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Biomedical subjects

D Fletcher

Publications and source records attributed to D Fletcher.

At least 37 records · Page 2Linked to original sources
PubMed2001

A guilt gradient in the illegal use of parking spaces reserved for people with disabilities: field observations over five years.

Three parking spaces clearly designated as reserved for people with disabilities were observed from 8:00 AM until 9:00 PM on Monday through Saturday of the second or third week in November for five consecutive years. During the seven weeks of observation, 962 drivers parked illegally in those three reserved spaces. Informal observations and previous research suggested that illegal parkers would be more likely to park in the least conspicuous parking spaces, and, as predicted, a significant monotonic relationship was found. Thus, the data generally agree with the prediction that illegal parkers in spaces reserved for people with disabilities are less likely to park in the more conspicuous parking spaces and are more likely to park in the least conspicuous parking spaces, suggesting a guilt gradient in this illegal parking.

Attitude↗
PubMed2000

Deficiency in inducible nitric oxide synthase results in reduced atherosclerosis in apolipoprotein E-deficient mice.

Inducible NO synthase (iNOS) present in human atherosclerotic plaques could contribute to the inflammatory process of plaque development. The role of iNOS in atherosclerosis was tested directly by evaluating the development of lesions in atherosclerosis-susceptible apolipoprotein E (apoE)-/- mice that were also deficient in iNOS. ApoE-/- and iNOS-/- mice were cross-bred to produce apoE-/-/iNOS-/- mice and apoE-/-/iNOS+/+ controls. Males and females were placed on a high fat diet at the time of weaning, and atherosclerosis was evaluated at two time points by different methods. The deficiency in iNOS had no effect on plasma cholesterol, triglyceride, or nitrate levels. Morphometric measurement of lesion area in the aortic root at 16 wk showed a 30-50% reduction in apoE-/-/iNOS-/- mice compared with apoE-/-/iNOS+/+ mice. Although the size of the lesions in apoE-/-/iNOS-/- mice was reduced, the lesions maintained a ratio of fibrotic:foam cell-rich:necrotic areas that was similar to controls. Biochemical measurements of aortic cholesterol in additional groups of mice at 22 wk revealed significant 45-70% reductions in both male and female apoE-/-/iNOS-/- mice compared with control mice. The results indicate that iNOS contributes to the size of atherosclerotic lesions in apoE-deficient mice, perhaps through a direct effect at the site of the lesion.

Animals↗
PubMed2000

Peroperative titration of morphine improves immediate postoperative analgesia after total hip arthroplasty.

PURPOSE: To determine the Influence of peroperative titrated morphine on postoperative pain control. METHODS: Forty patients received general anesthesia for total hip arthroplasty (THA) and were divided into two groups of 20. In the Peroperative group (Perop group;) morphine was titrated at the end of surgery (3 mg i.v. every 5 or 10 min) in spontaneously breathing intubated patients, until the respiratory rate (RR) decreased. No morphine was administered to Postop group. In the Post Anesthesia Care Unit (PACU) patients in Perop and Postop groups received morphine until adequate pain relief VAS < or = 30 mm. Patients used patient-controlled analgesia (PCA) for the next 24 hr. In the PACU, the delay for analgesia, doses of morphine used and incidence of side effects were recorded. RESULTS: In the Perop group, patients received 10.3 +/- 1.3 mg (2-20 mg) as peroperative titration and had achieved adequate analgesia more rapidly than in the Postop group (42 +/- 7 min vs 76 +/- 7 min); P = 0.0026). Analgesia in the PACU in the Postop group required larger doses of morphine (15.4 +/- 1.5 mg;) than in the Perop group (7.3 +/- 1.3 mg; P = 0.0004). The respiratory rate decrease during peroperative morphine titration was correlated to the morphine dose needed in the PACU (P = 0.035). Respiratory depression in the PACU was more common in the Postop group than in the Perop group (five patients vs no patient P = 0.017). CONCLUSION: This study demonstrated that the peroperative administration of morphine can facilitate immediate postoperative pain management.

