Assessment of anastomotic reliability with pulse oximetry in graded intestinal ischemia: an experimental study in dogs

BACKGROUND/PURPOSE: Pulse oximetry has been proposed as an appropriate and feasible technique in the assessment of intestinal ischemia in recent years. In this study the authors aimed to assess the reliability of anastomoses in the dog small intestine in which there is graded irreversible ischemia as measured by pulse oxymeter. METHODS: In a control group of four dogs, without any devascularization, three small bowel anastomoses were formed in each dog. The study group consisted of 12 dogs. In each animal three intestinal segments with different levels of ischemia were created by ligating the marginal vessels proximally and distally in sequence beginning from the midpoint of the segmental vascular arcade. Preanastomotic pulse oximeter readings between 80% and 90% were assigned to mild ischemia, 70% and 80% to moderate, and 60% and 70% to severe ischemia group. Pulse oximetry measurements were obtained from probes applied to the antimesenteric serosal surfaces at the midpoint of small intestinal segments. A total of 48 intestinal segments (12 nonischemic in the control group and 36 with three different levels of ischemia in the study group) were transected in the midpoint and anastomosed in double layers. Postanastomotic SaO2 values were also noted. The anastomoses were evaluated 48 hours later macroscopically if there was any leakage, and biopsy specimens were obtained for histopathologic ischemic gradings. All results were studied statistically. RESULTS: Histopathologic grades between each group were statistically different (P < .01 for each comparison) except for control and mild ischemia groups (P > .05), worsening as the level of ischemia increased. Pre- and postanastomotic pulse oximetry measurements correlated very well with the histological gradings (r = -0.90, P < .001 and r = -0.93, P < 0.001 respectively). Number of anastomotic leakages were none in control, one in mild, nine in moderate, and 12 (all of the anastomoses) in severe ischemia groups. In the moderate ischemia group with an average preanastomotic pulse reading of 76.75%, each of the leaking anastomoses had a postanastomotic pulse measurement of lower than 70%. The finding that the difference between histopathologic grades of control and mild ischemia groups with average preanastomotic pulse measurements of 96% and 85%, respectively is not statistically significant enables us to suggest that a saturation of at least 85% is necessary for a reliable anastomosis. CONCLUSION: These results suggest clearly that anastomotic reliability can be predicted objectively with pulse oximetry.     

Medical treatment of heart failure at a tertiary hospital of S?o Paulo]

The clinical hemostatic effect of tranexamic acid mouthwash after oral surgery was evaluated in 47 patients receiving oral anticoagulant therapy. Surgery was performed after the anticoagulant medication was reduced in 15 patients (control group) and with no change in anticoagulant therapy in 32 patients (test group). The only statistical difference between the two treatment groups at baseline was the level of anticoagulation, which was significantly higher in the test group. There was no significant difference between the two treatment groups in the incidence of bleeding after oral surgery. The results indicated that a combination of local antifibrinolytic therapy and a local hemostatic agent is effective in preventing postoperative bleeding after oral surgery in patients treated with anticoagulants.     

Rotavirus and reovirus interaction with mouse peritoneal resident phagocytic cells

Rotaviruses and reoviruses are involved in human and animal diseases. It is known that both viruses penetrate the gastrointestinal tract but their interaction with phagocytic cells is unknown. To study this interaction, peritoneal resident phagocytic cells were used and rotavirus and reovirus replication in peritoneal phagocytic cells was observed. However, rotavirus replication in these cells led to the production of defective particles since MA-104 cells inoculated with rotavirus phagocytic cell lysate did not show any evidence of virus replication. On the basis of these results, we suggest that, although reovirus dissemination may be helped by these phagocytic cells, these cells may control rotavirus infection and probably contribute to the prevention of its dissemination.     

Measurement uncertainties arising from unpowered shipment of dcvoltage references

We have measured the hysteresis in output voltage arising from loss of power for three Fluke 732B dc voltage references. Continuously powering the internal temperature-controlled oven provides the best accuracy with such Zener-diode-based dc voltage references. Batteries are used to provide power continuity when shipping between laboratories. We have shown that for these particular instruments, an apparent hysteresis induced by humidity is likely to dominate any hysteresis arising from loss of battery power when transit between laboratories takes three days or more. Our conclusion is that as much, if not more, care needs to be taken when dealing with humidity than with loss of battery power when shipping between laboratories. When the highest accuracy of dc voltage comparison is required, it becomes necessary to apply voltage corrections using the measured values of humidity coefficients and the relative humidity occurring during transit     

Early withdrawal from mental health treatment: Implications for psychotherapy practice.

[Correction Notice: An erratum for this article was reported in Vol 46(2) of Psychotherapy: Theory, Research, Practice, Training (see record 2009-08897-009). The fourth author’s name was mistakenly left out of the author byline and table of contents. The correct author listing for this article is presented in the erratum.] Despite more than 50 years of research on client attrition from therapy, obstacles to the delivery and success of treatments remain poorly understood, and effective methods to engage and retain clients in therapy are lacking. This article offers a review of the literature on attrition, highlighting the methodological challenges in effectively addressing the complex nature of this problem. Current interventions for reducing attrition are reviewed, and recommendations for implementing these interventions into psychotherapy practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Synthetic Instruction Mix for Evaluating Microprocessor Performance

Need to rate the performance of that new microprocessor you're interested in? Here's a simple, easy way to do just that.     

Copper‐Catalyzed Highly Regioselective Oxidative C?H Bond Amidation of 2‐Arylpyridine Derivatives and 1‐Methylindoles

Copper(I) bromide‐catalyzed amidation of 2‐arylpyridine derivatives and 1‐methylindoles with a variety of amides was achieved by employing tert‐butyl peroxide (TBP) as oxidant. Aryl halides could be tolerated under the reaction conditions. Neither a special ligand nor a base was required for this amidation process.