Twenty-four hour hyperinsulinemic-euglycemic clamp improves postoperative nitrogen balance only in low insulin sensitivity patients following cardiac surgery.

BACKGROUND: Critically ill patients often suffer from a protein catabolic state. The aim of this study was to demonstrate that nitrogen balance (NB) in cardiac patients admitted to the intensive care unit (ICU) is related to their insulin sensitivity level and that supraphysiologic doses of insulin can restore anabolism. MATERIALS AND METHODS: Twenty-eight patients that were admitted to ICU in enteral and/or parenteral nutrition have been enrolled in this study. All patients received a standard nutrition protocol for at least 3 days before starting the study. These patients received either enteral or parenteral nutrition based on 1.4 kcal/kg/h and 1.1 g/kg/24 h of proteins. Participants were studied for three 24 h periods (P1 , P2 , and P3 ). Twenty-four hour NB was calculated from urinary urea nitrogen excretion, fixed protein and energy intake during each of the three periods (P1 , P2 , and P3 ). Simultaneous to P2, a 24 h hyperinsulinemic-euglycemic clamp (HEC) was performed to determine patients' insulin sensitivity (IS) or insulin resistance (IR), as well as the impact of high doses of insulin on NB. RESULTS: Nitrogen balance remained consistently positive in the IS group regardless of the clamp. In IR patients, NB was negative before the clamp and became positive during P2 and P3 . Insulin sensitivity improved during the HEC in IR patients (P < 0.001). CONCLUSIONS: A negative NB was found only in insulin resistant patients admitted to the ICU for more than 7 days. A 24-h period HEC improved NB in these patients.

Motion sickness susceptibility patterns of psychotic illness.

Motion sickness susceptibility can be used as a neurophysiologic index to establish a polar spectrum of personality difference. Previous observations on a psychiatric patient population have shown that persons in transition between these extremes enter the hospital at a younger age, have a longer stay, and are more likely to receive a diagnosis of schizophrenia. The relationship of this midspectrum, early-onset disorder to other psychotic illnesses has been unclear. Examination of a large sample shows that a midspectrum psychiatric illness, which is most common in young men and is usually diagnosed as schizophrenia, is balanced at the extremes of susceptibility by an older-onset illness, which is most common in women and is often diagnosed as affective in nature. A gradual transition appears to exist between the two types of illness.

Motion sickness--key to neurobiologic variation.

Individual variation in motion sickness susceptibility correlates with a wide variety of perceptual, cognitive, and personality variables suggesting that it may be a unique index of individual difference in fundamental mechanisms of the orientation process. Data from a large ongoing clinical study involving over 1,500 psychiatric inpatients indicate a clear-cut association between a number of the MMPI scales (including Social Isolation, Ego Strength and Schizophrenia) and motion sickness susceptibility. Marked difference across the motion sickness susceptibility spectrum in the condition on discharge of lithium and antidepressant treated patients was also found, when compared to other drug therapies, suggesting specific drug responses by the motion sick group.

Early postpartum discharge at a university hospital. Outcome analysis.

OBJECTIVE: To determine whether implementation of an early hospital discharge policy was effective in safely reducing hospital stay and acceptable to patients. STUDY DESIGN: The study was a prospective, observational trial. Early discharge was defined as discharge from the hospital either on the first day after vaginal delivery or on the second day after delivery by cesarean section. A "stayover mom" policy was subsequently implemented to allow a mother the option to remain in the hospital overnight after discharge. This prospective study was divided into three consecutive three-month periods: (1) routine care (n = 576), (2) early discharge (n = 622), and (3) early discharge with stay-over mom (n = 574). Primary outcome measurements were length of hospital stay and patient willingness. RESULTS: With proper review of written instructions, all eligible patients were willing to be discharged early. As compared with the routine care group, the length of hospital stay was shorter by 0.8 days (95% CI, 0.4-1.2 days) in the early discharge group (P < .01) and by 1.1 days (95% CI, 0.5-1.7 days) in the early discharge with stayover mom group (P < .005). The stayover mom policy was more desirable because of limitations in obtaining timely transportation and concern about the infant warranting continued observation. The need for maternal readmission was rare (15 cases, 0.8% of total), with endometritis equally common (n = 3 in each group). CONCLUSION: Early postpartum discharge, especially including a stayover mom policy, was acceptable to our predominantly Medicaid population. The reduced hospital stay was not associated with increased maternal morbidity.

A clinically useful polling technique for assessing susceptibility to motion sickness.

