Fatal methotrexate-induced pneumonitis in a psoriatic patient

Pulmonary toxicity, as an adverse effect of methotrexate (MTX) therapy, is uncommon in psoriatics. This report concerns a patient with psoriatic arthritis who developed fatal pneumonitis with a histopathological pattern of the organizing stage of diffuse alveolar damage and who was receiving MTX at a dose of 15 mg weekly for 1 month. The patient died despite the immediate withdrawal of MTX, the administration of corticosteroids, and adequate supportive care. Since MTX pneumonitis is a potentially fatal complication, new pulmonary symptoms, even in patients on low-dose MTX treatment, should be appropriately investigated.     

Pressure applied on the extra 1 acupuncture point reduces bispectral index values and stress in volunteers

We investigated the effect of pressure application on the acupuncture point "extra 1" and on a control point on the bispectral index (BIS) values and on stress in 25 volunteers. In each volunteer, pressure was applied on the extra 1 point for 10 min and on a control point for 5 min on different days and in a randomized manner. The BIS value was recorded before applying pressure on the extra 1 point, during pressure application every 30 s for 10 min, and after pressure release. Regarding the control point, BIS values were recorded for 5 instead of 10 min during pressure application because acupressure on that point was associated with an unpleasant feeling. Each volunteer was asked to score stress before and after pressure application from 0 to 10. The BIS values were significantly reduced 2.5, 5, 7.5, and 10 min during pressure application on the extra 1 point (P < 0.001 for each comparison, respectively) and returned to the baseline values after pressure release. Pressure application on the control point decreased BIS values (P < 0.01 and P < 0.05 at 2.5 and 5 min, respectively). However, these values were maintained close to 90% and were significantly higher than those obtained during pressure on the extra 1 point (P < 0.001 and P < 0.001 for the 2.5- and 5-min comparisons). The verbal sedation score values obtained after pressure application on the extra 1 point were also lower when compared with the values obtained after pressure application on the control point (P < 0.001). IMPLICATIONS: This crossover study investigated the effect of pressure application on the acupuncture "extra 1" point in healthy volunteers. Acupressure applied for 10 min on the extra 1 point significantly reduced the BIS values and the verbal stress score when compared with acupressure applied on a control point.     

Transdermal clonidine: does it affect pain after abdominal hysterectomy?

Clonidine has analgesic properties. We evaluated the analgesic effect of clonidine perioperatively. Forty patients undergoing abdominal hysterectomy received randomly the evening before surgery transdermal clonidine covered with overlay (CLO group) or the overlay alone (CTL group). Ten min before induction they received i.v. clonidine 1 microgram.kg-1 (CLO) or normal saline (CTL). Induction was accomplished with fentanyl 5 micrograms.kg-1, thiopentone 5 mg.kg-1, cis-atracurium 0.15 mg.kg-1 and maintenance with sevoflurane 2% in 70% N2O. Hemodynamic parameters were recorded intraoperatively. Pain was assessed by VAS at rest and movement 2, 4, 6, 8, 24, 48, 72 h and 30 days, postoperatively. During the first 8 h postoperatively all patients received controlled analgesia with fentanyl followed by morphine i.m. 0.15 mg.kg-1 and paracetamol. From 24-72 h postoperatively, patients received 75 mg propoxyphene and 600 mg paracetamol i.m., on demand. Arterial blood pressure was lower in the CLO group 0, 3, 10 min after intubation. There was no difference in pain or fentanyl consumption 8 h postoperatively. The CLO group required less analgesics 24 h postoperatively (p = 0.023). The two groups did not differ in pain or analgesic requirements 72 h and 30 days postoperatively. Clonidine had a weak opioid sparing effect 24 h post-operatively, but did not affect pain in long term.     

