Betel nut chewing and selected psychophysiological variables.

28 male operators of earth movers, with an average age of 30 years, after chewing various quantities of betel not, volunteered to participate in a laboratory study of visual choice-reaction time, digit span, eye-hand coordination, pulse rate, and blood pressure. Analysis of variance identified a statistically significant increase in pulse rate only. Given no significant decrement in scores on any work-related measure discussion concerns the possible use of betel put at the work: place and particularly as an antidore for drivers fatigue. Limitations of the study, implications of the findings, and suggestions for research are discussed.

Effects of nitrous oxide on diazepam sedation of young children.

This study was performed to test the hypothesis that nitrous oxide augments the effects of diazepam sedation of young children by reducing crying and movement and improving the overall quality of sedation. Twenty-four children (mean age of 32 months) were sedated on two occasions with two different treatment regimens. All subjects received a standard oral dose of 0.5 mg/kg of diazepam with and without nitrous oxide during each of two treatment visits. During one visit, the subjects received 50% nitrous oxide and 50% oxygen for the first 20 min followed by 100% oxygen for the balance of the procedure and, during the second visit, the reverse regimen was used. All subjects were restrained in a Papoose Board (Olympic Medical, Seattle, WA) with an auxiliary head restraint. Successful sedation, as evidenced by lack of crying or movement that interrupted treatment, occurred in 83% of administrations. Vital signs remained essentially unchanged throughout all treatment with the exception of transitory elevation of the pulse and respiratory rates, which usually occurred when the mouth prop was inserted, local anesthesia was administered, and the rubber dam was placed. When the evaluation of the overall sedation was compared with and without nitrous oxide, it was better with nitrous oxide 56% of the time, worse 13% of the time, and the same in the remaining 31% of the comparisons. It is concluded that nitrous oxide may slightly augment the effect of diazepam sedation of young children, but it does not do so uniformly for all children receiving sedation.

Chronic ouabain infusion does not cause hypertension in sheep.

Ouabain is claimed to be a hormone of adrenal origin, capable of raising arterial pressure in rats. We infused ouabain in conscious sheep under carefully controlled circumstances to determine its effects on blood pressure, urine electrolytes, and vasoactive hormones. Eight healthy ewes were studied while taking a constant intake of dietary sodium and potassium. Ouabain infusion at 0.25 mg daily over 22 days reduced heart rate and arterial pressure and had no effect on pressor responsiveness to incremental intravenous infusions of angiotensin II. Ouabain induced minor, but statistically significant, decrements in urine volume, urinary sodium excretion, plasma renin and angiotensin II concentrations, and a rise in plasma aldosterone and cortisol. Plasma ouabain levels averaged 1.37 +/- 0.28 nmol/l during ouabain infusion. In conclusion, high-dose chronic ouabain infusion in sheep did not elevate arterial pressure or alter pressor responsiveness to angiotensin II, was antidiuretic and antinatriuretic, and induced minor perturbations in circulating renin, angiotensin II, aldosterone, and cortisol.

Biophysiological effects of Ukrain therapy in a patient with breast cancer (case report).

The effects on different biophysiological parameters and subjective impressions were studied in a patient with breast cancer who was not previously given any therapy before receiving Ukrain. Daily measurements of pulse, blood pressure, temperature and various laboratory examinations were carried out. Development and course of subjective and objective phenomena seem to be typical for patients in whom Ukrain could induce long-term complete remission. The patient described here has had to data 12 years without any oncopathological symptoms.

Caffeine attenuates scopolamine-induced memory impairment in humans.

Caffeine consumption can be beneficial for cognitive functioning. Although caffeine is widely recognized as a mild CNS stimulant drug, the most important consequence of its adenosine antagonism is cholinergic stimulation, which might lead to improvement of higher cognitive functions, particularly memory. In this study, the scopolamine model of amnesia was used to test the cholinergic effects of caffeine, administered as three cups of coffee. Subjects were 16 healthy volunteers who received 250 mg caffeine and 2 mg nicotine separately, in a placebo-controlled double-blind cross-over design. Compared to placebo, nicotine attenuated the scopolamine-induced impairment of storage in short-term memory and attenuated the scopolamine-induced slowing of speed of short-term memory scanning. Nicotine also attenuated the scopolamine-induced slowing of reaction time in a response competition task. Caffeine attenuated the scopolamine-induced impairment of free recall from short- and long-term memory, quality and speed of retrieval from long-term memory in a word learning task, and other cognitive and non-cognitive measures, such as perceptual sensitivity in visual search, reading speed, and rate of finger-tapping. On the basis of these results it was concluded that caffeine possesses cholinergic cognition enhancing properties. Caffeine could be used as a control drug in studies using the scopolamine paradigm and possibly also in other experimental studies of cognitive enhancers, as the effects of a newly developed cognition enhancing drug should at least be superior to the effects of three cups of coffee.

