Level of awareness of mammography among women attending outpatient clinics in a teaching hospital in Ibadan, South-West Nigeria.

BACKGROUND: Mammography has been used in developed countries with considerable success but very little is known about this imaging modality in low resource settings. This study examined the level of awareness of mammography and determined factors influencing the level of awareness. METHODS: We conducted a hospital based cross sectional study to investigate the level of awareness of mammography among 818 randomly selected women attending the General Outpatient clinics (GOP) of the University College Hospital (UCH), Ibadan, Nigeria. Independent predictors of level of awareness of mammography were identified using multiple logistic regression analysis. RESULTS: The proportion of women who ever heard of mammography was 5%, and they demonstrated poor knowledge of the procedure. Those with primary or secondary levels of education were about three times less likely to be aware of mammography when compared with those with tertiary level of education (OR = 0.3, 95% CI, 0.12 - 0.73). Also, participation in community breast cancer prevention activities (OR = 3.4, 95% CI, 1.39 - 8.36), and previous clinical breast examination (OR = 2.34, 95% CI, 1.10 - 4.96) independently predicted mammography awareness. Newspapers and magazines appeared to be the most important sources of information about mammography screening. CONCLUSION: The level of awareness of mammography is poor among women attending outpatient clinics in the studied population. Interventions promoting awareness of this screening procedure should give particular attention to the illiterate and older women while clinicians performing breast examinations should utilize the opportunity to inform women about the mammography procedure. Promotion of educational articles on breast cancer and its screening methods via media remains vital for the literate.

The Trend of Cholecystectomies After the Introduction of Laparoscopic Surgery in a District Hospital in Abuja, North Central Nigeria.

Background Laparoscopic cholecystectomy is not readily available in secondary care hospitals in Nigeria, even though it is now the gold standard for the treatment of cholelithiasis and other gallbladder diseases worldwide. Thus, many hospitals in Nigeria still offer open cholecystectomies. This retrospective study investigated the trend of cholecystectomies performed in the general surgery unit of a district hospital in Abuja before and after the commencement of laparoscopic surgery services in 2016. Methodology This retrospective study was conducted in Asokoro District Hospital, Abuja, Nigeria The records of all patients who underwent a cholecystectomy from January 2000 to December 2019 were retrieved and analyzed for the number, types, and rate of cholecystectomies performed per year. All open cholecystectomies were performed via a right subcostal incision, whereas all laparoscopic cholecystectomies were performed via the standard four-port incisions approach. Results A total of 96 patients underwent cholecystectomies from January 2000 to December 2019. In total, 50 (52.08%) open cholecystectomies were performed in 20 years with a yearly average of 2.5, and 46 (47.92%) laparoscopic cholecystectomies were performed in four years with a yearly average of 11.5. The trend of open cholecystectomies in four years dropped from three (30%) in 2016 to one (5.26%) in 2019, whereas laparoscopic cholecystectomies increased from seven (70%) to 18 (94.74%) within the same period. Conclusions There is a drop in the trend of open cholecystectomies and an increase in both laparoscopic and total cholecystectomies in our hospital. We recommend adequate capacity and subsidized laparoscopic cholecystectomy for secondary healthcare facilities in Nigeria.

Pattern of Mammography Utilization by Women Attending Asokoro District Hospital, Abuja, Nigeria.

Introduction: Mammography is a major tool for the screening and diagnosis of breast cancer globally. Poor funding and lack of good public health education for mammography in resource-limited countries limit access to mammographic services. In these settings, patients bear the cost of breast cancer screening from out-of-pocket expenses. The aim of this study was to interrogate the pattern of utilization of mammography by women of childbearing age, who attended Asokoro District Hospital (ADH) for Healthcare, with the view to increase uptake. Materials and Methods: This was a 4-year retrospective, cross-sectional study of 534 women who attended ADH from July 2015 to June 2019 for screening or diagnostic mammography. Data were extracted from completed questionnaire by women who had mammography during the period under review. The data were entered into Statistical Package for the Social Sciences version 27 by IBM for analysis. Results: The mean age of the women was 47.8 years ± 7.7 with a range of 30-82 years. Most of the women, 525 (94.9%), were referred for mammography by health workers; only nine (5.1%) had mammography on self-referral. In all, 71% of the women paid for their mammography from their pockets, whereas 28.1% made payments through the National Health Insurance Scheme (NHIS). A total of 100% of women who reported for mammography on self-referral paid for the services from their pockets. The association between the funding options and mode of referral was statistically significant, P = 0.049. Conclusion: This study showed that referral for mammography by health workers was responsible for not only most of the mammograms conducted but also all the women who utilized NHIS to pay for this service. Resources should therefore be directed towards creating awareness among health workers, especially with the present level of NHIS coverage in the population, in order to increase the uptake of screening mammography in the population.

