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ABSTRACT: BACKGROUND: /st>There are controversies regarding the most efficient shoulder position during infraclavicular subclavian venous catheterization. We hypothesized that, regarding the success rate of subclavian venous catheterization, the neutral shoulder position would not be inferior to the retracted shoulder position. METHODS: /st>A total of 362 patients who underwent elective surgery were randomly assigned to two groups: those who underwent subclavian venous catheterizations in the neutral shoulder position (neutral group, n=181) or in the retracted shoulder position (retracted group, n=181). In the retracted group, a 1 litre saline bag was placed longitudinally beneath the spinal column between the scapulae to allow the shoulders to fall into a 'retracted' position. The incidence of failures to place the central venous catheters and complications such as arterial puncture, pneumothorax, or haemothorax were recorded. RESULTS: /st>The success rates were 95.6% (173/181) in the neutral group and 96.1% (174/181) in the retracted group. The difference of 0.5% was within the prespecified non-inferiority margin of 5% with a P-value of 0.017 [two-sided 95% confidence interval (CI), -0.036 to 0.047; upper limit of the 95% CI, 0.040]. There were four catheterization failures (2.2%) in the neutral group and two failures (1.1%) in the retracted group. Complication rates were not significantly different between the neutral and retracted groups [3/181 (1.7%) vs 4/181 (2.2%) for arterial punctures and 1/181 (0.6%) vs 1/181 (0.6%) for pneumothorax]. CONCLUSIONS: /st>The neutral shoulder position was as effective as the retracted shoulder position for infraclavicular subclavian venous catheterization. Shoulder retraction does not appear to be necessary for the infraclavicular subclavian venous catheterization.Clinical trial registrationClinicalTrials.gov, NCT01368692.
BJA British Journal of Anaesthesia 03/2013; · 4.24 Impact Factor
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ABSTRACT: In several recent clinical trials on cardiac surgery patients, remote ischaemic preconditioning (RIPC) showed a powerful myocardial protective effect. However the effect of RIPC has not been studied in patients undergoing off-pump coronary artery bypass graft surgery. We evaluated whether RIPC could induce myocardial protection in off-pump coronary artery bypass graft surgery patients. Patients undergoing elective off-pump coronary artery bypass graft surgery were randomly allocated to the RIPC (n = 65) or control group (n = 65). After induction of anaesthesia, RIPC was induced by four cycles of five-minute ischaemia and reperfusion on the upper limb using a pneumatic cuff. Anaesthesia was maintained with sevoflurane, remifentanil and vecuronium. Myocardial injury was assessed by troponin I before surgery and 1, 6, 12, 24, 48 and 72 hours after surgery. There were no statistical differences in troponin I levels between RIPC and control groups (P = 0.172). Although RIPC reduced the total amount of troponin I (area under the curve of troponin increase) by 26%, it did not reach statistical significance (RIPC group 53.2 +/- 72.9 hours x ng/ml vs control group 67.4 +/- 97.7 hours x ng/ml, P = 0.281). In this study, RIPC by upper limb ischaemia reduced the postoperative myocardial enzyme elevation in off-pump coronary artery bypass graft surgery patients, but this did not reach statistical significance. Further study with a larger number of patients may be needed to fully evaluate the clinical effect of RIPC in off-pump coronary artery bypass graft surgery patients.
Anaesthesia and intensive care 09/2010; 38(5):924-9. · 1.28 Impact Factor
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ABSTRACT: During laparoscopic gynecologic surgery, pneumoperitoneum combined with the Trendelenburg position moves the carina towards the tip of the endotracheal tube (ETT), decreasing the margin of safety for the ETT position and increasing accidental endobronchial intubation. However, it remains to be established whether the tracheal length itself is actually changed. We conducted a prospective observational study to measure the change in the length of the trachea and the distance between the ETT tip and the carina in patients undergoing gynecologic laparoscopic surgery.
Twenty-three patients scheduled for laparoscopic gynecologic surgery were enrolled. In the neutral position, the tracheal length was measured using a fiberoptic bronchoscope. The distance between the ETT tip and the carina was also measured. The tracheal length and the distance between the ETT tip and the carina were measured again 10 min after carbon dioxide (CO(2)) pneumoperitoneum (12-14 mmHg) combined with the Trendelenburg position (15 degrees ).
