ABSTRACT
BACKGROUND AND OBJECTIVES: Although many studies have found no difference between thoracic epidural block and unilateral thoracic paravertebral block after thoracotomy, no previous studies have compared epidural block with bilateral thoracic paravertebral block (bTPVB) in patients undergoing open liver resection. We aimed to investigate whether there was a significant analgesic advantage of thoracic epidural over bTPVB after liver resection. METHODS: This randomized, prospective, open-label study included adult patients undergoing elective open liver resection. Patients were randomized to receive either thoracic epidural block or bTPVB, through which ropivacaine (0.2%) was infused for 3 days. The primary outcome was pain Verbal Rating Scale (VRS) score (0-10) at rest and with postoperative incentive spirometry. Secondary outcomes included VRS at rest, inspired volumes during incentive spirometry, patient-controlled analgesia hydromorphone utilization, measures of hemodynamic stability, and postoperative bowel function. RESULTS: Eighty patients completed the study and received thoracic epidural block (n = 41) or bTPVBs (n = 39). No catheter-related complications were noted. The primary outcome, pain (VRS) with incentive spirometry, was significantly lower in the epidural group (epidural vs bTPVB, mean [SD]) (4.5 [2.7] vs 5.4 [2.7] at 24 hours postoperatively, and 3.2 [2.1] vs 4.6 [2.4] at 48 hours postoperatively). Maximal inspired volumes at 24 hours postoperatively (917 [379] vs 1042 [468] mL) and cumulative utilization of patient-controlled analgesia hydromorphone during the first 48 hours postoperatively (10.7 [7.9] vs 13.6 [8.5] mg) were not significantly different between groups. Decrease in mean arterial pressure from baseline at 24 hours postoperatively was greater for the epidural group (-12.6 [15.8] vs -3.8 [16.2]; P = 0.016). CONCLUSIONS: This study suggests that there is a modest analgesic advantage of thoracic epidural over bTPVBs for patients after open liver resection.
Subject(s)
Analgesia, Epidural/methods , Anesthetics, Local/administration & dosage , Hepatectomy/methods , Nerve Block/methods , Pain, Postoperative/prevention & control , Adult , Aged , Analgesia, Epidural/adverse effects , Analgesia, Patient-Controlled/methods , Analgesics, Opioid/administration & dosage , Anesthetics, Local/adverse effects , Arterial Pressure/drug effects , Blood Coagulation/drug effects , Elective Surgical Procedures , Female , Hepatectomy/adverse effects , Humans , Hydromorphone/administration & dosage , Male , Middle Aged , Nerve Block/adverse effects , Pain Measurement , Pain, Postoperative/diagnosis , Pain, Postoperative/etiology , Pennsylvania , Prospective Studies , Recovery of Function , Respiration/drug effects , Spirometry , Time Factors , Treatment OutcomeABSTRACT
We performed a detailed investigation of the structural and optical properties of multi-layers of InP/GaAs quantum dots, which present a type II interface arrangement. Transmission electronic microscopy analysis has revealed relatively large dots that coalesce forming so-called quantum posts when the GaAs layer between the InP layers is thin. We observed that the structural properties and morphology affect the resulting radiative lifetime of the carriers in our systems. The carrier lifetimes are relatively long, as expected for type II systems, as compared to those observed for single layer InP/GaAs quantum dots. The interface intermixing effect has been pointed out as a limiting factor for obtaining an effective spatial separation of electrons and holes in the case of single layer InP/GaAs quantum-dot samples. In the present case this effect seems to be less critical due to the particular carrier wavefunction distribution along the structures.
