High-dose oral morphine in cancer pain management: a report of twelve cases

We present 12 case reports from patients treated with more than 600 mg of morphine per day. We found no "opioid-nonresponsive pain" under treatment with a combination of morphine and nonopioids, supplemented with coanalgesics where appropriate. Side effects of morphine therapy were controlled with adjuvant drugs. Serious adverse effects were not observed. Episodes of break-through pain, dysphagia, and dyspnea caused by far advanced cancer disease were seen frequently.

Early aqueous activity on primitive meteorite parent bodies

The interstellar material from which the solar system formed has been modified by many processes: evaporation and condensation in the solar nebula, accretion into protoplanetary bodies and post-accretion processes within these bodies. Meteorites provide a record of these events and their chronology. Carbonaceous CI chondrites are among the most primitive, undifferentiated meteorites, but nevertheless show evidence of post-accretion alteration; they contain carbonates that are believed to have formed by reactions between anhydrous CI precursor materials and circulating fluids in the meteorite parent body (or bodies), yet little is known about the nature of these reactions or the timescale on which they occurred. Here we report measurements of excess 53Cr--formed by the decay of short-lived 53Mn--in five carbonate fragments from the CI chondrites Orgueil and Ivuna. Our results show that aqueous alteration on small protoplanetary bodies must have begun less than 20 Myr after the time of formation of the oldest known solar-nebula condensates (Allende refractory inclusions). This upper limit is much shorter than that of 50 Myr inferred from previous studies, and clearly establishes aqueous alteration as one of the earliest processes in the chemical evolution of the solar system.

Carbonates in CI chondrites: clues to parent body evolution

All CI chondrites are regolith breccias consisting of various types of chemically and mineralogically distinct mineral and lithic fragments (or units). In the CI chondrite Ivuna, for example, four different lithological units were identified and are referred to as lithology I, II, III, and IV. So far, lithologies III and IV have been identified in Orgueil as well. It appears that at least Ivuna and Orgueil consist of the same basic lithologies in different proportions. Carbonates in CIs occur as individual grains within such lithic units or exist as large fragments between them. Carbonate fragments are remnants of former carbonate veins and, in contrast to individual carbonate grains, are not genetically linked to lithological units. Four different types of carbonates (dolomite, breunnerite, calcite, siderite) occur in CIs and they constitute, on average, 5 vol% of each studied section. In this study, carbonates in the CI chondrites Orgueil, Ivuna, Alais, and Tonk were studied petrographically, mineralologically, and chemically. The results clearly indicate that, in contrast to most previous studies, compositional differences exist between dolomites within and among CI chondrites. From these differences it can be derived that (1) several episodes of alteration occurred on the CI parent body, (2) physicochemical conditions during carbonate formation must have been different among CIs, and (3) CI carbonates obviously were formed at low temperatures in equilibrium with surrounding fluid(s). While local compositional changes in fluid(s) on a micrometer to millimeter scale (as reflected by dolomite compositions within CI chondrites) were most likely controlled by the availability of Ca2+ Mg2+, Fe2+, and especially Mn2+ ions in the aqueous solutions, more widespread compositional changes on a meter (or even larger) scale were controlled by variable pH, Eh, CO2 partial pressure, and, especially, temperature conditions (as reflected by the compositional variability of dolomites among CIs).

Regulation of NPY/NPY Y1 receptor/G protein system in rat brain cortex

Neuropeptide Y (NPY) content, NPY receptors, and alpha-subunits of the G proteins Go and Gi were determined in cerebral cortex of male normotensive Wistar-Kyoto and spontaneously hypertensive rats at 3-28 wk of age and of adult female rats. NPY lacked major effects on adenylate cyclase or inositol phosphate formation. NPY content was similar in all normotensive groups but lower in spontaneously hypertensive rats at all ages. 125I-NPY labeled a homogeneous population of Y1-like receptors. The Y1 NPY receptor number gradually increased with age with similar values in both strains but was significantly smaller in female than in male rats. The Y1 NPY receptor affinity was similar in all male groups but greater in female rats. The abundance of immunodetectable Go alpha and Gi alpha and of pertussis toxin substrates was less at 3 wk than in older rats but similar in both sexes and strains. We conclude that rat cerebral cortex contains Y1-like receptors; sex, age, and blood pressure differentially regulate NPY content, Y1 NPY receptors, and Go alpha and Gi alpha.

