Effects of lidocaine with and without epinephrine on plasma epinephrine and lidocaine concentrations and hemodynamic values during third molar surgery.

Lidocaine with epinephrine is currently the most common local anesthetic agent used for impacted third molar surgery. The purpose of the present study was to define the adverse hemodynamic effects and plasma concentrations of lidocaine and epinephrine on 17 healthy patients during the impacted teeth operations. Arterial blood pressure (systolic blood pressure, diastolic blood pressure), heart rate, peripheral oxygen saturation range, and electrocardiography were measured by an automatic noninvasive pressure device and monitor. High-performance liquid chromatography was used to measure the changes of plasma concentrations of epinephrine and lidocaine from blood samples taken 5 different times during the operation. We concluded that lidocaine-epinephrine is effective local anesthetic and had no important adverse events in healthy patients during the third molar surgery.     

Vaccination of human volunteers with heat-killed M. leprae: local responses in relation to the interpretation of the lepromin reaction

The early (Fernandez) and late (Mitsuda) lepromin reactions were closely examined in a group of healthy, BCG-vaccinated individuals who were given four doses of a heat-killed, armadillo-derived vaccine, i.e., 1.5 X 10(7), 5 X 10(7), 1.5 X 10(8), and 5 X 10(8) bacilli. There was a clear dose-response relationship for both the early and late reactions with no leveling of the responses within the range of doses examined. While the early response was negative in most of the volunteers, the late response was positive in all of the volunteers. No association was found between the early lepromin test and the pre-vaccination skin test to PPD. There was also no association between the early lepromin test and the pre-vaccination skin test response to a soluble Mycobacterium leprae antigenic preparation (MLSA) in general, but there was a good correlation between these two parameters at the highest vaccine dose. The late lepromin response showed no association with either the prevaccination or post-vaccination skin test response to PPD. However, there was a significant correlation between the late lepromin response and the post-vaccination skin test response to MLSA. In general, no association could be found between the in vivo skin tests and the in vitro lymphocyte transformation test (LTT). Thus, the lepromin test is essentially a vaccination which elicits a specific response to M. leprae antigens provided that the dose of armadillo lepromin given is higher than 5 X 10(7). Therefore, it is unsuitable as a diagnostic test for leprosy.(ABSTRACT TRUNCATED AT 250 WORDS)     

United states non-Hodgkin's lymphoma surveillance by occupation 1984-1989: A twenty-four state death certificate study

Death certificates from 23,890 male and female non-Hodgkin's lymphoma (NHL) cases and 119,450 noncancer controls from 24 states for the period 1984-1989 were used to generate hypotheses regarding occupational associations. Cases were frequency matched by age, race, and gender with five controls per case. Odds ratios were calculated for 231 industries and 509 occupations. Significant associations were observed for a variety of white-collar professionals (i.e., real estate agents, secretaries, bookkeepers, teachers, postal employees, business agents, engineers, chemists, and medical professionals) and blue-collar occupations (i.e., firefighters, farm managers, aircraft mechanics, electronic repairers, mining machine operators, and crane and tower operators). © 1995 Wiley-Liss, Inc.     

Mental stress-induced myocardial ischemia in coronary artery disease patients with left ventricular dysfunction

Background  Reduced left ventricular ejection fraction (LVEF) is a risk factor for poor outcomes in patients with coronary artery disease (CAD). Mental stress-induced myocardial ischemia (MSIMI) also identifies a subset of CAD patients at increased risk for future cardiovascular events. Susceptibility to MSIMI in patients with CAD and reduced LVEF is unknown. Methods and Results  We enrolled 182 patients (67 women) with a mean age of 64 years and a documented history of CAD in this study. Baseline resting ejection fraction was determined by use of technetium 99m sestamibi gated single photon emission computed tomography. Abnormal LVEF was defined as less than 45% for men and less than 50% for women (based on published norms for our software [Cedars-Sinai Medical Center]). All participants underwent mental stress testing with a public speaking task. Rest/stress myocardial perfusion single photon emission computed tomography was performed via conventional methodology. Images were visually compared for number and severity of perfusion defects by use of a scoring method from 0 to 4. A summed difference score was calculated as the difference between summed stress and rest scores. A score of greater than 3 was considered abnormal. MSIMI developed in 19% of patients with normal LVEF and 31% of those with reduced LVEF. There is no statistically significant difference between the two groups (P=.11). Conclusions  CAD patients with left ventricular dysfunction are equally susceptible to MSIMI as those with normal LVEF. This study was supported by grants HL 070265 and HL 072059 from the National Heart. Lung, and Blood Institute. This material is also the result of work supported by resources and with the use of facilities at the Department of Veterans. Affairs Medical Center, Gainesville, Fla.     

