Comparison of nifedipine and propranolol as second line agent for hypertension in black Kenyans.
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Adult↗
Biomedical subjects
C L Chang
Publications and source records attributed to C L Chang.
Comparison of the effect of EMLA cream, subcutaneous ring anaesthesia and a double cuff technique in the prevention of tourniquet pain.
We have examined the effect of EMLA on tourniquet pain and compared it with those of subcutaneous ring anaesthesia (SRA), a double cuff technique and a single cuff (control) during i.v. regional anaesthesia. The durations of analgesia (mean 57.3 (SD 16.6) min) and tolerance (72.3 (13.9) min) to tourniquet inflation in the EMLA group were comparable to those in the SRA group (54.1 (16.2) min and 68.3 (19.0) min), but significantly (P < 0.05) greater than those in the control group (30.0 (10.7) min and 45.6 (14.0) min). The double cuff technique was the most effective method, with 91.5 (14.9) min duration of analgesia. We conclude that EMLA provided a significant analgesic effect on tourniquet pain compared with the control group, but a relatively limited analgesic effect compared with a double cuff technique.
Adolescent↗
Portable chest imaging: comparison of storage phosphor digital, asymmetric screen-film, and conventional screen-film systems.
The quality of chest images obtained with portable radiography was evaluated for a conventional screen-film system, a new asymmetric screen-film chest system, and computed radiography (CR). Sixty chest images were obtained in 20 patients in an intensive care unit. The CR system was ranked by all three evaluating radiologists as substantially better in overall diagnostic quality, interpretability of the lungs, and musculoskeletal detail and by two of the three observers as better for the visibility of catheters and lines. In the upper abdomen and mediastinum, there was not a clear preference. Standard deviations of film density were +/- 0.12, +/- 0.41, and +/- 0.39 for the CR, conventional, and asymmetric systems, respectively. For the same systems, phantom results indicated the relative lung contrast values were 1.2, 1.0, and 0.89, respectively. Similarly, the limiting resolution values in the lung were 2.0, 4.2, and 6.3 line pairs per millimeter. The CR system had twice the root-mean-square noise of the screen-film systems. Overall, the preferred system for portable chest imaging was the CR system.
Electricity↗
The site of action of lidocaine in intravenous regional anesthesia.
Despite vast clinical experience and success with intravenous regional anaesthesia (IVRA), the site and mode of action of the local anesthetic agents remains controversial. Many investigations have been published, but conclusions are variable. The principal site of action of lidocaine in IVRA was studied using 15 ASA I-II patients receiving surgical operation on the hands and forearms. A 22 gauge plastic cannula was inserted into the median cubital vein at the elbow. A double cuff tourniquet was secured on the upper arm, as described by Bier and modified by Homes. Another single tourniquet was then applied on the forearm as near the plastic catheter as possible. Two different concentrations of lidocaine (0.5% and 2%) in a total dose of 3 mg kg-1 was slowly injected into the vein via the catheter after the limb was exsanguinated and the tourniquets were inflated. The results showed that 0.5% lidocaine produced analgesia only on the intercuff area; there was no analgesic response noted on the forearm distal to the third tourniquet after a 15 minutes observation. However patients who received 2% lidocaine experienced in analgesia rapidly on the intercuff area and also slowly on the forearm and hand. The anesthesia developed from the fingertips upward. Based on this evidence, we concluded that the principal site of action of lidocaine in IVRA depends on concentration. The lower concentration acts on the sensory nerve endings and the small nerves. Whereas, the higher concentration acts on both nerve trunks and nerve endings.
Adolescent↗
Removal of renal cell carcinoma extending into the right atrium using cardiopulmonary bypass, profound hypothermia and circulatory arrest.
A 65-year-old man presented with renal cell carcinoma of the right kidney with a tumor thrombus extending up the vena cava to the right atrium. Cardiopulmonary bypass, profound hypothermia and total circulatory arrest were used to create a bloodless field for excision of the renal cell carcinoma and its tumor thrombus. Acute respiratory failure and deep jaundice developed after the operation and the patient was transferred to the intensive care unit for critical care. After respiratory therapy and nutritional support, the liver function was restored. The endotracheal tube was weaned one month later. The patient has had total resolution of all symptoms and there is no evidence of tumor recurrence of distant metastases after 6 months follow-up.
