Guidelines for sedation and/or analgesia by non-anaesthesiology doctors

BACKGROUND AND OBJECTIVE

Postoperative nausea and vomiting after craniotomy may increase intracranial pressure and morbidity in children. This prospective, randomized, placebo-controlled and double-blinded study was designed to evaluate the antiemetic efficacy of prophylactic ondansetron after intracranial tumour resections in children.

METHODS

Ninety children were divided into three groups and received saline (Group 1), ondansetron 150 microg kg-1 intravenously at dural closure (Group 2) or two doses of ondansetron 150 microg kg-1 intravenously, the second dose repeated after 6 h (Group 3). Episodes of nausea, emesis and side-effects were noted for 24 h postoperatively.

RESULTS

Overall 24 h incidence of postoperative nausea and vomiting was not significantly different among the three groups (9 (37.5%) in Group 1 vs. 7 (27%) in Group 2 and 8 (32%) in Group 3, P = 0.73). No difference in rescue antiemetic treatment or postoperative nausea and vomiting at specific time intervals (0-6 and 6-24 h postoperative period) was seen among the three groups. No significant side-effects were noted in any of the three groups.

CONCLUSIONS

Ondansetron, in this study of 90 children, was not very effective in preventing nausea and vomiting after neurosurgical operations.

Observation of a resonancelike structure in the pi +- psi' mass distribution in exclusive B-->Kpi +- psi' decays

A distinct peak is observed in the pi +/- psi' invariant mass distribution near 4.43 GeV in B-->K pi +/- psi' decays. A fit using a Breit-Wigner resonance shape yields a peak mass and width of M=4433+/-4(stat)+/-2(syst) MeV and Gamma=45-13+18(stat)-13+30(syst) MeV. The product branching fraction is determined to be B(B 0-->K -/+Z+/-(4430)) x B(Z+/-(4430)-->pi+/-psi')=(4.1+/-1.0(stat)+/-1.4(syst)) x 10(-5), where Z+/-(4430) is used to denote the observed structure. The statistical significance of the observed peak is 6.5 sigma. These results are obtained from a 605 fb(-1) data sample that contains 657 x 10(6) BB pairs collected near the Upsilon(4S) resonance with the Belle detector at the KEKB asymmetric energy e+ e- collider.

Observation of a near-threshold enhancement in the e+e- -->Lambda+_(c)Lambda-_(c) cross section using initial-state radiation

We report a measurement of the exclusive e+ e- -->Lambda+_(c)Lambda-_(c) cross section as a function of center-of-mass energy near the Lambda+_(c)Lambda-_(c) threshold. A clear peak with a significance of 8.2sigma is observed in the Lambda+_(c)Lambda-_(c) invariant mass distribution just above threshold. With an assumption of a resonance origin for the observed peak, a mass and width of M=[4634 (+8)_(-7)(stat)(+5)_(-8)(syst)] MeV/c(2) and Gamma_(tot)=[92 (+40)_(-24)(stat)(+10)_(-21)(syst)] MeV are determined. The analysis is based on a study of events with initial-state-radiation photons in a data sample collected with the Belle detector at the Upsilon(4S) resonance and nearby continuum with an integrated luminosity of 695 fb(-1) at the KEKB asymmetric-energy e+ e- collider.

Measurement of the e+e- -->pi+pi- J/psi cross section via initial-state radiation at Belle

The cross section for e(+)e(-)-->pi(+)pi(-)J/psi between 3.8 and 5.5 GeV/c(2) is measured using a 548 fb(-1) data sample collected on or near the Upsilon(4S) resonance with the Belle detector at KEKB. A peak near 4.25 GeV/c(2), corresponding to the so called Y(4260), is observed. In addition, there is another cluster of events at around 4.05 GeV/c(2). A fit using two interfering Breit-Wigner shapes describes the data better than one that uses only the Y(4260), especially for the lower-mass side of the 4.25 GeV enhancement.

Dipylidium caninum infection in a child: a rare case report

Dipylidiasis is a zoonotic parasitic infestation caused by the dog tapeworm Dipylidium caninum. Human dipylidiasis has been rarely reported in English literature. Young children are mostly at risk of acquiring the infection due to their close association with dogs and cats. We report a rare case of Dipylidium caninum infection in a 4 year old male child. The diagnosis was based on microscopic examination of stool. Confirmation of the proglottid segments was done by histopathological examination. To the best of our knowledge this is the first human case of Dipylidium caninum reported from this part of the country.

