The potency (ED50) and cardiovascular effects of rapacuronium (Org 9487) during narcotic-nitrous oxide-propofol anesthesia in neonates, infants, and children.

We studied the neuromuscular blocking effects of rapacuronium (Org 9487) (dose-response curve, onset, and 50% effective dose [ED50] value), and changes in heart rate and blood pressure, as well as evidence of histamine release in neonates, infants, and children in an open-label, randomized, two-center study. Fifteen neonates, 30 infants, and 30 children were studied. Anesthesia was induced and maintained with propofol, nitrous oxide:oxygen (60:40), and fentanyl. Mechanomyographic monitoring of neuromuscular function was performed at the thumb. The potency (ED50) for neonates, infants, and children were 0.32 (95% confidence interval [CI] 0.15-0.61), 0.28 (95% CI 0.11-0.61), and 0.39 (95% CI 0.17-0.85) mg/kg, respectively. Neonates who received 0.3, 0.6, or 0.9 mg/kg Org 9487 developed a maximum T1 twitch depression of 34 +/-28%, 98 +/- 3%, and 99 +/- 2%, respectively. Time-to-peak effect (onset time) for 0.9 mg/kg Org 9487 was 57 +/- 20 s. Maximum percent T1 twitch depression (+/-SD) in infants who received 0.3, 0.6, or 0.9 mg/kg rapacuronium was 41 +/- 34%, 96 +/- 7%, and 100 +/- 1%, respectively. Time-to-peak effect for 0.9 mg/kg Org 9487 was 62 +/- 29 s. In children 0.3, 0.6, and 0.9 mg/kg rapacuronium resulted in an average percent T1 twitch suppression of 29 +/- 23, 83 +/- 11, and 90 +/- 16, respectively. Time-to-peak effect of 0.9 mg/kg Org 9487 was 96 +/- 33 s, respectively. There was no evidence of histamine release or significant changes in heart rate or blood pressure in either group at any dose. Rapacuronium is a low-potency nondepolarizing muscle relaxant with a fast onset of relaxation and minimal cardiovascular effects. Its potency (ED50) is similar in neonates (0.32 mg/kg), infants (0.28 mg/kg), and children (0.39 mg/kg). T1 suppression (90% +/- 16) is less and time to peak effect (96 +/- 33 s) is greater (0.9 mg/kg rapacuronium) in children, compared with the combined group of infants and neonates. IMPLICATIONS: This study assesses the potency of rapacuronium (Org 9487) in pediatric patients. The potency of rapacuronium is similar in neonates (0.32 mg/kg), infants (0.28 mg/kg), and children (0.39 mg/kg).     

Alcoholic hepatitis

Opinion statement Alcoholic hepatitis is a multisystem disease seen in individuals who chronically abuse alcohol. When severe, it is associated with a very high mortality rate, with nearly 50% of severely affected persons dying within 1 month of hospitalization. Primary therapy is complete alcohol abstinence and supportive care. Corticosteroids have been shown to be beneficial in a subset of severely ill patients with alcoholic hepatitis and concomitant hepatic encephalopathy. Pentoxifylline has been shown to improve short-term survival rates. Other pharmacologic interventions, including colchicine, propylthiouracil, calcium channel antagonists, and insulin with glucagon infusions, have not been proven to be beneficial. Nutritional supplementation with high-calorie, high-protein diets does not improve mortality rates. Orthotopic liver transplantation is highly controversial in this population of patients and currently is not indicated as definitive treatment. Extracorporeal liver support devices are still in their developmental stage and are only experimental.     

Serial axial length measurements in congenital glaucoma

PURPOSE: To illustrate the utility of axial length measurements in the management of congenital glaucoma. METHODS: Interventional case series. Twelve eyes of six consecutive patients with congenital glaucoma were followed with serial axial length measurements. The axial growth patterns were compared with the normal growth curve. RESULTS: Eight (66.7%) of 12 eyes had initial axial lengths longer than the normal range, and 4 eyes (33.3%) were within the normal range. After surgical intervention with good intraocular pressure control in 10 eyes, 3 eyes showed a decrease of axial length and 7 eyes showed no decrease of axial length, but the axial growth pattern paralleled the normal growth curve. After surgical intervention with poor intraocular pressure control, 2 eyes had axial growth pattern greater than the normal pattern. CONCLUSION: With intraocular pressure control in congenital glaucoma, axial length may decrease or the axial growth pattern may parallel the normal growth curve. Axial length measurements may be useful to monitor the control of congenital glaucoma.     

