Postoperative pain and self-management: women's experiences after cardiac surgery

Title.  Postoperative pain and self-management: women's experiences after cardiac surgery.
Aim.  This paper is a report of a study to describe women's experiences and their self-management of postoperative pain after elective cardiac surgery.
Background.  Cardiac surgery involves several pain-sensitive areas, and untreated postoperative pain may lead to chronic pain. Early discharge requires increased patient participation in pain management. Women report more postoperative pain than men after cardiac surgery.
Methods.  Semi-structured interviews were conducted in 2004–2005 with 10 women 1–2 weeks after discharge from their first elective cardiac surgery. Qualitative content analysis was used to identify recurring themes. Pain diaries were used to record postoperative pain experiences 1–2 weeks before the interviews, providing more nuances to the experiences of pain and pain management.
Findings.  Postoperative pain experiences varied from no pain to pain all the time. Worst pain intensity was recorded as moderate or more. Pain experiences depended on what women's expectations of pain after cardiac surgery. None wanted to complain about their painful experiences. The women had needed for more individualized information about self-management of pain, and had difficulties remembering the information they had received. Most did not want to use pain medication, or waited to do so until pain was unbearable.
Conclusion.  Patients need more individualized and gender-specific information before early discharge from cardiac surgery to improve self-management. More specific predischarge education on self-management using analgesics regularly might prevent pain ratings rising to a severe level after discharge home.     

Comparison of in-house and commercial 16S rRNA sequencing with high-performance liquid chromatography and genotype AS and CM for identification of nontuberculous mycobacteria

Sequencing of the 16S gene or other targets and line probe assay are in wide use for the identification of nontuberculous mycobacteria. We compared in-house and commercial sequencing with 3 sequence databases against high-performance liquid chromatography (HPLC) and line probe assay (HAIN Genotype AS and CM) for the identification of 84 reference, clinical, and unique strains representing 41 species. Consensus of methods was used as reference standard. Sequencing identification was more specific and flexible than HPLC, but it was limited by database content and quality as well as fragment length. No one database satisfied all requirements. In-house sequencing was lower in cost than commercial sequencing or line probe assay.     

Extradural haematoma: a rare, but fatal complication of pyknodysostosis

We report a 4-year-old girl with pyknodysostosis who suffered a skull fracture and epidural haematoma following a minor fall. Craniotomy was needed to evacuate the haematoma and prevent mortality. Extradural haematoma in this group of patients is rare, ours being the second case reported in literature.     

Medical treatment of Jehovah's witnesses

A 35-year-old man attempted suicide by a shotgun discharge to his abdomen. Although the patient had been awake, oriented, and conversing about baseball during the emergency medical services ride to the hospital, he made no mention of his religious beliefs. He is bleeding profusely when he arrives at the emergency room (ER). He is taken to the operating room (OR) for abdominal surgery to stop the bleeding and repair his damaged liver. He has lost a critical amount of blood and is under anesthesia when a call to the OR comes from an ER nurse who has been approached by the patient's family and given a Jehovah's Witness card signed by the patient. The card states: "NO BLOOD TRANSFUSION! As a God-fearing Christian and a believer in Jehovah's word, the Bible, I hereby demand that blood, in any way, shape or form, is NOT to be fed into my body; however, blood substitutes may be used in case of extreme loss of blood."     

NIH 11082 produces anti-depressant-like activity in the mouse tail-suspension test through a delta-opioid receptor mechanism of action

The present study examined the effects of NIH 11082 ((-)-(1R,5R,9R)-5,9-dimethyl-2'-hydroxy-2-(6-hydroxyhexyl)-6,7-benzomorphan hydrochloride), a benzomorphan analogue, in the mouse tail-suspension, an assay used to detect anti-depressant agents. NIH 11082 significantly decreased immobility time during tail-suspension, with a comparable magnitude as the tricyclic anti-depressant desipramine. Importantly, NIH 11082 failed to elicit convulsions or other overt behavioral signs of toxicity. The delta-opioid receptor antagonist naltrindole (AD50=2.0 mg/kg), but not the non-selective mu-opioid receptor antagonist naltrexone or the kappa-opioid receptor antagonist nor-BNI, blocked the effects of NIH 11082 in the tail-suspension test. These results reinforce the notion that delta-opioid receptor agonists can produce significant effects in a behavioral model used to screen anti-depressant drugs.     

