Flora Colonization and Oral Glucose Levels During the Early Postnatal Period in High-Risk Newborns

PURPOSE: A longitudinal study was conducted to explore flora colonization and oral glucose high-risk newborns during the first 7 days after birth. METHODS: Oral secretions of hospitalized newborns were obtained for microbial cultures and glucose test at days 1-7 after birth. RESULTS: Among the total 112 newborns, 40% were girls and 73% were premature. Mean gestational age was 34.4±3.2 weeks and weight was 2,266±697.5 grams. The most common flora included Streptococcus (28.2%), Methicillin-resistant Staphylococcus aureus (MRSA, 10.9%), Staphylococcus (6.0%) and Coagulase- Negative Staphylococcus (CNS, 4.0%). The average oral glucose level was 29.2±23.0mg/dl~58.2±39.5mg/dl. Newborns with higher oral glucose than serum (crude odds ratio [ORc] =1.75; 95% confidence interval [CI] =1.03-2.97), phototherapy (ORc=3.30; 95% CI=2.29-4.76) and prone position (ORc= 2.04; 95% CI=1.13-3.69) were more likely to be colonized. Having oral tubes (ORc=0.42; 95% CI=0.29-0.59), parental nutrition (ORc=0.21; 95% CI=0.13-0.32) and antibiotics (ORc=0.51; 95% CI=0.36-0.73) had protective effects. For oral glucose statistical significances existed on time effect among newborns with Streptococcus (F=9.78, p=.024), MRSA (F=7.60, p=.037) or CNS (F=11.15, p=.019) and interaction between time and colonization among newborns with all of four flora (F=2.73, p=.029) or colonization with only Staphylococcus (F=2.91, p=.034). CONCLUSION: High-risk newborns develop flora colonization at an early period of life. Their clinical features were associated with types and time of oral flora colonization. They need close monitoring and multifaceted intervention to improve oral environment and infection control.

Análise dos reflexos em prematuros submetidos ao posicionamento funcional em Terapia Intensiva Neonatal / Analysis of reflexes in premature infants undergoing functional positioning in a Neonatal Intensive Care

Objetivo: Verificar se prematuros extremos, submetidos ao posicionamento funcional, conseguem adquirir integração dos reflexos primitivos quando comparados aos prematuros. Métodos: Trata-se de um relato de série de oito casos constituído de prematuros extremos e prematuros. Os bebês foram submetidos ao posicionamento funcional na Unidade de Terapia Intensiva Neonatal, na postura prona, supina e decúbito lateral, utilizando-se coxins para assegurar a contenção e oferecer a sensação de segurança, três vezes por dia, durante a internação. Os reflexos dos bebês foram avaliados no 30º e 60º dias de nascimento, de junho a outubro de 2012, por meio do Teste de Performance Infanto Motora (TIMP). Resultados: Observaram-se diferenças entre os escores das avaliações no TIMP após o 30º dia de vida entre os grupos; contudo, não se verificaram diferenças na avaliação aos 60 dias. Conclusão: Os bebês submetidos ao posicionamento funcional precoce, adquiriram adequada integração dos reflexos primitivos após 60 dias de vida.

Objective: To determine whether the extremely preterm infants, who were subjected to functional positioning, can acquire integration of primitive reflexes when compared to preterm. Methods: This is a report of eight cases consisting of extremely preterm and preterm infants. All babies in the study were subjected to functional positioning in the Neonatal Intensive Care Unit, organized in the prone, supine and lateral positions with the use of cushions to ensure restraint and offer a sense of security, in a frequency of three times a day, during hospital length. The reflexes of the infants were evaluated at the 30th and 60th days of birth in the period from June to October 2012 through the Test of Infant Motor Performance (TIMP). Results: There were differences in scores of the TIMP after the 30th day of life among the groups; however, there was no difference in scores of the second evaluation performed at 60th day. Conclusion: Babies submitted to the early functional positioning managed to acquire proper integration of primitive reflexes after 60 days of life.