Endothelium removal augments endothelium-independent vasodilatation in rat mesenteric vascular bed.

BACKGROUND AND PURPOSE: The vascular endothelium regulates vascular tone by releasing various endothelium-derived vasoactive substances to counteract excess vascular response. We investigated whether the vascular endothelium regulates vasodilatation via released endothelium-derived contracting factors (EDCFs), by examining the effect of endothelium removal on responses to periarterial nerve stimulation (PNS) and various vasodilator agents. EXPERIMENTAL APPROACH: The rat mesenteric vascular bed was perfused with Krebs solution. Vasodilator responses to PNS and 5 min perfusion of vasodilator agents in preparations with endothelium were compared with those in the same preparations without endothelium. The endothelium was removed by 30 s perfusion with sodium deoxycholate. KEY RESULTS: Endothelium removal significantly augmented vasodilator responses to PNS and calcitonin gene-related peptide (CGRP), isoprenaline (beta-adrenoceptor agonist), SNP and 8-bromo-cGMP (8-Br-cGMP; cGMP analogue) but not BAY41-2272 (soluble guanylate cyclase activator). The augmentation of SNP-induced vasodilatation after denudation was much greater than that of CGRP- or isoprenaline-induced vasodilatation. In the preparations with an intact endothelium, L-NAME (nitric oxide synthase inhibitor) significantly augmented vasodilator responses to PNS and CGRP, isoprenaline, SNP and 8-Br-cGMP, but not BAY41-2272. Indomethacin (cyclooxygenase inhibitor) and seratrodast (thromboxane A(2) receptor antagonist), but not phosphoramidon (endothelin-1-converting enzyme inhibitor) or BQ-123 (selective endothelin type A receptor antagonists), significantly augmented vasodilator responses to PNS and CGRP, isoprenaline, SNP and BAY41-2272. CONCLUSION AND IMPLICATION: These results suggest that the endothelium in rat mesenteric arteries regulates and maintains vascular tone via counteracting not only vasoconstriction through releasing endothelium-derived relaxing factors, but also vasodilatation, in part by releasing an EDCF, thromboxane A(2).

Demonstration of the high collection efficiency of a broadband Mo/Si multilayer mirror with a graded multilayer coating on an ellipsoidal substrate.

A graded and broadband Mo/Si multilayer mirror for EUV spectroscopy is demonstrated. This mirror has an average reflectivity profile of 16% in the wavelength region from 15 nm to 17 nm and an effective area of 1100-1500 mm(2). This reflectivity is about 4 times larger than that of a standard Mo/Si multilayer mirror on a 1 in. diameter substrate, showing that the mirror can be used for measuring EUV fluorescence at wavelengths in the region around 15 nm to 17 nm.

Noninvasive method to obtain input function for measuring tissue glucose utilization of thoracic and abdominal organs.

We have developed a method for the noninvasive estimation of regional tissue glucose utilization in humans that employs positron emission tomography (PET) and 2-(18F)fluoro-2-deoxy-d-glucose (FDG). Unlike other methods, the input function used in this method is obtained from the corrected time-activity curve of the descending aorta, not the left ventricle, because the descending aorta is relatively free of spillover from other organs and extends from the upper thorax to the lower abdomen. With this method the time-activity curve of the descending aorta must be corrected for the partial volume effect and the difference in counts between plasma and whole blood. Using the noninvasively obtained input function, regional tissue glucose utilization was calculated by Patlak graphic analysis. k1k3/(k2 + k3) was in good agreement with k1k3/(k2 + k3) calculated from the plasma input function by arterial sampling (r = 0.9995). These results suggest that the input function and regional tissue glucose utilization (not only of myocardium but also of other thoracic and abdominal organs) can be determined noninvasively.

Effect of total adipose weight and systemic hypertension on left ventricular mass in children.

