Breastfeeding after anaesthesia: a review of the pharmacological impact on children.

Post-anaesthetic advice imparted to breastfeeding mothers can vary. This is due in part to the differing information from published data, product information sheets and inevitably from the unhindered flow of opinions available on the internet. This literature review examined the evidence relating to drugs commonly used in the modern anaesthetic setting and their impact on breastfed children. It suggests that special precautions are rarely warranted in the post-anaesthetic care of breastfeeding patients.

Epidemiology of traumatic cervical spinal cord injury in Tianjin, China.

STUDY DESIGN: A retrospective epidemiological study. OBJECTIVE: To describe the recent epidemiological characteristics of traumatic cervical spinal cord injury (TCSCI) in adults in Tianjin. SETTING: Tianjin Medical University General Hospital. METHODS: This study included all TCSCI patients aged ≥ 15 years who were admitted to a general hospital from December 2008 to November 2011. Epidemiological characteristics including gender, age, marital status, occupation, etiology, level of injury, severity and America Spinal Injury Association (ASIA) impairment scale were recorded. RESULTS: A total of 143 patients with TCSCI were included in the study. Mean age was 54.6 ± 14.6 years (men 53.5 ± 14.9 years, women 54.2 ± 12.1 years), with a range of 18-87 years, and the male/female ratio was 5:1. The leading cause was falls (49.7%), followed by motor vehicle accidents (36.4%). The most common injury site was C5, accounting for 42%. In all, 74 (51.7%) patients had complications; the most common complication was hyponatremia (30.1%), followed by urinary infection (23.1%), respiratory infection (18.2%), bedsore (9.8%) and deep venous thrombosis (4.9%). As for the severity, ASIA grade D was encountered most frequently. Six patients died, five of whom died from respiratory failure. CONCLUSION: The epidemiology of TCSCI has its own characteristics. Falls were the leading causes, and TCSCI occurred most frequently in the middle-aged and elders. Therefore, establishing public policies aimed at preventing injuries should focus on falls and more attention should be paid to the aged regarding their vulnerability to low fall. Additionally, complications should be prevented in TCSCI patients.

Development of an imaging-planning program for screen/film and computed radiography mammography for breasts with short chest wall to nipple distance.

OBJECTIVE: Imaging breasts with a short chest wall to nipple distance (CWND) using a traditional mammographic X-ray unit is a technical challenge for mammographers. The purpose of this study is the development of an imaging-planning program to assist in determination of imaging parameters of screen/film (SF) and computed radiography (CR) mammography for short CWND breasts. METHODS: A traditional mammographic X-ray unit (Mammomat 3000, Siemens, Munich, Germany) was employed. The imaging-planning program was developed by combining the compressed breast thickness correction, the equivalent polymethylmethacrylate thickness assessment for breasts and the tube loading (mAs) measurement. Both phantom exposures and a total of 597 exposures were used for examining the imaging-planning program. RESULTS: Results of the phantom study show that the tube loading rapidly decreased with the CWND when the automatic exposure control (AEC) detector was not fully covered by the phantom. For patient exposures with the AEC fully covered by breast tissue, the average fractional tube loadings, defined as the ratio of the predicted mAs using the imaging-planning program and mAs of the mammogram, were 1.10 and 1.07 for SF and CR mammograms, respectively. The predicted mAs values were comparable to the mAs values, as determined by the AEC. CONCLUSION: By applying the imaging-planning program in clinical practice, the experiential dependence of the mammographer for determination of the imaging parameters for short CWND breasts is minimised.

Emergency management and infection control in a radiology department during an outbreak of severe acute respiratory syndrome.

