Fused umbilical arteries: prenatal sonographic diagnosis and clinical significance

This report describes a series of 5 fetuses with fused umbilical arteries that had the prenatal feature of a single umbilical artery near the placental insertion and the normal 2 umbilical arteries at the fetal end of the cord. In 1 case this vascular anomaly was associated with unilateral renal agenesis in a fetus with a subsequent diagnosis of Hallermann-Streiff syndrome. No perinatal complications were identified in the remaining 4 fetuses. Postpartum examination of the cord revealed that the 2 umbilical arteries fused to form 1 artery for a long segment of the distal portion of the cord. Our findings suggest that the prenatal evaluation of the umbilical cord to document the number of vessels should include multiple views of the cord and demonstration of the 2 intra-abdominal umbilical arteries with color Doppler imaging for a confident diagnosis. Our observation also suggests that, at least in some cases, single umbilical artery may result from incomplete splitting of the single artery normally present in early human embryos.

Sensory properties of citric acid: psychophysical evidence for sensitization, self-desensitization, cross-desensitization and cross-stimulus-induced recovery following capsaicin

In a first experiment, human subjects used a bipolar scale to rate the irritant sensation elicited by 10 sequentially repeated applications of either 3 ppm capsaicin or 250 mM citric acid on one side of the dorsal surface of the tongue, at 1 min intervals (30 s inter-stimulus interval). Citric acid-evoked irritation significantly increased across trials, consistent with sensitization. With capsaicin there was a large degree of inter- and intra-individual variation in successive ratings with no overall sensitization. Following the sequential stimulation series and a 10 min rest period, self- and cross-desensitization effects were tested in a two-alternative forced choice (2-AFC) paradigm by placing either citric acid or capsaicin on both sides of the tongue and asking subjects to indicate which side of the tongue yielded a stronger irritant sensation. Subjects also gave separate intensity ratings for irritation on each side of the tongue. Capsaicin self-desensitization was confirmed, while cross-desensitization to citric acid was not observed. In addition, citric acid self-desensitization and cross-desensitization to capsaicin were observed. In a second experiment a stronger capsaicin solution (33 ppm) was applied to one side of the tongue using cotton swabs. After the burning sensation elicited by capsaicin had disappeared, citric acid was applied bilaterally and cross-desensitization was observed using the same 2-AFC and rating procedures. This was followed by repeated re-application of citric acid at 1 min intervals to the capsaicin-treated side. The irritant sensation elicited by citric acid increased significantly, indicating a 'cross-stimulus-induced recovery' from capsaicin desensitization. In a final experiment we investigated the effect of the sodium channel blocker amiloride on the perceived irritation elicited by citric acid or capsaicin. Following application of amiloride to one side of the tongue with cotton swabs, either citric acid or capsaicin was applied bilaterally and subjects asked to perform a 2-AFC and intensity ratings. Amiloride significantly, albeit weakly, reduced the irritation elicited by citric acid while it weakly but significantly enhanced capsaicin-evoked irritation. These findings are discussed in terms of involvement of vanilloid and acid-sensitive ion channels in acid-evoked irritation and pain.

Isoflurane depresses electroencephalographic and medial thalamic responses to noxious stimulation via an indirect spinal action

Anesthetics such as isoflurane act in the spinal cord to suppress movement in response to noxious stimulation. Spinal anesthesia decreases hypnotic/sedative requirements, possibly by decreasing afferent transmission of stimuli. We hypothesized that isoflurane action in the spinal cord would similarly depress the ascending transmission of noxious input to the thalamus and cerebral cortex. In six isoflurane-anesthetized goats, we measured electroencephalographic (EEG) and thalamic single-unit responses to a clamp applied to the forelimb. Cranial bypass permitted differential isoflurane delivery to the torso and cranial circulations. When the cranial-torso isoflurane combination was 1.3% +/- 0.2%-1.0% +/- 0.4% the noxious stimulus did not evoke significant changes in the EEG or thalamic activity: 389 (153-544) to 581 (172-726) impulses/min, (median, 25th-75th percentile range, P: > 0.05). When the cranial-torso isoflurane combination was 1.3% +/- 0.2%-0.3% +/- 0.2%, noxious stimulation increased thalamic activity: 804 (366-1162) to 1124 (766-1865) impulses/min (P: < 0.05), and the EEG "desynchronized": total EEG power decreased from 25 +/- 20 microV(2) to 12 +/- 8 microV(2) (P: < 0.05). When the cranial-torso isoflurane was 1.7% +/- 0.1%-0.3% +/- 0.2%, the noxious stimulus did not significantly affect thalamic: 576 (187-738) to 1031 (340-1442) impulses/min (P: > 0.05), or EEG activity. The indirect torso effect of isoflurane on evoked EEG total power (12.6 +/- 2.7 microV(2)/vol%, mean +/- SE) was quantitatively similar to the direct cranial effect (17.7 +/- 3.0 microV(2)/vol%; P: > 0.05). These data suggest that isoflurane acts in the spinal cord to blunt the transmission of noxious inputs to the thalamus and cerebral cortex, and thus might indirectly contribute to anesthetic endpoints such as amnesia and unconsciousness.

