Effect of Tramadol on Bispectral Index during Intravenous Anaesthesia with Propofol and Remifentanil

The aim of this study was to investigate the effects of tramadol on the Bispectral Index (BIS) during total intravenous propofol-remifentanil anaesthesia. Forty-four adult ASA Physical status I-II patients, scheduled for elective general surgical procedures were included in a prospective observational randomized study. Doses for anaesthetics and opioids were adjusted to keep the BIS value at 50±5. After 20 minutes of stable anaesthesia, the subjects were randomly allocated to receive intravenous saline (control group) or tramadol 1.5 mg/kg (tramadol group). BIS values, mean arterial pressure, and heart rate were recorded every five minutes for 20 minutes. Mean BIS values after tramadol administration were not significantly different from those following saline, throughout the observation period (P>0.05). There were no patients in whom BIS values were more than 60 or who presented explicit recall of events under anaesthesia. There were no significant changes in mean arterial pressure, SpO2, or heart rate (P>0.05). The results indicate that the administration of tramadol during stable total intravenous anaesthesia with propofol-remifentanil does not affect BIS values. The clinical relevance is that tramadol can be safely administered pre- and intraoperatively as pre-emptive or preventive analgesia without modification of the depth of anaesthesia.

Immunossupressant and organ transplantation: immunophilins targeting agent and alternative therapies

Since the first attempt to replace a dysfunctional organ, clinics and scientific had to overcome many setbacks in order to warrant the success and viability of both the organ and the receptor. Despite the improvement of surgical procedures, some grafts fail within the following days or week due to immunologic rejection. Many ongoing researches are still seeking the perfect immunossupresors. Calcineurin targeting agents have been consolidated as a worldwide immnunossupressant therapy, but due to its widely functional role in many cell types, this strategy often represents a highly risk therapy due to side effects observed with these agents. Here we summarized the latest and past knowledge regarding immunossupression therapies, including the promising and widely used Immunophilin-targeting antagonist therapies.

Transcranial Doppler and anesthetics

Transcranial Doppler (TCD) is widely used to investigate the effects of anesthetic drugs on cerebral blood flow. Its repeatability and non-invasivity makes it an ideal, first choice method. Anesthesia providers are required to be conscious of the cerebral hemodynamic effects of drugs given in their practice, especially in neurosurgery and in subjects with impaired brain functions. The purpose of this review is to present the basic concepts of the TCD technique and the effects on cerebral hemodynamics of the most popular anesthetic drugs evaluated using TCD ultrasonography.

Immunopathology of an hDAF transgenic pig model liver xenotransplant into a primate

BACKGROUND

hDAF transgenic pigs do not display the inherent hyperacute rejection reactions of pig-to-primate xenotransplants. The purpose of this study was to determine the immunopathologic phenomena following an hDAF transgenic pig hepatic orthotopic xenotransplant into a baboon.

METHODS

Donor animals were unmodified pigs (n=4) and hDAF transgenic pigs (n=2). Recipient animals were baboons (Papio anubis). Liver biopsies were immunostained using monoclonal antibodies to C3, C5b-9, IgG, IgM, CD2, CD4, CD8, CD68, CD20, Bric 216, CD31, and fibrin, and polyclonal antibody to C4.

RESULTS

hDAF transgenic grafts showed IgG, IgM, and C4 endothelial deposits. However, no fibrin, C3, or C5b9 deposits were observed after reperfusion. hDAF xenografts displayed CD31 staining in the portal spaces, perilobular areas, and at hepatic sinuisoidal levels. The baboon that lived for 4 days displayed either CD4 or CD8 T-cells periportal infiltrate.

CONCLUSIONS

Future studies will seek to determine the physiologic role of CD31 hepatic sinusoidal expression in transgenic xenotransplants, and will also study the role of T-cell infiltrates in xenograft rejection.

Smoking as a risk factor for preinvasive and invasive cervical lesions in female sex workers in Venezuela

OBJECTIVES

To determine whether the number of cigarettes smoked per day and years of smoking were risk factors for preinvasive and invasive cervical lesions in Venezuelan female sex workers.

METHODS

The clinical history of 438 female sex workers (FSWs) was taken and each received a gynecological examination, a Pap smear, and a colposcopic examination. A colposcopically-guided cervical biopsy was taken when the epithelium appeared abnormal.

RESULTS

The FSWs' mean age was 32.16+/-8 years. Age at first sexual intercourse was 15.9+/-2 years, parity was 4.1+/-2.3, live births were 3+/-3, and age at first delivery was 16.6+/-4.7 years. Cervical biopsies were performed in 84 FSWs. Sixty-four of them (76.2%) had preinvasive or invasive lesions and 47 (73.4%) were current smokers (Relative Risk) (RR), 1.26; 95% confidence interval (CI), 1.02-1.55; P<0.03]. FSWs who smoked more than 20 cigarettes per day had an increased RR to get a premalignant or malignant cervical lesion (RR, 1.27; 95% CI, 1.02-1.52; P<0.03). There was no statistically significant difference between FSWs who smoked 20 cigarettes or more per day and FSWs who smoked less than 20 cigarettes per day (RR, 1.36; 95% CI, 0.81-2.29; P<0.25). FSWs who had been smoking for 5 years or more were at risk to develop preinvasive or invasive cervical lesions (RR, 1.37; 95% CI, 1.01-1.86; P<0.04).

