Treatment with autologous bone marrow mononuclear cells in patients with critical lower limb ischaemia. A pilot study.

BACKGROUND AND AIMS: Treatment with autologous, bone marrow mononuclear stem cells has shown effects in patients with chronic limb ischaemia in one randomized clinical study. The aim of the study was to test the potential effect of stem cell treatment in a strict defined group of patients with stable critical limb ischaemia (CLI). DESIGN: A prospective, combined-centre pilot study. MATERIAL: Eight patients with CLI of the lower extremities, and without any other treatment options. METHODS: Bone marrow cells were harvested from the patient's iliac crest and, after separation, injected into the calf muscles of the affected leg. Outcome was evaluated by digital subtraction angiography (DSA), visual analogue scale (VAS) and several non-invasive circulatory physiological tests. RESULTS: There were no complications from the procedures. Two patients were amputated two months after cell injection. Five patients reported pain relief after four months. Five patients could be evaluated at eight months. According to VAS and physiological tests, they were all either stable or showed improvement. CONCLUSION: This method seems to be a safe option for treating patients with CLI. Inclusion of patients took a long time, mainly because many patients with CLI are offered endovascular treatment in our institution. While symptomatic improvement was found in individual patients, larger trials are required to investigate efficacy. This will probably require multi-centre participation.

Epidural ropivacaine 7.5 mg/ml for elective Caesarean section: a double-blind comparison of efficacy and tolerability with bupivacaine 5 mg/ml.

BACKGROUND: Ropivacaine is a new local anaesthetic drug known to be less cardiotoxic than bupivacaine. The aims of this comparative study with bupivacaine were to evaluate efficacy, safety and tolerability for the mother and the neonate when using ropivacaine 7.5 mg/ml for epidural anaesthesia for elective Caesarean section. METHODS: In a double-blind, multicentre trial the patients were randomised to receive 20 ml of either ropivacaine 7.5 mg/ml or bupivacaine 5 mg/ml. The quality of the peroperative analgesia and abdominal muscle relaxation as well as tolerability and safety in both the mother and the neonate were evaluated. RESULTS: A total of 122 patients were evaluated for efficacy and tolerability. There were no significant differences in the onset time and the extent of the sensory spread or motor block. The peroperative quality of anaesthesia and muscle relaxation was similar in both groups. No significant side effects were observed, except for a more profound drop in systolic blood pressure in the ropivacaine group. The anaesthetics were well tolerated by the neonate in both groups, evaluated by Apgar and NACS scores. CONCLUSION: Ropivacaine 7.5 mg/ml administered epidurally resulted in equally effective anaesthesia for Caesarean section as bupivacaine 5 mg/ml. Because of the lower cardiotoxicity of ropivacaine, the new amide has a potential in replacing bupivacaine when used epidurally for Caesarean section.

[Tracheobronchial tumors treated with laser. 7-year experiences at Aker hospital]. / Trakeobronkiale tumorer behandlet med laser. Erfaringer fra syv år ved Aker sykehus.

The first Nd-YAG laser treatment for endoluminal airway obstruction in Norway was performed at Aker Hospital in November 1983. During the ensuing seven years 68 patients have been treated, involving altogether 172 procedures. During the early years a flexible bronchoscope was used to guide the flexible laser probe, in later years the usual practice has been to use the rigid bronchoscope, 54 patients were treated for malignant tumour, three for semi-malignant and 11 for benign tumour. In general, the best results were achieved with a proximal location of the tumour. Two patients died during the procedure from hypoxia, and one patient died from hemoptysis on the fifth day after operation. Based on retrospective studies of the clinical journal and the results from postmortem examination of 97 consecutive patients who died from pulmonary carcinoma, we anticipated that six of these patients would have benefited from laser treatment on at least one occasion during their disease. In Norway, with an incidence of approximately 400 cases of pulmonary carcinomas each year per million inhabitants, we estimate the need of lung laser procedures to be 25 per million each year.