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PubMed1988

Acute and long-term renal and metabolic effects of piretanide in congestive cardiac failure.

1. The renal and metabolic effects of the sulphamoylbenzoic acid diuretic, piretanide, have been studied, under controlled dietary conditions, in 39 patients with congestive cardiac failure. 2. In acute studies, peak saluresis occurred within 4 h of oral piretanide administration; saluresis was complete within 6 h, after which a significant antidiuretic effect was observed. Addition of triamterene, 50 mg, blunted the 0-6 h kaliuretic effect of piretanide. Over 24 h, piretanide, alone, caused insignificant urinary losses of potassium when compared with control. 3. In comparative studies, the piretanide dose-response curve was found to be parallel to that of frusemide over the dose range studied. The 0-6 h saluretic responses of piretanide, 6, 12 and 18 mg, were found to be equivalent to frusemide, 40, 80 and 120 mg respectively. The collective mean ratios of all the saluretic responses to each dose of piretanide with the corresponding dose of frusemide was observed to be 0.99 +/- 0.12, over 0-6 h period, and 0.86 +/- 0.09 over the 24 h period. The relative potency of piretanide, when compared with frusemide was found to be 6.18 (95% confidence limits 4.87-8.33), over the 0-6 h period, and 4.73 (95% confidence limits 3.65-6.14), over 24 h period. 4. In 15 patients in severe cardiac failure, urinary recovery of piretanide, over first 6 h, at the start of treatment was 21.2 +/- 2.1% while efficiency of the diuretic (mmol Na/mg drug) was 47.3 +/- 4.1. Long-term piretanide therapy was continued in the same group for up to and in some cases over 3 years. No other diuretics or potassium supplements were given. Piretanide dosage ranged from 6 to 24 mg day-1 according to clinical need. Plasma potassium fell significantly at 12 and 24 months, though remaining within the normal range. At these same times, significant elevations in both plasma urate and total fasting cholesterol were observed. Two patients developed overt gout on high dose piretanide therapy (24 mg day-1). Piretanide was well tolerated, and effective in the management of congestive cardiac failure without any other recognized metabolic or electrolyte changes.

Adult↗
PubMed1977

Cell loss from three established lines of the C3H mouse mammary tumor: a comparison of the 125I-UdR and the 3H-TdR-autoradiographic methods.

The 125I-UdR method for measuring cell loss from solid tumors has been reevaluated. The rate of tumor cell loss from three established lines (S 102F, S102S and Slow) of the C3H mouse mammary tumor was determined by the 125I-UdR method and the results were compared to the estimates for cell loss as determined by the combined approach of cellular 3H-TdR autoradiography and volumetric growth-rate determinations. This detailed comparison shows that the two methods complement each other but cannot substitute for one another because they give different quantitative information. The combined approach measures the flow of viable cells, as determined morphologically, from the proliferating compartment to the quiescent comparment, the quiescent compartment out of the tumor, etc., but does not evaluate the flow of degenerate cells or acellular (necrotic) debris. In contrast, the 125I-UdR method indicates the net flow of intact cells and/or dead cells as well as debris from the tumor as the 125I-labeled material is lost from the tumor, but gives limited internal information. thus, depending on the specific experiment, an investigator could choose one or the other of the methods to answer the question. Perhaps both would be desirable at times; however, in most cases, one could not substitute one method for the other. The data from the Slow tumors also indicate that in certain tumors, the quantitative information from the 125I-UdR method may be quite limited, i.e. the confidence limits within an experiment as well as the replication error between experiments may be high.

Animals↗
PubMed1992

Gastric and colorectal cancer in the rural Indian subcontinent: a survey of patients attending mission hospitals.

