Assessment of hot flushes and vaginal dryness among obese women undergoing bariatric surgery.

OBJECTIVE: Menopausal symptoms are associated with a negative impact on the quality of life, leading women to seek medical treatment. Obesity has been linked to higher levels of menopausal symptoms such as hot flushes. This assessment will explore whether the prevalence and bother of hot flushes and vaginal dryness change from pre- to post-bariatric surgery among obese midlife women. METHODS: This study is a longitudinal analysis of data from 69 women (ages 35-72 years) undergoing bariatric surgery with reported reproductive histories and menopausal symptoms at preoperative and 6-month postoperative visits. Prevalence of and degree of bother of hot flushes and vaginal dryness at pre- and post-surgery were compared using McNemar's test and Wilcoxon signed-rank test. RESULTS: The reported degree of bother of symptoms associated with hot flushes decreased from pre- to post-surgery (p < 0.01). There was no significant change in the prevalence of hot flushes or vaginal dryness in the overall study sample. CONCLUSIONS: The degree of bother of symptoms associated with hot flushes among midlife women may decrease after bariatric surgery. These results highlight important secondary gains, including less bothersome menopausal symptoms, for women who choose bariatric surgery for weight loss.

Vasoactive actions of local anaesthetics on human isolated umbilical veins and arteries.

1. An in vitro study, using helical preparations of human umbilical arteries and veins obtained from healthy women at term pregnancy, was designed to determine: (a) whether three local anaesthetics commonly utilized in obstetric anaesthesia (bupivacaine, 2-chloroprocaine, and lignocaine) can induce contraction or relaxation of resting umbilical vessels; (b) whether these agents can induce contraction or relaxation of umbilical vessels which have been previously induced to contract by a known activator, potassium chloride (KCl); and (c) the relative potency of these agents as compared to KCl. 2. The results indicate that: (a) these local anaesthetics are vasoactive on human umbilical vascular smooth muscle; (b) bupivacaine induces contraction in over 90% of the resting vessels examined, while 2-chloroprocaine consistently causes relaxation and lignocaine causes a small degree of contraction in 40% of vessels examined; (c) bupivacaine causes further contraction (or potentiation) of KCl-contracted muscle in 50% of the vessels studied, while 2-chloroprocaine and lignocaine both induce relaxation of these contracted vessels.

Subclinical human immunodeficiency virus-related changes in oral mucosa shown by image analysis of tongue smears.

There is evidence that certain lesions of the oral mucosa, such as hairy leukoplakia (HL), in patients seropositive for human immunodeficiency virus correlate with the subsequent development of acquired immune deficiency syndrome. The authors suggest that HL is a final manifestation of alterations that gradually develop after HIV infection. To recognize inapparent early subclinical changes in oral mucosa, the authors applied methods of digital image analysis to investigate tongue smears from healthy control subjects and immunosuppressed patients after chemotherapy and HIV infection. Their studies concentrated on nuclear morphologic features and chromatin structure. The results obtained with a large set of subvisual parameters indicated significant differences in nuclear and chromatin features between the smear patterns of investigated groups. One important implication of these studies is that computerized image analysis of simply prepared tongue smears enables one to recognize subvisual HIV-related changes before clinical evidence of HL appears.

A proposed mechanism of bupivacaine-induced contraction of human umbilical artery smooth muscle cells.

This in vitro study using ring preparations of human umbilical vessels and cultured human umbilical artery smooth muscle cells was designed to determine: (a) the mechanism of bupivacaine-induced contraction of ring preparations, and (b) whether similar concentrations of bupivacaine release Cal(2+) in cultured smooth muscle cells. Isometric tension was recorded from ring preparations of human umbilical veins and arteries in an isolated tissue chamber. Separate fluorescence and electrophysiology studies were done with cultured human umbilical artery smooth muscle cells. Bupivacaine-evoked contractions of ring preparations were either tonic or twitch in nature. The contraction of ring preparations was dependent on extracellular Cal(2+) and sensitive to nifedipine inhibition. Bupivacaine also increased intracellular Cal(2+) in patterns consistent with tonic or phasic tension responses seen in isometric recordings. In addition, the membrane-resting potential was depolarized by bupivacaine. Since similar concentrations of bupivacaine caused both contraction and a rise in intracellular Ca(2+), the bupivacaine-evoked contraction was the result of increased cell Cal(2+) and the source of this Ca(2+) was the extracellular space.

Bupivacaine inhibition of L-type calcium current in ventricular cardiomyocytes of hamster.

