Efficacy of landiolol in attenuating hemodynamic responses to local epinephrine infiltration in patients undergoing vaginal total hysterectomy

Purpose Local epinephrine infiltration often causes ₁-adrenoceptor-mediated tachycardia, hypertension, and arrhythmia. Landiolol, a short acting ₁-adrenoceptor blocker, may represent the most ideal agent to attenuate these adverse effects. In this study, we examined the effects of landiolol on the hemodynamic changes resulting from local infiltration of epinephrine.Methods Thirty-six patients undergoing vaginal total hysterectomy under general anesthesia were randomly assigned to one of three groups: control group (n = 12), L5 group (n = 12), and L10 group (n = 12). In the control, L5, and L10 groups, the patients were given saline, landiolol 5mg, and 10mg, respectively, just before infiltration of epinephrine(1:300000; total dose, about 100µg) into the surgical field. Blood pressure and heart rate was assessed before and 5, 10, 15, 20, 25, 30min after the initiation of epinephrine infiltration. If systolic blood pressure and heart rate exceeded 160mmHg and 120 beats·min^–1, respectively, Ca blockers of either diltiazem 5mg or nicardipine 1mg and/or 2% sevoflurane were given.Results Epinephrine infiltration significantly increased systolic blood pressure from 122 ± 15 to 170 ± 29mmHg and heart rate from 63 ± 8 to 106 ± 10 beats·min^–1. In both the L5 and L10 groups, the increase in heart rate (from 69 ± 16 to 87 ± 16 beats·min^–1, P < 0.01, and from 70 ± 18 to 76 ± 9 beats·min^–1, P < 0.01, respectively) was significantly smaller compared to the control group, but the increase in systolic blood pressure was significantly attenuated in the L10 group (from 116 ± 18 to 140 ± 27mmHg, P < 0.01). The number of patients given either Ca blockers or sevoflurane in the control group was significantly higher than that in the landiolol groups (P < 0.01).Conclusion The present study suggests that landiolol 10mg may be a more suitable dose than landiolol 5mg to antagonize hyperdynamic states induced by local administration of epinephrine.     

A Prostacyclin Analogue,OP-41483α-CD,Restores the Ability of a β<Subscript>2</Subscript>-Adrenergic Agonist to Stimulate Alveolar Fluid Clearance in Rats

Purpose. It is not yet known whether a prostacyclin analogue can affect alveolar fluid clearance. According to recent studies, high-dose (10^–3M) terbutaline, a ₂-adrenergic agonist, failed to increase alveolar fluid clearance. Therefore, we examined the effects of OP-41483-CD, a prostacyclin analogue, on alveolar fluid clearance in the presence of high-dose terbutaline in rats.Methods. Albumin solution containing Evans blue dye and various drugs was instilled into the alveolar airspaces of isolated rat lungs, which were then inflated with 100% oxygen at an airway pressure of 8cmH₂O. Alveolar fluid clearance was measured by the progressive increase in dye concentrations over 1h.Results. Although 10^–5 and 10^–4M terbutaline increased alveolar fluid clearance, 10^–3M terbutaline did not. OP-41483-CD restored the ability of 10^–3M terbutaline to stimulate alveolar fluid clearance. The effect of OP-41483-CD was consistent with the effect of atenolol, a ₁-adrenergic antagonist. The effect of OP-41483-CD on alveolar fluid clearance was unchanged in lungs inflated with nitrogen. Prostaglandin E (PGE)₁ and PGE₂ analogues had similar effects to OP-41483-CD on alveolar fluid clearance.Conclusion. These results indicate that a prostacyclin analogue restores the ability of high-dose terbutaline to stimulate alveolar fluid clearance.     