IMPLICATIONS

Isoflurane action in the spinal cord diminished the transmission of noxious input to the brain. Because memory and consciousness are likely dependent on the "arousal" state of the brain, this indirect action of isoflurane could contribute to anesthetic-induced amnesia and unconsciousness.

Prenatal diagnosis of solid placental masses: the value of color flow imaging

OBJECTIVES

To determine the value of color flow imaging in the prenatal differentiation of solid placental masses protruding from the fetal surface of the placenta.

METHODS

Seven pregnancies in which a large solid mass was seen on the fetal surface of the placenta were prospectively studied. Color flow imaging was used to identify vessels within the mass and the prenatal ultrasound finding correlated with placental pathology.

RESULTS

Postpartum examination of the placenta revealed four cases of chorioangioma, two cases of subchorionic thrombohematoma and one case of subamniotic hematoma. Prenatal ultrasound using color flow imaging correctly identified all cases of placental chorioangioma by the demonstration of blood flow within the mass. Conversely, absence of blood flow signals was invariably documented in both cases of subchorionic thrombohematoma and in the single case of subamniotic hematoma. Among the four cases of chorioangioma, two developed complications requiring delivery. No complications were noted in cases of avascular placental masses in this series.

CONCLUSIONS

Color Doppler ultrasound plays an important role in the prenatal evaluation of solid placental masses. This technique allows the identification of those cases at increased risk of pregnancy complications which need close monitoring throughout gestation.

Sensitization, desensitization and stimulus-induced recovery of trigeminal neuronal responses to oral capsaicin and nicotine

Repeated application of capsaicin at a 1-min interstimulus interval (ISI) to the tongue induces a progressively increasing irritant sensation (sensitization), followed after a rest period by reduced sensitivity to further capsaicin (desensitization). Sequential reapplication of capsaicin induces irritation that eventually increases to initial levels: stimulus-induced recovery (SIR). In contrast, repeated application of nicotine elicits a declining irritant sensation across trials. To investigate possible neural correlates of these phenomena, we recorded from single units in superficial laminae of the dorsomedial trigeminal subnucleus caudalis (Vc) that responded to noxious thermal (54 degrees C) and chemical (1 M pentanoic acid) stimulation of the tongue of anesthetized rats. We then recorded responses to either capsaicin (330 microM) or nicotine (0.6 M), delivered either once, repeatedly at 1-min ISI, or continually by constant flow. After the initial capsaicin application and a rest period, the capsaicin was reapplied in the identical manner to test for SIR. The mean response of 14 Vc units to sequential application of pentanoic acid did not vary significantly across trials, indicating lack of tachyphylaxis or sensitization. The averaged response of 11 Vc units to repeated capsaicin increased significantly across the first eight trials and then plateaued. Following the rest period, spontaneous firing had returned to the precapsaicin level. With capsaicin reapplication, the averaged response increased again after a significant delay (due to desensitization), but did not reattain the peak firing rate achieved in the initial series (partial SIR). Constant-flow application of capsaicin induced an identical sensitization followed by nearly complete SIR. A single application of capsaicin induced a significant rise in firing in eight other units, but the rate of rise and maximal firing rate were both much lower compared with repetitive or constant-flow capsaicin. When capsaicin was reapplied once after the rest period, there was no change in firing rate indicating absence of SIR. These results indicate that maintenance of the capsaicin concentration induces a progressive increase in neuronal response that parallels sensitization. With recurrent capsaicin application, desensitization can be overcome to result in a delayed recovery of Vc responses similar to SIR. In contrast, the averaged response of 17 Vc units to repeated or constant-flow application of nicotine increased only over the first 3 min, and then decreased to spontaneous levels even as nicotine was still being applied. These results are consistent with the decrease in the perceived irritation elicited by sequential application of nicotine in humans.

Isoflurane anaesthetic depth in goats monitored using the bispectral index of the electroencephalogram

The bispectral index (BIS) of the electroencephalogram has recently been used to monitor the depth of anaesthesia in humans. The BIS is a dimensionless number that varies between 0 and 100. We hypothesized that the BIS could also be used to monitor depth of isoflurane anaesthesia in goats. Needle electrodes were placed over the frontal region of the scalp of goats and 5%, isoflurane was administered via a mask. The BIS number was determined at clinically relevant end-points. The BIS number did not change when the animals became recumbent (95 +/- 5 to 94 +/- 7, n = 15), but decreased to 65 +/- 13 and 64 +/- 15 when the corneal reflex and withdrawal response to a noxious stimulus, respectively, were lost (p < 0.001, n = 12). Direct laryngoscopy and intubation increased the BIS (56 +/- 7 to 83 +/- 11; p < 0.05, n = 10), as did a noxious pinch to the dew-claw (57 +/- 9; to 76 +/- 9; p < 0.05, n = 10). The spectral edge (frequency below which 95% of the total power resided) paralleled the change in BIS. We conclude that the depth of isoflurane anaesthesia in goats can be monitored using the BIS, although further work is needed to determine its sensitivity and specificity.

