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Favored schemes for trapped-ion quantum logic gates use bichromatic laser fields to couple internal qubit states with external motion through a "spin-dependent force." We introduce a new degree of freedom in this coupling that reduces its sensitivity to phase decoherence. We demonstrate bichromatic spin-dependent forces on a single trapped 111Cd+ ion, and show that phase coherence of the resulting entangled states of spin and motion depends critically upon the spectral arrangement of the optical fields. This applies directly to the operation of entangling gates on multiple ions.
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We report new techniques for driving high-fidelity stimulated Raman transitions in trapped-ion qubits. An electro-optic modulator induces sidebands on an optical source, and interference between the sidebands allows coherent Rabi transitions to be efficiently driven between hyperfine ground states separated by 14.53 GHz in a single trapped 111Cd+ ion.
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STUDY OBJECTIVE: To evaluate clinical and cellular changes of bone through the rapid growth phase of development after intraosseous infusion of hypertonic or isotonic solutions at slow or fast infusion rates in a pig model. METHODS: This was a prospective, randomized, partially blinded, comparative study using a porcine model in an urban teaching hospital laboratory with further development in a local farm environment. Sixty pigs weighing 12 to 30 kg were anesthetized and endotracheally intubated, and a no. 15 Jamshidi bone marrow needle was inserted into a front forelimb. Hypertonic (mannitol) or isotonic (saline) solutions of 8 mL/kg were infused through the intraosseous site at a rapid or slow infusion rate. Animals were observed for approximately 6 months, after which they were killed and the front forelimbs harvested for gross pathologic and histologic evaluation. RESULTS: No clinical complications were noted in any of the animal groups. No substantial histologic differences were found between the hypertonic and isotonic groups. Although gross pathologic lesions were found in 32% of the hypertonic groups and in fewer than 5% of the isotonic groups, this difference was not statistically significant. Equal bone changes were found in the slow- and rapid-infusion groups. CONCLUSION: The rate of intraosseous infusion and the osmolarity of the infused fluid did not appear to be related to any gross pathologic or histologic cellular or marrow changes or to any clinical complications in animal development in this study.
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Medula Óssea/patologia , Infusões Intraósseas/efeitos adversos , Metacarpo/patologia , Animais , Medula Óssea/crescimento & desenvolvimento , Fibrose , Membro Anterior , Soluções Hipertônicas/administração & dosagem , Soluções Isotônicas/administração & dosagem , Metacarpo/crescimento & desenvolvimento , Necrose , Estudos Prospectivos , Distribuição Aleatória , SuínosRESUMO
STUDY OBJECTIVE: To assess the efficacy of SC sumatriptan injection versus placebo in the treatment of acute migraine in ED patients and that of open-label 100 mg sumatriptan PO tablets for recurrent migraine. DESIGN: Randomized, double-blind, placebo-controlled, multi-center trial. SETTING: Twelve EDs in the United States. PARTICIPANTS: Adult patients presenting to the ED from September 1992 through April 1993 with a diagnosis of migraine as determined by International Headache Society criteria. Patients were randomized to receive 6 mg sumatriptan SC or placebo. Patients were monitored for improvement in headache severity using a four-point scale and for time to meaningful relief using a stopwatch. The time to discharge from the ED was recorded. An open-label 100 mg sumatriptan PO tablet was given to all patients on discharge from the ED for use at home if the headache recurred within 24 hours. RESULTS: One hundred thirty-six patients were enrolled. Seventy-five percent of patients treated with sumatriptan achieved meaningful relief compared with 35% treated with placebo (P < .001). The median time to meaningful relief was 34 minutes in the group that received sumatriptan. Seventy percent of patients in the sumatriptan group versus 35% in the placebo group reported mild or no pain at discharge (P < .001). Migraine-associated symptoms such as nausea, photophobia, and phonophobia were significantly reduced in the sumatriptan group (P < .005). The median time to discharge from the ED was shorter for the sumatriptan group than for the placebo group (60 versus 96 minutes, respectively; P = .001). At baseline, 15% of patients in the sumatriptan group and 19% of patients in the placebo group reported mild or no clinical disability. At the time of discharge, patients with mild or no disability increased to 75% in the sumatriptan group compared with 44% in the placebo group (P = .001). Fifty-seven of 92 patients (62%) with mild or no pain at discharge took open-label oral sumatriptan for headache recurrence, and 37 (65%) experienced meaningful relief within 2 hours. Median time to meaningful relief after oral sumatriptan was 65 minutes. CONCLUSION: Sumatriptan (6 mg SC) is effective in treating acute migraine in the ED. Oral sumatriptan (100 mg) is effective in treating headache recurrence within 24 hours.
