Absorption kinetics of paracetamol are not influenced by high anxiety levels in preoperative patients

OBJECTIVE

If the absorption kinetics of orally administered drugs in preoperative patients are influenced by high anxiety levels as maintained by Simpson and Stakes [1987], then this aspect would have to be taken into consideration in the preparation for surgery and would make dose adjustments necessary in such patients.

METHODS

We differentiated and quantified the anxiety level in 40 patients, 4 - 5 hours prior to an operation, using the State-Trait Anxiety Inventory (STAI). Subsequently, all patients were given 1000 mg of paracetamol and serum levels were analyzed by means of HPLC.

RESULTS

Over the first 3 hours after application there were no significant differences in the parameters C(max) and t(max) between patients with high levels of anxiety and patients with low levels of anxiety. However, AUC (area under curve) values were slightly higher in patients with high levels of anxiety.

CONCLUSIONS

No clinically relevant differences in absorption parameters were observed in patients with high and low levels of anxiety.

Implementation intentions and facilitation of prospective memory

Forming detailed implementation intentions for a future behavior can increase the probability that the behavior is actually completed. We investigated whether this intention effect could be used to improve prospective memory in older adults. As expected, participants who formed an implementation intention were more than twice as likely to self-initiate the intended behavior (writing down the day of the week on every sheet of paper received during the experiment) compared with participants who either were merely instructed to do so or actively rehearsed the instruction. Forming an implementation intention, however did not improve performance on a task that required a response to salient cues. We conclude that detailed implementation intentions facilitate prospective memory on tasks that lack salient cues and require self-initiation.

In vitro genesis of subaxial cervical unilateral facet dislocations through sequential soft tissue ablation

STUDY DESIGN

In vitro anatomic study investigating the degree of soft tissue disruption required to produce a subaxial cervical unilateral facet dislocation.

OBJECTIVES

To develop an understanding of the relative contributions to stability of the subaxial cervical soft tissues and to define an anatomic threshold of injury necessary to produce a unilateral cervical facet dislocation.

SUMMARY OF BACKGROUND DATA

The literature at this time is unclear regarding the precise pathomechanics of a cervical unilateral facet dislocation and the required threshold of soft tissue injury necessary for its genesis. Published clinical reports do not make any specific reference to these factors or are unclear in their objectivity.

METHODS

Two adjacent vertebra at a time in 10 fresh-frozen subaxial cervical spine specimens (C2-C3 to C6-C7) were transfixed in the coronal plane with 3.5-mm Schanz screws. A steady unilateral vertical distraction force resulting in lateral cervical flexion was applied to these screws as the surrounding cervical soft tissue structures were sequentially ablated. Four experimental models were developed, varying the order of soft tissue disruption.

RESULTS

The physiologic coupling of subaxial cervical unilateral distraction and rotation, because of the spatial orientation or inclination of the cervical facet joints, allowed the creation of a unilateral facet dislocation without an additional flexion moment. Disruption of the ipsilateral articular capsule, ligamentum flavum, and more than half of the anulus fibrosus was necessary for the genesis of a unilateral facet dislocation. Disruption of the supraspinous and interspinous ligaments was not necessary but appeared to facilitate or lessen the force required to dislocate a unilateral facet. Disruption of the anterior and posterior longitudinal ligaments and intertransverse ligaments was not necessary to create a unilateral facet dislocation.

CONCLUSION

This anatomic study further supports the theory that discontinuity of the anterior and posterior longitudinal ligaments is not necessary for a unilateral facet dislocation to occur. The ipsilateral facet capsule, anulus fibrosus, and ligamentum flavum appear to be the physical soft tissue restraints that need to be disrupted to produce a unilateral facet dislocation.

[Injuries of the thoracic vertebrae in head-first dive into water]

116 patients with cervical spine injuries due to water sport accidents treated in eight Austrian institutions from 1991 to 1998 were reviewed retrospectively. There were 93% male, 72% were 15 to 29 years of age. 93% had injuries from diving into swimming pools or into open water. At discharge 58 patients had Frankel A lesions, 39 had incomplete cord lesions Frankel B to D, and 19 patients had no neurological injury. This data suggest that in Austria approximately one person per one million inhabitants per year sustains a spinal cord injury in a diving accident in shallow water.