Cross-desensitization of capsaicin-evoked oral irritation by high but not low concentrations of nicotine in human subjects

We previously showed that sequential application of a relatively low nicotine concentration (7.4 mM) to the tongue, followed by a rest period, induced self-desensitization, i.e. a reduction of oral irritation elicited by subsequent nicotine, but not cross-desensitization of capsaicin-evoked irritation. We presently investigated if cross-desensitization of capsaicin-evoked irritation might be induced by higher concentrations of nicotine. Nicotine (74 or 300 mM) was applied once, unilaterally to the tongue of human subjects. When the irritant sensation had completely subsided, capsaicin (33 microM) was applied bilaterally. In a 2-alternative forced-choice (2-AFC) test, subjects indicated which side of the tongue had a stronger irritant sensation. They additionally rated the intensity of irritation on each side separately. Pretreatment with 74 mM nicotine did not induce cross-desensitization, since no significant difference was observed in intensity ratings or in choice of the treated vs. non-treated side in the 2-AFC. However, 300 mM nicotine did induce cross-desensitization, since a significant majority of subjects chose the non-treated side as having a stronger capsaicin-evoked irritant intensity and assigned significantly higher ratings to that side. These psychophysical findings are discussed in terms of possible neural mechanisms of desensitization.

Somatosensory cortex: a comparison of the response to noxious thermal, mechanical, and electrical stimuli using functional magnetic resonance imaging

In the present study, functional magnetic resonance imaging (fMRI) was used to examine pain perception in humans. Three types of noxious stimuli were presented: electric shock (20.8 mA, 2 Hz), heat (48 degrees C), and mechanical, as well as a control tactile stimulus. The significance of activation at the level of the voxel was determined using correlation analysis. Significant region of interest (ROI) activation was determined by comparing the percentage of active voxels in each ROI to activation in a control ROI in the visual cortex. In response to tactile and shock stimuli, consistent activation was seen in the postcentral gyrus, parietal operculum, and ipsilateral cerebellar cortex. No significant cortical activation was detected in response to noxious heat or mechanical stimulation when compared to nonpainful intensity levels. The data did not indicate adaptation, although further study in this area is necessary. Stationary noxious thermal and mechanical stimulation are "pure" noxious stimuli, while electrical stimulation influenced nociceptive and nonnociceptive receptors. Lack of detectable activation in response to pure noxious stimuli supports the idea that nociceptive and nonnociceptive fibers are interspersed in the somatosensory cortex. Conflicting results from recent functional imaging studies of pain perception regarding cortical activation indicate that it is essential to consider both the tactile and nociceptive components of the stimuli used, the spatial extent of stimulation, and the possibility of adaptation to the response. Furthermore, these results suggest that subtractive or correlative methods may not be sufficiently sensitive to image the activity of nociceptive cells, which are sparsely distributed throughout the somatosensory cortex.

Superficial dorsal horn neurons identified by intracutaneous histamine: chemonociceptive responses and modulation by morphine

We have investigated whether neurons in superficial laminae of the spinal dorsal horn respond to intracutaneous (ic) delivery of histamine and other irritant chemicals, and thus might be involved in signaling sensations of itch or chemogenic pain. Single-unit recordings were made from superficial lumbar dorsal horn neurons in pentobarbital sodium-anesthetized rats. Chemoresponsive units were identified using ic microinjection of histamine (3%, 1 microl) into the hindpaw as a search stimulus. All superficial units so identified [9 nociceptive-specific (NS), 26 wide-dynamic-range (WDR)] responded to subsequent ic histamine. A comparison group of histamine-responsive deep dorsal horn neurons (n = 16) was similarly identified. The mean histamine-evoked discharge decayed to 50% of the maximal rate significantly more slowly for the superficial (92.2 s +/- 65.5, mean +/- SD) compared with deep dorsal horn neurons (28. 2 s +/- 11.6). In addition to responding to histamine, most superficial dorsal horn neurons were also excited by ic nicotine (22/25 units), capsaicin (21/22), topical mustard oil (5/6), noxious heat (26/30), and noxious and/or innocuous mechanical stimuli (except for 1 unit that did not have a mechanosensitive receptive field). Application of a brief noxious heat stimulus during the response to ic histamine evoked an additive response in all but two cases, followed by transient depression of firing in 11/20 units. Intrathecal (IT) administration of morphine had mixed effects on superficial dorsal horn neuronal responses to ic histamine and noxious heat. Low morphine concentrations (100 nM to 1 microM) facilitated histamine-evoked responses (to >130% of control) in 9/24 units, depressed the responses (by >70%) in 11/24, and had no effect in 4. Naloxone reversed morphine-induced effects in some but not all cases. A higher morphine concentration (10 microM) had a largely depressant, naloxone-reversible effect on histamine responses. Responses of the same superficial neurons to noxious heat were facilitated (15/25), reduced (8/25), or unaffected (2/25) by low morphine concentrations and were depressed by the higher morphine concentration. In contrast, deep dorsal horn neuronal responses to both histamine and noxious heat were primarily depressed by low concentrations of morphine in a naloxone-reversible manner. These results indicate that superficial dorsal horn neurons respond to both pruritic and algesic chemical stimuli and thus might participate in transmitting sensations of itch and/or chemogenic pain. The facilitation of superficial neuronal responses to histamine by low concentrations of morphine, coupled with inhibition of deep dorsal horn neurons, might underlie the development of pruritus that is often observed after epidural morphine.

