Safety and technical success of diphenhydramine as an alternative local anaesthetic agent for radiology procedures.

AIM: To evaluate retrospectively the safety and technical success of subcutaneous diphenhydramine as an alternative local anaesthetic for radiology procedures. MATERIALS AND METHODS: Between January 2000 and April 2021, 84 image-guided procedures were performed in 81 adult patients (mean age 61 years, 86% female) using 1% injectable diphenhydramine as a local anaesthetic. Indications were history of severe allergy to "-caine" local anaesthetics in 76 (90%) patients and recent administration of bupivacaine liposomal injectable suspension in eight (10%) patients. Twelve of the 84 (14%) procedures were performed with concomitant moderate sedation. Patient characteristics, procedural techniques, and clinical outcomes were reviewed. Early and delayed (30-day) complications were classified as either related to local diphenhydramine injection or to the procedure itself. Procedure-related complications were gradated using the Clavien-Dindo system. RESULTS: Percutaneous biopsy was the most frequently performed procedure (57/84, 67%). Fifty-nine (70%) of the 84 procedures were ultrasound guided. The most common procedural site was the breast (34/84, 40%). All procedures were technically successful. There were two minor injection-related complications related to post-procedural pain. A single minor procedure-related complication involved a patient requiring hospital admission for post-renal biopsy related haematuria. CONCLUSION: Injectable diphenhydramine appears to be a safe and effective local anaesthetic alternative in patients with "-caine" class contraindications undergoing radiology procedures. A future prospective trial would be useful to assess the safety profile in an large cohort of patients.

Psychometric behaviour of BDI in Alzheimer's disease patients with depression.

The psychometric properties of the Beck Depression Inventory (BDI) in subjects with Alzheimer's disease (AD) and depression have not been fully evaluated. Item endorsement patterns may be distorted by the presence of AD. This was tested by applying the BDI to a sample of 129 subjects with probable AD without depression and to 57 subjects with both probable AD and depression. It was found that the BDI under diagnoses depression in the context of AD. ROC curves for total BDI and cognitive and somatic items subsets showed low sensitivity and low areas under the curve indices. The results suggest that the BDI is not an ideal instrument to measure depression in AD. This may not result solely from the swing of the somatic items subset, but from other aspects which require further investigation.

Hormonal regulation and cellular localization of fatty acid synthase in human fetal lung.

Fatty acid synthase (FAS; EC 2.3.1.85) supplies de novo fatty acids for pulmonary surfactant synthesis, and FAS gene expression is both developmentally and hormonally regulated in the fetal lung. To further examine hormonal regulation of FAS mRNA and to determine the cellular localization of FAS gene expression, we cultured human fetal lungs (18-22 wk gestation) as explants for 1-4 days in the absence (control) or presence of glucocorticoid [dexamethasone (Dex), 10 nM] and/or cAMP agents (8-bromo-cAMP, 0.1 mM and IBMX, 0.1 mM). FAS protein content and activity increased similarly in the presence of Dex (109 and 83%, respectively) or cAMP (87 and 111%, respectively), and responses were additive in the presence of both hormones (230 and 203%, respectively). With a rabbit anti-rat FAS antibody, FAS immunoreactivity was not detected in preculture lung specimens but appeared in epithelial cells lining the tubules with time in culture. Dex and/or cAMP markedly increased staining of epithelial cells, identified as type II cells, whereas staining of mesenchymal fibroblasts was very low under all conditions. With in situ hybridization, FAS mRNA was found to be enriched in epithelial cells lining the alveolar spaces, and the reaction product increased in these cells when the explants were cultured with the hormones. The increased FAS mRNA content in the presence of Dex and/or cAMP is primarily due to increased stabilization of mRNA, although Dex alone increased the transcription rate by approximately 30%. We conclude that hormonal treatment of cultured human fetal lungs increases FAS gene expression primarily by increasing stability of the message. The induction of FAS during explant culture and by hormones occurs selectively in type II epithelial cells, consistent with the regulatory role of this enzyme in de novo synthesis of fatty acid substrate for surfactant synthesis in perinatal lungs.