To investigate the effect of obesity and hypertension on left ventricular (LV) mass in children, we performed echocardiography and measured the height, weight, and blood pressure of 267 healthy children (145 boys and 122 girls) aged 12 years. The percentage of body fat was estimated using bioelectric impedance to derive the total adipose weight and lean body weight. End-diastolic measurements of LV parameters were obtained from M-mode echocardiograms. The LV mass was calculated by using the formula of Devereux et al. A strong positive correlation was demonstrated between non-normalized LV mass and height or other measures of body size. Systolic blood pressure was weakly correlated with non-normalized LV mass in boys. The impact of height on LV mass differed between boys and girls. Thus, different allometric formulas to normalize the LV mass for height were determined, using the height to the 3.1 and 1.9 powers for boys and girls, respectively. Regression analysis revealed that only total adipose weight affected the normalized LV mass, and that the effect of total adipose weight was greater in girls than in boys. The obese children had a significantly greater normalized LV mass than the nonobese children. The increase in the LV mass due to obesity appeared to be eccentric, because of the lack of an association between the indices of obesity and relative wall thickness. Our data indicate that appropriate normalization of LV mass is necessary for each study population, and that LV hypertrophy due to obesity begins in childhood.

Pharmacological actions of AH-9700 on micturition reflex in anesthetized rats.

In radioligand binding assays, AH-9700 (1-[2-(3,4-dihydro-6,7-dimethyl-2-naphthalenyl)ethyl]pyrrolidine fumarate) had high affinity for sigma receptors and moderate affinity for muscarinic receptors. The affinity of AH-9700 for sigma(1) receptors was significantly reduced in the presence of 5'-guanylyl-imidodiphosphate (GppNHp). In isolated bladder strips of rats, AH-9700 inhibited carbachol-induced contractions. In anesthetized rats, i.v. administration of AH-9700 and typical sigma receptor ligands, (+)-pentazocine and 1,3-di-o-tolylguanidine (DTG), but not oxybutynin, dose-dependently inhibited rhythmic isovolumetric reflex bladder contractions. AH-9700 and oxybutynin suppressed the amplitude of rhythmic bladder contractions. On the other hand, at doses lower than used i.v., the i.c.v. administration of AH-9700 or the sigma receptor ligands inhibited rhythmic bladder contractions without suppressing the amplitude. This inhibitory effect of AH-9700 was markedly reduced by pretreatment with i.c.v. pertussis toxin. These results suggest that AH-9700 exerts a marked anti-micturition reflex effect through central sigma receptors possibly related to pertussis toxin-sensitive Gi/o-proteins and a moderate spasmolytic effect based on its peripheral anti-muscarinic activity.

Analysis of sarcoplasmic reticulum proteins in patients susceptible to malignant hyperthermia.

It has been suspected that the cause of malignant hyperthermia (MH) is an abnormality in the sarcoplasmic reticulum of skeletal muscle. We isolated the sarcoplasmic reticulum from malignant hyperthermia-susceptible (MHS) patients and controls and analysed the protein composition with sodium dodecyl sulfate polyacrylamide gel electrophoresis. There were no remarkable changes in the sarcoplasmic reticulum protein composition profile of the scanned gel of the patients. Quantitative measurement of the relative proportion of each band in the gel, however, revealed a slight decrease in calsequestrin and a slight increase in protein of molecular weight 23,000. (Ca2+ -Mg2+)ATPase had no altered subfragments in MHS patients. Crude mitochondrial proteins and myoplasmic proteins showed minor alterations in composition in some patients. The data supported the thesis that malignant hyperthermia is due to defects in several different cell membranes including the sarcoplasmic reticulum and the mitochondria.

Analysis of non-histone chromatin proteins in porcine malignant hyperthermia.

Non-histone chromatin proteins (NHCP) were isolated from skeletal muscle, left ventricle and liver of swine susceptible to malignant hyperthermia and from controls. These proteins were extracted with phenol buffers and fractionated by polyacrylamide gel electrophoresis. Isoelectrofocusing gel electrophoresis revealed quantitative differences in NHCP from skeletal muscle between disease and control groups. The high resolution of proteins by two-dimensional polyacrylamide gel electrophoresis showed a relative similarity between skeletal muscle, heart and liver although some differences could be discerned. Non-histone chromatin proteins of molecular weight 35,000-45,000, focusing between pH7 and 9, were increased in skeletal muscle nuclei derived from malignant hyperthermia-susceptible swine. These proteins appear to be important in the maturation of messenger RNA. No alterations were seen in either heart or liver. We conclude that an increase in NHCP which is associated with the processing of messenger RNA, may be important in the phenotypic expression in skeletal muscle of malignant hyperthermia in swine.

