Measurement of post-operative pain and narcotic administration in infants using a new clinical scoring system

We developed a clinical neurologic and behavioral scoring system composed of 10 items to measure the post-operative pain levels in infants: (1) sleep during preceeding hour, (2) facial expression of pain, (3) quality of cry, (4) spontaneous motor activity, (5) Spontaneous excitability, (6) flexion of fingers and toes, (7) sucking, (8) global evaluation of tone, (9) consolability and (10) sociability. Using this system, a group of infants ranging from one to seven months in age and undergoing minor surgical procedures was studied. The infants were randomly assigned to two groups: Group I received Fentanyl intravenously (3 g/kg) prior to surgery, and Group II received a placebo. The infants then were studied post-operatively in the recovery room at 30, 60, 90 and 120 min intervals. Over the entire post-operative observation period, 54% of the infants in Group I had satisfactory analgesia compared to 18% in Group II. There were no significant differences in Group I and Group II in oxygenation, carbon dioxide elimination, blood pressure, heart rate or temperature.     

Kindling and electrode effects on the benzodiazepine receptors density of olfactory bulb and hippocampus after olfactory bulb kindling.

The olfactory bulb (OB) kindling is a model of limbic secondary generalized epilepsy. Ten days after the completion of OB kindling, we have studied the long term effects of both electrode insertion and kindling on the binding of [3H]diazepam to crude mitochondrial fractions. On the one hand, we have shown that electrode implantation in sham-operated controls induced an obvious increase in benzodiazepine (BZD) receptor density (Bmax) only at the site of the electrode in comparison to sham-unoperated rats. These results might indicate an additional mechanism extending earlier observations reported by others, who have shown that prolonged electrode implantation induced changes in sham-operated and kindled rats. On the other hand, the long lasting effect of OB kindling on the binding parameters of [3H]diazepam was examined in the focus and in the hippocampus. The results indicate a bilateral increase of BZD receptors in the OB and an ipsilateral increase in the hippocampus. These changes might be a regulation phenomenon in response to a hyperexcitability state and to focal stimulations.     

Regulation of T-cell receptor signalling by membrane microdomains

There is now considerable evidence suggesting that the plasma membrane of mammalian cells is compartmentalized by functional lipid raft microdomains. These structures are assemblies of specialized lipids and proteins and have been implicated in diverse biological functions. Analysis of their protein content using proteomics and other methods revealed enrichment of signalling proteins, suggesting a role for these domains in intracellular signalling. In T lymphocytes, structure/function experiments and complementary pharmacological studies have shown that raft microdomains control the localization and function of proteins which are components of signalling pathways regulated by the T-cell antigen receptor (TCR). Based on these studies, a model for TCR phosphorylation in lipid rafts is presented. However, despite substantial progress in the field, critical questions remain. For example, it is unclear if membrane rafts represent a homogeneous population and if their structure is modified upon TCR stimulation. In the future, proteomics and the parallel development of complementary analytical methods will undoubtedly contribute in further delineating the role of lipid rafts in signal transduction mechanisms.     

Thermal pleasantness sensation: an indicator of thermal stress

Summary The degree of pleasantness or unpleasantness of thermal sensation aroused by a particular peripheral thermal stimulus has been shown to be an indicator of thermal state of the body in relation to the thermoregulatory set point. This phenomenon is known as thermal alliesthesia. The quantification of thermal alliesthesia was possible using two methods: (1) A set of temperature stimuli (15, 20, 25, 30, 35, and 38 C) was applied, by means of a Peltier thermode 5.5×2.7 cm², on the back of the hand, the forehead, and the back of the neck. When each stimulus had been applied for 5 s the subjects voted their degree of thermal pleasantness/unpleasantness on a psychophysical scale ranging from +2.0 for very pleasant to –2.0 for very unpleasant. (2) The subjects were also asked to adjust the Peltier thermode temperature, without looking at the temperature scale, such that the temperature (on the back of the neck) was maintained at the level the subjects considered most pleasant. The subjects also rated their general thermal comfort sensation on a five point scale ranging from +2.0 for very comfortable to –2.0 for very uncomfortable. Rectal temperature and skin temperature at eight locations were continuously recorded. Passive thermal exposures (54) were made with nine passive subjects and 42 exposures were done with working (50 watt) subjects. All exposures were carried out in a climatic chamber at a constant temperature, relative humidity (45%), and air speed (0.3 m/s). Each subject underwent 6 exposures at six room temperatures of 15, 20, 25, 30, 35, and 40 C. The results of work exposures confirmed the findings of previous studies; namely, the effect of core temperature change overrides any effect due to mean skin temperature on alliesthesial response. A mathematical function to predict the mean slope of the thermal pleasantness rating/stimulus line (a measure of the alliesthesial response) was derived using the data obtained from the passive thermal exposures. The results indicate that alliesthesial response can be used as a quantitative indicator of thermal stress.Supported by the European Coal and Steel Community, Luxembourg     

Self-expanding oesophageal metal stents for the palliation of dysphagia due to extrinsic compression

The role of self-expanding metallic stents is well established in the palliation of oesophageal stenosis and dysphagia due to primary oesophageal malignancy. However, their role in palliation of dysphagia due to external compressive mediastinal malignancies is not well established. The purpose of this study was to assess the efficacy of self-expanding metallic stents in the palliation of dysphagia due to extrinsic oesophageal compression by mediastinal malignancy. Between January 1995 and January 1998, 21 patients with oesophageal compression due to malignant mediastinal tumours underwent oesophageal stent placement for palliation of dysphagia. Complete data were available in 17 patients (10 men and 7 women). The mean age was 63.5 years (range 46–89 years). A total of 19 stents were placed successfully. The dysphagia grade prior to and after oesophageal stent placement was assessed and the complications documented. Of the 17 patients, 16 reported an improvement in dysphagia. The mean dysphagia score improved from 3.1 prior to treatment to 1.3 after treatment. In 1 patient the stent slipped during placement and another stent was placed satisfactorily. Early complications (within 48 h) in the form of mild to moderate retrosternal chest pain occurred in 5 patients. This was treated symptomatically. Late complications (after 48 h) in the form of bolus impaction occurred in 2 patients. This was successfully treated with oesophagoscopy and removal of bolus. In 2 patients the stent was overgrown by tumour and in one of these an additional stent was placed. In 1 patient incomplete closure of a tracheo-oesophageal fistula was observed. There was no procedure- or stent-related mortality. The mean survival time of this group was 2.1 months. Self-expanding metallic stents can be safely and effectively used in the palliation of dysphagia due to external mediastinal malignancies. Received: 21 October 1998; Revised: 1 February 1999; Accepted: 4 February 1999