Employment status 1 year after out-of-hospital cardiac arrest in comatose patients treated with therapeutic hypothermia.

BACKGROUND: Therapeutic hypothermia for comatose survivors of out-of-hospital cardiac arrest (OHCA) has improved survival and neurologic outcome. This study focused on return to work 1 year after therapeutic hypothermia. METHODS: From June 2004 to June 2009, patients between 18 and 65 years of age with OHCA, who were treated with hypothermia from two regions, representing one third of the national population, were identified from the Danish National Patient Registry, and from hospital and ambulance records. The patients' employment status was obtained from the Danish Ministry of Employment. RESULTS: One hundred thirty-three comatose patients after OHCA treated with hypothermia were identified. One hundred and four (78%) patients were employed, or able to work, at the time of cardiac arrest. This particular group of patients showed significant lower in-hospital mortality compared to the group of patients who were not able to work before cardiac arrest; 13% vs. 48%, respectively (P < 0.001). The workable group had a lower Charlson comorbidity score (P = 0.004), a higher incidence of witnessed cardiac arrest (P = 0.004) and a higher incidence of shockable heart rhythm (P < 0.001). Eighty-seven patients (84%), who were able to work prior to cardiac arrest, survived, and 55 (65%) of these patients were employed or able to work at 1 year follow-up. CONCLUSION: The majority of patients employed, or able to work prior to OHCA, had returned to work at one year follow-up. Predictors of return to work in comatose patients treated with hypothermia have to be identified in a larger-scale study.

Response to single twitch or single burst stimulation of the ulnar nerve as predictive guide for intubating conditions.

Disappearance of response to single twitch stimulation (STS) or train-of-four stimulation (TOF) of the ulnar nerve is insufficient as predictive guide for intubating conditions during onset of non-depolarizing neuromuscular block. Double burst stimulation (DBS) appears to be a more reliable indicator of the optimal time for intubation. In the present study, the disappearance of tactile detectable response to 0.1 Hz single twitch stimulation (STS) of the ulnar nerve was compared with disappearance of response to 0.1 Hz single burst stimulation (three stimuli at 50 Hz = SBS) as predictor for optimal intubating conditions during onset of block induced by 0.08 mg.kg-1 of vecuronium in 100 patients under light general anaesthesia where thiopentone was used as the sole anaesthetic. Intubation was performed immediately after disappearance of the twitch response. Likewise 0.05 Hz STS and 0.05 Hz SBS stimulation were compared under identical circumstances in another 100 patients. Intubating conditions were unacceptable in 10%, 14%, 8% and 10% of the patients in the 0.1 Hz STS, 0.1 Hz SBS, 0.05 Hz STS and 0.05 Hz SBS groups, respectively. There were no significant differences between the groups. In conclusion, neither absence of response to STS stimulation nor absence of response to SBS stimulation of the ulnar nerve at either 0.1 Hz or 0.05 Hz frequency does guarantee acceptable intubating conditions during onset of neuromuscular block induced by vecuronium 0.08 mg.kg-1 when thiopentone is used as the sole anaesthetic.

Short-term results and long-term patients' appraisal of abdominal colposacropexy for treatment of genital and vaginal vault prolapse.

OBJECTIVE: To evaluate short-term results and long-term patients' satisfaction of abdominal colposacropexy performed for massive genital prolapse in our institute during a 14-year period. STUDY DESIGN: A retrospective analysis was performed of 101 consecutive women who underwent abdominal colposacropexy. The procedure consisted of retroperitoneal interposition of a Mersilene mesh between a prolapsed vaginal vault or uterus and the anterior surface of the sacrum. A questionnaire was used to evaluate patients' satisfaction after surgery. RESULTS: In the short-term there was an acceptable rate of complications of surgery, comparable with that reported in the literature. Prolapse-related complaints evaluated by questionnaire were markedly diminished after surgery. Pain and functional complaints were only partly improved in a subgroup of patients. Only 32% of the patients responded that they were fully cured after operation. CONCLUSIONS: Abdominal colposacropexy shows a particularly favorable result on prolapse-related complaints. Functional complaints and pain are not substantially relieved by this procedure. The complication rate of surgery is acceptable.

[Prevention of neonatal tetanus in developing countries hampered by local organization and limited knowledge of health personnel and traditional midwives; North Sulawesi (Indonesia)]. / Preventie van neonatale tetanus in ontwikkelingslanden bemoeilijkt door lokale organisatie en beperkte kennis bij gezondheidswerkers en traditionele vroedvrouwen; Noord-Sulawesi (Indonesië).