Adult↗
PubMed2000

[Periodic evaluation of practices in postoperative pain management] .

OBJECTIVE: Periodical assessment of practices as part of a quality assurance program: impact on postoperative pain. PATIENTS: All patients evaluated from the first postoperative day during a week. METHODS: Two surveys performed at a six month interval after establishment of some corrective measures. Different items were evaluated: pre-anaesthesia information for patients, pain severity and satisfaction with pain treatment. Medical data were consulted concerning postoperative analgesic prescriptions, their realization, pain assessment by nurses. Between the two surveys, first survey results were presented to anaesthesiologists. Then guidelines for prescriptions were suggested and new monitoring guidelines were proposed to nurses in surgical ward. RESULTS: 94 patients were evaluated during each survey. Patients had undergone orthopaedic, visceral, urology, ophthalmology and vascular surgery. Half of the patients did not receive information about pain before surgery. 43% of patients had a pain scores = 30/100 during movements; no difference was found between the two evaluations. Satisfaction graded as "moderate or insufficient" decreased from 22% (1rst survey) to 10 (2nd survey) (p < 0.05). Non steroidal anti-inflammatory drugs and nefopam prescriptions increased between the two surveys (p < 0.05). Association of three or four analgesics increased between the two surveys and monotherapies decreased (p < 0.05). Concordance of prescriptions with guidelines was 55% during first survey and 62% during the second (NS). Pain severity was not recorded for 36% of patients at first survey and in 18% at the second (p < 0.05). CONCLUSION: Although anaesthesiologists and nurses changed their practice due to a quality insurance program concerning postoperative pain, its consequence on the severity of postoperative pain was not significant.

Analgesics↗
PubMed2000

The benefits of intraoperative small-dose ketamine on postoperative pain after anterior cruciate ligament repair.

UNLABELLED: In a randomized, double-blinded study with three parallel groups, we assessed the analgesic effect of intraoperative ketamine administration in 45 ASA physical status I or II patients undergoing elective arthroscopic anterior ligament repair under general anesthesia. The patients received either IV ketamine 0.15 mg/kg after the induction of anesthesia and before surgical incision and normal saline at the end of surgery (PRE group); normal saline after the induction of anesthesia and before surgical incision and IV ketamine at the end of surgery (POST group); or normal saline at the beginning and the end of surgery (CONT group). Anesthesia was performed with propofol (2 mg/kg for induction, 60-200 microg x kg(-1) x min(-1) for maintenance), sufentanil (0.2 microg/kg 10 min after surgical incision, followed by an infusion of 0.25 microg x kg(-1) x h(-1) stopped 30 min before skinclosure), vecuronium (0.1 mg/kg), and 60% N2O in O2 via a laryngeal mask airway. Postoperative analgesia was initially provided with IV morphine in the postanesthesia care unit, then with IV patient-controlled analgesia started before discharge from the postanesthesia care unit. Pain scores, morphine consumption, side effects, and degree of knee flexion were recorded over 48 h and during the first and second physiotherapy periods, performed on Days 1 and 2. Patients in the ketamine groups required significantly less morphine than those in the CONT group over 48 h postoperatively (CONT group 67.7+/-38.3 mg versus PRE group 34.3+/-23.2 mg and POST group 29.5+/-21.5 mg; P < 0.01). Better first knee flexion (CONT group 35+/-10 degrees versus PRE group 46+/-12 degrees and POST group 47+/-13 degrees; P < 0.05) and lower morphine consumption (CONT group 3.8+/-1.7 mg versus PRE group 1.2+/-0.4 mg and POST group 1.4+/-0.4 mg; P < 0.05) were noted at first knee mobilization. No differences were seen between the PRE and POST groups, except for an increase in morphine demand in the PRE versus the POST group (P < 0.05) in the second hour postoperatively. IMPLICATIONS: We found that intraoperative small-dose ketamine reduced postoperative morphine requirements and improved mobilization 24 h after arthroscopic anterior ligament repair. No differences were observed in the timing of administration. Intraoperative small-dose ketamine may therefore be a useful adjuvant to perioperative analgesic management.

