We have compared pain scores at rest and on standardized movement, and morphine consumption using patient-controlled analgesia in 60 patients who had undergone total abdominal hysterectomy. Patients were allocated randomly to one of three groups: in the saline group, 0.9% sodium chloride 50 ml was administered into the pelvic cavity before closure of the peritoneum; in the second group, the solution administered was 20 ml of 0.5% bupivacaine solution with epinephrine 1:200,000 diluted with saline to a final volume of 50 ml; in the third group, the solution used was 20 ml [corrected] of 2% lidocaine with epinephrine 1:200,000 diluted with saline to a final volume of 50 ml. We found that there was no significant difference between the three groups in visual analogue pain scores at 8, 12, 36 or 48 h after operation at rest or on movement, and no significant difference in sedation or dose of antiemetic administered. Mean morphine consumption in the first 24 h was 54.6 (SEM 5.9) mg in the saline group, 55.5 (6.4) mg in the bupivacaine group and 52.5 (5.3) mg in the lidocaine group. In the second 24 h, morphine consumption was 34.9 (6.6) mg, 28.1 (3.5) mg and 28.0 (3.5) mg in the three groups, respectively. We conclude that i.p. administration of local anaesthetic solution into the pelvic cavity did not confer appreciable analgesia in patients undergoing abdominal hysterectomy.

Adult↗

PubMed1998

Effect of infiltration with ropivacaine on blood loss during reduction mammoplasty.

Ropivacaine is a new aminoamide local anaesthetic agent. Unlike other agents in its class, such as bupivacaine, it has been found to be vasoconstrictive. We have sought to investigate if this property is clinically useful and may reduce surgical blood loss. Reduction mammoplasty is a procedure in which considerable blood loss may occur. We have compared pre-incision infiltration of ropivacaine 75 mg in 0.9% saline 60 ml with the current practice of infiltration with bupivacaine 75 mg in 0.9% saline 60 ml and epinephrine (adrenaline) 5 micrograms ml-1. We studied five subjects; each received both solutions by infiltration, one to each breast, in random order and both the operating surgeon and anaesthetist were blind to the solution given. For data analysis, blood loss was expressed in ml/kg of tissue excised. There was no significant difference between the two regimens for duration of surgery or amount of tissue excised; however, ropivacaine was associated with markedly greater intraoperative blood loss than bupivacaine (median 696 (range 305-1366) ml kg-1 vs 300 (169-608) ml kg-1; P = 0.04, Wilcoxon rank sum test). Postoperative blood loss was not significantly different between groups (116 (14-173) ml kg-1 vs 98 (13-332) ml kg-1; P = 0.69, Wilcoxon rank sum test). We conclude that the vasoconstrictive properties of ropivacaine were not sufficiently great to merit its use as a sole agent for infiltration before reduction mammoplasty.

Adult↗

PubMed1998

Postoperative analgesia and lung function: a comparison of morphine with extradural block. 1971.

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Analgesia↗

PubMed1998

No association between the K variant of the butyrylcholinesterase gene and pathologically confirmed Alzheimer's disease.

The polymorphic K variant of the butyrylcholinesterase ( BCHE-K ) gene recently has been demonstrated to have an elevated frequency in Alzheimer's disease (AD) patients carrying the epsilon4 allele of the apolipoprotein (APO E) gene when compared with a control population. We therefore genotyped a large series of pathologically confirmed AD patients and controls to confirm this association. We found no change in the frequency of this genetic variant, either in the AD group as a whole or in early- or late-onset patients when compared with age-matched controls. Stratification of these groups with reference to the APO E epsilon4 allele also showed no difference between AD and control groups. To determine if a biological effect were present, we also looked at senile plaque and neurofibrillary tangle densities in the frontal, temporal, parietal and occipital cortices in AD patients either carrying or not carrying a copy of the K variant. We found no difference in plaque or tangle load between these two groups in either the total, late-onset or early-onset AD subjects. Stratification of the total AD group in terms of APO E epsilon4 allele possession, and further comparison of plaque and tangle load between carriers and non-carriers of BCHE-K still failed to disclose a relationship between BCHE-K and AD. We conclude that in the population studied here there is no association between BCHE-K and AD, or that if such a relationship exists it is precluded by another, as yet unknown factor.

Age of Onset↗

PubMed1998

Air temperature and relative humidity effects on behavioral activity of blacklegged tick (Acari: Ixodidae) nymphs in New Jersey.

Air-temperature and relative humidity data were used to explain variation in behavioral activity of Ixodes scapularis Say nymphs. We estimated behavioral activity as the residual variation in drag-sample data after seasonal changes in population density were removed by regression. The seasonal decline in drag samples between June and August 1995 on field plots at Morristown National Historical Park, NJ, can be described by a simple negative exponential function. Residuals around a fitted exponential were significantly correlated with temperature and with relative humidity measured at the leaf-litter surface, and explained 34 and 44% of the variance, respectively. Multiple regression on temperature and relative humidity explained 51% of the variance. These regressions estimated the explanatory power of microclimate, independent of seasonal correlations, and might provide a basis for day-to-day prediction of human exposure to Lyme disease.

