Sciatic nerve block and the improvement of femoral nerve block analgesia after total knee replacement.
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Aged↗
Biomedical subjects
R Fournier
Publications and source records attributed to R Fournier.
Epinephrine and clonidine do not improve intrathecal sufentanil analgesia after total hip replacement.
BACKGROUND: We compared analgesia after intrathecal sufentanil alone, sufentanil with epinephrine 200 microg and sufentanil with clonidine 30 microg in patients after total hip replacement, the endpoints being onset and duration of action. METHODS: We performed a randomized double-blind study of 45 patients for elective total hip arthroplasty using continuous spinal anaesthesia. As soon as a pain score higher than 3 on a 10 cm visual analogue scale was reported, sufentanil 7.5 microg alone, sufentanil 7.5 microg + epinephrine 200 microg or sufentanil 7.5 microg + clonidine 30 micro g in 2 ml normal saline was given intrathecally. Pain scores, rescue analgesia (diclofenac and morphine) and adverse effects (respiratory depression, postoperative nausea and vomiting, itching) were observed for 24 h after surgery. RESULTS: Time to a pain score of <3 [6 (SD 1) vs 6 (1) vs 5 (1) min], time to the lowest pain score [7 (2) vs 8 (2) vs 8 (2) min] and time to the first dose of systemic analgesic for a pain score >3 [281 (36) vs 288 (23) vs 305 (30) min] were similar in all three groups. Adverse effects and analgesic requirements during the first 24 h were also similar. CONCLUSION: After total hip replacement, all three analgesic regimens gave good analgesia with comparable onset and duration of action, and minor adverse effects.
Aged↗
GATA-3 has dual regulatory functions in human interleukin-5 transcription.
Interleukin-5 (IL-5) is a T-cell cytokine involved in Type 2 diseases and is commonly described as being coordinately regulated with other Type 2 cytokines, such as IL-4 and IL-13. Considering the unique control of eosinophilia by IL-5, such coordinate regulation would be surprising. In fact, the biological specificity of eosinophilia and its control by IL-5 suggests a unique and independent control of IL-5 regulation. In this report we show the binding of GATA-3 to three sites in the human IL-5 promoter in the human T-cell line PER117. The previously identified -70 site and another site at position -152 are shown to positively regulate IL-5 transcription. More importantly, the site located at -400 acts as a powerful repressor of IL-5 transcription with mutagenesis of this site allowing a high level expression of IL-5 without the activation of other factors normally required for IL-5 expression. Whereas GATA-3 has been proposed to be involved in the regulation of the IL-4/IL-5/IL-13 locus, we show here that it has another function in controlling IL-5 transcription that supports the observed unique biological function of this cytokine.
Base Sequence↗
Epinephrine does not prolong the analgesia of 20 mL ropivacaine 0.5% or 0.2% in a femoral three-in-one block.
UNLABELLED: We tested the effect of epinephrine added to 20 mL ropivacaine 0.5% and 0.2% on postoperative analgesia via a femoral catheter after total knee replacement. Forty-one patients undergoing total knee replacement under combined peripheral block/general anesthesia were randomly allocated to two groups. After insertion of a femoral catheter, 21 patients in the Ropivacaine-Epinephrine (ROPI-EPI) group received 20 mL ropivacaine 0.5% plus epinephrine 1:200,000, whereas 20 patients in the Ropivacaine group (ROPI) received 20 mL plain ropivacaine 0.5%. Thereafter, a sciatic block with 30 mL bupivacaine 0.5% plus epinephrine 1:200,000 was performed in all patients, followed by general anesthesia. After surgery, patient-controlled analgesia (PCA) with ropivacaine 0.2% plus epinephrine 1:200,000 for Group ROPI-EPI and plain ropivacaine 0.2% for Group ROPI was available via the femoral catheter (200 mL ropivacaine 0.2% +/- epinephrine, bolus 20 mL, lockout 120 min). The patients were instructed to use PCA when the knee pain score was >3 cm. The interval between the initial ropivacaine injection and the first PCA injection determined the duration of 20 mL ropivacaine 0.5% +/- epinephrine, whereas the interval between the first and second PCA injection determined the duration of 20 mL ropivacaine 0.2% +/- epinephrine. The average duration of ropivacaine 0.5% was 657 +/- 345 min for the ROPI-EPI group and 718 +/- 423 min for the ROPI group (NS), whereas for ropivacaine 0.2%, the average duration was 409 +/- 245 min for the ROPI-EPI group and 419 +/- 339 min for the ROPI group (not significant). We conclude that epinephrine does not influence the duration of analgesia of the ropivacaine concentrations investigated. IMPLICATIONS: We evaluated the effect of epinephrine on the duration of analgesia of 20 mL ropivacaine 0.5% or 0.2% injected in femoral three-in-one block for pain relief after total knee replacement. Our results show that epinephrine does not alter the duration of analgesia of the two solutions investigated.