Probes for narcotic receptor mediated phenomena. 34. Synthesis and structure-activity relationships of a potent mu-agonist delta-antagonist and an exceedingly potent antinociceptive in the enantiomeric C9-substituted 5-(3-hydroxyphenyl)-N-phenylethylmorphan series

Both of the enantiomers of 5-(3-hydroxyphenyl)-N-phenylethylmorphan with C9alpha-methyl, C9-methylene, C9-keto, and C9alpha- and C9beta-hydroxy substituents were synthesized and pharmacologically evaluated. Three of the 10 compounds, (1R,5R,9S)-(-)-9-hydroxy-5-(3-hydroxyphenyl-2-phenylethyl-2-azabicyclo[3.3.1]nonane ((1R,5R,9S)-(-)-10), (1R,5S)-(+)-5-(3-hydroxyphenyl)-9-methylene-2-phenethyl-2-azabicyclo[3.3.1]nonane ((1R,5S)-(+)-14), and (1R,5S,9R)-(-)-5-(3-hydroxyphenyl)-9-methyl-2-phenethyl-2-azabicyclo[3.3.1]nonane ((1R,5S,9R)-(+)-15) had subnanomolar affinity at mu-opioid receptors (Ki = 0.19, 0.19, and 0.63 nM, respectively). The (1R,5S)-(+)-14 was found to be a mu-opioid agonist and a mu-, delta-, and kappa-antagonist in [35S]GTP-gamma-S assays and was approximately 50 times more potent than morphine in a number of acute and subchronic pain assays, including thermal and visceral models of nociception. The (1R,5R,9S)-(-)-10 compound with a C9-hydroxy substituent axially oriented to the piperidine ring (C9beta-hydroxy) was a mu-agonist about 500 times more potent than morphine. In the single-dose suppression assay, it was greater than 1000 times more potent than morphine. It is the most potent known phenylmorphan antinociceptive. The molecular structures of these compounds were energy minimized with density functional theory at the B3LYP/6-31G* level and then overlaid onto (1R,5R,9S)-(-)-10 using the heavy atoms in the morphan moiety as a common docking point. Based on modeling, the spatial arrangement of the protonated nitrogen atom and the 9beta-OH substituent in (1R,5R,9S)-(-)-10 may facilitate the alignment of a putative water chain enabling proton transfer to a nearby proton acceptor group in the mu-opioid receptor.     

Erectile dysfunction, discrepancy between high prevalence and low utilization of treatment options: results from the 'Cottbus Survey' with 10 000 men

OBJECTIVE: To investigate the age-stratified prevalence of erectile dysfunction (ED) and its comorbidities, and to assess the population's knowledge, utilization, and general attitude towards the treatment for ED. SUBJECTS AND METHODS: In all, 10 000 men received a 35-item questionnaire including the International Index of Erectile Function (IIEF) and sociodemographic questions regarding life style, comorbidities, quality of sexual life and knowledge or experience of ED therapy. In all, 3124 responses were included (31.2%), 2499 men lived in well established partnerships and were assessed as the basic study group. RESULTS: In the entire population the prevalence rate of ED was 40.1%. However, although known, medical treatment for ED is used only by a minority of affected men. The prevalence of ED was independently associated with age, peripheral arterial occlusive disease, hypertension, ischaemic heart disease, diabetes mellitus, and liver diseases. Correlations between sexual quality of life (QoL) and ED were statistically significant (P < 0.01) and moderate to strong (absolute values: Spearman's rho 0.35-0.76). Although 96% of the study population knew at least one phosphodiesterase type 5 (PDE5) inhibitor by name, only 53% considered taking the medication and only 9% of the men with ED had had experience with available PDE5 inhibitors. CONCLUSIONS: The sexual QoL was significantly reduced by ED. Despite high levels of awareness and general acceptance of oral medication for ED, experience with PDE5 inhibitors was low. Further investigation is required to evaluate the general impact of ED on sexual QoL and the need or wish for treatment.     

Cognitive and Social Development in Preschool Children Born to Women Using Substances

Prenatal substance exposure is associated with physical birth defects and increased risk of regulatory and neuropsychological difficulties of children born to mothers using substances while pregnant. Myriad factors, such as maternal psychopathology, stress, and poor living circumstances, may influence childhood development in addition to the teratological effect of prenatal substance exposure. This study explores the long-term developmental consequences in children from birth to age 7 born to women using substances and are in treatment. A series of t tests were performed to explore group effects on the cognitive and social dimensions of Griffiths Mental Development Scales compared with Swedish norms. The results showed significant effects on eye and hand coordination in children aged birth to 7 years and on hearing and speech, practical reasoning, and the general quotient in children aged 3 to 7 years. Children who were exposed primarily to alcohol in utero scored significantly lower on the personal and social skills subscale, eye and hand coordination subscale, and the general quotient than children exposed primarily to substances other than alcohol. These effects did not appear to be mediated by the mothers’ social background or treatment history. The results suggest that children who are exposed to substances, in particular alcohol, in utero are vulnerable overall, but especially in eye and hand coordination and personal and social skills.