Aged↗
Prolonged fasting in pediatric outpatients does not cause hypoglycemia.
Two hundred and thirty healthy children scheduled for receiving elective minor surgery were assigned into 4 different groups. Group I (small infant group) included 27 infants of age from 1 to 3 months (2.0 +/- 0.6 months), Group II (infant group) included 42 infants age from 3 to 12 months (7.4 +/- 2.8 months), Group III (pre-school children group) included 122 patients of age from 1 to 6 years (3.1 +/- 1.4 years). The remained 39 cases of age older than 6-years-old (8.0 +/- 1.5 years) were collected in group IV (old children group). All studied children were starved for at least 4, 6, or 8 hours in infants, pre-school children, and old children group, respectively, pre-operatively. The fasting time and fasting blood glucose levels of the 4 groups were 6.7 +/- 1.4 hours and 109.0 +/- 22.9 mg% in group I, 7.7 +/- 2.3 hours and 98.6 +/- 18.0 mg% in group II, 10.4 +/- 2.9 hours and 96.9 +/- 24.7 mg% in group III, and 12.6 +/- 2.6 hours and 95.7 +/- 20.5 mg% in group IV, respectively. No one in the 230 children had blood glucose less than 40 mg% even in 5 infants who were starved for 12 hours or more. Therefore, we concluded that preoperative starvation is well tolerated than the originally expected in the infants and children. The fasting time before anesthesia can be executed safely even though the operation schedule may not be right on time.
Age Factors↗
Continuous succinylcholine infusion and phase II block in short surgical procedures.
The study was designed to observe continuous succinylcholine infusion and phase II block in short surgical procedures (duration < 90 min). The characteristics of neuromuscular blockade produced by continuous succinylcholine infusion were observed in 15 adult patients anesthetized with nitrous-oxide-isoflurane (0.7% end tidal concentration) and fentanyl, and were compared with the single-dose technique (n = 13) in recovery time. Ulnar nerve was stimulated supramaximally with repeated train-of-four (interval = 10 sec, frequency = 2 Hz) via surface electrodes at the wrist using an electromyographic monitor (Datex, Relaxograph, Finland). The infusion rate was adjusted to maintain the height of the first twitch (T1) in each train of four at 5-10% of control twitch height. The mean duration of infusion was 50.74 +/- 18.06 minutes. The steady state infusion rate required to maintain 90% to 95% twitch depression was 83.5 +/- 21.4 micrograms/kg/min. Five patients developed phase II block (T4/T1 < 0.5) designated as IB. The other ten did not develop phase II block as IA. Recovery times (T1 = 10.50%, 10-100%) between IA and IB were not statistically significantly different. The recovery time of train-of-four fade (T1 = 10% to T1 = 100% and train of four > 75%) was 5.73 +/- 0.43 minutes. However, recovery times between continuous infusion group and single dose group were significantly different.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Analgesic effect of tramadol HCL in ESWL].
Since its introduction, extracorporeal shock-wave lithotripsy (ESWL) has become the treatment of choice in patients with urinary calculi. But the pain during ESWL is intolerable for many patients. Tramadol HCL resembles morphine in that it depresses motor and sensory responses of the spinal nociceptive system by a spinal and a supraspinal action. The side effects of tramadol are less than morphine. A prospective study was performed to determine the effect of tramadol in ESWL for the patients with urinary tract calculi. Ninety patients were randomized divided into three groups. Group A 40 patients (male:female = 31:9) received oral tramadol HC1 100 mg; group B 17 patients (male:female = 12.5) received multi-vita; group C 33 patients (male:female = 26:7) received analgesic (contained aspirin 399 mg and codeine phosphate 15 mg). The patients took the drugs 30 minutes before ESWL. The patients with renal calculi > 2 cm in diameter or ureteral calculi > 1 cm in diameter were excluded. The lithotriper used in our hospital is Siemens Lithostar. According to the description of the patients postoperatively, the pain intensity during ESWL was identified with Verbal Scale and Visual Analogue Scale (VAS). The statistical method is one-way ANOVA. Statistical difference is significant when p < 0.05. The mean age of patients group A is 46.5 +/- 17.1, group B 45.5 +/- 14.4, and group C 50.5 +/- 14.6. The mean diameter of urinary calculi of group A is 0.98 +/- 0.41 cm, group B 1.09 +/- 0.33, and group C 1.06 +/- 0.43.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Inhibitory effect of neuropeptide Y (NPY) on the in vitro activity of dopamine-beta-hydroxylase.
