INVOLVEMENT OF HYPOGASTRIC AND PELVIC NERVES FOR CONVEYING CYSTITIS INDUCED NOCICEPTION IN CONSCIOUS RATS

PURPOSE: We determined the sites of the antinociceptive action of morphine in the experimental model of cyclophosphamide induced cystitis and investigated the afferent nerve fibers involved in nociception transmission originating from the bladder. MATERIALS AND METHODS: Cyclophosphamide (200 mg./kg.) given intraperitoneally was used to induce cystitis in male rats and their behavior was observed and scored. The effect of 2 mg./kg. systemic morphine given intravenously on cyclophosphamide induced behavioral modifications was tested when administered alone and after 100 microg. naloxone per rat given intrathecally at the L1 to L2 or L6 to S1 level. The spinal antinociceptive effect of morphine was also tested when administered intrathecally alone at 10, 100 and 200 microg. per rat at L1 to L2, alone at 100 microg. per rat at L1 to L2 or L6 to S1, alone at 100 microg. per rat at L1 to L2 and L6 to S1 simultaneously, alone at 200 microg. per rat at L1 to L2 and after 100 microg. naloxone per rat given intrathecally at L6 to S1 at 100 microg. per rat at L1 to L2. RESULTS: Cyclophosphamide induced marked modifications in the behavior of the rats, including a decreased breathing rate, eye closing and specific postures. Morphine given intravenously reversed these behavioral disorders and this reversal was completely prevented by pretreatment with intrathecal naloxone. A dose of 100 microg. per rat given intrathecally also reversed these behavioral disorders by about 25% at the L1 to L2 and L6 to S1 levels. In addition, a dose of 100 microg. morphine per rat administered intrathecally and simultaneously at L1 to L2 and L6 to S1 produced an effect equal to the sum of those observed when administered separately, that is about 50%, whereas morphine at an intrathecal dose of 200 microg. at L1 to L2 produced the same effect as 100 microg. given intrathecally at the same level or at L6 to S1 (25%). Also, 100 microg. naloxone per rat administered intrathecally at L6 to S1 prevented the effect of 100 microg. morphine at L1 to L2. CONCLUSIONS: These results confirm the previously reported antinociceptive effect of systemic morphine in this model of cyclophosphamide cystitis, suggest that this antinociceptive action is completely located at the spinal site and most importantly demonstrate by the pharmacological approach and behavioral analysis that nociceptive sensations originating from the bladder are conveyed by hypogastric and pelvic nerves in this cyclophosphamide cystitis model in the conscious rat.     

Discovery of a pituitary adenoma following a gonadotropin-releasing hormone agonist in a patient with prostate cancer

Gonadotropin-releasing hormone (GnRH) agonists have become the treatment of choice for locally advanced and metastatic prostate cancer. We report a case of prostate cancer in which this treatment led to severe symptoms of intracranial hypertension due to the concomitant presence of an asymptomatic functional pituitary adenoma. A 70-year-old white man was initially evaluated for a multifocal adenocarcinoma, Gleason score 6 (3+3) with perineural invasion suggesting an extracapsular extension. A conformational external beam radiation (74 Gy) with a concomitant GnRH agonist (leuprolide) was initiated. Almost 10 days after the administration of leuprolide the patient complained of visual disturbance, diplopia and other symptoms of intracranial hypertension. Magnetic resonance imaging (MRI) of the brain demonstrated a large sella mass lesion. To relieve the patient's symptoms, a transsphenoidal subtotal tumorectomy was necessary. The histopathological examination revealed an invasive gonadotroph pituitary adenoma. Two years later, there is no sign of progression either on his prostatic disease (prostate-specific antigen of 0.21 ng/mL) or on his pituitary disease (FSH, 4.7 UI/L, LH, 3.1 UI/L and total testosterone, 627 ng/dL) with values of the hypothalamic-pituitary axis in the normal range. We advocate that a high index of suspicion of pituitary tumor must be considered in any case of intracranial hypertension following the administration of GnRH agonist. Abarelix could have a place in such cases.     

Structural characterizations of neuropeptide tyrosine (NPY) and its agonist analog [Ahx5-17]NPY by NMR and molecular modeling

The structures of human NPY and of its centrally truncated agonist analog [Ahx^5–17]NPY have been investigated in DMSO-d₆ by two-dimensional NMR and by molecular modeling. For both peptides, a complete resonance assignment was achieved and a large number (more than 200) of inter-residue NOE connectivities were observed, including long-range connectivities between the N- and C-terminal ends of the chain. Molecular models were calculated using NOE constraints by distance geometry, simulated annealing and conjugate gradient energy minimization. The results indicate that both peptides are folded in the center of their chain, NPY adopting the hairpin shape, whereas the central portion of [Ahx^5–17]NPY is characterized by relatively large loops. In contrast to previous models, practically no α-helical structure exists for these peptides under our conditions, but two β-turns are found in NPY and one in [Ahx^5–17]NPY. The proximity of the terminal ends could be the determinant factor for their activity. © Munksgaard 1995.     

