Effect of a nitric oxide donor (glyceryl trinitrate) on nociceptive thresholds in man

Several animal studies suggest that nitric oxide (NO) plays a role in central and peripheral modulation of nociception. Glyceryl trinitrate GTN) exerts its physiological actions via donation of NO. The purpose of the present study was to examine the effect of this NO donor on nociceptive thresholds in man. On two different study days separated by at least , week 12 healthy subjects received a staircase infusion of GTN (0.015, 0.25. 1.0 ,2.0 mg/kg/min. 20 min each dose) or placebo in a randomized double-blind crossover design. Before the infusion and after 15 min of infusion on each dose, pressure pain detection and tolerance thresholds were determined by pressure a gometry (Somomedic AB, Sweden) in three different anatomic regions (finger, a temporal region with interposed myofascial tissue and a temporal region without interposed myofascial tissue. Relative to placebo, the three higher GTN doses induced a decrease in both detection and tolerance thresholds in the temporal region with interposed myofascial tissue ( p =0.003 detection and p =0.002 tolerance threshold: Friedman). No such changes were observed in the other two stimulated regions. These results could reflect central facilitation of nociception by NO. However, we regard convergence, of nociceptive input from pericranial myofascial tissue and from cephalic blood vessels dilated by NO as a more likely, explanation of our findings.     

Effects of resuscitation fluids on nonadaptive immune responses

BACKGROUND: Colloidal plasma-expander fluids are commonly used as an alternative to blood components in the resuscitation of patients suffering from hemorrhagic shock and trauma. Of these, hydroxyethyl starch is also used as a cryopreservative, and these dual properties have been utilized in the development of a blood storage system that allows the direct transfusion of red cells. The prolonged intravascular persistence of hydroxyethyl starch suggests that phagocytic clearance may be impaired and that the presence of hydroxyethyl starch could exacerbate transfusion-induced immunomodulation. STUDY DESIGN AND METHODS: The effects of colloidal resuscitation fluids on the activation response and phagocytic function of polymorphonuclear cells (PMNs) and monocytes in normal peripheral blood were examined. To mimic the hemolysis associated with cryopreservation, the effects of 1- and 5- percent red cell lysate were studied. Flow cytometric assays were used in all cases. RESULTS: The percentage of phagocytic monocytes and PMNs was not altered; nor were the rates of phagocytosis impaired after incubation with resuscitation fluids. Upregulation of cell surface integrin during activation was similarly unmodified by the fluids. CONCLUSION: Hydroxyethyl starch and other resuscitation fluids do not affect some important antimicrobial functions of the nonadaptive arm of the immune response. This suggests that posttrauma or transfusion- induced immunomodulation is not exacerbated by inhibition at this level.     

Radiography after orthognathic surgery. Part I. Normal appearance

Osteotomies of the mandible and/or maxilla (orthognathic surgery) are common procedures for correcting facial defects. Radiographs of these patients are routinely obtained, and the radiologist must be aware of the normal postoperative appearance as well as surgical complications that may occur. This article presents the common surgical procedures done (sagittal split, vertical subcondylar, genioplasty mandibular osteotomies; and Le Fort I and mid-palatal split maxillary osteotomies) and the routine appearance of uncomplicated procedures on posteroanterior skull and panoramic radiographs. The metallic immobilization devices and orthodontic appliances are also described.     

Bone mineral content in early-postmenopausal and postmenopausal osteoporotic women: comparison of measurement methods

To investigate associations among methods for noninvasive measurement of skeletal bone mass, we studied 40 healthy early postmenopausal women and 68 older postmenopausal women with osteoporosis. Methods included single- and dual-energy quantitative computed tomography (QCT) and dual-photon absorptiometry (DPA) of the lumbar spine, single-photon absorptiometry (SPA) of the distal third of the radius, and combined cortical thickness (CCT) of the second metacarpal shaft. Lateral thoracolumbar radiography was performed, and a spinal fracture index was calculated. There was good correlation between QCT and DPA methods in early postmenopausal women and modest correlation in postmenopausal osteoporotic women. Correlations between spinal measurements (QCT or DPA) and appendicular cortical measurements (SPA or CCT) were modest in healthy women and poor in osteoporotic women. Measurements resulting from one method are not predictive of those by another method for the individual patient. The strongest correlation with severity of vertebral fracture is provided by QCT; the weakest, by SPA. There was a high correlation between single- and dual-energy QCT results, indicating that errors due to vertebral fat are not substantial in these postmenopausal women. Single-energy QCT may be adequate and perhaps preferable for assessing postmenopausal women. The measurement of spinal trabecular bone density by QCT discriminates between osteoporotic women and younger healthy women with more sensitivity than measurements of spinal integral bone by DPA or of appendicular cortical bone by SPA or CCT.     

Wegener granulomatosis of the breast

Two cases of Wegener granulomatosis of the breast are reported. In both cases, this rare disease was detected on mammographic examination and was diagnosed for the first time by a fine-needle aspiration biopsy of the breast. The mammographic findings can lead to misinterpretations and can be confused with advanced mammary carcinoma or the alterations caused by lymphoblastoma, leukemia, or Hodgkin disease. The total regression of the tumorlike lesions in the breast, evidence of involvement of the lung with only slight clinical symptoms, and a very protracted course of the disease were remarkable in both cases.     

神经根减压术中体感诱发电位监测结果与临床预后的相关性

目的：观察腰骶神经根病变患者肌皮神经节段刺激体感诱发电位(DSEP)术中监测结果与术后临床症状改善之间的相关性。方法：对22例经cT或MRI检查证实的腰骶神经根压迫症患者进行神经根减压手术并进行术中诱发电位监测，在术前及术后9周(8-10周)进行临床随访检查。结果：减压手术中DSEP的波幅增高，则术后临床症状明显改善(P＜0．001)；术后DSEP波幅较术前增高（P＜0．001)，潜伏期缩短(P＜0．05)。结论：脊神经根减压中DSEP变化与术后临床症状改善呈正相关；术中DSEP波幅升高可预示术后临床症状改善。