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Group L (group + l)
Selected AbstractsAdding sufentanil to levobupivacaine or ropivacaine intrathecal anaesthesia affects the minimum local anaesthetic dose requiredACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2009R. PARPAGLIONI Background: We carried out this prospective, randomized, double-blind study in order to evaluate whether the intrathecal addition of sufentanil 3.3 mcg affects both the minimum local anaesthetic dose (MLAD) of spinal levobupivacaine and ropivacaine for a caesarean section and enhances the spinal block characteristics. Methods: One hundred and eighty women were randomly allocated into four groups: levobupivacaine (Group L), levobupivacaine plus sufentanil (Group L+S), ropivacaine (Group R) and ropivacaine plus sufentanil (Group R+S). Each received 3 ml of the study solution intrathecally as part of a combined spinal/epidural technique. The initial dose was 12 mg for Groups L and L+S, and 15 mg for Groups R and R+S. The test solution was required to achieve a visual analogue pain score (VAPS) of 30 mm or less to be considered effective at skin incision, uterine incision, birth, peritoneal closure and at the conclusion of surgery. Effective or ineffective responses determined a 0.5 mg decrease or increase of the same drug, respectively, for the next patient in the same group, using an up,down sequential allocation. Results: Using the Dixon and Massey formula, the MLAD was 10.65 mg [confidence interval (CI) 95%: 10.14,11.56] in Group L, 4.73 mg (CI 95%: 4.39,5.07) in Group L+S, 14.12 mg (CI 95%: 13.50,14.60) in Group R and 6.44 mg (CI 95%: 5.86,7.02) in Group R+S. Conclusions: The addition of sufentanil reduced the MLAD of both the local anaesthetics. It did not affect their potency ratio significantly and resulted in enhanced spinal anaesthesia. [source] The use of low dose plain solutions of local anaesthetic agents for spinal anaesthesia in the prone position: bupivacaine compared with levobupivacaineANAESTHESIA, Issue 1 2009O. Cuvas Summary In this study, we aimed to test the hypothesis that 1-ml plain solution of 0.5% bupivacaine or 0.5% levopubivacaine administered in a subarachnoid block can provide adequate anaesthesia and operating conditions for pilonidal cyst/sinus operations performed in the prone position. There were no significant differences between the two groups in terms of patient demographic data, duration of operation, patient-surgeon satisfaction, haemodynamic changes and side effects. There were no significant differences found in the onset time, highest block level achieved, two segment regression, time to S2 regression of sensory block and the number of anaesthetised dermatomes, between the two groups (p = 0.077, 0.057, 0.091, 0.084 and 0.057 respectively). The incidence of complete motor blockade was 16% and 8% in Group B at the start and at the end of the operation. There was no complete motor blockade in Group L (p = 0.110 and 0.490 respectively). We conclude that both regimens are effective and safe for use in subarachnoid anaesthesia for pilonidal cyst/sinus operations performed in the prone position. [source] ,Multimodal' approach to management of prostate biopsy pain and effects on sexual function: efficacy of levobupivacaine adjuvant to diclofenac sodium , a prospective randomized trialANDROLOGIA, Issue 1 2010T. Aktoz Summary We assessed the analgesic efficacy of levobupivacaine when administered as an adjuvant to diclofenac sodium in prostate biopsy pain management and effects of prostate biopsy on sexual function. Ninety patients underwent transrectal ultrasound (TRUS)-guided biopsy of the prostate and were randomly assigned to three groups: group D received diclofenac sodium suppository; Group L received periprostatic injection of levobupivacaine; group DL received diclofenac suppository and levobupivacaine in addition. Patients were asked to use a visual analogue scale score (VAS) questionnaire about pain after 10 core prostate biopsy. Sixty-two patients reported to be prostate cancer-free underwent further evaluation with the International Index of Erectile Function-5 (IIEF-5) questionnaire at 1 and 3 months after biopsy. Mean pain scores during prostate biopsy were significantly lower in group DL and were superior to the group L and group D (P < 0.001). Mean IIEF-5 score prior to biopsies was significantly higher when compared with the mean IIEF-5 score 1 month after biopsy (P < 0.0001). Mean IIEF-5 scores 1 month after biopsy were significantly lower when compared with the mean IIEF-5 scores 3 months after biopsy (P = 0.002). TRUS-guided prostate biopsies have a statistically significant impact on short-term erectile function, but this difference is not clinically significant; however, medium-term erectile function is not affected both statistically and clinically. [source] Intra-uterine bupivacaine and levobupivacaineAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2010Ayse MIZRAK Aim:, The study aimed to compare the effect of intrauterine bupivacaine and levobupivacaine with placebo in reducing the post-procedure discomfort owing to pain caused by suction endometrial sampling. Methods:, This study was conducted on randomly selected 45 women with abnormal uterine bleeding and who had undergone outpatient hysteroscopy and endometrial biopsy under sedation with propofol 0.5 mg/kg. The study was performed using 5 mL of bupivacaine 0.5% (Group B, n = 15) or levobupivacaine 0.5% (Group L, n = 15) or placebo solution (Group C, n = 15) intrauterine via a catheter over a 5 min period after suction endometrial sampling. The number of patients with visual analogue scale >3, total postoperative analgesic requirements, satisfaction of patients and adverse events were measured. Nonparametric and parametric data were analysed using Kruskal,Wallis and one-way anova tests respectively. Results:, Women in Groups L and B had statistically significantly less pain than the women in Group C (P = 0.03). When compared with placebo, five ml of bupivacaine 0.5% and levobupivacaine 0.5% respectively were recorded to decrease the incidence of postoperative analgesic consumption from 41 to 35% (P = 0.01). The satisfaction score of the patients in Group L was significantly higher than that of the patients in Group C (P = 0.03). Conclusion:, Intrauterine levobupivacaine or bupivacaine is effective in decreasing the pain associated with the endometrial biopsy and curettage under propofol sedation. [source] Wound infiltration with magnesium sulphate and ropivacaine mixture reduces postoperative tramadol requirements after radical prostatectomyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2009P. TAUZIN-FIN Purpose: This prospective, randomized, double-dummy study was undertaken to compare the effects of magnesium sulphate (MgSO4) administered by the intravenous vs. the infiltration route on postoperative pain and analgesic requirements. Methods: Forty ASA I or II men scheduled for radical retropubic prostatectomy under general anaesthesia were randomized into two groups (n=20 each). Two medication sets A and B were prepared at the pharmacy. Each set contained a minibag of 50 ml solution for IV infusion and a syringe of 45 ml for wound infiltration. Group MgSO4.IV patients received set A with 50 mg/kg MgSO4 in the minibag and 190 mg of ropivacaine in the syringe. Group MgSO4/L received set B with isotonic saline in the minibag and 190 mg of ropivacaine +750 mg of MgSO4 in the syringe. The IV infusion was performed over 30 min at induction of anaesthesia and the surgical wound infiltration was performed during closure. Pain was assessed every 4 h, using a 100-point visual analogue scale (VAS). Postoperative analgesia was standardized using IV paracetamol (1 g/6 h) and tramadol was administered via a patient-controlled analgesia system. The follow-up period was 24 h. Results: The total cumulative tramadol consumption was 221 ± 64.1 mg in group MgSO4.IV and 134 ± 74.9 mg in group MgSO4.L (P<0.01). VAS pain scores were equivalent in the two groups throughout the study. No side-effects, due to systemic or local MgSO4 administration, were observed. Conclusion: Co-administration of MgSO4 with ropivacaine for postoperative infiltration analgesia after radical retropubic prostatectomy produces a significant reduction in tramadol requirements. [source] Effect of two medicinal herbs (Astragalus radix and Lonicera japonica) on the growth performance and body composition of juvenile pikeperch [Sander lucioperca (L.)]AQUACULTURE RESEARCH, Issue 11 2008Zdzis, aw Zak Abstract The aim of this study was to determine the impact of feeding juvenile pikeperch diets with medicinal herb adjuvants on the growth performance, proximate body composition, fatty acids profile (whole fish, muscle tissues, viscera) and cytological and histological indicators of the liver and middle intestine. The fish (mean body weight of ca. 110 g) were fed diets with a 0.1% supplement of Astragalus radix (group A), Lonicera japonica (group L) or a mixture of these herbs (A. radix+L. japonica; group A/L) for 8 weeks. The herbal supplementation was not noted to have had an impact on the analysed indicators of fish