Relative dispersion of intravascular transit times during isolated human limb perfusions for recurrent melanoma

Aims We have characterized the relative dispersion of vascular and extravascular markers in the limbs of three patients undergoing isolated limb perfusions with the cytotoxic melphalan for recurrent malignant melanoma both before and after melphalan dosing. Methods A bolus of injectate containing [Cr-51] labelled red blood cells, [C-14]-sucrose and [H-3]-water was injected into an iliac or femoral artery and outflow samples collected at 1 s intervals by a fraction collector. The radioactivity due to each isotype was analysed by either gamma [Cr-51] or beta [C-14 and H-3] counting. The moments of the outflow fraction-time profiles were estimated by a nonparametric (numerical integration) method and a parametric model (sum of two inverse Gaussian functions). Results The availability, mean transit time and normalised variance (CV2) obtained for labelled red blood cells, sucrose and water were similar before and after melphalan dosing and with the two methods of calculation but varied between the patients. Conclusions The vascular space is not well-stirred but characterized by a CV2 similar that reported previously for in situ rat hind limb and rat liver perfusions. A flow-limited blood-tissue exchange was observed for the permeating indicators. Administration of melphalan did not influence the distribution characteristics of the indicators.

Use of a thermodilution catheter to measure core body temperature, central venous pressure and cardiac output during anaesthesia and surgery in the dog

The use of thermodilution and other methods of monitoring in dogs during surgery and critical care was evaluated. Six Greyhounds were anaesthetised and then instrumented by placing a thermodilution catheter into the pulmonary artery via the jugular vein. A catheter in the dorsal pedal artery also permitted direct measurement of arterial pressures. Core body temperature (degreesC) and central venous pressure (mmHg) were measured, while cardiac output (mL/min/kg) and mean arterial pressure (mmHg) were calculated. A mid-line surgical incision was performed and the physiological parameters were monitored for a total of two hours. All physiological parameters generally declined, although significant increases (P<0.05) were noted for cardiac output following surgical incision. Central venous pressure was maintained at approximately 0mmHg by controlling an infusion of sterile saline. Core body temperature decreased from 37.1+/-0.6degreesC (once instrumented) to 36.6+/-0.60degreesC (at the end of the study), despite warming using heating pads. Physiological parameters indicative of patient viability will generally decline during surgery without intervention. This study describes an approach that can be undertaken in veterinary hospitals to accurately monitor vital signs in surgical and critical care patients.

O2 consumption by the fick method. Methodologic factors.

This study aimed to compare O2 consumption (VO2) determination by the gas-exchange (VO2GE) and Fick (VO2F) methods in cardiac surgical patients. A total of 10 mechanically ventilated postoperative patients were studied prospectively. Thermodilution was performed using three randomly applied techniques: room temperature saline injected at end expiration, room temperature saline randomly injected in the respiratory cycle, and iced saline injected at end expiration. The influence of the number of thermodilution determinations was assessed by comparing results from 2 and 10 injections. The variability of VO2F was greater than that of VO2GE. There was no bias between VO2GE and VO2F values using injectate at room temperature. Accuracy and precision were not improved by increasing the number of cardiac output determinations from 2 to 10. A significant bias was observed using ice-cold injectate, VO2F being 18.0 +/- 15.4 ml/min/m2 lower than VO2GE (p = 0.001). Published results when comparing VO2F and VO2GE are discrepant. However, a significant bias was found in all studies using cold injectate, with lower VO2F values. We conclude that iced injectate should not be used to assess VO2 in critically ill patients.

Spectrophotometric determination of manganese in steels by on-line electrochemical oxidation

The aim of this work is to propose a flow spectrophotometric procedure for manganese determination in steel based on electrochemical oxidation of Mn(II) to Mn(VII) at a Pt electrode surface by means of the catalytic effect of Ag(I). The on-line oxidation step was obtained by injecting sample and electrolyte solution directly into an electrolytic cell. After electrolysis, the injectate was homogenized by bubbling air. The permanganate ions produced were passed through the spectrophotometer where absorbance was monitored at 545 nm. Effects of direct current, silver concentration, timing, flow rates, concentration and composition of support electrolyte were investigated. Direct current and silver content manifested themselves as the most relevant parameters. For determination of manganese in the 5.00 - 150 mg L -1 range (r=0,9998) and 60 s electrolysis time, the sample throughput was 20 h -1. Accuracy was assessed by analyzing ten steel standard reference materials. Results are precise (R.S.D. <3%) and in agreement with certified values of reference materials and with standard methods at 95% confidence level.