Efficacy of Hemocontrol Biofeedback System in Intradialytic Hypotension-Prone Hemodialysis Patients

We conducted a study to determine whether the hemocontrol biofeedback system (HBS) can improve intradialytic hypotension (IDH) in hypotension-prone hemodialysis (HD) patients compared with conventional HD. In this multicenter prospective crossover study, 60 hypotension-prone patients were serially treated by conventional HD for 8 weeks (period A), by HD with hemoscan blood volume monitoring for 2 weeks (period B0), and by HBS HD for 8 weeks (period B1). The number of sessions complicated by symptomatic IDH during 24 HD sessions (14.9+/-5.8 sessions, 62.1% in period A vs 9.2+/-7.2 sessions, 38.4% in period B1, P<0.001) and the number of IDH-related nursing interventions in a session (0.96+/-0.66 in period A vs 0.56+/-0.54 in period B1, P<0.001) significantly decreased in period B1 than in period A. Recovery time from fatigue after dialysis was significantly shorter in period B1 than in period A. The patients with higher post-dialysis blood pressure, lower difference between pre- and post-dialysis blood pressure, less frequent IDH, and higher pre- and post-dialysis body weight in period A responded better to HBS in period B1 in regard to the reduction of IDH. In conclusion, HBS may improve the patient tolerability to HD by reducing the IDH frequency and promoting faster recovery from fatigue after dialysis.

Safe Sedation and Hypnosis using Dexmedetomidine for Minimally Invasive Spine Surgery in a Prone Position

Dexmedetomidine, an imidazoline compound, is a highly selective alpha2-adrenoceptor agonist with sympatholytic, sedative, amnestic, and analgesic properties. In order to minimize the patients' pain and anxiety during minimally invasive spine surgery (MISS) when compared to conventional surgery under general anesthesia, an adequate conscious sedation (CS) or monitored anesthetic care (MAC) should be provided. Commonly used intravenous sedatives and hypnotics, such as midazolam and propofol, are not suitable for operations in a prone position due to undesired respiratory depression. Dexmedetomidine converges on an endogenous non-rapid eye movement (NREM) sleep-promoting pathway to exert its sedative effects. The great merit of dexmedetomidine for CS or MAC is the ability of the operator to recognize nerve damage during percutaneous endoscopic lumbar discectomy, a representative MISS. However, there are 2 shortcomings for dexmedetomidine in MISS: hypotension/bradycardia and delayed emergence. Its hypotension/bradycardiac effects can be prevented by ketamine intraoperatively. Using atipamezole (an alpha2-adrenoceptor antagonist) might allow doctors to control the rate of recovery from procedural sedation in the future. MAC, with other analgesics such as ketorolac and opioids, creates ideal conditions for MISS. In conclusion, dexmedetomidine provides a favorable surgical condition in patients receiving MISS in a prone position due to its unique properties of conscious sedation followed by unconscious hypnosis with analgesia. However, no respiratory depression occurs based on the dexmedetomidine-related endogenous sleep pathways involves the inhibition of the locus coeruleus in the pons, which facilitates VLPO firing in the anterior hypothalamus.

Safe Sedation and Hypnosis using Dexmedetomidine for Minimally Invasive Spine Surgery in a Prone Position