growth performance, condition or feed conversion ratio (P>0.05). Statistically significant intergroup differences were noted in the value of the hepatosomatic index, hepatocyte size, their nucleus and nucleus/cytoplasm diameter ratio (P<0.05). Significant intergroup differences were also noted in the appearance of the hepatic parenchyma. Statistically significant intergroup differences were also noted in the protein content of the whole fish body. The analysis of the proximal composition of the fish viscera, in turn, indicated significant differences in the fat content (P<0.05). Among the analysed group of fatty acids (saturated , SFA, monoenoic , MUFA, polyenoic , PUFA) contained in the whole fish, the fillets and the viscera, significant intergroup differences were noted with regard to SFA (viscera) and MUFA (whole fish) (P<0.05). The total PUFA content was stable, although significant intergroup differences were noted with regard to a few of the acids that belong to this group (P<0.05). [source] Subcutaneous lispro and intravenous regular insulin treatments are equally effective and safe for the treatment of mild and moderate diabetic ketoacidosis in adult patientsINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 4 2006H. Ö. Ersöz Summary In this prospective, randomised, open trial, we wanted to evaluate the efficacy and safety of hourly subcutaneous (SC) insulin lispro administration in the treatment of diabetic ketoacidosis (DKA) in comparison with intravenous (IV) regular insulin treatment. Twenty patients were enroled in the study. The patients were randomly assigned into two groups. Following a bolus injection of 0.15 U/kg IV regular insulin, group L received half of this dose as hourly SC insulin lispro while group R was treated conventionally with IV regular insulin infusion. At the end of treatment period, time that needed for normalisation of serum glucose, ,-hydroxybutyrate, blood pH and urine ketone levels were not different in groups L and R. There was no mortality or serious side effects in both groups. In this study, we revealed that treatment of mild and moderate DKA with SC insulin lispro is equally effective and safe in comparison with IV regular insulin. [source] Lidocaine vs. magnesium: effect on analgesia after a laparoscopic cholecystectomyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2010I. M. SAADAWY Background: This double-blinded study aimed at evaluating and comparing the effects of magnesium and lidocaine on pain, analgesic requirements, bowel function, and quality of sleep in patients undergoing a laparoscopic cholecystectomy (LC). Methods: Patients were randomized into three groups (n=40 each). Group M received magnesium sulfate 50 mg/kg intravenously (i.v.), followed by 25 mg/kg/h i.v., group L received lidocaine 2 mg/kg i.v., followed by 2 mg/kg/h i.v., and group P received saline i.v. Bolus doses were given over 15 min before induction of anesthesia, followed by an i.v. infusion through the end of surgery. Intraoperative fentanyl consumption and averaged end-tidal sevoflurane concentration were recorded. Abdominal and shoulder pain were evaluated up to 24 h using a visual analog scale (VAS). Morphine consumption was recorded at 2 and 24 h, together with quality of sleep and time of first flatus. Results: Lidocaine or magnesium reduced anesthetic requirements (P<0.01), pain scores (P<0.05), and morphine consumption (P<0.001) relative to the control group. Lidocaine resulted in lower morphine consumption at 2 h [4.9 ± 2.3 vs. 6.8 ± 2.8 (P<0.05)] and lower abdominal VAS scores compared with magnesium (1.8 ± 0.8 vs. 3.2 ± 0.9, 2.2 ± 1 vs. 3.6 ± 1.6, and 2.1 ± 1.4 vs. 3.3 ± 1.9) at 2, 6, and 12 h, respectively (P<0.05). Lidocaine was associated with earlier return of bowel function and magnesium was associated with better sleep quality (P<0.05). Conclusion: I.v. lidocaine and magnesium improved post-operative analgesia and reduced intraoperative and post-operative opioid requirements in patients undergoing LC. The improvement of quality of recovery might facilitate rapid hospital discharge. [source] Coronary Artery Stenting in Vessels with Reference Diameter < 3 MMJOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 5 2000ALFRIED GERMING M.D. The study included 220 consecutive patients with coronary artery stenting. In 128 patients (60.8 ± 10.2 years, 68% men), a total of 184 stents were placed in coronary vessels with a reference diameter < 3 mm (group S). One hundred thirty-four stents were implanted in 92 patients (62.9 ± 9.8 years, 82.6% men) in vessels > 3 mm (group L). There was no significant