Psychophysical and neurobiological evidence that the oral sensation elicited by carbonated water is of chemogenic origin

The sensation produced by carbonated beverages has been attributed to chemical excitation of nociceptors in the oral cavity via the conversion of CO(2) to carbonic acid in a reaction catalyzed by carbonic anhydrase. In separate studies, we tested if the carbonic anyhdrase blocker, acetazolamide, reduced either the intensity of sensation in humans or c-fos expression by trigeminal neurons in rats, evoked by application of carbonated water to the tongue. In the psychophysical experiment, one-half of the dorsal tongue was pretreated with acetazolamide (1 or 2%), after which the tongue was exposed bilaterally to carbonated water. In a two-alternative forced-choice paradigm, subjects chose which side of the tongue yielded a stronger sensation and additionally rated the magnitude of sensation on each side. Pretreatment with acetazolamide reduced the magnitude of sensation elicited by carbonated water in a concentration-dependent manner, since a significant majority of subjects chose the untreated side of the tongue as having a stronger sensation and assigned significantly higher intensity ratings to that side. Acetazolamide did not affect the irritant sensation from citric acid, while capsaicin pretreatment reduced both the sensation elicited by carbonated water and the irritation induced by citric acid application. In a separate experiment using rats, delivery of carbonated water to the tongue significantly increased the number of cells expressing c-fos-like immunoreactivity in the dorsomedial trigeminal nucleus caudalis (versus saline controls); this was significantly reduced by pretreatment with acetazolamide. Our results support the hypothesis that carbonated water activates lingual nociceptors via conversion of CO(2) to carbonic acid; the nociceptors in turn excite trigeminal neurons involved in signaling oral irritation.

Role of neuronal nicotinic-acetylcholine receptors in the activation of neurons in trigeminal subnucleus caudalis by nicotine delivered to the oral mucosa

To characterize the role of neuronal nicotinic acetylcholine receptors (nAChRs) in oral irritation and pain, we employed the method of c-fos immunohistochemistry to map the locations and numbers of brainstem neurons that express the immediate-early gene, c-fos, after application of nicotine to the tongue, either alone or after pretreatment with cholinergic antagonists. Groups of anesthetized rats received the following chemicals delivered bilaterally to the dorsal tongue: (1) 0.9% NaCl followed by nicotine (1%, 61 mM), (2) the nAChR antagonist, mecamylamine 0.1% (= 4.9 mM) followed by nicotine, (3) the muscarinic antagonist atropine (0.1% 1.46 mM) followed by nicotine, (4) atropine (1%, 14.6 mM) followed by nicotine, (5) 0.9% NaCl as a control, and (6) unstimulated controls. Two hours later, animals were perfused with phosphate-buffered saline followed by 4% paraformaldehyde through the aorta. Post-fixed brainstems were cut in 50-micron frozen sections and immunohistochemically processed for fos-like immunoreactivity (FLI). Following application of nicotine, there were significant increases in FLI compared with saline-treated controls in dorsomedial and ventrolateral aspects of the trigeminal caudalis. Pretreatment with either mecamylamine or the high (1%) concentration of atropine significantly reduced nicotine-evoked FLI in these areas, while pretreatment with the low (0.1%) atropine concentration did not significantly affect FLI. These results are consistent with the idea that nicotine activates nAChRs residing on lingual nociceptive fibers, which, in turn, excite neurons in trigeminal caudalis.

Risks of funipuncture in fetuses with single umbilical arteries

OBJECTIVE

To estimate procedure-related risks of funipuncture in fetuses with single umbilical arteries (UAs).

METHODS

We identified fetuses that had blood samples collected by funipuncture and in which single UAs were detected, prenatally or postnatally. We also recorded maternal demographics, prenatal sonographic findings, gestational age at the time of the procedure, procedure-related complications, and perinatal outcomes.

RESULTS

Over 2 years, 14 fetuses identified as having single UAs had funipuncture for prenatal karyotyping at a median gestational age of 29 weeks (range 20-34 weeks). Each had additional abnormal prenatal sonographic findings. The approach to the cord was transplacental in six cases and transamniotic in eight. There were no failed procedures, and 13 of 14 funipunctures were successful on the first attempt. Three fetuses (21%) had complications (bradycardia in two cases and bleeding in one case), a complication rate not greater than that reported in large series of fetuses that had fetal blood sampling. All three complications were associated with the transamniotic approach. There were no procedure-related pregnancy losses within 2 weeks of the procedure in this series.