OBJECTIVE: Evaluation of the policy to prevent neonatal tetanus in North-Sulawesi (Indonesia). DESIGN: Descriptive and questionnaire study. SETTING: Twelve villages in the district of Minahassa, Sulawesi, Indonesia. METHOD: The policy aimed at preventing neonatal tetanus was studied during the period April-June 1992. The relevant knowledge was tested of the community health workers (CHWs, n = 142) and traditional birth attendants (TBAs, n = 37) active in the 12 villages. To this purpose, 54 and 27 workers, respectively, were interviewed using a standard questionnaire. RESULTS: Not all women were vaccinated sufficiently to prevent their unborn children from tetanus; mostly, adequate vaccination records were lacking. 33% of the TBAs were unaware that neonatal tetanus can be prevented by hygienic delivery; in this respect there was no difference between trained and untrained TBAs. Of the CHWs, 39% were familiar with the correct vaccination policy and 26% did not know that pregnant women have to be vaccinated. 70% of the CHWs and TBAs wrongly believed that neonatal tetanus no longer occurred in their village. CONCLUSION: CHWs and TBAs showed little interest in neonatal tetanus, so that they were lacking in motivation regarding hygienic delivery procedures and preventive tetanus toxoid vaccination. Implementation of a good preventive programme in developing countries mostly requires organizatory rather than biomedical improvement.

Epidural morphine for postoperative pain relief in children.

Epidural morphine for postoperative pain relief is in general use, and has proved to be very efficient in adults. The epidural technique and the use of epidural morphine are much less frequent in children. For 2 years we have prospectively followed 76 children who had epidural morphine for postoperative pain relief after major abdominal surgery. The age distribution was from newborn to 13 years, with a median age of 12 months. It was estimated that 94% of the patients had good analgesia for the first 24 postoperative hours and no other opioids were given. The side effects were few, but one case of respiratory depression was seen and 20% of the children had pruritus. There were four dural punctures and three catheters slipped out accidentally, but otherwise the treatment was continued as long as it was considered necessary (1-11 days). The use of postoperative ventilatory support decreased during the investigation. We observed a change in the sleeping pattern with an increased number of sleep-induced myoclonia during the administration of epidural morphine. In conclusion, the use of epidural morphine in children for postoperative pain relief is very efficient. The minimal effective dose has not been established as yet, but 50 micrograms/kg every 8 h, supplemented with small doses of bupivacaine, provides excellent analgesia in the immediate postoperative period after major abdominal surgery. The side effects are few, but the risk of respiratory depression is always present and observation in the intensive care unit or recovery for the first 24 h is strongly recommended.

Spontaneous preterm birth: a case-control study.

Information on demographic characteristics, life-style, and reproductive, prenatal, and medical history was obtained from the prenatal records of 140 women with a preterm delivery (cases) and 280 women with a term delivery (controls) matched by age. Compared with controls, a greater proportion of cases were nonwhite, never married, and educated less than 12 years. When logistic regression was used to control for confounding variables, a number of risk factors were found to be associated with an increased risk for preterm delivery: a history of a prior preterm delivery (relative risk, 3.5; confidence interval, 1.6 to 7.8), smoking during the pregnancy (p value test of trends, 0.005), and a prepregnancy weight less than 61.5 kg (relative risk, 2.0; 95% confidence interval, 1.2 to 3.2). Seven (5%) cases and none of the controls indicated a history of maternal diethylstilbestrol exposure (p less than 0.001). A history of prior induced abortion was associated with a modest increase in risk for a spontaneous preterm delivery (relative risk, 1.6; confidence interval, 0.9 to 2.7), and this risk increased with increasing numbers of induced abortions (p value for chi 2 test of trend, 0.02).

[Meckel's diverticulum---clinical picture, diagnosis and treatment]. / Meckels Divertikel--Klinik, Diagnose und Behandlung.

Meckel's diverticulum is the most common anomaly of the gastrointestinal tract. It is usually asymptomatic, but it can cause rectal bleeding and bowel obstruction in both children and adults. Different investigative methods are used to diagnose Meckel's diverticulum. When a Meckel's diverticulum is suspected to cause rectal bleeding in children, the first choice of examination is the Meckel scan. Angiography is an alternative method in adults. Demonstration of a Meckel's diverticulum using barium meal examination is rare, but enteroclysis has been stated to be the most accurate method in detecting Meckel's diverticulum and other focal abnormalities of the small bowel.