difference according to clinical baseline characteristics. The primary end point of this retrospective study was the rate of periinterventional complications (death, stent thrombosis, myocardial infarction, urgent angioplasty, or surgical revascularization). The, secondary end point was the clinical and angiographic follow-ups (restenosis, recurrent angina, further revascularization) after 3 months. Cardiac complications occurred in group S in two (1.6%) patients, two stent thromboses with urgent angioplasty, one Q-wave and one non-Q-wave infarction. There was one (1.1%) event in group L, a stent thrombosis with Q-wave infarction and urgent angioplasty. Angiography at 3-month follow-up was performed in 148 patients. Restenosis occurred in group S in 31.8% and in group L in 21.7% (NS). Data according recurrent angina and recommended surgical revascularization did not differ between both groups. In group S, significantly more angioplasties of the stented lesion were performed (23/60 patients) compared to group L (6/88) (P = 0,015). Coronary artery stenting in vessels with a reference diameter < 3 mm can be performed without a high rate of periinterventional complications. Restenosis tends to be more frequent in the small vessel group, a higher rate of reangioplasties have to be expected. The clinical follow-up is comparable to a control group. [source] Evaluating Patients with Acute Ischemic Stroke with Special Reference to Newly Developed Atrial Fibrillation in Cerebral EmbolismPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 9 2007MINORU TAGAWA M.D. Background:Cardioembolic strokes are extensive and have a poor prognosis. To identify the cardiovascular risk factors of cardioembolic stroke, we evaluated the cardiovascular status with special reference to persistent atrial fibrillation (AF) and paroxysmal atrial fibrillation (PAF) combined with the type of acute ischemic stroke. Methods:We divided 315 consecutive patients admitted to our Department of Neurosurgery with an acute ischemic stroke into four types of brain infarction using clinical history, onset pattern of stroke, and brain imaging: cardioembolic (group E, n = 105), lacunar (group L, n = 92), atherothrombotic (group T, n = 111), and unclassified (n = 7). All patients underwent standard electrocardiography (ECG), a 24-hour ECG recording (Holter ECG) and transthoracic echocardiography (UCG). Results:Persistent AF or PAF was detected in 97 patients (31.5%) using Holter ECG: more frequently in group E (67.6%) than in groups L (15.2%) or T (9.2%). Persistent AF or PAF was first diagnosed on admission using a standard ECG in 16 patients (5.2%) with no previous history and 14 of these patients belonged to group E (13.3%). PAF was newly detected on Holter ECG in another 26 patients (8.4%) and 13 of these patients (12.4%) belonged to group E. Concerning UCG, left atrial enlargement and mitral regurgitation were more frequent in group E than in group L or T. Conclusion:Holter ECG in addition to ECG on admission is important for detecting persistent AF or PAF in patients with ischemic stroke, especially with cardioembolism as diagnosed by neuroimaging. [source] Discovery and transmission of functional QTL in the pedigree of an elite soybean cultivar Suinong14PLANT BREEDING, Issue 3 2010J. Qin With 3 figures and 5 tables Abstract In this study, we extended in silico mapping for single trait to analyse data from multiple environments by calculating intraclass correlations and to mapping pleiotropic QTL for multiple traits by defining new statistic to measure the correlation between multiple traits and the marker. Data sets include phenotypes of eight agronomic traits obtained from six different ecologic environments and years, and genotypic information from 477 polymorphic markers on 14 ancestral lines in the pedigree of ,Suinong14'. With in silico mapping, a total of 39 markers distributed on 14 linkage groups are detected as QTL responsible for eight agronomic traits and 10 QTL are identified as having pleiotropic effects. Tracing transmission of functional QTL in the pedigree indicated that certain QTL, such as Sat_036 on linkage group D1a, Satt182 on linkage group L, and Satt726 on linkage group B2 may be responsible for the contribution of exotic germplasm to the improved cultivars. [source] Significance of CT Attenuation Value in Liver Grafts Following Right Lobe Living-Donor Liver TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 5 2005Taku Iida In adult living-donor liver transplantation (LDLT), the assessment of the allograft functional reserve is important for