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Transtornos de Enxaqueca/tratamento farmacológico , Sumatriptana/uso terapêutico , Doença Aguda , Administração Oral , Adulto , Idoso , Método Duplo-Cego , Serviço Hospitalar de Emergência , Feminino , Humanos , Injeções Subcutâneas , Masculino , Pessoa de Meia-Idade , Recidiva , Fatores de Tempo , Resultado do TratamentoRESUMO
STUDY OBJECTIVE: To determine if intramedullary aspirate from intraosseous needle placement can be used as a source for evaluating blood compatibility. DESIGN: A prospective, nonrandomized, crossover study. SETTING/PARTICIPANTS: Patients admitted to the hematology/oncology service undergoing bone marrow aspiration for medical purposes. INTERVENTIONS: Patients had simultaneous samples of bone marrow aspiration from the posterior iliac crest and peripheral venous blood drawn and sent for typing and screening. MEASUREMENTS AND MAIN RESULTS: The paired samples were evaluated for ABO and Rh typing as well as the presence of human leukocyte activity by evaluating the reaction strength between the marrow and venous samples. RESULTS: No differences were seen in the reaction strength between the paired samples in any subjects for ABO and Rh typing (P = .90, yielding beta = .0523). In addition, human leukocyte activity was detected in both the marrow and venous samples in one patient. CONCLUSION: Bone marrow aspirates following intraosseous infusion can be used for accurate and reliable typing and screening of blood.
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Tipagem e Reações Cruzadas Sanguíneas/métodos , Medula Óssea , Sistema ABO de Grupos Sanguíneos/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Sistema do Grupo Sanguíneo Rh-Hr/isolamento & purificaçãoRESUMO
Serum drug levels from a single intraosseous attempt in nontraumatized bone have proven comparable to levels from IV drug infusions. However, in the clinical situation, inexperienced personnel may make multiple intraosseous attempts, which could allow significant extravasation from multiple intramedullary entrance sites. Serum drug levels arising from multiple intraosseous attempts in traumatized bone were compared with those arising from single intraosseous attempts in nontraumatized bone. We administered phenobarbital to 24 dogs randomly divided into single- (11) and multiple-attempt (13) groups. In the multiple-attempt group, we created three intramedullary insertion sites in a linear fashion and infused through only the central site. In the single-attempt group, only a single infusion site was created. Phenobarbital then was infused into the intramedullary space, and central venous phenobarbital samples were collected at one-, three-, six-, and ten-minute intervals. The single-attempt group attained significantly higher serum phenobarbital levels at each interval compared with the multiple-attempt group (P less than .0001). Therefore, to be an effective mode of therapy, it is critical to achieve single-attempt intraosseous needle placement for intraosseous infusion.
