EFFECT OF STIMULATION OF THE P6 ANTIEMETIC POINT ON POSTOPERATIVE NAUSEA AND VOMITING

The antiemetic action of stimulation of the P6 (Neiguan) acupuncture(ACP) point has been studied in women, premedicated with nalbuphine10 mg, undergoing minor gynaecological operations under methohexitonenitrousoxide-oxygen anaesthesia. Invasive ACP—manual or electricalat 10 Hz—applied for 5 min at the time of administrationof the premedication markedly reduced the incidence of vomitingand nausea in the first 6 h after operation, compared with untreatedcontrols. This did not occur with stimulation of a "dummy" ACPpoint outside the recognized ACP meridians. Non-invasive methods(stimulation via a conducting stud or by pressure) were equallyas effective as invasive ACP during the early postoperativeperiod. However, both these non-invasive approaches were lesseffective than invasive ACP in the 1–6 h postoperativeperiod, although each was as effective as two standard antiemetics(cyclizine 50 mg, metoclopramide 10 mg). In view of the totalabsence of any side effects in more than 500 ACP procedures,the clinical applications of this finding are worthy of furtherstudy.     

TINEA VERSICOLOR HYPOPIGMENTATION: HISTOCHEMICAL AND THERAPEUTIC STUDIES

ABSTRACT: One hundred and thirty-four patients with tinea versicolor were divided into 3 treatment groups: (1) 30% sodium thiosulfate application, (2) 30% sodium thiosulfate application plus ultraviolet light, and (3) 30% sodium thiosulfate application, ultraviolet light, and meladinine tablets (amoidin 0.01 g and amidin 0.005 g). Analysis of the 79 patients who completed the 6-week study showed no statistical difference. Therefore, topical treatment should be instituted as quickly as possible to prevent pigmentary changes. Ultraviolet light should be used only after the fungus has cleared in order not to darken the skin further     

U.S. Experience with the AddVent VDD(R) Pacing System

The AddVent pacemaker generator and model 1328C AV single-pass lead is a new pacemaker system capable of VDD or VDDR modes. The purpose of this study was to present the initial experience with AddVent in the United States and Canada. Between May 10, 1995 and May 3, 1996, 53 devices were implanted in 52 patients and followed for a mean of 217 (±39) days. At the predischarge, 1-, 3-, and 6-month follow-up evaluations, atrial sensing thresholds and ventricular sensing and capture thresholds were measured in the supine, sitting, and standing positions to evaluate stability of atrial sensing with respect to body posture at rest. At the 1-month follow-up, a treadmill exercise test was performed to evaluate atrial sensing during exercise and to evaluate two new features of the AddVent called "sensor-mediated rate smoothing" and "preferential P wave sensing." Atrial sensing thresholds were not significantly different (P > 0.05) among body postures for any follow-up period or among follow-up periods for each posture. At rest, the percentage of appropriately tracked P waves observed was > 99% at each follow-up period. During treadmill exercise, the percentage of appropriately tracked P waves was > 98.7%. Appropriate preferential P wave sensing and sensor-mediated rate smoothing (VDDR mode) was observed. The AddVent pacing system provides safe and effective pacing therapy. Several features of VDDR pacing offer advantages over standard VDD pacing.     

Determinants of Dietary Intake in a Sample of White and Mexican-American Children

Objective To assess the influence of several potential psychosocial determinants on children's eating behavior.Participants Three hundred fifty-one Mexican-American and non-Hispanic white children (mean age=4.4 years old at baseline) participated in the San Diego Study of Children's Activity and Nutrition for up to 2.5 years.Methods Child's eating behavior was described by 3 dependent variables: total energy, percentage energy from fat, and sodium intake per 1,000 kcal. Dietary information was collected 4 days a year using a 24-hour food intake record, which was a combination of direct observation and interviews with food preparers. The 35 predictor variables from child, parental, demographic, and environmental domains were collected by behavioral observation, interviewer-administered questionnaires, and physical measurements.Statistical analyses Bivariate and regression analyses via mixed linear models were performed.Results Variables from the children's domain (such as skinfold thickness and weight) had the strongest associations with energy intake; parental variables (such as fat avoidance behavior and prompts to increase children's food intake) were associated with child's percentage energy from fat and sodium intake. In regression analyses, parsimonious subsets of variables accounted for 46% of variance in energy intake (3 variables), 40% of the variance in percentage of energy from fat (4 variables), and 44% of variance in sodium intake per 1,000 kcal energy (1 variable) in between-subject variance components.Conclusions Fat and sodium intake of children may be improved by improving parents’ nutrition habits and by having parents encourage children to eat a healthful diet. Few modifiable correlates of children's energy intake were identified. J Am Diet Assoc. 1998;98:1282–1289.     

