Sunday, February 5, 2006
Are Lower Back Tattoos A Contraindication To Labor Epidurals?
-
Printer Friendly|#| Trackback
My Google News section on 'epidurals' came up with an interesting hit: Lower-back tattoos are popular with women, but do they make having epidurals during childbirth more dangerous?. It's a very good question because, at least in my practice, lower back tattoos are extremely common in laboring women. So common, in fact, that Saturday Night Live has a commercial parody for a product called Turlington's Lower Back Tattoo Remover (quicktime | windows media).
I was taught to avoid putting an epidural needle through tattooed skin and have gone to great lengths to do so. For example, one patient had a very large tattoo of what appeared to be the face of the devil on her lower back. On closer inspection, I noticed that the devil's right nares (which was free of tattoo ink) was right over her L3-4 interspace. I wished I'd taken a picture of that epidural catheter snaking out of the devil's nose.
I can't seem to find much science on the subject save for one abstract which makes a very reasonable suggestion to avoid coring out tattooed skin by making a small incision, if necessary. This may sound like a lot of trouble, but all it takes is a 16 gauge (or similarly large) hypodermic needle inserted into the skin first, then the epidural needle through that 'incision'.
Tuesday, January 24, 2006
No Trasylol For Me or My Patients, Please
-
Printer Friendly|#| Trackback
Trasylol (Aprotinin) is a very expensive drug used during many kinds of cardiac surgery to reduce blood loss. In today's print edition of the NEJM (but not online yet) is a very important article by Dennis Mangano (very, very smart anesthesiologist) which shows an "association between aprotinin and serious end-organ damage" including doubling the risk of renal failure requiring dialysis, a 55% increase in the risk of MI or heart failure, and a near doubling of the risk of stroke or encephalopathy. The good news is that there are alternative drugs which cost one tenth as much and are also very good at reducing the need for blood transfusion. More soon....
Monday, January 2, 2006
Baxter Moves Ahead With Generic Sevoflurane
-
Printer Friendly|#| Trackback
Baxter moves ahead with drug despite fight (Chicago Sun-Times):
"Unfazed by a continuing legal battle with Abbott Laboratories , Deerfield-based Baxter International will launch its generic inhaled anesthetic sevoflurane in the United States and Japan in the first half of this year."
[Via Yahoo Search: anesthesia]
Sunday, January 1, 2006
Prilosec and C.Diff?
-
Printer Friendly|#| Trackback
Reading a blog far afield of medicine, then to the Washington Post, I cam across an interesting nugget on C. Diff. The JAMA published an article on December 21, 2005 titled Use of Gastric AcidâSuppressive Agents and the Risk of Community-Acquired Clostridium difficileâAssociated Disease [abstract]. In two population-based case-control studies:
" The incidence of C difficile in patients diagnosed by their general practitioners in the General Practice Research Database increased from less than 1 case per 100 000 in 1994 to 22 per 100 000 in 2004. The adjusted rate ratio of C difficileâassociated disease with current use of proton pump inhibitors was 2.9 (95% confidence interval [CI], 2.4-3.4) and with H2-receptor antagonists the rate ratio was 2.0 (95% CI, 1.6-2.7). An elevated rate was also found with the use of nonsteroidal anti-inflammatory drugs (rate ratio, 1.3; 95% CI, 1.2-1.5). "
A teleconference is planned for January 18th to discuss these results as part of the new Author-in-the-room series.
Sunday, December 4, 2005
Sales of Impotence Drugs Fall, Defying Expectations - New York Times
-
Printer Friendly|#| Trackback
Sales of Impotence Drugs Fall, Defying Expectations - New York Times:
"Seven years after Pfizer made Viagra a cultural touchstone and commercial blockbuster, the market for impotence medicines appears to have fallen well short of what was once predicted."
[Via New York Times]
Sunday, November 20, 2005
Trial lawyers blocking avian flu bill
-
Printer Friendly|#| Trackback
ATLA blocking avian flu bill:
" The Washington Post's Jeffrey Birnbaum reports: "Legislation that would pour billions of dollars into the production of vaccines against avian flu and other pandemic diseases is threatened by the trial lawyers' lobby, which objects to proposed limits on lawsuits against drug manufacturers. "
All in the name of protecting patients, I'm sure.
[Via PointOfLaw Forum]
Sunday, October 9, 2005
The Cervical Cancer Vaccine
-
Printer Friendly|#| Trackback
The Well Timed Period offers some (well referenced) Q's and A's about the cervical cancer vaccine:
"Q: Why do we need to vaccinate the population at large?
Q: Why are the vaccine trials focused on preferentially vaccinating young women?
Q: Why are HPV 16 and 18 the target of Merck's vaccine?
Q: Are the researchers working on the HPV vaccine aware of potential barriers to its acceptance?
"
She concludes:
" The HPV vaccine is an extremely significant development because it offers tremendous possibility in helping reduce the incidence of abnormal Pap smears, cervical cancer, and genital warts in the United States as well as worldwide. "
Thursday, July 7, 2005
We are all Britons
-
Printer Friendly|#| Trackback
[Shape of Days]
Thursday, May 26, 2005
Face-Lift Played Major Part in Woman's Death
-
Printer Friendly|#| Trackback
Face-Lift Played Major Part in Woman's Death, City Finds - New York Times:
You may remember the story several weeks ago about an Irish citizen who died the morning after a face lift in a plastic surgeon's office in New York. I've kept a Google Alert on this subject and this popped up today:
" An investigation by the New York City Medical Examiner's Office has concluded that the death of a 42-year-old Irish woman earlier this year was caused in significant part by face-lift surgery she underwent in the Manhattan office of a doctor who has repeatedly been sued for malpractice. "
Not much (any) detail. Maybe more will come out soon.
[Via ]
Thursday, May 19, 2005
Neuromuscular blocker binders around the corner?
-
Printer Friendly|#| Trackback
Organon is working on the first of a new class of drugs called selective relaxant binding agents (SRBA). The first drug, called Org 25969, is about to enter phase three trials in the US. These drugs can supposedly reverse neuromuscular blockade at any depth of neuromuscular block by binding the neuromuscular blocker.
Though this news release and the Organon website are short on details, this site has the scoop:
"The novel concept of using a ring-shaped cyclodextrin to engulf a neuromuscular blocking drug is fascinating.2 Cyclodextrins are cyclic oligosaccharides which are recognised to encapsulate lipophilic molecules such as steroids. They are water soluble and well tolerated biologically. Org 25969 consists of eight such sugar molecules in a ring, the outside of which is hydrophilic, and the inside, hydrophobic. The size and shape of the ring is designed to produce a cavity into which a neuromuscular blocking drug such as rocuronium will tightly fit. Org 25969 is capable of forming a binary host – guest complex of high affinity with rocuronium, for two of its externally charged side-chains react with the quaternary nitrogen groups of the muscle relaxant. It is able to encapsulate all four steroidal rings of rocuronium within its lipophilic cavity. This encapsulation or chelation reverses the effect of rocuronium, by preventing its access to the nicotinic receptor and promoting its dissociation from it."
[via Medical News Today]
| |
1 |
2 |
3 |
4 |
| 5 |
6 |
7 |
8
|
9 |
10 |
11 |
| 12 |
13 |
14 |
15 |
16 |
17 |
18 |
| 19 |
20 |
21 |
22 |
23 |
24 |
25 |
|
26
|
27 |
28
|
|
|
Jan Mar
|