Susceptibility to motion sickness is a powerful index of individual differences and can be assessed in large populations without a test of performance. Although all questionnaire techniques introduce some error, we have demonstrated that a simple set of questions can lead to a five-point rating system with adequate validity and reliability. Our observations may be useful to any investigator interested in individual differences and have been extremely effective in sorting out behavioral trends in large samples of patients.

Relationship between visual orientation and susceptibility to motion sickness.

24 male subjects were divided into 3 groups, on the basis of their susceptibility to motion sickness. All subjects were then required to set a luminous line in an apparently vertical position while viewing the line from a body position which was deviated 70 degrees laterally from the upright. No visible frame of reference was available. A significant relationship between motion sickness susceptibility and errors in judging the vertical was discovered, the "intermediate" susceptibility group making the greatest errors. The role of the vestibular system in visual orientation and motion sickness is discussed. The result also indicates the potential value of using perceptual performance as a tool in the study of motion sickness and its correlates.

Adaptation of the visual vertical during prolonged body tilt varies with susceptibility to motion sickness.

Judgments of the visual vertical, made without a visual reference frame-work, from a tilted-body position, result in systematic constant errors (Aubert effects). Pitblado and Mirabile (1977) showed that these errors vary with motion-sickness susceptibility, persons of intermediate susceptibility showing the greatest error. Recent exploratory work suggested patterns of progressive intra-session change in Aubert effects which might further differentiate groups of differing susceptibility. The raw data for Pitblado and Mirabile's 1977 study were reanalyzed for possible progressive change. This new analysis showed significant progressive reductions in Aubert effects for groups originally high and low, but a nearly significant increase in the intermediate group. New implications concerning group differences in vestibular function are discussed.

Anesthetic management for right upper extremity amputation due to recidivous cutaneous carcinoma and acute postoperative pain control in patients affected by epidermolysis bullosa.

A 22-year-old male who was affected by epidermolysis bullosa (EB) and xeroderma pigmentosa (with structural and pathological changes that preclude orotracheal intubation) underwent right upper extremity amputation and ipsilateral axillary lymphadenectomy. The patient was operated without intubation, thereby assuring an optimal state of acute postoperative pain control by regional anesthesia. Intravenous administration of ketamine and remifentanil plus low-dose sevoflurane resulted in anesthesia with spontaneous breathing by the patient. Moreover, the intraoperative brachial plexus nerve block before amputation followed by positioning of an epidural catheter to deliver continuous infusion of local anesthetics close to the cut nerves during surgery obtained a very good level of acute postoperative pain control.

Separation of affective disorder into seasonal and nonseasonal types using motion sickness susceptibility as a marker.

A sample of 133 candidates for antidepressant or mood-stabilizing medication treatment, with acute onset or a new phase of illness between the autumnal and vernal equinoxes, was gathered over a 3-year period from a private outpatient practice. All patients were diagnosed using DSM-III-R criteria, rated on a standard motion sickness (MS) questionnaire, and asked whether they had experienced cardinal symptoms of seasonal affective disorder (SAD). There was a positive relationship between greater MS and SAD in the entire patient sample. When a subsample of 23 patients was given a 2-week trial of phototherapy and rated for improvement, MS-susceptible patients responded better than MS-resistant patients.

Motion sickness susceptibility and solution choice in a pragmatic paradox.

This paper reports on an experiment which employed a classic paradox, known as the 'prisoner's dilemma', to explore possible differences in problem solving preference across a spectrum of motion sickness susceptibility. A mathematical form of the problem was used in which the subject was asked to imagine playing a game without communicating with his hypothetical partner. There were three possible solutions to the problem, a win-win, a lose-lose, and a win-lose solution. The results support the contention that a cognitive bias exists across a spectrum of motion sickness susceptibility, highly motion sick individuals having a greater tendency to pick the solution which allows both participants to win. This bias runs counter to that which might be expected on the basis of personality traits (non-motion sick individuals are more socially involved), and suggests that the cognitive tendency may reflect basic problem-solving strategies rooted in orientation process. The potential implications of these findings are discussed.

Physiologic role of nitric oxide in the maintenance of uterine quiescence in nonpregnant and pregnant sheep.