CIRCULATING IMMUNE COMPLEXES IN VARIOUS FORMS OF BEHÇET'S DISEASE

Background. The etiology of Behget's disease (BD) is uncertain but there is strong evidence that the immune system is implicated in its pathogenesis. Methods. We assessed circulating immune complexes (CIC) in peripheral blood of 34 patients with BD, forming eight clinical groups, using a laser nephelometer to obtain more insight in the pathogenesis of different clinical forms of bd. Twenty healthy controls and eight patients with recurrent oral ulcerations were also included in the study. Results. Levels of CIC were significantly higher in patients (1.83 ± 0.93 μg/mL) than in controls (0.84 ± 0.51 μg/mL; P < 0.001). High titers were found in the groups of patients with erythema nodosum (3.14 ± 0.44 μg/mL), neurologic manifestations (2.9 ± 0.58 μg/mL), and ocular manifestations (2.34 ± 0.93 μg/mL). Compared to patients with recurrent oral ulcerations (1.91 ± 0.77 μg/mL), the mean value of CIC in patients with BD did not differ significantly, but the groups of patients having erythema nodosum, positive pathergy, and neurologic manifestations had significantly higher levels (P < 0.05) and the group of patients at the mild end of the spectrum (group 8) had a significantly lower level (1.09 ± 0.41 μg/mL) (P < 0.05). Only the groups having erythema nodosum, positive pathergy, and neurologic manifestations had significantly higher levels of CIC when compared to other groups lacking these clinical features, whereas group 8 had a significantly lower level (P < 0.05) when compared to all other groups. Conclusion. Our results show that CIC may be involved in the pathogenesis of BD, especially in those clinical forms of the disease with erythema nodosum, neurologic manifestations, and ocular manifestations. Patients at the mild end of the BD spectrum do not show significant changes in CIC levels compared to healthy control subjects. We can, therefore, suggest that in BD CIC may be implicated more in the pathogenesis of some features than of others.     

Plasma concentrations of bupivacaine during extradural anaesthesia for Caesarean section

The clinical effects and plasma levels associated with the use of 0.5% bupivacaine with and without the addition of 1:200,000 adrenaline (5 micrograms/ml) were studied in 30 patients who underwent extradural anaesthesia for elective Caesarean section. The addition of adrenaline to bupivacaine prolongs analgesia, reduces the degree of hypotension and delays its onset. Plasma bupivacaine levels were consistently lower when adrenaline was added, but this difference was significant only at 10 minutes after the initial dose. Prolonging the interval between increments seems to be a more reliable way to reduce plasma concentration than the addition of the catecholamine.     

Isoflurane as an alternative to halothane for Caesarean section

Two series of 25 patients who underwent elective Caesarean section with general anaesthesia were given either 0.75% isoflurane or 0.5% halothane as supplements to 50% nitrous oxide in oxygen used for maintenance. The potent inhalational agent was given for the entire operative period and no case of intra-operative dreaming or awareness was reported. The infusion dose of suxamethonium was significantly less with isoflurane, 50 micrograms/kg/minute (SD 17), as compared to halothane, 64 micrograms/kg/minute (SD 24) (p less than 0.02). Recovery from anaesthesia was more rapid with isoflurane. The surgeon's assessment of uterine relaxation and bleeding using a visual analogue score indicated that this was significantly less with isoflurane. Infant well-being as judged by Apgar score and cord blood gas analysis, showed little difference between the two inhalational agents.     

THYROTROPHIN AND PROLACTIN RESPONSIVENESS TO THYROTROPHIN RELEASING HORMONE IN CUSHING'S DISEASE

Serum thyrotrophin response to thyrotrophin releasing hormone was impaired in all of eight subjects with untreated Cushing's disease; while all of six similar subjects tested after adequate treatment by a pituitary implant of ¹⁹⁸ Au then showed a normal response. In all five of the untreated patients studied, the serum prolactin response to TRH was normal. Thus chronically excessive cortisol levels as seen in Cushing's disease inhibit pituitary TSH responsiveness to TRH without affecting the prolactin response to TRH Evidently the release of TSH and of prolactin by TRH are governed by independent mechanisms.     

Novel class of silicon-based protective groups for the side chain of tyrosine

A novel class of silyl-based protective groups compatible with the Bpoc/t-Bu strategy has been developed for the side chain of tyrosine. Carbobenzyloxy (CBZ) and biphenylisopropyloxy (Bpoc)-O-β-trimethylsilylethyl-tyrosine ( 10 and 12 ) and CBZ-O-β-dimethylphenylsilylethyl-tyrosine 14 were prepared in reasonable yields and in very high purity. The trimethylsilylethyl (TMSE) group proved to be 3–4 times more stable than the tert-butyl ether group towards 0.5% TFA. The latter is removed up to 4% during the acidolysis of the Bpoc group. As expected, the dimethylphenylsilylethyl (DMPSE) group was even more resistant towards 0.5% TFA (five time greater than the TMSE analog). Both silyl protective groups were found to be resistant towards a variety of reagents used in peptide synthesis, such as trialkylamines, hydroxybenzotriazole, trialkylphosphine and nucleophiles. They are readily removed in neat TFA in 5–20 min in the absence of cation scavengers, without any detectable alkylation of the phenolic ring. The application of the new silyl-based protective group was demonstrated by the synthesis of the C-terminal 29 amino acid peptide of the basic pancreatic trypsin inhibitor by the prior thiol capture methodology. The protected octapeptide Boc-C(Acm)QT(tBu)FW(TMSE)GG-PO-dibenzofuranthiol was synthesized by solid-phase peptide synthesis using Bpoc-(O-TMSE)-Tyr-OH in greater than 90% yield and coupled to an unprotected 21-mer. The partially blocked, purified peptide was deprotected quantitatively in neat TFA in 1 h.