Neuropeptide Y (NPY) is found to be costored with norepinephrine (NE) in vesicles of the nerve terminals. An endogenous inhibitor of dopamine-beta-hydroxylase (DBH), the synthetic enzyme of NE, has been mentioned. In an attempt to clarify the effect of NPY on DBH activities, an in vitro assay is carried out using chromatographic analysis of NE formation from dopamine. NPY (20-80 pmol/ml) produced a dose-dependent depression of NE formation catalysed by the purified bovine adrenal DBH. Lineweaver-Burke plots (Km = 1.1 mM, Vmax = 10 pmol/min/mg protein) showed a non-competitive inhibition in NPY (30 pmol/ml, IC50)-treated samples. Moreover, failure of denatured NPY even at maximum concentration to influence the DBH activities suggested the essential of natural form of NPY. Participation of sulfhydryl compound seems also negligible, because N-ethylmaleimide did not overcome the effect of NPY. These results indicate that NPY has the ability to inhibit the catalytic action of DBH.
Animals↗
Use of indomethacin in the prophylaxis of ureteral colic following extracorporeal shock wave lithotripsy.
Ureteral obstruction leading to pain seems to be related to an increase of renal prostaglandins (PG). We designed a prospective double-blind, placebo controlled protocol for evaluating the effect of indomethacin, a PG-synthetase inhibitor, in the prophylaxis of ureteral colic following extracorporeal shock wave lithotripsy (ESWL). Sixty patients undergoing ESWL were randomized into two groups, group 1 (study group) received 50 mg indomethacin capsule three times daily and group 2 (control group) received multiple-vitamin tablet three times daily. Twenty-four hours urine samples were collected before and three days after ESWL was performed for PGE2 (predominant renal PG) determination. Subjective pain after ESWL was recorded with pain score (0-10 degrees). Oral codein or pethidine injection were available for relieving pain following ESWL. The pain score, analgesic requirement and urinary PGE2 in pre- and post-ESWL were used to compare the two groups. The pain score was 4.00 +/- 0.25 and 3.00 +/- 0.25 in the control and study groups respectively; it had a statistically significant difference (p < 0.01). In control group, 12 and 14 patients required 23 doses of codein and 18 doses of pethidine. In the study group, three and four patients required five doses of codein and eight doses of pethidine. The difference was statistically significant (p < 0.05). In the control group, the mean pre- and post-ESWL urinary PGE2 was 305 +/- 65.8 and 474 +/- 101 micrograms/24-hr respectively. In the study group, the mean pre- and post-ESWL urinary PGE2 was 289 +/- 60.7 and 186 +/- 26.5 micrograms/24-hr respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Effect of premedication on the changes of neuropeptide Y (NPY) in anesthesia.
Premedication is one of the popular techniques in anesthesia, not only for the decrease of side effects but also for the increase of actions. Clinically, we found that plasma neuropeptide Y-like immunoreactivity (NPY-IR) was lowered in patients who had received premedication. In rats, plasma NPY-IR was not modified by the intravenous injection of diazepam. Pethidine reduced the plasma NPY-IR level which could be reversed by naloxone. Direct inhibition of plasma NPY-IR through an activation of opioid receptors can thus be considered. To the cold-stress stimulation, plasma NPY-IR was markedly raised. Diazepam reduced this stimulation-induced increase of plasma NPY-IR in a dose-dependent manner. Similar derivative of benzodiazepine produced an inhibition in a way following the potency as that to produce anxiolytic action. Also, this inhibition was reversed by PK11195, an antagonist of peripheral benzodiazepine receptors. Moreover, pain-stimulated increase of plasma NPY-IR in rats was also reduced by pethidine. This action was totally reversed in the presence of naloxone, indicating the participation of opioid receptors in the process. The obtained results suggest that premedication of diazepam and/or pethidine has the ability to decrease plasma NPY-IR in animals.
