Effects of lidocaine with and without epinephrine on plasma epinephrine and lidocaine concentrations and hemodynamic values during third molar surgery.

Lidocaine with epinephrine is currently the most common local anesthetic agent used for impacted third molar surgery. The purpose of the present study was to define the adverse hemodynamic effects and plasma concentrations of lidocaine and epinephrine on 17 healthy patients during the impacted teeth operations. Arterial blood pressure (systolic blood pressure, diastolic blood pressure), heart rate, peripheral oxygen saturation range, and electrocardiography were measured by an automatic noninvasive pressure device and monitor. High-performance liquid chromatography was used to measure the changes of plasma concentrations of epinephrine and lidocaine from blood samples taken 5 different times during the operation. We concluded that lidocaine-epinephrine is effective local anesthetic and had no important adverse events in healthy patients during the third molar surgery.     

Vaccination of human volunteers with heat-killed M. leprae: local responses in relation to the interpretation of the lepromin reaction

The early (Fernandez) and late (Mitsuda) lepromin reactions were closely examined in a group of healthy, BCG-vaccinated individuals who were given four doses of a heat-killed, armadillo-derived vaccine, i.e., 1.5 X 10(7), 5 X 10(7), 1.5 X 10(8), and 5 X 10(8) bacilli. There was a clear dose-response relationship for both the early and late reactions with no leveling of the responses within the range of doses examined. While the early response was negative in most of the volunteers, the late response was positive in all of the volunteers. No association was found between the early lepromin test and the pre-vaccination skin test to PPD. There was also no association between the early lepromin test and the pre-vaccination skin test response to a soluble Mycobacterium leprae antigenic preparation (MLSA) in general, but there was a good correlation between these two parameters at the highest vaccine dose. The late lepromin response showed no association with either the prevaccination or post-vaccination skin test response to PPD. However, there was a significant correlation between the late lepromin response and the post-vaccination skin test response to MLSA. In general, no association could be found between the in vivo skin tests and the in vitro lymphocyte transformation test (LTT). Thus, the lepromin test is essentially a vaccination which elicits a specific response to M. leprae antigens provided that the dose of armadillo lepromin given is higher than 5 X 10(7). Therefore, it is unsuitable as a diagnostic test for leprosy.(ABSTRACT TRUNCATED AT 250 WORDS)     

United states non-Hodgkin's lymphoma surveillance by occupation 1984-1989: A twenty-four state death certificate study

Death certificates from 23,890 male and female non-Hodgkin's lymphoma (NHL) cases and 119,450 noncancer controls from 24 states for the period 1984-1989 were used to generate hypotheses regarding occupational associations. Cases were frequency matched by age, race, and gender with five controls per case. Odds ratios were calculated for 231 industries and 509 occupations. Significant associations were observed for a variety of white-collar professionals (i.e., real estate agents, secretaries, bookkeepers, teachers, postal employees, business agents, engineers, chemists, and medical professionals) and blue-collar occupations (i.e., firefighters, farm managers, aircraft mechanics, electronic repairers, mining machine operators, and crane and tower operators). © 1995 Wiley-Liss, Inc.     

The effect of calcium dobesilate on venous function following saphenectomy in coronary artery bypass grafting

BACKGROUND: The aim of this study was to determine whether prophylactic use of calcium dobesilate (CD) can improve venous function after saphenous vein harvest in coronary artery bypass graft (CABG). MATERIALS AND METHODS: A total of 100 patients who underwent elective CABG were divided into four equal groups. In Group A, the greater saphenous vein (GSV) was harvested below the knee and, in Group B, through the knee till the groin. These patients remained untreated. Group C received CD in a dosage of 1500 mg po daily after the GSV was harvested below the knee. Group D received same dosage of CD after the GSV was harvested through the knee till the groin. Venous function of ipsilateral leg was evaluated clinically and by Doppler ultrasonography in the postoperative first week and second month. RESULTS: Clinical findings of venous insufficiency were observed with a similar rate between groups at both early and late periods. In Groups A and B, after 2 months, flow velocities decreased and reflux periods increased significantly. In groups C and D, treatment with CD for 2 months after saphenectomy resulted in a significant increase in flow velocities and a significant decrease in reflux periods. Patients in Groups B and D have significantly more impaired venous functions. CONCLUSION: Saphenectomy results in ipsilateral leg venous dysfunction, which seems to be unrelated to leg swelling and to be more prominent in patients with high-level saphenectomy. In addition, to be careful about the restriction of the saphenectomy procedure into the most appropriate level, prophylactic use of CD can prevent this deterioration when it was added to varice socks.     