Brain lesion size and phase shift as an index of cerebral autoregulation in patients with severe head injury

Summary ¶Background. Whether the phase relationship (phase shift) between cerebral blood flow velocity as assessed by transcranial Doppler ultrasound and blood pressure at 0.1Hz can be used to assess cerebral autoregulation (CA) in patients with severe traumatic brain injury (TBI). Methods. In 33 healthy volunteers (mean age, SD; 37±17 years, range 17–65) middle cerebral artery (MCA) blood velocity (V) was recorded simultaneously with finger blood pressure (BP) over a period of 10 minutes under normocapnic and hypocapnic conditions to generate normative data. In 27 patients with severe TBI (Glasgow Coma scale score 8) serial close in time investigations of cranial computed tomography (CT) scanning and phase shift assessment were performed on days 1, 3, 5, and 8 after trauma. Phase shift in the MCA was compared to brain parenchyma lesion size in the MCA territory on CT scanning. Lesion size was classified into 0, normal; 1, presence of a small lesion (diameter <3cm); 2, presence of a large lesion (>3cm). Findings. Compared to normocapnia, hypocapnia significantly increased phase shift at 0.1Hz from 78±28° to 101±25° (p<0.001). In the TBI patients, 115 comparisons between CT findings and CA results were possible. Phase shift detected a pathological CA in 31 instances, which were more frequent in CT lesion type 2 (19/42) than in group 0 (7/44) and group 1 (5/29). Interpretation. When CA is intended to be assessed by use of phase shift, the hyperventilation setting needs its own reference values. In MCA territories containing a traumatic lesion greater than 3cm in diameter phase shift at 0.1Hz will detect a high frequency (44%) of a disturbed state of CA.Published online July 23, 2003     

Beneficial Effects of Apolipoprotein A-I on Endotoxemia

Purpose. Although many studies have shown the beneficial effects of lipoproteins on animals with endotoxemia, little is known about the impact of apolipoprotein A-I (apoA-I) on tumor necrosis factor (TNF-) release in response to lipopolysaccharide (LPS). The present study was conducted to determine whether the administration of apoA-I inhibits the release of TNF- and influences the survival rate of rats with endotoxemia.Methods. Forty male Wistar rats were divided randomly into four groups. Rats in the first and second groups were given 1mg/kg LPS intraperitoneally (i.p.) and blood was collected 1h later to measure the serum levels of TNF-. Either 10mg/kg apoA-I or Tris-buffered saline was injected i.p. and the serum TNF- levels were measured again 2h later. Rats in the third and fourth groups were given 5mg/kg LPS. Following the administration of 10mg/kg apoA-I or Tris-buffered saline, animals were observed for 5 days and survival rates were determined.Results. ApoA-I inhibited the release of serum TNF- and improved the survival rates of rats with endotoxemia.Conclusion. The administration of apoA-I suppressed the TNF- release in endotoxemia and decreased the mortality rates of rats.     

Effects of oral atenolol on volatile anesthetic induction with sevoflurane in adults

Purpose To determine whether premedication with a -blocker can bring about a more rapid and smooth induction of anesthesia, we investigated the effect of oral premedication with atenolol on volatile anesthetic induction with sevoflurane by monitoring the cardiac output (CO) and bispectral (BIS) index.Methods Twenty-four patients undergoing general anesthesia with endotracheal intubation were randomly divided into two groups: a control group (n = 12) and a -blocker group (n = 12). Each patient in the -blocker group was premedicated with oral atenolol 25mg 1h before the induction of anesthesia. Anesthesia was induced by the repeated vital capacity technique with 5% sevoflurane and 66% nitrous oxide. The trachea was intubated 5min after sevoflurane exposure. The CO and BIS index, as well as the induction time and specific side effects of induction (e.g., movement of limbs), were recorded.Results There were no significant differences in induction time and specific side effects between the groups. The downward-sloping part of the BIS index curve in the -blocker group (mean, 2.9 ± 0.2) was significantly sharper than that in the control group (2.5 ± 0.2), and the BIS index after induction of anesthesia was significantly lower in the -blocker group (21.0 ± 2.2) than in the control group (24.2 ± 2.0). CO in the -blocker group was significantly lower than in the control group during the study period. The hemodynamic changes caused by endotracheal intubation were inhibited in the -blocker group but not in the control group.Conclusion Oral premedication with 25mg of atenolol provides a more rapid decrease in BIS index and is recommended for use in stable volatile anesthetic induction with sevoflurane.     

33. Der „kalte” Schilddrüsenknoten

Zusammenfassung Der kalte Schilddrüsenknoten gilt als typischer Verdachtsbefund für ein Schilddrüsencarcinom. Seine tatsächliche Dignität ist mit klinischen Mitteln sowie Szintigraphie und Sonographie letztlich nicht zu klären. Das beste abgrenzende Selektionskriterium ist die Feinnadel-Punktionscytologie, wodurch mit Gültigkeit für das Kropfendemiegebiet etwa die Hälfte als suspekte Befunde von dem anderen Teil hochwahrscheinlich gutartiger Veränderungen getrennt und für die Operationsindikation reserviert werden kann.     