Endoscopic palliation of malignant obstructive jaundice using resterilized accessories: an audit of success, complications, mortality and cost.

OBJECTIVE: To assess the success, complications and cost of endoscopic endoprosthesis placement for palliation of obstructive jaundice caused by malignancy. METHODS: Four hundred and two consecutive patients with obstructive jaundice due to nonresectable malignancy undergoing endoscopic stenting were studied. Commercial or home-made 7F or 10F endoprostheses were placed using minor modifications of the standard technique. The accessories were sterilized and reused. RESULTS: Endoprosthesis placement was successful in 291 patients (72.4%, 95% CI 67.7-76.7)-241 in one attempt, 49 in two attempts, and one in three attempts. Fifty nine patients (14.6%, 95% CI 11.4-18.6) had procedure-related complications, including cholangitis (30), pancreatitis (15), perforation (3) and bleeding (11). The incidence of cholangitis was significantly higher in bifurcation blocks than in other lesions (17.6% vs 4.7%, p = 0.0005). The success rate did not differ between distal and proximal lesions (68.1% vs 72.9%). The procedural cost per patient could be reduced from Rs 14,850 to Rs 6565 by reusing accessories after sterilization, and using home-made stents. CONCLUSIONS: Endoscopic endoprosthesis placement is a safe and effective method for palliation of malignant obstructive jaundice. Preparation of indigenous stents and reuse of accessories can reduce the cost of the procedure by over 50%.

Topical pharyngeal anesthesia without intravenous sedation during upper gastrointestinal endoscopy.

BACKGROUND: There have been conflicting reports about the usefulness of topical pharyngeal anesthesia as a pre-endoscopic medication. AIMS: To assess the effect of topical pharyngeal anesthesia without intravenous sedatives on easing upper gastrointestinal endoscopy. METHODS: 153 consecutive consenting patients were randomized to receive either placebo (normal saline) spray (78 patients) or 80 mg of 4% lidocaine spray (75 patients). Difficulty of intubation was judged both by the patient and the physician on a linear analogue scale. RESULTS: There was no significant difference in the scores in the two groups (p > 0.05). The patient and physician assessments correlated well. CONCLUSIONS: Topical lignocaine spray does not facilitate upper gastrointestinal endoscopy in the absence of intravenous sedation.

Dilatation of radiation-induced esophageal strictures under sublingual buprenorphine analgesia: a pilot study.

BACKGROUND: Pain during dilatation of radiation strictures is a troublesome complaint. There is little information on sedation and analgesia during this procedure. We performed a pilot study to compare the analgesic efficacy of sublingual buprenorphine and intravenous pentazocine during dilatation of radiation-induced esophageal strictures. METHODS: Thirty-one patients with esophageal cancer who had radiation-induced strictures were randomized to receive either buprenorphine 0.2 mg sublingually two hours before dilatation (n = 17) or pentazocine 30 mg intravenously five minutes before dilatation (n = 14). Dilatation was considered successful if it could be performed to 12 mm diameter or more. Pain experienced during dilatation was graded as mild, moderate or severe. RESULTS: Sixteen patients in the buprenorphine group and 12 in the pentazocine group were dilated to > 12 mm size (p = ns). Twelve and nine patients respectively in the two groups experienced mild or no pain; ten and six patients had minor side-effects (p = ns). CONCLUSION: Buprenorphine is useful for sedoanalgesia during dilatation of radiation-induced strictures of the esophagus.

Synchronous adenocarcinoma and lymphoma of the colon.

Synchronous lymphoma and adenocarcinoma of the colon are extremely rare. A 32-year-old woman was referred to us for colon cancer. Investigations revealed two primary tumors, one in the cecum and the other in the sigmoid colon. Subtotal colectomy with ileorectal anastomosis was performed. Histology revealed the cecal tumor to be non-Hodgkin's lymphoma, diffuse small cell type with plasmacytoid features. The sigmoid colon tumor was moderately differentiated adenocarcinoma. The patient received 6 cycles of chemotherapy postoperatively for lymphoma but died of recurrent disease after 17 months.

Removal of impacted basket during endoscopic papillotomy: a novel method using precut papillotome.