How pleasant was your childhood? Beliefs about memory shape inferences from experienced difficulty of recall

People's beliefs about how memory works can affect their inferences from experienced difficulty of recall. Participants were asked to recall either 4 childhood events (experienced as an easy task) or 12 childhood events (experienced as a difficult task). Subsequently, they were led to believe that either pleasant or unpleasant periods of one's life fade from memory. When the recall task was difficult (12 events), participants who believed that memories from unpleasant periods fade away rated their childhood as less happy than participants who believed that memories from pleasant periods fade away. The opposite pattern was observed when the recall task was easy (4 events). This interplay of recall experiences and memory beliefs suggests that the judgmental impact of subjective experiences is shaped by beliefs about their meaning. It also suggests that the recall difficulty in clinical memory work may lead a person to make negative inferences about his or her childhood, provided the person shares the popular belief that memory represses negative information.

A comparative profilometric in vitro study of the susceptibility of polished and natural human enamel and dentine surfaces to erosive demineralization

This study sought to compare the depths of erosive lesions in samples from different tooth sides as well as from enamel, dentine and root surfaces, and to examine the effect of preparation and polishing of specimens on erosive demineralization. From 30 impacted human third molars, two enamel samples from the mesial, distal, buccal and oral aspects, and similar samples from the radicular dentine, were prepared. One of each pair of samples was polished whereas the other was left untreated. Four samples were also prepared from the coronal dentine. For erosive demineralization, all samples were immersed in 0.05 M citric acid for 3 h and the erosion depth was calculated profilometrically. In general, natural surfaces showed significantly smaller erosion depths than polished surfaces (p< or =0.001) and enamel samples showed greater depths than coronal dentine (not significant) and root dentine (p< or =0.001). The erosion depths of the four tooth sides correlated significantly for polished enamel and coronal dentine samples but not for natural enamel specimens. There was no correlation between erosion depths for enamel and coronal dentine, and only a weak correlation between enamel and root dentine.

[Atlanto-axial rotation and distance in small children. A postmortem study]

The aetiology of atlanto-axial rotatory subluxation is obscure. Therefore, a post mortem investigation was designed in order to evaluate the C 1-2 rotation and translation mobility and to clear the borderline between mobility and instability and to clear the role of the atlanto-axial joints in atlanto-axial rotatory subluxation. C 1-2 specimen of 2 months, 9 months and 53 months old children were used. In the intact specimen and after sequential decision of the atlanto-axial joint capsule, the atlanto-axial membrane, the transverse ligament of the atlas, and eventually the alar ligaments, the atlas was rotated and anteriorly translated over the axis. The end point of the movements was recorded radiographically. Decision of the anatomic structures increased the rotation of up to 25 degrees. The joint capsules are lax and wide thus allowing rotation with almost complete subluxation. The subluxation of atlanto-axial joints probably stays within the normal range of motion and is not a factor of atlanto-axial rotatory subluxation. Interlocking of the facets could not be observed. In atlanto-axial rotatory subluxation the atlanto-dental interval becomes asymmetric. Its radiographic projection is variable and therefore ist does not present a valuable radiographic parameter.

[Fatal streptococcal infection after tibial intramedullary nailing. Case report]

A 29 years old patient with an unsuspicious medical history is reported, two developed a toxic shock syndrome after intramedullary nailing for a closed tibia fracture. The patient died within 24 hours. The infection was caused by Streptococcus Group A. The diagnosis of the toxic shock syndrome was not without difficulties and was delayed. Post mortem examination revealed an unknown acute leukemia of the myeloic type.

Effects of perceptual fluency on judgments of truth

Statements of the form "Osorno is in Chile" were presented in colors that made them easy or difficult to read against a white background and participants judged the truth of the statement. Moderately visible statements were judged as true at chance level, whereas highly visible statements were judged as true significantly above chance level. We conclude that perceptual fluency affects judgments of truth.

Looking back at anger: reference periods change the interpretation of emotion frequency questions

When asked to report on behaviors and experiences, participants draw on the specified reference period to infer the question meaning: Short reference periods suggest that the question pertains to frequent experiences; long reference periods suggest that it pertains to rare ones. Because frequent experiences are typically less intense than rare ones, this meaning shift results in reports of different experiences. Three experiments support this analysis in the domain of emotion reports. Participants asked how frequently they get angry (a) assumed that the question refers to less intense and more frequent episodes when presented with a short (1-week) rather than a long (1-year) reference period, (b) reported more extreme episodes in the latter case, and (c) provided differential frequency reports. These differences reflect conversational inference processes and cannot be fully accounted for by memory search biases.

