Randomized, placebo-controlled trial of combination antiemetic prophylaxis for day-case gynaecological laparoscopic surgery.

In a randomized, double-blind trial, we compared i.v. ondansetron 4 mg (control), i.v. ondansetron 4 mg and cyclizine 50 mg (combination) and i.v. saline 0.9% (placebo), given after induction of standardized anaesthesia, for the prevention of nausea and vomiting (PONV) after day-case gynaecological laparoscopic surgery. Compared with placebo, fewer patients in the control group vomited (9/20 versus 11/59, P = 0.02) or needed rescue antiemetic (7/20 versus 9/59, P = 0.06) before discharge. Compared with the control, fewer patients in the combination group (n = 60) vomited (11/59 versus 2/60, P = 0.01) or needed rescue antiemetic (29/59 versus 2/60, P = 0.03) before discharge. The incidence of vomiting in the combination group was less than 5% overall. Compared with the control, the combination group had a significantly lower incidence (P = 0.001) and severity (P < 0.001) of nausea after discharge and more patients with no PONV at any time during the study (15/59 versus 27/60, P = 0.03). Unlike the placebo and control groups, no patient receiving combination prophylaxis was admitted overnight for PONV management.

Effect of demand frequency on lockout period. The Abbott Provider 5500 Patient-Controlled Analgesia machine.

An Abbott Provider 5500 Patient Controlled Analgesia machine was noticed to have developed a prolonged lockout period when frequent analgesic demands were being made. This study tested five other machines and demonstrated that the duration of the lockout period was influenced by the frequency of analgesic demands. This finding could have clinical implications and we recommend that the duration of the lockout period should be specifically examined during the testing of patient-controlled machines.

Sustained release metoclopramide for prophylaxis of post-operative nausea and vomiting.

Oral metoclopramide may be given as a premedicant to reduce post-operative nausea and vomiting, but there is little evidence that it is effective. We studied the anti-emetic action of a sustained release formulation of metoclopramide (Gastromax 30 mg) in 39 fit women undergoing inpatient laparoscopy under general anaesthesia with a standardized anaesthetic technique in a double-blind placebo-controlled trial. No benefit was demonstrated. (Incidences: nausea: 13 of 20 patients [placebo] and 13 of 19 [metoclopramide]; vomiting: 13 of 20 and 12 of 19.)

Effects of shape, size, and air velocity on entry loss factors of suction hoods.

This study further elucidated the effects of air velocity, aspect ratio (face length to face width), and area ratio (face area to duct area) on entry loss factors of suction hoods. A full scale ventilation system was utilized to determine the entry loss factor attributable to each of 20 square and rectangular hoods with a 90 degrees included angle. Static and velocity pressures were measured using Pitot tubes connected by tubing to piezo-resistive pressure transducers and inclined tube manometers. The entry loss factor, Fh, is the ratio of hood total pressure loss to mean velocity pressure. Values of Fh determined in this study ranged from 0.17-1.85. The values of Fh were a hyperbolic function of area ratio with a region rapidly increasing change for area ratios less than 5. For area ratios greater than 5, the values of Fh approached an asymptote of 0.17. Among hoods with a given area ratio (e.g., 2.5, 5.1, or 10.2), values of Fh were independent of aspect ratio. To a limited extent, Fh values decreased as mean air velocities increased from 319-1770 m/min (1046-5807 feet/min).

Neuroleptic bioavailability, psychosocial factors, and clinical status: a 1-year study of schizophrenic outpatients after dose reduction.

Serum neuroleptic levels, prolactin levels, and clinical state were assessed for 1 year in 29 schizophrenic outpatients whose clinically determined neuroleptic dose had been reduced by 50%. Fifty-five percent of the subjects remained stable. Neuroleptic dose did not differ between relapsed and stable patients. Serum prolactin (PRL) assessed 2 weeks after dose reduction and mean PRL after reduction were significantly lower among relapsers. Serum neuroleptic levels were significantly lower for relapsers in patients on haloperidol. Among relapsers, there were no serum PRL or neuroleptic level differences between stable periods and the relapse episode. Among patients with relatively low neuroleptic bioavailability, relapsers reported lower levels of social activity and had social networks that were less enjoyable, more aversive, and less helpful than those of stable patients.