Observation of two resonant structures in e+ e- -->pi+ pi- psi(2S) via initial-state radiation at Belle

The cross section for e+ e- --> pi+ pi- psi(2S) between threshold and sqrt[s]=5.5 GeV is measured using 673 fb(-1) of data on and off the Upsilon(4S) resonance collected with the Belle detector at KEKB. Two resonant structures are observed in the pi+ pi- psi(2S) invariant-mass distribution, one at 4361 +/- 9 +/- 9 MeV/c2 with a width of 74 +/- 15 +/- 10 MeV/c2, and another at 4664 +/- 11 +/- 5 MeV/c2 with a width of 48 +/- 15 +/- 3 MeV/c2, if the mass spectrum is parametrized with the coherent sum of two Breit-Wigner functions. These values do not match those of any of the known charmonium states.

Inclusive measurement of the photon energy spectrum in b --> sgamma decays

We report a fully inclusive measurement of the flavor changing neutral current decay b --> sgamma in the energy range 1.8 GeV < or = E*gamma < or = 2.8 GeV, covering 95% of the total spectrum. Using 140 fb(-1), we obtain B(b --> sgamma) = (3.55+/-0.32(+0.30+0.11)(-0.31-0.07)) x 10(-4), where the errors are statistical, systematic, and from theory corrections. We also measure the first and second moments of the photon energy spectrum above 1.8 GeV and obtain (Egamma) = 2.292+/-0.026+/-0.034 GeV and (E2gamma) - (Egamma)2 = 0.0305+/-0.0074+/-0.0063 GeV2, where the errors are statistical and systematic.

Evidence for direct CP violation in B0-->K+pi- decays

We report evidence for direct CP violation in the decay B0-->K+pi(-) with 253 fb(-1) of data collected with the Belle detector at the KEKB e(+)e(-) collider. Using 275x10(6) BB pairs we observe a B-->K+/-pi(-/+) signal with 2140+/-53 events. The measured CP violating asymmetry is A(CP)(K+pi(-))=-0.101+/-0.025(stat)+/-0.005(syst), corresponding to a significance of 3.9sigma including systematics. We also search for CP violation in the decays B+-->K+pi(0) and B+-->pi(+)pi(0). The measured CP violating asymmetries are A(CP)(K+pi(0))=0.04+/-0.05(stat)+/-0.02(syst) and A(CP)(pi(+)pi(0))=-0.02+/-0.10(stat)+/-0.01(syst), corresponding to the intervals -0.05<A(CP)(K+pi(0))<0.13 and -0.18<A(CP)(pi(+)pi(0))<0.14 at 90% confidence level.

Rupture of aorta and inferior vena cava during lumbar disc surgery

Major vascular injury during lumbar disc surgery has been recognized as an unusual but well described complication. A potentially fatal outcome can be avoided by a high index of suspicion and an early diagnosis. We present a rare case of aortic and inferior vena caval injury in a 50-year-old female patient undergoing intervertebral disc surgery at lumbar one and two levels. A quick diagnosis and prompt management resulted in a favourable outcome for the patient.

Observation of B(0)-->D(*-)tau(+)nu(tau) decay at Belle

We report an observation of the decay B{0}-->D{*-}tau{+}nu{tau} in a data sample containing 535x10{6} BB pairs collected with the Belle detector at the KEKB asymmetric-energy e{+}e{-} collider. We find a signal with a significance of 5.2sigma and measure the branching fraction B(B{0}-->D{*-}tau{+}nu{tau})=(2.02{-0.37}{+0.40}(stat)+/-0.37(syst))%. This is the first observation of an exclusive B decay with a b-->ctaunu{tau} transition.

Evidence for D0-D0 mixing

We observe evidence for D(0)-D(0) mixing by measuring the difference in the apparent lifetime when a D(0) meson decays to the CP eigenstates K(+)K(-) and pi(+)pi(-) and when it decays to the final state K(-)pi(+). We find the relative difference of the lifetimes y(CP) to be [1.31+/-0.32(stat)+/-0.25(syst)]%, 3.2 standard deviations from zero. We also search for a CP asymmetry between D(0) and D(0) decays; no evidence for CP violation is found. These results are based on 540 fb(-1) of data recorded by the Belle detector at the KEKB e(+)e(-) collider.

