Showing papers by "Rotterdam University of Applied Sciences published in 1993"

Dobutamine stress echocardiography for assessment of perioperative cardiac risk in patients undergoing major vascular surgery.

Abstract: BACKGROUNDThe purpose of this study was to determine the predictive value of dobutamine stress echocardiography for perioperative cardiac events in patients scheduled for elective major noncardiac vascular surgeryMETHODS AND RESULTSPatients (n = 136; mean age, 68 years) unable to exercise underwent a dobutamine stress test before surgery (incremental dobutamine infusion [10-40 microgramskg-1min-1] continued with atropine [025-1 mg iv] if necessary to achieve 85% of the age-predicted maximal heart rate without symptoms or signs of ischemia) The clinical risk profile was evaluated by Detsky's modification of Goldman's risk factor analysis Echocardiographic images were evaluated by two observers blinded to the clinical data of the patients, and results of the test were not used for clinical decision making Technically adequate images were obtained in 134 of 136 patients, one major complication occurred (ventricular fibrillation), and three tests were discontinued prematurely because of side effects

Scoliosis in children after thoracotomy for aortic coarctation.

Abstract: A follow-up study was performed to assess the prevalence of scoliosis in 160 patients in whom aortic coarctation had been treated operatively through a left posterolateral incision in the fourth intercostal space. Scoliosis had not been seen in any patient before the thoracotomy, but a scoliosis of 10 degrees or more was observed in thirty-five patients (22 per cent) at the follow-up examination, which was performed an average of seven years after the thoracotomy. The scoliosis was a thoracic curve and was directed to the left in twenty-six of the thirty-five patients. Most of the curves were mild (between 10 and 20 degrees) and hardly progressed during the follow-up period. The high-risk period for the onset of scoliosis began about three years after the operation. The prevalence of scoliosis did not correlate significantly with the age or sex of the patients.

Central grafting for persistent nonunion of the tibia. A lateral approach to the tibia, creating a central compartment

Abstract: We report the operative technique and results of a new method of central grafting for persistent nonunion of the tibial shaft. The operation is performed through a lateral approach, anterior to the fibula. Fresh autogenous bone from the iliac crest is used to form a central bridge between the tibia and fibula above, below and at the level of the nonunion. In 48 tibiae, most with long-standing nonunion and some with infection or bone defects, sound healing was obtained in 45 after one operation. Only one failure needed amputation.

Effect of pH on absorption of sufentanil citrate in a portable pump reservoir during storage and administration under simulated epidural conditions

Abstract: Sufentanil (5μg/ml as citrate) was investigated for its stability when diluted with sodium chloride 0.9%, in 100 ml polyvinyl chloride portable pump reservoirs during administration under simulated epidural conditions at 32°C for 48 h. Sufentanil was absorbed into the polyvinyl chloride, resulting in a reduction of 10.9% of the concentration after 48 h. The absorption of sufentanil (5μg/ml as citrate), alone and in combination with bupivacaine hydrochloride (2 mg/ml), was investigated when diluted with sodium chloride 0.9% in combination with a citrate buffer (pH 4.6), in the same reservoirs under similar conditions. There was no loss of sufentanil after 48 h in both experiments. The effect of the pH on the absorption of sufentanil in polyvinyl chloride was investigated at different pH values. After storage for 21 days at 32°C there was 5.1% loss of sufentanil at pH 4 and 80.6% loss at pH 6. The citrate buffer at the optimum pH (4.6) has a low, acceptable buffer capacity for epidural administration.

Compliance with the medical regimen and partner's quality of life after heart transplantation.

