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  • 1
    Electronic Resource
    Electronic Resource
    Oxford, UK : Blackwell Science Ltd
    Anaesthesia 55 (2000), S. 0 
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: This study evaluates the pharmacokinetics of ropivacaine in children after caudal epidural injection. Twenty male children undergoing inguinal hernia repair were enrolled after ethics committee approval and informed parental consent, and were grouped according to age (10 ‘infants’ aged less than 1 year and 10 ‘toddlers’ aged 1–5 years). After induction of general anaesthesia, caudal epidural injection using ropivacaine 0.2% 1 ml.kg−1 was performed. Plasma concentrations of ropivacaine in the first 2 h after injection were determined by reversed-phase high-pressure liquid chromatography. Caudal blockade with ropivacaine 2 mg.ml−1 resulted in mean (SD) peak plasma concentrations of 0.73 [0.27]µg.ml−1 in infants and 0.49 [0.21]µg.ml−1 in toddlers (p 〈 0.01). Maximum plasma concentrations occurred after a median [range] period of 60 [15–90] min and 52.5 [30–120] min in infants and toddlers, respectively. Two infants (weighing 3.8 and 5.0 kg) showed the highest individual maximum plasma concentrations: 1.31 and 1.11 µg.ml−1. No clinical signs of local anaesthetic toxicity were observed. The results of the present investigation suggest that, from a pharmacokinetic point of view, caudal blockade using ropivacaine 0.2% 1 ml.kg−1 can be regarded as a safe technique in children, i.e. in infants as well as in toddlers.
    Type of Medium: Electronic Resource
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  • 2
    ISSN: 1365-2044
    Source: Blackwell Publishing Journal Backfiles 1879-2005
    Topics: Medicine
    Notes: Postoperative nausea and vomiting (PONV) are frequent and unpleasant symptoms. This prospective study aimed to assess the efficacy of a multimodal approach to prevent PONV, and patient satisfaction using the willingness-to-pay method. Two validated risk scores were applied to forecast the individual risk for PONV in 900 consecutive patients of whom 108 were identified as high-risk patients (predicted risk: 79–87%). High-risk patients received multimodal anti-emetic prophylaxis: total intravenous anaesthesia with propofol, high fractional inspired oxygen (80%), omission of nitrous oxide, dexamethasone 8 mg, haloperidol 10 µg.kg−1, and tropisetron 2 mg. Of the remaining patients with low or moderate risk for PONV, a random sample of 71 females received balanced propofol-desflurane anaesthesia without prophylactic anti-emetics. All patients were interviewed 2 and 24 h after surgery for occurrence of nausea and vomiting. Patient satisfaction was measured using the willingness-to-pay method. The incidence of PONV (95%-confidence interval) in the control-group was 41% (29–51%), slightly lower than predicted by the risk scores (53–57%). The multimodal anti-emetic approach reduced the predicted risk (79–87%) in the high risk-group to 7% (3–14%). This was associated with a high willingness-to-pay median (25th/75th percentile) of £84 (£33–184) in the multimodal anti-emetic grouped compared to £14 (£4–30) in the control group. A multimodal anti-emetic approach can considerably reduce the incidence of PONV in high-risk patients and is associated with a high patient satisfaction as measured by the willingness-to-pay method.
    Type of Medium: Electronic Resource
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  • 3
    Electronic Resource
    Electronic Resource
    New York, NY [u.a.] : Wiley-Blackwell
    Molecular Reproduction and Development 27 (1990), S. 93-101 
    ISSN: 1040-452X
    Keywords: Somatomedin ; sis protooncogene ; Menstrual cycle ; Endometrium ; Myometrium ; Leiomyoma ; Life and Medical Sciences ; Cell & Developmental Biology
    Source: Wiley InterScience Backfile Collection 1832-2000
    Topics: Biology
    Notes: The human uterus repeatedly exhibits cyclic biochemical and cytological changes during the reproductive period of life. These changes are the result of a well-characterized endocrine network involving the hypothalamus, pituitary, and ovary. The exact nature of the mechanism(s) by which the sex steroids act on the uterus remains to be elucidated. Possible local mediators of hormonal action on the uterus include polypeptide growth factors. Using the method of RNA transfer blot hybridization, we have analyzed tissue samples from the cycling human endometrium and tissue samples of human myometrium and myometrial benign tumor (leiomyoma) for the presence of platelet-derived growth factor (PDGF) and insulin-like growth factor (IGF) RNA. All the uterine tissues examined possessed RNA for PDGF-B chain and IGF-I and -II. Two transcripts were observed for PDGF-B chain, four were observed for IGF-I, and eight were observed for IGF-II. Overall, the relative abundance of PDGF-B chain RNA was consistent in all of the uterine tissues examined. In contrast, IGF RNA relative abundance varied. IGF-I RNA was highest in late proliferative stage endometrium, and IGF-II RNA was highest in early proliferative stage endometrium. Both IGF-I and IGF-II RNAs were greater in amount in leiomyoma than in myometrium. The increased IGF-I RNA in late proliferative-stage human endometrium correlates with the known elevation of estradiol secretion by the ovary and the increased concentration of uterine estradiol receptors during this stage of the menstrual cycle. Furthermore, these data are consistent with reports of increased IGF-I RNA in the rat uterus in response to administration of estradiol. Elevated levels of IGF RNA in leiomyomas may be related to the genesis and/or progression of these myometrial tumors.
    Additional Material: 3 Ill.
    Type of Medium: Electronic Resource
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