Effect of short-term ingestion of konjac glucomannan on serum cholesterol in healthy men.

The effects of the soluble fiber konjac glucomannan (GM) on serum cholesterol concentrations were investigated in 63 healthy men in a double-blind crossover, placebo-controlled study. After a 2-wk baseline period, the subjects were given 3.9 g GM or placebo daily for 4 wk. After a washout period of 2 wk, crossover took place, followed by another 4 wk of treatment. The subjects were encouraged not to change their ordinary diets or general lifestyle during the investigation. GM fibers reduced total cholesterol (TC) concentrations by 10% (P < 0.0001), low-density-lipoprotein cholesterol (LDL-C) concentrations by 7.2% (P < 0.007), triglycerides by 23% (P < 0.03), and systolic blood pressure by 2.5% (P < 0.02). High-density-lipoprotein cholesterol (HDL-C) and the ratio of LDL-C to HDL-C did not change significantly. No change in diastolic blood pressure or body weight was observed. No adverse effects were observed. The results of this study show that GM is an effective cholesterol-lowering dietary adjunct.

Respiratory function, electrocardiography and quality of life in individuals with muscular dystrophy.

All individuals in a Swedish county afflicted with any type of hereditary muscular dystrophy (MD) were identified and 57 (85 percent) of eligible individuals in the age range 16 to 64 were included in the study. Respiratory disturbances were estimated by means of spirometry and analysis of arterial blood gases, and 58 percent yielded abnormal results on at least one of these examinations. Elevated PCO2 was found more commonly than reduced forced vital capacity (FVC) and there was a moderate association between these parameters. Respiratory symptoms, most commonly breathlessness, were encountered in 79 percent. Pathologic ECG recordings were found in 21 individuals (37 percent). Conduction disturbances and affection of the myocard were most frequent in myotonic dystrophy. Quality of life was assessed by means of the Sickness Impact Profile instrument and the Kaasa test. The results showed that quality of life was significantly related to FVC and to the symptom of abnormal fatigue. Respiratory and cardiac parameters showed a greater number of significant correlations with measures of functional ability than with subjective well-being.

Respiratory effects of high thoracic epidural anaesthesia.

The respiratory effects of high thoracic epidural anaesthesia (TEA) were studied in nine healthy volunteers by means of spirometry, nitrogen single-breath test and flow-volume loop. After the baseline measurements an epidural catheter was inserted at T4 level, and 5 ml of 0.5% bupivacaine were injected. This volume led to sensory block within dermatomes T1-T5. Total lung capacity, vital capacity and inspiratory capacity decreased slightly but significantly during TEA. Expiratory reserve volume was not affected. Maximal inspiratory flow at 50% VC decreased 24%. Maximal expiratory flow at 75% VC and peak expiratory flow were not changed. N2 difference during a constant flow rate of 0.5 l/s and forced expiratory volume in 1 s were not changed, which indicates that there were no changes of bronchial tone. The respiratory effects of high TEA in this study were caused by the motor block of the intercostal muscles.

Circulatory changes during high thoracic epidural anaesthesia--influence of sympathetic block and of systemic effect of the local anaesthetic.

Circulatory changes during high thoracic epidural anaesthesia (TEA) were studied in nine healthy volunteers by means of echocardiography and systolic time intervals. The subjects also underwent a physical work test with bicycle ergometry. To evaluate the systemic effect of the local anaesthetic (bupivacaine), the same subjects were investigated 3 weeks later when a corresponding dose of the local anaesthetic was injected intramuscularly instead of epidurally. On the first occasion, after baseline measurements an epidural catheter was inserted at T4 level and 5 ml of 0.5% bupivacaine were injected. This volume led to sensory block within dermatomes T1-T5. On the second occasion all subjects received 8 ml of 0.5% bupivacaine intramuscularly. Heart rate (HR) and systolic blood pressure decreased during TEA, both at rest and during exercise. Following i.m. injection, HR decreased at rest but remained unchanged during exercise. The systolic blood pressure was not affected but the diastolic blood pressure increased during the exercise test. After administration of TEA, stroke volume (SV) decreased 22% and cardiac output (CO) 33%. Following i.m. injection of bupivacaine, SV decreased 8% and CO 20%. The pre-ejection period/left ventricular ejection time ratio increased 23% during TEA and 16% after i.m. injection. The results indicate that the circulatory changes did not seem to be caused entirely by the cardiac sympathetic block, but were due partly to the systemic effect of bupivacaine.

Pancreatitis after sphincter of Oddi manometry.

