Implementation of a fast-track-pathway including analgo-sedation with local anaesthesia for outpatient varicose vein surgery: a cohort study.

OBJECTIVE: To evaluate the clinical and economical impact of a fast-track anaesthesia protocol in the management of primary varicose vein (VV) surgery. METHODS: Over a 10-month period (from 1 December 2009 to 30 September 2011), all patients eligible for open VV surgery (N = 176) were enrolled in a fast-track clinical pathway including titrated analgo-sedation combined with local anaesthesia. This fast-track cohort was compared with a historical cohort undergoing similar procedures and receiving general anaesthesia (GA) or spinal anaesthesia (SA) (between 1 December 2009 to 30 September 2011, N = 200). The length of stay in the operating facilities and postoperative recovery areas were reported and hospital costs were estimated. In addition, the occurrence of adverse events and unplanned hospital admission were compared between the two consecutive periods. RESULTS: Patients characteristics and surgical procedure were not different in the two cohorts. After implementation of the fast-track pathway, the incidence of postoperative adverse events decreased from 41% to 2.3%, with no need for overnight hospital stay (0% versus 7%). The reduction in anaesthesia-controlled time (-47%) and in postoperative recovery time (-61%) were associated with an increased operating capacity (1 extra case per day) and with substantial cost-savings (mean reduction of €312 per case, P < 0.001). CONCLUSIONS: Implementation of a fast-track pathway for outpatient VV surgery was successful, safe and efficient. Analgo-sedation combined with infiltrative anaesthesia (instead of GA or SA) contributed to increase the operating capacity and to reduce the workload of nursing personnel.

Allopregnanolone levels decrease after gonadotropin-releasing hormone analog stimulation test in girls with central precocious puberty.

BACKGROUND: Allopregnanolone, a neuroactive steroid mainly secreted by adrenals and gonads, is a hormone that seems to play a role in precocious puberty, as demonstrated by its high baseline levels found in girls with central precocious puberty (CPP). Allopregnanolone concentrations significantly increase after GnRH and ACTH stimulation test suggesting both its ovarian and adrenal production. AIM: Aim of this study was to evaluate allopregnanolone concentrations after GnRH and GnRH agonist analog stimulation test in girls with CPP to better establish its secretion source. SUBJECTS AND METHODS: Gonadotropins and steroid hormones were evaluated in different days after GnRH and triptorelin stimulation test in 15 CPP girls. RESULTS: After GnRH stimulation, LH, FSH, and allopregnanolone concentrations significantly increased (p<0.05). After triptorelin administration LH, FSH, estradiol and DHEAS levels significantly increased (p<0.05), while allopregnanolone concentrations significantly decreased (1.08±0.24 vs 0.87±0.28 nmol/l; p=0.003). CONCLUSIONS: The different response of allopregnanolone to GnRH and GnRH agonist analog might reflect the agonist and antagonist action exerted by these secretagogues. Our data suggest the prevalent gonadal allopregnanolone production in CPP subjects and the usefulness of its measurement in the diagnosis of CPP.

Type A behavior pattern in a German sample of post-infarction patients below age 40.

While Type A is predominant in 62 coronary subjects below age 40, its specificity is to be questioned because for controls the A:B ratio is very similar. Cases display significantly more hostility and loud/explosive speech than controls. During the interview, cases belonging to different Type A categories did not differ in heart rate, skin resistance responses and blood pressure, when task values are used. Furthermore, no differences between coronary A and B subjects are found on cardiological findings, inclusive severity of coronary atherosclerosis.

The Type - A behavior pattern applied to problems in the rehabilitation of MI - patients below age 40: associations with personality dimensions and psychophysiological parameters essential to CHD.

In a sample of 60 MI-patients below age 40 there were mainly found correlations between the component "hostility" and personality dimensions indicating job stress and problems in the patients adjustment to their new situation as chronically ill persons. Whereas self- and expert ratings do not differentiate between Type A1 and B subjects psychophysiological testing reveals a groups difference between both groups in Ps. Therefore it can be assumed, that in daily life Type A MI-patients are prone to respond with an elevated Ps.