Acetaminophen↗
[Dedifferentiation of mature teratomas secondary to testicular cancer: report of 2 cases].
The authors report two cases of adenocarcinomatous dedifferentiation of a recurrent mature teratoma arising 3 and 20 years after the initial resection. This is a rare event, occurring after macroscopically or microscopically incomplete resection of a mature teratoma. The nature of this recurrence was difficult to determine prior to histological examination. However, PET scan suggests the diagnosis of malignant teratoma in the presence of increased uptake by the lesion. These tumours have a poor prognosis. Treatment consists of complete resection of the tumour mass. The possibility of long-term malignant dedifferentiation of a teratoma therefore requires prolonged and regular life-long surveillance of patients presenting a mature teratoma after chemotherapy for non-seminomatous germ cell tumour of the testis.
Adenocarcinoma↗
Onset and offset of intrathecal morphine versus nalbuphine for postoperative pain relief after total hip replacement.
BACKGROUND: We designed this study to compare the postoperative analgesic effects of intrathecal morphine and nalbuphine, the endpoints being onset and offset of action. METHODS: Geriatric patients scheduled for elective total hip replacement under continuous spinal anaesthesia were randomized to two double-blinded groups in the recovery room as soon as they experienced a pain score higher than 3 cm on the visual analogue scale (VAS, 0-10 cm). Either 160 microg morphine or 400 microg nalbuphine in 4 ml normal saline were administered intrathecally. Pain scores on VAS, rescue analgesia (diclofenac and morphine, not allowed during the first 60 min), and the adverse effects (respiratory depression, postoperative nausea and vomiting, itching) were recorded for 24 h after surgery. RESULTS: The study was stopped after inclusion of 2 x 12 patients due to slow onset of analgesia in the morphine patients. In the nalbuphine group, when compared to the morphine group, the time to a pain score <3 cm (8+/-6 vs. 31+/-32 min, P<0.001), the time to the lowest pain score (18+/-11 vs. 66+/-75 min, P<0.001) and the time to the first systemic analgesic intervention for a pain score >3 cm (218+/-256 vs. 1076+/-440 min, P<0.05) were significantly shorter. The analgesic requirements during the first 24 h were significantly lower in the morphine group (P<0.001). CONCLUSION: We conclude that after total hip replacement, administration of intrathecal nalbuphine resulted in a significantly faster onset of pain relief and shorter duration of analgesia than intrathecal morphine.
Aged↗
A comparison of intrathecal analgesia with fentanyl or sufentanil after total hip replacement.
UNLABELLED: We designed this study to compare the postoperative analgesic effects of intrathecal fentanyl and sufentanil, the end points being onset, quality, and duration of action. A total of 42 geriatric patients, scheduled for elective total hip replacement under continuous spinal anesthesia, were randomized in two double-blinded groups as soon as they experienced a pain score higher than 3 of 10 on the visual analog scale in the recovery room. Either 7.5 microg sufentanil or 40 microg fentanyl in 2 mL normal saline were intrathecally administered. Pain scores, rescue analgesia (ketorolac and morphine), and adverse effects (respiratory depression, postoperative nausea and vomiting, and itching) were recorded for 24 h after surgery. In both groups, comparing sufentanil to fentanyl, the time to a pain score <3 (9 +/- 9 vs 11 +/- 8 min), the time to the lowest pain score (18 +/- 6 vs 20 +/- 15 min), and the time to the first systemic analgesic intervention for a pain score >3 (241 +/- 102 vs 214 +/- 120 min) were comparable as were the analgesic requirements during the first 24 h. We conclude that, after total hip replacement, both lipid soluble opioids produce excellent analgesia with comparable onset, duration of action, and low incidence of minor adverse effects. IMPLICATIONS: We compared the postoperative analgesic properties of 40 microg intrathecal fentanyl and 7.5 microg sufentanil after total hip replacement. Both opioids provided satisfactory analgesia, with comparable onset (11 +/- 8 vs 9 +/- 9 min) and duration of action (214 +/- 120 vs 241 +/- 102 min), as well as low incidence of minor side effects.