Direction and side used to determine the extent of sensory block after subarachnoid anesthesia do not influence the level of the block

Methods of sensory testing in neuraxial anesthesia may supposedly account for different results in reporting the extent of the block. To determine whether the caudad to cephalad versus the cephalad to caudad direction as well as the side of testing, left versus right, may affect the assessment of sensory block after subarachnoid anesthesia, two groups of patients undergoing transurethral surgery were studied. One group, 44 patients were tested for the influence of direction of block determination and another group 50 patients for the influence of side. Subarachnoid anesthesia was performed with 100 mg of 5% hyperbaric lidocaine using a 25 Whitacre needle with its opening consistently pointing cranially and the patient in the sitting position. To assess the sensory block four lines were drawn bilaterally along the posterior, middle, and anterior axillary lines and a line 5 cm medial to the anterior axillary line. A pressure palpator was moved along each of the four lines and patients were asked to answer if they detected a stimulus, with "yes/no". In the 44 patients assessment of sensory block was performed from caudad to cephalad direction on one side and viceversa on the other. In the other 50 patients the extent of the block was compared between the right and left side. In 44 patients, the level of sensory block determined 20, 25 and 30 minutes after the subarachnoid anesthesia in a cephalad to caudad direction was found at the T11 dermatome at each time point and did not differ when compared to the levels determined following the caudad to cephalad direction. In the second study in a different group of 50 patients, the level of sensory block 20, 25 and 30 minutes after the subarachnoid injection was found at the T11 dermatome on the right side at each time point and did not differ from the level determined on the left side. We conclude that the level of sensory block after subarachnoid anesthesia with lidocaine is independent of the direction of testing and the side the assessment is performed using the pressure palpator.     

Responses to mechanical and electrical stimuli are not attenuated by late pregnancy

Pregnancy has been associated with increased pain threshold. This study investigates the responses to mechanical and electrical stimuli in pregnant and non-pregnant women. Thirty pregnant women were subjected before and four days after elective caesarean section under regional anaesthesia to mechanical and electrical stimuli on both forearms. Thirty nonpregnant women were subjected to the same stimuli at the same time points. The responses to mechanical stimuli were expressed in mm of the Visual Analogue Scale (VAS) and averaged for both forearms. The VAS scores obtained after the electrical stimuli were divided by the mA recorded when the stimulus was applied, expressed in mm/mA and averaged. The responses to mechanical stimuli recorded before and four days after application did not differ between the two groups (F = 0.884, df = 3,116, P = 0.452). In the pregnant group the VAS values before and four days after the caesarean section were 16.4 +/- 14.4 mm and 12.8 +/- 12.5 mm respectively. In the nonpregnant group the VAS values recorded four days apart were 17.5 +/- 14.3 mm and 13.4 +/- 11.9 mm respectively. The responses to electrical stimuli applied four days apart also did not differ between the two groups (F = 2.433, df = 3,116, P = 0.069). The VAS values obtained after the first and second application of the electrical stimulus were 0.914 +/- 0.606 mm/mA versus 0.586 +/- 0.410 mm/mA in the pregnant and 0.853 +/- 0.538 mm/mA versus 0.725 +/- 0.467 mm/mA in the nonpregnant group. These results, under the study conditions, do not support the hypothesis that late pregnancy is associated with increased antinociception in humans.     

Cortisol levels during enflurane anesthesia in man

Serum cortisol levels were determined in 44 patients who underwent hysterectomy under enflurane or under halothane anesthesia by means of a radioimmunoassay technique. Of the 44 patients, in 21 anesthesia was maintained by enflurane and d-tubocurarine and 23 patients maintenance of anesthesia was carried out by halothane and d-tubocurarine. Blood samples for serum cortisol estimations were obtained from each patient before induction of anesthesia, 10 min. after induction, 10 min. after skin incision, at the end of the operation and in the ward on the fourth postoperative day. Cortisol levels increased in both groups at the end of the operation with a significantly higher mean value in the enflurane group (p less than 0.05) compared to that of the halothane group.     

