Safety of 0.5% epidural levobupivacaine for cesarean section / 第二军医大学学报

Objective: To study the efficacy of 0. 5% epidural levobupivacaine for cesarean section and its serum level in the parturients and transportation via the placenta by comparing with 0. 5% bupivacaine. Methods: Forty healthy parturients undergoing elective cesarean section with epidural anesthesia were randomized to receive 15 ml of either 0. 5% levobupivacaine (group L) or 0. 5% bupivacaine (group B) in a double-blind fashion. The efficacy endpoint measures included onset, offset, adverse effect, and quality of anesthesia. Neonatal blood gas analyses, Apgar score determinations, and neurobehavioral examinations were performed. The drug concentrations were determined by high performance liquid chromatography in the parturients and neonates; and the serial electrocardiograms were obtained. Results: The onset and persistence of sensory block and motor block, maximal block level, electrocardiogram changes, Apgar score determinations, neurobehavioral examinations, and blood gas findings were similar between the two groups. The frequency of hypotension was 75. 0% in the levobupivacaine group and 90. 0% in the bupivacaine group (P=0. 051), and there was no severe adverse reactions. The maximum drug concentrations were seen 30 min later in the parturients, being(896±86) and (901 ±79) ng/mL in group L and B, respectively, with the areas under the concentration-time curve being (3 167± 132) and (2 935±96) h/(ng • mL-1), and the umbilical vein-to-maternal vein ratios being 0. 300 ±0. 091 and 0. 279 ±0. 116, respectively. Conclusion Epidural 0. 5% levobupivacaine for cesarean section has similar efficacy with 0. 5% bupivacaine, and can meet the demand of operation, with less adverse effect to the parturients and no effect to the neonates. The pharmacokinetic parameters and trans-placenta transportation rates are also similar to between levobupivacaine and bupivacaine.

The strategy of posterior decompression and re-establishing the insertion of extensor for ossification of posterior longitudinal ligament involved in C(2) / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate an approach of posterior cervical spinal canal decompression and re-establishing the insertion of extensor, aim at the ossification of the posterior longitudinal ligament (OPLL) involved in C(2).</p><p><b>METHODS</b>From 2002 to 2006, 10 patients with OPLL involved in C(2) underwent open-door laminoplasty, with the posterior cervical ligamentous complex and the insertion of extensor reconstructed on C(2), were reviewed retrospectively. The range of decompression was from C(2) to C(7). The sagittal diameter of C(2) vertebral canal, alignment of the cervical spine (C(2)-C(7) angle), and JOA score before and after operation were contrasted respectively.</p><p><b>RESULTS</b>All patients were followed up, average 14 months. Before the operation, the average sagittal diameter of C(2) vertebral canal was 5.6 mm (4 - 8.8 mm), JOA score was 9.6 scores (6 - 12 scores), C(2)-C(7) angle was 6.5 degrees (-2 degrees - 12 degrees ). After the operation, the average sagittal diameter of C(2) vertebral canal was 13.4 mm (10 - 18.2 mm, P < 0.01), JOA score was 10.9 scores (8 - 14 scores) and the C(2)-C(7) angle was 7.4 degrees (3 degrees - 14 degrees ) in earlier. Finally, the JOA score was 13.2 scores (10 - 17 scores, P < 0.05), and the C(2)-C(7) angle was 7.0 degrees (2 degrees - 15 degrees , P > 0.05) at last.</p><p><b>CONCLUSIONS</b>The open-door laminoplasty, with an approach of the posterior cervical ligamentous complex and the insertion of extensor reconstructed, is an appropriate method for treating OPLL involved in C(2). This process keeps the cervical curve in a better way, and decompresses the spinal canal effectively.</p>

Pelvic artery representation on three-dimensional reconstructed multislice spiral CT images: variability between the young and the elderly / 南方医科大学学报

<p><b>OBJECTIVE</b>To analyze the variability in pelvic artery representation on three-dimensional reconstructed multislice spiral CT images between young adults and the elderly.</p><p><b>METHODS</b>Eight young adult volunteers from the medical staff and 8 elderly people undergoing regular coronary artery examination, who were all free of coronary artery disease and diabetes mellitus, were enrolled in this study. After administration of the contrast agent through the median cubital vein at 3.5 ml/s, the subjects underwent contrast-enhanced CT angiography of the pelvic arteries utilizing a 16-row multislice spiral CT. The images were collected and processed with volume reconstruction (VR) technique for three-dimensional reconstruction to distinguish the arteries and their branches.</p><p><b>RESULTS</b>Good visualization of the pelvic artery was observed on the reconstructed CT images of the young subjects, which revealed in detail up to the third- and even the fourth-order vessels, and the arteries were smooth and had plenty of branches; but in the elderly only the second- or third-order vessels were shown, and the arteries appeared stiff with only a few branches.</p><p><b>CONCLUSIONS</b>Compared with the young adults, the elderly have generally poor visualization of the pelvic arteries on three-dimensional reconstructed multislice spiral CT images possibly in association with atherosclerosis and the functional deterioration of the blood vessels in the latter, which is relative to vascular morphologic changes, suggesting the necessity of studying the pelvic vessels with developmental and functional methods.</p>