Dexmedetomidine, an imidazoline compound, is a highly selective alpha2-adrenoceptor agonist with sympatholytic, sedative, amnestic, and analgesic properties. In order to minimize the patients' pain and anxiety during minimally invasive spine surgery (MISS) when compared to conventional surgery under general anesthesia, an adequate conscious sedation (CS) or monitored anesthetic care (MAC) should be provided. Commonly used intravenous sedatives and hypnotics, such as midazolam and propofol, are not suitable for operations in a prone position due to undesired respiratory depression. Dexmedetomidine converges on an endogenous non-rapid eye movement (NREM) sleep-promoting pathway to exert its sedative effects. The great merit of dexmedetomidine for CS or MAC is the ability of the operator to recognize nerve damage during percutaneous endoscopic lumbar discectomy, a representative MISS. However, there are 2 shortcomings for dexmedetomidine in MISS: hypotension/bradycardia and delayed emergence. Its hypotension/bradycardiac effects can be prevented by ketamine intraoperatively. Using atipamezole (an alpha2-adrenoceptor antagonist) might allow doctors to control the rate of recovery from procedural sedation in the future. MAC, with other analgesics such as ketorolac and opioids, creates ideal conditions for MISS. In conclusion, dexmedetomidine provides a favorable surgical condition in patients receiving MISS in a prone position due to its unique properties of conscious sedation followed by unconscious hypnosis with analgesia. However, no respiratory depression occurs based on the dexmedetomidine-related endogenous sleep pathways involves the inhibition of the locus coeruleus in the pons, which facilitates VLPO firing in the anterior hypothalamus.

Nonaneurysmal Subarachnoid Hemorrhage : Rare Complication of Vertebroplasty

On rare occasions, percutaneous vertebroplasty (PV) may be associated with adverse spinal and extraspinal events. Subarachnoid hemorrhage (SAH) has not been reported complication following a PV. This is a report of two elderly women with spine compressions who developed idiopathic SAH after injecting polymethylmethacrylate into the thoracolumbar region transcutaneously. PV was performed as an usual manner on prone position under local anesthesia for these patients. During the interventions, two patients complained of a bursting nature of headache and their arterial blood pressure was jumped up. Computed tomography scans revealed symmetric SAH on the both hemispheres and moderate degree of hydrocephalus. Any intracranial vascular abnormalities for their SAH were not evident on modern neuroangiography modalities. One patient received a ventricular shunt surgery, but both fully recovered from the procedure-related SAH. The pathophysiologic mechanism that induce SAH will be discussed, with suggesting the manner that prevent and minimize this rare intracranial complication after PV.

Ultrasound-guided cervical facet joint IMS

BACKGROUND:Cervical facet joint stimulation is a good therapeutic option for treating chronic neck pain.Fluoroscopy is the gold standard, as an imaging tool, for performing cervical facet joint stimulation.Ultrasound guided stimulation is safe and accurate, but there have been no reports on using ultrasound guided cervical facet joint stimulation to treat chronic neck pain.We wanted to describe successful ultrasound guided cervical facet joint IMS for treating patients with chronic neck pain. METHODS:Twenty six adult patients were treated with IMS on a cervical facet joint.A low frequency ultrasound system was used (Qsonix by Ultrasonix, Canada with a 6?12 Hz linear probe).The patients were positioned in the prone position with a slight extended neck.A parasagittal posterior view of the cervical spine was obtained with using a sterile technique.This allowed visualization, in a single view, of all the cervical facet joints on the one side.We performed this procedure with a transverse approach after manually palpating the facet joint.This allowed real-time monitoring of the needle along its entire length. RESULTS:The posterior neck pain and the dorsal back pain were both decreased after needle stimulation.Ultrasound guided dry needling could be performed accurately for all the patients. CONCLUSIONS:This is the first description of cervical facet dry needle stimulation under ultrasound guidance for treating chronic neck pain.The advantages of ultrasound guidance include accurate targeting, reducing the unwanted injury and improved patient discomfort.

Sacrococcygeal Cystic Teratoma / 대한비뇨기과학회지

A case of sacrococcygeal cystic teratoma in a 16 month-old female infant having suffered from urinary retention and severe constipation for 3 days was herein reported. Confirmative diagnosis was possible by barium enema and contrast media injection into cystic mass located in the presacrococcygeal region. Successful removal of the cystic teratoma with the patient in a prone position was performed. Uneventful postoperative course followed.

