Biomedical subjects
Publications and source records attributed to J S McDonald.
The diagnosis and management of pelvic pain presents a challenge to the medical practitioner. The approach should be systematic and organized to provide the best possible care. The aim of this article is to increase awareness among urologists so that they may be more able to understand and support their patients.
BACKGROUND: The role of the delta-opioid receptor in ethanol drinking has remained unclear despite the use of traditional pharmacological and correlational approaches. The results of several studies suggest that pharmacological blockade of these receptors results in decreases in ethanol drinking behavior, but an approximately equal number of reports have failed to observe an effect of delta-receptor antagonism on ethanol drinking. It is clear that alternative approaches to understanding opioid-receptor involvement in ethanol drinking are needed. METHODS: In this study, ethanol drinking was examined in delta-opioid receptor knockout (KO) mice by using first a two-bottle-choice test, then an operant self-administration paradigm and a second two-bottle-choice test, in that order. In addition, because KO mice were previously shown to display enhanced anxiety-like behavior relative to wild-type (WT) mice, the effect of ethanol self-administration on anxiety-like responses was determined. RESULTS: delta KO mice initially showed no evidence of a preference for ethanol in the first two-bottle-choice drinking test; however, after an experience of operant self-administration of ethanol, a preference for ethanol developed in the second two-bottle-choice test. KO mice also showed a preference for ethanol over water and self-administered more ethanol than WT mice in the operant self-administration paradigm. The ethanol self-administered in this procedure was sufficient to reverse the innate anxiety-like response observed in this strain. CONCLUSIONS: delta KO mice showed a greater preference for ethanol and consumed more ethanol than their WT counterparts, suggesting that a decrease in delta-receptor activity is associated with increased ethanol-drinking behavior. It is hypothesized that delta receptors may influence ethanol self-administration at least partly through an effect of these receptors on anxiety-like behavior.
BACKGROUND: Severe pelvic pain secondary to pudendal neuropathy can be treated with repeated local anesthetic nerve blocks or with surgical decompression of the nerve. Computed tomographic (CT) needle guidance to identified reliable anatomic points might be useful for improved success rates. TECHNIQUE: A CT scan is used to determine baseline anatomy and identify the sacrospinous process. A metallic marker is used to create a perpendicular pathway from the sacrospinous process upward to the skin surface, where a local anesthetic is injected. A 22-gauge, 5-inch needle is inserted downward in a perpendicular direction to the target. Deep penetration and direction are confirmed by serial CT scans. Medication is injected and the needle is removed. EXPERIENCE: Twenty-six women with diagnoses of pudendal neuropathy were treated with injection therapy once per month, for five total treatments each. About three-quarters experienced improvement. There were no complications in this series. Outcomes were gratifying considering the complex patient population, all having failed multiple therapeutic trials. CONCLUSION: We believe this technique warrants further evaluation and application in instances where noninvasive therapy of pudendal neuropathy is indicated.
Opioid peptides long have been hypothesized to play a role in ethanol reinforcement. Neuropharmacological studies have shown that opioid receptor antagonists decrease ethanol self-administration in rodents and prevent relapse in humans. However, the exact mechanism for such powerful effects has remained elusive. The availability of mu-opioid receptor knockout mice has made possible the direct examination of the role of the mu-opioid receptor in mediating ethanol self-administration. In the present experiments, both nosepoke and lever operant ethanol self-administration and several tests of two bottle-choice ethanol drinking were studied in these genetically engineered mice. In no case did knockout mice show evidence of ethanol self-administration, and, in fact, these mice showed evidence of an aversion to ethanol under several experimental conditions. These data provide new evidence for a critical role for mu-opioid receptors in ethanol self-administration assessed with a variety of behavioral paradigms and new insights into the neuropharmacological basis for ethanol reinforcement.
Recent integration of spatial localization equipment with imaging systems presents more precise methods for the delivery of deep body nerve blocks. This technology builds on the already accepted use of CT as a guide for many currently used nerve blocks by delivering improved control, precision, and visualization of needle placement. This paper discusses the improvements and possibilities this technology brings to the treatment of neuropathies.