CONCLUSION

Funipuncture does not seem to be associated with increased risk of procedure-related complications or pregnancy losses in fetuses with single UAs, although the risk could be greater with transamniotic than with transplacental sampling.

Propofol directly depresses lumbar dorsal horn neuronal responses to noxious stimulation in goats

PURPOSE

We tested the hypothesis that propofol, acting in the brain, would either enhance, or have no effect, on lumbar dorsal horn neuronal responses to a noxious mechanical stimulus applied to the hindlimb. We recorded the response of lumbar dorsal horn neurons during differential delivery of propofol to the brain and torso of goats.

METHODS

Goats were anesthetized with isoflurane and neck dissections performed which permitted cranial bypass. A laminectomy was made to allow microelectrode recording of lumbar dorsal horn neuronal activity. Isoflurane was maintained at 0.8+/-0.1% to both head and torso throughout the study. During cranial bypass propofol was separately administered to the torso (1 mg x kg(-1), n = 7; 3.75 mg x kg(-1), n = 8) or cranial (0.04 mg x kg(-1), n = 7; 0.14 mg kg(-1), n = 8) circulations.

RESULTS

Propofol administered to the torso depressed dorsal horn neuronal responses to noxious stimulation: low dose: 500+/-243 to 174+/-240 impulses x min(-1) at one minute post-injection, P<0.001; high dose: 478+/-204 to 91+/-138 impulses x min(-1) at one minute post-injection, P<0.05). Propofol administered to the cranial circulation had no effect: low dose: 315+/-150 to 410+/-272 impulses x min(-1), P>0.05; high dose: 462+/-261 to 371+/-196 impulses x min(-1), P>0.05.

CONCLUSIONS

These data indicate that propofol has a direct depressant effect on dorsal horn neuronal responses to noxious stimulation, with little or no indirect supraspinal effect.

Isoflurane action in the spinal cord blunts electroencephalographic and thalamic-reticular formation responses to noxious stimulation in goats

BACKGROUND

Isoflurane depresses the electroencephalographic (EEG) activity and exerts part of its anesthetic effect in the spinal cord. The authors hypothesized that isoflurane would indirectly depress the EEG and subcortical response to noxious stimulation in part by a spinal cord action.

METHODS

Depth electrodes were inserted into the midbrain reticular formation (MRF) and thalamus of six of seven isoflurane-anesthetized goats, and needle-electrodes were placed into the skull periosteum. In five of seven goats, an MRF microelectrode recorded single-unit activity. The jugular veins and carotid arteries were isolated to permit cranial bypass and differential isoflurane delivery. A noxious mechanical stimulus (1 min) was applied to a forelimb dewclaw at each of two cranial-torso isoflurane combinations: 1.1+/-0.3%-1.2+/-0.3% and 1.1+/-0.3-0.3+/-0.1% (mean +/- SD).

RESULTS

When cranial-torso isoflurane was 1.1-1.2%, the noxious stimulus did not alter the EEG. When torso isoflurane was decreased to 0.3%, the noxious stimulus activated the MRF, thalamic, and bifrontal-hemispheric regions (decreased high-amplitude, low-frequency power). For all channels combined, total (-33+/-15%), delta(-51+/-22%), theta (-33+/-19%), and alpha (-26+/-16%) power decreased after the noxious stimulus (P<0.05); beta power was unchanged. The MRF unit responses to the noxious stimulus were significantly higher when the spinal cord isoflurane concentration was 0.3% (1,286+/-1,317 impulses/min) as compared with 1.2% (489+/-437 impulses/min, P<0.05).

CONCLUSIONS

Isoflurane blunted the EEG and MRF-thalamic response to noxious stimulation in part via an action in the spinal cord.

Activation of spinal wide dynamic range neurons by intracutaneous microinjection of nicotine

Nicotine evokes pain in the skin and oral mucosa and excites a subpopulation of cutaneous nociceptors, but little is known about the central transmission of chemogenic pain. We have investigated the responses of lumbar spinal wide dynamic range (WDR)-type dorsal horn neurons to intracutaneous (ic) microinjection of nicotine in pentobarbital-anesthetized rats. Nearly all (97%) units responded to nicotine microinjected ic (1 microl) into the low-threshold region of the hind-paw mechanosensitive receptive field in a concentration-related manner (0.01-10%). Responses to repeated injections of 10% nicotine exhibited tachyphylaxis at 5-, 10-, and 15-min interstimulus intervals. Significant tachyphylaxis was not seen with 1% nicotine. All nicotine-responsive units tested (n = 30) also responded to ic histamine (1 microl, 3%) and did not exhibit tachyphylaxis to repeated histamine. However, there was significant cross-tachyphylaxis of nicotine to histamine. Thus 5 min after ic nicotine, histamine-evoked responses were attenuated significantly compared with the initial histamine-evoked response prior to nicotine, with partial recovery over the ensuing 15 min. Neuronal excitation by ic nicotine was not mediated by histamine H1 receptors because ic injection of the H1 receptor antagonist, cetirizine, had no effect on ic nicotine-evoked responses, whereas it significantly attenuated ic histamine-evoked responses in the same neurons. The lowest-threshold portion of cutaneous receptive fields showed a significant expansion in area at 20 min after ic nicotine 10%, indicative of sensitization. Responses to 1% nicotine were significantly reduced after ic injection of the nicotinic antagonist, mecamylamine (0.1% ic), with no recovery over the ensuing 40-60 min. These data indicate that nicotine ic excites spinal WDR neurons, partly via neuronal nicotinic acetylcholine receptors that are presumably expressed in cutaneous nociceptor terminals. Repeated injections of high concentrations of nicotine led to tachyphylaxis and cross-tachyphylaxis with histamine, possibly relevant to peripheral analgesic effects of nicotine.