Adolescent↗
PubMed2000

The effect of remifentanil on the bispectral index change and hemodynamic responses after orotracheal intubation.

UNLABELLED: In order to examine whether changes in the bispectral index (BIS) may be an adequate monitor for the analgesic component of anesthesia, we evaluated the effect of remifentanil on the BIS change and hemodynamic responses to laryngoscopy and tracheal intubation. Fifty ASA physical status I patients were randomly assigned, in a double-blinded fashion, to one of five groups (n = 10/group) according to the remifentanil target effect compartment site concentration (0, 2, 4, 8, or 16 ng/mL). The target-controlled infusion (TCI) of remifentanil was initiated 3 min after the TCI of propofol that was maintained at the effect-site concentration of 4 microg/mL throughout the study. After the loss of consciousness and before the administration of vecuronium 0.1 mg/kg, a tourniquet was applied to one arm and inflated above the systolic blood pressure in order to detect any gross movement within the first minute after tracheal intubation, which was performed 3 min after remifentanil TCI began. A BIS value was generated every 10 s. Arterial blood pressure and heart rate (HR) were measured every minute, noninvasively. Measures of mean arterial pressure (MAP), HR, and BIS were obtained before the induction, before the start of remifentanil TCI, before laryngoscopy, and 5 min after intubation. The relationships between remifentanil effect-site concentrations and BIS change or hemodynamic responses (changes in MAP and HR) to intubation were determined by logarithmic regression. BIS values were not affected by remifentanil before laryngoscopy. During this period, MAP and HR decreased significantly (P < 0.01) in the remifentanil 8 and 16 ng/mL groups. Changes in BIS, MAP, and HR were negatively correlated with remifentanil effect-site concentration (P < 0.0001). The number of movers in the remifentanil 0-, 2-, 4-, 8-, and 16-ng/mL groups was, respectively, 10, 9, 7, 1, and 0. Hypotensive episodes (MAP < 60 mm Hg) were noted in 1, 2, and 5 patients in the remifentanil 4-, 8-, and 16-ng/mL groups, respectively. We conclude that the addition of remifentanil to propofol affects BIS only when a painful stimulus is applied. Moreover, remifentanil attenuated or abolished increases in BIS and MAP after tracheal intubation in a comparable dose-dependent fashion. IMPLICATIONS: Bispectral index change is as sensitive as hemodynamic responses after a painful stimulus for detecting deficits in the analgesic component of anesthesia. It may, therefore, be a useful monitor of the depth of anesthesia in patients who are incapable of HR and MAP responses to noxious stimuli because of medications or cardiovascular disease.

Adolescent↗
PubMed2000

The efficacy of intravenous 0.15 versus 0.25 mg/kg intraoperative morphine for immediate postoperative analgesia after remifentanil-based anesthesia for major surgery.