Observation of a near-threshold omegaJ/psi mass enhancement in exclusive B-->KomegaJ/psi decays

We report the observation of a near-threshold enhancement in the omegaJ/psi invariant mass distribution for exclusive B-->KomegaJ/psi decays. The results are obtained from a 253 fb(-1) data sample that contains 275 x 10(6) BB pairs that were collected near the Upsilon(4S) resonance with the Belle detector at the KEKB asymmetric energy e(+)e(-) collider. The statistical significance of the omegaJ/psi mass enhancement is estimated to be greater than 8sigma.

Measurement of azimuthal asymmetries in inclusive production of hadron pairs in e(+)e(-) annihilation at Belle

The Collins effect connects transverse quark spin with a measurable azimuthal dependence in the yield of hadronic fragments around the quark's momentum vector. Using two different reconstruction methods, we find evidence of statistically significant azimuthal asymmetries for charged pion pairs in e(+)e(-) annihilation at a center-of-mass energy of 10.52 GeV, which can be attributed to a transverse polarization of the primordial quarks. The measurement was performed using a sample of 79 x 10(6) hadronic events collected with the Belle detector.

Observation of new states decaying into Lambda(c)(+)Kappa(-)pi(+) and Lambda(c)(+)Kappa(0)/(s)pi(-)

We report the first observation of two charmed strange baryons that decay into Lambda(c)(+)Kappa(-)pi(+). The broader of the two states is measured to have a mass of 2978.5+/-2.1+/-2.0 MeV/c2 and a width of 43.5+/-7.5+/-7.0 MeV/c2. The mass and width of the narrow state are measured to be 3076.7+/-0.9+/-0.5 MeV/c;{2} and 6.2+/-1.2+/-0.8 MeV/c2, respectively. We also perform a search for the isospin partner states that decay into Lambda(c)(+)Kappa(0)/(s)pi(-) and observe a significant signal at the mass of 3082.8+/-1.8+/-1.5 MeV/c2. The data used for this analysis were accumulated at or near the Upsilon(4S) resonance, using the Belle detector at the e+ e- asymmetric-energy collider KEKB. The integrated luminosity of the data sample used is 461.5 fb(-1).

Observation of a chi(c2)' candidate in gamma gamma --> DD production at belle

We report on a search for new resonant states in the process gamma gamma --> DD. A candidate C-even charmonium state is observed in the vicinity of 3.93 GeV/c2. The production rate and the angular distribution in the gamma gamma center-of-mass frame suggest that this state is the previously unobserved chi(c2)', the 2(3)P2 charmonium state.

Fungemia due to Trichosporon mucoides in a diabetes mellitus patient: a rare case report

Trichosporon species are widely distributed in nature and can occasionally belong to the human microbiota. For many years, Trichosporon beigelii, the only species of this genus, was found as the aetiological agent of superficial skin infection called white piedra. However, many cases of invasive trichosporonosis caused by different newly delineated species of Trichosporon have been published in increasing numbers in recent past years, especially in immunocompromised persons. We report a rare case of fungemia due to Trichosporon mucoides in a diabetes mellitus patient, which will add to the emerging list of trichosporonosis infections.

Observation of a charmoniumlike state produced in association with a J/psi in e+e- annihilation at sqrt[s] approximately equal to 10.6 GeV

We report the first observation of a charmoniumlike state recoiling from the J/psi in the inclusive process e+e- -->J/psi+anything at a mass of (3.943+/-0.006+/-0.006) GeV/c{2}. We also observe the decay of this state into D*D[over ] and determine its intrinsic width to be less than 52 MeV/c{2} at the 90% C.L. These results are obtained from a 357 fb{-1} data sample collected with the Belle detector near the Upsilon(4S) resonance, at the KEKB asymmetric-energy e+e- collider.