The World Health Organization classified Taiwan as a serious epidemic-stricken area when the extent of severe acute respiratory syndrome (SARS) in Taiwan became clear. As of 11 July 2003, 671 probable SARS cases had been identified in Taiwan and 7 healthcare workers had died from the disease. Radiographers were easily infected by SARS because they had close contact with suspected or probable cases while conducting chest X-ray examinations. Three radiographers had been infected by the end of May 2003. Because of the impact of SARS on the Radiology Department, the department established a SARS emergency infection control team and re-designed the department's infection-control and emergency-management procedures based on the concept of risk-grade protection. This effort included installing a radiographic room at the fever-screening station, re-allocating human resources in the Radiology Department, training the department staff in infection control, and drafting new operational procedures for radiographers conducting X-ray examinations on SARS patients. The goal of this program was to reduce the infection rate and distribute materials efficiently in the department. This article introduces the emergency-management procedure of the Radiology Department during the SARS outbreak and the infection-protection experience of the department staff.

Decommissioning of a 60Co unit and estimation of personal doses.

Chang-hua Christian Hospital needs to uninstall the 60Co unit. The mode of this 60Co teletherapy unit is SHIMADZU RTGS-10. The original lead head was taken as the source container of this 60Co unit. The source head was dismantled and put into the prepared wooden box, after the source was sealed. This study describes the planning and dismantling of the retirement and transport of the 60Co unit, and personal doses measured during the procedure. This work estimates the doses of radiation received by exposed workers during the dismantling of the machine. The workers received doses of approximately 53 microSv. This study shows that the original lead head can be used as the source container of this 60Co unit. The 60Co machine was smoothly dismantled and transported by conscientious and careful workers, using planned and controlled radiation protection, following the ALARA (as low as reasonably achievable) rule.

Estimation of mean-glandular dose from monitoring breast entrance skin air kerma using a high sensitivity metal oxide semiconductor field effect transistor (MOSFET) dosimeter system in mammography.

Estimation of mean-glandular dose (MGD) has been investigated in recent years due to the potential risks of radiation-induced carcinogenesis associated with the mammographic examination for diagnostic radiology. In this study, a new technique for immediate readout of breast entrance skin air kerma (BESAK) using high sensitivity MOSFET dosimeter after mammographic projection was introduced and a formula for the prediction of tube output with exposure records was developed. A series of appropriate conversion factors was applied to the MGD determination from the BESAK. The study results showed that signal response of the high sensitivity MOSFET exhibited excellent linearity within mammographic dose ranges, and that the energy dependence was less than 3% for each anode/filter combination at the tube potentials 25-30 kV. Good agreement was observed between the BESAK and the tube exposure output measurement for breasts thicker than 30 mm. In addition, the air kerma estimated from our prediction formula provided sufficient accuracy for thinner breasts. The average MGD from 120 Asian females was 1.5 mGy, comparable to other studies. Our results suggest that the high sensitivity MOSFET dosimeter system is a good candidate for immediately readout of BESAK after mammographic procedures.

Characterization of high-sensitivity metal oxide semiconductor field effect transistor dosimeters system and LiF:Mg,Cu,P thermoluminescence dosimeters for use in diagnostic radiology.

Monitoring radiation exposure during diagnostic radiographic procedures has recently become an area of interest. In recent years, the LiF:Mg,Cu,P thermoluminescence dosimeter (TLD-100H) and the highly sensitive metal oxide semiconductor field effect transistor (MOSFET) dosimeter were introduced as good candidates for entrance skin dose measurements in diagnostic radiology. In the present study, the TLD-100H and the MOSFET dosimeters were evaluated for sensitivity, linearity, energy, angular dependence, and post-exposure response. Our results indicate that the TLD-100H dosimeter has excellent linearity within diagnostic energy ranges and its sensitivity variations were under 3% at tube potentials from 40Vp to 125kVp. Good linearity was also observed with the MOSFET dosimeter, but in low-dose regions the values are less reliable and were found to be a function of the tube potentials. Both dosimeters also presented predictable angular dependence in this study. Our findings suggest that the TLD-100H dosimeter is more appropriate for low-dose diagnostic procedures such as chest and skull projections. The MOSFET dosimeter system is valuable for entrance skin dose measurement with lumbar spine projections and certain fluoroscopic procedures.