Animals↗
[A comparison of transrectal fine needle aspiration and biopsy of prostatic lesion].
Transrectal fine needle aspiration and biopsy were performed on 100 patients with suspicious prostatic lesions using 22 gauge aspiration needles and 18 gauge biopsy needles. These collections were made from January 1990 to June 1991. Sufficient prostate tissue for cytological and histological diagnosis were obtained in 97% (97/100) and 99% (99/100), respectively. Thirty-nine patients (39%) were diagnosed having cancer with an accuracy rate of 89.7% (35/39) by histology and 69.2% (27/39) by cytology. One patient with a normal cytological aspiration was found to have an atypical biopsy, therefore, the biopsy was repeated and the prostate showed adenocarcinoma. Our results indicate that the needle aspiration cytology has a less accurate diagnosis rate than the needle biopsy histology. Fine needle aspiration is a safe and effective outpatient procedure but there is a definite learning curve before its use can be fully exploited. It is important to have experienced urologists and pathologists to perform these aspirations until sufficient experience is accumulated.
Aged↗
Acute neuroendocrine and metabolic stress responses of anesthesia and surgery.
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Anesthesia↗
Renal angiomyolipoma: experience of 23 patients.
We reported 29 kidneys with angiomyolipoma in 23 patients (14 women and 9 men). One of these cases was associated with tuberous sclerosis. Their age ranged from 20 to 82 years (mean 48.9). Six patients had bilateral renal involvement and 7 had multiple lesions in one kidney. Synchronous renal tumors were noted in three patients. One patient was associated with renal cell carcinoma, and the other two patients with transitional cell carcinoma. Nineteen tumors in 16 patients were larger than 4 cm. Among them 93.8% (15/16 patients) were symptomatic and tumor hemorrhage was found in 57.9% (11/19 kidneys). Of these patients, 17 renal units underwent surgical intervention (including 8 total nephrectomy, 7 partial nephrectomy and 2 enucleation of tumor). Preoperative diagnosis was made in 82.4% (14/17) with combined imaging of sonogram and CT scan. One patient received embolization only. There were two mortalities: one patient with tumor rupture who received emergent nephrectomy but died of irreversible hypovolemic shock, and the other with tuberous sclerosis and pulmonary fibrosis who received embolization for spontaneous rupture of tumor but expired due to respiratory failure. Among nine patients receiving renal preserving operation, the post-operative effective renal plasma flow of the affected kidneys ranged from 96 to 184 ml/min (mean 131.7 ml/min). There was no evidence of recurrence during a mean followup of 2.6 years. Eight asymptomatic patients with 9 renal masses had incidental angiomyolipoma and did not undergo exploration. We did not note any progression of the lesions in the cases under observation for a mean followup of 2.6 years.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Hormonal screening in impotent patients.
Of a total 260 impotent patients entered in a hormonal study, serum testosterone, prolactin and hormonal abnormalities were detected in 30 (11.5%) patients (18 with hypotestosteronemia and 12 with hyperprolactinemia). The 18 cases of hypotestosteronemia included: 8 cases of hypergonadotropic hypogonadism due to klinefelter's syndrome (1), orchitis (2), chronic alcoholism (1), and idiopathic primary gonadal failure (4) and 10 cases etiologically unknown hypotestosteronemia. Nine of the 18 patients also displayed other organic etiologies (6 vasculogenic and 3 diabetic impotence). After replacement of testosterone propionate by intramuscular injection, the improvement in impotence was significant in 12 patients (excellent in 1, good in 11) and insignificant in 6 (poor in 3, no response in 3). The positive response rate was 89% (8/9) for sole hypotestosteronemia and 44% (4/9) for hypotestosteronemia accompanied by other organic causes of impotence. In the 12 patients with hyperprolactinemia, 4 had prolactinomas. Of these, 3 were treated by surgery and 1 with bromocriptine. Three (excellent in 2, good in 1) of the 4 showed a positive erection response afterwards, but the other patient's response was poor because of postoperative residual tumor. Two patients had drug-induced hyperprolactinemia (haloperidol and methyldopa) and for one, impotence was improved after withdrawal of haloperidol. However, the other responded poorly due to vasculogenic impotence. Six patients with hyperprolactinemia of unknown etiology (2 accompanied by vasculogenic impotence, 2 by diabetic impotence and 2 by sole hyperprolactinemia) were treated with bromocriptine and improvement was noted in 3. The positive response rate was 71.4% (5/7) for sole hyperprolactinemia and 40% (2/5) for hyperprolactinemia accompanied by other organic causes of impotence. Good results were achieved in prolactinoma, sole hyperprolactinemia and hypotestosteronemia.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Interactions of adenosine and vecuronium in neuromuscular blockade in cats.