The effect of multiple oral dosing of nimodipine on glibenclamide pharmacodynamics and pharmacokinetics in elderly patients with type-2 diabetes mellitus.

Possible interactions between the calcium channel blocker nimodipine and the hypoglycemic sulphonylurea glibenclamide were investigated in patients with type-2 diabetes mellitus. These 11 patients had taken their individually adjusted antidiabetic treatment unchanged for at least 3 months and showed a satisfactory stabilization on their disease. The concomitant administration of nimodipine 30 mg t.i.d. for 6 days did not change glibenclamide pharmacokinetics as compared with the findings after glibenclamide monotherapy. The normalized AUCss,norm were 11.6 (5.0) kg x h x 1(-1) at glibenclamide monotherapy and 12.3 (5.1) kg x h x 1(-1) after combined medication, resulting in an AUC-ratio for glibenclamide of 109 (23%). Mean elimination half-lives were determined as 2.7 (0.9) h after glibenclamide alone and 3.6 (1.9) h after nimodipine comedication. There was no evidence of significant alterations in glibenclamide efficiency as seen from glucose and insulin kinetics after the simultaneous administration of glibenclamide and nimodipine (insulin Cmax, 57.0 (30.8) mU/l after glibenclamide and 64.4 (32.1) mU/l after combined treatment). Nimodipine pharmacokinetics under nimodipine and glibenclamide steady-state conditions were similar to findings in literature: AUCss,norm 0.10 (0.04) microgram x h x 1(-1), Css,max 20.7 (8.3) microgram x 1(-1). Hemodynamics, clinical chemistry and tolerance did not differ during both treatments. Thus, a clinically relevant drug interaction between nimodipine 30 mg t.i.d. and glibenclamide during long-term treatment can be excluded.

Collective effect of a Chinese formula--a study of xiao-jian-zhong-tang.

Components of a traditional Chinese medicine formula Xiao-Jian-Zhong-Tang were divided into three groups: (1) Radix Paeoniae Lactiflorae, (2) Radix Astragali, and (3) Cinnamon twig, Radix Glycyrrhizae, Fructus jujubae and Saccharum Granorum. Extracts of each group were injected into rats to observe the blood pressure wave spectrum changes at the caudate artery. The whole formula was also extracted and injected into rats to monitor blood pressure wave spectrum changes. Each group has its own effect on the Fourier components of the blood pressure wave. The meridian effects of these herbs are the same as described in the Chinese medical literature, if we consider each meridian in resonance with a specific Fourier component. The whole formula when injected into rats had an effect on the Fourier components of the blood pressure wave similar to the linear combination of individual effect of the three herb groups when used separately. This may be the fundamental idea behind formula construction.

Effects of local anesthetics on experiential, physiologic and endocrine measures in healthy humans and on rat hypothalamic corticotropin-releasing hormone release in vitro: clinical and psychobiologic implications.

