Muscle pain after outpatient laparoscopy--influence of propofol versus thiopental and enflurane

The incidence and pattern of postoperative muscle pains was studied in 155 healthy women undergoing outpatient laparoscopic surgery who were assigned randomly to one of five treatment groups. Group 1 (control) received thiopental and succinylcholine, 1 mg/kg, followed by enflurane and nitrous oxide. Group 2 received d-tubocurarine, 3 mg, followed by succinylcholine, 1.5 mg/kg, but was otherwise similar to Group 1. Groups 3 and 4 were similar to Group 1, but received propofol instead of thiopental, and Group 4 also received a variable-rate propofol infusion instead of enflurane. Finally, Group 5 was similar to Group 3, but received atracurium instead of succinylcholine. Muscle fasciculations were often observed in Groups 1, 3, and 4, but were attenuated in Group 2 and absent in Group 5. Overall, postoperative shoulder pain occurred in 81%, 72%, and 29% of patients on the first, second, and third postoperative days, respectively. The incidence of this symptom did not differ among the five groups. Neck pain occurred less frequently than shoulder pain in each group, and also occurred less often in Group 5 than in Group 1. Muscle stiffness occurred less often than muscle pain, and also occurred less frequently in Group 5 than in Group 1. In conclusion, succinylcholine contributes to neck pain and muscle stiffness after laparoscopic procedures. Compared to thiopental and enflurane, the use of propofol for induction and/or maintenance of anesthesia failed to alter the incidence of postlaparoscopic muscle pain or stiffness.

Effects of ketorolac on postoperative analgesia and ventilatory function after laparoscopic cholecystectomy

Ketorolac, a nonsteroidal anti-inflammatory drug, is alleged to produce postoperative analgesia without opioid-related side effects. Patients undergoing laparoscopic cholecystectomy were assigned randomly to receive either ketorolac or a placebo (saline) according to a double-blind protocol. Preoperative (baseline) pulmonary function was evaluated using a Respiradyne II monitor. Patients received midazolam, 2 mg, and 2 mL of either ketorolac, 60 mg (n = 31), or saline (n = 29), 20-40 min before surgery. Anesthesia consisted of thiopental, 4-5 mg/kg, and vecuronium, 0.1 mg/kg, for induction, and isoflurane, 0.5%-2.0%, with 67% nitrous oxide in oxygen for maintenance. A second 2-mL dose of the same study medication (ketorolac, 60 mg, or saline) was administered 4 h after the initial dose. Postoperatively, 66% of patients in the saline group complained of pain requiring treatment with fentanyl compared to 32% in the ketorolac group (P < 0.05). There were no significant differences between the two groups with respect to postoperative sedation, anxiety, pain, or nausea visual analog scores. Compared to the preoperative values, significant decreases in pulmonary function tests were noted in both groups at 4 h after the operation and the following morning (P < 0.01). In the ketorolac group, only values of forced expiratory volume at 1 s and forced expiratory flow at 25%-75% of the forced vital capacity at 4 h after the operation were significantly higher than those in the saline group (P < 0.05). Incidences of nausea (45% vs 52%) and vomiting (10% vs 10%) were similar in both groups. In conclusion, ketorolac decreased the postoperative requirement for opioid analgesic medication.(ABSTRACT TRUNCATED AT 250 WORDS)

Two new steroidal saponins from dried fermented residues of leaf-juices of Agave sisalana forma Dong No. 1

In a previous paper, we reported the isolation and structure determination of three new steroidal saponins, dongnosides C (3), D (2) and E (1) from the dried fermented residues of leaf-juices of Agave sisalana forma Dong No. 1. In a continuing study on this plant, two additional new major steroidal saponins, named dongnosides B (4) and A (5), were obtained. Their structures were characterized respectively as tigogenin 3-O-alpha-L-rhamonpyranosyl-(1-->4)-beta-D-glucopyranosyl-(1-->2)- [beta-D- glucopyranosyl-(1-->3)]-beta-D-glucopyranosyl-(1-->4)-beta-D-galactop yranoside and 3-O-alpha-L-rhamnopyranosyl-(1-->4)-beta-D-glucopyranosyl-(1-->2)-[beta- D- xylopyranosyl-(1-->3)-beta-D-glucopyranosyl-(1-->3)]-beta-D- glucopyranosyl-(1-->4)-beta-D-galactopyranoside on the basis of chemical and physicochemical evidence.