The effect of adenosine on the neuromuscular blockade induced by vecuronium and the capacity of neostigmine to reverse this combined blockade were studied in 30 cats on a standard sciatic nerve--tibialis anterior muscle preparation. Adenosine infused to 6 cats at a constant rate (3.9 +/- 1.1 mg/kg/min) to produce a stable 50% reduction of the mean arterial pressure did not affect neuromuscular transmission. At the same 50% reduction of the mean arterial pressure by adenosine or sodium nitroprusside infusion in another 15 cats, adenosine (n = 9) significantly potentiated vecuronium-induced neuromuscular blockade, but sodium nitroprusside (n = 6) did not. Neostigmine antagonized the neuromuscular blockade of similar degrees produced either by the combination of adenosine with vecuronium in the above 9 cats or by vecuronium alone in the remaining 9 cats. There was no significant difference in the doses of neostigmine given. Because no potentiation was found at the same level of hypotension induced by sodium nitroprusside, the potentiation effect of adenosine on neuromuscular blockade is not likely to be due to the hypotensive effect of adenosine, but may be due to impairment, by adenosine, of acetylcholine release from motor nerve endings. We conclude that adenosine potentiates neuromuscular blockade by vecuronium and that neostigmine can be expected to reverse this combined blockade.
Adenosine↗
[The effect of succinylcholine on the recovery of atracurium-induced neuromuscular blockade].
At the end of abdominal surgery, a brief but profound neuromuscular blockade may be needed to facilitate closure of abdominal wall. Succinylcholine (Sch) was the agent used in this regard before. This study was undertaken to observe the effect after administration of Sch (1 mg/kg) at various levels of recovery from atracurium. 40 ASA I or II patients undergoing elective surgery were randomly assigned to one of four groups with 10 in each. Anesthesia was induced with thiopental 5 mg/kg and Sch 1.5 mg/kg i.v., and maintained with 0.7% isoflurane (end-tidal concentration) and 50% N2O in O2 The electromyographic response of the hypothenar muscle was recorded in response to supramaximal train-of-four stimuli delivered to the ulnar nerve at 20 s intervals using a relaxograph (Datex). Control records were obtained after induction of anesthesia. When the first twitch (T1) had recovered above 50% from the intubating dose of Sch, atracurium 0.5 mg/kg was administered. Spontaneous recovery of T1 was observed. Patients in group I received 1 mg/kg of Sch, when T1 returned to 20% and those in groups II, III, and IV received the same dose of Sch when T1 returned to 40%, 60% or 80% of control respectively. The response was observed at 20s intervals for at least 5 min after the administration of Sch. It was regarded as effective response if the T1 returned to less than 5% of control.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
A comparison of umbilical venous blood levels of neuropeptide Y and catecholamines between cesarean section and normal spontaneous delivery.
This study was designed to determine the presence and different levels of placental neuropeptide Y (NPY) in women at parturition between normal spontaneous delivery (NSD) and cesarean section (C/S) under spinal anesthesia and to compare it with the level of catecholamines. Umbilical vein plasma levels of neuropeptide Y and catecholamines of the placental cord were measured at delivery in 40 parturient women who were divided into two groups, with 20 patients in each. NSD group underwent vaginal delivery without the presence of intrapartum fetal distress. C/S group received elective cesarean section (C/S) under spinal anesthesia. The results showed that umbilical vein level of NPY in NSD patients was significantly less than C/S patients (160.32 pg/ml vs 346.25 pg/ml, p less than 0.01). But for catecholamines levels, C/S group were significantly less than that of NSD group.
Anesthesia, Obstetrical↗