UNLABELLED: We evaluated the effect of perioperative administration of two doses of morphine for postoperative analgesia after remifentanil-based anesthesia. The prospective, randomized study included 245 patients from 33 centers. All patients were scheduled for abdominal or urological surgery lasting more than 1 h. General anesthesia used remifentanil as the perioperative opioid (1 microg/kg as a bolus then, 0.5 microg/kg as a continuous infusion). A morphine bolus of 0. 15 mg/kg (0.15-mg group) or 0.25 mg/kg (0.25-mg group) was administered 30 min before the end of surgery. In the postanesthesia care unit, pain scores for patients were evaluated by using behavioral pain scores of 1-3, verbal pain scores of 0-3, and visual analog scale scores of 0-10). Postoperative analgesia was obtained by a morphine titration (3 mg every 5 min). Demographic and surgery characteristics were similar in both groups. The delay for first demand of morphine was similar in the 0.15-mg and the 0.25-mg groups (26 [9-60] and 30 [10-60] min, respectively). The frequency of morphine titration was similar in both groups (75% and 66%, respectively). The amount of morphine used in the postanesthesia care unit was smaller in the 0.25-mg group (0.16 [0.0-1.25] vs 0.10 [0.0-0.56] mg/kg; P = 0.008). In the 0.25-mg group, the behavioral pain score was lower at 15 min, the verbal pain score was lower at 60 min (P < 0.001), and similar at 30 min. The visual analog scale pain score at 30 min and 60 min was similar in both groups. The incidence of minor side effects was similar in both groups. However, three cases of postoperative respiratory depression occurred in the 0.25-mg group compared with no cases in the 0.15-mg group. In conclusion, perioperative administration of morphine alone does not provide entirely adequate immediate postoperative pain control after remifentanil-based anesthesia in major surgery. IMPLICATIONS: The administration of 0.15 or 0.25 mg/kg perioperative morphine during remifentanil-based anesthesia for major surgery does not preclude additional morphine administration in the postanesthesia care unit. The larger dose of 0.25 mg/kg slightly improves postoperative analgesia; however, it may be responsible for postoperative respiratory depression.

Adult↗
PubMed2000

Acute opioid tolerance: intraoperative remifentanil increases postoperative pain and morphine requirement.

BACKGROUND: Rapid development of acute opioid tolerance is well established in animals and is more likely to occur with large doses of short-acting drugs. The authors therefore tested the hypothesis that intraoperative remifentanil administration results in acute opioid tolerance that is manifested by increased postoperative pain and opioid requirement. METHODS: Fifty adult patients undergoing major abdominal surgery were randomly assigned to two anesthetic regimens: (1) desflurane was kept constant at 0.5 minimum alveolar concentrations and a remifentanil infusion was titrated to autonomic responses (remifentanil group); or (2) remifentanil at 0.1 microg. kg-1. min-1 and desflurane titrated to autonomic responses (desflurane group). All patients were given a bolus of 0.15 mg/kg morphine 40 min before the end of surgery. Morphine was initially titrated to need by postanesthesia care nurses blinded to group assignment. Subsequently, patients-who were also blinded to group assignment-controlled their own morphine administration. Pain scores and morphine consumption were recorded for 24 postoperative h. RESULTS: The mean remifentanil infusion rate was 0.3 +/- 0.2 microg. kg-1. min-1 in the remifentanil group, which was significantly greater than in the desflurane group. Intraoperative hemodynamic responses were similar in each group. Postoperative pain scores were significantly greater in the remifentanil group. These patients required morphine significantly earlier than those in the desflurane group and needed nearly twice as much morphine in the first 24 postoperative h: 59 mg (25-75% interquartile range, 43-71) versus 32 mg (25-75% interquartile range, 19-59; P < 0.01). CONCLUSIONS: Relatively large-dose intraoperative remifentanil increased postoperative pain and morphine consumption. These data suggest that remifentanil causes acute opioid tolerance and hyperalgesia.

Analgesia, Patient-Controlled↗
PubMed2000

The implementation of the HOT program at the Royal Women's Hospital.

At the Royal Women's Hospital from November 1995, mothers and their infants were discharged on day three (a three-night stay) following a normal vaginal birth, if they were considered to be well and coping with early postnatal life. However, by March 1996, there were indications that not all mothers were managing breastfeeding as well as they needed to after discharge home. In an effort to reduce early avoidable breastfeeding problems, an extensive re-education program was undertaken. The 'Hands-Off Technique' Program (HOT) aimed to address the problem by educating the midwifery staff on ways to teach mothers about correct positioning and self-attachment of their babies without actually doing it for them.