The nature, frequency, severity, and possible causes of complications after 207 sphincter of Oddi manometry measurements were studied in 146 patients. Acute pancreatitis was diagnosed in 6% (12 of 207) of the investigations and in 8% (12 of 146) of the patients examined. The pancreatitis was mild in all patients. After cannulation of the pancreatic duct, acute pancreatitis occurred in 10 of 95 (11%) patients compared with one of 93 (1%) when the manometry catheter entered the bile duct only (p less than 0.02). Seven (58%) of the patients who developed acute pancreatitis, however, were found to be suffering from chronic pancreatitis. Some 26% of all sphincter of Oddi manometry measurements on patients with this diagnosis were complicated by an acute attack of pancreatitis compared with 3% (p less than 0.001) in patients without signs of chronic pancreatitis. In all patients the pancreatitis developed within three hours of manometry. We conclude that pancreatitis may occasionally follow sphincter of Oddi manometry measurement, even in patients without pancreaticobiliary disease, and that underlying chronic pancreatitis constitutes a definite risk. Sphincter of Oddi manometry measurement in control subjects should therefore be performed only in centres where the safety of the procedure has been established, and the presence of chronic pancreatitis should be excluded beforehand. Cannulation of the pancreatic duct should be avoided. Manometry can be safely performed, however, as an outpatient procedure.

Comparison of intramuscular and epidural morphine for postoperative analgesia in the grossly obese: influence on postoperative ambulation and pulmonary function.

In a randomized double-blind study of thirty grossly obese patients undergoing gastroplasty for weight reduction, the effects of intramuscular and epidural morphine were compared as regards analgesia, ambulation, gastrointestinal motility, early and late pulmonary function, duration of hospitalization, and occurrence of deep vein thrombosis in the postoperative period. The patients were operated on under thoracic epidural block combined with light endotracheal anesthesia. A six-grade scale was devised to quantify postoperative mobilization. A radioactive isotope method using 99mTc -plasmin was employed to detect postoperative deep vein thrombosis. For 14 hr after the first analgesic injection, respiratory frequency was noted every 15 min and arterial blood gases were measured hourly. Peak expiratory flow was recorded daily until the patient was discharged from hospital. Spirometry was performed the day before and the day after surgery. Plasma concentrations of morphine were measured after both intramuscular and epidural administration. Both intramuscular and epidural morphine gave effective analgesia, but the average dose of intramuscular morphine was up to seven times greater than that required by the epidural route. A larger number of patients receiving epidural morphine postoperatively were able to sit, stand, or walk unassisted within 6, 12, and 24 hr, respectively. Being alert and more mobile as a result of superior postoperative analgesia from epidural morphine, patients in this group benefited more from vigorous physiotherapy routine, which resulted in fewer pulmonary complications. Furthermore, earlier postoperative recovery of peak expiratory flow and bowel function presumably contributed to a significantly shorter hospitalization in patients receiving epidural morphine. There was no evidence of prolonged respiratory depression in this high-risk category of patients. The 99mTc -plasmin tests revealed no significant difference between the two groups.

Conventional and controlled release diltiazem. Bioavailability in healthy volunteers and anti-anginal effects in combination with metoprolol in stable angina pectoris.

Diltiazem CR tablets 120 mg b.i.d. for 1 week were compared with plain tablets 60 mg q.i.d. in 13 healthy male volunteers in a study of pharmacokinetic variables. Their antianginal efficacy was also compared in 23 patients with stable angina pectoris who were already on metoprolol. Both studies were of randomised, cross over design, and the clinical study was double blind. The pharmacokinetic variables of the two formulations were very similar except for the longer tmax of 4.4 h for diltiazem CR in comparison to 2.9 h for the plain tablets. The mean relative bioavailability of diltiazem CR in comparison with plain tablets was 1.14. The clinical study showed that after four weeks on diltiazem CR 120 mg b.i.d. or diltiazem plain tablets 60 mg q.i.d. in addition to metoprolol, there were significant decreases in weekly anginal attacks from 11 to 5 attacks/week, the number of nitroglycerin tablets consumed from 6 to 3 tablets/week, and an increase in the maximum workload from 116 to 126 and 123 W for diltiazem CR and plain diltiazem tablets, respectively, as compared to placebo. Five of the patients were angina free during diltiazem treatment. No difference in anti-anginal efficacy between the two preparations was seen. It was concluded that CR 120 mg b.i.d. appears bioequivalent to plain diltiazem tablets 60 mg q.i.d.