Total Intravenous Anesthesia

During radical prostatectomy procedures under total intravenous anesthesia, acute hemodynamic responses to retropubic dissection (30% +/- 8% to 36% +/- 12% [mean +/- SD] increases in mean arterial pressure) were treated with supplemental doses of either an opioid analgesic (alfentanil) or a sedative-hypnotic (propofol) to return the mean arterial pressure to within 10% of the preincision value. Although both drugs were effective, control with propofol required 10.1 +/- 2.5 min compared with 6.3 +/- 2.6 min in the alfentanil group (mean +/- SD; P < 0.01). Plasma stress hormone concentrations increased significantly in response to this surgical stimulus: epinephrine increased from 246% +/- 169% to 283% +/- 330%; norepinephrine increased from 44% +/- 33% to 83% +/- 104%; and antidiuretic hormone increased from 1300% +/- 1591% to 1700% +/- 1328%. Both alfentanil and propofol were equally effective in returning the catecholamine concentrations to their preincision levels. However, antidiuretic hormone levels remained above preincision values in both groups. Despite earlier awakening (3.4 +/- 2.9 vs 9.1 +/- 6.8 min; P < 0.05) in the alfentanil treatment group, there was no difference in time to spontaneous ventilation or tracheal extubation between the groups. In addition, 36% of the alfentanil-treated patients required antihypertensive therapy in the postanesthesia care unit compared with only 9% in the propofol group (P < 0.05). Postanesthesia care unit and hospital discharge times were similar in both treatment groups. We conclude that supplemental doses of alfentanil or propofol were equally effective in controlling acute hemodynamic and hormonal responses to surgical stimuli during total intravenous anesthesia.

Three new oleanene glycosides from Sophora flavescens

Three new oleanene glycosides, sophoraflavosides II-IV (2-4) were isolated together with sophoraflavoside I (1) as the corresponding methyl ester forms from Sophorae Radix, the fresh roots of Sophora flavescens AITON (Leguminosae). Their structures have been elucidated as oxytrogenin 3-O-alpha-L-rhamnopyranosyl-(1-->2)-beta-D-galactopyranosyl-(1-->2)-beta -D- glucuronopyranoside (2), 3-O-alpha-L-rhamnopyranosyl-(1-->2)-beta-D-galactopyranosyl-(1-->2)-beta -D-glucuronopyranosyl oxytrogenin 22-O-alpha-L-arabinopyranoside (3) and 3-O-alpha-L-rhamnopyranosyl-(1-->2)-beta-D-galactopyranosyl-(1-->2)-beta -D-glucuronopyranosyl oxytrogenin 22-O-beta-D-glucopyranosyl-(1-->2)-alpha-L-arabinopyranoside (4), along with unambiguous characterization as 3 beta,22 beta,24-trihydroxyolean-12-en-29-oic acid for their sapogenol, named oxytrogenin (5) on the bases of chemical reactions and spectral analyses.

Comparative effects of ketorolac, dezocine, and fentanyl as adjuvants during outpatient anesthesia

The comparative effects of ketorolac, dezocine, and fentanyl were evaluated in 136 healthy female patients undergoing outpatient laparoscopic procedures according to a randomized, double-blind protocol. Patients received ketorolac (60 mg) or dezocine (6 mg) or fentanyl (100 micrograms, control group) before the start of the operation. A standardized general anesthetic technique consisting of midazolam (2 mg), fentanyl (50 micrograms), and propofol (2 mg/kg) for induction of anesthesia followed by propofol (120 micrograms.kg-1.min-1), vecuronium (1-2 mg), and 67% nitrous oxide in oxygen for maintenance of anesthesia, was used. In the postanesthesia care unit, 61% of patients in the fentanyl group received analgesic drugs for persistent pain, compared with 34% and 25% in the ketorolac and dezocine groups, respectively. Similarly, less postoperative fentanyl (mean +/- SD) was required in the ketorolac (22 +/- 33 micrograms) and dezocine (18 +/- 35 micrograms) groups, compared with the fentanyl (58 +/- 71 micrograms) group. However, 52% of the patients receiving dezocine required antinausea therapy in the postanesthesia care unit, compared with 20% and 18% in the fentanyl and ketorolac groups, respectively. Finally, recovery times were significantly shorter in the ketorolac (vs dezocine) group. Although both ketorolac and dezocine were effective alternatives to fentanyl when administered during outpatient laparoscopy, dezocine was associated with an increased incidence of postoperative nausea and a delayed discharge time compared with ketorolac.