Local anesthetics, given i.v. to treat cardiac arrhythmias and for regional anesthesia, exert prominent central nervous system side effects, such as sensory distortions and mood changes. In experimental animals, these drugs activate limbic structures, such as the amygdala, that may coordinately regulate sensory processing, mood and pituitary hormone secretion during stress. Clinically relevant i.v. doses of the short-acting local anesthetic procaine were administered to 17 healthy volunteers and topographic electroencephalographic (EEG) spectra, stress-responsive neuroendocrine and cardiovascular parameters and sensory-cognitive and mood changes were examined. Because corticotropin-releasing hormone (CRH) mimics the behavioral and physiologic responses to stress and activates limbic structures in experimental animals, the effects of procaine and lidocaine on immunoreactive CRH release from rat hypothalami in vitro were also explored. Procaine administration produced a dose-related increase in fast (21-50 Hz) EEG activity, a significant decrease in alpha EEG activity and dose-dependent increases in heart rate, systolic blood pressure and plasma adrenocorticotropic hormone, cortisol and prolactin secretion. Dose-dependent increases in sensory distortions involved virtually all modalities, particularly auditory, visual and somatosensory. Mood changes occurred in most subjects, including anxiety, euphoria and arousal. In vitro, procaine and lidocaine both produced significant dose-related increases in immunoreactive CRH release from rat hypothalami, maximal at 10(-6) M, that were blocked by carbamazepine, a limbic anticonvulsant used in the management of mood disorders. The electrophysiologic effects of procaine in these volunteers were analogous to local anesthetic effects in experimental animals and consistent with the activation of subcortical structures localized within the temporal lobe, such as the amygdala. The effects of procaine on stress-responsive neurohormones were similar to those of amygdala stimulation both in experimental animals and human subjects. The in vitro data suggested that procaine-induced pituitary-adrenal activation involves stimulation of hypothalamic CRH, although additional (e.g., limbic-hypothalamic) mechanisms may contribute in vivo. These data were compatible with a direct action of local anesthetics on limbic structures that might account for many of the central effects seen with the systemic use of these agents in clinical practice.

Alteration of pulse in human subjects by three Chinese herbs.

Human subjects were fed with extract of three Chinese herbs, Panax ginseng, Panax quinquefolium roots and Ganoderma lucidum. Pulse of the radial artery was examined. Our results indicate that each herb has a specific effect on the Fourier components of the pulse, and is in agreement with traditional Chinese medical descriptions.

Nifedipine versus ritodrine for suppression of preterm labour.

OBJECTIVE: To compare the efficacy of tocolysis with specific regimens of nifedipine and ritodrine. Maternal side effects and neonatal outcome also were evaluated. DESIGN: A prospective, randomised trial. SUBJECTS: Seventy-one women, including 11 with twin pregnancies, who had uterine contractions and observed cervical changes. MAIN OUTCOME MEASURES: Prolongation of pregnancy for 48 h, seven days and until 36 weeks of pregnancy were evaluated for each treatment. Maternal side effects and haemodynamic changes were compared, as well as neonatal outcomes. RESULTS: Delivery was delayed for 48 h, seven days, and until the 36th week of gestation in 83%, 67%, and 50%, respectively, of women in the nifedipine group, compared with 77%, 63% and 43%, respectively, of women in the ritodrine group (no significant difference). Maternal side effects were significantly less common in the ritodrine group (no significant difference). Maternal side effects were significantly less common in the nifedipine group (27%) than in the ritodrine group (77%) (P < 0.001). The neonatal outcome was similar in the two groups. The fall in mean arterial and diastolic blood pressure, and the rise in maternal heart rate were significantly greater in the women who received ritodrine compared with those treated with nifedipine. CONCLUSIONS: Nifedipine is as effective as ritodrine in suppressing preterm labour. Its use is associated with less frequent side effects.

Smoking-related subjective and physiological changes: pre- to postpuff and pre- to postcigarette.

Twenty-six female regular smokers participated in two sessions, smoking a cigarette and drinking for comparison a cup of coffee in each. Cardiovascular, electromyogram (EMG), motor activity, and electroencephalogram (EEG) parameters were assessed before and after smoking a cigarette or drinking a cup of coffee. The same variables were averaged for 5-s periods preceding, during, and following the first six puffs and sips. As the expected psychophysiological changes might be related to pleasure, the experimental design included both pleasant-tasting coffee and cigarettes and preparations manipulated to be unpleasant. Comparing pre/post consumption and pre/post puffing changes, heart rate increased as expected pre/post a cigarette but not pre/post puffing. On the other hand, there was no change in heart rate pre/post a cup of coffee but a transient increase pre/post sipping. The pre/post puffing and pre/post sipping changes in the EEG power distribution were similar for both drugs, occurred already in anticipation of puffing and sipping, and qualitatively suggested sedation as opposed to the pre/post cigarette arousing effects. These results might explain the observations of subjective tranquilizing effects during the consumption of a stimulant. Although the taste manipulations produced significant subjective effects, they did not influence the anticipatory effects.