Isoflurane blunts electroencephalographic and thalamic-reticular formation responses to noxious stimulation in goats

BACKGROUND

Anesthetics, including isoflurane, depress the electroencephalogram (EEG). Little is known about the quantitative effects of isoflurane on EEG and subcortical electrical activity responses to noxious stimulation. The authors hypothesized that isoflurane would depress the results of EEG and subcortical response to noxious stimulation at concentrations less than those needed to suppress movement. Furthermore, determination of regional differences might aid in elucidation of sites of anesthetic action.

METHODS

Ten goats were anesthetized with isoflurane, and minimum alveolar concentration (MAC) was determined using a noxious mechanical stimulus. Depth electrodes were inserted into the midbrain reticular formation and thalamus. Needle electrodes placed in the skull periosteum measured bifrontal and bihemispheric EEG. The noxious stimulus was applied at each of four anesthetic concentrations: 0.6, 0.9, 1.1, and 1.4 MAC.

RESULTS

At an isoflurane concentration of 0.6 MAC, the noxious stimulus activated the midbrain reticular formation, thalamic, and bifrontal-hemispheric regions, as shown by decreased high-amplitude, low-frequency power. For all channels combined (mean +/- SD), total (-33+/-7%), delta (-47+/-12%), theta (-23+/-12%), and alpha (-21+/-6%) power decreased after the noxious stimulus (P < 0.001); beta power was unchanged. At 0.9 MAC, total (-35+/-5%), delta (-42+/-7%), theta (-35+/-8%), and alpha (-23+/-11%) power decreased after the noxious stimulus (P < 0.001); beta power was unchanged. At 1.1 MAC only one site, and at 1.4 MAC, no site, had decreased power after the noxious stimulus.

CONCLUSIONS

Isoflurane blunted EEG and midbrain reticular formation-thalamus activation response to noxious stimulation at concentrations (1.1 MAC or greater) necessary to prevent movement that occurred after noxious stimulation. It is unknown whether this is a direct effect or an indirect effect via action in the spinal cord.

Accuracy of the haemoglobin alkaline denaturation test for detecting maternal blood contamination of fetal blood samples for prenatal karyotyping

The haemoglobin alkaline denaturation test was routinely performed in 183 fetal blood samples obtained by cordocentesis for prenatal karyotyping by adding 0.1 ml of the blood into a glass test tube containing 5 ml of water and 0.3 ml of 10 per cent KOH as the alkali reagent. The mixture was agitated gently and read at 2 minutes, at which time it was interpreted as a pure fetal blood sample or contaminated with maternal blood according to the change in colour. In order to determine the accuracy of this test to detect maternal blood contamination, the results were compared with the number of fetal and maternal cells detected by standard cytogenetic techniques in those blood samples obtained from male fetuses (n=97). Among these samples, the haemoglobin alkaline denaturation test gave an adult haemoglobin reaction in two cases (2.1 per cent); both samples showed different degrees of maternal 46,XX cells in the metaphases examined (29 of 30 cells in one case and 2 of 31 cells in the other). Conversely, of the 95 samples which gave a fetal haemoglobin reaction, the cytogenetic analysis did not reveal any maternal cells in the metaphases analysed (median 30 cells, range 20-65). We concluded that the haemoglobin alkaline denaturation test is an accurate method for excluding clinically significant maternal blood contamination of fetal blood samples obtained for prenatal karyotyping. This simple, inexpensive technique provides immediate information and, therefore, can be safely incorporated as a bedside test for analysis during fetal blood sampling procedures.