ABSTRACT
Introducción: el crecimiento es un indicador de salud en los niños, mientras que la talla baja en ellos plantea un problema pediátrtico frecuente. Esto exige destacar la resencia dee una enfermedad subyacente. Se creó en el año 1996 un grupo de trabajo interdisciplinario en el aréa de consultorios extrnos dedel Centro Hospirtalario Pereira Rossell. Objetivo: describir las características clínicas de los niños con talla baja o disminución de la velocidad de crecimiento, o ambas, en los que se utilizó un algoritmo de estudio preestablecido. Material y método: ingrgesaron al estudio los niños que tenían talla por debajo de -2DE (dos desvíos estándar negativos) de la media por tablas y gráficos de referencia según edad y sexo (National Center for Health Statistics, Organización Mundial de la Salud 1979) o velocidad de crecimiento por debajo del percecntil 25 (Tanner JM, Whitehouse RH), o ambas, que tuvieron un seguimiento suficiente para alcanzar el diagnóstico etiológico. Se realizó anamnesis y exámen físico con historia clínica codificada. Se utilizó un algoritmo de estudio elaborado por el grupo en base a la bibliografía. Resultados: entre 1996 y 2002 se recibieron 170 niños de los cuales ingresaron al estudio 85 pacientes ya que el resto no cumplía con los criterios de inclusión. Del total de casos: 41 eran del sexo femenino y 44 deel sexo masculino, con un rango de edades entre 7 meses a 14 años y 3 meses, con una media de 6 años y 8 meses. El diagnóstico de la causa de estatura baja fue el siguiente: talla baja genética (TBG): 22, multifactorial: 17, nutricional: 14, retardo constitucional del crecimiento y desarrollo (RCCD): 10, síndromes genéticos: 7, endocrinológicos: 6, enfermedad celíaca: 5, causa no aclarada: 2, psicoafectivo: 1, mixto (TBG y RCCD): 1. Conclusiones: se confirmó talla baja o velocidad de crecimiento disminuída en 49,4 por ciento del total de niños transferidos. Las causas más frecuentes de talla baja fueron las variantes normales del crecimiento (TBG y RCCD). En 49,4 por ciento se confirmó talla baja y velocidad de crecimiento disminuída, lo que significa que 40,6 por ciento restante fue derivado con un diagnóstico de falla de crecimiento incorrecto. La mayoría de los pacientes no tuvieron elementos clínicos orientadores de la causa de la talla baja, siendo esta la única manifestación clínica. (AU)
Subject(s)
Humans , Female , Male , Infant , Child, Preschool , Child , Adolescent , Developmental Disabilities/etiology , Developmental Disabilities/diagnosis , Growth Disorders/diagnosis , Growth Disorders/etiology , Body Height , Weight by Height , Prospective StudiesABSTRACT
Introducción: el crecimiento es un indicador de salud en los niños, mientras que la talla baja en ellos plantea un problema pediátrtico frecuente. Esto exige destacar la resencia dee una enfermedad subyacente. Se creó en el año 1996 un grupo de trabajo interdisciplinario en el aréa de consultorios extrnos dedel Centro Hospirtalario Pereira Rossell. Objetivo: describir las características clínicas de los niños con talla baja o disminución de la velocidad de crecimiento, o ambas, en los que se utilizó un algoritmo de estudio preestablecido. Material y método: ingrgesaron al estudio los niños que tenían talla por debajo de -2DE (dos desvíos estándar negativos) de la media por tablas y gráficos de referencia según edad y sexo (National Center for Health Statistics, Organización Mundial de la Salud 1979) o velocidad de crecimiento por debajo del percecntil 25 (Tanner JM, Whitehouse RH), o ambas, que tuvieron un seguimiento suficiente para alcanzar el diagnóstico etiológico. Se realizó anamnesis y exámen físico con historia clínica codificada. Se utilizó un algoritmo de estudio elaborado por el grupo en base a la bibliografía. Resultados: entre 1996 y 2002 se recibieron 170 niños de los cuales ingresaron al estudio 85 pacientes ya que el resto no cumplía con los criterios de inclusión. Del total de casos: 41 eran del sexo femenino y 44 deel sexo masculino, con un rango de edades entre 7 meses a 14 años y 3 meses, con una media de 6 años y 8 meses. El diagnóstico de la causa de estatura baja fue el siguiente: talla baja genética (TBG): 22, multifactorial: 17, nutricional: 14, retardo constitucional del crecimiento y desarrollo (RCCD): 10, síndromes genéticos: 7, endocrinológicos: 6, enfermedad celíaca: 5, causa no aclarada: 2, psicoafectivo: 1, mixto (TBG y RCCD): 1. Conclusiones: se confirmó talla baja o velocidad de crecimiento disminuída en 49,4 por ciento del total de niños transferidos. Las causas más frecuentes de talla baja fueron las variantes normales del crecimiento (TBG y RCCD). En 49,4 por ciento se confirmó talla baja y velocidad de crecimiento disminuída, lo que significa que 40,6 por ciento restante fue derivado con un diagnóstico de falla de crecimiento incorrecto. La mayoría de los pacientes no tuvieron elementos clínicos orientadores de la causa de la talla baja, siendo esta la única manifestación clínica.