Evidence of the purely leptonic decay B- --> tau- nu(tau)

We present the first evidence of the decay B- --> tau- nu(tau), using 414 fb(-1) of data collected at the Upsilon(4S) resonance with the Belle detector at the KEKB asymmetric-energy e+ e- collider. Events are tagged by fully reconstructing one of the B mesons in hadronic modes. We detect the signal with a significance of 3.5 standard deviations including systematics and measure the branching fraction to be B(B- --> tau- nu(tau)) = (1.79(-0.49) +0.56(stat)(-0.51) +0.46(syst)) x 10(-4). This implies that fB = 0.229(-0.031) +0.036(stat)(-0.037) +0.034(syst) GeV and is the first direct measurement of this quantity.

Measurement of branching fractions and polarization in B-->phiK(*) decays

We present the first measurement of decay amplitudes in B-->phiK* and measurements of branching fractions in B-->phiK(*) decays based on 78.1 fb(-1) of data recorded at the Upsilon(4S) resonance with the Belle detector at the KEKB e+e- storage ring. The decay amplitudes for the different phiK*0 helicity states are measured from the angular distributions of final state particles in the transversity basis. The longitudinal and transverse complex amplitudes are |A0|2=0.43+/-0.09+/-0.04, |A(perpendicular)|2=0.41+/-0.10+/-0.04, arg((A(parallel))=-2.57+/-0.39+/-0.09, and arg((A(perpendicular))=0.48+/-0.32+/-0.06. The direct CP-violating asymmetries are found to be consistent with zero.

Observation of anomalous upsilon(1S)pi+pi(-) and upsilon(2S)pi+pi(-) production near the upsilon(5S) resonance

We report the first observation of e;{+}e;{-}-->Upsilon(1S)pi;{+}pi;{-}, Upsilon(2S)pi;{+}pi;{-}, and first evidence for e;{+}e;{-}-->Upsilon(3S)pi;{+}pi;{-}, Upsilon(1S)K+K-, near the peak of the Upsilon(5S) resonance at sqrt[s] approximately 10.87 GeV. The results are based on a data sample of 21.7 fb;{-1} collected with the Belle detector at the KEKB e;{+}e;{-} collider. Attributing the signals to the Upsilon(5S) resonance, the partial widths Gamma(Upsilon(5S)-->Upsilon(1S)pi;{+}pi;{-})=0.59+/-0.04(stat)+/-0.09(syst) MeV and Gamma(Upsilon(5S)-->Upsilon(2S)pi;{+}pi;{-})=0.85+/-0.07(stat)+/-0.16(syst) MeV are obtained from the observed cross sections. These values exceed by more than 2 orders of magnitude the previously measured partial widths for dipion transitions between lower Upsilon resonances.

Intraocular Pressure Changes Associated with Intubation with the Intubating Laryngeal Mask Airway Compared with Conventional Laryngoscopy

This open, prospective, randomised study was designed to evaluate the changes in intraocular pressure and haemodynamics after tracheal intubation using either the intubating laryngeal mask airway (ILMA) or direct laryngoscopy. Sixty adult patients, ASA physical status 1 or 2 with normal intraocular pressure were randomly allocated to one of the two techniques. Anaesthesia was induced with propofol followed by rocuronium. Tracheal intubation was performed using either the ILMA or Macintosh laryngoscope. Intraocular pressure, heart rate and blood pressure were measured immediately before and after tracheal intubation and then minutely for five minutes. In the laryngoscopy group there was a significant increase in intraocular pressure (from 7.2 ± 1.4 to 16.8 ± 5.3 mmHg, P <0.01), which did not return to pre-intubation levels within five minutes, and also in mean arterial pressure after tracheal intubation, which returned to baseline levels after five minutes. In the ILMA group there were no significant changes in intraocular pressure (from 7.6±1.8 to 10.4±2.8 mmHg, P >0.05) or mean arterial pressure after tracheal intubation. Time to successful intubation was longer with the ILMA, 56.8 ± 7.8 seconds, compared with the laryngoscopy group, 33±3.6 seconds (P <0.01). Mucosal trauma was more frequent with the ILMA (eight of 30) compared with the laryngoscopy group (three of 30) (P <0.01). The postoperative complications were comparable. In terms of minimising increases in intraocular pressure and blood pressure, we conclude that the ILMA has an advantage over direct laryngoscopy for tracheal intubation.