Basket impaction is a rare problem during endoscopic papillotomy and stone extraction for the bile duct. Mechanical lithotriptor is usually employed to break the stone, but a few patients may require surgery. We describe a patient in whom a precut papillotome was used to break the stone and remove the impacted basket.

Massive lower gastrointestinal bleeding from cecal lymphoid polyp in renal transplant recipient.

A 25-year-old renal transplant recipient receiving anticoagulant therapy for renal vein thrombosis, presented with massive lower gastrointestinal bleeding. Superior mesenteric angiogram revealed active bleeding in the cecum. Colonoscopy revealed a sessile ulcerated polyp in the cecum with satellite polyps. The polyps were fulgurated with Nd:YAG laser. Colonoscopy later revealed a remnant of the polyp, which was excised. The histopathology revealed a lymphoid polyp.

Somatostatin: a metabolic regulator.

Somatostatin, the hypothalamic release-inhibiting factor, has been found to stimulate gluconeogenesis in rat kidney cortical slices. Stimulation by somatostatin was linear and dose-dependent. Other bioactive peptides such as cholecystokinin, gastrointestinal peptide, secretin, neurotensin, vasoactive intestinal peptide, pancreatic polypeptide, beta endorphin and substance P did not affect the renal gluconeogenic activity. Somatostatin-induced gluconeogenesis was blocked by phentolamine (alpha adrenergic antagonist) and prazosin (alpha1 adrenergic antagonist) but not by propranolol (beta adrenergic antagonist) and yohimbine (alpha2 adrenergic antagonist) suggesting that the effect is via alpha1 adrenergic stimuli. Studies on the involvement of Ca2+ revealed that tissue depletion and omission of Ca2+ from the reaction mixture would abolish the stimulatory effect of somatostatin. Furthermore, somatostatin enhanced the uptake of 45calcium in renal cortical slices which could be blocked by lanthanum, an inhibitor of Ca2+ influx. It is proposed that the stimulatory effect of somatostatin on renal gluconeogenesis is mediated by alpha1 adrenergic receptors, or those which functionally resemble alpha1 receptors and that the increased influx of Ca2+ may be the causative factor for carrying out the stimulus.

Tubal factors in sterility: a laparoscopic study of 697 cases of sterility.

PIP: Of 697 cases of sterility, 491 had primary sterility and 206 secondary. The subjects' uterus, tubes, ovaries, pouch of Douglas and the pelvis were visualized. 26.4% had chronic pelvic inflammatory disease with tubal damage responsible for infertility. 17.5% had complete bilateral blocked tubes. 3% had partial block with delayed spill of the dye. 10% had pelvic tuberculosis. 12.8% of the primary sterility cases and 4.3% of the secondary cases had tuberculosis. Cases with frank tubercles and caseation were diagnosed as tuberculosis. Only 31% of the cases with pelvic pathology would have been diagnosed with clinical examination alone. Laparoscopy is preferable when chronic pelvic infection, especially tuberculosis, is suspected.^ieng

Studies on gluconeogenesis, protein synthesis and cyclic AMP levels in isolated hepatocytes from alloxan diabetic rats.

Alloxan diabetic rats maintained on protamine zinc insulin for two weeks were used for these studies. Hepatocytes were isolated from these rats at various time intervals after withdrawal of insulin (0, 48, 72 and 96 hr). Gluconeogenesis with various concentrations of lactate and fructose was studied. Both lactate and fructose stimulated gluconeogenesis and showed progressive increases in glucose production up to 72 hr after the insulin withdrawal. Glucose production decreased at 96 hr. Protein synthesis in isolated hepatocytes from diabetic liver cells, as measured by the incorporation of radioactive isoleucine, valine and phenylalanine into protein, showed a decrease (5- to 6-fold) with time after insulin withdrawal. Glucagon (10(-6)M) alone increased cyclic AMP levels 10-fold in liver cells, in isolated cells from rats maintained on insulin (0 hr) or from rats withdrawn from insulin for 48 hr. The ability of glucagon to elevate cyclic AMP levels in isolated diabetic liver cells decreases 72 hr following insulin withdrawal.