37 missionaries working in India, Nepal, Pakistan, Bangladesh and Bhutan completed questionnaires regarding their clinical practice during the year 1980. Information was collected on the frequency of both gastric and colorectal cancers. More than 500,000 out-patients were reviewed and over 100,000 inpatients treated. A total of 291 gastric tumours and 169 colorectal carcinomas were diagnosed. Surgery was performed in 82% of the hospitals but only 36% had a histology service. In India and Pakistan there was no significant difference between the incidence of gastric and colorectal neoplasms. The relative risk of developing gastric rather than colorectal cancer in Bangladesh was 8 (95% confidence limits 4.5-14.2) and in Nepal the relative risk was 4 (95% confidence limits 2.0-7.0). A significant variation in the occurrence of cancer was observed between countries. Nepal had the highest and Pakistan the lowest numbers of both gastric and colorectal tumours. It seems likely that local environmental factors, such as diet, play a significant role in the development of these tumours.

Bangladesh↗
PubMed1994

The failing human heart is unable to use the Frank-Starling mechanism.

There is evidence that the failing human left ventricle in vivo subjected to additional preload is unable to use the Frank-Starling mechanism. The present study compared the force-tension relation in human nonfailing and terminally failing (heart transplants required because of dilated cardiomyopathy) myocardium. Isometric force of contraction of electrically driven left ventricular papillary muscle strips was studied under various preload conditions (2 to 20 mN). To investigate the influence of inotropic stimulation, the force-tension relation was studied in the presence of the cardiac glycoside ouabain. In skinned-fiber preparations of the left ventricle, developed tension was measured after stretching the preparations to 150% of the resting length. To evaluate the length-dependent activation of cardiac myofibrils by Ca2+ in failing and nonfailing myocardium, the tension-Ca2+ relations were also measured. After an increase of preload, the force of contraction gradually increased in nonfailing myocardium but was unchanged in failing myocardium. There were no differences in resting tension, muscle length, or cross-sectional area of the muscles between both groups. Pretreatment with ouabain (0.02 mumol/L) restored the force-tension relation in failing myocardium and preserved the force-tension relation in nonfailing tissue. In skinned-fiber preparations of the same hearts, developed tension increased significantly after stretching only in preparations from nonfailing but not from failing myocardium. The Ca2+ sensitivity of skinned fibers was significantly higher in failing myocardium (EC50, 1.0; 95% confidence limit, 0.88 to 1.21 mumol/L) compared with nonfailing myocardium (EC50, 1.7; 95% confidence limit, 1.55 to 1.86 mumol/L). After increasing the fiber length by stretching, a significant increase in the sensitivity of the myofibrils to Ca2+ was observed in nonfailing but not in failing myocardium. These experiments provide evidence for an impaired force-tension relation in failing human myocardium. On the subcellular level, this phenomenon might be explained by a failure of the myofibrils to increase the Ca2+ sensitivity after an increase of the sarcomere length.

Calcium↗
PubMed1993

Plasma and 24 h-urinary catecholamine concentrations in normal and patient populations.

Using a single HPLC-ECD methodology, plasma catecholamine data were compiled from 545 patients and 144 healthy subjects, and 24 h urinary free catecholamine data from 106 patients. From these data, normal reference ranges were derived for the clinical investigation of suspected phaeochromocytomas, specifically to address the question as to when a result is normal and when further investigation may be required. We have shown that noradrenaline and adrenaline concentrations in plasma and urine are not normally distributed, and basal plasma noradrenaline is significantly lower in normal volunteers than in hospital patients. We have also demonstrated that a reference range which does not take account of these factors will give a significant number of false-positive results. Age and sex did not appear to be significant variables for either plasma or urinary catecholamines. In the investigation of phaeochromocytoma, 95% confidence limits may be used as a warning to repeat sampling and 99% confidence limits as rendering the diagnosis extremely probable. In patients with phaeochromocytomas, urinary catecholamines had a 99.5% specificity and 100% sensitivity in the diagnosis, and thus provide for a rapid and efficient diagnostic screen.

Adolescent↗
PubMed1997

Phase II trial of docetaxel in non-Hodgkin's lymphomas: a study of the Cancer and Leukemia Group B.