Myelin protein expression in dissociated superior cervical ganglia and dorsal root ganglia cultures

Schwann cells of the adult rat superior cervical ganglia (SCG) synthesize negligible levels of the major myelin glycoprotein, P0, in vivo. This suggests that the sympathetic axons of the SCG are deficient in one of more components involved in the regulation of myelin protein expression. Here we have compared the ability of neurites from neonatal rat SCG and embryonic rat dorsal root ganglia (DRG) to induce Schwann cell expression of myelin proteins after growth in culture using a serum-free medium. Steady-state P0 mRNA levels in the SCG and DRG culture paradigms were determined with a sensitive polymerase chain reaction (PCR) assay that amplified cDNA produced by reverse transcription of mRNA. This semiquantitative assay showed a linear response to increasing amounts of P0 and actin mRNA and required substantially less cellular RNA than typical hybridization techniques. Using the PCR assay, we found that SCG cultures contained significantly lower amounts of P0 mRNA than did DRG cultures. To further confirm that SCG cultures have negligible expression of myelin proteins, immunoblot analyses were done to examine the steady-state levels of both P0 and myelin basic protein. While nonmyelinating DRG cultures had readily detectable amounts of these myelin-specific proteins, neither could be demonstrated in the SCG cultures. The data indicate that SCG neurites lack one or more signals needed to induce myelin protein expression. Employing SCG and DRG cultures in comparative biochemical studies should prove useful in identifying the axonal molecule(s) involved in the regulation of myelin protein expression.

On the relative importance of marker heterozygosity and intermarker distance in gene mapping

Molecular biologists are often confronted with the problem of whether they should try to generate large numbers of very closely linked markers of low heterozygosity or smaller numbers of less closely linked markers of high heterozygosity. In other words, What is more important for gene mapping, high marker heterozygosity or dense marker spacing? We investigated that problem by analytically computing the expected lod score per meiosis in which the new locus is informative and phase known. We also looked at the length of the 1-unit-of-lod-score support interval for the expected lod score from 100 such meioses. We found that while both quantities have an influence on the number of meioses needed to find linkage, the length of the support interval is almost entirely dependent on the intermarker distance, for heterozygosities between 20 and 100%. However, the probability of any given meiosis being phase known and the ability to develop an accurate map of the markers are functions of marker heterozygosity, further complicating the issue.

[Evaluation of the tissue-to-blood partition coefficient R for physiological pharmacokinetic models]

The tissue-to-blood partition coefficient R, fraction of drug unbound in blood fB and intrinsic clearance of elimination organ/tissue Cl'L are important parameters used in physiological pharmacokinetic models. Simple equations to evaluate R by AUC were derived in this paper for single bolus iv, the tissue-to-blood partition coefficient of nonelimination organ/tissue was exactly the ratio of AUC between tissue and blood, those equations were examined by the experimental data of rats following iv ethoxybenzamide 20 mg.kg-1, and compared with other methods. Equations to evaluate fBCl'L and other parameters were also given for linear elimination model.