The solvent extraction of radium using sym-Di[4(5)-tert-butylbenzo]-16-crown-5-oxyacetic acid.

The extraction of radium using sym-Di[4(5)-tert-butylbenzo]-16-crown-5-oxyacetic acid (DTBDB16C5-OAcH) in toluene is excellent. The reaction is reversible without counterions at pH higher than 9. The distribution ratio decreases as the dissolved concentration of alkaline earth ions increases. Probed factors involved in this solvent extraction system include pH values, solvents, metal ions, and the concentration of DTBDB16C5-OAcH. Liquid scintillation cocktails including Ultima Gold and Hionic Fluor were also evaluated in liquid scintillation counting.

Dose compensation of the total body irradiation therapy.

The aim of the study is to improve dose uniformity in the body by the compensator-rice and to decrease the dose to the lung by the partial lung block. Rando phantom supine was set up to treat bilateral fields with a 15 MV linear accelerator at 415cm treatment distance. The experimental procedure included three parts. The first part was the bilateral irradiation without rice compensator, and the second part was with rice compensator. In the third part, rice compensator and partial lung block were both used. The results of thermoluminescent dosimeters measurements indicated that without rice compensator the dose was non-uniform. Contrarily, the average dose homogeneity with rice compensator was measured within +/- 5%, except for the thorax region. Partial lung block can reduce the dose which the lung received. This is a simple method to improve the dose homogeneity and to reduce the lung dose received. The compensator-rice is cheap, and acrylic boxes are easy to obtain. Therefore, this technique is suitable for more studies.

The response of a thermoluminescent dosimeter to low energy protons in the range 30-100 keV.

This study demonstrates the thermoluminescence (TL) response of CaF2:Tm (commercial name TLD-300) to 30-100 keV protons which were generated by means of a Cockcroft-Walton accelerator. The phenomenon in which the total thermoluminescent output from CaF2:Tm (TLD-300) decreases with proton energy from 30 to 100 keV (with increase of LET) can be interpreted by the track structure theory (TST). The analysis of the glow peaks: P2 (131 degrees C), P3 (153.5 degrees C) and P6 (259 degrees C), of TLD-300 show the oscillatory decreasing phenomenon as a function of incident proton energy, which can be interpreted with the TST and the oscillatory emission of electrons in a thermoluminescent dosimeter (TLD) that is caused by resonant or quasi-resonant charge transfer in ion-atom interactions in this TLD-300.

The measurement of photoneutrons in the vicinity of a Siemens Primus linear accelerator.

This study involves the measurement of photoneutron contamination emitted from a Siemens Primus medical linear accelerator by using BD-PND bubble detectors. Various bubble detectors were arranged around the linac head with the interval of I m and at the same height as the isocenter to measure the dose equivalent distribution in the treatment room. The measurements were performed for 15 MV X-rays with 40 x 40cm2 and 0 x 0cm2 fields and for 15,18, and 21 MeV electrons with 25 x 25 cm2 electron cone. Neutron dose equivalent rate at the points of measurement in the treatment room decreased with increasing distance to the isocenter. The maximum neutron dose equivalents were at the isocenter, and the values for 15MV 40 x 40 and 0 x 0 cm2 were 1843+/-90 and 169.9+/-59.9 microSv per Gy X-ray, respectively. The values for 15, 18 and 21 MeV electrons with 25 x 25 cm2 cones were 100.0+/-20.4, 262.7+/-61.2 and 349.0+/-29.6 microSv per Gy electron, respectively. The neutron contamination of electrons less than 12 MeV was below the detection limit.

Skin dose measurement by using ultra-thin TLDs.

