Prophylactic perioperative hypogastric artery balloon occlusion in abnormal placentation.

OBJECTIVE: The aim of this paper is to describe and evaluate the technique of prophylactic balloon occlusion of hypogastric arteries in abnormal placentation. Five patients with suspected placenta accreta, placenta percreta, or placenta increta underwent perioperative balloon occlusion of hypogastric arteries after classic cesarean delivery and before hysterectomy with hypogastric artery ligation. Two patients did not require transfusions; of the three who did, the estimated blood loss ranged from 1100 to 4000 mL. CONCLUSION: We conclude that balloon occlusion of the hypogastric arteries is a safe and effective adjunct to cesarean hysterectomy in an attempt to minimize blood loss in patients with abnormal placentation.

Effectiveness of three types of sterilization on the contents of sharps containers.

The purpose of this study was to test the effect of treatment in a gravity steam autoclave, high-vacuum steam autoclave, or an unsaturated chemical vapor sterilizer on endospores present on strips or placed inside of dental anesthetic cartridges held within sharps containers. Strips with 1.7 X 10(5) Bacillus stearothermophilus endospores were used; the cartridges were soiled with an equal number of spores or spores mixed with blood. If sterilization was not accomplished after the initial period, additional exposure time was added. Neither the presence of blood or anesthetic solution nor the position of the container affected the efficiency of sterilization. Soiled cartridges were much more difficult than strips to sterilize. Intact cartridges could not be sterilized by two runs in a gravity steam autoclave or an unsaturated chemical vapor sterilizer or one run in a high-vacuum steam autoclave. Sterilization occurred after two runs in the gravity steam autoclave and unsaturated chemical vapor sterilizer only when one end of the cartridge was removed prior to processing. Results indicated that unopened spore-soiled cartridges are not readily sterilized by commonplace office sterilizers, even after extended exposure.

Parental versus professional perceptions of obstacles to pediatric diabetes care.

Parents of children with insulin-dependent diabetes mellitus (IDDM) (n = 38) were surveyed to identify common and difficult obstacles to diabetes care. A list of these obstacles was cross-validated by a second parent sample (n = 47) who rated each item according to how common and difficult each item was for them. The list then was rated by a sample of diabetes professionals (n = 15) to evaluate the extent of agreement between parents and health care professionals regarding the frequency with which these obstacles occur and the difficulty they pose to everyday diabetes care. Professionals disagreed with parents regarding which obstacles were most common and difficult, generally rating problems as significantly more common and difficult (t = 5.20, P = < .001) than did the parents who experienced them. The results of the survey underscore the importance of health care providers evaluating the concerns of the local patient community when developing educational and treatment services for these patients.