Mental stress-induced myocardial ischemia in coronary artery disease patients with left ventricular dysfunction

Background  Reduced left ventricular ejection fraction (LVEF) is a risk factor for poor outcomes in patients with coronary artery disease (CAD). Mental stress-induced myocardial ischemia (MSIMI) also identifies a subset of CAD patients at increased risk for future cardiovascular events. Susceptibility to MSIMI in patients with CAD and reduced LVEF is unknown. Methods and Results  We enrolled 182 patients (67 women) with a mean age of 64 years and a documented history of CAD in this study. Baseline resting ejection fraction was determined by use of technetium 99m sestamibi gated single photon emission computed tomography. Abnormal LVEF was defined as less than 45% for men and less than 50% for women (based on published norms for our software [Cedars-Sinai Medical Center]). All participants underwent mental stress testing with a public speaking task. Rest/stress myocardial perfusion single photon emission computed tomography was performed via conventional methodology. Images were visually compared for number and severity of perfusion defects by use of a scoring method from 0 to 4. A summed difference score was calculated as the difference between summed stress and rest scores. A score of greater than 3 was considered abnormal. MSIMI developed in 19% of patients with normal LVEF and 31% of those with reduced LVEF. There is no statistically significant difference between the two groups (P=.11). Conclusions  CAD patients with left ventricular dysfunction are equally susceptible to MSIMI as those with normal LVEF. This study was supported by grants HL 070265 and HL 072059 from the National Heart. Lung, and Blood Institute. This material is also the result of work supported by resources and with the use of facilities at the Department of Veterans. Affairs Medical Center, Gainesville, Fla.     

Effects of Nitrous Oxide on the Rat Heart In Vivo: Another Inhalational Anesthetic That Preconditions the Heart?

Background: For nitrous oxide, a preconditioning effect on the heart has yet not been investigated. This is important because nitrous oxide is commonly used in combination with volatile anesthetics, which are known to precondition the heart. The authors aimed to clarify (1) whether nitrous oxide preconditions the heart, (2) how it affects protein kinase C (PKC) and tyrosine kinases (such as Src) as central mediators of preconditioning, and (3) whether isoflurane-induced preconditioning is influenced by nitrous oxide.

Methods: For infarct size measurements, anesthetized rats were subjected to 25 min of coronary artery occlusion followed by 120 min of reperfusion. Rats received nitrous oxide (60%), isoflurane (1.4%) or isoflurane-nitrous oxide (1.4%/60%) during three 5-min periods before index ischemia (each group, n = 7). Control animals remained untreated for 45 min. Additional hearts (control, 60% nitrous oxide alone%, and isoflurane-nitrous oxide [0.6%/60%, in equianesthetic doses]) were excised for Western blot of PKC-[varepsilon] and Src kinase (each group, n = 4).

Results: Nitrous oxide had no effect on infarct size (59.1 +/- 15.2% of the area at risk vs. 51.1 +/- 10.9% in controls). Isoflurane (1.4%) and isoflurane-nitrous oxide (1.4%/60%) reduced infarct size to 30.9 +/- 10.6 and 28.7 +/- 11.8% (both P < 0.01). Nitrous oxide (60%) had no effect on phosphorylation (2.3 +/- 1.8 vs. 2.5 +/- 1.7 in controls, average light intensity, arbitrary units) and translocation (7.0 +/- 4.3 vs. 7.4 +/- 5.2 in controls) of PKC-[varepsilon]. Src kinase phosphorylation was not influenced by nitrous oxide (4.6 +/- 3.9 vs. 5.0 +/- 3.8; 3.2 +/- 2.2 vs. 3.5 +/- 3.0). Isoflurane-nitrous oxide (0.6%/60%, in equianesthetic doses) induced PKC-[varepsilon] phosphorylation (5.4 +/- 1.9 vs. 2.8 +/- 1.5; P < 0.001) and translocation to membrane regions (13.8 +/- 13.0 vs. 6.7 +/- 2.0 in controls; P < 0.05).     

The peri‐microvascular edema in hippocampal CA1 area in a rat model of sepsis

Encephalopathy is a common complication of sepsis. However, little is known about the morphological changes that occur in the brain during sepsis. In this study, fecal peritonitis was induced in Wistar rats, which had been monitored for 4 h before their brains were removed and samples from the CA1 area taken. In addition to higher blood pressure with a decreasing pattern and a significant drop in rectal temperature, an increased heart rate and marked respiratory failure were observed. The tissue was investigated and compared with corresponding hippocampal samples taken from sham‐operated and not operated control groups. Significantly more peri‐microvascular edema was found in the hippocampal CA1 area in the septic group. The percentages of the peri‐microvascular edema were 158.57 ± 3.6%, 122.84 ± 1.5% and 120.24 ± 1.9% in the fecal peritonitis group, sham‐operated and not operated control groups, respectively. The results may suggest that the edema observed around the microvessels may participate in the pathogenesis of the septic encephalopathy probably by causing in the microvascular permeability characteristics.