The peri‐microvascular edema in hippocampal CA1 area in a rat model of sepsis

Encephalopathy is a common complication of sepsis. However, little is known about the morphological changes that occur in the brain during sepsis. In this study, fecal peritonitis was induced in Wistar rats, which had been monitored for 4 h before their brains were removed and samples from the CA1 area taken. In addition to higher blood pressure with a decreasing pattern and a significant drop in rectal temperature, an increased heart rate and marked respiratory failure were observed. The tissue was investigated and compared with corresponding hippocampal samples taken from sham‐operated and not operated control groups. Significantly more peri‐microvascular edema was found in the hippocampal CA1 area in the septic group. The percentages of the peri‐microvascular edema were 158.57 ± 3.6%, 122.84 ± 1.5% and 120.24 ± 1.9% in the fecal peritonitis group, sham‐operated and not operated control groups, respectively. The results may suggest that the edema observed around the microvessels may participate in the pathogenesis of the septic encephalopathy probably by causing in the microvascular permeability characteristics.     

HLA-DR-restricted antigen-induced proliferation and cytotoxicity mediated by CD4+ T-cell clones from subjects vaccinated with killed M. leprae

Thirteen CD4+ T-cell clones raised against Mycobacterium leprae from three M. leprae-vaccinated subjects were studied for major histocompatibility complex (MHC) restriction in proliferative and cytotoxicity assays. These T-cell clones recognized at least nine different epitopes, ranging from M. leprae-specific to broadly crossreactive. Restriction studies with a panel of antigen-presenting cells (APCs) suggest that all of the T-cell clones recognized antigens in the context of the DR locus. Three T-cell clones with three different reactivities from a DR1, 2-positive subject responded to M. leprae in proliferation and cytotoxicity when the antigen was presented in the context of DR1-positive APCs. Four T-cell clones responding to M. leprae-specific or crossreactive epitopes from the second donor, who was DR4,DW4; DR4,Dw14-positive, and a single M. leprae-specific T-cell clone from the third subject, who was DR3,4:Dw4, recognized the antigens in the presence of Dw4 APCs. Four crossreactive T-cell clones from the second subject responded in the presence of Dw14-positive APCs, and one limited crossreactive clone recognized the antigen in the context of DR4 and DR7-positive cells, suggesting that its response was restricted by a common determinant. The T-cell clones that recognize the 65-kDa, 18-kDa, and 13B3 recombinant M. leprae antigens in proliferative assays were cytotoxic for autologous adherent cells pulsed with the respective antigens.(ABSTRACT TRUNCATED AT 250 WORDS)     

Case report: Osseous metaplasia of the endometrium: a rare cause of infertility and its hysteroscopic management

This case report presents a very rare and long-standing causeof infertility, osseous metaplasia of the endometrium, and describesits successful management by hysteroscopy. A woman with a historyof induced abortion 12 years ago, failed to conceive from thattime on. The infertility work-up was unrevealing except forthe presence of intracavitary calcification on ultrasonography.After diagnostic hysteroscopy, solid bony spicules coveringthe posterior wall of the endometrial cavity were removed bywire loop resectoscope. Histology established the diagnosisof osseous metaplasia of the endometrium. The patient conceivedin her second spontaneous cycle and has an ongoing pregnancyat the time of writing. Hysteroscopy was an effective meansof extracting this heterotopic tissue, thereby re-establishingfertility even after a long period of infertility.     

Serum lipid levels in psoriasis

A predisposition to occlusive vascular diseases has been reported in patients with psoriasis and it has been suggested that some of these patients have some disorders of lipid metabolism. In this study, serum lipid levels were investigated in psoriatic patients to explore to the knowledge of this relationship. One hundred psoriatic patients and 100 non- psoriatic controls were included in the study. Total cholesterol, triglyceride, high-density lipoprotein-cholesterol (HDL-cholesterol), low-density lipoprotein-cholesterol (LDL-cholesterol), and very low-density lipoprotein-cholesterol (VLDL-cholesterol) levels were measured. In patients with psoriasis, total cholesterol and LDL-cholesterol levels were found to be significantly higher than those of controls. No significant differences were found in the other parameters. We concluded that psoriatic patients should be evaluated and followed up for the risk of hyperlipidemia and obstructive vascular diseases.