OBJECTIVE: This study evaluated the role of nitric oxide in the maintenance of uterine quiescence in nonpregnant and pregnant ewes. STUDY DESIGN: Sixteen ovariectomized nonpregnant and 10 pregnant (115 days' gestation) chronically instrumented ewes were studied. Uterine contractility was assessed by electromyography and intrauterine pressure recordings. Nitric oxide synthase inhibition was induced with nitro-L -arginine methyl ester or aminoguanidine (4. 5 mg/kg per hour) given during estrogen replacement with 17beta-estradiol (100 microg/d) or in late gestation. In the pregnant group we evaluated the ability of nitric oxide synthase inhibition to alter the responsiveness to oxytocin-induced uterine contractility. Blood pressure and common internal iliac artery blood flow were assessed to confirm nitric oxide synthase inhibition. In addition, the effects of the nitric oxide donor nitroglycerin and the cyclooxygenase inhibitor indomethacin were studied in nonpregnant sheep. The effect of nitric oxide in vitro on myometrial spontaneous and induced contractions was also studied. RESULTS: In nonpregnant estrogen-replaced sheep, nitric oxide synthase inhibition and nitroglycerin administration did not alter uterine contractility, despite significant changes in blood pressure. In contrast, indomethacin decreased electromyographic results to 70% of baseline after 1 hour and 47% after 2 hours. In pregnant ewes nitric oxide synthase inhibition failed to alter uterine contractility in response to oxytocin. These findings are in contrast to results of the in vitro study in which nitric oxide was shown to relax sheep myometrium. CONCLUSION: The absence of significant effects of nitric oxide synthase inhibition and nitric oxide donors on uterine contractility in vivo suggests that nitric oxide does not play a physiologic role in the regulation of uterine contractility in nonpregnant or pregnant ewes.

Motion sickness: an index of sensory conflict relating to behavior.

Diverse measures of behavior are examined in a student and large patient sample for the purpose of supporting the concept that conflict in sensory mechanisms may contribute to diminished or impaired function. Evidence supports the contention that two patterns of orientation may exist at the extremes of motion sickness susceptibility and that individuals showing transitional patterns of organization may be vulnerable to different kinds of central nervous system disorganization. The authors believe that a consideration of sensory function as it relates to patterns of behavior may contribute to an expansion in the medical model of mental illness.

Susceptibility to motion sickness and field dependence-independence as measured with the rod and frame test.

This paper reports an experiment investigating the relationship between field dependence-independence and susceptibility to motion sickness in a normal volunteer and in a psychiatric patient population. Both variables have previously been related to psychiatric diagnosis and possible differential interaction between the cerebral hemispheres. Anticipated differences in field dependence according to degrees of motion sickness were not found; however, significant male-female and patient-control differences were observed and these occurred primarily in the non-motion sick and intermediate motion sick groups, suggesting that fundamental differences in field attitude do exist across in apparent spectrum of motion sickness.

Nonpregnant sheep uterine type I and type III nitric oxide synthase expression is differentially regulated by estrogen.

The aim of this study was to characterize the effect of estrogen on the expression of neuronal and endothelial isoforms of nitric oxide (NO) synthase (NOS) in myometrium, endometrium, and caruncle (nonglandular endometrium) in nonpregnant sheep. Twenty sheep were castrated during synchronized estrus (Days 14-16) and 4 days after surgery treated i.v. through the jugular with 100 microg/day of estradiol-17beta for 5 (n = 6) or 8 (n = 6) days or with vehicle (n = 8). Nitric oxide synthase mRNA was measured by ribonuclease protection assay, and NOS protein mass was measured by Western immunoblotting. Data were analyzed by ANOVA and Tukey's test. The three distinct uterine compartments studied contained the mRNA and protein for the neuronal (type I NOS) and the endothelial (type III NOS) isoforms of NOS. However, no inducible NOS was detected. Estrogen exhibited a differential effect on NOS expression in a tissue compartment- and NOS isoform-specific manner. In myometrium and caruncles, but not in endometrium, type I NOS mRNA and protein mass increased significantly (p < 0.05) after 5 or 8 days of estrogen. In contrast, type III NOS increased significantly in myometrium only after 8 days, whereas in endometrium and caruncles the increase was significant in the 5-day treatment group (p < 0.05). We conclude that the expression of type I NOS and type III NOS in the uterus are differentially regulated by estrogen. This differential regulation suggests that the NO produced within the uterus serves more than one physiological role. In myometrium it may be a uterorelaxant and regulate glucose utilization, and in endometrium and myometrium it may regulate blood flow.

Susceptibility to motion sickness and ego closeness, ego distance as measured by the autokinetic response tendency.

This paper reports results from one phase in an ongoing study of the relationship between vestibular function and various aspects of personality, cognitive style and symptom formation in mental illness. In the experiment reported here a measure of autokinesis was shown to relate to motion sickness experience as judged by actual stimulation in a rotating chair. Low and intermediate sensitive subjects showed less autokinesis than the most motion sick individuals (two-way analysis of variance F = 5.735, P = 0.006). Males in this sample showed a significantly greater autokinetic tendency than females (two-way analysis of variance F = 6.995, P = 0.011).