Comparison of induction, maintenance, and recovery characteristics of sevoflurane-N2O and propofol-sevoflurane-N2O with propofol-isoflurane-N2O anesthesia

Induction of, maintenance of, and recovery from sevoflurane anesthesia were compared with propofol and isoflurane anesthesia when administered with nitrous oxide to patients undergoing gynecologic surgery. Seventy-five healthy (ASA I or II), consenting patients were randomly assigned to receive either (I) propofol for induction of anesthesia and isoflurane-nitrous oxide for maintenance (control), (II) propofol for induction and sevoflurane-nitrous oxide for maintenance, or (III) sevoflurane-nitrous oxide for induction and maintenance of anesthesia. Inhaled induction of anesthesia with sevoflurane-nitrous oxide was rapid (109 +/- 25 s to loss of consciousness) and without any untoward hemodynamic changes or episodes of coughing and laryngospasm. Mean arterial blood pressure after induction of anesthesia with propofol (71 +/- 11, 73 +/- 12 mm Hg for groups I and II, respectively) was lower than when sevoflurane (80 +/- 14 mm Hg) was used. The emergence time after discontinuation of isoflurane-nitrous oxide (6.7 +/- 2.2 min) was significantly longer than after propofol-sevoflurane-nitrous oxide or sevoflurane-nitrous oxide alone (4.1 +/- 2.2 and 4.0 +/- 2.0 min for groups II and III, respectively). However, later recovery events did not differ between groups. Serum fluoride levels increased after administration of sevoflurane but not isoflurane. The levels of fluoride ions correlated with the degree of exposure to sevoflurane in MAC-hours. In conclusion, induction of anesthesia with either propofol or sevoflurane-nitrous oxide was rapid and without significant side effects. Emergence and early recovery after maintenance of anesthesia with sevoflurane-nitrous oxide was significantly faster than that after an isoflurane-nitrous oxide combination.

Relaxation therapy for hypertension: setting-specific effects

We determined the effect of relaxation therapy for hypertension in patients whose blood pressure remained elevated despite the use of antihypertensive medication. The effect was assessed in multiple settings, including the relaxation therapist's office, the Hypertension Clinic, and the patient's natural environment, the latter using 24-hour automated ambulatory blood pressure measures. Nineteen patients were randomized either to temperature biofeedback-assisted relaxation or to an attention control, "stress education." Antihypertensive medication was kept constant. In the behavioral therapist's office, blood pressure decreased in equivalent amounts with both treatments. Hypertension Clinic nurse blood pressure remained stable or increased with both treatments, but again there was no difference between treatments. Ambulatory blood pressure increased with relaxation therapy and decreased with stress education, the effect being significant for diastolic pressure. The effects on ambulatory blood pressure were limited to the waking hours. The only variable that showed superior effects for relaxation therapy was physician-determined blood pressure. These results call into question the generalizability of the effects of relaxation therapy from one setting to another.

New Diterpenoids from Euphorbia sieboldiana

From the acetone extract of roots of EUPHORBIA SIEBOLDIANA, three known diterpenes, ENT-atisane-3beta,16alpha,17-triol ( 1), ingenol ( 4), and helioscopinolide A ( 5) as well as two new diterpenes, 3beta- O-acetyl- ENT-atisane-16alpha,17-diol ( 2), and ingenol-20-palmitate ( 3) were isolated. Their structures were elucidated by spectroscopic methods and chemical transformations.

A potential mucus precursor in Tetrahymena wild type and mutant cells

By using an antibody to a specific mucus polypeptide (34 kDa) to study whole cell extracts of both a secretory mutant (SB281) and wild type (wt) Tetrahymena, we demonstrate that a 57-kDa polypeptide is a probable precursor to the 34-kDa secretory polypeptide. We postulate that the precursor accumulates in the mutant cells because it cannot be cleaved. This mutant contains no recognizable mature secretory granules (mucocysts). By immunoelectron microscopy, the 34-kDa polypeptide was localized in wt cells specifically to the mature mucocysts and to their released products. Localization in mutant cells occurred in two different types of cytoplasmic vesicles: small electron dense vesicles (0.3-0.5 microns in diameter) and large electron lucent vacuoles (1.2-3.5 microns in diameter). Immunoblot analyses of homogenates of mutant and wt cells with the anti-34-kDa serum revealed a dominant band in the mutant at Mr 57 kDa whereas the wt showed a dominant band only at Mr 34 kDa. Furthermore, the 57-kDa polypeptide is immunoprecipitated with anti-34-kDa serum from the mutant cell. Further evidence for a precursor relation of the 57-kDa polypeptide in mutant cells to the 34-kDa mucus polypeptide of wt cells was obtained by the use of drugs (monensin, chloroquine, NH4Cl) that block secretory product processing in wt cells. Extracts of drug-treated wt cells showed the presence of a 57-kDa cross reacting band even after 18 h of incubation in growth medium whereas untreated control cells contained the 34-kDa mature protein almost exclusively. These results indicate that processing of the precursor to the 34-kDa polypeptide occurs in an acidic compartment(s) possibly in either the trans Golgi network, or condensing vacuoles or both.

