A comparison of the antinociceptive and temperature responses to morphine and fentanyl derivatives in rats

In addition to producing antinociception, opioids exert profound effects on body temperature. This study aimed at comparing antinociceptive and hyperthermic responses between two groups of μ-opioid receptor agonists: fentanyl (4-anilinopiperidine-type) and morphine (phenanthrene-type) derivatives in rats. Analgesic activity was assessed by tail immersion test and the body temperature by insertion of a thermometer probe into the colon. Fentanyl (F), (±)-cis-3-methyl fentanyl (CM), (±)-cis-3-carbomethoxy fentanyl (C), (±)trans-3-carbomethoxy fentanyl (T) and (±)-cis-3 butyl fentanyl (B) produced dose-dependent increase in antinociception and hyperthermia. The relative order of analgesic potency was: CM(11.27)>F(1)>C(0.35)≥T(0.11)≥B(0.056). Similar to this, the relative order of hyperthermic potency was: CM(8.43)>F(1)>C(0.46)≥T(0.11)≥B(0.076). Morphine (M), oxycodone (O), thebacon (T) and 6,14-ethenomorphinan-7-methanol, 4,5-epoxy-6-fluoro-3-hydroxy-α,α,17-trimethyl-, (5α,7α) (E) also produced dose-dependent increase in antinociception and hyperthermia. Among morphine derivatives the relative order of analgesic potency was: E(56)>O(5)≥T(2.6)>M(1), and similar to this, the relative order of hyperthermic potency was: E(37)>O(3)≥T(2.3)>M(1). Morphine (phenanthrene-type) and fentanyl (4-anilinopiperidine-type) derivatives produced hyperthermia in rats at doses about 2 times lower, and 6–11 times higher, than their median antinociceptive doses, respectively. This study is first to identify difference between these two classes of opioid drugs in their potencies in producing hyperthermia. Further studies are needed to clarify the significance of these findings.     

Surgical treatment of a left ventricular apical thrombus via robotic surgery

Left ventriculotomy for thrombus removal is usually associated with a high incidence of cardiac arrhythmias and decreased ejection fraction. A 51‐year‐old male patient was admitted to the emergency department with loss of consciousness. Transthoracic echocardiography revealed a 20 × 24‐mm left ventricular apical nonpedunculated thrombus with normal ejection fraction. A persistent thrombus was shown on magnetic resonance imaging despite anticoagulation therapy. Robotic surgery was planned to avoid possible ventriculotomy‐related complications, considering the preoperative neurological condition of the patient. The thrombus was completely removed surgically through left atriotomy using the DaVinci robotic system. In conclusion, robotic surgery can be used in the surgical treatment of left ventriculotomy thrombus in selected patients.     

Anaplastic oligo-astrocytoma occurring after resection of a cerebral cavernous malformation; malignant transformation? Case report and review on etiology

We report a 71-year-old woman who presented with a cerebral cavernous malformation in the right frontal lobe for which she underwent total resection. Three years later, she was admitted with seizures and neuroimaging revealed a partially calcified lesion in the area of the earlier cavernous malformation, consistent with a residual malformation. A few months later she presented with cognitive decline and neuroimaging now revealed a large mass lesion in the same area as the cavernous malformation, irregularly enhancing, spreading through the corpus callosum to the left frontal lobe. Histological examination showed an anaplastic oligo-astrocytoma. These findings suggest that cerebral cavernous malformations, or at least a subgroup, have the potential for oligodendrocytic and astrocytic transformation. Various hypotheses to explain the etiology of these rare cases are discussed.     

Allele frequencies for 15 STR loci in a population from the Republic of Macedonia

Allele frequencies of 15 STR loci (D8S1179, D21S11, D7S820, CSF1PO, D3S1358, TH01, D13S317, D16S539, D2S1338, D19S433, vWA, TPOX, D18S51, D5S818, and FGA) were determined in a sample of 163 unrelated individuals from the Republic of Macedonia. AmpFISTR Identifiler Kit (Applied Biosystems) was used for PCR amplification. For all 15 loci, the combined matching chance is 6.6×10¹⁸ and the power of exclusion is 99.999954%.     

Drugs, muscle pallor, and pyomyositis

A 33-year-old athletic male was unexpectedly found dead in his bed. For several days prior to his death he complained of tenderness and swelling of his right buttock. The post-mortem examination revealed unilateral pale gluteal muscles and pustular impetiginized skin lesions of the right lower leg. The muscle histology demonstrated pronounced acute inflammation and limited necrosis of muscle fibers confined to the right gluteal muscles. Vascular occlusion and renal abnormalities were excluded by post-mortem angiography and histology respectively, and the diagnosis of non-tropical pyomyositis, possibly originating from the dermatological infection, was made. Toxicological testing revealed a potentially lethal intoxication with fentanyl and morphine. Pyomyositis is etiologically attributed to an infection and predominantly affects large limb or trunk muscles. Males are affected more frequently than females. Histologically, it is dominated by acute inflammatory infiltrates and may lead to sepsis and subsequent death. Although occurring less frequently, pyomyositis must be considered in the differential diagnosis of macroscopic localized muscle pallor, together with vascular occlusion and rhabdomyolysis. In such cases, only the examination of fresh frozen muscle tissue samples from different locations, together with the histological examination of the internal organs, particularly the kidneys, will facilitate the confirmation of the correct diagnosis.     

Cerebral arterial air embolism in a child after intraosseous infusion

Cerebral arterial air embolism (CAAE) has been reported as a rare complication of medical intervention. There has been one reported case of CAAE after the use of an intraosseous infusion (IO) system. We report on a case of CAAE after tibial IO infusion in a 7-month-old girl during resuscitation.     

The protective effect of betanin and copper on spinal cord ischemia–reperfusion injury

Context: Both copper and betanin have been implicated as having significant bioactivity against ischemic damage in a variety of experimental and clinical settings. The aim of this study is to investigate whether betanin and copper have any protective effect on spinal cord in an ischemia–reperfusion (I/R) model in rats.Design: Spraque-Dawley rats were used in four groups: Sham group (n = 7), control group (laparotomy and cross-clamping of aorta, n = 7), betanin treatment group (dosage of 100 mg/kg of betanin administered intraperitoneally (i.p.) 60 min before laparotomy, n = 7), copper sulfate treatment group (administered copper sulfate i.p. at a dose of 0.1 mg/kg/day for 7 days before laparotomy, n = 7). Malondialdehyde (MDA), glutathione (GSH) levels, myeloperoxidase (MPO) and superoxide dismutase (SOD) activity were measured. Terminal deoxynucleotidyl transferase (TdT) dUTP Nick-End Labeling (TUNEL) assay was also performed to evaluate apoptosis.Setting: Kafkas University, Faculty of Medicine, Kars, Turkey.Results: I/R injury was successfully demonstrated with the surgical model. Betanin and copper treatment significantly decreased MDA levels, MPO activity and the number of apoptotic cells in the spinal cord. Betanin and copper treatment significantly increased GSH levels. Copper treatment significantly increased SOD activity, whereas betanin was not as effective. Apoptotic cells were significantly decreased in both treatment groups.Conclusion: I/R injury of the spinal cord can be successfully demonstrated by aortic clamping in this surgical model. Betanin/Copper sulphate has ameliorative effects against operative I/R injury. Low toxicity of those agents makes them ideal targets for clinical research for this purpose.