[The "posterior cervical line". A radiodiagnostic parameter of the cervical spine in children]

The Posterior Cervical Line helps to differentiate pseudosubluxation from the true dislocation C 2/3 in children. But the line can also be used to recognize other pathologic conditions of the upper cervical spine in children, like atlanto-axial sagittal instability or rotatory dislocation.

Long-term results of unstable pelvic ring fractures in children

Seventeen patients less than 12 years old sustained unstable pelvic ring fractures and were treated non-operatively. They were followed for 2 to 25 years. The subjective long-term results depended on the presence or absence of low back pain. This correlated strongly with pelvic asymmetry. Five patients complained about chronic back pain, two were functionally impaired by severe pelvic asymmetry. Healing of an unstable pelvic fracture in malposition with asymmetry causes poor results and must be prevented.

[MRI, CT and CT arterial portography in the diagnosis of malignant liver tumors in liver cirrhosis]

PURPOSE

To determine the value of magnetic resonance imaging (MRI), computed tomography (CT) and CT arterial portography (CTAP) in detecting malignant liver lesions in cirrhosis patients.

MATERIALS AND METHODS

The radiological examinations (CT, MRI and CTAP) of 47 patients suffering from cirrhosis having undergone an orthotopic liver transplantation (OLTX) were analysed retrospectively. The number of detected liver lesions was compared with the results of the histopathological findings after OLTX.

RESULTS

13/21, 11/18 and 7/12 of the malignant lesions were detected by MRI, CT and CTAP respectively. In MRI one false positive case was shown, two in CT and three in CTAP. Almost the same lesions were identified by all three procedures. The examination of the liver with MRI and CT and CTAP did not bring additional information. Most of the lesions that were missed were less than 2 cm in diameter.

CONCLUSIONS

The rate of detection of HCC in patients with cirrhosis was about 60%. MRI and CT yielded similar results.

[Femoral neck fractures in childhood]

In a retrospective multicenter study we followed-up 30 fractures of the neck of the femur in children aged 11 years (1.5-15 years) for 4.8 years (0.5-20.0 years). It is the aim of this study to analyse factors possibly related to outcome, like age at injury, type of fracture, interval between injury and treatment, method of stabilization and postoperative interval until full weight bearing. At follow-up subjective parameters (pain, weather sensitiveness), clinical parameters (range of motion, claudication, leg length discrepancies) and radiological parameters (hip series) were investigated and medical charts and roentgenograms were reviewed using a standardized protocol. 29 of 30 children (96.7%) have sustained displaced fractures. Non-operative treatment has been applied in 4 children. 26 femoral neck fractures (type I: 1, type II: 8, type III: 17) were stabilized by internal fixation using screws and/or pins. Following non-operative treatment one child suffered a coxa vara and another child suffered a avascular femoral head necrosis in combination with coxa vara and leg length shortening of 4 cm. Following operative treatment 9 of 26 children (34.6%) suffered a avascular femoral head necrosis and 3 children (11.5%) suffered a coxa vara. In 6 of 26 children (23%) we observed leg length discrepancies > 2 cm. We were not able to demonstrate any significant follow-up result differencies between the groups of children who have sustained type II or type III fractures, or between the groups of children aged < 10 years when compared to children aged > 10 years, or between the group of children who were operated on within 6 hours after the accident when compared to the group of children operated > 6 hours after the accident. We observed no significant follow-up result differences between the groups of children who had different intervals between operation and full weight bearing. Operative fracture management remains the treatment of choice in the majority of displaced femoral neck fractures in children. However, in our limited study we were not able to demonstrate any significant follow-up result differences between the group of children treated by immediate open reduction and internal fixation (interval injury - operation < 6 hours) when compared to children who had been operated > 6 hours after the injury.

The fate of missed atlanto-axial rotatory subluxation in children

Torticollis in children can be due to atlanto-axial rotatory subluxation. If diagnosis, based on plain lateral radiography and on computed tomography, and specific treatment are delayed, reduction becomes difficult to accomplish. Atlanto-axial fusion might be indicated to cure the instability. Thus, a diagnostic delay may prevent restoration of cervical spine function. In acquired torticollis in children, radiographic evaluation is indicated if the symptoms are not relieved within 1 week, but immediate radiography is indicated in traumatic torticollis.