Jerzy Miskowiak

Local Anesthesia for Extracorporeal Shock Wave Lithotripsy: A Study Comparing Eutetic Mixture of Local Anesthetics Cream and Lidocaine Infiltration

A study of the anesthetic efficacy of a eutetic mixture of local anesthetics (EMLA cream) versus lidocaine infiltration in extracorporeal shock wave lithotripsy (ESWL) was done. A total of 46 patients had 30 gm. of EMLA cream applied to the skin over the kidney and 45 had subcutaneous infiltration anesthesia with 20 ml. 1% lidocaine with epinephrine. All patients received an intravenous dose of morphine just before ESWL. The patients were comparable with regard to age, sex, weight, morphine dosage, number of shock waves given and duration of treatment. Median pain score and the amount of supplementary analgesics were not significantly different between the 2 groups. There were no significant differences between the groups with regard to post-ESWL skin changes. Therefore, EMLA cream can be recommended for ESWL provided it is applied correctly.

Food Intake before and after Gastroplasty for Morbid Obesity

Preoperatively, the energy intake was high, the protein intake was sufficient, whereas the relative contribution of fat was greater than and of carbohydrate less than the recommended values. After gastroplasty a dramatic fall occurred in the intake of energy and all nutrients, and a relative reduction in the contribution of fat at 3 months and of carbohydrate at 12 months was observed. Preoperatively, the intake of vitamins D, B6, folacin, biotin, magnesium, iron, zinc, manganese, copper, and fluoride was deficient. Twelve months after operation the intake of these components and of vitamin E and iodine was less than half of the values recommended.

Topical anesthesia with eutetic mixture of local anesthetics cream in vasectomy: 2 randomized trials.

Two paired randomized trials testing topical anesthesia with a eutetic mixture of local anesthetics (EMLA cream*) in vasectomy were performed. In 1 trial EMLA cream was applied on 1 side of the scrotum, while infiltration anesthesia into the skin and subcutaneous tissue with mepivacaine was used on the contralateral side. All but 1 of the 13 patients (p less than 0.05) preferred infiltration anesthesia because of pain as the incision reached the subcutaneous tissue. In the other trial 29 patients received EMLA cream on 1 side of the scrotum before bilateral mepivacaine infiltration. There was significantly less pain on the sides with the anesthetic cream (p less than 0.001). Many patients would pay the price of the cream. In conclusion, EMLA cream cannot replace but it can supplement infiltration anesthesia during vasectomy.

Extracorporeal Shock Wave Lithotripsy of Kidney Stones does not Induce Transient Bacteremia. A Prospective Study

AbstractDuring 58 extracorporeal shock wave lithotripsies 161 blood cultures were drawn to evaluate the incidence of bacteremia during the procedure. Only 3 blood cultures drawn during the procedure yielded bacteria, in all cases probably skin flora contaminants. Post-lithotripsy fever was noted in 29% of the patients, and could not be associated with transient bacteremia and was not influenced by antimicrobial prophylaxis. Patients with a positive urine culture after extracorporeal shock wave lithotripsy may have an increased risk of septicemia.

Gastric emptying of liquid before and after gastroplasty for morbid obesity.

Gastric emptying of a liquid meal was investigated with a radionuclide method before and 1 week and 3 and 12 months after gastroplasty operation for morbid obesity. Gastroplasty results in a small proximal pouch with a narrow stoma to the remaining stomach. The total gastric emptying was delayed 3 months after gastroplasty (p less than 0.01). Twelve months after gastroplasty, emptying of the proximal pouch was faster than at 3 months (p less than 0.01). This may indicate dilatation of the stoma between the two gastric pouches during this period. Surprisingly, the total gastric emptying 12 months after gastroplasty was not only faster than at 3 months but also faster than before surgery. The explanation, therefore, cannot only be attributed to a dilated stoma, and hormonal mechanisms may be involved. A lack of correlation between preoperative weight and emptying was observed, but because the material consists of only obese subjects, no conclusion can be drawn about the postulated role of gastric emptying in developing obesity. Emptying of the total stomach and of the proximal pouch failed to correlate with postoperative weight losses. The weight loss after gastroplasty evidently bears little, if any, relation to the postoperative changes in gastric emptying of liquids.

Stripping of the distal ureter after nephrectomy for pelvis papilloma.

A new technique for removal of the distal ureter using a vein stripper was successfully used in eight patients after nephrectomy for pelvis papilloma. The method described is safe and shortens operating time.

ABDOMINAL SCINTIPHOTOGRAPHY WITH 99mTECHNETIUM-LABELLED ALBUMIN IN ACUTE GASTROINTESTINAL BLEEDING: An Experimental Study and a Case-report

In a new diagnostic method in acute gastrointestinal bleeding, after an intravenous injection of 99mtechnetium-labelled albumin, the distribution of radioactivity in the abdomen is followed for 40-60 minutes by sequential scintiphotography. The site of simulated gastrointestinal bleeding could be identified in all five volunteers. In a patient with severe bleeding from diverticula in the sigmoid colon the method gave a correct estimate of the site of the bleeding and of its rate.

Transurethral incision of urethral diverticulum in the female

A new technique of transurethral incision of urethral diverticulum was successfully used in two women. The method described is safe, simple and shortens operating time.

HOW THE LOWER ŒSOPHAGEAL SPHINCTER AFFECTS SUBMUCOSAL ŒSOPHAGEAL VARICES

Abstract Œsophageal varices are found in the submucosa of the lower œsophageal sphincter (L.E.S.). Portagraphic studies after vasopressin administration showed occlusion of submucosal œsophageal varices and distension of the para-œsophageal veins. Œsophagography and endoscopy after administration of anticholinergics showed considerable dilatation of the submucosal œsophageal varices. Because vasopressin increases, and anticholinergics decrease, L.E.S. pressure it is suggested that L.E.S. pressure is an important factor in the development of submucosal œsophageal varices.

Continuous intestinal dialysis for uraemia by intermittent oral intake of non-absorbable solutions : an experimental study

A new approach to intestinal dialysis was investigated in a normal person and in a patient with chronic uraemia and a renal creatinine clearance of 10 ml/min. Both subjects drank 1-1.5 l non-absorbable solutions of polyethylene glycol or mannitol every fourth hour. The solutions stayed in the intestines for about four hours in the normal person and for 1.5 to 3 hours in the patient. The patients intestinal clearances were 6-10.4 ml/min for creatinine, 4 ml/min for uric acid and 10.7-15.4 ml/min for phosphate, which compares favourably to those from 12 hours weekly haemodialysis. Continuous intestinal dialysis was well tolerated and the results indicate that this might be a useful way of treating uraemia if conventional methods are unavailable.