The current study was conducted to characterize discriminated avoidance learning in mice by using a Y-maze task. In Experiment 1, the task parameters were manipulated, including the amount of time spent in the start arm, the amount of time to make the avoidance response, and the intertrial interval (ITI) using C57 x SJL F1 hybrid mice. Avoidance performance was significantly improved with longer times to avoid the shock and longer ITIs. In Experiment 2, mice from 4 inbred strains (BALB/cByJ, DBA/2J, C57BL/6J, and SJL/J), an F1 hybrid (C57 x SJL), and 1 outbred strain (CD1) were tested with various ITIs. Strain differences were observed in avoidance learning, with BALB, DBA, C57 x SJL and CD1 mice showing significantly better avoidance learning than C57 mice, which were better than SJL mice. These data demonstrate that Y-maze performance is significantly influenced by the genetic background of the mouse and the parameters of the task.
OBJECTIVE: To install and successfully use early commercial automatic anesthesia recordkeepers, the Diatek Arkive "Organizer" units, in the operating rooms at a major university medical center. METHODS: Because of the history of previous academic attempts at automatic anesthesia recordkeeping, the units were installed on a "surprise" basis, with hardly any discussion of the devices beforehand. RESULTS: The devices themselves had a number of minor difficulties at the start, most of which were promptly corrected. Eventually the units were in use in all non-cardiac general operating rooms. At one point, usage reached over 90% of possible cases. Continued opposition to the device on the part of certain individuals, coupled with the obsolescence of the present devices in light of new technology, led to the eventual abandonment of the system and removal of the devices from service. DISCUSSION: Total resistance to the new devices on the part of a few vocal faculty members was a major factor in the ultimate downfall of the system. The method of introduction, and especially the lack of involvement of faculty, residents, surgeons, operating room personnel, hospital computer personnel, and the hospital administration in the installation also played a role in the failure of the system. Lack of a workable training mechanism for new residents prevented that user group from rapidly gaining comfort with the systems.
We have previously shown that the pre- and postoperative administration of an analgesic dose of morphine attenuated the tumour-enhancing effects of surgery. This study was undertaken to assess the relative role and exclusive importance of pre- versus postoperative morphine administration on neuroendocrine, metastatic, and behavioural outcomes of surgery in Fischer 344 rats. The natural killer (NK) sensitive mammary adenocarcinoma cell line, MADB106, was used in a lung clearance assay to assess host resistance to metastasis. Either morphine or its vehicle was administered to all rats at three times: (1) 30 min before surgery (8 mg kg-1, in saline); (2) immediately after surgery in a slow release suspension (SRS, 4 mg kg-1); and (3) 5 h after surgery at the time of tumour cell inoculation (2 mg kg-1, in SRS). Five surgery groups underwent an experimental laparotomy with halothane anaesthesia and received either the vehicle at all three times or morphine in one of four different regimens: before surgery only, at all three times, after surgery only at times 2 and 3, and after surgery total at times 2 and 3 with the preoperative dose added at time 2. Two control groups underwent anaesthesia alone and received either morphine or the vehicle at all three times. Surgery resulted in a twofold increase in tumour cell retention, which was significantly attenuated by all four morphine treatment regimens (P < 0.05). Furthermore, the two surgery groups that were treated with morphine preoperatively appeared to derive greater benefit; whereas the preoperatively treated groups exhibited a 65-70% attenuation of surgery-induced increases in tumour cell retention, only a 50% attenuation was evident in the two groups treated postoperatively. Surgery significantly reduced rearing behaviour and morphine reversed this effect such that most morphine-treated surgery groups exhibited similar levels of rearing behaviour as was observed in the unoperated animals throughout the 4-h postoperative observation period. Morphine treatment also significantly attenuated surgery-induced increases in plasma corticosterone concentrations assessed at 5 h after surgery. If such relationships hold in humans, these findings support the suggestion that the pre-surgical administration of morphine is key in optimizing its beneficial effects on surgery-induced increases in metastasis.
The availability of numerous genetically homogenous mouse strains permits the analysis of genetic influences on behavior and also behavioral sensitivity (responsivity) to drugs of abuse. The current study was conducted to characterize discriminated operant responding for food in four inbred strains (Balb/cByJ, DBA/2J, C57BL/6J, SJL/J), an F1 Hybrid (C57BL/6xSJL), and one outbred strain (CD1) of mouse. The effect of cocaine on this operant behavior was also examined. Initially, all animals were trained to nosepoke for food on a continuous reinforcement schedule. The minimum response requirement for reinforcement was increased every 5 days until the animals were responding on an FR-15 schedule of reinforcement. All strains increased operant responding as the schedule of reinforcement was raised. However, significant differences in response rate and discrimination learning were observed among the various strains of mice. Cocaine administration reduced operant responding for food in Balb/cByJ, C57BL/6J, C57BL/6xSJL/J and CD1 mice at a dose of 15.0 mg/kg, whereas higher doses were required in DBA/2J mice (30.0 mg/kg) and SJL/J mice (56.0 mg/kg). These results suggest that operant performance and the effect of cocaine on this behavior is differentially influenced by genetic make-up.
