When Is a Bispectral Index of 60 Too Low?: Rational Processed Electroencephalographic Targets Are Dependent on the Sedative-Opioid Ratio

Background: Opioids are commonly used in conjunction with sedative drugs to provide anesthesia. Previous studies have shown that opioids reduce the clinical requirements of sedatives needed to provide adequate anesthesia. Processed electroencephalographic parameters, such as the Bispectral Index (BIS; Aspect Medical Systems, Newton, MA) and Auditory Evoked Potential Index (AAI; Alaris Medical Systems, San Diego, CA), can be used intraoperatively to assess the depth of sedation. The aim of this study was to characterize how the addition of opioids sufficient to change the clinical level of sedation influenced the BIS and AAI.

Methods: Twenty-four adult volunteers received a target-controlled infusion of remifentanil (0-15 ng/ml) and inhaled sevoflurane (0-6 vol%) at various target concentration pairs. After reaching pseudo-steady state drug levels, the modified Observer's Assessment of Alertness/Sedation score, BIS, and AAI were measured at each target concentration pair. Response surface pharmacodynamic interaction models were built using the pooled data for each pharmacodynamic endpoint.

Results: Response surface models adequately characterized all pharmacodynamic endpoints. Despite the fact that sevoflurane-remifentanil interactions were strongly synergistic for clinical sedation, BIS and AAI were minimally affected by the addition of remifentanil to sevoflurane anesthetics.     

Morphology of corneal nerves in soft contact lens wear. A comparative study using confocal microscopy

The aim of this study was to evaluate corneal innervation in soft contact lens wearers using the Tomey Confoscan confocal microscope (40x/0.75 objective lens). Three distinct age- and sex-matched subject groups were involved, including extended soft (hydrogel and silicone-hydrogel) contact lens wearers, overnight soft (hydrogel) contact lens wearers, and non contact lens wearers. A number of variables were objectively measured, subjectively evaluated, or graded in order to investigate the distribution and morphology of corneal nerves. For most of the evaluated parameters, no statistically significant differences were found. However, qualitative observations showed noticeable differences in corneal nerve appearance among the different subject groups; the degree of corneal oedema was suggested as the main causative factor. In conclusion, neither the short-term (overnight wear) nor the long-term (12-month extended wear) soft contact lens wear appeared to affect the morphology and/or distribution of corneal nerves as viewed with confocal microscopy.     

Acute and chronic effects of cisplatinum upon testicular function in the rat

One of the side effects of cisplatinum-based chemotherapy is the impairment of spermatogenic function. In order to understand the mechanisms responsible for this side effect, the present study examined the short- and long-term effects of five daily injections of 2 mg/kg cisplatinum upon the functional normality of Leydig cells and Sertoli cells in intact adult rats, and their relationship with the status of spermatogenesis. Results of the present study demonstrate that cisplatinum treatment resulted in a progressive but reversible loss of germ cells from the seminiferous epithelium. Although testicular testosterone contents reduced transiently after the adminisration of cisplatinum, these testosterone levels are otherwise sufficient to support complete spermatogenesis. Thus, the cisplatinum-induced germinal regression cannot be accounted for by hypoandrogenism. The testicular ABP contents of the drug-treated rats remained unchanged during the treatment period, decreased transiently 30 days after the treatment, and returned to normal 120 days after treatment. A decrease in epididymal ABP content was also noted 10 and 30 days after the drug treatment. These observations suggest that Sertoli cell functions were affected by cisplatinum treatment. The effects of cisplatinum upon Sertoli cells were further demonstrated by the dose-dependent suppression of the production of ABP, lactate, and estradiol in cultured Sertoli cells. In addition, cisplatinum administration resulted in a reversible decrease in pituitary weights and an irreversible decrease in seminal vesicle weights. These results further demonstrate the toxic effects of cisplatinum upon various aspects of the male reproductive system.     

Acute suppurative parotitis in a patient on total parenteral nutrition

A report of a patient who developed acute suppurative parotitis while on total parenteral nutrition for small bowel fistula is presented. The importance of early detection of parotitis as a cause of fever is emphasized. Attention to oral hygiene and early resumption of oral intake, whenever possible, are to be encouraged.     

Posterior Cervical-Thoracic Thermograms: Pattern Persistence and Correlation with Chronic Headache Syndromes

SYNOPSIS
These experiments investigate thermographic patterns in the posterior cervical/thoracic (PCT) region of 530headache patients and 30 headache/injury-free volunteers. The study examines: The longitudinal persistence ofProximal and Distal patterns; three distinct midline patterns (PCT I, II, and III); and their correlation with diagnosis,injury, and pain.
Twenty-four (80%) of 30 randomly selected subjects displayed unchanged Proximal patterns at the meanobservation period of 5.5 months. PCT pattern fluctuations occurred in 13/30 (43.3%) subjects. The distinctivenessof each subject's Proximal and Distal patterns was verified by blind calling of thermogram pairs. Patternpersistence was validated with alcohol spray-Patterns were identical regardless of using a 0.5°C or 1.0°Ctemperature setting. Temperature settings of 1.0°C yielded more distinct Proximal and Distal patterns.
Chi square analysis determined that there was no significant difference in the number of PCT III patterns in theexperimental or control groups.
In conclusion, it appears that Proximal and Distal Patterns may be consistent over time and individually unique,but that PCT patterns fluctuate and, therefore, do not correlate with chronic headaches.     

Ziprasidone, Diazepam, or the Combination for Prevention of Cocaine Toxicity in a Mouse Model

Background Acute cocaine poisoning is a common problem in the United States. Sedation with benzodiazepines is the standard treatment, but animal studies have suggested that ziprasidone is also protective.
Objectives To assess whether the combination of these two medications would offer more protection than either treatment alone.
Methods This was a randomized, blinded, placebo-controlled trial in CF-1 mice. The authors administered intraperitoneal injections of 2 mg/kg diazepam (group D), 4 mg/kg ziprasidone (group Z), the same dose of both drugs (group DZ), or saline 15 minutes before intraperitoneal administration of 105 mg/kg cocaine (an estimated lethal dose to 70%). The number of animals with seizures and apparent lethality over the following 30 minutes was recorded.
Results All treatments increased survival relative to placebo (relative risk: D = 2.6, Z = 2.3, DZ = 2.9) and decreased seizures (relative risk: D = 0.5, Z = 0.3, DZ = 0.02).
Conclusions This study suggests that diazepam and ziprasidone have efficacy for preventing lethality from cocaine poisoning in an animal model but that the combination offers little addition to either therapy alone. However, the combination may be more effective for prevention of cocaine-induced seizures.