Subject(s)
Humans , Male , Child, Preschool , Adolescent , Female , Infant , Child , Weight by Height , Body Height , Prospective Studies , Growth Disorders , Developmental Disabilities/diagnosis , Developmental Disabilities/etiologySubject(s)
Military Nursing , Wounds and Injuries/nursing , Aerospace Medicine , Emergencies , Humans , Panama , United StatesABSTRACT
Neuropeptide Y (NPY) was studied as a marker for neuroblastoma in 12 children. All but one patient with neuroblastoma had elevated plasma NPY concentrations at diagnosis. During treatment NPY values returned to normal in 9 of 12 children. All three children without normalization of plasma NPY values died; two of them had a relapse and the third died of toxic effects. Plasma NPY appears to be a sensitive marker of neuroblastoma.
Subject(s)
Biomarkers, Tumor/blood , Neuroblastoma/diagnosis , Neuropeptide Y/blood , Adolescent , Child , Child, Preschool , Female , Homovanillic Acid/blood , Humans , Infant , Male , Neuroblastoma/blood , Neuroblastoma/therapy , Phosphopyruvate Hydratase/blood , Vanilmandelic Acid/bloodABSTRACT
The poor health status of El Salvador's displaced is a direct result of government policy which defines civilians as legitimate military targets. The effects of this 'strategic hamlet' policy on health is vividly seen in five areas of concern: war related trauma, infectious diseases, malnutrition and insufficient health services due to the repression of health providers and lack of resources. This report documents the major causes of mortality and morbidity among the 500,000 displaced in El Salvador and discusses the efforts of government and private organizations to meet their health needs. Health services for the displaced are primarily provided by private voluntary organizations which base their work on active neutrality. However, neutrality has become almost as dangerous as active opposition. The active repression of health workers by government security forces has exacerbated the already severe shortage of health care services for the displaced.
Subject(s)
Health Policy , Health , Refugees , Disasters , El Salvador , Health Services Accessibility , Humans , United States , WarfareABSTRACT
To examine the possible involvement of atrial natriuretic peptide (ANP) in sodium homeostasis in premature infants, two groups of low birth weight infants with different dietary sodium regimens were studied. Sodium balance and plasma concentration of ANP were measured at weekly intervals for 5 weeks. At 1 week of age the study was started by dividing infants into two groups, group 1 with low and group 2 with increased sodium intake. Mean plasma concentrations of ANP were 47.7 +/- 7.6 and 51.4 +/- 9.5 fmol/ml, respectively. A steady decrease in plasma ANP concentration to 18.8 +/- 2.9 fmol/ml was observed in infants with sodium intake 1.5 mmol/kg/d (group 1), which was related to the decrease in serum sodium concentration in this group. In contrast, supplementation with NaCl 4.6 mmol/kg/d (group 2) was associated with a 30% increase in plasma ANP concentration, significantly different (P less than 0.025) from that in infants not given supplement, and was also higher than the values in full-term neonates. Our data suggest that altered sodium homeostasis induces regulatory changes in plasma ANP levels. ANP may provide a sensitive and important hormonal system for the control of sodium balance, even in premature neonates.