Aged↗
Lumbar plexus block reduces pain and blood loss associated with total hip arthroplasty.
BACKGROUND: The usefulness of peripheral nerve blockade in the anesthetic management of hip surgery has not been clearly established. Because sensory afferents from the hip include several branches of the lumbar plexus, the authors hypothesized that a lumbar plexus block could reduce pain from a major hip procedure. METHODS: In a double-blind prospective trial, 60 patients undergoing total hip arthroplasty were randomized to receive general anesthesia with (plexus group, n = 30) or without (control group, n = 30) a posterior lumbar plexus block. The block was performed after induction using a nerve stimulator, and 0.4 ml/kg bupivacaine, 0.5%, with epinephrine was injected. General anesthesia was standardized, and supplemental fentanyl was administered per hemodynamic guidelines. Postoperative pain and patient-controlled intravenous morphine use were serially assessed for 48 h. RESULTS: The proportion of patients receiving supplemental fentanyl intraoperatively was more than 3 times greater in the control group (20 of 30 vs. 6 of 29, P = 0.001). In the postanesthesia care unit, a greater than fourfold reduction in pain scores was observed in the plexus group (visual analogue scale [VAS] pain score at arrival 1.3 +/- 2 vs. 5.6 +/- 3, P < 0.001), and "rescue" morphine boluses (administered if VAS > 3) were administered 10 times less frequently (in 2 of 28 vs. in 22 of 29 patients, P < 0.0001). Pain scores and morphine consumption remained significantly lower in the plexus group until 6 h after randomization (VAS at 6 h, 1.4 +/- 1.3 vs. 2.4 +/- 1.4, P = 0.007; cumulative morphine at 6 h, 5.6 +/- 4.7 vs. 12.6 +/- 7.5 mg, P < 0.0001). Operative and postoperative (48 h) blood loss was modestly decreased in the treated group. Epidural-like distribution of anesthesia occurred in 3 of 28 plexus group patients, but no other side-effects were noted. CONCLUSIONS: Posterior lumbar plexus block provides effective analgesia for total hip arthroplasty, reducing intra- and postoperative opioid requirements. Moreover, blood loss during and after the procedure is diminished. Epidural anesthetic distribution should be anticipated in a minority of cases.
Analgesia, Patient-Controlled↗
[Current chemotherapy of locally advanced or metastatic bladder tumors].
Standard chemotherapy of transitional cell carcinoma of the bladder is actually the combination of cisplatine, methothrexate, vinblastine and doxorubicine (MVAC). Although a high response rate, long term survival are rarely observed. More effective agents without toxicity are necessary. Several agents have demonstrated activity alone or in combinations. Combinations regimens use, paclitaxel, gemcitabine and Gallium nitrate, who prove activity alone or in combination with cisplatine or carboplatine, with a response rate of 40 to 70% in patient with visceral localisations. The optimal regimen is not yet determined.
Antineoplastic Agents↗
[Surgical treatment of priapism: experience of 56 cases in an African setting].
Since priapism is uncommon, treatment is controversial and difficult. In this article we describe a practical, well-documented approach for management of priapism in countries with a high incidence of sickle cell disease. This approach is based on our experience including a total of 56 black patients (49 adults and 7 children) as well as on the results reported in the literature. The patients in our series were examined and treated by the same physician over an 18 year period in various African countries, i.e., Burkina (n = 8), Chad (n = 12), Gabon (n = 19), and Niger (n = 17). Etiologies and pathophysiology are reviewed. In all cases, surgical treatment involved diversion from corpora cavernosa. In the 51 cases with follow-up periods of 3 months or longer, results were considered as excellent in 17 cases (33 p. 100), partial in 5 (9.8 p. 100), and unsuccessful in 29 (56.8). Since 1984, needle drainage with a unilateral transglandular cavernosal-spongiosum shunt based on the technique described by Al Ghorab's has led to better results with immediate detumescence in 80 p. 100 of cases and a long-term success rate of 52 p. 100 (13/25 cases with sufficient follow-up). Except in cases involving sickle cell anemia in which concomitant medical treatment of priapism can be useful, immediate surgical treatment is the only technique effective in avoiding secondary impotence, which was common in our series (58.6). Our p. 100 needle drainage technique appears to be the method of choice for simplified achievement of a unilateral transglandular cavernosal-spongiosum shunt.