Concordância entre o débito cardíaco estimado através das técnicas de termodiluição transpulmonar e de análise de contorno de pulso e a técnica de termodiluição de artéria pulmonar em cães anestesiados com isoflurano

Pós-graduação em Anestesiologia - FMB

Placement of coiled catheters into the paravertebral space

There are conflicting results with regard to the use of catheter-based techniques for continuous paravertebral block. Local anaesthetic spread within the paravertebral space is limited and the clinical effect is often variable. Discrepancies between needle tip position and final catheter position can also be problematic. The aim of this proof-of-concept study was to assess the reliability of placing a newly developed coiled catheter in human cadavers. Sixty Tuohy needles and coiled catheters were placed under ultrasound guidance, three on each side of the thoracic vertebral column in 10 human cadavers. Computed tomography was used to assess needle tip and catheter tip locations. No catheter was misplaced into the epidural, pleural or prevertebral spaces. The mean (SD) distance between catheter tips and needle tips was 8.2 (4.9) mm. The median (IQR [range]) caudo-cephalad spread of contrast dye injectate through a subset of 20 catheters was 4 (4-5[3-8]) thoracic segments. All catheters were removed without incident. Precise paravertebral catheter placement can be achieved using ultrasound-guided placement of a coiled catheter.

Geochemical determination of the fate and transport of injected fresh wastewater to a deep saline aquifer

Deep well injection into non-potable saline aquifers of treated domestic wastewater has been used in Florida for decades as a safe and effective alternative to ocean outfall disposal. The objectives of this study were to determine the fate and transport of injected wastewater at two deep well injection sites in Miami Dade County, Florida, USA. Detection of ammonium in the Middle Confining units of the Floridan aquifer above the injection zone at both sites has been interpreted as evidence of upward migration of injected wastewater, posing a risk to underground sources of drinking water. Historical water quality data, including ammonia, chloride, temperature, and pH from existing monitoring wells at both sites from 1983 to 2008, major ions collected monthly from 2006 and 2008, and a synoptic sampling event for stable isotopes, tritium, and dissolved gases in 2008, were used to determine the source of ammonium in groundwater and possible migration pathways. Geochemical modeling was used to determine possible effects of injected wastewater on native water and aquifer matrix geochemistry. Injected wastewater was determined to be the source of elevated ammonium concentrations above ambient water levels, based on the results of major ion concentrations, tritium, dissolved noble gases and 15N isotopes analyses. Various possible fluid migration pathways were identified at the sites. Data for the south site suggest buoyancy-driven vertical pathways to overlying aquifers bypassing the confining units, with little mixing of injected wastewater with native water as it migrated upward. Once it is introduced into an aquifer, the injectate appeared to migrate advectively with the regional groundwater flow. Geochemical modeling indicated that CO 2-enriched injected wastewater allowed for carbonate dissolution along the vertical pathways, enhancing permeability along these flowpaths. At the north site, diffusive upward flow through the confining units or offsite vertical pathways were determined to be possible, however no evidence was detected for any on-site confining unit bypass pathway. No evidence was observed at either site of injected wastewater migration to the Upper Floridan aquifer, which is used as a municipal water supply and for aquifer storage and recovery.

Determination of vertical and horizontal pathways of injected fresh wastewater into a deep saline aquifer (Florida, USA) using natural chemical tracers

Two deep-well injection sites in south Florida, USA, inject an average of 430 million liters per day (MLD) of treated domestic fresh wastewater into a deep saline aquifer 900 m below land surface. Elevated levels of NH3 (highest concentration 939 µmol) in the overlying aquifer above ambient concentrations (concentration less than 30 µmol) were evidence of the upward migration of injected fluids. Three pathways were distinguished based on ammonium, chloride and bromide ratios, and temperature. At the South District Wastewater Treatment Plant, the tracer ratios showed that the injectate remained chemically distinct as it migrated upwards through rapid vertical pathways via density-driven buoyancy. The warmer injectate (mean 28°C) retained the temperature signal as it vertically migrated upwards; however, the temperature signal did not persist as the injectate moved horizontally into the overlying aquifers. Once introduced, the injectate moved slowly horizontally through the aquifer and mixed with ambient water. At the North District Wastewater Treatment Plant, data provide strong evidence of a one-time pulse of injectate into the overlying aquifers due to improper well construction. No evidence of rapid vertical pathways was observed at the North District Wastewater Treatment Plant.

Nerve localization techniques for peripheral nerve block and possible future directions

Ultrasound guidance is now a standard nerve localization technique for peripheral nerve block (PNB). Ultrasonography allows simultaneous visualization of the target nerve, needle, local anesthetic injectate and surrounding anatomical structures. Accurate deposition of local anesthetic next to the nerve is essential to the success of the nerve block procedure. Unfortunately, due to limitations in the visibility of both needle tip and nerve surface, the precise relationship between needle tip and target nerve is unknown at the moment of injection. Importantly, nerve injury may result both from an inappropriately placed needle tip and inappropriately placed local anesthetic. The relationship between the block needle tip and target nerve is of paramount importance to the safe conduct of peripheral nerve block. This review summarizes the evolution of nerve localization in regional anesthesia, characterizes a problem faced by clinicians in performing ultrasound guided nerve block and explores the potential technological solutions to this problem.