Ketamine Improves the Management of Exaggerated Postoperative Pain Observed in Perioperative Fentanyl-treated Rats

Background: Although opioids are unsurpassed analgesics, experimental and clinical studies suggest that opioids activate N-methyl-d-aspartate pronociceptive systems leading to pain hypersensitivity and short-term tolerance. Because it is difficult in humans to differentiate pain from hyperalgesia during the postoperative period, the authors performed experimental studies with fentanyl using the rat incisional pain model for evaluating relations between hyperalgesia and short-term tolerance. Because N-methyl-d-aspartate receptor antagonists oppose both pain hypersensitivity and tolerance induced by opioids, the authors examined the capability of ketamine for improving exaggerated postoperative pain management.

Methods: During halothane anesthesia, a hind paw plantar incision was performed in rats receiving four fentanyl subcutaneous injections (100 [mu]g/kg per injection, every 15 min). In some groups, three subcutaneous ketamine injections (10 mg/kg per injection, every 5 h) were performed in saline- or fentanyl-treated rats. One day after surgery, the analgesic effect of morphine (2 mg/kg subcutaneous) was tested. Analgesia, mechanical hyperalgesia, tactile allodynia, and pain score were assessed for several days using the paw pressure vocalization test, the von Frey application test, and the postural disequilibrium test.

Results: Fentanyl induced analgesia but also produced exaggerated postoperative pain as indicated by the enhancement of hyperalgesia, allodynia, and weight-bearing decrease after hind paw plantar incision. Ketamine pretreatment prevented such a fentanyl-induced enhancement of postoperative pain and improved its management by morphine.     

Polymères thiocarboxyliques, 5. Synthèse de poly(oxyéthylène)s à fonction dithioester terminale. Application au traitement de cellules d'électrophorèse

Poly(oxyethylene)s with dithioster end groups were obtained from mono- and dihydroxyl terminated commercial polymers by reaction with dimethyl chloroacetamide, subsequent thionation of the amide group, and usual conversion of the thioamides into the dithioesters 14, 15 and 20, 21 . The best results were obtained in the syntheses of the S-carboxymethyl dithioesters ( 15 and 21 ). The resulting reactive poly(oxyethylene)s were grafted upon silica tubes and electrophoresis cells, previously activated by aminopropylsilanization. These graftings result in lowering of the surface potential of the tubes and in suppression of the electro-osmosis flow in an electrophoresis cell tested with a TiO₂ standard sample.     

Successful treatment of acute head and neck dog bite wounds without antibiotics

Dog bites continue to be the most common bite injury in the United States. We previously reported a series of 61 patients with 215 dog bite wounds. Of these, 55 patients had 188 dog bite wounds of the head and neck area which were treated with copious saline pressure irrigation, meticulous wound and wound edge debridement, repeated copious saline pressure irrigation, adequate antibiotic coverage, wound closure, and close postoperative monitoring. A wound infection rate of .53% and a patient infection rate of 1.8% were obtained using this protocol. Our present study uses the same protocol with the exclusion of antibiotic coverage. Our series of 49 patients with 145 head and neck wounds reveals a wound infection rate of 1.4% and a patient infection rate of 4%. This is not statistically significantly different from the outcome of the previous study.     

The Fort McMurray demonstration project in social marketing: health- and safety-related behaviour among oil sands workers

This is the first round in a series of surveys conducted inFort McMurray as part of the Fort McMurray Demonstration Projectin social marketing. This component of the survey was intendedto focus on the most prominent group of employed workers inthe community and to compare their patterns of response withthe community as a whole. Respondents to the survey were overwhelminglymale (96%), married (72.9%) and living in households of twoto five persons (87.9%). They were predominantly aged 30–44(55%) and graduates of high school (53.5%). Younger male workers(below age 30) were more likely to have a high school diploma(78.3%) or some additional technical or vocational training(21.7% compared to 12.5% overall) and to be unmarried or separated.Attitudes toward safety-related behaviours were stronger thanfor respondents from the community as a whole. Approximately70–100% of all age groups and both sexes showed strongagreement with attitudes involving child car seats and the unacceptabilityof drinking and driving. These attitudes include strong advocacyof vigorous enforcement of occupational health and safety standards.However, they showed a variability similar to the communityas a whole in behaviour at home compared to work, generallyreporting more consistent use of personal protection on thejob than in their own homes, particularly hearing protection.Even so, they were much less likely to perform stretching andwarm-up exercises prior to exertion than community residentsin general. The potential may exist to transfer the technologyand attitudes from workplace health and safety to communitysafety. One possible strategy to accomplish this is to involveworkers in this industry directly in community initiatives.This strategy may be generalizable to any community in whichthere are major employers who place a heavy emphasis on riskcontrol and occupational health and safety.     

