Pain management in ambulatory surgery.

Successful ambulatory surgery is dependent on analgesia that is effective, has minimal adverse effects, and can be safely managed by the patient at home after discharge. A number of studies have identified that the provision of effective postoperative analgesia is inadequate for a significant proportion of patients. The following discussion details the current available analgesic options for ambulatory surgery patients and the rationale for their use. Preemptive analgesia should be given to all patients unless there are specific contraindications. Consideration should be given to the use of long-acting oral COX-2 selective nonsteroidal anti-inflammatory drugs (NSAIDs) and long-acting oral opioids to treat postoperative pain. A standardized multimodal postdischarge analgesic regimen tailored to the patient's expected postoperative pain levels should be prescribed. Patient follow-up by telephone questionnaire will confirm those surgical procedures that result in mild or moderate-to-severe postoperative pain and the effectiveness of treatment plans.     

Glomerular podocyte vacuolation in idiopathic membranous glomerulonephritis.

Vacuoles in glomerular visceral epithelial cells were found in 149 of 254 patients with idiopathic membranous glomerulonephritis (IMGN). In the whole population studied, 115 patients were nephrotic, 88 (76.5%) of which were found to have intraepithelial vacuoles. Fifty (35.9%) of 139 non-nephrotic patients had vacuolated podocytes (p less than 0.01). Vacuolation occurred most frequently in stages II and III of IMGN. A few intraepithelial vacuoles were observed in stage IV. Increase in vacuolation tended to correlate with subepithelial deposits which were larger in size. From these results, we concluded that the appearance of epithelial vacuolation coincides with an increased filtration of protein in IMGN and that it is an important histological marker when diagnosing the level of severity of glomerular lesions. It was not, however, prognostic.     

Differentiation between rat brain and mouse vas deferens delta opioid receptors

Certain enkephalin analogues, including those which contain the conformationally restricted amino acid E-(2R,3S)-cyclopropylphenylalanine [2R,3S)-delta E Phe), have been shown to have high affinity for brain delta opioid receptors but are much less active in mouse vas deferens bioassays. To investigate whether there are differences between delta opioid receptors in brain and mouse was deferens, the ability of a selective delta opioid compound, [D-Pen2,pCl-Phe4,D-Pen5]enkephalin (pCl-DPDPE), and [D-Ala2,(2R,3S)-delta E Phe4,Leu5]enkephalin methyl ester (CP-OMe), to inhibit [3H]pCl-DPDPE binding in both rat brain and mouse vas deferens were measured. pCl-DPDPE recognized brain and mouse vas deferens binding sites with equal affinity, however, CP-OMe showed 33 fold lower affinity in mouse vas deferens compared to brain. This suggests that mouse vas deferens delta opioid receptors may be distinct from brain delta opioid receptors.