Evaluation of the Roche MagNA Pure 96 nucleic acid extraction platform for the Seegene Anyplex II HPV28 detection assay.

AIM: Validate the Roche, MagNAPure96 (MP96) nucleic acid extraction platform for Seegene Anyplex II HPV28 (Anyplex28) detection of Human Papillomavirus. METHODS AND RESULTS: Comparisons were made for Anyplex28 genotyping from 115 cervical samples extracted on the Hamilton, STARlet and the MP96. Two DNA concentrations were used for the MP96, one matched for sample input to the STARlet and another 5× concentration (laboratory standard). Agreement of HPV detection was 89·8% (κ = 0·798; P = 0·007), with HPV detected in 10 more samples for the MP96. There was a high concordance of detection for any oncogenic HPV genotype (κ = 0·77; P = 0·007) and for any low-risk HPV genotype (κ = 0·85; P = 0·008). DNA extracted at laboratory standard had a lower overall agreement 85·2% (κ = 0·708; P < 0·001), with 17/115 discordant positive samples that tested negative after STARlet extraction. Of the discordant genotypes, 72·7% were detected in the lowest signal range for Anyplex28 ('+'). CONCLUSIONS: MP96 performed with high concordance to STARlet, although produced DNA with a higher analytical sensitivity on the Anyplex28. SIGNIFICANCE AND IMPACT OF THE STUDY: This analysis supports the use of samples extracted on the MP96 for HPV genotyping using the Anyplex28. Furthermore, an increase in DNA concentration increased analytical sensitivity of the Anyplex28, particularly appropriate for prevalence studies.

Comparison of pancuronium and vecuronium for fetal neuromuscular blockade during invasive procedures.

Neuromuscular blocking agents, used to arrest fetal motion for invasive intrauterine procedures, may cause temporary fetal heart rate changes. After 21 invasive procedures using either pancuronium bromide or vecuronium bromide, post-procedure fetal heart rate tracings were retrospectively compared. Pancuronium was associated with an increased fetal heart rate and decreased beat-to-beat variability for 2.5 hours after its use, whereas vecuronium caused no fetal heart rate changes. Vecuronium bromide offers advantages over pancuronium, because the decreased effect on the fetal heart allows better assessment of fetal well-being immediately following invasive intrauterine procedures.

Symptomatic salicylate ototoxicity: a useful indicator of serum salicylate concentration?

A three phase study was designed to define further the sensitivity and specificity of symptomatic salicylate ototoxicity (primarily tinnitus) for serum salicylate concentrations. In phase one 260 patients with osteoarthritis and 112 with rheumatoid arthritis, none taking salicylates, were interviewed about their ear symptoms. Their responses were not significantly different from those of 134 salicylate treated patients with rheumatoid arthritis previously reported. In the second phase 56 patients who were taking salicylates, and who volunteered the complaint of tinnitus, had serum salicylate concentrations measured while symptomatic, and 30 (54%) had concentrations less than 1.3 mmol/l. Few tolerated an upward salicylate dose adjustment. For phase three, 94 patients were found to have a salicylate concentration above 2.2 mmol/l on one or more occasion, and these subjects were interviewed. Fifty two patients (55%) had no tinnitus, and tinnitus correlated with the blood salicylate concentration in only 28 (30%). Audiological evaluation of most of the symptomatic patients was carried out, and results were abnormal in the majority, even in those patients not reporting tinnitus. Symptomatic salicylate ototoxicity is too nonspecific and too insensitive to be a useful indicator of serum salicylate concentration.

Effect of injection rate on level and duration of hypobaric spinal anesthesia.

The purpose of this study was to determine whether injection rate affects the spread of hypobaric spinal anesthesia. Hypobaric spinal anesthesia was performed on 20 patients for total hip arthroplasty. Dural puncture was performed with a 22-gauge Whitacre needle. All patients received 10 mg of hypobaric tetracaine with epinephrine. An electrically driven syringe pump was used to inject the anesthetic solution at either slow (250 sec) or fast (10 sec) rates. Ten patients received slow injections, and 10 received fast injections. Anesthetic levels, duration of anesthesia, and specific gravities of injectate and CSF were measured. Slow injection resulted in less spread of spinal anesthesia. Four-segment regression of anesthetic levels took significantly longer in the slow injection group. Local anesthetic mixtures used were consistently hypobaric compared to patient CSF. We conclude that slow injection of hypobaric tetracaine through a 22-gauge Whitacre needle produces lower levels of spinal anesthesia that tend to be of longer duration than levels resulting from fast injection.

Plasma glucose concentrations during liver transplantation.

