The influence of baricity on the haemodynamic effects of intrathecal bupivacaine 0.5%

This study compared the haemodynamic effects of subarachnoid block with plain bupivacaine 0.5% (dextrose-free), heavy bupivacaine 0.5% (in dextrose 8%) and a mixture of these two solutions, i.e. bupivacaine 0.5% in dextrose 4%. Thirty-six male patients, aged 55-89 years, undergoing transurethral surgery were recruited. Invasive systolic arterial and central venous pressures were recorded at 5-s intervals after the block was initiated using a computerised data-collection system. The height of sensory blockade was recorded at 5-min intervals. No preload was given and episodes of hypotension were treated with colloid (8 ml x kg(-1)) and, if this was ineffective, a metaraminol infusion. Systolic arterial and central venous pressures decreased in all three groups following block (p < 0.05). These decreases were more rapid in onset in the heavy bupivacaine group compared with plain bupivacaine group (p < 0.005). Patients in the heavy bupivacaine group also had a greater requirement for early treatment of hypotension (< 10 min) and treatment with metaraminol (p < 0.05). The onset of sensory blockade was more rapid in the heavy group compared with the mixed group, although final sensory levels were similar. The onset of haemodynamic and sensory changes are more rapid when using heavy bupivacaine intrathecally. This leads to a higher and earlier incidence of hypotension and requirement for treatment.     

Urotensin I-CRF-Urocortins: A mermaid’s tail

From the individual perspective of the two authors who were long-time colleagues of Karl Lederis at the University of Calgary, the events and personal interactions are described, that are relevant to the discovery of Urotensin I (UI) in the Lederis laboratory, along with the concurrent discovery of Urotensin II (UII) in the Bern laboratory and corticotropin-releasing factor (CRF/CRH) in the Vale laboratory. The fortuitous sabbatical experiences that put Professors Lederis and Bern on the track of the Urotensins, along with the essential isolation paradigm that resulted in the complete sequencing and synthesis of UI and UII are summarized. The chance interaction between Drs. Vale and Lederis who, prior to the publications of the sequences of UI and CRF, realized the sequence commonalities of these peptides with the vasoactive frog peptide, sauvagine, is outlined. Further, the relationship between the pharmacological studies done with UI in the Calgary laboratory and the more recent understanding of the biology and receptor pharmacology for the entire Urotensin I-CRF-Urocortin peptide family is dealt with. The value of a comparative endocrinology approach to understanding hormone action is emphasized, along with a projection to the future, based on new hypotheses that can be generated by unexplained data already in the literature. Based on the previously described pharmacology of the UI-CRF-Urocortin peptides in a number of target tissues, it is suggested that the use of current molecular approaches can be integrated with a ‘classical’ pharmacological approach to generate new insights about the UI-CRF-Urocortin hormone family.     

Portrayal of depression and other mental illnesses in Australian nonfiction media

This study describes Australian media portrayal of mental illnesses, focusing on depression. A random sample of 1,123 items was selected for analysis from a pool of 13,389 nonfictional media items about mental illness collected between March 2000 and February 2001. Depression was portrayed more frequently than other mental illnesses. Items about depression, eating disorders, and substance use disorders most commonly described policies or programs, whereas items about schizophrenia most frequently portrayed individuals or symptoms and treatment. A minority of items about depression presented information about symptoms, causes, treatment, or prognosis. Although such information was generally accurate, a proportion of items conveyed misleading messages. There is therefore scope for increasing the level of accurate information provided about depression in the Australian media. © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 283–297, 2005.     

Effect of chronic administration of an aromatase inhibitor to adult male rats on pituitary and testicular function and fertility

The aim of the present study was to evaluate the effects of the administration of a potent non-steroidal aromatase inhibitor, anastrozole, on male reproductive function in adult rats. As anastrozole was to be administered via the drinking water, a preliminary study was undertaken in female rats and showed that this route of administration was effective in causing a major decrease in uterine weight (P<0.02). In an initial study in male adult rats, anastrozole (100 mg/l or 400 mg/l) was administered via the drinking water for a period of 9 weeks. Treatment with either dose resulted in a significant increase ( approximately 10%) in testis weight and increase in plasma FSH concentrations (P<0.01) throughout the 9 weeks. Mating was altered in both groups of anastrozole-treated rats, as they failed to produce copulatory plugs. Histological evaluation of the testes from anastrozole-treated rats revealed that spermatogenesis was grossly normal. In a more detailed study, adult rats were treated with 200 mg/l anastrozole via the drinking water for periods ranging from 2 weeks to 1 year. Plasma FSH and testosterone concentrations were increased significantly (P<0.001) during the first 19 weeks of treatment. However, LH concentrations were increased only at 19 weeks (P<0.001) in anastrozole-treated rats, and this coincided with a further increase in circulating and intratesticular testosterone concentrations (P<0.05). No consistent change in inhibin-B concentrations was observed during the study. Suppression of plasma oestradiol concentrations could not be demonstrated in anastrozole-treated animals, but oestradiol concentrations in testicular interstitial fluid were reduced by 18% (P<0.01). Mating was again inhibited by anastrozole treatment, but could be restored by s.c. injection of oestrogen, enabling demonstration that rats treated for 10 weeks or 9 months were still fertile. Testis weight was increased by 19% and 6% after treatment for 19 weeks and 1 year, respectively. Body weight was significantly decreased (P<0.01) by 19 weeks of anastrozole treatment; after 1 year the animals appeared to have less fat as indicated by a 27% decrease in the weight of the gonadal fat pad. The majority of anastrozole-treated animals had testes with normal spermatogenesis but, occasionally, seminiferous tubules showed abnormal loss of germ cells or contained only Sertoli cells. Ten percent of anastrozole-treated animals had testes that appeared to contain only Sertoli cells, and one rat had 'giant' testes in which the tubule lumens were severely dilated. Morphometric analysis of the normal testes at 19 weeks showed no difference in the number of Sertoli cells or germ cells, or the percentage volumes of the seminiferous epithelium, tubule lumens and interstitium between control and anastrozole-treated rats. On the basis of the present findings, oestrogen appears to be involved in the regulation of FSH secretion and testosterone production, and is also essential for normal mating behaviour in male rats. Furthermore, these data suggest that the brain and the hypothalamo-pituitary axis are considerably more susceptible than is the testis to the effects of an aromatase inhibitor. Anastrozole treatment has resulted in a model of brain oestrogen insufficiency.     