DNA toxicity of cocaine hydrochloride and cocaine freebase by means of DNA image analysis on Tetrahymena pyriformis

An assay for computerized scoring of the DNA content of the protozoan Tetrahymena pyriformis has been used for the detection of toxic responses to cocaine, since DNA is responsible for the replication of the genetic material and also reflects closely the number of chromosomes in the nucleus. Thus, doubling of the number of chromosomes in a cell will also correspond to doubling of the DNA content and of the nuclear volume. Two chemical forms of cocaine were used, cocaine hydrochloride and cocaine freebase (crack), at two doses of 1 and 2 mg per 100 ml of protozoan culture, respectively. Image analysis of the protozoan nucleus patterns revealed a rapid stimulating effect on the DNA content for both cocaine hydrochloride and freebase after 1 h of incubation. However, after 2 h of treatment a reduction, although not statistically significant, of the DNA content of the protozoan was observed. These observations were further correlated with the phagocytic activity of the protozoan cultures. This paper provides some possible explanations of the toxic effects of cocaine on this particular cell model.     

Intra-arterial thrombolysis using rt-PA in patients with acute stroke due to vessel occlusion of anterior and/or posterior cerebral circulation

Introduction The aim of our study was to evaluate the safety and efficacy of intra-arterial (IA) thrombolysis using recombinant tissue plasminogen activator (rt-PA) in patients with acute stroke due to occlusion in the anterior or posterior circulation. Methods We retrospectively analyzed the clinical and radiological data of 88 consecutive patients with acute ischemic stroke who underwent emergency cerebral angiography for the purpose of subsequent IA thrombolysis. The neurological deficit on admission and discharge was graded using the National Institutes of Health Stroke Scale (NIHSS) score. Baseline computer tomography (CT) scans were examined for any signs indicative of cerebral ischemia. The angiographic findings were classified according to the Thrombolysis in Myocardial Infarction (TIMI) score for myocardial infarction. Follow-up CT scans were examined for hemorrhagic complication. Results Of the 88 patients who underwent IA thrombolysis, 63 presented with complete or partial arterial occlusion in the suspected perfusion area. In these 63 patients, the median NIHSS score dropped from 15 points on admission to 10 points at discharge. The recanalization rate was 52.6% for partial and complete reperfusion. In-hospital mortality was 20.6% (9.1% for carotid, 44.4% for basilar territory occlusion). Intracerebral bleeding (ICB) occurred in 38.6% of the patients with occlusion in the anterior circulation, resulting in these patients presenting a worse clinical outcome than those without ICB. Only minor extracranial bleedings occurred in 20.6% of patients. Patients with ICB had a significantly higher frequency of ischemic signs on the baseline CT scan. Conclusion Occlusion of a cerebral artery is present in about 75% of the patients eligible for thrombolytic therapy. Intra-arterial thrombolysis using rt-PA in patients with acute ischemic stroke can achieve re-vascularization, although ICB remains the major risk factor affecting its efficacy.     

Metallurgical characterization of experimental Ag-based soldering alloys

AimTo characterize microstructure, hardness and thermal properties of experimental Ag-based soldering alloys for dental applications.Materials and methodsAg12Ga (AgGa) and Ag10Ga5Sn (AgGaSn) were fabricated by induction melting. Six samples were prepared for each alloy and microstructure, hardness and their melting range were determined by, scanning electron microscopy, energy dispersive X-ray (EDX) microanalysis, X-ray diffraction (XRD), Vickers hardness testing and differential scanning calorimetry (DSC).ResultsBoth alloys demonstrated a gross dendritic microstructure while according to XRD results both materials consisted predominately of a Ag-rich face centered cubic phase The hardness of AgGa (61 ± 2) was statistically lower than that of AgGaSn (84 ± 2) while the alloys tested showed similar melting range of 627–762 °C for AgGa and 631–756 °C for AgGaSn.ConclusionThe experimental alloys tested demonstrated similar microstructures and melting ranges. Ga and Sn might be used as alternative to Cu and Zn to modify the selected properties of Ag based soldering alloys.