PURPOSE: To evaluate the new anticancer agent, docetaxel, with a novel mechanism of action in patients with non-Hodgkin's lymphoma International Working Formulation (IWF) A through H, to determine the response rate by histologic group and the toxicities of this agent in this population. PATIENTS AND METHODS: Sixty-eight patients previously treated for non-Hodgkin's lymphoma with two prior cytotoxic regimens for low-grade and one prior regimen for intermediate-grade lymphoma were entered onto this phase II trial. Central pathologic review was required. Twenty-four IWF A to C and 31 IWF D to H patients with normal hepatic and renal function, performance status (PS) 0 to 2, and adequate hematologic function were eligible. Patients received docetaxel 100 mg/m2 intravenously over 1 hour without corticosteroid premedications every 3 weeks with weekly hematologic monitoring, and tumor assessment every 3 weeks. For grade 3 or 4 hematologic toxicity, the docetaxel dosage was lowered to 75 mg/m2. Patients received a maximum of six cycles of therapy. RESULTS: The major response rate was 13% (95% confidence limits, 3% to 32%) for IWF A to C and 16% (95% confidence limits, 5% to 34%) for IWF D to H; response durations ranged from 1.4 to 20 months. Time to response ranged from 1.3 to 2.8 months. Patients refractory to previous chemotherapy were less apt to respond to docetaxel, but the differences were not statistically different in this small sample size. Twelve percent of IWF A to C and 6% of IWF D to H patients discontinued treatment because of toxicity. The major toxicity was granulocytopenia (grade 3 to 4), which occurred in virtually all patients during the first course of therapy. CONCLUSION: This study confirms that docetaxel has limited but definite activity in patients with non-Hodgkin's lymphoma and suggests that the previously reported responses with taxanes can not be attributed solely to the use of corticosteroid premedications.

Adult↗
PubMed1993

Short and long term outcome in a consecutive series of 419 patients with acute dialysis-requiring renal failure.

UNLABELLED: This analysis was done in a consecutive series of 419 patients with potentially reversible acute renal failure (ARF) requiring dialysis treated during the 12 year period January 1977 to December 1988. The aims were to describe the relationship between morbidity, mortality, and the year of admission, to evaluate the effects of various follow-up periods and stratification on main prognostic factors, and to report long term survival. RESULTS: 1) There was a significantly higher (p < 0.001) number of organ failures/patient in the last 6 year period compared with the first 6 year period. 2) Early (day 90) mortality was 46% and did not change significantly during the 12 year period. 3) Etiology, age of the patient, and the severity and the progression of the underlying disease were the most important factors determining outcome. 4) Time of censorship and stratification of the patients influenced prediction models. 5) Estimated 5 year survival rate was 52% (95% confidence limits 44-60%) in patients with a medical etiology, and 28% (95% confidence limits 20-36%) in patients with a surgical etiology. CONCLUSIONS: 1) Prognosis did not change significantly during the 12 year study period, and was almost solely dependent on the severity and progression of the underlying disease process. 2) Changed censoring time and stratification were important tools for enhancing the yield of information from the study. 3) The time(s) and method(s) of risk scoring, stratification(s) of patients, the time(s) of censorship on vital status, and the method for statistical analysis have to be identical if results of treatment for ARF from different centers should be compared.

Acute Kidney Injury↗
PubMed1982

Short-term inhalation toxicity of perfluoroisobutylene.

Perfluoroisobutylene (PFIB) is a highly toxic, colorless gas. The 4-hour Approximate Lethal Concentration in male rats is 0.5 ppm (v/v). The median lethal concentration (LC50) was calculated for groups of 10 male Crl:CD rats, exposed, nose-only, for either 0.25, 0.50, 1, 2, 5, or 10 minutes to various concentrations of PFIB. Atmospheric concentrations of PFIB were determined by gas chromatography (electron capture detector). No mortalities or signs of respiratory irritation were seen during exposure. Weight loss and respiratory impairment were evident up to 48 hours post-exposure. Affected rats either died with gross pathological signs of pulmonary congestion or recovered with no apparent residual effects. The 0.25-minute LC50 was 361 ppm (321--415 ppm, 95% Confidence Limits); the 10-minute LC50 was 17 ppm (15--19 ppm, 95% Confidence Limits). The steep slope of the concentration-mortality curve at each time interval reflected the narrow range of concentrations that produced mortality (LC1-LC99). In addition, a "Concentration x Time = Constant" relationship was apparent from 0.25 to 10 minutes.

