A randomized trial comparing sevoflurane and propofol in children undergoing MRI scans

Objectives:  We compared three primary outcomes of pausing the magnetic resonance imaging (MRI) scan, emergence quality and respiratory complications.
Aim:  To measure and compare the quality between sevoflurane and propofol in children undergoing MRI scans.
Background:  No randomized controlled trial exists comparing the quality between sevoflurane and propofol for MRI.
Methods/Materials:  Two hundred unpremedicated children (18 months to 7 years) scheduled for brain MRI scans were recruited. After induction with sevoflurane, children were randomized to receive sevoflurane [general anesthesia with sevoflurane (GAS)] via laryngeal mask airway (LMA) or propofol [general anesthesia with propofol (GAP)] bolus and infusion for their scan. The three primary outcomes of pausing the MRI scan (P), agitation (A), and respiratory complications (R) were compared. Timeliness of care was also measured.
Results:  No MRI scan pauses were found in 92% and 80% in the GAS and GAP groups. The median and interquartile A scores were 3 (0, 7) in GAS and 0 (0, 4) in GAP groups respectively. There was no difference in respiratory complications between GAS and GAP ( P  = 0.62). The median and interquartile postanesthesia care unit (PACU) times were 25 (18, 34) for GAS and 31 (25, 44) for GAP ( P  = 0.0001). The median and interquartile total times were 78 (69, 90) for GAS and 88 (78, 100) for GAP ( P  = 0.0002).
Conclusion:  Our study compared the three primary outcomes of pausing, agitation, and respiratory complications between the two groups, and we found no difference in respiratory complications. However, the GAP group had more pausing and less agitation than the GAS group.     

Ethical concerns in the management of pain in the neonate

The debate about the management of pain in the neonate has continued to evolve over the past 30 years. This controversy can be understood as evolving through now three eras of thought about the effect of pain and its management in newborns and infants. The first generation was characterized by a widespread belief that newborns lacked the complete development of the neuroanatomical and neuroendocrine components necessary to perceive pain. During this period, newborns often received inadequate anesthesia and analgesia for painful procedures, if not no treatment at all. The second generation was heralded by research that demonstrated that newborns did demonstrate similar or even exaggerated physiological and hormonal responses to pain compared with those observed in older children and adults and that exposure to prolonged or severe pain may increase neonatal morbidity. Controversy in this generation focused around the dosage of analgesia to newborns as well as the risks and benefits of pain management techniques. We are now in a third generation of thought about pain in the neonate, defined by intense debate over the significance of a growing number of studies in immature animal models that demonstrate degenerative effects of several anesthetics on neuronal structure. The challenge of this era is to integrate the advances in diagnosis and treatment achieved in previous generations with ongoing adaptation of clinical practice as dictated by research advances in the field. In this review, we examine the evolution of medical thought and ethical concerns regarding pain treatment in the neonate.     

T Lymphocyte Subsets in Parenteral and Non-parenteral Heroin Abusers in Britain

Parenteral drug abusers comprise the second largest group of patients with the acquired immune deficiency syndrome (AIDS). To determine whether heroin abusers in Britain had immunologic abnormalities similar to those seen in AIDS, we determined T lymphocyte subsets in 14 parenteral heroin abusers and 10 non-parenteral heroin abusers. No significant differences were found in T4/T8 ratios or in the absolute numbers of T3, T4, or T8-positive cells. These results suggest that neither narcotic drugs nor repeated exposure to unsterile injectable substances are responsible for low T4/T8 ratios in parenteral drug abusers with AIDS.     

The Effects of Psychoeducation and Self-Monitoring in a Cognitive-Behavioral Program for Body-Image Improvement

Cognitive-behavioral therapy (CBT) is an efficacious treatment for body-image difficulties and disorders. The current study evaluated two combined components of Cash's (1997) self-administered bodyimage CBT program-psychoeducation and self-monitoring. Twenty-five body-dissatisfied college students enrolled in the threeweek program and were required to hand in homework weekly in brief meetings with the experimenter. From pre- to posttest, participants became significantly more satisfied with their appearance and reported less situational body-image dysphoria, less weightrelated concern, and less investment in their appearance as a source of self-evaluation. Changes generalized to improved self-esteem, eating attitudes, and social anxiety. Better self-monitoring compliance predicted greater reductions in body-image dysphoria. The study's methodological limitations and clinical implications are considered, and mechanisms of change are discussed.     

ANALYSIS OF THE RET PROTO-ONCOGENE IN SPORADIC PARATHYROID ADENOMAS

Missense germline mutations of the RET proto-oncogene have recently been identified in the hereditary cancer syndromes MEN2A, MEN2B, and FMTC, all characterized by medullary carcinoma, but also including phaeochromocytoma in MEN2A and MEN2B and parathyroid disease in MEN2A. In addition, somatic RET proto-oncogene mutations have been identified in a subset of sporadic medullary carcinomas and phaeochromocytomas. This study investigated the possibility that RET plays a role in sporadic parathyroid neoplasia. Firstly, normal and neoplastic parathyroid tissues were screened for expression of the RET proto-oncogene, using an RT-PCR approach on autopsy material. Secondly, 20 archival parathyroid adenomas were screened for somatic mutations in the transmembrane region of RET, the region associated with germline mutations in MEN2A and hence parathyroid disease, using a PCR–solid phase direct sequencing approach. RET expression was identified in all the parathyroid tissues analysed. However, no mutations were identified in any of the 20 adenomas, suggesting either that other mechanisms of RET activation occur, such as translocation, or that RET plays a more minor role in the growth control of the parathyroid cells than in C cells or phaeochromocytes.