Propofol 1% versus propofol 2% in children undergoing minor ENT surgery

Background. The induction characteristics of propofol 1% and 2% were compared in children undergoing ENT surgery, in a prospective, randomized, double‐blind study. Methods. One hundred and eight children received propofol 1% (n=55) or 2% (n=53) for induction and maintenance of anaesthesia. For induction, propofol 4mgkg-1 was injected at a constant rate (1200mlh-1), supplemented with alfentanil. Intubating conditions without the use of a neuromuscular blocking agent were scored. Results. Pain on injection occurred in 9% and 21% of patients after propofol 1% and 2%, respectively (P=0.09). Loss of consciousness was more rapid with propofol 2% compared with propofol 1% (47s vs 54s; P=0.02). Spontaneous movements during induction occurred in 22% and 34% (P=0.18), and intubating conditions were satisfactory in 87% and 96% (P=0.19) of children receiving propofol 1% or 2%, respectively. There were no differences between the two groups in respect of haemodynamic changes or adverse events. Conclusions. For the end‐points tested, propofol 1% and propofol 2% are similar for induction of anaesthesia in children undergoing minor ENT surgery. Br J Anaesth 2003: 90: 375-

Walking performances and muscle oxygen desaturation are increased after supervised exercise training in Takayasu arteritis: a case report and a review of the literature.

Takayasu arteritis (TAK) is a rare chronic inflammatory vasculitis predominantly affecting the aorta and its main branches. Takayasu arteritis has been shown to increase cardiovascular risk. Supervised exercise training (SET) is a well-recognized and effective therapeutic tool improving walking performances in patients with chronic atherosclerotic disease; however, the effects of SET, and the underlying mechanisms, remain poorly documented in TAK patients. We reviewed the literature and investigated the effects of a 12-week SET programme on walking performances, physical function, and calf muscle oxygen saturation (StO <sub>2</sub> ; assessed by near-infrared spectroscopy) during exercise in a 28-year-old man with TAK and symptoms of arterial lower limb claudication. The literature review evidences only two recent publications suggesting that exercise training is effective and well-tolerated in patients with arteritis. The treadmill pain-free (+22%) and maximal (+273%) walking distance, 6-min walking distance (+66%), and physical function of lower extremities (+20%) following SET were significantly improved in our patient. Moreover, we observed a greater muscle oxygen desaturation (increased oxygen extraction) during exercise. Following SET, the increased oxygen extraction may be related to improved microvascular milieu leading to a better match between muscle oxygen supply and demand during exercise. These new results may contribute to mechanistic insights in peripheral adaptations following exercise training in TAK patients and may help to explain, at least partly, the increased walking performances. Although more studies are needed to better explore the impact of exercise training, these results suggest that exercise should be recommended in TAK patients

Phenotypic description of cardiac findings in a population of Dogue de Bordeaux with an emphasis on atrial fibrillation

The aim of this study was to describe the clinical phenotype of Dogue de Bordeaux (DdB) referred for cardiac investigation, with particular reference to the prevalence of atrial fibrillation and associated features. Review of canine medical records of two United Kingdom veterinary referral hospitals identified 64 DdB with available echocardiographic and electrocardiographic (ECG)/Holter data. Atrial fibrillation was documented in 25 (39%) dogs and supraventricular tachycardia was recorded in five (7.8%) dogs. In a subset of 34 dogs, excluding congenital heart disease (n = 17), presence of a cardiac mass (n = 7) and non-cardiac neoplasia (n = 6), 19 (56%) dogs had atrial fibrillation, with a median heart rate of 200 beats per min (bpm) on presentation. Atrial fibrillation was inconsistently associated with cardiac chamber remodelling, but was frequently associated with systolic dysfunction (13/19, 68.4%) and right sided atrial or ventricular dilatation (14/19, 73.7%) in dogs with atrial fibrillation in this subset. No dogs in this subset had right sided atrial or ventricular dilatation in the absence of supraventricular arrhythmia or systolic dysfunction. The absence of structural heart disease in some dogs with supraventricular arrhythmias suggests that an underlying primary arrhythmic process might be responsible for initiating remodelling, although a primary cardiomyopathy cannot be ruled out

Transient Myocardial Thickening in Cats Associated with Heart Failure.

BACKGROUND: Cats with hypertrophic cardiomyopathy (HCM) and congestive heart failure (CHF) can have resolution of both left ventricular hypertrophy and CHF. OBJECTIVES: To describe the clinical characteristics of cats with transient myocardial thickening (TMT) and CHF compared with a control population of cats without resolution of HCM. ANIMALS: A total of 21 cats with TMT, 21 cats with HCM. METHODS: Retrospective study. Clinical records at 4 veterinary centers were searched for TMT cases and a control group of cats with HCM and CHF. TMT was defined as initial maximal left ventricular wall thickness (LVWT) ≥6 mm with left-sided CHF, with subsequent resolution of CHF, reduction in left atrium/aorta (LA/Ao), and LVWT<5.5 mm. HCM was defined as persistent LVWT ≥6 mm. RESULTS: Cats with TMT were younger (2 [0.4-11.4] years) than cats with HCM (8 [1.6-14] years) (P < 0.0001), and antecedent events were more common (15/21 versus 6/21, respectively) (P = 0.01). In cats with TMT, LVWT normalized from 6.8 [6.0-9.7] mm to 4.8 [2.8-5.3] mm and LA/Ao decreased from 1.8 [1.6-2.3] to 1.45 [1.2-1.7] after a mean interval of 3.3 (95% CI: 1.8-4.7) months. CHF recurred in 1 of 21 TMT and 15 of 21 cats with HCM. Cardiac treatment was discontinued in 20 of 21 cats with TMT and 0 of 21 HCM cats. All cats with TMT survived, whereas 8 of 19 cats with HCM died during the study period. CONCLUSIONS AND CLINICAL IMPORTANCE: TMT occurs in younger cats, and antecedent events are common. The prognosis is better in cats with CHF associated with TMT than HCM

Neutrophilic airways inflammation in lung cancer: the role of exhaled LTB-4 and IL-8

Background: Recent advances in lung cancer biology presuppose its inflammatory origin. In this regard, LTB-4 and IL-8 are recognized to play a crucial role in neutrophil recruitment into airways during lung cancer.Notwithstanding the intriguing hypothesis, the exact role of neutrophilic inflammation in tumour biology remains complex and not completely known.The aim of this study was to give our contribution in this field by investigating LTB-4 and IL-8 in the breath condensate of NSCLC patients and verifying their role in cancer development and progression.Method: We enrolled 50 NSCLC patients and 35 controls. LTB-4 and IL-8 concentrations were measured in the breath condensate and the blood of all the subjects under study using EIA kits. Thirty NSCLC patients and ten controls underwent induced sputum collection and analysis.Results: LTB-4 and IL-8 resulted higher in breath condensate and the blood of NSCLC patients compared to controls. Significantly higher concentrations were found as the cancer stages progressed. A positive correlation was observed between exhaled IL-8 and LTB-4 and the percentage of neutrophils in the induced sputum.Conclusion: The high concentrations of exhaled LTB-4 and IL-8 showed the presence of a neutrophilic inflammation in the airways of NSCLC patients and gave a further support to the inflammatory signalling in lung cancer. These exhaled proteins could represent a suitable non-invasive marker in the diagnosis and monitoring of lung cancer. © 2011 Carpagnano et al; licensee BioMed Central Ltd