BACKGROUND: The local anesthetic bupivacaine is cardiotoxic when accidentally injected into the circulation. Such cardiotoxicity might involve an inhibition of cardiac L-type Ca2+ current (ICa,L). This study was designed to define the mechanism of bupivacaine inhibition of ICa,L. METHODS: Cardiomyocytes were enzymatically dispersed from hamster ventricles. Certain voltage- and time-dependencies of ICa,L were recorded using the whole-cell patch clamp method in the presence and absence of different concentrations of bupivacaine. RESULTS: Bupivacaine, in a concentration-dependent manner (10-300 microM), tonically inhibited the peak amplitude of ICa,L. The inhibition was characterized by an increase in the time of recovery from inactivation and a negative-voltage shift of the steady-state inactivation curve. The inhibition was shown to be voltage-dependent, and the peak amplitude of ICa,L could not be restored to control levels by a wash from bupivacaine. CONCLUSIONS: The inhibition of ICa,L appears, in part, to result from bupivacaine predisposing L-type Ca channels to the inactivated state. Data from washout suggest that there may be two mechanisms of inhibition at work. Bupivacaine may bind with low affinity to the Ca channel and also affect an unidentified metabolic component that modulates Ca channel function.

The response of umbilical vessels, with and without vascular endothelium, to local anesthesia in low PO2 and hypercarbia.

BACKGROUND AND OBJECTIVES: Human umbilical vessels are sensitive to local anesthetic agents as well as to a variety of other exogenous and endogenous substances. Changes in blood gases such as hypoxia and hypercarbia may alter these responses. This study examined the effects of local anesthetic agents under these conditions and how the effects are related to the vascular endothelium. METHODS: Veins and arteries, dissected from umbilical cords of healthy newborns, were cross-sectioned to form rings. The rings were mounted in a muscle chamber containing Krebs-Ringer bicarbonate solution that was gassed to approximate control, low PO2 or hypercarbic conditions. Changes in isometric tension were recorded in response to increasing concentrations of bupivacaine (B), lidocaine (L), or 2-chloroprocaine (2-CP). In half the experiments, intimal rubbing was used to remove the endothelium of rings for the purpose of disclosing the role of endothelial-derived factors. RESULTS: The normal contracting (increasing baseline tone) or relaxing (decreasing baseline tone) responses to local anesthesia were unchanged by hypercarbia, but low PO2 suppressed the relaxing effect of 2-CP on arteries. Removal of endothelium enhanced the relaxing effect of 2-CP on arteries, and unmasked a contracting effect of L on arteries. Rubbed vessels, while exposed to low PO2 or hypercarbia, became less responsive to 2-CP. CONCLUSIONS: Changes in the internal environment are capable of altering the response of umbilical vascular smooth muscle to local anesthesia. Additionally, the vascular endothelium appears to influence the degree of response to anesthesia.

Umbilical vessels endothelium and vascular reactivity.

In vitro preparations of isolated umbilical vessels are ideal for the study of vasoactive substances. These vessels display vascular reactivity in response to numerous substances, although the mechanism of action of many of these agents is unknown. The present study was undertaken to study the role of the endothelium in the vasoactivity of these preparations, and to examine their cellular integrity. Umbilical artery and vein were studied using conventional isometric techniques, and using high power light microscopy. We found that umbilical vessel rings had no relaxant response to agents believed to release endothelium-derived relaxant factor (EDRF). Mechanical and chemical treatment to remove endothelium did not significantly alter vascular response to known contractile agonists. Cellular morphology is well maintained in ring preparations. Finally, mechanical rubbing of the intima of these rings is more reliable in endothelium removal, as compared to chemical removal with the detergent saponin.

Variable phenotype in Greig cephalopolysyndactyly syndrome: clinical and radiological findings in 4 independent families and 3 sporadic cases with identified GLI3 mutations.

Greig cephalopolysyndactyly (GCPS) (OMIM 175700) is an autosomal dominant disorder characterized by a distinct combination of craniofacial, hand and foot malformations. In this report, clinical and radiological findings of 12 patients with GCPS derived from 4 independent families and 3 sporadic cases with documented GLI3 mutations are presented with particular emphasis on inter- and intrafamilial variability. In a particularly instructive family in which 9 members of 4 generations could be studied clinically and molecularly, a missense mutation (R625W) is transmitted and shows a partially penetrant pattern. In a branch of the family, the GCPS phenotype skips a generation via a normal female carrier without clinical signs providing evidence that GCPS does not always manifest full penetrance as generally supposed.