Effect of obesity on echocardiographic parameters in children.

We studied the effect of obesity on echocardiographic parameters in Japanese children. The subjects were 341 children: 106 first graders (age 6 years), 166 seventh graders (age 12 years), and 69 tenth graders (age 15 years). They were assigned to six groups according to school grade and sex. Echocardiographic parameters included thickness of the interventricular septum and of the posterior wall, end diastolic left ventricular internal dimension, and left ventricular mass. Left ventricular parameters were normalized for height, and for height to the power of 2.7. The obesity index as well as the body mass index were used to estimate obesity, because the obesity index is frequently used in Japan. There were significant correlations between the indices of obesity and left ventricular internal dimension or left ventricular mass in each group. The obesity index was more strongly correlated than the body mass index with posterior wall thickness and left ventricular internal dimension. For normalization of left ventricular parameters, correction for height was better for the first graders, whereas correction for height to the power of 2.7 was better for seventh and tenth graders. The most important finding was that the effect of obesity on left ventricular parameters was evident at 6 years of age.

Influence of medium-chain triglyceride-based lipid emulsion on rat polymorphonuclear cell functions.

Intravenous lipid emulsions are used as energy and essential fatty acids sources. There are controversial reports postulating in vitro and in vivo inhibitory effects of long-chain triglycerides (LCT) upon the blood polymorphonuclear leukocytes (PMNL) functions. In the present study the in vivo and in vitro effects of LCT and a physical mixture of medium- and long-chain triglycerides (MCT/LCT) emulsions were investigated on select PMNL functions, i.e., chemotaxis, phagocytosis, and bacterial killing. Blood from 20 rats was incubated with LCT, MCT, MCT/LCT, and saline, respectively. MCT-containing emulsions exhibited an inhibitory effect on all PMNL functions investigated, whereas LCT exerted an effect on the phagocytic index only. The administration of a parenteral supply of LCT, MCT/LCT, and saline for 30 h followed by saline infusion for 14 h in discontinuous mode did not influence any of the investigated PMNL functions. Similarly, continuous infusion over 44 h at increasing infusion rates up to 1.5 mL/h did not affect the PMNL functions. The obvious difference between in vitro and in vivo response of the PMNL model emphasizes the necessity for continuous monitoring of in vivo conditions. Appropriate interpretation of the data requires continuous circumspection and consideration of trials in a clinical setting.

Interactions among protein molecules in freeze-gel of soymilk and protein structures in heated soymilk during cooling.

To estimate the interactions forming in soymilk freeze-gel, lyophilized gel was extracted successively with various solvents. A mixture of urea, sodium dodecyl sulfate (SDS), and 2-mercaptoethanol (2-ME) dissolved the proteins effectively. The thiol-disulfide exchange reactions and hydrophobic interactions were shown to have a complex relation with a three-dimensional network. The addition of SDS or 2-ME resulted in an incomplete gel or no precipitation of soymilk. In our previous paper (Shimoyamada et al. Food Sci. Technol. Res. 1999, 5, 284-288), the significance of precooling to form small, homogeneously distributed ice crystals in soymilk was reported. In this study, precooling was shown to maintain the partially denatured structures of soybean proteins in soymilk that had unfolded due to heat treatment. These phenomena were considered to be other important functions of precooling in freeze-gelation.

[Early detection of absorption of irrigating fluid during transurethral resection of the prostate with alcohol gas detector tube].