Field trials of the Baby Check score card in general practice.

Sixteen general practitioners (GPs) used the Baby Check score card to assess illness severity in 86 babies under 6 months old. Their reactions to Baby Check were positive: in 79 (92%) it gave an accurate assessment of the baby''s illness and 16 (100%) said they would trust it. Fifteen (94%) found it useful, and most of those who did not said the baby was not ill or had an obvious diagnosis. Thirteen (81%) said they would use it and wanted their health visitors and midwives to use it and 15 (94%) wanted the mothers in their practice to use it. The majority (64%) of babies scored 0-7; 31% scored 8 to 19; and only 5% scored over 20. Well babies had low scores, while the two sickest babies, needing urgent hospital treatment, scored 29 and 33. The use of Baby Check by GPs would help them assess babies thoroughly and quantify illness severity objectively.     

Identification of prognostic factors and risk groups in patients found to have nodal metastasis at the time of radical hysterectomy for early-stage squamous carcinoma of the cervix

In a retrospective study conducted at the University of Alabama at Birmingham, the University of Michigan, and the Mayo Clinic, 185 patients with previously untreated FIGO stage IB and IIA squamous cell carcinoma of the cervix were found to have nodal metastasis at the time of radical hysterectomy and pelvic lymphadenectomy. Of these patients, 103 received adjuvant pelvic irradiation. Cancer recurred in 76 patients; the median time to recurrence was 3.1 years. The prognostic significance of patient age, clinical stage, lesion diameter, number and location of nodal metastases, and use of adjuvant radiation therapy was determined by multivariate analysis. Only patient age (P = 0.0006), lesion diameter (P less than 0.0001), and number of nodal metastases (P = 0.0004) were noted to be significant factors in determining overall survival. Rates of recurrence were also related to these factors. Employment of these significant variables led to identification of four risk groups. In general, patients with small cervical lesions (diameter less than 1 cm) and no more than two nodes with metastases fell into the low-risk category; those patients with large cervical lesions (diameter greater than 4 cm) and more than two involved nodes fell into the high-risk category. All other patients were categorized into intermediate-risk groups. Ten-year survival was 92% in the low-risk group (n = 13), 70% in the low-intermediate-risk group (n = 66), 56% in the high-intermediate-risk group (n = 66), and 13% in the high-risk group (n = 20). This risk group classification identifies subgroups of early-stage cervical carcinoma patients found to have nodal metastasis at the time of radical hysterectomy that warrant appropriately selected adjuvant therapy.     

The prognosis and management of cervical cancer associated with pregnancy.

OBJECTIVE: We sought to evaluate the prognosis of patients with stage IB cervical cancer related to pregnancy. METHODS: We reviewed 53 patients from the University of Michigan diagnosed with cervical cancer related to pregnancy between 1960-1989. Patients with stage IB disease were compared with a control group less than 46 years old to determine whether pregnancy influenced survival. RESULTS: The mean age of the patients was 30.5 years (range 22-45). The number of patients treated by 5-year periods decreased from a high of 17 during 1965-1969 to a low of three during 1985-1989. The following cell types and stages were treated: squamous cell stages IA (four), IB (35), and IIB (six); adenocarcinoma stages IB (five) and IIB (two); and small-cell stage IIB (one). The 35 patients with stage IB disease had a cumulative 5-year survival of 83%. Positive lymph nodes were present in eight of 24 patients. There was no significant difference in 5-year survival according to the time of therapy (P = .45): Ten second-trimester patients had 90% survival, five third-trimester patients had 75% survival, and 20 postpartum patients had 75% survival. Eighteen of 21 patients treated by radical hysterectomy survived: three of four treated at term, five of five treated in the second trimester, and ten of 12 treated postpartum. Seven of 12 patients treated by radiation therapy survived: one of one treated at term, five of six treated in the second trimester, and one of five treated postpartum. When we compared these patients with 170 nonpregnant women less than 46 years old with stage IB squamous cell cancer, pregnancy did not adversely influence survival (P = .13). CONCLUSIONS: The number of patients diagnosed with invasive cervical cancer related to pregnancy has decreased. Survival is not altered by pregnancy for stage IB disease.     

Axillary and rectal temperature measurements in infants.

Rectal and axillary temperatures were measured during the daytime in 281 infants seen randomly at home and 656 at hospital under 6 months old, using mercury-in-glass thermometers. The normal temperature range derived from the babies at home was 36.7-37.9 degrees C for rectal temperature and 35.6-37.2 degrees C for axillary temperature. Rectal temperature was higher than axillary in 98% of the measurements. The mean (SD) difference between rectal and axillary temperatures was 0.7 (0.5) degrees C, with a range of 3 degrees C. When used in hospital to detect high temperature, axillary temperature had a sensitivity of 73% compared with rectal temperature. This is too insensitive for accurate detection of an infant's high temperature. Rectal temperature measurement is safer than previously suggested: perforation has occurred in less than one in two million measurements. If an infant's temperature needs to be taken, rectal temperature should be used.