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Background Pain is considered as being one cause of post-operative emergence agitation (EA) from sevoflurane anaesthesia. The purpose of this study was to investigate the pure effect of post-operative pain on EA after sevoflurane anaesthesia in preschool children undergoing excision of scalp nevi. Methods Forty-four children, 1–7 years old, undergoing scalp nevus excision were enrolled. Patients were randomly assigned to two groups: the remifentanil group received single intravenous injection of short-acting synthetic opioid, remifentanil 1 μg/kg just before the scalp incision, and the block group received scalp nerve block with 0.25% ropivacaine after intubation. The end-tidal sevoflurane concentration was maintained around 1.5 vol% unless the mean arterial pressure is out of ±20% range of preoperative values during surgery in both groups. Watcha behaviour scale for EA and face, legs, activity, cry, consolability (FLACC) scale scores for pain were recorded post-operatively. Results There was no difference in end-tidal sevoflurane concentration between the two groups during surgery and the emergence period. Agitation incidence and scores were not different between the two groups during the recovery period. FLACC scale was significantly lower in the block group than in the remifentanil group at post-anaesthesia care unit (PACU) arrival, at 10 and 20 min after PACU arrival, respectively. Conclusion The scalp nerve block decreased the early post-operative pain after paediatric nevus excision, but it did not decrease the incidence of EA with sevoflurane anaesthesia.

Aim Various techniques have been described for performing a pudendal nerve block (PNB) and have associated problems such as multiple needle injections, the need for special equipment and consumption of time. This study aimed to describe a nerve-stimulator-guided PNB using a pararectal approach and to evaluate the safety and the efficacy of that procedure. Method We conducted a prospective study of 53 patients who underwent a PNB from December 2009 to July 2010. With the index finger of the left hand inserted into anus, we guided the nerve stimulator needle along the second finger tip on the ischial spine to the site where the maximal contraction of the external anal sphincter could be felt. Once the position of the needle tip had been confirmed, the desired drug was injected. Of the 53 patients, a cohort of eight underwent manometry before and after the pudendal block. Results A total of 53 patients underwent the nerve-stimulator-guided procedure: 13 patients for pudendal neuralgia and the other 40 patients for anorectal disease. The mean maximal resting and squeezing pressures before the block were 55 and 161 mmHg, respectively, compared with 35 and 67 mmHg after the block. The PNB took just minutes to perform, was well tolerated by the patients, and resulted in neither severe complications nor repeated attempts. Conclusion Nerve-stimulator-guided PNB using a pararectal approach proved to be easy and safe, with acceptable patient tolerance. In addition, it can be used for a variety of anorectal procedures where relaxation of anal tone is required.

Summary Introduction: We determined the utility of leukocyte cell population data (CPD) for the screening of sepsis and fungemia. Methods: Blood culture-positive CBC samples, 117 bacteremia and 27 fungemia, and 134 CBC samples from healthy controls were analyzed using the DxH800 and CPD of neutrophils, lymphocytes, and monocytes were analyzed. Immature granulocytes (IG) were counted using Sysmex XE-2100. Results: The neutrophils and monocytes volume were increased significantly, and the neutrophils light scattering values were reduced significantly in the sepsis samples. ROC curves evidenced excellent sensitivity in the lymphocyte SD parameters (sensitivity 78–89%, specificity 78–87%), monocytes volume (at 177.5, sensitivity 88.2% specificity 87.3%), and monocytes volume SD (at 22.16, sensitivity 93.1% specificity 91.0%) for sepsis. The IG value was significantly higher in sepsis and the ROC curve evidenced a sensitivity of 82.8% and a specificity of 90.8% for sepsis. Only lower angle light scatter of lymphocytes SD value evidenced good sensitivity and specificity in the discrimination of fungemia from bacteremia (sensitivity 74.1%, specificity 72.4% at 12.6). Conclusion: Many of the leukocyte CPD have been identified as useful parameters of sepsis. Hopefully, these parameters can ultimately be incorporated into a decision rule for the screening of sepsis samples and to discriminate fungemia from bacteremia.

A semi-analytical analysis of flexible plates with curved boundaries is presented. Through a co-ordinate transformation, the original spatial domain of the plate is mapped onto a rectangular region, where the isoparametric strip distributed transfer functions of the plate are introduced. The transfer function formulation yields closed-form predictions of the displacement, stresses and eigensolutions of the plate. The accuracy and efficiency of the proposed approach is demonstrated in numerical examples. Copyright © 1999 John Wiley & Sons, Ltd.

The stereocontrolled synthesis of the monomeric subunit of the macrolide dimer disorazole C 1 ( 1 ) has been accomplished by convergent coupling of 3 and 4 using the Stille method.

A batch fermentation is modelled with constant and variable yeild terms. It is shown that the model cannot exhibit oscillations if a constant yield term is used. Oscillations in the cell concentration, but not in the limiting substrate concentration, can be simulated if a variable yield function of the limiting substrate is used. Conditions, for which the variable yield needs to satisfy in order to generate oscillations in the cell concentration, are discussed. The primary condition is that the yield must become zero at the same time that the specific growth rate does. Experimental results exhibiting oscillatory behavior are presented and compared with the proposed model.

The yield function, for an enzyme-substrate kinetic model of the system, is investigated. Considering Y to be a function of the substrate concentration S, its value as S --> O(+) is investigated.In the "pseudo-steady-state domain," this differential yield function is shown to be bounded above and below by yield functions that are obtained by using the Michaelis-Menten and Briggs-Haldane functions to relate the enzyme-substrate concentration C to S. It is also shown that the yield constant, which is commonly used for enzyme and fermentation systems, is an integral average of the differential yield function. The average yield constant can be used to show consistency of data by relating the area above and below the average yield line when the yield function is plotted against the substrate concentration. The role of the dimensionless parameter, epsilon = k(m)/E*, on the asymptotic yield, is also investigated. The mathematical results are demonstrated on experimental data for a horseradish-peroxidase enzyme system and a gluconic acid fermentation process.