Nineteen patients (mean age, 70 years; range, 58-80 years) undergoing elective transurethral resection of benign hypertrophy of the prostate (mean weight of resectate, 25 g; range 10-59 g; mean resection time, 61 min; range 45-80 min) under spinal anesthesia were studied for early detection of absorption of irrigating solution by means of expired breath alcohol analysis. The irrigating fluid used in all resections was tenfold diluted Urigal solution containing 1% ethanol. Expired breath was collected into a rubber bag every 10 min during the surgery, and the concentration of ethanol was analyzed using a gas detector tube (GASTEC LTD.). Hemodynamic parameters including central venous pressure were routinely measured at the same intervals. The volumetric fluid balance was measured every 20 min. Blood was collected preoperatively, at the same 20-min intervals during the resection, and 4-6 hours after the end of the operation. Serum electrolytes, hemoglobin and total plasma protein concentration were measured, and blood gas tension was analyzed. Mean arterial pressure, central venous pressure, blood gas tension showed no significant changes at these observed time intervals. Heart rate decreased 120 min after the start of the operation. Ethanol was detected in the expired breath 10 min after the start of the surgery, and showed progressive increase in concentration until the end of the surgery. Serum electrolyte concentrations and hemoglobin content showed gradual decrease proportional to the increase in irrigating fluid volume. The ethanol concentration in the expired breath was significantly correlated with the change in serum sodium concentration.(ABSTRACT TRUNCATED AT 250 WORDS)

[Analysis of cerebral blood flow SPECT imaging on standard brain atlas in patients with dementia of Alzheimer type].

Statistical parametric map (SPM) has been developed by Friston et al. to analyze focal changes in rCBF induced by brain activation. This automated and objective approach has the potential of being applied to SPECT image data sets. This study evaluated an automated analysis of brain SPECT imaging in patients with dementia of Alzheimer type (DAT) using SPM95. Seventeen patients with clinically diagnosed moderate to severe DAT and nine normal control subjects were studied. The SPECT device used was a triple-headed rotation gamma camera GCA9300A/HG. All images were transformed into the standard anatomical space of the stereotactic brain atlas of Talairach and Tournoux, and then smoothed. Statistical analysis was made between DAT and normal control groups. SPM analysis of SPECT images revealed that the parieto-temporal areas and posterior cingulate gyrus of both cerebral hemispheres were significantly decreased in DAT patients compared to normal controls. In conclusion, SPM analysis of SPECT images proved to be useful in the evaluation of abnormal perfusion areas of demented patients.

[Stepwise analysis of cerebral blood flow SPECT imaging on standard brain atlas in patients with dementia of Alzheimer's type].

Statistical parametric mapping (SPM) has been developed by Friston et al. to analyze focal changes in regional cerebral blood flow (rCBF) induced by brain activation. This automated and objective approach has the potential of being applied to single photon emission computed tomography (SPECT) image data sets. This study evaluated an automated analysis of N-isopropyl-p[123I]iodoamphetamine SPECT (123I-IMP) imaging in patients with dementia of Alzheimer's type (DAT) using statistical parametric mapping '95 (SPM'95). Eighteen patients with clinically diagnosed mild to severe DAT who were classified into two groups and ten normal control subjects were studied. The SPECT device used was a triple-headed rotation gamma camera. All images were transformed into the standard anatomical space of the stereotaxic brain atlas of Talairach and Tournoux, and then smoothed. Statistical analyses were made between severe DAT, mild DAT and normal control groups. SPM analysis of 123I-IMP SPECT images revealed that the parietotemporal association areas and posterior cingulate gyri of both cerebral hemispheres were significantly decreased in CBF in mild DAT group compared to normal controls. In comparison of DAT groups, the right hippocampal area and basal forebrain were significantly decreased in CBF in severe DAT group. In conclusion, these results obtained by SPM analysis of SPECT images suggested that the right hippocampal area and basal forebrain followed the parietotemporal association areas and posterior cingulate gyri in the reduction of the rCBF in patients with DAT.

[Minimal-flow xenon and semiclosed circuit anesthesia for computed tomographic measurement of local cerebral blood flow (LCBF)].

For the purpose of decreasing the volume of expensive xenon, anesthesia with minimal-flow xenon and semiclosed circuit were induced for computed tomographic LCBF measurement. Eighteen patients with ischemic cerebral disease were studied. Anesthesia was induced with minimum dose of thiopental, diazepam and fentanyl. Muscle relaxation was obtained by means of pancuronium bromide. Patients were intubated and ventilated mechanically with flows of 6 l/min. O2 for 20 to 30 minutes to eliminate nitrogen from the system. O2 concentrations in semiclosed circuit were monitored throughout the procedures using galvanic battery. Endtidal CO2 tension was also measured for maintaining normocarbia. Blood gas analyses were carried out before xenon inhalation, during xenon inhalation and immediately before stopping inhalation of xenon-oxygen mixture. Xenon inhalation programs were subdivided into three groups, each of them consisted of 6 patients. The formula for calculating fresh gas flow for low flow semiclosed circuit was introduced according to Shimoji's which was based on the original formula of Foldes. O2 concentration in circuit was predicted to be 25%. Mean xenon uptake for initial 20 minutes was predicted to be 125 ml/min. or 360 ml/min. (Formula: see text) (CRO2: O2% in semiclosed circuit. FO2: fresh O2 flow ml/min. FXe: fresh xenon flow ml/min. VO2: oxygen consumption ml/min. VXe: mean xenon uptake ml/min.) The first group started xenon inhalation during pure xenon inflow into semiclosed circuit for two minutes and followed by about 68% xenon in O2 inhalation for 23 minutes. FXe and VXe were fixed at 700 ml/min and 360 ml/min respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