The tissue-specific mammalian transcription factor, Pit-1, activates transcription in Saccharomyces cerevisiae

Pit-1 is a tissue-specific transcription factor which binds to specific DNA sequences within 5' flanking regions of the PRL and GH genes and activates the transcription of these genes. Previous studies have shown that expression of Pit-1 is necessary to activate transcription from the PRL or GH promoters in heterologous mammalian cells. In the present study the ability of Pit-1 expression vectors to activate expression of reporter genes in Saccharomyces cerevisiae was examined. The test system used Pit-1 expression vectors and an indicator plasmid containing multiple copies of a Pit1-binding site as a replacement for the upstream activator sequence of the CYC1 promoter. Significant activation of indicator plasmid expression was detected only in the presence of functional Pit-1 expression vectors. In both mammalian and yeast cells, amino-terminal deletions of the Pit-1 coding sequence produced similar and gradual loss of transcriptional activation. This finding indicates that similar or identical regions of Pit-1 are required for transcriptional activation in mammalian and yeast cells. Although synthetic DNA elements containing multiple copies of a single Pit-1-binding site were sufficient to permit Pit-1-mediated transcriptional activation in both yeast and mammalian cells, DNA fragments representing the proximal region or distal enhancer region of the PRL gene were transcriptionally active only in mammalian cells. These studies establish the ability of Pit-1 to stimulate transcription in the absence of other tissue-specific factors and provide a system for further genetic studies of Pit-1 structure/function relationships as well as evaluation of target sequences necessary for Pit-1 action.

Correlation between CT and DNA contents in peripheral lung cancers

The DNA contents of 30 lung cancers were correlated with preoperative chest CT findings. Tumors with diameters less than 4 cm had lower DNA contents than larger ones, and tumors with spiculated margins had lower DNA than those with lobulated or smooth margins. As DNA contents are correlated with prognosis, the border configuration of peripheral lung cancers may be enough to predict prognosis.

[Commercial investigation and identification of Chinese drug mabo]

According to a commercial investigation on the Chinese drug mabo being marketed in Gansu Province, there are 17 species belonging to 2 orders, 3 families and 8 genera, of which 6 species including Calvatia candida are discovered on the market for the first time. Morphologic and microscopic characteristics have been studied. A key to the identification is given.

[Medicinal Polygonatum in northwest China]

This paper reports 16 species of medicinal plants of Polygonatum found in northwest China, along with their distribution, ecological conditions, infraspecies variations and clinical applications. A key to the species is provided.

SPRINT II: a second generation single photon ring tomograph

SPRINT II is a stationary detector ring tomograph designed for brain imaging. Eleven two-dimensional sodium iodide camera modules that use maximum-likelihood position logic are arranged in a 50-cm-diameter ring with a scintillator packing fraction of 96%. A 34-cm-diameter rotating lead aperture ring containing either 10 or 12 slits is used for in-plane collimation, while the z-axis collimator is constructed of parallel lead foil rings. The field of view is 22 cm in diameter by 12 cm long. Sensitivity is 10 count/s/muCi for an on-axis (99m)Tc point source and 8500 count/s/muCi/cm(3) for 19.8-cm-diameter by 6.2-cm-long cylindrical source. Longitudinal resolution is 10 mm FWHM, and in-plane resolution varies from 8 mm FWHM on-axis to 5 mm FWHM at a radius of 9 cm. Performance results are presented.