Outbreak of Erwinia carotovora on Zantedischia spp. in South Africa

In South Africa, summer-flowering Arum lilies are grown for the tuber, potted plant, and cut flower markets. In 1998, an outbreak of soft rot was detected on Zantedischia oculata cv. Black Magic and Z. elliottiana plants from several nurseries. Crop losses of up to 25% were incurred. The initial symptom was wilting of leaves. When plants were lifted from the soil, soft rot of the tuber was found. Tuber rot usually developed on one side, and plants developing from affected tubers wilted and died. No discoloration of leaf or tuber tissues was found. Isolations from diseased tissues consistently yielded bacterial colonies that were translucent, white, and glistening and that had entire margins on nutrient agar. Ten representative isolates were chosen for further characterization. Erwinia carotovora subsp. carotovora strain B56 was included as a reference strain. All isolates were gram-negative rods, oxidase and arginine dihydrolase negative, catalase positive, and facultatively anaerobic. They degraded pectate and rotted potato slices but did not hydrolyze starch. All isolates fermented glucose, reduced nitrates to nitrites, and grew at a maximum temperature of 37°C. Isolates produced acids from D(+)-glucose, D(+)-cellobiose, melibiose, amygdalin, L(+)-arabinose, D-mannitol, L(+)-rhamnose, sucrose, ribose, D(-)xylose, and D(-)glucose but not from D-arabinose, D-sorbitol, or maltose. Isolates liquefied gelatin and used citrate, arbutine, esculin, salicin, and cellobiose as the sole carbon source. Pathogenicity to Zantedischia spp. was tested by injection of tubers with an inoculum suspension containing 10⁸ CFU/ml. Control plants were inoculated with sterile distilled water. Inoculated plants were kept in a greenhouse at 24°C. Symptoms developed 2 days after inoculation with the pathogen and appeared to be identical to those observed on diseased material in nurseries. Control plants did not rot. The bacterium was readily reisolated from diseased plants, confirmed to be the inoculated pathogen, and identified as E. carotovora, based on morphological, biochemical, and physiological characteristics and pathogenicity. E. aroideae has been reported to cause soft rot of rhizomes of winter-flowering Arum lilies (Z. aethiopica) in South Africa (1). However, this is the first report of soft rot caused by E. carotovora subsp. carotovora on tubers of Z. oculata and Z. elliottiana plants in South Africa. Reference: (1) V. Wager. 1970. Flower Garden Diseases and Pests. Purnell, Cape Town, South Africa.

Quantitative and qualitative effects of isoflurane on movement occurring after noxious stimulation

BACKGROUND

Anesthetic potency is assessed by determination of the anesthetic concentration that prevents gross, purposeful movement in response to noxious stimulation. It is unclear whether anesthetics cause a progressive decrease in the number and force of limb movements evoked by noxious stimulation, or a step decrease (consistent with an all-or-none effect at the site of action). The authors hypothesized that isoflurane and halothane would progressively depress the movement response.

METHODS

Isoflurane minimum alveolar concentration (MAC) was determined in rats (N = 14) using a clamp applied to a hind paw. Lateral head movements and flexions of the forelimbs and hindlimbs were measured with force transducers. Isoflurane was adjusted to 0.6, 0.9, 1.1, and 1.4 MAC, the noxious stimulus applied, and the force and number of limb and head movements determined. Force and movement determinations were made in seven additional halothane-anesthetized rats.

RESULTS

Isoflurane MAC was 1.3 +/- 0.1%. In general, if movement occurred after application of the noxious clamp, the head and all limbs were involved. At 0.6 MAC, the median number of extremity and head movements was 3.5 (10th-90th percentile, 2.0-11.4) with force generated per movement (force/movement) = 6.4 (2.0-13.2) N-s. Movement number decreased to 2.1 (0.25-4.2) at 0.9 MAC (P < 0.05), but force/movement was unchanged at 4.5 (0.4-15.1) N-s (Newton-second). At 1.1 MAC, movement number and force/movement decreased to 0.2 (0.0-1.5) and 0.1 (0.0-3.2) N-s, respectively (P < 0.005). No significant movement occurred at 1.4 MAC. The halothane-anesthetized rats had similar findings, although at 0.6 MAC they generated more movements (10.5 [5.2-19.8]) than the rats receiving isoflurane (P < 0.05).

CONCLUSIONS

The results indicate that increasing anesthetic concentration from 0.6 to 0.9 MAC had little effect on the motor system controlling the force of limb movements, and the neural system generating repeated limb movements was depressed, consistent with a differential anesthetic effect at separate sites.

Neurobiological and psychophysical mechanisms underlying the oral sensation produced by carbonated water

Carbonated drinks elicit a sensation that is highly sought after, yet the underlying neural mechanisms are ill-defined. We hypothesize that CO(2) is converted via carbonic anhydrase into carbonic acid, which excites lingual nociceptors that project to the trigeminal nuclei. We investigated this hypothesis using three methodological approaches. Electrophysiological methods were used to record responses of single units located in superficial laminae of the dorsomedial aspect of trigeminal subnucleus caudalis (Vc) evoked by lingual application of carbonated water in anesthetized rats. After pretreatment of the tongue with the carbonic anhydrase inhibitor dorzolamide, neuronal responses to carbonated water were significantly attenuated, followed by recovery. Using c-Fos immunohistochemistry, we investigated the distribution of brainstem neurons activated by intraoral carbonated water. Fos-like immunoreactivity (FLI) was significantly higher in the superficial laminae of dorsomedial and ventrolateral Vc in animals treated with carbonated water versus controls. Dorzolamide pretreatment significantly reduced FLI in dorsomedial Vc. We also examined the sensation elicited by carbonated water in human psychophysical studies. When one side of the tongue was pretreated with dorzolamide, followed by bilateral application of carbonated water, a significant majority of subjects chose the untreated side as having a stronger sensation and assigned significantly higher intensity ratings to that side. Dorzolamide did not reduce irritation elicited by pentanoic acid. The present data support the hypothesis that carbonated water excites lingual nociceptors via a carbonic anhydrase-dependent process, in turn exciting neurons in Vc that are presumably involved in signaling oral irritant sensations.