[The effect of isoflurane on plasma concentration-response curve of vecuronium determined with continuous infusion method].

To investigate the interaction between vecuronium and isoflurane at the neuromuscular junction in man, I determined the plasma concentration-response curve of vecuronium both under balanced and isoflurane (0.7% and 1.2% end-tidal) anesthesia. In addition, I also determined clinically the infusion rate of vecuronium that made a suitable sustained relaxation possible. I used train-of-four (TOF) stimulation to monitor neuromuscular blockade by vecuronium. Plasma isoflurane concentration was kept constant throughout the observation period. Plasma clearances of vecuronium calculated from the infusion rate and resulting plasma concentration were also found not to be different among the three groups. A significant leftward shift of the concentration-response (T1 inhibition) curve was found both between 1.2% isoflurane group and NLA group, and between 1.2% isoflurane group and 0.7% isoflurane group. The relationship between T1 inhibition and TOF ratio reduction was found not to be different among the three groups. I conclude that 1.2% isoflurane potentiates vecuronium-induced T1 inhibition, but it does not affect the relationship between T1 inhibition and TOF ratio reduction in man. It is helpful for clinical determination of the infusion rate to measure the time period from bolus administration of vecuronium 0.1 mg.kg-1 to reappearance of T3.

[Anesthesia for a patient with pemphigus erythematosus].

An 82-year-old female with pemphigus erythematosus had the head of femur replaced. In her case, systemic lupus erythematosus and myasthenia gravis, typical complications of pemphigus erythematosus, were not present. As even slight friction easily causes blisters in patients with pemphigus, we paid attention mainly to fragility of the skin and the mucus membranes and were careful to minimize physical stimulation of the skin. Because the mucosa of the pharynx or oral cavity could easily be damaged and form blisters during intubation, which in turn might make the management of the upper airway more difficult, we selected spinal anesthesia. No serious perioperative complications, except a few blisters around the wound were observed. We thus successfully managed anesthesia of a patient with pemphigus erythematosa.

[The influences of local anesthetics on ryanodine-induced contracture in rat skeletal muscle].

One hundred and fifty paired extensor long digital muscles were excised from Wistar rats and each muscle was prepared in Krebs-Ringer's solution (K-R solution) then gassed with a mixture of 95% O2-5% CO2. The medium for the control muscles was replaced with K-R solution containing 10(-6) M ryanodine and that for the experimental muscles was replaced with medium containing 10(-6) M ryanodine and local anesthetic (LA) (procaine, tetracaine, benzocaine, lidocaine or bupivacaine at various concentration). Isometric contracture tension was recorded throughout the experiment. The ratios of the maximal contracture tension (C-ratio) and the elapsed time (T-ratio) of the muscles treated with LA compared to those of control muscles were calculated. Tetracaine (0.125-1.0 mM) specifically reduced the C-ratio. Procaine (0.5-1.0 mM) and tetracaine (10-60 microM) increased the T-ratio. Procaine (8-16 mM), benzocaine (4-8 mM), lidocaine (0.5-4 mM) and bupivacaine (0.125-1 mM) reduced the T-ratio. The influences of LAs on ryanodine-induced contracture could be explained in terms of their effects on the Ca(2+)-induced Ca2+ release mechanism, direct Ca2+ efflux from sarcoplasmic reticulum (SR), activity of Ca2+ uptake into SR and ryanodine-receptor binding. The complexity of LA effects on ryanodine-induced contracture will affect the results of ryanodine contracture tests for malignant hyperthermia when the muscle specimen is excised under local anesthesia.