Assessment of the acutely ill cancer patient

The process of assessing the acutely ill cancer patient must be organized and systematic. The framework outlined in this article provides a method that ensures complete and consistent data collection. These data can then be utilized to formulate specific patient problems and diagnostic statements and to form the basis for specific nursing actions.     

Tooth pulp-evoked potentials in the monkey: cortical surface and intracortical distribution

The distribution of tooth pulp-evoked potentials (TPEPs) was characterized in the primary motor (MI), primary somatosensory (SI) and secondary somatosensory (SII) cortices of the monkey. Bipolar electrical tooth pulp stimulation elicited TPEP components P23 and N44 over SI, P26 and N72 over MI, and P72, N161, P280, N420, P561 and N662 over SII. Muscular artifacts and extradental input did not affect the TPEP as demonstrated by experiments using a neuromuscular blocking agent and removal of the pulp, respectively. The short latency TPEPs recorded over SI and MI were evoked by low stimulus intensities and activation of A beta nerve fibers, whereas the long latency TPEPs recorded over SII required higher stimulus intensities and the additional recruitment of A delta nerve fibers. Intracortical recordings revealed polarity reversals of components P23 and N44 in area 3b, P26 and N72 in area 4, and P72, N161, P280, N420, P561 and N662 in the upper bank of the lateral sulcus (SII). Evidence presented in this study suggests that TPEPs recorded from SI and MI relate to non-nociceptive mechanisms while TPEPs recorded from SII relate to nociceptive mechanisms.     

Naloxone fails to reverse pain thresholds elevated by acupuncture: acupuncture analgesia reconsidered

We were unable to demonstrate the reversal of dental acupunctural analgesia following the injection of 0.4 mg naloxone using evoked potential methodology. Since our findings differed from those of Mayer, Price and Rafii who used pain threshold methods, we attempted to replicate their study. Subjects who demonstrated acupunctural analgesia during electrical stimulation of the LI-4 point on the hands received either 1.2 mg naloxone or normal saline under double blind conditions. Pain thresholds elevated by acupuncture failed to reverse when naloxone was given. Review of experimental design issues, other related human subjects research, and animal studies on acupunctural analgesia provided little convincing evidence that endorphins play a significant role in acupunctural analgesia. Because endorphins can be released in response to a stressor, endorphin presence sometimes correlates with acupunctural treatment in animal studies and some human studies, especially those involving pain patients. The primary analgesia elicited by acupunctural stimulation seems to involve other mechanisms.     

Multiple molecular forms of certain lysosomal enzymes separated by isoelectric focusing on cellulose acetate membranes.

Analytical isoelectric focusing on cellulose acetate membranes offers greater resolution of the enzyme pattern than does standard electrophoresis and offers numerous advantages over other support media in isoelectric focusing. A series of lysosomal enzymes, deficiencies of which cause lethal storage diseases in infants and children, can be shown to exist as multiple molecular forms by analytical isoelectrical focusing on cellulose acetate membranes. This analytical technique should be a valuable tool in the investigation of enzyme polymorphism and genetically determined enzyme deficiency diseases.     

Pain measurement: an overview

The practice and theoretical basis of pain measurement is reviewed and critically examined in the areas of animal research, human subjects laboratory investigation and clinical study. The advantages and limitations of both physiological and behavioral methods are discussed in each area, and subjective report procedures are evaluated in human laboratory and clinical areas. The need for procedures that bridge these areas is emphasized and specific issues are identified. Progress in the technology of pain measurement over recent decades is reviewed and directions for future work are suggested.     

Determination of serum bile acids by glass capillary gas-liquid chromatography.

Bile acids were extracted from serum samples by chromatography on Amberlite XAD-2 and, after alkaline or enzymic hydrolysis, purified by chromatography on aluminium oxide. The quantitation was carried out by gas-liquid chromatography with an OV-101 glass capillary column using their methyl ester trimethylsilyl derivatives. The mean total amount of cholic, chenodeoxycholic and deoxycholic acids in a group of healthy fasting women was 2.14 mumol/l, in a group of fasting pregnant women at 8-12 weeks of gestation 1.13 mumol/l and at 38-41 weeks of gestation 2.10 mumol/l. In patients with cholestasis of pregnancy the total bile acid levels varied from 6 to 86 mumol/l.     

Biliary bile acids in uncomplicated pregnancy and in cholestasis of pregnancy

Conjugated and sulfated bile acids were determined by gas-liquid chromatography and by high-pressure liquid chromatography in gallbladder bile samples of four pregnant women at term and of two patients with cholestasis of pregnancy. In healthy pregnant women the mean ratio of cholyl/chenodeoxycholyl/deoxycholyl glycine was 3.7 : 1 : 0.23 and that of taurine conjugates 3.0 : 1 : 0.25, respectively. In gallbladder bile pool of non-pregnant females these ratios were 1.0 : 1 : 0.00 and 1.0 1 : 0.70, respectively. Thus cholic acid predominated in pregnancy bile. In patients with cholestasis of pregnancy, cholid acid comprised 90% of total biliary bile acids, the proportion of chenodeoxycholic acid was greatly decreased and nonsulfated deoxycholic acid was not detected. The proportion of sulfated bile acids of total biliary bile acids was between 0.4 and 1.2% in uncomplicated pregnancy and 0.3 and 0.5% in cholestasis patients.     

Simultaneous isothermal determination of diphenylhydantoin and phenobarbital serum levels by gas-liquid chromatography following flash-heater hexylation.

A rapid, accurate, precise, and sensitive procedure for the simultaneous determination of diphenylhydantoin and phenobarbital under isothermal conditions involves on-column hexylation of the compounds. After extraction of serum samples, the evaporated residues are dissolved in tetrahexylammonium hydroxide. An aliquot of the resulting solution is introduced directly into a gas chromatograph where conversion to hexyl derivatives and subsequent separation takes place. The hexylated derivatives are identified by their retention times relative to appropriate internal standards. Concentrations are obtained from standard curves plotting relative peak height versus concentration of drug.     

Comparative effects of acupuncture in Japan and the United States on dental pain perception

The effects of low frequency electrical acupunctural stimulation on the perception of induced dental pain were compared in two cultural settings. Twenty Japanese and 20 American subjects (consisting of 10 Caucasians and 10 second or third generation Japanese) were tested in two functionally identical laboratories, one at Tottori University in Yonago, Japan and the other at the University of Washington. Each subject underwent a control and an acupuncture session on separate days with subjects counterbalanced for carry-over order effects. Sensory decision theory (SDT) analysis demonstrated a significant reduction in perceptual capability and an increased bias against reporting stimuli as painful following the acupuncture as treatment which was performed bilaterally at traditional facial points. No significant differences between groups in alteration of perceptual capability, bias or pain threshold were demonstrated, indicating that the cultural and racial differences studied did not influence responses to acupuncture in a laboratory setting.