Anasthetic management of congenital fusion of the jaws in a neonate

Fusion of the jaws in the neonate is a very rare congenital anomaly which may be associated with other congenital defects such as aglossia, facial hemiatrophy or retrognathia. Ventilatory management for surgical separation of the fused jaws presents severe problems. In a recent case of a neonate with almost completely fused jaws requiring general anaesthesia, we used subanaesthetic doses of ketamine in combination with an insufflation technique. It took 45 minutes to reach the surgical stage of anaesthesia due to misplacement of the nasotracheal tube through an unsuspected cleft palate towards a gap between the jaws, a previously unreported combination of complications.     

Na+, K+-ATPase inhibition,a new mechanism for cold-induced vasoconstriction in cutaneous veins

The putative existence of an endogenous opioid antisecretory mechanism in the small intestine was tested in anaesthetized Sprague-Dawley rats. Cholera secretion was elicited with cholera toxin and net fluid secretion was measured in viva using a gravimetric technique allowing on line registrations. Opioid blockade with naloxone (10 mg kg^-1 i.v.) increased the cholera secretion significantly but had no effect on control absorption. Pretreatment with phentolamine (2 mg kg^-1 i.v.) eliminated the effect of opioid blockade indicating an interaction between the opioid and the adrenergic mechanisms. The effect of naloxone on cholera secretion was unchanged after acute division of the sympathetic nerves to the intestine and removal of the adrenals. Chronic sympathetic denervation of the small intestine, on the other hand, abolished the effect of opiate blockade on the secretion. The antisecretory effect of sympathetic nerve stimulation was unchanged by opiate blockade. Conclusion: An intrinsic antisecretory opioid mechanism has been demonstrated in the small intestine of the rat. This endogenous opioid mechanism seems to decrease secretion indirectly via peripheral activation of the sympathetic antisecretory system.     

The Diagnostic Significance of Reciprocal ST Segment Depression in Acute Myocardial Infarction

The relationship between reciprocal ST-segment depression, theresult of an early submaximal exercise ECG, and the anatomyof coronary artery disease was explored in 142 patients withacute myocardial infarction. Reciprocal ST-segment depression was observed in 65 per centof 79 patients with inferior infarction and 57 per cent of 63with anterior infarction. Thirty-three of the 52 patients withreciprocal ST-segment depression had a significant stenosisof the coronary artery supplying the reciprocal ST-segment territory(63 per cent), and 31 of the 46 patients with a positive exercisetest had a significant stenosis of the coronary artery supplyingthe ischaemic territory (67 per cent). Forty-one of the patientswith reciprocal ST-segment depression (79 per cent) and 35 ofthe patients with positive exercise tests (76 per cent) werefound to have multivessel coronary artery disease. The study showed that reciprocal ST-segment depression was associatedwith stenosis of the coronary artery supplying the territoryopposite the infarct in nearly two-thirds of the patients andwith multivessel coronary artery disease in almost four-fifthsof them. Reciprocal ST-segment depression after infarction wasas accurate as a positive submaximal exercise test at predictingthe presence of multivessel coronary artery disease.     

Tocolytic Effect of the Cyclooxygenase-2 Inhibitor,Meloxicam: Studies on Uterine Contractions in the Rat

The objective of this study was to assess the tocolytic activity of meloxicam, a novel cyclooxygenase-2 inhibitor, in a comparative study with the non-steroidal anti-inflammatory drug, indomethacin. The in-vitro tocolytic effect of meloxicam and indomethacin (10^?9-10^?5M) was evaluated on spontaneously-contracting uterine strips from non-pregnant rats and from rats at various stages of pregnancy. The rhythmic motility of the strips was reproducibly maintained over several hours. The effect of drugs was evaluated from the extent of inhibition of the frequency and amplitude of contractions. Both indomethacin and meloxicam induced dose-dependent inhibitory effects, with meloxicam being slightly more potent in all groups studied, particularly in early pregnancy. These results suggest that meloxicam, which has fewer side-effects than cyclooxygenase-1 inhibitors, could be a potentially useful tocolytic agent in the treatment of premature labour.