Non-invasive continuous arterial pressure and pulse pressure variation measured with Nexfin(®) in patients following major upper abdominal surgery: a comparative study.

We compared the accuracy and precision of the non-invasive Nexfin(®) device for determining systolic, diastolic, mean arterial pressure and pulse pressure variation, with arterial blood pressure values measured from a radial artery catheter in 19 patients following upper abdominal surgery. Measurements were taken at baseline and following fluid loading. Pooled data results of the arterial blood pressures showed no difference between the two measurement modalities. Bland-Altman analysis of pulse pressure variation showed significant differences between values obtained from the radial artery catheter and Nexfin finger cuff technology (mean (SD) 1.49 (2.09)%, p < 0.001, coefficient of variation 24%, limits of agreement -2.71% to 5.69%). The effect of volume expansion on pulse pressure variation was identical between methods (concordance correlation coefficient 0.848). We consider the Nexfin monitor system to be acceptable for use in patients after major upper abdominal surgery without major cardiovascular compromise or haemodynamic support.

The effect of propofol on haemodynamics: cardiac output, venous return, mean systemic filling pressure, and vascular resistances.

BACKGROUND: Although arterial hypotension occurs frequently with propofol use in humans, its effects on intravascular volume and vascular capacitance are uncertain. We hypothesized that propofol decreases vascular capacitance and therefore decreases stressed volume. METHODS: Cardiac output (CO) was measured using Modelflow(®) in 17 adult subjects after upper abdominal surgery. Mean systemic filling pressure (MSFP) and vascular resistances were calculated using venous return curves constructed by measuring steady-state arterial and venous pressures and CO during inspiratory hold manoeuvres at increasing plateau pressures. Measurements were performed at three incremental levels of targeted blood propofol concentrations. RESULTS: Mean blood propofol concentrations for the three targeted levels were 3.0, 4.5, and 6.5 µg ml(-1). Mean arterial pressure, central venous pressure, MSFP, venous return pressure, Rv, systemic arterial resistance, and resistance of the systemic circulation decreased, stroke volume variation increased, and CO was not significantly different as propofol concentration increased. CONCLUSIONS: An increase in propofol concentration within the therapeutic range causes a decrease in vascular stressed volume without a change in CO. The absence of an effect of propofol on CO can be explained by the balance between the decrease in effective, or stressed, volume (as determined by MSFP), the decrease in resistance for venous return, and slightly improved heart function. CLINICAL TRIAL REGISTRATION: Netherlands Trial Register: NTR2486.

[Autonomy: to what extent is the concept relevant in psychiatry?]. / Autonomie: een zorgelijk begrip?

BACKGROUND: Autonomy is an important concept in psychiatry, but because it is a somewhat abstract and ambiguous notion, it is not applicable in its entirety in a psychiatric context. This becomes obvious in situations where patients are receiving long term care and treatment. AIM: To modify the concept of autonomy in such a way that it acquires an extra dimension that renders it applicable to daily psychiatric practice. METHOD: The literature was reviewed in order to find articles that reveal the tensions that arise between autonomy and dependence in psychiatry and that reflect the human characteristics that are concealed behind the modern concepts of autonomy, freedom and respect for autonomy. RESULTS: Concepts such as person, identity, acknowledgement, dialogical ethics and life histories are used as an addition to the concepts of autonomy of Kant and Mill. A phenomenological and a context sensitive conception of autonomy is needed within the perspective of dialogical ethics. A dialogical perspective requires from psychiatric professionals a susceptibility for what the patient as a human being really has to say. On the basis of a dialogue where there is space and attention for life histories, backgrounds and the potentials of patients, a new perspective can be developed that is shared by the persons involved. CONCLUSION: In psychiatry, statements about real autonomy and genuine respect for autonomy are only truly meaningful within the context of doctors, nurses and patients. A hermeneutic approach to patients which involves dialogue creates new opportunities in the field of staff-patient relations.

University students and HIV in Namibia: an HIV prevalence survey and a knowledge and attitude survey.