CONCLUSIONS

The risk for FSWs to develop preinvasive or invasive cervical lesions increased with the number of cigarettes they smoked per day and their years of smoking.

Cyto-colpo-histological Study in Sexual Workers

OBJECTIVE

To determine the false-negative, false-positive, sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) rates of Pap smears and colposcopy in sexual workers.

MATERIALS AND METHODS

Four hundred thirty-eight prostitutes were given a gynecological examination, Pap smear, and colposcopic examination of the cervix. A cervical biopsy was taken under colposcopic guidance when there was abnormal epithelium.

RESULTS

There were 81 premalignant and malignant lesions. Twenty-two Pap smear reports were abnormal: 17 CIN1, four CIN2, and one CIN3. Pap smears had a 14.4% false-negative rate, 0.9% false-positive rate, sensitivity 22.2%, specificity 98.8%, NPV 84.4%, and PPV 81.8%. Eighty-four biopsies were taken from abnormal colposcopic findings, and 96.4% were reported as premalignant and malignant lesions. Colposcopy had a 0.8% false-positive rate, sensitivity 100%, specificity 99.2%, NPV 100%, and PPV 96.4%.

CONCLUSIONS

Pap smear had a low-sensitivity and colposcopy had a high sensitivity and specificity.

Sonographic evaluation of local recurrences of soft tissue sarcomas

The aim of our study was to establish whether ultrasonography can be proposed as the main diagnostic technique for the follow-up of soft tissue sarcoma (STS). In 26 patients with previous history of STS, a sonographic examination was carried out using a 5 MHz linear transducer to identify early local recurrences. Sonography was performed every 3 months and a computed tomographic (CT) control was made when the sonogram showed findings strongly suggestive of recurrence. STS recurrences were detected by sonography in 20 of 26 patients (77%) and were confirmed by histologic examination. In six cases, sonographic results were uncertain and in three of these the recurrence was ascertained by biopsy. CT scan provided a correct diagnosis in 16 patients (61.5%) and only in cases with lesions greater than 5 cm in diameter. From our experience we conclude that high frequency sonography is a most accurate noninvasive approach in early detection of STS recurrences. CT plays an important role in the cases amenable to surgery treatment and is recommended to obtain a better assessment of anatomic connection between tumor and adjacent structures.

[Changes in feeding behavior in anorexic individuals. Description of 2 clinical cases]

The change in the eating behaviour of anorexic individuals has been studied with particular attention to the case of two biovular heterozygotic twins. It is observed that dietetic treatment backed by careful psychiatric therapy is a decisive factor in the resolution of the pathology.

[Type I diabetes mellitus and autoimmunity. Description of 9 clinical cases]

Diabetes mellitus type I can ben divided into two forms, IA and IB, with partially different clinical and pathogenetic characteristics. The present paper looks at type I diabetic patients presenting associated pathologies of autoimmune type, largely involving the endocrine system.

[Hypoglycemia caused by partial deficiency of growth hormone. Description of a clinical case]

A clinical case of a female patient suffering from recurrent, especially nighttime, attacks of hypoglycaemia is reported. Clinical tests found these to be the consequence of partial hypophyseal deficiency of growth hormone.

[Preliminary experience in health education in a group of 52 diabetic patients]

The results of a study carried out in a random sample of patients who had filled out a questionnaire of selected questions are reported. The questionnaire was re-presented after a cycle of health education and the replies compared so as to assess specific learning.

Effects of tamoxifen, estradiol benzoate and medroxyprogesterone acetate on the growth of DMBA-induced rat mammary carcinoma

The potential synergism of sequential combinations of tamoxifen (TMX) or estradiol benzoate (E2B) with medroxyprogesterone acetate (MPA) in inhibiting the growth of 7.12-dimethylbenz(a)anthracene(DMBA) - induced rat mammary tumors has been investigated. In addition, the effect of TMX and E2B on estrogen and progesterone receptors' (ERs and PgRs) synthesis has been evaluated in the attempt to elucidate possible mechanisms involved. Previous treatment both with TMX and E2B has been shown to strongly enhance the antitumor activity of MPA. A priming on PgR synthesis has been observed only after E2B administration, TMX producing a sharp decrease in PgR levels. It is concluded that, while the priming action exerted by E2B on PgRs might explain the potentiating effect shown by E2B on MPA activity, the synergism observed between TMX and MPA should be explained on an extrareceptorial basis, an induction on PgR synthesis by TMX not being evident at the dosage and priming time employed in this study.