Predictors of successful neuraxial block: a prospective study.

BACKGROUND AND OBJECTIVE: The epidural and subarachnoid spaces should be identified at the first attempt, since multiple punctures increase the risk of postdural puncture headache, epidural haematoma and neural trauma. The study aimed to describe the predictors of successful neuraxial blocks at the first attempt. METHODS: After institutional Review Board approval, 1481 patients undergoing spinal or epidural anaesthesia were prospectively enrolled. For each block we recorded: gender, age, height, weight, body habitus, anatomical landmarks (palpability of the spinous processes), spinal anatomy, patient positioning, premedication, needle type and gauge, approach, spinal level of the block, and the provider's level of experience. Retrieval of cerebrospinal fluid or loss of resistance to saline or air identified the subarachnoid and epidural spaces, respectively. The outcome variable was the first attempt success or failure (whether or not the needle was correctly located with one skin puncture and produced adequate surgical anaesthesia). Backward stepwise logistic regression tested its association with the other variables. RESULTS: The first-attempt rate of success was 61.51%. Independent predictors (Odds ratio, 95% confidence limits) were the quality of anatomical landmarks (1.92 (1.57; 2.35)), the provider's level of experience (1.24 (1.15; 1.33)) and the adequacy of patient positioning (3.84 (2.84; 5.19)). CONCLUSIONS: The successful location of the subarachnoid or the epidural space at the first attempt is influenced by the quality of patients' anatomical landmarks, the adequacy of patient positioning and the provider's level of experience.

[Rotavirus detection in feces of children with acute diarrhea] / Detecção de rotavírus nas fezes de crianças com diarréia aguda.

OBJECTIVE: To determine the prevalence of rotavirus in the etiology of acute diarrhea in children from Natal city, RN, Brazil and investigate the existence or not of a seasonal distribution of this pathogen in our environment.METHODS: Fecal samples from 1,903 children (boys and girls) with ages ranging from 1 month to 10 years, living in Natal-RN, who presented acute diarrhea episodes in a period from January 1996 to December 1998, were analyzed. We searched viral particles directly in the feces by a passive agglutination reaction using anti-rotavirus specific-group monoclonal antibodies coated latex particles.RESULTS: 151 children (7.9%) of the studied population presented a positive reaction, revealing the presence of rotavirus particles in feces. Considering, however, only the children (ages from 1 to 24 months) who are more susceptible to rotavirus infection, we verified that from 1,065 examined children, 136 of them (12.8%) presented positive reaction for rotavirus, and the great majority of all children with positive reaction (96.3%) had ages ranging from 6 to 24 months. Analysis of the distribution of the cases of rotavirus infection in the three year revealed that the incidence of infection was higher in July, August, and September.CONCLUSIONS: The results indicated rotavirus infections have an important role in the etiology of acute diarrhea cases. The majority of the acute diarrhea cases positive for rotavirus occurred during the first two years of life, reaching mainly children from 6 to 24 months, with the highest incidence of infection during the months of July, August, and September.

Hypoglycemia induced by insulin increases hepatic capacity to produce glucose from gluconeogenic amino acids.

AIM: To investigate the hepatic capacity to produce glucose during hypoglycemia induced by insulin (HII). METHODS: Livers from 24-h fasted rats which received i.p. insulin (HII rats) or saline (control rats) were perfused in situ. The gluconeogenic substrates L-alanine (5 mmol/L), L-glutamine (5 mmol/L), L-lactate (2 mmol/L), and glycerol (2 mmol/L) were employed. The gluconeogenic activity was measured as the difference between rates of glucose released during and before the substrate infusion. In part of the experiments the production of urea was measured. Before the liver perfusion blood was collected for determination of glycemia and insulinemia. RESULTS: HII rats showed: (a) hypoglycemia and hyperinsulinemia; (b) increased hepatic capacity to produce glucose from L-alanine and L-glutamine; (c) increased hepatic ureogenesis from L-alanine and L-glutamine; and (d) increased hepatic glucose production from glycerol. However, hepatic glucose production from L-lactate was not affected by hypoglycemia. CONCLUSION: In spite of hyperinsulinemia the hepatic capacity to produce glucose from L-glutamine and L-alanine increased during HII. These results can be attributed to the higher hepatic catabolism of both amino acids, since the ability of the liver to produce glucose was not affected by hypoglycemia.

[Psychosocial impact on children with mucopolysaccharidosis]. / Repercussões psico-sociais na criança com mucopolissacaridose.

The authors present a global valuation of the psychological repercussion of the child produced by a cronic and genetic disease like mucopolissacaridosis. The A. describe also those repercussion on the family and the school of the child. Finally they point the actual therapeutic support of the child and his family and remarks the need or pedopsychiatric management.