Comparison of unilateral and bilateral spinal anesthesia with 2% hyperbaric prilocaine in day-case inguinal herniorrhaphy: a randomized controlled trial.

BACKGROUND: Hyperbaric 2% prilocaine produces a faster onset and shorter duration of spinal anesthesia than a plain solution. The anesthetic profile could be improved by restricting the block to the operative side. We compared unilateral versus conventional bilateral spinal anesthesia with hyperbaric 2% prilocaine in day-case patients undergoing unilateral inguinal herniorrhaphy. METHODS: Eighty patients were randomly assigned to receive either conventional bilateral (N.=40) or unilateral (N.=40) spinal anesthesia with 50 mg hyperbaric prilocaine 2%. In the unilateral group, lateral decubitus was maintained for 10 minutes. Sensory and motor block courses, time to first micturition, and side effects were recorded. RESULTS: On the operated side, the highest sensory block was T8 (T12-T2) in the unilateral and T9 (T11-T4) in the bilateral group (P=0.0328); the time to motor (115 ± 26 min in the unilateral and 108 ± 24 min in the bilateral groups, P=0.2350) and sensory (156 ± 30 min in the unilateral and 158 ± 26 min in the bilateral groups, P=0.7550) block resolution was similar in both groups. On the non-operated side, the unilateral group had a faster motor (64 ± 48, P<0.001) and sensory (120 ± 47, P<0.001) time to block resolution than the conventional group. Restricted unilateral motor and sensory block was achieved in 30% and 12.5% of patients, respectively. Time to voiding was shorter in the unilateral than in the conventional group (220 ± 47 vs. 249 ± 51 min, respectively, P=0.0104). There were no significant differences in adequacy for surgery and side effects between the groups. CONCLUSION: In day-case inguinal herniorrhaphy, attempting unilateral spinal anesthesia with 50 mg hyperbaric 2% prilocaine produced faster time to voiding.

[Tracheal intubation with fiberscope in traumatology of the cervical spine. Our clinical experience]. / Intubazione tracheale con fibroscopio nella traumatologia del rachide cervicale. Nostra esperienza clinica.

Cervical spine lesions require early stabilisation. The fibroscope was used in order to avoid irreversible damage to the medulla during intubation. Twenty-five patients aged between 18 and 70 years old were treated. Pre-medication and local anesthesia of the nostril, rhinopharynx and oropharynx was performed. Local anesthesia of the hypopharynx was omitted to avoid the tussigenic reflex which is dangerous in this pathology. The patient was then deeply sedated maintaining respiratory activity. The tracheal tube was then introduced into the nostril and the fibroscope was then positioned using this as a guide. Following the insertion of the fibroscope in the trachea, the latter was then used to slide the tracheal tube down. The authors consider this technique to be useful in this pathology since it is risk free if used as described above.

[Axonal polyneuropathy caused by acute multiple organ disease]. / Polineuropatia assonale da malattia acuta multiorgano.

Complications involving the peripheral nervous system known as CIP have been reported during the course of prolonged sepsis and MOFS. These may be differentiated from Guillain-Barré's syndrome by their electrophysiological characteristics of axonal neuronal damage and the normality of spinal fluid tests. The Authors report and discuss a case which was brought to their attention.

Chemical protective clothing standard test method development: Part II. Degradation test method.

A "round-robin" interlaboratory evaluation of a proposed American Society for Testing and Materials (ASTM) standard test method was conducted for measuring the resistance of chemical protective clothing materials to degradation by liquid chemicals. The objective of this project was to determine the relative precision of the method and, where appropriate, recommend modifications that would improve reliability. In the round-robin format, eight laboratories used the proposed method to test each of five protective clothing materials against five liquid chemicals that are widely used commercially. The resulting data revealed that the proposed test method was not stringent enough to generate acceptable levels of accuracy and precision. Both intra- and interlaboratory standard deviations showed a high degree of variability in changes for the three physical properties evaluated. Changes in the method were identified which, if implemented, should improve accuracy and precision considerably.

Resurrecting the art of risk control.

The author defines risk control as the process of minimizing accidental and other extraordinary losses by anticipating and preventing unplanned events. Loss control, on the other hand, is defined as the process of minimizing accidental and other extraordinary losses by containing unplanned events after they occur. By these definitions, many people who think they practice risk control are actually practicing loss control. A few people who practice loss control are actually practicing risk control.

[Pseudotumor of the breast during a course of acute leukemia]. / Pseudo tumore mammario in corso di leucosi acuta.

A case of breast infiltration with neoplasm-like clinical and radiological findings, occurring during acute leukaemia treated with polychemiosteroid therapy is described. Although at histopathological investigation this neoplasm is considered a reticulolymphoblastosarcoma, a personal suggestion that this breast infiltration is a blastic localization is put forward. This observation is a starting point for suggesting that antiblastic polichemio-therapy can change the clinical aspects of acute leukaemia.

Removal of cyanoacrylate vapor from work spaces by activated carbon.

The purpose of this research program was to evaluate several gas sorbents for methyl-2-cyanoacrylate vapor collection efficiency and service life in portable, recirculating room air filters. Two acid carbons were found to be effective and are recommended for further evaluation under actual field conditions.