Comparative study of intravenous administration of Ringer’s lactate,Ringer’s acetate and 5% glucose containing these Ringer’s solutions in human being

The effects of the administration of Ringers lactate (L) and Ringers acetate (A) solution on blood biochemistry in human subjects operated for tympanoplasty under general anesthesia were investigated. And the feasibilities of the clinical use of Ringers lactate (LD) and Ringers acetate (AD) solution containing 5% glucose were also assessed. In all cases the rate of infusion was 500ml for initial 20min, and then 5ml·hr^–1·kg^–1 B.W. for 3hr and 10min.There were significant increases in blood L- and D-lactate, pyruvate, and L-lactate/pyruvate ratio in L group. A significant increase in blood acetate but not lactate was found in A group. These metabolic changes were minimal and considered as clinically not significant. The urinary excretion of lactate, pyruvate, acetate and glucose were also negligible. In both LD and AD group, the higher blood concentrations of lactate, pyruvate, acetate and glucose were found than in L and A group. Urinary excretions of these metabolites were much higher in LD and AD group than in L and A group. So glucose containing Ringers lactate or acetate solutions should be administered in appropriate amounts and rate not to induce clinically significant metabolic alterations.(Kuze S, Naruse T, Ito Y et al.: Comparative study of intravenous administration of Ringers lactate, Ringers acetate and 5% glucose containing these Ringers solutions in human being. J Anesth 4: 155–161, 1990)     

Effect of tumor necrosis factor-α and interferon-γ on the growth of human prostate cancer cell lines

Human recombinant tumor necrosis factor- (rTNF-, 10^-12–10^-8 M) inhibited the proliferation of androgen-dependent LNCaP cells by 32–56%. In contrast, proliferation of androgen-independent PC-3 and JCA-1 cells was only slightly inhibited, or not inhibited at all, respectively. Human recombinant interferon- (rIFN-, 500 U/ml) decreased proliferation of PC-3 and JCA-1 cells by 35% and 53%, respectively, but had no effect on LNCaP cells. Interestingly, the combination of rIFN- and TNF- had greater antiproliferative effects on JCA-1 cells than treatment with either cytokine alone. However, the antiproliferative effects of this combination were similar to those observed for PC-3 or LNCaP cells treated with rIFN- or TNF- alone, respectively. These data suggest that some forms of androgen-independent prostate cancer may benefit from a combination therapy of IFN- and TNF-, while the use of IFN- alone may be more efficacious in others.     

Association of meningiomas with dural “tails”; Surgical significance

Summary Intracranial meningiomas are characteristically benign tumours with a tendency to recur following surgical resection. Our group is investigating the pathogenesis of meningioma recurrence. In our initial studies we identified two cases of dural tails associated with intracranial meningiomas. Gadolinium-enhanced magnetic resonance images were utilized to identify the dural tails preoperatively. These images aided us in performing a more complete surgical resection of the meningiomas. Histopathological confirmation of meningotheliomatous cell infiltration into the dural tails demonstrates their surgical significance.     

Analgesic effect of intravenous ATP on postherpetic neuralgia in comparison with responses to intravenous ketamine and lidocaine

Purpose No study has been performed on the analgesic effect of adenosine 5-triphosphate (ATP) on postherpetic neuralgia (PHN). We conducted an open-label trial of ATP in patients with PHN, and compared ATP with ketamine and lidocaine.Methods Twelve patients with PHN were studied. On separate days, ketamine (0.3mg·kg^–1), lidocaine (2mg·kg^–1), and ATP (100µg·kg^–1·min^–1 or less for 120min) were administrated intravenously. The intensity of spontaneous pain as well as tactile allodynia was assessed using a visual analog scale (VAS). When the VAS score for spontaneous pain was decreased by more than 50%, the patient was classified as a responder.Results Five, 6, and 6 patients responded to ketamine, lidocaine, and ATP, respectively. In 6 ATP responders, pain relief developed slowly and lasted for 9 (median) h (range: 3–72h). All 5 ketamine responders and only 1 of 7 ketamine nonresponders responded to ATP (5/5 vs 1/7, P < 0.05, ² test) whereas 2 of 6 responders to lidocaine and 4 of 6 nonresponders to lidocaine responded to ATP (2/6 vs 4/6, P > 0.05). The ketamine responders responded to ATP more often than did the lidocaine responders (5/5 vs 2/6, P < 0.05).Conclusion Intravenous ATP exerted slowly developing and long-lasting analgesic effects in half of patients with PHN. Patients with ketamine-responsive PHN were likely to respond to ATP.     