adequate graft regeneration. From March 2002 to December 2003, 30 adult recipients underwent right lobe LDLT. Mean CT attenuation values (CT-AVs) in the graft were measured on unenhanced CT for 6 months after LDLT. The histological features of the graft parenchyma were evaluated with post-operative liver biopsy specimens. Mean CT-AVs after LDLT were decreased significantly from the pre-operative values, recovered to over 60 HU within 6 months. There was a positive linear correlation between the CT-AVs and the receptor index (LHL15) in technetium-99m-diethylenetriaminepenta-acetic acid-galactosyl-human serum albumin (99mTc-GSA) liver scintigraphy (r = 0.803, p = 0.005). The recipients were divided into two groups according to the CT-AV at one post-operative week (group H; ,55HU, group L; <55HU). The low CT-AVs, under 55 HU, in group L were prolonged for 3 months compared with those in group H (p < 0.05). The 1-year cumulative survival rate was 94.7% and 45.5% in groups H and L, respectively (p = 0.014). Histological findings revealed that the parenchymal damage was severe in the grafts with low CT-AVs. The CT-AVs in the grafts may be a useful parameter for assessing the allograft functional reserve. [source] ,Multimodal' approach to management of prostate biopsy pain and effects on sexual function: efficacy of levobupivacaine adjuvant to diclofenac sodium , a prospective randomized trialANDROLOGIA, Issue 1 2010T. Aktoz Summary We assessed the analgesic efficacy of levobupivacaine when administered as an adjuvant to diclofenac sodium in prostate biopsy pain management and effects of prostate biopsy on sexual function. Ninety patients underwent transrectal ultrasound (TRUS)-guided biopsy of the prostate and were randomly assigned to three groups: group D received diclofenac sodium suppository; Group L received periprostatic injection of levobupivacaine; group DL received diclofenac suppository and levobupivacaine in addition. Patients were asked to use a visual analogue scale score (VAS) questionnaire about pain after 10 core prostate biopsy. Sixty-two patients reported to be prostate cancer-free underwent further evaluation with the International Index of Erectile Function-5 (IIEF-5) questionnaire at 1 and 3 months after biopsy. Mean pain scores during prostate biopsy were significantly lower in group DL and were superior to the group L and group D (P < 0.001). Mean IIEF-5 score prior to biopsies was significantly higher when compared with the mean IIEF-5 score 1 month after biopsy (P < 0.0001). Mean IIEF-5 scores 1 month after biopsy were significantly lower when compared with the mean IIEF-5 scores 3 months after biopsy (P = 0.002). TRUS-guided prostate biopsies have a statistically significant impact on short-term erectile function, but this difference is not clinically significant; however, medium-term erectile function is not affected both statistically and clinically. [source] Effect of two medicinal herbs (Astragalus radix and Lonicera japonica) on the growth performance and body composition of juvenile pikeperch [Sander lucioperca (L.)]AQUACULTURE RESEARCH, Issue 11 2008Zdzis, aw Zak Abstract The aim of this study was to determine the impact of feeding juvenile pikeperch diets with medicinal herb adjuvants on the growth performance, proximate body composition, fatty acids profile (whole fish, muscle tissues, viscera) and cytological and histological indicators of the liver and middle intestine. The fish (mean body weight of ca. 110 g) were fed diets with a 0.1% supplement of Astragalus radix (group A), Lonicera japonica (group L) or a mixture of these herbs (A. radix+L. japonica; group A/L) for 8 weeks. The herbal supplementation was not noted to have had an impact on the analysed indicators of fish growth performance, condition or feed conversion ratio (P>0.05). Statistically significant intergroup differences were noted in the value of the hepatosomatic index, hepatocyte size, their nucleus and nucleus/cytoplasm diameter ratio (P<0.05). Significant intergroup differences were also noted in the appearance of the hepatic parenchyma. Statistically significant intergroup differences were also noted in the protein content of the whole fish body. The analysis of the proximal composition of the fish viscera, in turn, indicated significant differences in the fat content (P<0.05). Among the analysed group of fatty acids (saturated , SFA, monoenoic , MUFA, polyenoic , PUFA) contained in the whole fish, the fillets and the viscera, significant intergroup differences were noted with regard to SFA (viscera) and MUFA (whole fish) (P<0.05). The