Immunochemical analysis of a cytochrome P-450IA1 homologue in human lung microsomes

The monoclonal antibody MAb 1-7-1, which specifically binds to cytochromes P-450IA1 and P-450IA2 in 3-methylcholanthrene-induced rat liver microsomes, was used to identify a cytochrome P-450IA1 homologue in human lung microsomes. Although MAb 1-7-1 had similar affinity constants for human and rat microsomes, the amount bound to human lung microsomes was severalfold lower than that bound to microsomes from untreated rat or rabbit lung and much lower than the amount bound to 3-methylcholanthrene-induced rat lung or liver microsomes. The amount bound to untreated baboon lung microsomes was similar to that bound to human lung microsomes. Three cytochrome P-450IA1-catalyzed activities, 7-ethoxyresorufin O-deethylase, 7-ethoxycoumarin, O-deethylase, and aryl hydrocarbon hydroxylase, were measurable in human lung microsomes, but the cytochrome P-450IA2-dependent activity acetanilide 4-hydroxylase was not. MAb 1-7-1 inhibited, and its binding correlated strongly with, 7-ethoxyresorufin O-deethylase activity (r = 0.92, p less than 0.01) in human lung microsomes. 7-Ethoxyresorufin O-deethylase activities in human lung were similar to those measured in untreated baboon lung but considerably lower than those present in untreated rabbit lung, untreated or 3-methylcholanthrene-induced rat lung and liver, or human liver. We conclude that MAb 1-7-1 recognizes a cytochrome P-450IA1 homologue in human lung and that no cytochrome P-450IA2 homologue is detected. Cytochrome P-450IA1 is expressed in human lung at relatively low levels, similar to those observed in untreated primate (baboon) lung. The majority of the 19 human lung samples examined do not exhibit a permanent polycyclic aromatic hydrocarbon-induced state with respect to this isozyme.     

Is the message getting through? Nutritional knowledge of pregnant women in Edinburgh and London

This paper reports the results of a survey in which pregnant women in London and Edinburgh were asked about their knowledge and understanding of the recent recommendations of expert committees (James, 1983; DHSS, 1984). In general, Londoners had a better understanding, although in both regions manual groups were less knowledgeable, with the Edinburgh manual group the least well informed.     

Implementation of a Patient Charting System: Challenges Encountered and Tactics Adopted in a Burn Center

The rapid movement of information technologies into health care organizations has raised managerial concern regarding the capability of today's institutions to satisfactorily manage their introduction. Indeed, several health care institutions have consumed huge amounts of money and frustrated countless people in wasted information systems implementation efforts. Unfortunately, there are no easy answers as to why so many health informatics projects are not more successful. In this light, the aim of this study is to provide a deeper understanding of how clinical information systems are being implemented by emphasizing research efforts on the dynamic nature of the process, that is, the “how” and “why” of what happened. Using a case study methodology, we examined the implementation of a patient charting system in the Burn Center of a large, not-for-profit, teaching hospital. Based on an in-depth examination of this implementation, several insights are offered to those who have responsibility for managing complex and risky clinical information system implementation projects.     

Antegrade continence enemas in the management of intractable faecal incontinence.

The introduction of the Malone procedure has improved the outlook for children with severe faecal incontinence. Phosphate and saline enemas are administered through the exteriorized appendix in antegrade fashion to achieve evacuation and ensure cleanliness. The appendix functions as a non-refluxing catheterizable channel: If it is not available for use, a tubularized caecal flap is a safe alternative. We have constructed Malone stomas using the appendix in 20 patients and another seven patients have undergone the caecal flap modification. The mean age was 8.6 years. Eleven of the patients were boys and 16 (59%) were girls. Six children required dilatation or revision of their stomas for stenosis. One developed small bowel obstruction and another has stopped using the stoma. The results of the continence enemas were considered to be very good by the vast majority of patients and their carers. Our recent experience suggests that bisacodyl may be a valuable adjunct to the antegrade enemas of phosphate and saline. We believe that this procedure may be extended with benefit to adults with serious faecal incontinence in whom standard measures have failed.