Animals↗
PubMed1988

[Cutaneous vibration and thermal-cooling threshold in control subjects].

The cutaneous vibration and thermal-cooling thresholds were evaluated on the palmar side of the distal phalanx of the right index finger and on the plantar side of the distal phalanx of the right great toe in 70 control subjects without sensory symptoms and signs, aged from 13 to 83 years, by using a Vibration Sensitivity Tester and a Thermal Sensitivity Tester (Sensortek, N. J., USA). Both vibration and thermal-cooling thresholds of the index finger, and vibration threshold of the great toe were statistically significantly increased with age. Based on the data obtained from these subjects, the lower and upper limits of 95% confidence limit of the predicted value of each of the thresholds for each decade were calculated. These values are useful for the detection of the abnormal cutaneous vibration and thermal-cooling thresholds not only in general neurology, but also in occupational neurology.

Adolescent↗
PubMed2000

Tonsillectomy and tonsillitis in Cape Town--age and sex of patients.

OBJECTIVES: To assess the sex and age of patients undergoing tonsillectomy in the Cape Town metropolitan area. METHODOLOGY: A retrospective audit was conducted from 1991 to 1995 comparing the sex and age of patients undergoing tonsillectomy with patients admitted to hospital for acute tonsillitis and the general population. RESULTS: A total of 7,250 tonsillectomies were performed for recurrent tonsillitis, and 111 adult patients were admitted with acute tonsillitis. When the data for the adult tonsillectomy patients were isolated, the female/male ratio was 3.22:1, which is highly significant when compared with the data for the general population (Cornfield's 95% confidence limit: 2.82, 3.68) and for patients with acute tonsillitis (Cornfield's 95% confidence limit: 1.14, 2.65). CONCLUSION: Recurrent tonsillitis requiring tonsillectomy occurs more commonly in female than male patients.

Adolescent↗
PubMed1989

[Complications of appendectomy during pregnancy].

A retrospective investigation revealed that in 11 out of 23 pregnant women submitted to operation on account of suspected appendicitis the diagnosis could be confirmed. The perinatal and the maternal mortalities were both 0. In the women submitted to operation, the frequency of obstetric complications was found to be 17%, 95% confidence limits 5-39%, and the frequency of surgical complications was 17%, 95% confidence limits 5-39%. The diagnostic specificity was found to be significantly higher in women who had previously born children. Brief duration of symptoms preoperatively and operation employing beta-sympathomimetics are recommended.

Adult↗
PubMed1989

High-dose, potentially myeloablative chemotherapy and autologous bone marrow transplantation for patients with advanced Hodgkin's disease.

Twenty three patients with Hodgkin's disease were treated with BCNU (carmustine), etoposide, and cyclophosphamide at doses of 450-600 mg/m2, 1500-2000 mg/m2, and 120 mg/kg respectively. Bone marrow refrigerated at 4 degrees C for 2-5 days or cryopreserved at -80 degrees C was used to reconstitute bone marrow function. The median age was 28 (range 16-48), and the median Karnofsky performance status was 70. Nineteen patients had progressive disease while on chemotherapy. The median number of prior regimens was three (1-7), and the median number of prior chemotherapy drugs was 10 (range 4-12). Ten patients had received at least two of the drugs used in this study and four had had all three. Indicator lesions included lung (10), peripheral lymph nodes (9), retroperitoneal nodes (8), liver (3), and chest wall masses (2). Ten patients achieved a complete remission (43.5%; 95% confidence limits 23-64%), and five patients had a partial remission (21.7%; 95% confidence limits 5-39%). The median duration of complete remission was 6 months (range 2-13+ months). Responses were shorter in duration for patients with primary refractory disease. Liver function abnormalities were noted in nine (39%) cases. Post transplant, the recovery time was 18 days (range 11-43) for WBC and 24 days (11-77) for platelets. Two patients died of septic episodes while neutropenic. The median number of RBC units used was seven (range 1-45). Ten patients had evidence of pulmonary dysfunction. In seven patients there was symptomatic improvement with steroid therapy, but three patients who were not treated with steroids died as a result of interstitial pneumonia. Future programs should consider bone marrow transplantation in patients with Hodgkin's disease earlier in the course of disease, at the time of minimal residual disease, and employ newer, potentially less toxic drugs.