To investigate whether reducing integumental temperature influences pulmonary mechanics and interacts with inhaling cold air, 10 normal and 10 asthmatic subjects participated in a three-part trial in which cooling the skin of the head and thorax and isocapnic hyperventilation of frigid air were undertaken as isolated challenges and then administered in combination. Integumental cooling for 30 min caused airway obstruction to develop in both populations [change in 1-s forced expiratory volume (delta FEV1) asthmatic subjects = 10% ; normal subjects = 6%)]. Hyperventilation, however, only affected the asthmatic subjects (delta FEV1 asthmatic subjects = 18%; normal subjects = 3%). In contrast to expectations, the combined challenge did not produce a summation effect (delta FEV1 asthmatic subjects = 21%; normal subjects = 7%). These data demonstrate that the skin of the trunk and head is cold sensitive and when stimulated causes similar degrees of bronchial narrowing in both normal subjects and patients with airway disease independent of any ventilatory effect. They also indicate that cooling of the skin does not add to the obstructive consequences of hyperpnea.
This paper describes an interdisciplinary effort to simulate and visualize the mechanisms involved in compression neuropathies, specifically tissue deformation occurring during vaginal delivery. These neuropathies often evolve into chronic pelvic pain. We present our methodologies of using high resolution magnetic resonance acquisitions from submillimeter pulse sequences to develop interactive computer simulations based on physically plausible volume models to drive 3D simulations of childbirth. This effort will elucidate tissue movements and mechanics involved in pain disorders and better explain the etiology of these disorders.
The objective of this study was to determine whether elevated levels of N-ras correlated with clinicopathological data. Complete clinical data were available on 133 of 481 patients surgically treated for squamous cell carcinoma of the head and neck (SCCHN) who had immunohistochemical data for N-ras. Advanced stages of disease were strongly related to the staining for N-ras in tumour cells (P = 0.0031). The stage of disease was inversely related to duration of survival (P = 0.0017). Initial statistical evaluation revealed an apparent correlation between survival and N-ras staining. However, duration was found to be independent of the level of N-ras. The illusory relationship initially was a result of the confounding effect of the stage of disease.
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To solve the problem of monitoring the patient during administration of anesthesia, a commercially available head-up display (HUD) was evaluated during one day of surgery at the Ohio State University Hospitals. This monitor is mounted on a headband worn by the anesthesiologist. It projects a monochrome image of monitor data directly into one eye. Eleven anesthesiologists tested the device. Most users were able to adjust to the monitor in about fifteen minutes. Nine of the testers expressed a desire to evaluate the monitor further. Their major complaints were that the connecting cable between the HUD and its computer was too short, the resolution of the monitor was inadequate, and the data on the screen were not organized in a familiar way. If these problems could be corrected, most users believed that this HUD could be a valuable tool to aid the anesthesiologist in the operating room.
Automated anesthesia recordkeepers have been used to monitor patients during surgery in up to 90% of cases at The Ohio State University. The record-keeping devices are complex and can be difficult to troubleshoot. The 1st-CLASS Fusion Program, an expert system "shell-program," has been programmed to allow the resident or nurse anesthetist to solve the two most common types of problems associated with the recordkeeper: printer problems and patient monitor problems. Use of this program allows the resident or nurse anesthetist to troubleshoot the recordkeeper quickly and accurately and promotes in the user a sense of competence and control over the technology.
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Pyostomatitis vegetans is a rare condition characterized by pustules that affect the oral mucosa. It is consistently associated with inflammatory bowel disease and is usually resistant to treatment. We present the case of a 65-year-old white man with pyostomatitis vegetans that was associated with ulcerative colitis and adenocarcinoma of the colon. Fluocinonide gel resulted in a complete but temporary clearance of the lesions. Complete remission was achieved immediately after a total colectomy.