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Medula Óssea , Injeções/métodos , Fenobarbital/sangue , Animais , Cães , Fenobarbital/administração & dosagem , Distribuição Aleatória , Tíbia , Fatores de TempoRESUMO
Automatic skin staplers have been commonly used for surgical wound closure for many years. The efficiency and ease of placement of skin staplers make them an attractive alternative to suture repair of selected lacerations in the emergency department. Emergency physicians, however, have been reluctant to use staplers in the ED. We evaluated skin staples in 76 patients presenting with 87 lacerations to the scalp, trunk, or extremities, excluding hands and feet. Patients returned to the ED in two and seven to ten day for wound check and staple removal. Skin stapling was assessed for efficiency, cosmetic results, complications, and cost-effectiveness. Only one significant complication was noted in our study group - a dehiscence of a scalp laceration secondary to hematoma collection. There was also a minor dehiscence of a superficial laceration of the leg due to inadequate primary closure, which did not result in any cosmetic deformity. No infectious complications, delayed wound healing, or cosmetic problems were seen. Skin stapling was easier and quicker than suture repair at a lower overall cost in most circumstances. Our study shows skin stapling to be an efficient and cost-effective alternative method to suture wound closure for selected lacerations in patients presenting to the ED, without compromising wound healing or cosmetic results.
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Pele/lesões , Grampeadores Cirúrgicos , Técnicas de Sutura , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Estudos de Avaliação como Assunto , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Grampeadores Cirúrgicos/efeitos adversos , Grampeadores Cirúrgicos/economia , CicatrizaçãoRESUMO
Intraosseous infusion has become an increasingly popular technique for vascular access in critically ill or injured children. Continuing acceptance of this procedure by physicians and possibly by prehospital personnel may lead to inadvertent placement through the immature growth plate. In our study, we intentionally penetrated the epiphyseal plate with the intraosseous needle and infused fluids in order to observe what complications, if any, might arise from this procedure. Twenty pigs 3 to 4 weeks old had a bone marrow aspiration needle introduced into the medullary cavity through the tibial epiphysis under fluoroscopic visualization. Sodium bicarbonate at 2 mEq/kg (n = 10) or 0.9 normal saline at 2 mL/kg (n = 10) was infused through the intraosseous needle. Radiographs of the involved growth plates were taken at two months and six months after infusion. No growth disturbances or growth plate abnormalities were detected clinically or radiographically through the rapid growth phase of the porcine tibia. Therefore, we believe that intraosseous infusion is a safe method of alternative vascular access associated with no significant growth defects despite injury to the developing growth plate from placement and infusion.
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Medula Óssea , Cateterismo/efeitos adversos , Fraturas Salter-Harris , Tíbia/crescimento & desenvolvimento , Animais , Cateterismo/métodos , Lâmina de Crescimento/diagnóstico por imagem , Radiografia , Suínos , Fatores de TempoRESUMO
Authors of recent literature have made several references to the use of intraosseous infusion in emergency situations. This method has provided a useful route of medication and fluid administration when peripheral IV access has been unsuccessful. Controlled studies on intraosseous infusion have been limited. To more accurately evaluate the effectiveness of this technique, we administered diazepam to 20 dogs randomly assigned to either peripheral IV (n = 10) or tibial intraosseous (n = 10) groups. Intramedullary placement usually was performed within 15 seconds. Central venous diazepam samples were collected at one-, three-, six-, ten-, and 20-minute intervals. Intraosseous infusion achieved and maintained serum diazepam levels comparable to those achieved by IV administration. This study was repeated with phenobarbital using a different set of 20 dogs with samples collected at one-, three-, six-, and ten-minute intervals. Results were similar in that the levels were comparable regardless of the use of intraosseous or IV administration. Complications using this technique have been few. When peripheral IV access is unobtainable, intraosseous infusion has been shown to be an effective and efficient alternative for administering medications and fluids.
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Diazepam/administração & dosagem , Fenobarbital/administração & dosagem , Animais , Cromatografia Gasosa , Diazepam/sangue , Cães , Infusões Intravenosas , Fenobarbital/sangueRESUMO
Seventy-seven dermis-fat graft specimens with cup shapes of varying diameters were removed from nine cadavers, and their volumes were determined by volume displacement. Theoretical volumes were calculated by assuming that the cup shape of the grafts would result in a volume size between that of a cone and that of a cylinder, all of equal diameters and heights. The resulting data demonstrate a close correlation between the measured and the calculated volumes. Graft volume in different-sized orbits can be accurately determined by preplacement of different-sized Mule spheres and testing for adequacy of fit.