Adolescent↗
PubMed1978

Analysis of fat-soluble vitamins. XIX. Collaborative studies on the chemical assay for vitamin D concentrates.

In 1971, a chemical method for the assay of vitamin D in concentrates containing only vitamin D was collaboratively studied by 14 laboratories, using 6 different samples from 2 European manufacturers. On the basis of these results, the laboratories were divided into 2 groups: 5 with significant laboratory biases of greater than or equal to 2%, and 9 laboratories with nonsignificant bias. The 9 laboratories were subdivided into 2 groups which differed significantly as to reproducibility within laboratories. The reproducibility between laboratories, expressed as a standard deviation in per cent with 95% confidence limits, was 1.2% (confidence range 0.6-7.3) and 4.7% (confidence range 2.4-29.3) for 3 and 6 laboratories, respectively. A second collaborative test was performed in 1974, using 12 vitamin D resin samples in oil from 3 United States manufacturers, to compare 2 chemical vitamin D assay methods (with and without maleic anhydride) and to compare results from the chemical and biological methods; 9 laboratories participated in the chemical method study and 3 in the rat bioassay study. The correlation of results of the chemical method including maleic anhydride treatment and the rat bioassays was satisfactory. The reproducibility of the chemical method was about the same as that in the first collaborative test.

Fats↗
PubMed1995

Simultaneous determination of dextrorphan and guaifenesin in human plasma by liquid chromatography with fluorescence detection.

A sensitive liquid chromatographic (LC) method was developed and validated for the simultaneous determination of dextrorphan and guaifenesin in human plasma using fluorescence detection. Dextrorphan and guaifenesin were extracted from plasma by a liquid-liquid extraction procedure using chloroform containing laudanosine as the internal standard. A cyano column (15 cm x 46 mm i.d., Spherisorb 5-CN) and a mobile phase containing acetonitrile-triethylamine-distilled water (10:1:89, v/v/v) (pH 6) were used. The concentration-response relationship for dextrorphan was found to be linear over a concentration range of 23-515 ng ml-1 with a lower limit of detection of 20 ng ml-1; the accuracy of the method would fall (95% confidence limit) within 9.53% and 11.07% of the true value for the inter-and intra-day, respectively; the inter- and intra-day precision, as measured by RSD, ranged from 1.88% to 30.07% (mean 2.28%) and from 4.69% to 7.51% (mean 5.67%) over the dynamic concentration range of the method (33-326 ng ml-1). The concentration-response relationship for guaifenesin was found to be linear over a concentration range of 181-8136 ng ml-1 with a lower detection limit of 30 ng ml-1; the accuracy of the method would fall (95% confidence limit) within 9.78% and 8.04% of the true value for the inter- and intra-day, respectively; the inter- and intra-day precision, as measured by the RSD, ranged from 2.55 to 6.07% (mean 3.90%) and from 3.12 to 3.90% (mean 3.52%) over the dynamic concentration range of the method (435-6430 ng ml-1).(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Oral↗
PubMed1997

Can pregnant women obtain their own specimens for group B streptococcus? A comparison of maternal versus physician screening. The Mount Sinai GBS Screening Group.