Postnatal development of flicker sensitivity in guinea pigs

Background: The retinal response to flickering stimuli (steady state ERG) recruits many retinal elements and is a sensitive indicator of early retinal dysfunction. This study reports the post‐natal maturation of the steady state ERG response in guinea pigs. Methods: The steady state ERG response to flickering stimuli (0.6 to 20 Hz) was recorded from dark adapted (more than 12 hrs) English Shorthair guinea pigs (n = 7) using flashes that produced rod and cone dominated responses. Temporal sensitivity functions and critical fusion frequencies (GFF) were derived over a range of ages from postnatal day (PND) 1 to 45. Results: Guinea pig rod and cone temporal sensitivity functions show shape characteristics and CFF similar to humans. Furthermore, the post‐natal development of the guinea pig temporal characteristics is also similar to that of humans—they are present at birth and mature rapidly post‐natally. The time‐course of CFF maturation is similar for rod and cone mediated responses. Conclusions: These data show that the temporal response and its maturation in the guinea pig retina is similar to that in humans. Therefore, we propose that the guinea pig is a particularly useful animal model to study retinal disease in early childhood.     

Effects of dietary calcium on atherosclerosis, aortic calcification, and icterus in rabbits fed a supplemental cholesterol diet

Background  

Vascular calcification is implicated in myocardial infarction, instability and rigidity of the aortic wall, and bioprosthetic failures. Although an increase in the calcium (Ca) content in atherogenic diets has been shown to decrease atherosclerosis in rabbits, whether Ca supplementation and deficiency can affect atherosclerosis-related aortic calcification remains unknown.     

Chirurgie des sarcomes des tissus mous des membres et de la paroi du tronc

Surgical advances over the last twenty years have increased the rate of local control of soft tissue sarcoma from 70 to 80 %. However, the management of soft tissue sarcoma, especially initial treatment, remains inadequate outside specialized treatment centres. This paper discusses how to minimize diagnostic errors and perform biopsies. Soft tissue sarcoma surgery requires careful planning and must be integrated into a multidisciplinary therapeutic approach. A “whoops” excision can compromise a patient’s prognosis. The quality of surgery is best evaluated by the UICC residual disease (R) system, which helps to adapt complementary treatments.     

Evidence for a novel gene for familial febrile convulsions, FEB2, linked to chromosome 19p in an extended family from the Midwest

Febrile convulsions are a common form of childhood seizure. It is estimated that between 2 and 5% of children will have a febrile convulsion before the age of 5. It has long been recognized that there is a significant genetic component for susceptibility to this type of seizure. Wallace, Berkovic and co-workers recently reported linkage of a putative autosomal dominant febrile convulsion gene to chromosome 8q13-21. We report here another autosomal dominant febrile convulsion locus on chromosome 19p. Linkage analysis in this large multi- generational family gave a maximum pairwise lod score of 4.52 with marker Mfd120 at locus D19S177. Linkage to the chromosome 8 locus was excluded in this family. Haplotype analysis using both affected and unaffected family members indicates that this febrile convulsion gene, which we call FEB2 , can be localized to an 11.7 cM, 1-2 Mb section of chromosome 19p13.3, between loci D19S591 and D19S395.      

世界神经病联合会国际合作共济失调量表介绍

目的:介绍世界神经病联合会国际合作共济失调量表内容。方法:全文翻译世界神经病联合会国际合作共济失调量表,并检索Medline1997-01/2006-10与世界神经病联合会国际合作共济失调量表相关文献,检索词"International Cooperative Ataxia Rating Scale"。结果:世界神经病联合会国际合作共济失调量表是半定量化的神经功能评价量表,可以描述和定量评估典型小脑性共济失调症状。该量表是目前世界上惟一被广泛使用的评价共济失调疾病的神经功能量表,评价项目设置最为科学和齐全。适用于包括脊髓小脑性共济失调、小脑性共济失调以及Friedreich共济失调等多种类型的共济失调疾病。其评估效力已被研究结果所证实,虽然某些方面可能有待完善。在国内,该量表尚未得到相关领域研究者的认识和使用。结论:世界神经病联合会国际合作共济失调量表在国际神经病学相关研究领域得到较广泛的使用,有利于客观科学评估病情和治疗效果,值得在中国推广应用。