total PUFA content was stable, although significant intergroup differences were noted with regard to a few of the acids that belong to this group (P<0.05). [source] Perioperative Monitoring of Thromboelastograph on Hemostasis and Therapy for Cyanotic Infants Undergoing Complex Cardiac SurgeryARTIFICIAL ORGANS, Issue 11 2009Yongli Cui Abstract This study investigated features and treatments of perioperative coagulopathies in cyanotic infants with complex congenital heart disease (CCHD). Thirty-six infants with cyanotic CCHD were involved and divided into two groups: In group H (n = 20), hematocrit (HCT) > 54%, and in group L (n = 16), HCT < 54%. Blood was sampled at anesthesia induction (T1), rewarming to 36°C (T2), after heparin neutralization (T3), and 4 h after operation (T4). The hemostatic changes were evaluated by thromboelastograph (TEG). After surgery, group H was treated with fibrinogen-combined platelets (PLT), while group L was treated with PLT only. We observed the effect at T4. At T1, the hemostatic function in group H, deteriorating with the increase of HCT (P < 0.01), was obviously lower than that in group L (P < 0.01), but the PLT function was still complete. In group H, the hemostatic function at T2 decreased with a significant drop of PLT function (P < 0.01) and had little change of functional fibrinogen (Ffg) (P > 0.05). At T3, compared with T2, there were improvements in hemostatic function and Ffg (P < 0.01, respectively) without increase of PLT (P > 0.05) in group H. After therapy, PLT function in both groups restored to T1 level (P > 0.05); Ffg at T4 was significantly better than at T1 (P < 0.01) in group H, but Ffg at T4 with still normal function was lower than at T1 in group L (P < 0.01). Whole hemostatic function at T4 was back to normal and had no differences between two groups. So, we proposed that fibrinogen and PLT transfusion in combination should be better for infants with high HCT CCHD, but PLT alone might be enough for low HCT ones. [source] Alteration of inflammatory response following small-volume resuscitationBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 7 2000F. Gebhard Background Small-volume resuscitation is rather effective in the primary volume treatment of major trauma. Blood pressure stabilizing effects occur immediately but last for a limited period only. Influences on inflammatory reactions in humans have not been reported so far. This prospective randomized study therefore analysed the inflammatory response in the very early (pre)clinical period after administration of crystalloids plus starch, hyperosmolar/hyperoncotic starch and lyophilized plasma solutions. Methods Upon approval of the ethics committee, 41 patients were enrolled with multiple injuries (injury severity score (ISS) mean 34 (range 9,75)). The patients received randomly either standard solutions, i.e. starch plus crystalloids (group C (control); n = 14), hyperosmolar/hyperoncotic starch (group S (small volume); n = 14) or lyophilized plasma (group L (lyoplasma); n = 13). Subsets were performed according to the different solutions as well as to the severity of trauma (ISS below 17, 18,31, 32 or more) and survivors/non-survivors. The first blood sample was obtained at the scene of the accident before cardiopulmonary resuscitation, when appropriate. Subsequently, blood samples were collected hourly. All samples were spun immediately at 4°C and stored at ,70°C. Interleukin (IL) 6 as well as several different prostaglandins (PGI2, thromboxane A2, PGE2) were determined to characterize the overall inflammatory response. Results Eleven casualties (seven men and four women, mean age 31 years) died because of major trauma within 24 h after the incident. In all patients IL-6 levels promptly increased within the first 2 h, most pronounced in patients with the severest trauma (ISS greater than 32) and non-survivors. Patients in groups C and S had a comparable time course of IL-6 plasma levels with a slightly higher release in minor injuries (ISS less than 30). The same was true for prostaglandins. In contrast, patients in group L had clearly higher IL-6 concentrations during the first 2,12 h, again most pronounced in those with the severest trauma (ISS greater than 32). Conclusion These results demonstrate that the early systemic inflammatory response after small-volume resuscitation is rather similar to that of patients infused with standard-volume therapy after trauma. In contrast, lyoplasma seems to increase the inflammatory response regardless of the injury severity. © 2000 British Journal of Surgery Society Ltd [source] Echocardiographic