Spread of local anaesthetic solutions following sacral extradural (caudal) block: influence of posture

Extradural sacral (caudal) block was performed in 17 cases (14 patients) of chronic low back pain. In each case 22 ml of a bupivacaine/methylprednisolone solution incorporating a radioopaque dye was injected over a 2-min period. Patients were randomly assigned to receive the injection in the horizontal position or with 15 degrees head-up or head-down tilt applied to the operating table. Results indicate that analgesia is usually more localised than spread of solution determined by x-ray evidence and that higher levels of analgesia are achieved in patients in the head-up position. Possible causes are the differing distribution characteristics of the constituents of the solution and the gravitational effects of posture on cerebrospinal fluid mechanics. Technical problems associated with obesity, congenital abnormalities, vascular uptake of solution, and delayed spread of the injectant due to adhesions are discussed.     

Resistance of clinical isolates of Haemophilus influenzae in United Kingdom 1986.

Between 1 January and 31 March 1986, 2434 strains of Haemophilus influenzae collected from 23 laboratories in the United Kingdom were examined. With the same criteria as previous studies in 1977 and 1981 the prevalence of resistance was: ampicillin 7.8% (6.2% beta-lactamase producers and 1.6% non-producers), tetracycline 2.7%, chloramphenicol 1.7%, trimethoprim 4.2%, and sulphamethoxazole 3.5%. of the 87 capsulated strains, 15 produced beta-lactamase, nine were resistant to ampicillin but did not produce beta-lactamase, and two strains, one of which produced beta-lactamase, were resistant to chloramphenicol and tetracycline. Since 1977 the prevalence of resistance to ampicillin, chloramphenicol, and trimethoprim has increased significantly. During 1981-6 strains resistant to ampicillin but not producing beta-lactamase and strains resistant to trimethoprim have significantly increased.     

The five-ringed brown snake, Pseudonaja modesta (Gunther): report of a bite and comments on its venom

The first case report of systemic evenomation by the five-ringed brown snake, Pseudonaja modesta, is presented. The patient had mild general symptoms of envenomation only, with no coagulopathy or evidence of paralysis. Data on P. modesta venom is presented, which shows an absence of a coagulant component in this venom. The venom gives a positive reaction to brown snake venom in the CSL Venom Detection Kit.     

Previous weight loss experiences of bariatric surgery candidates: how much have patients dieted prior to surgery?

OBJECTIVE: To describe the dieting histories of bariatric surgery candidates. RESEARCH METHODS AND PROCEDURES: One hundred seventy-seven individuals with extreme obesity who sought bariatric surgery completed the Weight and Lifestyle Inventory, a self-report instrument that assesses several variables, including weight and dieting history. Patients' dieting histories were further explored with an aided recall during a preoperative behavioral/psychological evaluation performed by a mental health professional. RESULTS: Participants who completed the Weight and Lifestyle Inventory reported an average of 4.7 +/- 2.9 successful dieting attempts, defined as those that resulted in a loss of 10 lbs (4.5 kg) or more. These individuals reported a mean total lifetime weight loss of 61.1 +/- 41.3 kg. Despite these efforts, their weight increased from 89.4 +/- 27.4 kg at the time of their first diet (age 21.2 +/- 10.1 years) to 144.5 +/- 30.8 kg at the time they underwent their behavioral/psychological evaluation (age 43.0 +/- 11.0 years). Results of the aided recall revealed that participants had made numerous other efforts to lose weight that were unsuccessful. Self-directed diets and commercial programs were used more frequently. DISCUSSION: Individuals who sought bariatric surgery reported an extensive history of dieting, beginning in adolescence, that was not successful in halting progressive weight gain. Thus, the recommendation often made by insurance companies that patients delay surgery to attempt more conservative treatment options may be unwarranted, particularly in the presence of significant obesity-related comorbidities. Weight loss histories should be routinely examined during a behavioral evaluation to determine whether additional attempts at non-surgical weight loss are advisable. Future studies also are needed to explore the potential relationship between dieting history and postoperative outcome.     

The use of the polymerase chain reaction to map CD4+ T cell epitopes.

CD4+ T cells recognize processed exogenous antigen in the form of peptides bound to syngeneic major histocompatibility complex class II molecules on antigen-presenting cells. We have developed a novel and convenient method to synthesize and map CD4+ T cell epitopes of cloned antigens using polymerase chain reaction (PCR)-directed construction of genes expressing recombinant protein fragments. Unique restriction sites incorporated into the PCR primers were employed for the unidirectional cloning of gene fragments into a bacterial expression vector that can be induced to high-level expression. The bacterial lysate could be used directly in T cell proliferation assays. Overlapping recombinant fragments spanning the entire protein were generated and tested. The length of the sequence containing the epitope was further reduced by utilizing PCR to generate 3' truncations. Finally, a small number of overlapping peptides spanning a sequence of 39 amino acids were synthesized to identify a thirteen-amino acid peptide epitope within chicken transferrin that stimulates the T helper cell clone D10.G4.1. PCR-directed construction of fragments of antigen allows for optimal design of strategies for the mapping and analysis of CD4+ T cell epitopes.