Puncture technique and postural postdural puncture headache. A randomised, double-blind study comparing transverse and parallel puncture.

BACKGROUND: This clinical study was conducted in order to investigate the effect of two different orientations of the bevel during dural puncture on development of postural postdural puncture headache (PPDPH). METHODS: Two hundred and eighteen patients aged 18 to 50 years scheduled for minor non-obstetric surgery using spinal anaesthesia (SA) were included in this randomised, double-blind study. Dural puncture was performed using a 0.42 mm O.D. (27-g) Quincke spinal needle with the orientation of the bevel parallel or transverse relative to the longitudinal axis of the dural cylinder. All patients were blinded with regard to the puncture technique, and so was the anaesthesiologist performing a telephone interview 5 to 7 days postoperatively. The occurrence and duration of headache, backache and other complaints were recorded. Headache was classified as PPDPH or non-PPDPH, and intensity of the headache was registered using a numerical rating scale (NRS) from 0 to 10. RESULTS: Two hundred and twelve patients with a mean age of 35.3 years completed the study, 106 in each group. The two groups were comparable with regard to mean age, sex, local anaesthetics used and surgical procedure performed. Headache occurred in 44 patients postoperatively. PPDPH was diagnosed in 4/106 patients (3.8%) in the parallel group and 24/106 (22.6%) in the transverse group (P < 0.0002). Postoperative backache occurred in 31 and 20 patients (parallel compared to transverse) (NS). CONCLUSIONS: Dural puncture with the bevel of the needle transverse to the longitudinal axis of the dural cylinder gave significantly more cases of PPDPH than puncture with the bevel parallel to this axis even when using a 27-g Quincke needle. When using Quincke bevelled needles care must be taken to assure that the orientation of the bevel is parallel to the longitudinal axis of the dural sac.

High-intensity physical training in adults with asthma. A comparison between training on land and in water.

The purpose of this study was to determine whether inactive asthmatic patients could perform high-intensity physical training equally well on land as in water, and to compare the effects of these training forms. Thirty-two adults with asthma, randomized into two groups, underwent a 10-week supervised rehabilitation program with emphasis on physical training. All patients, irrespective of training form, were able to exercise to maximal intensity (80-90% of estimated maximal heart rate). No asthmatic attacks occurred in connection with the training sessions. Respiratory variables remained almost unchanged in both groups. The asthma symptoms declined during the rehabilitation period, and the subjects needed less acute asthma care after the rehabilitation. The cardiovascular condition improved significantly and similarly in the two groups. Ten patients, 5 in each group, had exercise-induced asthma at the start of the rehabilitation. Only 3 patients, 2 from the water group and 1 from the land group, had exercise-induced asthma after 10 weeks. We conclude that indoor training, either on land or in water, is beneficial. The effects of these two training forms are almost equivalent.

A 3-year follow-up of asthmatic patients participating in a 10-week rehabilitation program with emphasis on physical training.

OBJECTIVE: To determine if asthmatic patients who had participated in a 10-week rehabilitation program with emphasis on physical training (1) continued with physical training, (2) maintained their improved cardiovascular condition and lung function, and (3) retained their good asthma control through the following 3 years. DESIGN: A descriptive 3-year follow-up study. PATIENTS AND SETTING: A convenience sample of 58 patients who had previously undergone a 10-week outpatient rehabilitation program were followed up 6 months and 1, 1.5, 2, and 3 years after the start of the program at a lung clinic in a university hospital. MAIN OUTCOME MEASURES: A training log was kept by each patient to record frequency, intensity, and mode of training. Physical condition was evaluated with a submaximal 6-minute ergometry test and a 12-minute walking test, respiratory function with static and dynamic spirometry, and bronchial hyperreactivity with a metacholine provocation test. Asthma symptoms and asthma control were measured with a study-specific questionnaire. RESULTS: Thirty-nine subjects (68%) exercised regularly during all 3 years. The cardiovascular condition and lung function values remained almost unchanged in all 58 patients. There was a significant decrease in number of emergency room visits the year after the 10-week rehabilitation program compared to the year before. It remained stable throughout the following 2 years. There was also a decrease in asthma symptoms in all patients, but the decrease was significant only in a subgroup of 26 patients, who exercised one or two times a week. CONCLUSIONS: It is possible for asthmatic subjects to exercise at a moderate intensity level on a long-term basis without deleterious effects. Moreover, the high compliance rate might indicate that inactive asthmatic patients who are taught how to exercise choose to continue to be physically active.

Ontogeny of the sensitivity of the somatotrophes to thyrotrophin releasing hormone (TRH) and growth hormone releasing factor (GRF) in the embryonic and posthatch chick.

The ontogeny of the in vitro growth hormone (GH) release after stimulation with thyrotrophin releasing hormone (TRH) or growth hormone releasing factor (GRF) has been studied in two strains of chickens during the last week of embryonic development and the first week posthatch. Fourteen-day-old embryos did not yet respond to any of the stimuli applied, while the amplitude of the GH response to the different stimuli increased gradually from 18-day-old embryos to 1-day-old chicks. The evolution of the responses to both stimulating agents was parallel in the two strains of chickens, but the amplitude of the response was always higher in the rapidly growing broiler strain compared to the slowly growing layer strain. The highest GH response was at all stages obtained with the highest dose of GRF (100 nM). At a lower dose (10 nM), however, TRH seemed to be a more effective GH releasing agent than GRF at the posthatch stages.