Bladder tumour control by abdominal ultrasound and urine cytology

A blind study comparing abdominal ultrasound and cystoscopy was carried out in 186 patients. 20 bladder tumours sized from 2 to 5 mm were overlooked. Combination with urine cytology increased the diagnostic sensitivity. In order to reduce costs and patient inconvenience in the bladder tumour control population abdominal ultrasound and urine cytology is advocated as an alternative to cystoscopy. This control modality seems safe in patients with "low-risk" bladder tumour disease.     

Analgesia after inguinal herniorrhaphy with laparoscopic inspection of the peritoneum in children. Caudal block versus ilioinguinal/iliohypogastric block

The authors prospectively evaluated the efficacy of caudal epidural block versus local infiltration combined with ilioinguinal/iliohypogastric block for analgesia after inguinal herniorrhaphy with laparoscopic inspection of the peritoneum. During standardized anesthetic care, 24 children were randomized to Group I (caudal epidural block with 1.2 mL/kg of 0.25% bupivacaine) or to Group II (local infiltration with an ilioinguinal/iliohypogastric block). Postoperative pain scores were significantly lower at all four evaluation points in Group I than in Group II. Patients in Group I had a significantly decreased requirement for supplemental intravenous fentanyl. Intra-operative requirements for isoflurane were decreased in Group I. The expired concentration of isoflurane was 0.4 +/- 0.1 (mean +/- SEM) in Group I and 1.5 +/- 0.3 in Group II. Time to extubation was 3.8 +/- 0.5 minutes in Group I and 8.2 +/- 1.1 minutes in Group II. The time from arrival in the postanesthesia care unit until discharge home was 113 +/- 3 minutes in Group I and 152 +/- 11 minutes in Group II. Caudal epidural block was more effective than local infiltration in controlling pain after herniorrhaphy with laparoscopy in children and resulted in earlier discharge home.     

Prodrugs of Peptides. 9. Bioreversible N-α-Hydroxyalkylation of the Peptide Bond to Effect Protection Against Carboxypeptidase or Other Proteolytic Enzymes

Various N--hydroxyalkyl derivatives of N-acyl amino acids and di- and tripeptides were prepared by hydrolysis or aminolysis of N-acyl 5-oxazolidinones. The stability of these derivatives was studied in aqueous solution as a function of pH. The compounds were all degraded quantitatively to their parent N-acylated amino acid or peptide and aldehyde but with vastly different rates. At pH 7.4 and 37°C the half-lives of decomposition ranged from 4 min to 1500 hr. The structural factors influencing the stability included both steric and polar effects within the acyl and N--hydroxyalkyl moieties as well as within the amino acid attached to the N--hydroxyalkylated N-acyl amino acid. Whereas the N-benzyloxycarbonyl (Z) derivatives of the dipeptides Gly-L-Leu and Gly-L-Ala were readily hydrolyzed by carboxypeptidase A, the N-hydroxymethylated compounds, i.e., Z-Gly(CH₂OH)-Leu and Z-Gly(CH₂OH)-Ala, were resistant to cleavage by the enzyme as revealed by their similar rates of decomposition in the presence or absence of the enzyme at pH 7.4 and 37°C. The results suggest that N--hydroxyalkylation of a peptide bond protects not only this bond but also an adjacent peptide bond against proteolytic cleavage. Since the N--hydroxyalkyl derivatives are readily bioreversible, undergoing spontaneous hydrolysis at physiological pH, this prodrug approach promises to overcome the enzymatic barrier to absorption of various peptides.     

Facial pain

Summary In a prospective material of 1052 patients the precipitating factors, associated symptoms, psychological and neurological deficits have been examined.Mastication and talking are the most frequently occurring precipitating factors, 76% as regards Neuralgia, with typical starting difficulties. As regards Non-neuralgiform Pain 24%, with precipitation late in the masticatory process. There were trigger zones in 50% of the cases of Typical Trigeminal Neuralgia and in 9% of the patients with Non-neuralgiform Pain. In a series of cases the jaw joint is perceived as a trigger zone. Cold precipitates pain in 48%–39%. Other precipitating factors are much more rare-psychological stress in 15% of the patients with Non-neuralgiform Pain, however.Vegetative associated symptoms were relatively frequent, lacrimation occurred in 31% of the cases of Typical Trigeminal Neuralgia and in 20% of the cases of Non-neuralgiform Pain. Rhinorrhea and salivation were less frequent. In terms of figures migrainoid associated symptoms had no connection with vegetative associated symptoms or with pain in the eye.In 11 % of the patients pain occurred most frequently during the night and in 20% the frequency of pain was the same day and night. About 1/3 of the patients with Neuralgia experienced seasonal variations.Tenderness of foramina is a symptom of no significance. Very few patients had primary sensory loss. No eye or ear symptoms have been found which may be referred to as the patho-anatomical basis of the pain.About 1/3 of the patients with Non-neuralgiform Pain had psychological symptoms whereas hardly any patients with Neuralgia had them. MMPI test performed on a small matched material showed no difference between Neuralgia and Non-neuralgiform Pain.In material B an examination has been made of the jaw joint arthrosis symptoms. A restriction of the diagnosis of arthrosis has had the effect that it must be recognized that patients with facial pain do not have the high frequency of jaw joint diseases previously assumed. As was also the case in a series of normal material previously published, between 1/5 and 1/3 of the patients with Neuralgia had jaw joint arthrosis which was due to old age.This study has not revealed any connection between previous diseases, the onset of pain, the character and course of the pain, the character of the attack, the localization of pain, precipitating factors, associated symptoms and symptoms of loss on the one hand and the patho-anatomical substratum on the other.The psychological examinations were performed by Mr. Peter Bruun, chief psychologist, for whose cooperation I am grateful.