Adolescent↗
[Progression of stage I non-seminomatous germ cell tumors during surveillance. Role of positron emission tomography].
Surveillance is one of the options proposed in the management of stage 1 non-seminomatous germ cell tumours when there is only a low risk of progression. No consensus has yet been reached concerning the modalities of this surveillance and several protocols are available, including the CCAFU protocol. The presence of recurrences in this population at low risk of progression, estimated to be 5%, accounts for the continuing research for more precise predictive factors of occult metastases. Although several studies appear to indicate a useful predictive value for some of these factors, their application in clinical practice still appears to be difficult. PET metabolic imaging (positron emission tomography) could constitute a new approach to staging of these tumours, allowing the detection of tumour sites by an increase of carbohydrate metabolism of malignant cells. However, no study is yet available to define the real place of this technique.
Adult↗
Binding of YY1 and Oct1 to a novel element that downregulates expression of IL-5 in human T cells.
BACKGROUND: IL-5 controls development of eosinophilia and has been shown to be involved in the pathogenesis of allergic diseases. In both atopic and nonatopic asthma, elevated IL-5 has been detected in peripheral blood and the airways. IL-5 is produced mainly by activated T cells, and its expression is regulated at the transcriptional level. OBJECTIVE: This study focuses on the functional analysis of the human IL-5 (hIL-5) promoter and characterization of cis -regulatory elements and transcription factors involved in the suppression of IL-5 transcription in T cells. METHODS: Methods used in this study include DNase I footprint assays, electrophoretic mobility shift assays, and functional analysis by mammalian cell transfection involving deletion analysis and site-directed mutagenesis. RESULTS: We identified 5 protein binding regions (BRs) located within the proximal hIL-5 promoter. Functional analysis indicates that the BRs are involved in control of hIL-5 promoter activity. Two of these regions, BR3 and BR4 located at positions -102 to -73, have not previously been described as regulators of IL-5 expression in T cells. We show that the BR3 sequence contains a novel negative regulatory element located at positions -90 to -79 of the hIL-5 promoter, which binds Oct1, octamer-like, and YY1 nuclear factors. Substitution mutations, which abolished binding of these proteins to the BR3 sequence, significantly increased hIL-5 promoter activity in activated T cells. CONCLUSION: We suggest that Oct1, YY1, and octamer-like factors binding to the -90/-79 sequence within the proximal IL-5 promoter are involved in suppression of IL-5 transcription in T cells.
Base Sequence↗
Nuclear factor of activated T cells and YY1 combine to repress IL-5 expression in a human T-cell line.
BACKGROUND: IL-5 is an inducible T-cell cytokine with the unique ability to induce eosinophilia without increases in other cell compartments. Regulation of IL-5 expression is controlled primarily at the level of transcription. The role of eosinophilia in allergic disorders indicates IL-5 as a target for therapy. OBJECTIVE: This report aims to increase our understanding of IL-5 gene regulation by identifying distal control elements in the human (h) IL-5 promoter, determining the transcription factors that bind these elements and elucidating their role in control of hIL-5 gene expression. METHODS: Methods used in this study include deoxyribonuclease I footprint analysis, electrophoretic mobility shift assay, and functional analysis by transfection of PER-117 cells with site-directed mutants of the hIL-5 promoter. RESULTS: We have identified a protected region in the distal hIL-5 promoter that has sequence homology to the previously identified negative regulatory element within BR3. This protected region has not been previously reported and is shown to contain overlapping binding sites for YY1 and nuclear factor of activated cells. The binding sites exist between positions -447 and -459, and this sequence was named hPRE2-IL5. Substitution mutations that abolish binding of these proteins to hPRE2-IL5 result in a 2- to 3-fold increase in hIL-5 promoter activity in activated human T cells. CONCLUSION: We report the novel combination of YY1 and nuclear factor of activated T cells transcription factors binding to a distal hIL-5 promoter element where both factors are involved in down-regulation of hIL-5 gene expression in human T cell.