We reviewed the intraoperative plasma glucose concentrations in 100 consecutive patients who underwent orthotopic liver transplantation. The plasma glucose concentration increased significantly (P less than 0.05) from 110 +/- 46 mg/dl (mean +/- SD) to 204 +/- 60 mg/dl during the preanhepatic phase of transplantation (phase I). No significant change in plasma glucose concentrations occurred during the anhepatic phase (phase II). During the reperfusion phase (phase III), the mean plasma glucose concentration increased significantly (P less than 0.05) from 201 +/- 56 mg/dl to 384 +/- 72 mg/dl. The only glucose administered was that contained in the blood products. No correlation was found between the amount of glucose administered with the blood products and the changes in plasma glucose concentrations in these patients. None of the patients became hypoglycemic during any phase of the transplant procedure. All patients demonstrated a tendency toward hyperglycemia.

Steroid celiac plexus block for chronic pancreatitis: results in 16 cases.

Sixteen cases in which celiac plexus block with depot steroid was used to treat chronic pancreatitis pain were reviewed. Only 4 of 16 patients reported pain relief with the procedure. Of the 12 patients who did not obtain relief, narcotic dependence was present in 11 of 12. No patients in the "relief" group were narcotic dependent. Prior pancreatic surgery was present in 9 of the 12 patients without relief and in 1 of 4 patients with relief. It is postulated that refractory chronic pancreatitis pain may be an extreme form of what has been termed "abnormal illness behavior." Furthermore, these results underscore the poor results experienced using neural blockade for the relief of chronic pain when narcotic dependence is present.

The effects of age, epinephrine, and operative site on duration of caudal analgesia in pediatric patients.

The effects of age, operative site (penoscrotal or inguinal), and the addition of epinephrine 1:200,000 to bupivacaine on duration of postoperative analgesia after caudal block were prospectively and blindly evaluated in 341 children aged 13 months to 17 yrs. At the conclusion of the surgical procedures under halothane/N2O/O2 anesthetics (n = 419), caudal blocks were performed with 0.5 ml/kg of either 0.25% bupivacaine or 0.25% bupivacaine with 1:200,000 epinephrine injected at a rate of 0.5 ml/sec. The duration of analgesia was noted by parents or nurses who had been instructed how to identify, in a standard manner, the onset of postoperative pain. The mean duration of analgesia was significantly longer in young children (P less than 0.001), in children having penoscrotal operations (P less than 0.001), and when epinephrine was added to bupivacaine (P less than 0.001). There were no major complications. The authors conclude that duration of analgesia is significantly influenced by age, operative site, and the addition of epinephrine 1:200,000 to bupivacaine.

Human liver and conjugation of catecholamines.

To investigate the role of the liver in conjugation of catecholamines we measured the concentrations of free and conjugated norepinephrine, epinephrine, and dopamine in plasma of patients with severe liver disease who were undergoing liver transplantation. Comparisons were made with catecholamine levels in plasma of euhepatic patients who were undergoing abdominal aortic aneurysmectomy. We were also able to determine the importance of the liver in conjugation of exogenous dopamine because this compound was given to both groups of patients. The concentrations of conjugated amines were within the normal range in the patients undergoing liver transplantation, and administered dopamine was conjugated to a similar extent in the two groups of patients. The data suggest that the liver is not indispensable for the conjugation of circulating catecholamines.

Cardiorespiratory effects and kinetics of intrathecally injected D-Ala2-D-Leu5-enkephalin and morphine in unanesthetized dogs.

In unanesthetized dogs prepared with chronic tracheostomies and chronically implanted intrathecal (IT) catheters having openings in the cisterna magna and lumbar region, lumbar IT injection of D-Ala2-D-Leu5-enkephalin (DADL, 1-10 mg) and morphine (3-30 mg) produced a dose-dependent depression of the slope of the CO2 response function (minute expired volume [VE] vs. end-tidal [ET] CO2) as investigated by a modified Read rebreathing technique. The maximum depression occurred less than 3 h after IT injection of either agent and lasted as long as 12 h. The depression was totally reversed by naloxone (0.4 mg/kg, iv). Naloxone alone had no effect on ventilatory function. After 10 mg DADL, there was no significant change in heart rate (HR), mean arterial pressure (MAP), mean pulmonary artery pressure (MPAP), cardiac output (CO), systemic vascular resistance (SVR), pulmonary vascular resistance (PVR), or PaO2 during the 3 h postinjection. In contrast, PaCO2 was significantly elevated and pH significantly decreased (P less than 0.05). Naloxone administration after high-dose IT DADL resulted in a doubling of MABP, MPBP, CO, and SVR that lasted approximately 20 min. In concurrently measured cisternal cerebrospinal fluid (CSF) levels, both morphine and DADL displayed peak levels by 30-60 min. The lumbar CSF clearance curves for both agents were fitted with a two-compartment intravenous bolus model. The t 1/2 alpha was 13.8 +/- 3.6 min for DADL and 9.4 +/- 1.6 min for morphine (mean +/- SE). The t 1/2 beta was 101.3 +/- 17.7 min for DADL and 116.7 +/- 27.9 min for morphine.(ABSTRACT TRUNCATED AT 250 WORDS)