Simplified design of the “B” technique mammoplasty

The preoperative design of the B technique mammoplasty is somewhat complicated and less precise than that of other methods of breast reduction. A new maneuver for simplification of the design is presented.     

An in vitro method for comparing the efficacy of two preservation solutions in one canine liver using the 5′-nucleotidase assay

The activity and localization of the plasma membrane-bound enzyme 5-nucleotidase (5-NT) in liver tissue are sensitive parameters of ischemic damage. The value of 5-NT as a marker of liver graft viability was studied in relation to liver preservation. In six mongrel dogs, the main right and left branches of the portal vein were cannulated and flushed separately in situ with cold University of Wisconsin (UW) solution and Euro-Collins (EC) solution, respectively. After hepatectomy, the right and left liver lobes were split and stored at 5°C in either of the two solutions. 5-NT activity was demonstrated in cryostat sections of liver tissue using the lead salt method. After 48 h of storage in EC solution, the 5-NT score had decreased to 31%±16% (n=6), whereas in UW solution the 5-NT score was 76%±10% (n=6). Significantly (P<0.05) higher 5-NT scores were also found after 24-h and 72-h preservation times in UW versus EC solutions. This result is in keeping with the higher preservation tolerance of liver grafts preserved in UW solution. The 5-NT assay was studied in relation to graft function in orthotopic liver transplantation experiments in dogs. All dogs with liver grafts preserved in UW solution for 24 h (n=4) and 48 h (n=3) survived (>5 days). pretransplant 5-NT scores ranged from 61% to 100%. The 72-h-preserved livers (n=5) did not show life-supporting function. Pretransplant 5-NT scores (33%±12%, n=5) were significantly (P<0.05) decreased. The 5-NT score pretransplantation was a more reliable indicator of graft function than peak SGOT values post-transplantation. In conclusion, the 5-NT assay, in conjunction with the double flush method through the portal vein, provides a simple and rapid in vitro method to test solutions for liver preservation.     

Role of TGFβ in the anti-estrogen response/resistance of human breast cancer

Transforming growth factor (TGF) has potent inhibitory effects upon epithelial proliferation and malignant progression may be associated with breakdown of the autocrine and paracrine inhibitory loops in which TGF participates. The therapeutic effects of anti-estrogens may be partially attributable to boosting of local endogenous levels of TGF. This article reviews the evidence in support of TGF being a proximate effector in mediation of the anti-neoplastic effects of anti-estrogens. Both the conventional estrogen receptor (ER)³ dependent and ER independent mechanisms of action are likely to be involved. Evidence for preferential stromal induction of TGF by anti-estrogens is emphasized, together with the therapeutic potential of this strategy for improving outcome in early breast cancer irrespective of ER status.     

Comparison of adrenoceptor subtype expression in porcine and human bladder and prostate

We have quantified and characterized ₁-, ₂-and -adrenoceptor subtypes in porcine bladder detrusor and bladder neck, human bladder detrusor, and porcine and human prostate. ₁-, ₂- and -adrenoceptor were identified in radioligand binding studies using [³H]prazosin, [³H]RX 821002 and [¹²⁵I]iodocyanopindolol, respectively, as the radioligands. In porcine male and female detrusor and bladder neck and male prostate, adrenoceptors were detected in the order of abundance > _{2 1} (not detectable), with no major differences between the sexes or between detrusor and bladder neck. In human detrusor and prostate the order of abundance was > _{2 1} (not detectable) and ₁ > ₂. respectively. The ₂-adrenoceptors in all tissues were homogeneously of the _2A-subtype as evidenced by competition binding studies with yohimbine, prazosin, ARC 239 and oxymetazoline. The -adrenoceptors represented a mixed population with a dominance of the ₂-subtype in all tissues as demonstrated by competition binding with ICI 118,551 and CGP 20,712A. We conclude that pigs may be a suitable model for studies of detrusor function with respect to adrenoceptor expression. They may be less suitable for studies of bladder neck or prostate function.     

