Single-shot ropivacaine wound infiltration during cesarean section for postoperative pain relief

ObjectiveTo assess the efficiency of single-shot ropivacaine wound infiltration during cesarean section for postoperative pain relief, using a prospective, randomized, double-blinded study.Patients and methodsOne hundred consecutive patients with planned cesarean section were enrolled between September 2007 and May 2008 and randomized into two groups: single-shot wound infiltration of 20 mL of ropivacaine 7.5 mg/mL (Group R; n = 56) or single-shot wound infiltration of 20 mL of saline solution (group T; n = 44). The primary goal of this study was the double-blinded evaluation of the postoperative pain after coughing and leg raise using the 100-mm visual analog scales (VAS) during the first 48 postoperative hours after cesarean delivery. The secondary goals were the occurrence of nausea and vomiting and the morphine consumption.ResultsNumerical pain rating scale for pain evaluation was significantly lower (P < 0.05) in the ropivacaine group than in the control group at M0, M20, M40, M60, H2 and H4. But, at H8, H12 and H24, no significant difference for VAS was noted between the two groups. The occurrence of nausea and vomiting and the total morphine consumption were not significantly different between the two groups during the first 48 postoperative hours.Discussion and conclusionSingle-shot ropivacaine wound infiltration during planned cesarean section is a simple and safe procedure that provides effective reduction of post-partum pain within the first 4 hours.     

Should we screen patients for carotid artery disease before lung cancer resection?

BackgroundPostoperative stroke is a rare complication after lung cancer surgery but has a high mortality rate. No strategy has been recommended to detect carotid artery disease preoperatively in lung cancer patients. The main objective of this study was to evaluate whether a routine carotid duplex ultrasound (DUS) altered the preoperative management of these patients.MethodsWe performed a single-centre, retrospective study of all patients referred for lung cancer resection over a two-year period and reviewed the available carotid DUS results. We quantified the number of carotid artery disease diagnosis, the severity of the disease according to DUS results, and the number of treatments initiated preoperatively. We examined relationships between cardiovascular history and preoperative carotid artery disease diagnosis.ResultsAmong the 398 consecutive lung surgery patients, 6% had a preoperative history of stroke or transient ischemic attack, and one developed a postoperative stroke, of cardioembolic origin. Three hundred and seven patients (77%) had preoperative carotid DUS. Carotid DUS results elicited anti-platelet therapy initiation or endarterectomy before lung resection in 7 out of these 307 patients (2.3%). One hundred and seventy-one carotid DUS were retrospectively reviewed by an expert, who diagnosed carotid stenosis >50% and occlusion in 2.3% and 1.2% of patients, respectively. Abnormal carotid DUS was associated with history of lower extremity artery disease (P<0.001), diabetes mellitus (P<0.05) and dyslipidemia (P<0.05).ConclusionsThis retrospective observational study showed that routine preoperative carotid DUS led to few carotid stenosis detection and few perioperative management alterations. Carotid artery disease diagnosis was associated with cardiovascular history and risk factors. Future studies should examine how to select patients who will benefit from a preoperative carotid DUS.     

Induction of immunoreactive interleukin-1β and tumor necrosis factor-α in the brains of rabies virus infected rats

Interleukin-1β (IL-1β) and tumor necrosis factor-α (TNFα) are important cytokines in the development of brain inflammation during pathological process. During rabies virus infection, the level of these proinflammatory cytokines are enhanced in the brain. In the present study we determined the cellular localization of these two cytokines by immunocytochemistry in brains of rats infected with rabies virus, at different time-intervals of the disease (day 1, 3, 4, 5 and at final stage day 6 post-infection (p.i.)). Cellular identification of IL-1β (irIL-1β) and TNFα (irTNFα) immunopositive cells was studied using a polyclonal antibody against these cytokines and against glial fibrillary acidic protein (GFAP) to detect astrocytes and GSA-I-B4 isolectin to detect microglial cells and/or infiltrating macrophages. In brains of control and early infected rats, irIL-1β was only detected in fibers located in the hypothalamus, supraoptic and tractus optic nuclei and infundibular nucleus. From day 4 onwards until day 6 p.i., enhanced irIL-1β was found and identified either in activated ameboid and/or infiltrated macrophages (amygdala, thalamus, internal capsula, subtantia nigra, septal nuclei and around blood vessels), or in activated ramified cells (hypothalamus and periventricular nucleus, piriformis and cingulate cortex, hippocampus). IrTNFα was observed in the brains of rats at a final stage of disease (day 5 and 6 p.i.): in the hypothalamus, the amygdala, the internal capsula, the thalamus, the septal nuclei, the hippocampus, the habenular nuclei and around the blood vessels. Ir-TNFα was detected in round cells identified as ameboid microglia and/or infiltrated macrophages. A marked activation of microglial and astroglial cells was observed mainly in the hypothalamus, the thalamus and hippocampus and around the blood vessels, at day 4 p.i. and later, revealing a high central inflammatory reaction in brains of rabies virus infected rats. These results showed that IL-1β and TNFα are produced in the brain both by local microglial cells and infiltrating macrophages during rabies infection. Thus, these cytokines may play an important role in coordinating the dramatic inflammatory response associated with the rabies-encephalopathy as well as in the neural modification and alteration of brain functions.     