The treatment schedule for radiation therapy is often interrupted because of complicated skin reactions. Quantitative information relating beam parameters and skin reactions will be helpful. Measurements were performed for 6-15 MV photons and 6-21 MeV electrons with ultra thin TLD films (GR-200F, surface area 0.5 x 0.5cm2, nominal thickness 5 mg cm(-2)). The skin doses for various field sizes, ranging from 10 x 10 to 40 x 40 cm2, and various incident angles of beam from 0 degrees to 80 degrees were measured. The ratios of skin dose to maximum dose in phantom for 10 x 10 cm2 are 16.10+/-0.68%, 14.03+/-1.04% and 10.59+/-0.64% for 6, 10 and 15 MV, respectively. Such ratios increase with a larger field size. For electrons the ratios are 72.59+/-1.72%, 78.52+/-2.99%, 78.89+/-2.86%, 86.08+/-2.62%. 87.75+/-1.94% and 86.33+/-3.09% for 6, 9, 12, 15, 18 and 21 MeV, respectively. They also increase with a larger size. The oblique factors also increase with larger incident angle.

Naphazoline-induced suppression of aqueous humor pressure and flow: involvement of central and peripheral alpha(2)/I(1) receptors.

The objective of this study was to examine the ocular hydrodynamic effects of topically and centrally administered naphazoline, alone and following pretreatment with pertussis toxin (PTX) and alpha(2)/I(1)receptor antagonists. Topically and intracisternally administered naphazoline was examined for its ability to alter intraocular pressure (IOP) of rabbits in the absence and presence of receptor antagonists (rauwolscine, efaroxan) and a G(i/o)ribosylating agent PTX. In addition, the topical effects of naphazoline on pupil diameter and aqueous humor flow rate were evaluated. Topical unilateral application of naphazoline (7.5, 25 and 75 micro g; 25 micro l) elicited an ipsilateral dose-dependent mydriasis (2, 4 and 5.5 mm) that peaked at 2 hr with a duration of up to 5 hr. The IOP decreases induced by naphazoline were bilateral and dose-dependent (3, 6 and 10 mmHg); the response peaked at 1 hr and lasted for up to 5 hr. Pretreatment with efaroxan (250 micro g) elicited significantly greater antagonism of the ocular hypotensive response to naphazoline than did rauwolscine (250 micro g) suggesting an involvement of imidazoline (I(1)) receptors. Intracisternal application of naphazoline (3.3 micro g) also produced bilateral reductions (6 mmHg) of IOP that were immediate (10 min post drug) and lasted for approximately 2 hr. In PTX-pretreated (2.5 micro g kg(-1), i.a.) rabbits, the ocular hypotensive effects of naphazoline by both routes (topically and centrally) were attenuated by 50--65%. In addition to producing ocular hypotension, topical application of naphazoline (75 micro g; 25 micro l) caused significant reduction, from 2.8 to 1.5 micro l min(-1), in aqueous humor flow. These in vivo data indicate that, regardless of route of administration, alteration of aqueous humor flow by naphazoline was induced by the activation of alpha(2)and I(1)receptors. The ocular hypotensive effects produced by central administration did not result in sedation, therefore, there is the suggestion that central alpha(2)adrenergic receptors were stimulated minimally by naphazoline. Thus, these data suggest that ocular hypotensive effects and suppression of aqueous humor flow rate by naphazoline are mediated, in part, by alpha(2)and/or central I(1)at both central (brain) and peripheral (eye) sites. Moreover, these data indicate that the receptors are linked to PTX-sensitive G((i/o))proteins.

Monte Carlo simulation of a clinical linear accelerator.