Base Sequence↗
The conservative management of corynebacterium group D2 encrusted pyelitis.
OBJECTIVE: To evaluate the conservative management of encrusted pyelitis (EP), an infectious disease caused by urea-splitting micro-organisms (Corynebacterium group D2 being the most common), and characterized by stone encrustation of the collecting system. PATIENTS AND METHODS: Four patients (aged 17-62 years) with EP caused by Corynebacterium group D2 were treated conservatively with intravenous vancomycin and percutaneous acidification of the renal collecting system. Percutaneous nephrostomy tubes were placed to allow irrigation with Thomas' acid solution, the outflow being ensured by ureteric catheters. Patients were monitored and the results of and tolerance to treatment evaluated clinically, by biological assays, and by imaging techniques (ultrasonography, computed tomography and pyelography). RESULTS: No kidneys were lost and in all patients with initial renal failure, creatinine levels recovered to previous values. The adverse effects were moderate, consisting of flank pain or discomfort, and low-grade fever. Three patients developed asymptomatic fungal urinary tract infections requiring antifungal agents. The encrustations were treated effectively and almost disappeared in two patients, while the other two had no residual calcification. One transplanted-kidney recipient developed a ureteric stricture requiring surgical repair. Within a mean follow-up of 16 months, there was no recurrence of EP and the residual encrustation remained small. CONCLUSION: The conservative treatment of EP can avoid surgery in many cases, although there are some adverse effects of irrigation. The long-term follow-up and prevention of recurrent EP are nevertheless required.
Adolescent↗
Paternity in a patient with seminoma and carcinoma in situ in a solitary testis treated by partial orchidectomy.
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Adult↗
Postoperative analgesia with "3-in-1" femoral nerve block after prosthetic hip surgery.
PURPOSE: To evaluate the efficacy of a single shot "3-in-1" femoral nerve block for prosthetic hip surgery in association with general anaesthesia on post-operative analgesia. METHODS: Forty patients, ASA 1 to 3, received sham block or "3-in-1" femoral nerve block, following Winnie's landmarks with a nerve stimulator, and 40 ml bupivacaine 0.5% with epinephrine were injected after induction of anaesthesia. Vecuronium, 0.1 mg.kg-1, was added after performing the block and anaesthesia was maintained with isoflurane, oxygen 40% and nitrous oxide 60%. Fentanyl, 1.5 microgram.kg-1, was administered before incision to all patients. Heart rate, blood pressure, fentanyl requirements and FETiso were measured throughout surgery. During the post-operative period, 75 mg diclofenac i.m. and/or 0.1 mg.kg-1 morphine s.c. were administered when pain score was > 3/10 and repeated when necessary. Pain scores at first analgesic intervention, at 24 hr and 48 hr as well as diclofenac and morphine requirements after surgery were recorded. RESULTS: There was no difference in anaesthetic requirements during surgery. The time from performance of sham or "3-in-1" femoral nerve block to the first analgesic intervention (261 +/- 49 min versus 492 +/- 40 min, P < 0.05) and time from extubation to the first analgesic intervention (61 +/- 44 min vs 298 +/- 39 min, P < 0.05) were prolonged in the study group. However, pain scores and the analgesic requirements in the postoperative periods (24 and 48 hr) were similar. CONCLUSION: There is a short-term benefit during the first few postoperative hours in using a single shot "3-in-1" femoral nerve block to complement general anaesthesia for elective hip surgery.
Adjuvants, Anesthesia↗
[Benign neurogenic tumors of the lumbar plexus. Role of the enucleation procedure].
Benign neurogenic tumours originating from lumbar plexus or roots are rare. Two cases are reported. Resection, often possible with another localisation, may result in neurological deficit in these cases. Enucleation, the best choice, is not always feasible. Hollowing-out is therefore a procedure worth understanding.
Humans↗