Therapeutic bronchoalveolar lavage for pulmonary alveolar proteinosis in an infant

A 2-year-old male infant suffering from pulmonary alveolar proteinosis was treated by four unilateral bronchoalveolar lavages (BAL) in a 12-month period. The lavages were performed under general anaesthesia and controlled ventilation by introducing a fibrescope (3.6 mm external diameter) though either a tracheal tube (4.5 mm internal diameter) or a rigid bronchoscope. Each lobe of the lung was successively catheterized and the segments were washed separately with prewarmed saline solution injected through the side channel of the fibrescope. The described technique allows to perform BAL in safe conditions (i.e., controlled airways) in infants weighing more than 9 kg.     

Primary Intracoronary Stenting of Unprotected Left Main Coronary Artery Stenosis in Two Patients with No Contraindication to Surgery: Immediate and Follow-Up Results

Although successful stenting has been reported on protected left main coronary artery or unprotected left main in patients with prohibitive surgical risks or in bail-out situations, no case of left main primary stent implantation in patients without surgical contraindication has yet been reported. We report immediate and late clinical and angiographic results in two patients (57 and 38-year-old men) who had unprotected left main coronary disease, with isolated stenosis on a large and long left main trunk, ideally suitable for stenting. We believe that stenting could change the matter of the contraindication of balloon angioplasty in left main coronary disease. However, further studies with a large number of patients and long-term follow-up are necessary to determine whether this approach will constitute a valuable alternative to surgery in the future.     

Continuous infusion of ropivacaïne: an optimal postoperative analgesia regimen for iliac crest bone graft in children

Background: Postoperative analgesia of iliac crest (IC) donor site can be performed by on site infiltrations of local anesthetics (LA) or morphine. Single injections or continuous infusions of LA proved their efficacy in adults, but was not reported in children. We prospectively evaluated the interest of a continuous infusion of 0.2% ropivacaïne at the IC donor site in terms of postoperative pain relief and rescue analgesics consumption. Methods: Sixteen consecutive patients, aged from 4 to 16 years scheduled for maxillar alveolar graft with IC bone, were included. After IC bone graft surgery under general anesthesia, they received a 0.2–0.4 ml·kg^?1 bolus of 0.2% ropivacaïne through the IC catheter; then a continuous infusion of 0.2% ropivacaïne at 0.125 ml·kg^?1·h^?1 was administrated for 48 h with disposable elastomeric pumps. Children systematically received paracetamol (15 mg·kg^?1 four times a day) and niflumic acid (40 mg·kg^?1 twice a day). Postoperative pain was evaluated using a Visual Analog Scale (>7 years old) or Children and Infants Postoperative Pain Score (between 4 and 7 years old) every 4 h until H48. Doses of rescue analgesics and adverse events (LA toxicity, catheter’s removal, nausea–vomiting) were also noted. Three months after surgery a blinded clinical research assistant reviewed all children and assessed functional recovery, neuropathic chronic pain symptoms or local complications. Results: The median value of IC graft pain scores was 0 during whole studied period. Of the patients, 31.2% did not require any rescue analgesics and 43.8% needed only once. No adverse events related to LA and no removal of catheter were noted. One child had nausea in the 48‐h postoperative period, and one child had neuropathic pain symptoms at 3 months at the donor site. Conclusion: Continuous infusion of 0.2% ropivacaïne through an IC catheter is an optimal and safe technique of regional postoperative analgesia after bone graft harvest in children.     

Differential involvement of the human temporal lobe structures in short- and long-term memory processes assessed by intracranial ERPs

Intracranial event-related potentials (ERPs) elicited during a recognition memory task were recorded in 25 epileptic patients by using depth electrodes sampling four different regions within the temporal lobe (amygdala, hippocampus, anterior and posterior temporal cortices). The task was a continuous recognition memory task in which repeated items were presented after 6 or 19 intervening items following their first presentation. This study was performed to investigate the respective role of the different temporal lobe structures in short-term memory (STM) and long-term memory (LTM) processing. Subregions of the temporal lobe were differently involved in these two memory systems. The posterior temporal cortex is specifically involved in STM processing, whereas the amygdala, hippocampus, and anterior temporal cortex contribute to both STM and LTM. Moreover, it appeared that the latter structures play their own role in LTM. The anterior temporal cortex and amygdala may contribute to recency discrimination, and the hippocampus seems rather to be involved in maintaining memory traces. These findings suggest that the temporal lobe structures may function in a complementary way by subserving different aspects of information processing.