Interventional radiology in women with suspected placenta accreta undergoing caesarean section.

Placenta praevia in the presence of a previous uterine scar is associated with increased risk of placenta accreta, which could lead to major haemorrhage at delivery. Major haemorrhage is one of the leading causes of maternal mortality in the UK. Interventional radiology with trans-catheter balloon occlusion or arterial embolisation is a recognised technique for the management of intractable obstetric haemorrhage. Between December 2002 and May 2007 thirteen women in our institution with sonographic findings of anterior placenta praevia and suspected placenta accreta or percreta underwent caesarean sections with peri-operative bilateral internal iliac artery catheterization with or without balloon occlusion or embolisation. This case series describes our experience of anaesthetic and radiological techniques, surgical procedures and outcomes. The obstetricians and anaesthetists in our institution are of the impression that the use of peri-operative, preferably pre-operative, internal iliac artery catheterization with or without balloon occlusion or embolisation, in women with placenta accreta or percreta, improves the operative field and potentially reduces blood loss and transfusion requirements. We were unable to find evidence that this technique reduces the need for caesarean hysterectomy. Through our experience, we have developed a unit protocol for the management of women with suspected placenta accreta undergoing caesarean section.

[Do cows drink calcium?]. / Trinken Kühe Kalzium?

The objective of this study was to investigate how well cows drink the Propeller calcium drink, and it's effect on blood calcium concentration. Drinking was tested in 120 cows right after calving, before cows drank anything else. 60 cows each were offered 20 liters of Propeller calcium drink or 20 liters of water. Cows drank the Propeller as good as water. 72% of all cows drank all 20 liters, 18% drank on average 8.2 liters and 10% drank less than 1 liter. Blood calcium concentration was studied in 16 cows right after calving. Eight cows each were offered 20 liters of Propeller calcium drink or no calcium drink. Blood calcium significantly increased ten minutes after Propeller intake and stayed significantly elevated for 24 hours. Without calcium drink blood calcium levels decreased significantly. Advantages of the new Propeller calcium drink over calcium gels or boli could be that cows now drink calcium themselves and that the Propeller increases blood calcium concentration rapidly and long lasting.

Double-blind, randomized, placebo-controlled trial comparing rofecoxib with dexketoprofen trometamol in surgical dentistry.

BACKGROUND: Rofecoxib, a selective cyclooxygenase-2 inhibitor, and dexketoprofen trometamol, a single isomer non-steroidal anti-inflammatory drug (NSAID), are available for the treatment of acute pain. Both are claimed to have fewer adverse effects than traditional NSAIDs. We have compared them in a clinical setting. METHODS: We performed a double-blind randomized controlled trial involving 120 patients undergoing surgical removal of a single mandibular third molar at the Edinburgh Dental Institute. Those who developed moderate pain within 4 h of the procedure were allocated to one of three groups: rofecoxib 50 mg (Group RO, n=37); dexketoprofen trometamol 25 mg (Group DE, n=42); or placebo (Group PL, n=41). Participants monitored pain intensity and pain relief for 24 h using visual analogue scales (VAS) and verbal rating scales (VRS). The summed, time-weighted pain relief score to 8 h derived from the VRS (TOTPAR 8) was used as the primary outcome variable. RESULTS: No significant difference was demonstrated between Groups RO and DE using TOTPAR 8 as the primary outcome variable. Both drugs were significantly different compared with placebo. Rescue analgesia during the trial period was required by only 15 out of 37 subjects in Group RO, but 35 out of 42 subjects in Group DE. The median times to use of rescue medication were 150 (Group PL), 398 (Group DE) and 1440 min (Group RO). Both drugs were well tolerated and adverse events reported were mild to moderate in severity. CONCLUSIONS: Rofecoxib and dexketoprofen trometamol are effective treatments for acute pain using a dental pain model and are well tolerated. Rofecoxib has a longer duration of action as a single dose and gave adequate analgesia for over half of that study group; patients in the dexketoprofen trometamol group needed more rescue analgesia.

[Results of Kapandji-Sauvé procedure with distal radio-ulnar fusion and segmental resection of the ulna]. / Ergebnisse nach radioulnarer Arthrodese mit distaler Ellenteilresektion nach Kapandji-Sauvé

The Kapandji-Sauvé procedure was performed in 75 patients between 1990 and 2003. The most important indication was painful and restricted forearm rotation after fracture of the distal radius combined with dislocation or destruction of the distal radioulnar joint. 25 patients were followed up using a modified Martini score. We found a significant improvement of forearm rotation, reduction of pain and a good patient satisfaction in a long-term follow-up ranging from three to 12 years.

[Factors influencing the vitamin A concentration in the liver of cattle]. / Einflussfaktoren auf die Leber-Vitamin-A-Konzentration bei Rindern.

Nineteen long-term individual- and group-feeding experiments with 180 male calves, 338 growing bulls, 302 heifers, and 344 dairy cows were carried out in order to measure the influence of feeding (straw, silages or green fodder as roughages) and different vitamin-A supplies (0-40,000 IU per 100 kg body weight per day in growing cattle or 0-120,000 IU per dairy cow per day) on liver vitamin-A concentration. All together, 2,127 biopsies from livers were taken for retinol analysis. At the end of six growth experiments animals were slaughtered. Liver vitamin-A concentration of calves depends on their term at birth and is associated with the carotene intake of their mothers. The carotene content of feeds and the vitamin-A supply are the most important influencing factors on liver vitamin-A concentration of growing and lactating cattle. On the average, livers of calves fed with colostrum contained 100-200 IU, those of growing cattle fed with grass and legumes or with silages contained 200-300 or 100-200 IU resp., and those of cows fed with green fodder or silage contained 300-600 or 100-300 IU vitamin A resp. per g fresh liver. There were also values outside of the variations mentioned above. The vitamin-A storage capacity of liver and the effects of oral and parenteral vitamin-A supply to depleted calves and growing cattle were also tested.