OBJECTIVE: We aimed to compare the Group B Streptococcus (GBS) detection rate when pregnant women performed their own vaginal/anorectal swabs with that from the standard practice of physician-performed swabs. METHOD: The research involved a comparison of maternally obtained swabs for GBS with the current gold standard of physician-obtained swabs performed on the same patient. The women were surveyed about who they would prefer to do their swabs. This research was carried out in the offices of five family physicians and eight obstetricians at Mount Sinai Hospital, Toronto--a tertiary-care teaching hospital--between 1 November 1995 and 31 March 1996. The patients were consecutive pregnant women presenting for their 26-28 weeks antenatal visit. Patients were given a questionnaire and instructions describing how to perform a vaginal/anorectal swab. After each patient completed the survey and obtained her own GBS culture, the physician collected a GBS specimen in their usual manner. The main outcome measures were the results of self-performed and physician-obtained combined vaginal/anorectal culture specimens. RESULTS: Sixty-three matched pairs of GBS swab results and 161 patient surveys were collected. Using any positive result as the gold standard, the prevalence of GBS was 39 out of 163 (24%). Patients detected 38 cases for a sensitivity of 97% (lower 95% confidence limit 92), while physicians identified 32 cases for a sensitivity of 82% (95% confidence limit 70-94). Twenty-five per cent of the women preferred that the physician take the swab, while 75% were indifferent or preferred to self-swab. CONCLUSIONS: Patient-collected vaginal/anorectal swabs for GBS are at least as sensitive as the current practice of physician-performed swabs. The majority of participating patients were interested or willing to perform their own swab. Self-swabbing involves women more actively in their obstetrical care and may improve physician compliance with screening guidelines.

Adolescent↗
PubMed2006

The effect of dairy product ingestion on human immunodeficiency virus-related diarrhea in a sample of predominantly gay men: a randomized, controlled, double-blind, crossover trial.

BACKGROUND: In the highly active antiretroviral therapy (HAART) era, chronic diarrhea remains common in human immunodeficiency virus (HIV) illness. Empirical lactose avoidance is often advised despite lack of evidence of benefit in a population at risk for osteopenia and malnutrition. METHODS: The a priori hypothesis was that moderate lactose ingestion would not worsen diarrhea in this population. We used a double-blind, noninferiority, randomized crossover trial in a community setting of primary and tertiary care HIV clinics. The participants all had chronic diarrhea and were a volunteer sample of 49 predominantly white HIV-infected men who have sex with men. They ingested 240 mL of low-fat milk (12 g of lactose) and lactose-free milk during 2 separate study periods. The primary outcome was mean difference in stool weight between the 2 study periods in the 8 hours after milk ingestion. Lactose was judged not to worsen diarrhea if this difference did not exceed 167 g in 8 hours with 95% certainty. RESULTS: Forty-eight (98%) of 49 participants were male. Median age, CD4 cell count, and viral load were 42 years (range, 20-62 years), 390 cells/mL (range, 20-1100 cells/mL), and 112 copies/mL (range, <50 to >500,000 copies/mL), respectively. Thirty-nine participants (80%) were taking HAART medication. Ten participants (20%) were lactase deficient. The mean difference in stool weight between the 2 study periods was -41.3 g/8 h (upper 95% confidence limit, -13.5 g) for the entire group and +11.3 g/8 h (upper 95% confidence limit, +47.4 g) for the lactase-deficient group. CONCLUSIONS: Moderate lactose ingestion does not worsen diarrhea in HIV-infected persons with chronic diarrhea, regardless of lactase status. Therefore, avoidance of modest quantities of milk may not be justified in this population.

Adult↗
PubMed2005

Interventions to prevent hypothermia at birth in preterm and/or low birthweight babies.

