Comparison of continuous background infusion plus demand dose and demand-only parturient-controlled epidural analgesia (PCEA) using ropivacaine combined with sufentanil for labor and delivery.

BACKGROUND: Using ropivacaine combined with sufentanil, we determined the analgesic efficacy of parturient-controlled epidural analgesia (PCEA) with or without (demand-only PCEA) continuous background infusion in reducing labor pain in 66 parturients. METHODS: After placement of the epidural catheter and administration of an initial bolus containing ropivacaine 16 mg and sufentanil 10 microg, parturients were prospectively randomized into two groups. The PCEA solution consisted of ropivacaine 0.16% plus sufentanil 0.5 microg/mL. Parturients with PCEA plus continuous background infusion received 4 mL/h plus an hourly maximum of three 4-mL boluses on demand (lock-out time 20 min); parturients with demand-only PCEA received an hourly maximum of four 4-mL boluses (lock-out time 15 min) of anesthetic solution. Pain scores (VAS 0-100 mm), drug doses administered, duration of labor, sensory and motor epidural block characteristics, maternal satisfaction, neonatal outcome and adverse events were determined. RESULTS: Both regimens provided excellent parturients' satisfaction and pain relief. However, periods of VAS scores>40 mm during all stages of labor were significantly more frequent in parturients receiving demand-only PCEA (22.4%) compared to parturients receiving PCEA plus continuous background infusion (7.5%, P=0.0011). Drug doses administered, duration of PCEA, labor and delivery, epidural block characteristics, neonatal outcome and adverse events did not differ between groups. CONCLUSION: Under the conditions of the study, PCEA plus continuous background infusion was more effective than demand-only PCEA in treating labor pain without increasing consumption of anesthetic solution.

[Spontaneous gas gangrene in a diabetic patient with Clostridium septicum]. / "Spontaner" Gasbrand mit Kompartmentsyndrom bei einem diabetischen Patienten.

Atraumatic infections due to Clostridium septicum are known to be associated with immunosuppression or even malignancy. In this case report, we present a patient with severe Clostridium septicum infection related to advanced colon cancer that had not previously been diagnosed. The case demonstrates the strong association between Clostridium septicum infections and malignancy, particularly in the presence of other predisposing diseases such as diabetes mellitus. It strongly suggests excluding malignant neoplasms, especially of the gastrointestinal tract, when severe Clostridium septicum infections occur. Moreover, if patients with known colorectal or other malignancy develop septicaemia or spontaneous gas gangrene, clinicians should be aware of Clostridium septicum as one of the main causative agents, as early diagnosis and aggressive treatment are important to improve prognosis.

Preventing and containing trypanocide resistance in the cotton zone of West Africa.

Trypanocidal drugs are the most commonly purchased and used livestock input by resource-poor farmers in sub-Saharan Africa. The effective use of trypanocidal drugs by smallholder farmers is threatened by the development of widespread resistance. This is a particular concern for smallholder crop-livestock farmers in the cotton zone of West Africa. A recent project funded by the Germany Ministry for Economic Cooperation and Development (BMZ) confirmed significant resistance to trypanocidal drugs in villages with high trypanosomosis risk in Burkina Faso and Mali. Strategies for resistance prevention were investigated. Keeping trypanotolerant cattle was found to be an effective disease management strategy, but farmers' preference for trypano-susceptible breeds, for reasons unrelated to animal health, suggest that the intromission of zebu genotype will continue. Community vector control was found to be effective in managing trypanosomosis in the presence of resistance and the high-level participatory approach tested was found to be more sustainable than low-level approaches previously used in the region. This suggests that participatory vector control with appropriate external support is likely to be a viable option for implementing resistance 'clean-up'. Promoting rational drug use (RDU) emerged as a promising prevention strategy, with clear improvements in farmer knowledge, farmer practice and animal health outcomes. However, policy studies showed low understanding of the problem of resistance and the absence of an enabling environment for RDU. Engagement was initiated with actors involved in the problem of resistance and for its solution, including manufacturers, sellers and users of drugs, regulators and extension providers.

Government intervention in crop protection in developing countries.

Government interventions in the pesticide market are necessary, particularly in developing countries because of a high likelihood of market failure. The green revolution in Asia made governments introduce programmes which relied heavily on pesticide-based solutions to pest problems. With growing environmental concerns in donor and developing countries, a higher priority is given to natural factors of control. From a review of various types of government interventions it is concluded that government investments related to pest management should focus on reducing the dependence on pesticides rather than concentrating on the minimization of their side-effects.

[Effect of high dosages of fentanyl and piritramide upon haemodynamics, coronary blood flow and myocardial oxygen consumption (author's transl)]. / Hämodynamik, Koronardurchblutung und myokardialer Sauerstoffverbrauch unter hohen Fentanyl- und Piritramiddosen

High dosages of narcotic analgesics are frequently utilized as the sole anaesthetic agents for patients requiring open-heart surgery. The purpose of this study was to investigate the effect of high dosages of fentanyl and piritramide upon the cardiovascular system. In anaesthetized dogs (N2O:O2=2:1; 0.5 vol% halothane) 0.03 mg/kg fentanyl (=8) and 1.5 mg/kg piritramide (n=8) respectively were given intravenously as a bolus. After the administration of fentanyl there was a slight decrease in blood pressure (10%). The hypotension was the result of a decrease in cardiac output (thermodilution technique) by 13% due to bradycardia. Total peripheral resistance and myocardial contractility remained unaffected. Similar effects were only found late after injection of piritramide, since there was an initial cardiovascular response to piritramide characterized by a marked fall in blood pressure (29%). The major cause of arterial hypotension was peripheral vasodilatation. Load data and the decrease in max dp/dt however indicated also a slight myocardial depression. The altered haemodynamics led to a decrease in myocardial oxygen consumption with both narcotics, which was nearly paralleled by a reduction in coronary blood flow. The narrowing of arteriovenous oxygen difference of the heart proved coronary dilatatory properties of fentanyl and especially of piritramide. This study indicated that high dosages of fentanyl have advantages in comparison to high dosages of piritramide. The clinical implications of the results are discussed.