Antihypertensive monotherapy and stress-induced changes in physiological activity.

The effects of two types of laboratory stressors, a structured interview and the cold pressor test, on blood pressure (BP) and heart rate (HR) were studied in normotensive individuals (n = 16), unmedicated hypertensive patients (n = 12), and medicated hypertensive patients (n = 46). Fifteen patients were in the bisoprolol group, 16 patients were in the enalapril group, and 15 patients were in the nitrendipine group. Concurrent physiologic measures, finger pulse volume (FPV), electrodermal activity, and respiratory frequency (RF), were also used to evaluate the level of stress reached by the subjects during and after the tasks. No significant differences were evident between the different treatments in BP and other physiologic responses to stressors. Patients receiving bisoprolol maintained lower HR and systolic BP values, but these differences were not related to the reaction to the stressors. No significant differences were noted in diastolic BP (DBP) between the different groups. The highest physiologic responses were obtained during the structured interview. Antihypertensive monotherapy does not attenuate cardiovascular reactions induced by acute stress in controlled laboratory conditions. In laboratory studies of the relationships between stress and hypertension, it is important that social stressors be used and that physiologic rather than cardiovascular measures of stress be recorded.

Pulse oximetry during minor oral surgery with and without intravenous sedation.

This study investigated the levels of oxygen saturation and pulse rates of patients undergoing minor oral surgery under local analgesia, with (20 patients) or without (20 patients) intravenous sedation with midazolam. The results indicated that a statistically significant fall in arterial blood oxygenation of 1% to 2%, as measured by pulse oximetry, followed midazolam administration; however, this was physiologically insignificant. Both groups showed a similar postoperative small fall in oxygen saturation. Transient episodes (24 to 36 seconds) of physiologically significant mild hypoxia occurred during breath holding, but this condition was readily corrected by encouraging patients to breathe deeply. Midazolam had a small but significant calming effect on the higher preoperative pulse rates exhibited by anxious patients, but this effect was not sustained during the operating period. Both sedated and unsedated patients showed episodes of tachycardia that could have significance for patients with cardiac disease.

[Cardiovascular effects of everyday coffee consumption]. / Kardiovaskuläre Effekte des Alltagskaffees.

Whereas the earlier literature contains several studies on the acute cardiovascular effects of caffeine, systematic studies of the cardiovascular effects of regular daily coffee consumption have appeared only recently. Acute caffeine administration (total daily amount in one dose following caffeine abstinence) increases both systolic and diastolic blood pressures by 10-15 mm Hg and lowers the pulse by about 2-5 beats/min. Repeated caffeine administration leads to a rapid decline in the blood pressure response. Chronic switching between decaffeinated and caffeine-containing coffee showed no more than marginal changes in blood pressure. Plasma lipids are probably independent of caffeine consumption, but increase slightly with boiled (compared with filter) coffee. The question of the thermogenic effect of coffee consumption remains open. The prevalence of coronary disease appears to be epidemiologically independent of coffee consumption.

Topical anaesthesia of the larynx: cocaine or lignocaine?

A double-blind, randomized study compared the cardiovascular responses and extubation conditions using lignocaine or cocaine for topical anaesthesia of the larynx. Absorption of both agents from the trachea was quantified by serial venous plasma concentrations. Serial blood pressure, ECG, O2 saturation and end-tidal carbon dioxide measurements were obtained. Conditions at extubation were assessed on duration of coughing, graded on a scale of 1-4 (1 = no coughing, 2 = single cough, 3 = coughing lasting less than 30 s, 4 = coughing lasting 30 s or more). No difference was found in cardiovascular measurements between the two groups. The patterns of absorption of cocaine and lignocaine from the laryngeal mucosa were very similar, with peak absorption occurring at 10-15 min after laryngeal spraying. Although cocaine reduced the incidence of post-operative coughing when compared with lignocaine, this did not reach statistical significance.

Cardiopulmonary performance following changes in position and the administration of intravenous Diazemuls.