Effects of Total Hypophys Ectomy on the Blood Sugar and Pancreas in the Dog

Early attempts at determining the effects of experimental ablation of the hypophysis in the mammal resulted ambiguously, for the animals usually died from attendant injury to the brain or form infection, or , if they survived, some of the effects observed often were due to injury to the adjacent regions of the brain during the operation. In 1912, Aschner performed removal of the pituitary body by a transbuccal transsphenoidal route in the dog. Smith in 1927 and 1930 reported two methods of hypophysectomy in the rat; the first one was temporal approach, in this method he exposed the pituitary and destroyed with chromic acid injection; the second one was parapharyngeal route. In 1963, Falconi and Rossi described transauricular hypophysectomy in the rat and mice. It is well known that in studying the effects of hypophysectomy removal of the pituitary must be essentially complete without injury to the adjacent regions of the brain, especially in the hypothalamus. The present study was undertaken to device a method of total hypophysectomy and observe the effects on pancreatic structure and carbohydrate metabolism. In this study twenty adult mongrel dogs, weighting from 7 to 10 kg, were used. Twelve of them were male and eight were female. Operative procedure: Under pentobarbital sodium, 30 mg/kg body weight, intravenous anesthesia the dog was placed on the operating table in prone position, and a tube was inserted in the mouth to displace the mandibular angle anterodownwardly. A vertical incision from the midline to just behind the mandibular angle was made, the temporal muscles were also incised vertically and retracted to expose the temporal bone. Following wide craniectomy down to the base of middle cranial fossa and careful opening the dura, temporal lobe was elevated with about 1cm wide brain retractor at the tip of the middle cranial fossa. Since this approach was deep and narrow, a brilliant illumination was thrown from head lamp at neat the center of the binocular magnifier. As the third cranial nerve and intracranial portion of the internal carotid artery were exposed, arachnoid membrane was torn and aspirated cerebrospinal fluid slowly to obtain wider exposure, then elevated posterior communicating artery to expose the pituitary body and stalk. The stalk was clipped and sectioned then pituitary body was removed in a piece or sucked out under direct vision, and the would was closed in layers. In all experimental dogs, pre- and postoperative fasting blood sugar was measured, and the brain and pancreas were removed and fixed in 10 % neutral formalin solution following intracarotid artery infusion of 10% neutral formalin. The removed brain was examined and the pancreas was stained with hematoxylin-eosin, Maldonado, and Toluidine blue sating methods. The following results were obtained: 1. The average preoperative fasting venous blood sugar was 98.5+/-5.4mg% in 20 mongrel dogs. 2. In five hypophysectomized dogs, their preoperative average blood sugar was 99.2+/-5.2mg% and their postoperative blood sugar was decreased in the rage from 13.0 to 35.4mg% during the period from 56 to 77 days. 3. In ten dogs who received daily intramuscular injection of 2mg dexamethasone following hypophyseetomy, their average venous blood sugar was 99.5+/-6.12mg%, and their postoperative blood sugar was decreased in the range from 9.7 to 30.5mg%. 4. In five normal dogs, the number of cells per islet varied from 14 to 96 and the average number was 45, and the average ratio of alpha, beta to delta cells was 14.2 : 79.4 : 6.4; in hypophysectomized group the average number per islet was 53 and their ratio was 19.5 : 75.1: 5.4; in the group which received dexamethasone for a week following hypophysectomy, the average number per islet was 53 and the average ratio was 14.6 : 80.5: 4.9, and in the group which received dexamethasone for two weeks, the average number per islet was 37 and the ratio was 15.2 : 80.2 : 4.5. 5. The acini in the hypophysectomized dogs were rather atrophic and illustrated mild intracytoplasmic vacuolization, and the Langerhans islet demonstrated exhausted pattern with small and degranulated beta cells. However, the Langerhans islets of hypophysectomized dogs with dexamethasone administration showed regranulated beta cells in one dog. 6. In pancreas of hypophysectomized dogs increased number of mast cells along the interstitial tissue, periductal region, and peripancreatic fat tissue were observed. There were also one or two mast cells in the islet mainly along the capsule of islets. 7. In pancreas of hypophysectomized dog with dexamethasone administration a few mast cells were observed along the lobular margin and just beneath the capsule of the islets.