121. Modifizierte Technik der „Ersatzklappen”-Operation an der V. poplitea bei postthrombotischem Syndrom

Zusammenfassung Die Technik der Ersatzklappen-Operation an der V. poplitea bei postthrombotischem Syndrom wurde vom Initiator durch die Verwendung einer 24cm langen Silicone-Sehne modifiziert. Die Silicone-Sehne wird zwischen A. und V. poplitea durchgezogen, ihr mediales Ende an die Gracilissehne und ihr laterales Ende um die Bicepssehne vernäht. Bei 31 durchgeführten Operationen konnte klinisch und phlebographisch bei allen eine regelrechte Ersatzklappen-Funktion und eine Besserung der venösen Hämodynamik des Beines festgestellt werden.     

Arthrolyse «élargie» de la tibio-tarsienne

Résumé A propos de 12 cas de raideur en équin de l'articulation tibio-tarsienne, les auteurs présentent leur technique d'arthrolyse «élargie» qui leur a toujours permis de corriger l'attitude vicieuse du pied. Ils analysent les résultant obtenus et définissent les indications de cette intervention.Ils insistent sur l'intérêt qu'il y a à réorienter sans section osseuse, le secteur de mobilité de la tibio-tarsienne, en conservant les surfaces articulaires.

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Extended arthrolysis of the tibio-tarsal articulation

Summary The authors describe a technique of extended arthrolysis in 12 cases of tibio-tarsal equinus. This has consistently corrected the defective position of the foot. The results are analysed and the indications are defined.The importance of reorientating the sector of the tibio-tarsal mobility without bone section is stressed and the conservation of all articular surfaces.

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Some remarks on breast reduction by the “B” technique

The main disadvantage of the popular techniques for breast reduction are the scars left around the breasts. We present our experience with the B technique for breast reduction, which creates a much smaller size scar that is well hidden under the brassiere. Our conclusion is that the B technique is the method of choice for most breast reductions.     

The effect of simvastatin on serum cytokine levels and bone metabolism in postmenopausal subjects: negative correlation between TNF-α and anabolic bone parameters

In this prospective study, we aimed to evaluate the effect of simvastatin on bone metabolism and the correlation between changes in bone turnover parameters and serum cytokine levels. For this purpose, 38 postmenopausal subjects with hypercholesterolemia (>240mg/dl), not on osteoporosis treatment, were studied. Simvastatin was started at a dose of 20mg daily and continued for 3 months. Six patients were excluded from the study during the follow-up period. Pre- and post-treatment samples were analyzed for bone alkaline phosphatase (BAP) and osteocalcin (OCL), as markers of bone formation; for carboxyterminal telopeptide of collagen I (CTX), as a marker of bone resorption; and for interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-) cytokine levels. Total cholesterol level was decreased from 262.1 ± 30.9 to 210.2 ± 35.6mg/dl after simvastatin treatment (P < 0.0001). While no significant change was observed in serum CTX level, BAP and OCL levels were significantly increased (from 120.8 ± 56.6 to 149.5 ± 57.6IU/l [P = 0.008], and from 20.8 ± 12.6 to 34.7 ± 18.4µg/l [P = 0.015], respectively). In the analysis of cytokines, while no significant change was observed in IL-6 levels, the TNF- level was found to be significantly decreased after simvastatin treatment (from 77.9 ± 31.6pg/ml to 23.5 ± 12.6pg/ml [P = 0.021]). Individual changes in TNF- levels showed a moderate negative correlation with the individual changes in BAP and OCL levels (r = –0.550 [P = 0.001], and r = –0.497 [P = 0.004], respectively). In conclusion; 20-mg daily simvastatin treatment for 3 months significantly increased BAP and OCL levels (markers of bone formation) in hypercholesterolemic postmenopausal subjects, without affecting bone resorption. These findings support the idea that simvastatin has an anabolic effect on bone formation. Additionally, the presence of a negative correlation between TNF- levels and the anabolic bone parameters suggests that a cytokine-lowering effect of simvastatin may also be involved in the remodeling process and could exert some additive beneficial effect on bone metabolism.