Animals↗

PubMed1998

Descriptors of corneal shape.

With the advent of videokeratoscopy and similar technology, we are now provided with more information about corneal contour than ever before. One of the common problems in this area is which parameters should be used to quantify the corneal shape. From the time of Helmholtz, the ellipse has been used as a first-order approximation for the normal corneal profile, and in the optometric literature one or another of the conic shape parameters p, Q, or e have been used to describe the general shape of the corneal surface. The purpose of this technical note is to clarify the relationships between these various descriptors of corneal shape.

Cornea↗

PubMed1998

First- and third-order optical theory of gradient index materials, with application to contact lenses.

PURPOSE: To investigate the feasibility of using gradient index media in contact lenses, we developed simple methods which we used to derive the power and aberrations associated with the contact lenses. METHODS: In one method, we assume that the height of a ray does not change as it passes through the lens. We describe a second method in which the ray is assumed to follow a parabolic path as it passes through the lens. We use sophisticated third-order theory and finite raytracing for comparison with these methods. RESULTS: The methods are compared for contact lenses with parabolic radial gradient index media. Without the gradient index, these lenses would have zero power. The formula for power which assumes no change in ray height gives errors of approximally 0.8 and 1.5% for lenses of thicknesses 0.18 and 0.36 mm. However, the formula for third-order spherical aberration which uses the same assumption gives poor estimations. The method for calculating power using the parabolic ray path is very accurate. The sophisticated third-order aberration theory was reasonably accurate out to 2.5 mm ray height. The contact lenses with the gradient index media have much smaller aberration in air than do conventional contact lenses of the same powers, with the sign of the aberration being reversed. CONCLUSIONS: Our simple procedures give good estimations of powers of contact lenses with gradient index media. The approximate method, which assumes that the height of a ray does not change as it passes through the lens, should not be used for finding the spherical aberration of such a lens. Contact lenses with gradient index media have potential for minimizing spherical aberration.

Contact Lenses↗

PubMed1998

Aortoduodenal fistula: appearances on computed tomography: comment.

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Aortic Diseases↗

PubMed1998

Anti-U and haemolytic disease of the fetus and newborn.

The red cell alloantibody, anti-U, is uncommon but is a recognised cause of haemolytic disease of the fetus and newborn. We describe six pregnancies complicated by the presence of maternal anti-U, and review nine other well-documented cases. In these 15 cases severe haemolytic disease occurred only with titres of > or = 1/512, and titres as high as 1/4000 were not necessarily associated with significant haemolysis. We recommend that an anti-U titre of > or = 1/128 or more at > or = 17 weeks of gestation is an indication for assessment of haemolysis in the fetus. Amniocentesis is the preferred initial investigation.

Amniocentesis↗

PubMed1998

An epidemiological study of acute carbon monoxide poisoning in the West Midlands.

OBJECTIVES: To describe the epidemiology of carbon monoxide (CO) poisoning in a defined population, identifying those at greatest risk from acute poisoning resulting in admission to hospital or death. METHODS: A retrospective study with routinely collected information, set in the former West Midlands Regional Health Authority; population of 5.2 million. The data comprised 939 deaths and 701 hospital admissions due to CO poisoning between January 1988 to December 1994. The main outcome measures were age and sex standardised incidence rates (SIRs) for non-intentional, suicidal, and undetermined poisonings for health authorities and the linear relation with socioeconomic deprivation. RESULTS: Overall rate of non-intentional poisonings over the 7 year period was 7.6/100,000, an annual rate of 1.1/100,000. The 7 year rates were highest in people > or = 85; men 24.0/100,000 and women 19.7/100,000. For suicides the 7 year rate was 19.6/100,000, an annual rate of 2.8/100,000. The 7 year rates were highest for men of 35-39, 64.1/100,000, and for women aged 45-49, 15.3/100,000. None of the causes of poisoning were related to deprivation. Non-intentional poisonings showed a strong seasonal variation with the highest rates being recorded in the months October to March. Increased rates of poisoning were found in the rural districts of the West Midlands. There seems to have been a decline in suicides coinciding with the introduction of three way catalytic converters on cars. CONCLUSIONS: Elderly people and the very young are at the greatest risk from non-intentional CO poisoning and rates are highest in the winter months. Although deaths from non-intentional CO poisoning are declining nationally, in the West Midlands they have remained stable and hospital admissions are increasing. It is not solely an urban phenomenon with rates for non-intentional CO poisoning and suicides higher in the rural districts. Health authorities need to consider all populations in any prevention programme. Further work is needed to establish the extent of the burden of chronic CO poisoning and the impact of catalytic converters on suicides.

Adolescent↗

PubMed1998

Human vascular smooth muscle cells express receptors for CC chemokines.