Abstract: The authors investigated 40 heart transplant recipients and their partners to determine both the partner's quality of life upon transplantation and the experiences of both patient and partner with compliance with the medical regimen. Data on sleep disturbances, social isolation, emotional reactions, depression, anxiety, partner's apprehension, social support and compliance (regarding behaviour and emotional experience) were obtained approximately 21 months after transplantation. Compared to related study groups, partners did not experience more problems in sleep, social isolation, emotional reactions, depression and anxiety. Patients overestimated the apprehension of their partners significantly (p<0.0001). Generally speaking, with the exception of three items relating to eating fish, canned food and forgetfulness in medicine intake, patients and partners agreed with respect to actual compliance behaviour. Lowest compliance concerned regular physical exercise: 28%. Both patient and partner insisted that they had scarcely any emotional problem with the regimen. Further systematic research is needed to bring to light factors that affect compliance as well as adequate methods to bring about an improvement therein.

Electrical nerve and muscle stimulation by radio frequency surgery: role of direct current loops around the active electrode

Abstract: Tissue cutting by electrosurgery is often accompanied with stimulation of nerves and muscles, despite the high frequency of the alternating current being applied. The main source of the stimulation is thought to be the generation of a low-frequency current by the nonlinear sparking process. However, measurement of this low-frequency current in the generator electrode's circuit showed relatively small values, barely sufficient to support this hypothesis. In this study a more powerful low-frequency current could be identified, also originating from the nonlinear sparking process. Local direct and low-frequency currents, at a level of tens of milliamperes, appeared to be generated between different sites of the active-electrode-tissue interface. Probably these local currents have not been noticed before as they cannot be detected in the outer chain of generator, electrodes, and connecting wires. This finding may explain why most measures intended to prevent stimulation by modifying this outer chain have had only limited success. >

Automated Enzymatic Methods for Creatinine Measurement with Special Attention to Bilirubin Interference

Abstract: Four enzymatic methods for creatinine measurement were evaluated on a DuPont Dimension automatic analyzer. Biomed Creatinine-Duo-UV (BIO) and Raichem Creatinine Reagent Enzymatic (RAI) start creatinine breakdown with creatinine iminohydrolase (EC 3.5.4.21) resulting in the formation of NH4+. The Boehringer Mannheim Creatinine PAP (BM1) and SopaChem Creatinine (SOP) start the breakdown of creatinine with creatininase (EC 3.5.2.10) which yields creatine. In order to reduce bilirubin interference, the BM1 method was modified to contain K4Fe(CN)6. This substance was added with reagent 1 (BM2) or with reagent 2 (BM3). All the enzymatic creatinine methods tested displayed good linearity for concentrations up to at least 1000 mumol/l. The BIO, BM3, RAI and SOP methods showed good stability of test outcome for the tested period of a week. The outcome of the BM1 and BM2 method increased continually with time. Only the results of the RAI method were diminished by the presence of lipids. The BM1, BM2, BM3 and SOP methods showed no interference with haemoglobin, whereas this increased the outcome of the BIO method and slightly decreased the results of the RAI method. Using spiked human albumin solutions it was found that the BIO, BM2, BM3 and RAI methods displayed good resistance to interference by bilirubin or ditauro-bilirubin. The outcome of the BM1 and SOP method was strongly decreased by both bilirubin and ditauro-bilirubin. When creatinine was measured in a panel of sera originating from 100 patients with bilirubin concentrations higher than 50 mumol/l, the obtained results were in close agreement with those found for the spiked human albumin solutions.(ABSTRACT TRUNCATED AT 250 WORDS)

Laser surgery of the larynx using a metal insufflation catheter for ventilation of the lungs

Abstract: [3] SAMWON GLT, YOUNG JRB. Difficult tracheal intubation: A retrospective study. Anaesthesia 1987; 42: 487-90. [4] MALLAMPATI SR, GATT SP, GUGINO LD, DFSAI SP, WARAKSA B, FREIBERGER D, LIN PL. A clinical sign to predict difficult tracheal intubation: a prospective study. Canadian Anaestherists’ Society Journal 1985; 3 2 429-34. [5] CORMACK RS, LEHANE J. Difficult tracheal intubation in obstetrics. Anaesthesia 1084; 39 1105-11. [6] DCGRA S, FALCONER R, LATTO IP. Successful difficult intubation: tracheal tube placement over a gum elastic bougie. Anaesthesia 1990; 45: 337-6. 329-37.