BACKGROUND: Hypothermia incurred during routine postnatal resuscitation is a world-wide issue (across all climates), with associated morbidity and mortality. Keeping vulnerable preterm infants warm is problematic even when recommended routine thermal care guidelines are followed in the delivery suite. OBJECTIVES: To assess efficacy and safety of interventions, designed for prevention of hypothermia in preterm and/or low birthweight infants, applied within 10 minutes after birth in the delivery suite compared with routine thermal care. SEARCH STRATEGY: The standard search strategy of The Cochrane Collaboration was followed. Electronic databases were searched: MEDLINE (1966 to May Week 4 2004 ), CINAHL (1982 to May Week 4 2004), EMBASE (1974 to 09/07/04), the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 3, 2004), Database of Abstracts of Reviews of Effects (DARE 1994 to July 2004), conference/symposia proceedings using ZETOC (1993 to July 2004), ISI proceedings (1990 to 09/07/2004) and OCLC WorldCat (July 2004). Identified articles were cross-referenced. No language restrictions were imposed. SELECTION CRITERIA: All trials using randomised or quasi-randomised allocations to test a specific intervention designed to prevent hypothermia, (apart from 'routine' thermal care) applied within 10 minutes after birth in the delivery suite to infants of < 37 weeks' gestational age or birthweight </=2500 g. DATA COLLECTION AND ANALYSIS: Methodological quality was assessed and data were extracted for important clinical outcomes including adverse effects of the intervention by at least three independent reviewers. Authors were contacted for missing data. Data were analysed using RevMan 4.2.5. Relative risk (RR), risk difference (RD) and number needed to treat (NNT) with 95% confidence limits were calculated for each dichotomous outcome and mean differences (MD) with 95% confidence limits for continuous outcomes. MAIN RESULTS: Six studies giving a total of 304 infants randomised and 295 completing the studies were included. Four comparisons to 'routine care' were undertaken within two categories: 1) barriers to heat loss (four studies): plastic wrap or bag (three), stockinet caps (one) and 2) external heat sources (two studies): skin-to-skin (one), transwarmer mattress (one). Plastic barriers were effective in reducing heat losses in infants < 28 weeks' gestation (three studies, n = 159; WMD 0.76 degrees C; 95% CI 0.49, 1.03) but not in the 28 to 31 week group. There was insufficient evidence to suggest that plastic wrap reduces the risk of death within hospital stay (three studies, n = 161; typical RR 0.63; 95% CI 0.32, 1.22; typical RD -0.09; 95% CI -0.20, 0.03). There was no evidence of a significant difference in major brain injury, mean duration of oxygen therapy or hospitalisation for infants < 29 weeks' gestation. Stockinet caps were not effective (borderline significant for infants < 2000 g birthweight) in reducing heat losses.Skin-to-skin care was shown to be effective in reducing the risk of hypothermia when compared to conventional incubator care for infants 1200 to 2199 g birthweight (one study, n = 31; RR 0.09; 95% CI 0.01, 0.64; NNT 2; 2 to 4). The transwarmer mattress significantly kept infants </=1500 g warmer and reduced the incidence of hypothermia on admission to NICU (one study, n = 24; RR 0.30; 95% CI 0.11, 0.83; NNT 2 range 2 to 4). AUTHORS' CONCLUSIONS: Plastic wraps or bags, skin-to-skin care and transwarmer mattresses all keep preterm infants warmer, leading to higher temperatures on admission to neonatal units and less hypothermia. Given the low NNT, consideration should be given to using these interventions in the delivery suite. However, the small numbers of infants and studies and the absence of long term follow-up mean that firm recommendations for clinical practice cannot be given. There is a need to conduct large, high quality randomised controlled trials looking at long-term outcomes.

Humans↗
PubMed1989

Laser Doppler monitoring of replants using a small prism probe.

Eighteen patients admitted to Duke University Medical Center for upper limb replantation or revascularization were studied. A small laser Doppler flow prism probe and a cutaneous temperature probe were attached to the distal pulp of replanted digits. Measurements were recorded hourly for the first 3 postoperative days. In the successful cases, the mean laser Doppler flow measurement was 1.76 units (lower 97% confidence limit 0.5 units) and the mean temperature was 34.1 degrees C (lower 97% confidence limit 32 degrees C). In 4 patients with vascular compromise, the laser Doppler flow correctly identified the problem. The reduced size of the new laser Doppler probe makes monitoring of distal pulp flow technically easier while maintaining accuracy.

Arm↗