First Report of Crown Gall, Caused by Agrobacterium tumefaciens on Geraldton Wax (Chamelaucium uncinatum) in South Africa

Geraldton wax (Chamelaucium uncinatum, family Myrtaceae) plants are grown as cutflowers for the export market in South Africa. In July 1998, gall-like structures were observed on collars and roots of Geraldton wax plants in commercial fields in Wellington. The galls were observed after plants exhibited poor growth. The galls varied in size and in texture from soft and spongy to hard. Secondary symptoms involved poor root development and browning of stem tissues near galls. Isolations from the galls yielded nearly pure cultures of a Gram negative, rod-shaped bacterium on Roy Sauer medium (2), typical of an Agrobacterium sp. Carbon source utilization testing with the Biolog GN Bacterial Identification System (version 3.50) confirmed the bacterium as a biovar of A. tumefaciens with a similarity of 0.88. Pathogenicity was confirmed by injecting 4- to 6-week old tomato and tobacco plants and 1-year-old Geraldton wax plants with approximately 5 μl of the bacterial suspension (10⁸ CFU/ml) in sterile, distilled water. Inoculated plants were then transferred to a greenhouse at 25°C. Galls developed 1 month after inoculation. The bacterium was readily reisolated from the inoculated plants. A. tumefaciens is endemic to South Africa and has a very wide host range that includes several ornamentals (1). This is the first report of A. tumefaciens on Geraldton wax plants in South Africa. References: (1) J. F. Bradbury. 1986. Guide to Plant Pathogenic Bacteria. CAB Int., Slough, U.K. (2) N. W. Schaad. 1988. Laboratory Guide for Identification of Plant Pathogenic Bacteria. The American Phytopathological Society, St. Paul, MN.

Oral irritant properties of piperine and nicotine: psychophysical evidence for asymmetrical desensitization effects

Using a bipolar rating scale, human subjects rated the intensity of irritation sensation evoked by repeated application of piperine (75 p.p.m.) or nicotine (0.12%) to one side of the dorsal surface of the tongue. The intensity of irritation elicited by repeated application of piperine significantly increased, while irritation elicited by repeated nicotine significantly decreased. We additionally tested if nicotine or piperine desensitized the tongue. After either piperine or nicotine was repeatedly applied to one side of the tongue, a 5 or 10 min rest period ensued, followed by re-application of piperine or nicotine to both sides of the tongue. Subjects were asked to choose which side of the tongue gave rise to a stronger irritation in a two-alternative forced choice (2-AFC) paradigm. In addition, they gave separate ratings of the intensity of irritation on the two sides of the tongue. When piperine was applied bilaterally after unilateral pretreatment with piperine and a 10 min rest period, subjects consistently chose the non-pretreated side to yield stronger irritation and assigned significantly higher ratings to that side, indicative of piperine self-desensitization. A similar self-desensitization effect was found when bilateral application of nicotine followed unilateral treatment with nicotine and a 5 min rest period. Unilateral treatment with piperine also reduced nicotine-evoked irritation on the pretreated side (cross-desensitization), but treatment with nicotine did not affect piperine-evoked irritation. This asymmetrical cross-desensitization pattern is similar to that observed between capsaicin and nicotine and constitutes an additional similarity between piperine and capsaicin.

Dopamine reuptake inhibition in the rostral agranular insular cortex produces antinociception

We provide evidence for an antinociceptive effect of dopamine in the rat cerebral cortex that is mediated through descending nociceptive inhibition of spinal neurons. Injection of the dopamine reuptake inhibitor GBR-12935 in the rostral agranular insular cortex (RAIC), a cortical area that receives a dense dopaminergic projection and is involved in descending antinociception (Burkey et al.,1996), resulted in dose-dependent inhibition of formalin-induced nociceptive behavior, without any alteration of motor function. Injection of the dopamine reuptake inhibitor in the surrounding cortical areas had no effect on nociceptive behaviors. GBR-12935 also produced a reduction in noxious stimulus-induced c-fos expression in nociceptive areas of the spinal dorsal horn, suggesting that dopamine in the RAIC acts in part through descending antinociception. Electrophysiological recording from single wide dynamic range-type spinal dorsal horn neurons confirmed the descending nociceptive inhibitory effect. GBR-12935 in the RAIC significantly reduced neuronal responses evoked by noxious thermal stimulation of the skin, an effect that was reversed by local administration of the selective D1 receptor antagonist SCH-23390. Finally, administration of SCH-23390 alone in the RAIC decreased paw withdrawal latencies from noxious heat, suggesting that dopamine acts tonically in the cortex to inhibit nociception.