The effects of the physical parameters of an electron beam from a Siemens PRIMUS clinical linear accelerator (linac) on the dose distribution in water were investigated by Monte Carlo simulation. The EGS4 user code, OMEGA/BEAM, was used in this study. Various incident electron beams, for example, with different energies, spot sizes and distances from the point source, were simulated using the detailed linac head structure in the 6 MV photon mode. Approximately 10 million particles were collected in the scored plane, which was set under the reticle to form the so-called phase space file. The phase space file served as a source for simulating the dose distribution in water using DOSXYZ. Dose profiles at Dmax (1.5 cm) and PDD curves were calculated following simulating about 1 billion histories for dose profiles and 500 million histories for percent depth dose (PDD) curves in a 30 x 30 x 30 cm3 water phantom. The simulation results were compared with the data measured by a CEA film and an ion chamber. The results show that the dose profiles are influenced by the energy and the spot size, while PDD curves are primarily influenced by the energy of the incident beam. The effect of the distance from the point source on the dose profile is not significant and is recommended to be set at infinity. We also recommend adjusting the beam energy by using PDD curves and, then, adjusting the spot size by using the dose profile to maintain the consistency of the Monte Carlo results and measured data.

Mechanisms and sites of ocular action of 7-hydroxy-2-dipropylaminotetralin: a dopamine(3) receptor agonist.

The purpose of this study was to investigate mechanism(s) and site(s) of action involved in 7-hydroxy-2-dipropylaminotetralin (7-OH-DPAT)-induced ocular hypotension. As measured by pneumatonometry, the topical, unilateral application of 7-OH-DPAT (75 microg), a dopamine D(3)-preferring receptor agonist, decreased the intraocular pressure (IOP) bilaterally. The ocular hypotensive activity of 7-OH-DPAT was diminished in sympathetically denervated rabbits. Pretreatment with raclopride, a D(2)/D(3) receptor antagonist; UH232, a D(3) receptor antagonist; or U-99194A, a D(3) receptor antagonist antagonized 7-OH-DPAT-induced ocular hypotension. However, pretreatment with spiperone, a D(2) receptor antagonist, did not affect the 7-OH-DPAT-induced ocular hypotension. In addition, topically applied 7-OH-DPAT caused a reduction of aqueous humor flow rate. To examine sites of action, immunohistochemistry of D(3) dopamine receptors was performed. Dopamine D(3) receptors were found to be present on postganglionic sympathetic nerves in the ciliary body of normal rabbits but were virtually undetectable in the same tissue of sympathectomized rabbits. In summary, the IOP-lowering effect caused by 7-OH-DPAT was due, in part, to the suppression of aqueous humor flow. Immunohistochemical identification of D(3) receptors in the ciliary body, associated with the diminution of IOP-lowering effects by D(3) receptor agonist 7-OH-DPAT in sympathetically denervated rabbits provided evidence of neuronal site of action of 7-OH-DPAT. Suppression of 7-OH-DPAT-induced ocular hypotension by D(3) receptor antagonists (U-99194A and UH232) and sympathectomy, coupled with the immunohistochemical data, suggested that the primary site of D(3) receptor-mediated action of 7-OH-DPAT is located on postganglionic sympathetic nerve endings in the ciliary body of rabbit.

8OH-DPAT-Induced ocular hypotension: sites and mechanisms of action.