Australia↗
PubMed2000

Growth and developmental stability of Drosophila melanogaster in low frequency magnetic fields.

Magnetic fields (60 Hz) of 1.5 and 80 microT caused a significant reduction in the weight of Drosophila melanogaster. Moreover, fruit flies in an 80 microT field showed lower developmental stability than either those in a 0 or 1.5 microT field. Developmental instability was measured by fluctuating asymmetry and frequency of phenodeviants. More of the flies in the 80 microT field had fused abdominal segments, and they were more asymmetrical for wing vein R(4+5). The flies in the 1.5 microT field actually showed greater developmental stability than the control flies. Fewer of them had fused abdominal segments, and they were more symmetrical for wing vein R(4+5). Thus, at low field strengths, flies are more developmentally stable than control flies, even though they weigh less.

Animals↗
PubMed1999

Innervation and myoepithelial arrangements in the submandibular salivary gland of ferret investigated by enzyme, catecholamine and filament histochemistry.

Although the submandibular gland of ferret is useful for studying salivary secretory processes which are regulated by nerves and involve myoepithelial activity, little attention has been paid to its parenchymal innervation and myoepithelial arrangements. Therefore, glands obtained postmortem from mature ferrets of both sexes were here examined with the use of light-microscopic histochemical techniques for cholinesterases, phosphatases and phosphorylase, histofluorescence for catecholamines, and milling dyes. Acetylcholinesterase staining was associated with nerve trunks in the interlobular stroma and an extensive intralobular network of nerve fibres, presumably of a cholinergic type, embracing acini and ducts. There were fewer fibres containing fluorescing catecholamines, presumably adrenergic. They were largely associated with acini. Numerous stellate cells with fine branching processes embracing acini, presumably myoepithelial cells, and a few spindle-shaped basal cells, investing striated ducts, were demonstrated on frozen tissue by alkaline phosphatase, but not by adenosine triphosphatase, inosine diphosphatase and phosphorylase. Cells of similar shape and distribution were also demonstrated by staining with milling dyes on fixed tissues, indicating possibly a filamentous constituent conferring mechanical stability and/or contractile ability. Together, these results suggest, firstly, that a cholinergic-type parenchymal innervation is prominent in the submandibular gland of ferret, although many adrenergic nerves are also present, and, secondly that the gland has a very extensive myoepithelial network which is possibly involved in membrane transport, and the support and or contraction of the secretory parenchyma.

Actin Cytoskeleton↗
PubMed1999

Morphological phenotypes and functional capabilities of submandibular parenchymal cells of the ferret investigated by protein, mucosubstance and enzyme histochemistry.

Submandibular glands obtained post-mortem from mature ferrets of both sexes were examined with the use of light microscopical histochemical methods for proteins, mucosubstances and enzymes associated with cell functions or organelles. Demilunar cells showed carboxylated mucosubstances that were mainly non-sulphated, and diffuse activity for peroxidase, E600-sensitive esterase and acid phosphatase. Thiol groups were also detected in these cells. Central acinar cells showed sulphated mucosubstances, disulphides and reticular staining for thiamine pyrophosphatase. Intercalary ducts showed diffuse activity for NADH and NAD(P)H dehydrogenases. Striated ducts contained protein, tryptophan, disulphides, neutral mucosubstances and E600-sensitive esterase periluminally. Basally, the striated ductal cells showed variable activity for peroxidase, cytochrome oxidase, succinate dehydrogenase and acid phosphatase. Basolateral plasma membranes of these cells exhibited ouabain-sensitive Na,K-ATPase activity. The collecting ducts were characterized by variable periluminal staining for acid phosphatase, beta-glucuronidase, acid beta-galactosidase and E600-resistant esterase. The results suggest that the histological appearances of the acini of the submandibular gland of the ferret are dependent on the synthesis of secretory acid glycoproteins, that the striated ducts are involved with the secretion of tryptophan-rich product comprising neutral glycoproteins and showing esterase activity and with marked transport of ions and that the collecting ducts are involved with absorption.