Arson in mentally ill and criminal populations

Two groups of adult arsonists, 27 with mental illness and 23 not considered to be mentally ill, were examined for demographic features, premorbid factors, motives, and family background. Almost half (46%) of the mentally ill arsonists were mentally retarded. A large proportion of the not-mentally-ill group committed arson as a "crime of passion," 33% of which occurred under the influence of alcohol. Both groups reported a high proportion of absent fathers and seriously disturbed family relations. The relationship of these acts to sexual impulses was found to be minimal, a finding that contrasts with case report studies.     

Perception of optical flow in cortical blindness: a case report.

Motion perception was studied in a subject with bilateral lesion of the visual cortex, involving severe damage to cortical areas V1 and V4, but with no apparent damage to visual associative areas situated in occipito-parietal and lateral occipito-temporal (presumably V5) zones. He was able to perceive optical flow motions simulating motion in depth in "blind" parts of his visual field, provided that the stimulus-onset was temporally dissociated from its motion. Moreover, he was able to discriminate between different velocities and directions of motion. The results suggest that perimetrically "blind" parts of the visual field in this patient have true capacities to process visual motion. They are discussed in reference to the subject's ability to move freely in his environment and in reference to the role of extrastriate visual pathways in visual motion processing.     

Variability and singularity arising from poor compliance in a pharmacokinetic model I: the multi-IV case

We consider a simple multi-IV model for drug concentration in the case of poor patient compliance. The model is a stochastic one, and is thus able to take into account an irregular drug intake schedule. Under some assumptions, we study features of the drug concentration relevant for practical purposes such as its variability or the regularity of its cumulative probability distribution. We consider five variants: random instants for drug intake with either deterministic or random doses, both in continuous and discrete-time settings, plus a model with stochastically varying elimination rate. Our computations make it possible to assess in a precise way the effect of various significant parameters such as the mean rate of intake, the elimination rate, and the mean dose. They also quantify how much poor compliance will affect the regimen: in that view, we provide precise comparisons with the variability of concentration in the cases of (a) a fully compliant patient and (b) a population of fully compliant patients with lognormally distributed elimination rates. The time discretized version of our models reveal unexpected links with measures known as infinite Bernoulli convolutions. Our findings help in understanding the consequences of poor compliance, and may have practical outcomes in terms of drug dosing and scheduling.     

Biodistribution of doxorubicin-alkylated poly(L-lysine citramide imide) conjugates in an experimental model of peritoneal carcinomatosis after intraperitoneal administration.

Peritoneal spread is a common manifestation in ovarian and gastrointestinal cancer. Intraperitoneal (i.p.) chemotherapy after cytoreductive surgery is associated with high systemic or local toxicity. A macromolecular drug delivery system was evaluated with the aim of improving the therapeutic index of i.p. chemotherapy. Peritoneal carcinomatosis was generated in BDIX rats (n=55) by i.p. injection of 2 million DHDK12 cells. Fourteen days later, doxorubicin (DOX) and two DOX-alkylated poly(L-lysine citramide imide) conjugates bearing 9.5% and 20.5% (w/w) chemically bound drug, respectively, were given i.p. to rats at a single 2 mg DOX/kg dose. Free and polymer-bound DOX were assessed in plasma, peritoneal fluid, abdominal tissues and heart, 15 min, 2, 6, 24, 48 and 168 h after injection. According to pharmacokinetic profiles, the peritoneal fluid areas under the concentration versus time curves (AUCs) were 2 and 2.6 times greater for the conjugates (P-DOX20 and P-DOX10, respectively) than for the free drug, respectively. Conjugates crossed the peritoneal barrier slower than the free drug. For the tumor, AUCs were, respectively, 3 and 7 times higher for the conjugates than for free DOX. The elimination half-lives of the conjugates were higher than that calculated for the free drug. Only very small concentrations were detected in peripheral organs and in the heart. In contrast, significant retention and accumulation of the conjugates were found in abdominal organs, particularly in the tumor. There was no sign of macroscopic chemical peritonitis after injection of the polymer-DOX conjugates. In conclusion, the conjugates have higher elimination half-lives than free DOX and were preferentially retained in abdominal organs and in the peritoneal carcinomatosis. This feature is of clinical interest to target tumor deposits.