The purpose of this study was to define the ocular actions of 8-OH-DPAT(DPAT), a 5-HT(1A)receptor agonist. The intraocular pressure responses to topically applied DPAT were dose related (25, 125, 250 microgram) and bilateral in normal rabbits but of relatively short duration. Ocular hypotension induced by topical, unilateral DPAT (125 microgram) in normal eyes did not occur in sympathetically denervated eyes. DPAT-induced ocular hypotension was inhibited by pretreatment with spiroxatrine, a 5-HT(1A)and alpha(2C)receptor antagonist, but not spiperone, a 5-HT(2A)receptor antagonist. In contrast, the hypotensive effect produced by unilaterally applied DPAT in the contralateral eye was abolished following pretreatment with rauwolscine, an alpha(2)-receptor antagonist, but the DPAT-induced ocular hypotension was not antagonized in the treated (ipsilateral) eye. Following central administration of DPAT (3 microgram) into the lateral ventricle, intraocular pressure was lowered bilaterally at 10 min and the effect lasted for 2 hr. In in vitro experiments, DPAT (0.1, 1, 10 micrometer) failed to alter norepinephrine release in rabbit iris-ciliary bodies. However, DPAT depressed basal cAMP levels in rabbit iris-ciliary bodies and also caused a dose-related (1, 10, 100 micrometer) inhibition of isoproterenol (1 micrometer)-stimulated cAMP accumulation by 26%, 58% and 82%, respectively. These findings indicate that: (1) based upon bilateral activity by the topical route, DPAT-induced ocular hypotension could result, in part, through activation of 5-HT(1A)receptors in the eye and 5-HT(1A)receptors and/or alpha(2C)adrenoreceptors in the central nervous system, (2) the activity of DPAT on 5-HT(1A)and/or alpha(2C)receptors was confirmed by antagonism of the ocular hypotensive response by spiroxatrine, (3) although there is no apparent prejunctional effect of DPAT on sympathetic nerves of iris-ciliary bodies, the accumulation of basal and isoproterenol-stimulated cAMP levels were depressed by DPAT, and (4) as a result of inhibition by rauwolscine, the ocular hypotensive effect of DPAT in the contralateral eye could involve an action on alpha(2)adrenoreceptors in the central nervous system.

Enhanced nitric oxide synthesis reverses salt-induced alterations in blood flow and cGMP levels.

To understand the role of nitric oxide in salt-induced hypertension, we evaluated cardiovascular, hemodynamic and biochemical parameters in Dahl salt-sensitive rats fed low (0.3%) and high (8.0%) sodium diets. Two high salt groups received 1.25 and 2.5 g/L l-arginine in their drinking water. After three weeks of treatment, blood pressure was greater in the high salt groups. l-arginine did not modify salt-induced hypertension. Eicosapentaenoic acid (EPA) caused a smaller depressor response compared to normotensive rats. The increase in blood pressure was associated with decreases in aortic and renal blood flows. In renal artery, the reduction was counteracted by both l-arginine doses; whereas in the aorta, only the higher l-arginine one restored blood flow. The salt-induced reduction in aortic cyclic GMP level was only overcome by the higher l-arginine treatment. These data suggest that at the dose levels tested, nitric oxide reverses the reduction in cGMP and blood flow, but not the blood pressure changes associated with salt-induced hypertension.

Intraocular pressure lowering by S-allylmercaptocysteine in rabbits.

The purpose of this study was to examine the actions of a garlic-derived compound, S-allylmercaptocysteine (SAMC) on intraocular pressure (IOP) and to determine the possible involvement of sulfhydryl reactivity, sympathetic neuronal activity and atrial natriuretic peptide (ANP) in the IOP response. Topical, unilateral application of SAMC (20, 100, 200 microg) elicited dose-dependent decreases in IOP. The magnitude of the IOP-lowering effect induced by SAMC was between four to six mmHg. The ocular hypotensive responses were unilateral, peaked at one to three hours and lasted from two to four hours. The IOP-lowering effect by SAMC (100 microg) was enhanced modestly by topical, bilateral pretreatment with a reducing agent, tris(2-carboxyethyl) phosphine (100 microg) which itself produced no change in IOP. No alteration of pupil diameter was observed following topical application of either SAMC or tris(2-carboxyethyl) phosphine. Thus, alteration of sulfhydryl reactivity does not seem to be a major mechanism of action for SAMC. SAMC caused no change of basal and electrically stimulated norepinephrine release in rabbit iris-ciliary bodies, ruling out a prejunctional effect on sympathetic nerve activity. However, SAMC increased the ANP levels in aqueous humor by five-fold. It is concluded that the ocular hypotensive response induced by SAMC in rabbits could involve the elevation of ANP levels in aqueous humor.