Animals↗
PubMed1999

The effect of a sciatic nerve block on the development of inflammation in carrageenan injected rats.

UNLABELLED: Neurogenic inflammation may participate in postoperative inflammatory pain. We evaluated, in the rat, the influence of a short and prolonged sciatic nerve block on carrageenan-induced inflammation, the time course of which may be compared to postoperative inflammation. A catheter was placed on the right sciatic nerve and injected with 0.5% bupivacaine with epinephrine (0.2 mL): one injection in the Short Block Group, and four injections performed at 90-min intervals in the Prolonged Block Group. In all groups, the two hind paws were then injected with carrageenan. The development of inflammation was evaluated in both hind paws by measurement of paw circumference (PC) before, and 1, 2, 3, 4, 6, and 24 h after carrageenan injection. Temperature of both hind paws was evaluated at the same time points. The vocalization threshold to paw pressure test (VTPP) of both hind paws was evaluated at 6, 8, 10, 12, and 24 h after carrageenan injection. The left hind paw was used for the Control Group. A Sham Group had a catheter placed on the sciatic nerve and injected with normal saline. Inflammation developed in the Control Group with a maximum increase of PC (32%) and temperature (14%) 4 h after carrageenan injection and a maximal reduction of VTPP (44%) at 6 h, reflecting mechanical allodynia. A similar evolution was observed in the Sham Group. In the Short Block Group, the nerve block did not influence the PC, the paw temperature, or the VTPP when compared with the Control Group. In the Prolonged Block Group, when compared with the Control Group, the increased PC was reduced throughout the 24 h (P < 0.0001). The maximal increase in PC at 4 h was limited to 23%, as compared with the precarrageenan value. This effect on PC did not persist at 24 h. Paw temperature was increased (P = 0.07) throughout the study in the Prolonged Block Group, as compared with the Control Group. The VTPP reduction was still limited in the Prolonged Block Group at 24 h, as compared with the Control Group (P < 0.0001). We conclude that a prolonged sciatic nerve block limits carrageenan-induced increase in PC and, subsequently, mechanical allodynia at 24 h in rats. IMPLICATIONS: Our study has shown that a prolonged (6 h) but not a short sciatic nerve block (90 min) can limit edema and related pain after carrageenan-induced inflammation in rat.

Anesthetics, Local↗
PubMed1998

Pyrroles and other heterocycles as inhibitors of p38 kinase.

Investigation of furans, pyrroles and pyrazolones identified 3-pyridyl-2,5-diaryl-pyrroles as potent, orally bioavailable inhibitors of p38 kinase. 3-(4-pyridyl-2-(4-fluoro-phenyl)-5-(4-methylsulfinylphenyl)-pyrrol e (L-167307) reduces secondary paw swelling in the rat adjuvant arthritis model: ID50 = 7.4 mg/kg/b.i.d.

Animals↗
PubMed1998

A method for testing association patterns of social animals.

Association indices were originally developed to describe species co-occurrences, but have been used increasingly to measure associations between individuals. However, no statistical method has been published that allows one to test the extent to which the observed association index values differ from those of a randomly associating population. Here, we describe an adaptation of a test developed by Manly (1995, Ecology, 76, 1109-1115), which uses the observed association data as a basis for a computer-generated randomization. The observed pattern of association is tested against a randomly created one while retaining important features of the original data, for example group size and sighting frequency. We applied this new method to test four data sets of associations from two populations of Hector's dolphin, Cephalorhynchus hectori, using the Half-Weight Index (HWI) as an example of a measure of association. The test demonstrated that populations with similar median HWI values showed clear differences in association patterns, that is, some were associating nonrandomly whereas others were not. These results highlight the benefits of using this new testing method in order to validate the analysis of association indices. Copyright 1998 The Association for the Study of Animal Behaviour.

Journal Article↗