Arteriosclerotic lesions are characterized by the accumulation of T lymphocytes and monocytes and the proliferation of intimal smooth muscle cells. Expression of the chemokine monocyte chemoattractant protein-1 (MCP- 1) has been observed in arteriosclerotic plaques and has been proposed to mediate the transendothelial migration of mononuclear cells. More recently, MCP-1 has been proposed to affect the proliferation and migration of vascular smooth muscle cells (VSMCs). We have used reverse transcription-polymerase chain reaction (RT-PCR) to investigate chemokine mRNA expression in human arteriosclerotic lesions obtained from surgical biopsy of diseased vascular tissue and show, in addition to MCP-1, expression of the chemokine macrophage inflammatory protein-1alpha (MIP-1alpha) at higher levels than in "normal" aortic tissue. We have also used RT-PCR to characterize the expression of known chemokine receptors by primary human VSMCs. Messenger RNA for the MIP-1alpha/RANTES receptor, CCR-1, and the MCP-1/MCP-3 receptor, CCR-2, was expressed by unstimulated VSMCs grown under serum-free culture conditions for 24 hours. The receptors CCR-3, CCR-4, CCR-5, CXCR-1, and CXCR-2 were not expressed by VSMCs. The presence of functionally coupled receptors for MIP-1alpha on VSMCs was demonstrated by specific binding of biotinylated MIP-1alpha and increases in intracellular Ca2+ levels after exposure to this chemokine. Taken together, these results suggest that chemokines are likely to be involved in arteriosclerosis and may play a role in modulating the function of VSMCs in vivo.

Adult↗

PubMed1998

Association between decline in brain dopamine activity with age and cognitive and motor impairment in healthy individuals.

OBJECTIVE: Although it is documented that brain dopamine activity declines with age, the functional significance of this is not known. This study assessed the relation between measures of brain dopamine activity and indexes of motor and cognitive function in healthy individuals. METHOD: Thirty healthy volunteers aged 24-86 years were studied with positron emission tomography and [11C]raclopride to assess dopamine D2 receptors. All subjects underwent a neuropsychological test battery that included tasks found to be sensitive to dopamine alterations in patients with neurodegenerative disease and control tasks. RESULTS: Transfer of [11C]raclopride from plasma to brain in the striatum and cerebellum was not affected by age. In contrast, D2 receptor availability in the caudate and putamen declined with age. Correlations between D2 receptors and neuropsychological test performance were strongest for the motor task (Finger Tapping Test) and were also significant for most tasks involving frontal brain regions, including measures of abstraction and mental flexibility (Wisconsin Card Sorting Test) and attention and response inhibition (Stroop Color-Word Test, interference score). These relationships remained significant after control for age effects. CONCLUSIONS: Age-related decreases in brain dopamine activity are associated with a decline in motor function and may also contribute to impaired performance on tasks that involve frontal brain regions. Interventions that enhance dopamine activity may improve performance and quality of life for the elderly. The fact that correlations remained significant after age effects were partialed out suggests that dopamine activity may influence motor and cognitive performance irrespective of age.

Adult↗

PubMed1998

Family caregivers' criticism of patients with schizophrenia.

OBJECTIVE: Relationships were examined between patients' negative symptoms, family caregivers' knowledge of schizophrenia, caregivers' attributions about the cause of patients' symptoms, and caregivers' response to the symptoms. METHODS: A sample of 84 caregivers of patients with schizophrenia in Brisbane, Australia, were interviewed using a structured format and measures designed for the study. RESULTS: Results of regression analyses indicated that three variables significantly predicted caregivers' criticism of patients--a smaller proportion of negative symptoms in the patient's overall symptom pattern, the caregiver's low level of knowledge about the illness, and the caregiver's attributing the cause of negative symptoms to the patient's personality rather than to the illness. CONCLUSIONS: Overall, findings supported the utility of an attributional framework in enhancing conceptions about and research on schizophrenia and family caregiving.

Adolescent↗

PubMed1998

Secrecy, disclosure, and closet dynamics.

This paper examines the assumption that male homosexuality has a natural affinity with femininity and that male heterosexuality has a natural affinity with masculinity. An analysis of the relationship between people's disclosure or concealment of their homosexual practice or identity, particularly as it relates to notions of hegemonic masculinity and femininity provides the focus of this paper. It is argued that everyday understandings of homosexuality tend to be resolved in such as way as to press homosexuality into the service of privileging a male, masculine, and heterosexual subjectivity. This privileging is achieved, in part, as a result of the everyday social practices of homosexually active men's witting and unwitting deference to the hegemonic presumption that masculine men are naturally heterosexual, and its inverse, that feminine men are homosexual and are a perturbation of the natural order. We argue that this correlation is manufactured in everyday life in the world of appearances, but that the appearance of things is not reflected at a level of practice, which is to say, male homosexual practice is not necessarily feminine, just as male heterosexual practice is not necessarily masculine. Realities that conflict with the hegemonic realities are masked in the public world, for a variety of reasons. What we have called closet dynamics are the various discourses through which homosexuality is concealed and disclosed, and the various subject positions people take up in relation to those discourses.

Gender Identity↗