Twenty healthy volunteers entered a study to assess cardiopulmonary responses, as measured by pulse oximetry, following changes in posture in the dental chair and the administration of Diazemuls (diazepam) in doses sufficient to instill sedation (up to a maximum dose of 20 mg) in the volunteers to a degree such that ptosis was seen. The results indicate that SaO2 values remained above 95 per cent throughout the study. It is concluded that although changes in SaO2 and pulse rate do occur, these differences are not important in healthy individuals, although they may be more serious in patients with pre-existing cardiopulmonary disease.

IV sedation in pediatric dentistry: an alternative to general anesthesia.

This prospective study was conducted to determine the sedative effects of IV ketamine and fentanyl on vital signs and behavior. Twenty-seven children, classified as ASA I, with a mean age of 34 months, were studied. The dosages of IV ketamine and fentanyl given were 0.5 mg/kg and 0.5 mcg/kg, respectively, approximately every 15-20 min. The pulse rate averaged 125 throughout the case. Blood pressure averaged 112/64. The respiration rate averaged 22 breaths per min. Mean behavior composite scores were 1.9 at the initial examination and 3.3 during treatment. One child vomited during treatment. Post-treatment complications were discomfort in 19% (5), nausea in 22% (6), and vomiting in 15% (4) of the patients. We concluded that IV sedation of precooperative healthy pediatric patients with ketamine, fentanyl, and nitrous oxide/oxygen appears to be a safe and effective sedation modality with minimal side effects when administered and monitored by a qualified anesthetist, offering the practitioner an alternative to general anesthesia.

Alterations of pulse by Chinese herb medicine.

Rats were injected with the crude extract of Chinese herbs, Rhizoma Coptidis, Radix Bupleuri and Cinnamomum cassia Blume. The pulse of the tail artery were examined. The results indicated that each drug had a specific effect on the Fourier components of the pulse.

Acute and sustained changes in sodium balance during nifedipine treatment in essential hypertension.

PURPOSE: To assess the changes in sodium excretion and sodium balance after initiation of nifedipine treatment and after withdrawal of nifedipine. PATIENTS: Eight patients with uncomplicated mild to moderate essential hypertension were entered in a single-blind, placebo-controlled study of 39 days' duration. METHODS: Two 7-day periods while on a fixed sodium intake of 150 mmol/day approximately 3 weeks apart. After 4 days of a placebo and fixed sodium intake, patients were given nifedipine GITS (gastrointestinal therapeutic system) once a day and carefully studied for the following 4 days. Thereafter, patients continued to receive nifedipine GITS, and approximately 3 weeks later they were studied again for a week while on a fixed sodium intake. Nifedipine administration was stopped and changes occurring after withdrawal were studied. RESULTS: Nifedipine caused a significant increase in sodium excretion with a cumulative loss of sodium of 38 mmol per subject within the first 4 days of treatment. The withdrawal of nifedipine treatment caused a significant decrease in sodium excretion and a cumulative retention of sodium of 42 mmol per subject within the first 4 days of withdrawal. CONCLUSION: Nifedipine causes an acute and a sustained reduction in sodium balance in patients with essential hypertension. This prolonged effect may contribute to the mechanism whereby nifedipine lowers blood pressure.

Nimodipine in refractory epilepsy: a placebo-controlled, add-on study.

Twenty-two patients (8 male, 14 female) with refractory epilepsy entered a balanced, double-blind, placebo-controlled crossover trial of nimodipine as adjunctive therapy. Treatment periods of 12 weeks (nimodipine 30 mg tds, 60 mg tds, 90 mg tds each for 4 weeks and matched placebo) were followed by wash-out intervals of 4 weeks. Five patients withdrew (2 side-effects, 1 intercurrent illness, 2 non-compliance). Median values (placebo vs. nimodipine) did not vary for total (17 vs. 18), partial (14 vs. 18) and generalised tonic-clonic seizures (2 vs. 5) or seizure days (13 vs. 13). Monthly analysis also failed to uncover any benefit for nimodipine. Side-effects were reported no more frequently with nimodipine than with placebo and pulse and blood pressure did not alter significantly. Antiepileptic drug levels were not affected by nimodipine treatment but circulating nimodipine concentrations were low. In this trial, nimodipine did not fulfil the promise of its success in animal models of epilepsy. Enzyme induction by concurrent antiepileptic therapy may provide an explanation.