Effects of interpleurally administered bupivacaine 0.5% on opioid analgesic requirements and endocrine response during and after cholecystectomy: a randomized double-blind controlled study.

In 30 patients undergoing cholecystectomy, a randomized double-blind saline-controlled study was performed using interpleural 0.5% bupivacaine with or without epinephrine (5 micrograms.ml-1) in combination with 0.8% halothane inspired concentration in oxygen. The aim of the study was to investigate whether interpleural 0.5% bupivacaine could decrease the intraoperative opioid requirements and attenuate the metabolic endocrine response to surgical stress. Patients were randomly allocated to one of three groups: Group 1: 0.5% bupivacaine; Group 2: 0.5% bupivacaine with epinephrine (5 micrograms.ml-1); and Group 3: saline. The interpleural catheter was inserted after induction of anesthesia in the spontaneously breathing patient. The study drug was injected 30 min prior to surgery. Peak plasma bupivacaine concentrations in the respective groups were 1.30 +/- 0.78 and 1.16 +/- 0.48 micrograms.ml-1. In all patients concentrations were below suggested convulsive level. Two patients in Group 1 and two in Group 2 required intraoperative fentanyl (0.1 mg each). In contrast, eight patients in the saline group received an average of 0.21 mg (range 0.1 +/- 0.4 mg) fentanyl (P less than 0.05). Postoperatively, a second dose of the study drug was given. Subsequently, pain was assessed using a visual analog score and a verbal rating scale. Pain scores decreased significantly 30 min after the interpleural injection in both bupivacaine groups and remained unchanged in the saline group (P less than 0.05). Pain management by means of interpleural bupivacaine was successful in 17 of the 20 patients. In the saline group seven out of ten patients needed additional analgesics (P less than 0.05). Cortisol levels increased in response to surgery in all groups: maximum levels in Groups 1, 2 and 3 were: 1.09 +/- 0.29, 1.11 +/- 0.20 and 1.19 +/- 0.16 mumol.l-1, respectively. Plasma glucose concentrations increased significantly in all groups: maximum levels in Groups 1, 2 and 3 were: 7.6 +/- 1.3, 7.3 +/- 1.7 and 8.3 +/- 1.7 mmol.l-1, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Formulation of a stable p-acetylaminohippurate infusion fluid and determination of the serum concentrations.

An infusion fluid with p-acetylaminohippurate (PACAH) was formulated and a method for analysis of PACAH in serum, urine and infusion fluid based on reversed phase HPLC was developed. No significant degradation could be observed after steam sterilization for twenty minutes at 120 degrees C. From the results of an investigation of the degradation rate at elevated temperatures a negligible loss of content during storage for three years at 20 degrees C could be predicted. Steady state serum concentrations of PACAH after constant infusion were determined.

Can determination of lactic acid and pyruvic acid in cerebrospinal fluid help in diagnosing central nervous system involvement in systemic lupus erythematosus?

The central nervous system (CNS) is frequently affected by systemic lupus erythematosus (SLE). Other causes, especially infection, may also originate CNS disease in SLE patients. Our findings indicate that measurement of lactic acid and pyruvic acid in cerebrospinal fluid (CSF) may be of help in separating inactive CNS-SLE from active CNS-SLE. Also it may be of help in differentiating sterile meningitis caused by SLE from bacterial meningitis. Because of the special risk on tuberculous and fungal infections in SLE patients, also some findings concerning these specific forms of meningitis are given.

In vitro studies of 5, 10-methylenetetrahydrofolate reductase: inhibition by folate derivatives, folate antagonists, and monoamine derivatives.

Folate monoglutamates and folate antagonists have an inhibitory action on the activity of 5,10-methylenetetrahydrofolate reductase in rat brain. The type of inhibition was studied for dihydrofolic acid using the Lineweaver--Burk transformation. Some of the monoamine alkaloids, the in vitro products of 5,10-methylenetetrahydrofolate reductase, have either a stimulatory or inhibitory effect on the enzyme activity.

A patient with pyruvate carboxylase deficiency in the liver: treatment with aspartic acid and thiamine.

A seven-year-old girl with slowly progressive motor neurological impairment and high levels of lactate and pyruvate in blood and cerebrospinal fluid was found to have severe hepatic pyruvate carboxylase deficiency. However, in contrast to other patients with this deficiency, no mental retardation was apparent. Treatment with aspartic acid and thiamine over a period of seven years resulted in biochemical improvement and a stable neurological condition. The level of cognitive functioning remained the same. When treatment with aspartic acid was temporarily discontinued, lactate and pyruvate concentrations increased so markedly that the drug was resumed. This indicates that aspartic acid was the effective drug, and that the effect of thiamine was secondary.

Reduction of duration and severity of megimide seizures in rats on a folic acid deficient diet.

Folic acid deficient diet reduces the duration and severity of intravenous megimide seizures in the rat after 6 months of diet. Plasma and serum folate levels are strongly reduced after that period. The difference between Lactobacillus casei and Streptococcus faecalis activity in brain show a slight, but not significant, decrease after 12 months of diet.

Effects of change in dietary folic acid content on pentylenetetrazol seizure threshold in rat.

Pentylenetetrazol (PT) eeg thresholds were measured in rats on a folic acid (FA) deficient diet, normal diet, and a diet supplemented with large amounts of folic acid. The intraperitoneal dose per kilogram body weight of PT is significantly higher in the FA deficient group and significantly lower in the FA supplemented group than in rats on a normal diet. This indicates an effect of FA metabolism on PT epilepsy. The Lactobacillus casei minus Streptococcus faecalis activity of the brain is decreased in the FA deficient and increased in the FA supplemented group. The relation between brain folate metabolism and epilepsy is discussed.

Bone marrow imaging with 59Fe.

Commerically available collimators are not suitable for the visual demonstration of the kinetics of 59Fe, because of its physical properties. A locally designed collimator, that provides integral visual information of the whole body distribution of erythropoietic marrow, is discussed. Wholebody scans of 4 individuals are also included to demonstrate the capabilities of the collimator.