BACKGROUND: With an overall adult HIV prevalence of 15.3%, Namibia is facing one of the largest HIV epidemics in Africa. Young people aged 20 to 34 years constitute one of the groups at highest risk of HIV infection in Namibia. However, little is known about the impact of HIV on this group and its access to healthcare. The purpose of this study was to estimate HIV prevalence, to assess the knowledge of and attitudes towards HIV/AIDS, and to assess access to healthcare among university students in Namibia. METHODS: We assessed HIV/AIDS knowledge and attitudes, HIV prevalence and access to healthcare among students at the Polytechnic of Namibia and the University of Namibia. HIV prevalence was tested through anonymous oral fluid-based tests. RESULTS: Half (n = 2790/5568) of the university students and 45% (n = 2807/6302) of the Polytechnic students participated in the knowledge and attitudes surveys. HIV/AIDS knowledge was reasonable, except for misperceptions about transmission. Awareness of one's own HIV status and risks was low. In all, 55% (n = 3055/5568) of university students and 58% (n = 3680/6302) of Polytechnic students participated in the HIV prevalence survey; 54 (1.8%) university students and 103 (2.8%) Polytechnic students tested HIV positive. Campus clinics were not the major providers of healthcare to the students. CONCLUSIONS: Meaningful strategies addressing the gap between knowledge, attitude and young people's perception of risk of HIV acquisition should be implemented. HIV prevalence among Namibian university students appears relatively low. Voluntary counselling and testing should be stimulated. Efforts should be made to increase access to healthcare through the campus clinics.

[A study of uterine adhesions following suturing of the uterus with catgut or Vicryl in cesarean sections in cattle]. / Een onderzoek naar vergroeiingen van de uterus na het hechten van de uterus met catgut of Vicryl bij de sectio caesarea van het rund.

A caesarean section was performed in 202 cows for the first time. The uterus of 103 of these cows was sutured with Vicryl (7 metric) and the uterus of 99 cows was sutured with plain catgut (9 metric). The cows were randomly allotted to the two groups. All cows were rectally examined to diagnose adhesions between the uterus and the surrounding tissue five weeks post partum. Adhesions were found in 50% of the cases. There were no differences in the number of adhesions and the severity of the adhesions between the catgut and the Vicryl group (Table 1).

An outbreak of contact dermatitis from toluenesulfonamide formaldehyde resin in a nail hardener.

8 cases of contact dermatitis from toluenesulfonamide formaldehyde resin in a nail hardener are presented. Most patients had used nail lacquers containing this resin for many years without trouble, but became sensitized to the resin shortly after the introduction of this particular nail hardener. A hypothesis concerning the possible mechanism is given.

Controlled double-blind trial of fibrinolysin-desoxyribonuclease (Elase) solution in patients with chronic leg ulcers who are treated before autologous skin grafting.

A controlled, randomized, double-blind trial was performed in 34 hospitalized patients with chronic leg ulcers: 37 ulcerous legs were treated with Elase solution or with saline (placebo) solution. Elase was statistically significantly better in effect on debridement (p less than 0.05) and on enhancing of granulation (p less than 0.05) than saline in patients with chronic venous stasis ulcers. In patients with complex ulcers no statistically significant difference between the two treatments was seen.

Composition of renal basement membranes isolated under various conditions.

GBM isolated from a surgical biopsy directly or after a 22 hr incubation period--to imitate the usual interval between death and isolation--appeared to be nearly identical in amino acid composition. Sonication and detergent procedures for isolation of GBM and TBM lead to preparations of different chemical composition. Phosphorus analysis and electron micrographs indicate the presence of material of supposedly cellular origin in sonicated but not in detergent-treated bovine and human GBM. Detergent-treated bovine and human GBM preparations are more enriched in the collagen-typical amino acids than sonicated samples. SDS-PAGE analyses show a nearly identical polypeptide pattern. Sonicated and detergent-treated bovine TBM preparations are free of cellular material. They show in SDS-PAGE a similar heterogeneous polypeptide pattern, but with lower intensities of three components with molecular weights between 30 and 60 kdalton. Sulfated GAG's are present in higher concentration in sonicated than in detergent-treated GBM and TBM. Collagen is not extracted from glomeruli and tubules by detergent treatment.