Prevalence and pattern of symptoms in patients with cancer pain: a prospective evaluation of 1635 cancer patients referred to a pain clinic

In a prospective study, the prevalence of 15 physical symptoms and symptom groups was evaluated in 1635 cancer patients referred to a pain clinic. In addition to pain, patients suffered an average of 3.3 symptoms: insomnia (59%), anorexia (48%), constipation (33%), sweating (28%), nausea (27%), dyspnea (24%), dysphagia (20%), neuropsychiatric symptoms (20%), vomiting (20%), urinary symptoms (14%), dyspepsia (11%), paresis (10%), diarrhea (6%), pruritus (6%), and dermatological symptoms (3%). While symptom prevalence was influenced by tumor site, pain intensity, and opioid treatment, only a minor relationship was seen between symptoms and gender, age, or tumor stage. The data emphasize that it is not sufficient to simply address pain during the treatment of patients with cancer pain; a more global approach to symptom management is necessary.

Dose-response relationship of rocuronium bromide during intravenous anaesthesia

The dose-response relationship and time course of neuromuscular block following bolus injections of rocuronium was determined in four groups of nine patients each under nitrous oxide-narcotic anaesthesia. Each patient received a total of 800 micrograms kg-1 rocuronium in two divided doses, i.e. 120 and 680, 200 and 600, 250 and 550, or 300 and 500 micrograms kg-1. The respective second dose was injected when, following the first dose, the evoked twitch tension had recovered to 95% of its control value. The mean ED50 and ED95 values, calculated from the first doses, were 103 and 271 micrograms kg-1, respectively. The DUR25 ranged between 11 +/- 4 (200 micrograms kg-1) to 14 +/- 3 min (300 micrograms kg-1) following the first and from 30 +/- 6 (500 micrograms kg-1) to 43 +/- 11 min (680 micrograms kg-1) following the second doses. The recovery index following the second doses varied between 14 +/- 5 (500 micrograms kg-1) and 24 +/- 20 min (600 micrograms kg-1), more than twice as long as following the first doses. We conclude that rocuronium is a muscle relaxant of low potency with an intermediate duration of action.

Differences of size and shape of active and inactive X-chromosome domains in human amniotic fluid cell nuclei

It is a widely held belief that the inactive X-chromosome (Xi) in female cell nuclei is strongly condensed as compared to the largely decondensed active X-chromosome (Xa). We have reconsidered this problem and painted X-chromosome domains in nuclei of subconfluent, female and male human amniotic fluid cell cultures (46,XX and 46,XY) by chromosomal in situ suppression (CISS) hybridization with biotinylated human X-chromosome specific library DNA. FITC-conjugated avidin was used for probe detection and nuclei were counterstained with propidium iodide (PI). The shape of these nuclei resembling flat ellipsoids or elliptical cylinders makes them suitable for both two-dimensional (2D) and three-dimensional (3D) analyses. 2D analyses of Xi- and Xa-domains were performed in 34 female cell nuclei by outlining of the painted domains using a camera lucida. Identification of the sex chromatin body in DAPI-stained nuclei prior to CISS-hybridization was confirmed by its colocalization with one of the two painted X-domains. In 31 of the 34 nuclei the area AXi for the inactive X-domain was smaller than the area AXa for the active domain (mean ratio AXa/AXi = 1.9 +/- 0.8 SD, range 1.0-4.3). The signed rank test showed a highly significant (P < .0001) difference both between AXa and AXi and between the ratios r(Xa) and r(Xi), calculated by dividing the maximum length L of each X-domain by its maximum width W. In most nuclei (26/34) we found r(Xa) > r(Xi) demonstrating a generally more elongated structure of Xa. For 3D analysis a confocal scanning laser fluorescence microscope (CSLFM) was used. Ten to 20 light optical sections (PI-image, FITC-image) were registered with equal spacings (approx. 0.4 microns). A thresholding procedure was applied to determine the PI-labeled nuclear and FITC-labeled X-domain areas in each section. Estimated slice volumes were used to compute total nuclear and X-domain volumes. In a series of 35 female nuclei most domains extended from the top to the bottom nuclear sections. The larger of the two X-chromosome domains comprised (3.7 +/- 1.7 S.D.)% of the nuclear volume. A mean ratio of 1.2 +/- 0.2 SD (range 1.1-2.3) was found for the volumes of the larger and the smaller X-domains in these female nuclei. In a series of 27 male amniotic fluid cell nuclei the relative X-chromosome domain volume comprised (4.0 +/- 2.6 S.D.)%.(ABSTRACT TRUNCATED AT 400 WORDS)

[Outpatient dental surgery under anesthesiological monitoring. Investigation with 1022 patients at risk]

The aim of the study was to explore retrospectively the risks of ambulatory treatment under local anaesthesia during dental operations of elderly patients. Anaesthetic care was divided into control and therapeutical measures. Among the previous disorders the hypertension and its sequelae proved to be the main risk factors. The need of anaesthetic intervention doubled, when the time of operation exceeded 30 min. Due to good interdisciplinary cooperation, 99.3% of the operations took their proper course.