In the neutral position, the tracheal length was 11.09 +/- 0.90 cm and the distance between the ETT tip and the carina was 3.36 +/- 1.04 cm. After pneumoperitoneum combined with the Trendelenburg position, the distance between the ETT tip and the carina had decreased by 0.85 +/- 0.28 cm. The tracheal length had also decreased by 0.42 +/- 0.19 cm, which was equivalent to 49.7% of the decrease in the distance between the ETT tip and the carina.
These results suggest that tracheal shortening may contribute to a decrease in the distance between the ETT tip and the carina, increasing the risk of accidental endobronchial intubation during laparoscopic gynecologic surgery.
Acta Anaesthesiologica Scandinavica 03/2007; 51(2):235-8. · 2.19 Impact Factor
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ABSTRACT: It is well known that signal acquisition is the first step in signal processing. A simple and convenient method of acquiring biologic data is described here, which needs no special acquisition equipment, and is practical and makes the data acquisition more credible.
Zhongguo yi liao qi xie za zhi = Chinese journal of medical instrumentation 10/2001; 25(5):256-7, 271.
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ABSTRACT: Most, but not all, patients with von Recklinghausen neurofibromatosis develop tumors (neurofibromas) that contain large numbers of Schwann cells and fibroblasts. To begin to understand the molecular events that contribute to cell proliferation in these benign tumors, we have analyzed extracts of neurofibromas to determine whether they contain mitogens for Schwann cells or fibroblasts, or both. Schwann cell and fibroblast mitogens are present in neurofibroma extracts. All the neurofibromas analyzed contain a Schwann cell mitogen similar to a neuronal cell surface molecule known to stimulate Schwann cell proliferation during normal development; this mitogen also stimulates fibroblast proliferation. Basic fibroblast growth factor is present in 60% of tumors evaluated. Accumulation of mitogenic substances may contribute to the growth of neurofibromas.
Annals of Neurology 04/1990; 27(3):298-303. · 11.09 Impact Factor
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ABSTRACT: The cell surface of embryonic peripheral neurons provides a mitogenic stimulus for Schwann cells. We report (i) the solubilization of this mitogenic activity from rat dorsal root ganglion neurons grown in tissue culture and (ii) the solubilization and partial purification of mitogenic activity from neonatal rat brains. Extracted mitogenic activity is peripheral rather than intrinsic to the membrane, stable after extraction, and active as a mitogen in the absence of serum (the most stringent criterion defining the neuronal mitogen). We have previously provided evidence suggesting that a neuronal cell-surface heparan sulfate proteoglycan is required for expression of the neurons' mitogenic activity. We now show that mitogenic activity can be extracted from the membrane dissociated from proteoglycan as assayed by its ability to bind to immobilized heparin. After dissociation, low concentrations of heparin (1 micrograms/ml) inhibit the ability of the mitogen to stimulate Schwann cell division. Basic fibroblast growth factor (FGF) is weakly mitogenic for Schwann cells, but it is not present in mitogenic brain extracts (based on immunoblotting). Immunodepletion experiments with specific antibodies to FGF indicate that the mitogenic activity extracted from neurons is not a form of this heparin-binding mitogen. Acidic FGF is not mitogenic for Schwann cells and is not present in mitogenic brain extracts. We suggest that these and previous data indicate the neurite mitogen is a proteoglycan-growth factor complex that limits mitogenic activity to the axonal surface, protects mitogen against inactivation by other proteoglycans, and provides for effective presentation of mitogen to the Schwann cell.
Proceedings of the National Academy of Sciences 10/1988; 85(18):6992-6. · 9.68 Impact Factor
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ABSTRACT: One hundred baseline characteristics obtained at the time of diagnostic catheterization were examined for their prognostic value in 106 patients with unoperated aortic stenosis entered into the VA Cooperative Study on Valvular Heart Disease. A stepwise series of univariate and multivariate survival analyses were used to identify the independently significant prognostic indicators. Measures of the severity of valve stenosis, presence of coronary artery disease, and congestive heart failure are the important indicators of survival in unoperated aortic stenosis.
