovery are needed. Thirty three ASA physical status I patients for laryngomicrosurgery were randomly assigned to receive either anesthesia with propofol and small dose of fentanyl (Group P) or anesthesia with thiopental and sevoflurane (Group S). Group P was induced with propofol 2-3 mg.kg-1 and fentanyl 0.1 mg and maintained with propofol 6 mg.kg-1.h-1 (from 10 mg.kg-1.h-1 by 2 mg.kg-1.h-1 decrement in interval of 10 minutes). No intravenous analgesic was added. Group S was induced with thiopental 4 -5 mg.kg-1 and maintained with sevoflurane 2-3%. We compared emergence time and the state of recovery 5 minutes after extubation and 5 minutes after entering the recovery room. There was no episode of inadequate anesthetic state in both groups. The emergence time was significantly shorter in Group P than in Group S. The state of recovery was much better in Group P compared with Group S in both 5 minutes after extubation and 5 minutes after entering the recovery room. Therefore, anesthesia with propofol and small dose of fentanyl at induction is more adequate compared with anesthesia with sevoflurane in laryngomicrosurgery.

Survival of mouse morulae vitrified in an ethylene glycol-based solution after exposure to the solution at various temperatures.

Mouse morulae were exposed in one step to a vitrification solution (EFS, a modified PBS containing 40% ethylene glycol, 18% Ficoll, and 0.3-M sucrose) at various temperatures, then cooled rapidly in liquid nitrogen, and then warmed rapidly. All of the embryos exposed to the EFS solution for 0.5 min at 25 degrees C before vitrification developed in culture. However, survival rates were lower if the duration of exposure was prolonged to 2, 5, or 10 min. At lower ambient temperatures (20, 10, and 5 degrees C), high survival rates were associated with longer exposure to the EFS solution. The toxicity of the EFS solution was also lower at lower temperatures. The toxic injury of morulae was manifested as decompaction of the blastomeres. Among the three additives in the EFS solution, ethylene glycol, which can cross cell membranes, was responsible for the toxicity. The results show that the optimum time for exposure of the embryos to the EFS solution before rapid cooling varies with the ambient temperature, i.e., 0.5 min at 25 degrees C, 0.5-5 min at 20 degrees C, 2-5 min at 10 degrees C, and 2-10 min at 5 degrees C. If they are exposed for an optimum period, almost all mouse morulae can survive vitrification (94-100%).

Self-reported recovery time of daily activity after bone marrow harvesting from healthy donors.

PURPOSE: The study was planned to describe and compare the resumption of daily activity after bone marrow harvesting (BMH) under general anesthesia with different anesthetic agents, isoflurane, sevoflurane and propofol. METHODS: Sixty-five adult healthy allogenic donors (26 women, 39 men; 37.0 +/- 9.5 years of age; ASA class I or II) were studied. BMH was performed under general anesthesia with isoflurane, sevoflurane, or propofol as the main anesthetic agent. On day 1, donors were asked how soon they could resume five daily activities: talking, walking, drinking, eating, and reading. RESULTS: Although there was considerable variation in resumption time within and among these five activities, 77% of donors resumed all of these basic daily activities within 12 h after BMH. Donors who received propofol resumed talking significantly faster than those who received sevoflurane or isoflurane, but the choice of main anesthetic agent did not affect the time of resumption of other activities. Lower preoperative hemoglobin concentration and greater decline of hemoglobin concentration on day 1 were significantly associated with slower resumption of walking and reading. CONCLUSION: Although the choice of main anesthetic agent and anemia affected postoperative recovery, 77% of donors could resume these five daily activities within 12 h.