Pancreatic heterotopia as a cause of an acute abdomen.

A 6-year-old boy with fever, vomiting, abdominal pain, and leucocytosis was found to have a small nodule of heterotopic pancreatic tissue in the wall of the jejunum. Leakage of pancreatic enzymes caused inflammation and hemorrhagic necrosis of adjacent smooth muscle. Excision of the lesion was followed by prompt and permanent relief of all signs and symptoms. Small intestinal pancreatic rests can cause acute and chronic abdominal complaints and should be carefully sought at laparotomy when no other etiology is encountered.

Smoking cessation in chronically ill medical patients.

Eight male smokers with chronic pulmonary and/or cardiac disease participated in a 9-week treatment program that consisted of gradual nicotine withdrawal, self-management techniques, and relapse prevention strategies. At 1-year follow-up, 50% remained abstinent, while those who relapsed were smoking substantially less than prior to treatment. Reductions in CO and thiocyanate levels were both statistically significant and clinically meaningful. Nonspecific factors of group influence and support, as well as weekly feedback of CO levels, were judged as particularly important components of treatment. The availability of non-aversive strategies for smoking cessation in persons with chronic illness is important. These promising though preliminary findings indicate the need for additional applications of multi-component behavioral approaches with this population.

Ectopic gastric duplication cyst in an infant.

A case of an ectopic gastric duplication cyst that appeared to arise from the pancreas in a 10-week-old infant with a superficial mass in the left upper quadrant is reported. Preoperative ultrasound showed a cystic lesion with an inner echogenic layer (mucosa) and an outer anechoic rim (muscle). Technetium scan demonstrated that there was a gastric-type mucosa in the cyst. It is suggested that the ultrasound findings are specific for a gastric duplication cyst and that ultrasound and technetium scan alone will adequately characterize these lesions preoperatively.

The importance of behavioral and cognitive factors in heterosexual-social anxiety.

Subject groups were classified on the basis of behavioral ratings for degree of anxiety exhibited and level of social skill displayed during a simulated dating interaction. Subjects were then asked to view and evaluate their own skill performance and the performance of bogus subjects during the same interaction when presented on videotapes. All subject groups were accurate in rating the performance of bogus subjects during the same interaction when presented on videotapes. All subject groups were accurate in rating the performance of the bogus subjects but the high anxious/high skill subjects underestimated (in comparison to judge's ratings) their own skill while high anxious/low skill subjects accurately assessed their poor performance. Implications of the establishment of two types of heterosexual-socially anxious subjects were drawn for both clinical practice and research.

Neonatal staphylococcal scalded skin syndrome: massive outbreak due to an unusual phage type.

A massive outbreak of the staphylococcal scalded skin syndrome due to an organism with an unusual phage pattern, occurred during a 115-day period and involved 68 newborns. Generalized exfoliative dermatitis was seen in 24 babies, and Staphylococcus aureus was isolated from 23. Fourteen isolates were phage typed, with 13 reported as the epidemic strain 29/79/80/3A/3C/54/75. Eight babies had generalized scarlatiniform eruption without exfoliation (staphylococcal scarlet fever). Cultural data were available from six, all positive for S aureus. Four organisms were typed and reported as the epidemic strain. Of 34 infants with bullous impetigo 20 had cultures that were positive for S aureus, and four were phage typed, revealing the epidemic strain. Illness was mild in all patients; there were no deaths and no invasive forms of staphylococcal infection. The male to female ratio of generalized exfoliative disease was 5:1. The concept of a neonatal staphylococcal scalded skin syndrome, comprised of a triad of skin disorders induced by an exotoxin elaborated by certain strains of coagulase positive S aureus, is confirmed.