Features of Patients With Heart Failure Who May Benefit From Biventricular PacingECHOCARDIOGRAPHY, Issue 3 2003Amgad N. Makaryus Background: Recent studies suggest that cardiac resynchronization therapy through biventricular pacing (BVP) may be a promising new treatment for patients with advanced congestive heart failure (CHF). This method involves implantation of pacer leads into the right atrium (RA), right ventricle (RV), and coronary sinus (CS) in patients with ventricular dyssynchrony as evidenced by a bundle branch block pattern on electrocardiogram (ECG). Clinical trials are enrolling stable patients with ejection fractions (EF) , 35%, left ventricular end-diastolic diameters (LVIDd) , 54 mm, and QRS duration ,140 msec. We compared echocardiography features of these patients (group 1) with other patients with EF , 35%, LVIDd , 54 mm, and QRS < 140 msec (group 2 = presumably no dyssynchrony). Methods: Nine hundred fifty-one patients with CHF, LVID 54 mm, EF 35% by echocardiography were retrospectively evaluated. One hundred forty-five patients remained after those with primary valvular disease, prior pacing systems, or chronic atrial arrhythmias were excluded. From this group of 145 patients, a subset of 50 randomly selected patients were further studied (25 patients [7 females, 18 males] from group 1, and 25 patients [7 females, 18 males] from group 2). Mean age group 1 = 75 years old, mean age group 2 = 67 years old. Mean QRS group 1 = 161 msec, mean QRS group 2 = 110 msec. Each group was compared for presence of paradoxical septal motion, atrial and ventricular chamber sizes, LV mass, LVEF, and RV systolic function. Results: Of the initial group of 951 patients, 145 (15%) met inclusion criteria. In the substudy, 20/25 (80%) of group l and 7/25 (28%) of group 2 subjects had paradoxical septal motion on echo (Fisher's exact test, P = 0.0005). The t-tests performed on the other echocardiography variables demonstrated no differences in chamber size, function, or LV mass. Conclusions: Cardiac resynchronization therapy with BVP appears to target a relatively small population of our advanced CHF patients (15% or less). Although increasing QRS duration on ECG is associated with more frequent paradoxical septal motion on echo, it is not entirely predictive. Paradoxical septal motion on echo may therefore be more sensitive at identifying patients who respond to BVP. Further prospective studies are needed. (ECHOCARDIOGRAPHY, Volume 20, April 2003) [source] More Broken Bones: A 4-Year Double Cohort Study of Young Girls With and Without Distal Forearm FracturesJOURNAL OF BONE AND MINERAL RESEARCH, Issue 10 2000A. Goulding Abstract Predictors of childhood fractures have not been investigated previously. This study was undertaken to determine whether a previous history of forearm fracture, low bone mineral density (BMD; both areal bone mineral density [aBMD, g/cm2] and volumetric bone mineral apparent density [BMAD, g/cm3]), or anthropometry, influence fracture risk in young girls. At baseline, two cohorts of girls, aged 3,15 years, were evaluated: 100 had recently broken a forearm (group 1) and 100 were fracture free (group 2). Four years later we restudied 170 of these girls (82 from group l and 88 from group 2). We now report the relationships of previous fracture history, baseline BMD (measured by dual-energy X-ray absorptiometry), baseline weight, and height to risk of new fracture. More new fractures occurred in group l (37 fractures in 24 girls) than in group 2 (8 fractures in 7 girls; p = 0.0007). The independent predictors for occurrence of a new fracture at any skeletal site in a multivariate model adjusting for age, weight, total body aBMD, and fracture history were previous fracture (hazard ratio [HR], 3.28; 95% CI, 1.41-7.64); age (HR per l-year increase, 0.91; 95% CI, 0.84-0.99); total body aBMD (HR per l SD decrease, 1.92; 95% CI, 1.31-2.81); and body weight (HR per l SD increase, 1.49; 95% CI, 1.06-2.08). Girls with two risk factors together had substantially greater fracture risk: previous fracture and low spinal BMAD (HR, 9.4; 95% CI, 2.8-32.0), previous fracture and high body weight (HR, 10.2; 95% CI, 2.8-37.6), or previous fracture and low total body aBMD (HR, 13.0; 95% CI, 3.9-43.1). We conclude that previous forearm fracture, low total body aBMD, low spinal BMAD, and high body weight each increase risk of new fractures within 4 years in young girls. Interventions to reduce the risk of fractures, particularly forearm fractures, in girls warrant further study. 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