In the Intraoperative Hypothermia for Aneurysm Surgery Trial, neither systemic hypothermia nor supplemental protective drug affected short- or long-term neurologic outcomes of patients undergoing temporary clipping.

Propofol is an intravenous anaesthetic which is chemically unrelated to other anaesthetics. Induction of anaesthesia with propofol is rapid, and maintenance can be achieved by either continuous infusion or intermittent bolus injections, with either nitrous oxide or opioids used to provide analgesia. Comparative studies have shown propofol to be at least as effective as thiopentone, methohexitone or etomidate for anaesthesia during general surgery. The incidence of excitatory effects is lower with propofol than with methohexitone, but apnoea on induction occurs more frequently with propofol than with other anaesthetics. Additionally, a small number of studies of induction and maintenance of anaesthesia have found propofol to be a suitable alternative to induction with thiopentone and maintenance with halothane, isoflurane or enflurane. Propofol is particularly suitable for outpatient surgery since it provides superior operating conditions to methohexitone (particularly less movement), and rapid recovery in the postoperative period associated with a low incidence of nausea and vomiting. When used in combination with fentanyl or alfentanil, propofol is suitable for the provision of total intravenous anaesthesia, and comparative studies found it to be superior to methohexitone or etomidate in this setting. Infusions of subanaesthetic doses of propofol have been used to sedate patients for surgery under regional anaesthesia, and also to provide sedation of patients in intensive care. In the latter situation it is particularly encouraging that propofol did not suppress adrenal responsiveness during short term studies. If this is confirmed during longer term administration this would offer an important advantage over etomidate. Thus, propofol is clearly an effective addition to the limited range of intravenous anaesthetics. While certain areas of its use need further study, as would be expected at this stage of its development, propofol should find a useful role in anaesthetic practice.

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A radioimmunoassay (RIA) for human corticosteroid binding globulin (CBG) has been developed using 125I-labelled CBG and a monospecific solid-phase CBG-antiserum (CBG-Ab-cellulose). In an RIA of serum CBG concentrations, pure CBG standards (1-100 ng protein) or samples (1:200) were incubated (16 h at 20 degrees C) with 125I-labelled CBG and CBG-Ab-cellulose. After addition of 2 ml 0.9% NaCl, the tubes were centrifuged, supernatants were aspirated and the 125I-labelled CBG bound to the CBG-Ab-cellulose pellet was counted. The specificity of the RIA was confirmed by parallel displacement curves for serial dilutions of male, female and pregnancy sera, as well as pure CBG standards. The mean +/- S.D. recovery (99 +/- 8%) of pure CBG (1.6-25.0 ng) added to a diluted serum sample verified the accuracy of the method, and a good correlation (r = 0.97; n = 43) existed between serum CBG cortisol binding capacity (nmol/l) measurements and CBG concentrations (mg protein/l) measured by RIA. Intra- and interassay precisions (C.V.) at low to high serum CBG concentrations were less than 5% and less than 9% respectively. The mean +/- S.D. serum CBG concentrations (mg protein/l) measured by the RIA were: 21.8 +/- 4.6 in boys (n = 12), 20.0 +/- 4.2 in girls (n = 9), 20.7 +/- 2.7 in men (n = 6), 20.5 +/- 2.9 in women (n = 6) and 47.1 +/- 10.5 in pregnant women (n = 5).(ABSTRACT TRUNCATED AT 250 WORDS)

No abstract

Developments in information technology offer new opportunities to design electronic patient record systems (EPR) which integrate a broad range of functions such as clinical decision support, order entry, or electronic alerts. It has been recently suggested that EPR could support new applications for disease surveillance and patient safety. We describe the integration of a voluntary incident reporting system into an EPR used in operating theatres, to allow the reporting of accidents and preventable complications. We assessed system's reliability and users' acceptance. During the 4-years observation period (2002-2006), 48,983 interventional procedures were performed. Clinicians documented 85.1% of procedures on the incident reporting form. Agreement between chart review and electronically reported incidents was 80.6%. The integration of an incident reporting system into an EPR is reliable and well supported by health care professionals.

The efficacy of renal-dose dopamine to improve renal function or reduce renal impairment was studied in 52 patients undergoing elective coronary artery bypass surgery. The patients were prospectively randomised in a double-blind fashion to receive dopamine at 200 μg/min (group D) or placebo (group P) from induction for 24 hours. Although dopamine improved haemodynamics, there was no effect on urine output at 4 hours (D = 917, P=1231 ml: P = 0.066); urine output at 24 hours (D=3659, P=3304 ml: P = 0.36); creatinine clearance at 0–4 hours (D = 104, P=127 ml/min: P = 0.27); creatinine clearance on admission to ICU-4 hours (D=94.8, P=83.4 ml/min: P = 0.48); creatinine clearance at 20–24 hours (D = 91.2, P=107 ml/min: P = 0.48); free-water clearance at 0–4 hours (D=29.6, P= -59.8 ml/hr: P = 0.069); free-water clearance at 20–24 hours (D=43.2, P= -48.9 ml/hr: P = 0.55). The incidence of transient renal impairment was similar in both groups (D=36%, P=50%: P = 0.65). Our study failed to demonstrate that routine prophylactic renal-dose dopamine is associated with improvement in renal function, or with prevention of transient renal impairment in patients undergoing coronary artery bypass surgery.

Serum concentrations of sex hormone binding globulin (SHBG), corticosteroid binding globulin (CBG), and albumin were found to be normal in women with breast cancer (Ca), with benign breast disease (BBD), or with a family history of breast cancer (FHCa). Comparisons between serum steroid binding capacities and immunoassayable SHBG and CBG concentrations did not reveal abnormal forms of either protein. The serum distribution of estradiol (E2) was also determined, and women with Ca were found to have a significantly (P less than .025) higher mean percentage of non-protein-bound E2 than matched controls, but the difference was very small. In general, women with Ca also had proportionately more (P less than .05) albumin-bound E2 and less (P less than .05) SHBG-bound E2 in their sera than the controls, but the serum distributions of E2 in the BBD and FHCa subjects were the same as in controls. The dissociation rates of 5 alpha-dihydrotestosterone and E2 from SHBG in serum appear to increase with time in frozen serum samples, and this factor may effect measurements of the distribution of these steroids in serum.