Reduction of the gastrointestinal side effects of metrizamide myelography with oral dexamethasone.

A prospective, double-blind study was undertaken to assess the effectiveness of oral dexamethasone premedication in reducing a variety of side effects associated with metrizamide myelography. We also examined the relationship between side effects and needle size, total metrizamide dose, radiographic findings, and personality. Patients were randomly assigned to either a placebo group (44 patients) or a dexamethasone group (38 patients). All patients completed a 24-item symptom checklist before and 24 hr after lumbar myelography. In addition, all patients completed the Minnesota Multiphasic Personality Inventory prior to myelography. Analysis of variance demonstrated a statistically significant decrease in the frequency of gastrointestinal side effects (loss of appetite, nausea, vomiting) in the dexamethasone group. There were no significant differences between the two groups for the other 21 symptoms examined. We concluded that premedication with oral dexamethasone significantly reduces the gastrointestinal side effects associated with metrizamide myelography. This reduction was especially important in older patients.

Pibloktoq (hysteria) and Inuit nutrition: possible implication of hypervitaminosis A.

The hysterical reaction among Eskimo peoples known as pibloktoq, one of a group of aberrant behaviors occurring among Arctic and Circumarctic societies termed 'arctic hysterias', has been explained by a variety of theories: ecological, nutritional, biological-physiological, psychological-psychoanalytic, social structural and cultural. This study hypothesizes the possible implication of vitamin intoxication, namely, hypervitaminosis A, in the etiology of some cases of pibloktoq. Its biocultural approach implicates elements of several explanatory classes, which are not mutually exclusive. Experimental and clinical studies of nonhumans and humans reveal somatic and behavioral effects of hypervitaminosis A which closely parallel many of the symptoms reported for Western patients diagnosed as hysterical and Inuit sufferers of pibloktoq. Eskimo nutrition provides abundant sources of vitamin A and lays the probable basis in some individuals for hypervitaminosis A through ingestion of livers, kidneys, and fat of arctic fish and mammals, where the vitamin often is stored in poisonous quantities. Possible connections between pibloktoq and hypervitamonosis A are explored. A multifactorial framework may yield a more compelling model of some cases of pibloktoq than those that are mainly unicausal, since, among other things, the disturbance has been reported for males and females, adults and children, and dogs.

Detection of tetanus-induced effects in linearly lined-up micropatterned neuronal networks: application of a multi-electrode array chip combined with agarose microstructures.

One of the best approaches to understanding the mechanism of information acquisition and storage is to characterize the plasticity of network activity by monitoring and stimulating individual neurons in a topologically defined network and doing this for extended periods of time. We therefore previously developed an on-chip multi-electrode array (MEA) system combined with an array of agarose microchambers (AMCs). It is possible to record the firing at multiple cells simultaneously for long term and topographically control the cells position and their connections. In our present study, we demonstrated the effect of tetanic stimulation in a linearly lined-up patterned network on the AMC/MEA chip. We detected reproducible activity changes that were induced by tetanic stimulation and saw that these changes were maintained for 6-24 h. The results show the advantage of our AMC/MEA cultivation and measurements methods and suggest they will be useful for investigating the long-term plasticity depending on network topology and size.

Systemic complications with intravenous diazepam.

There are few published reports of complications following intravenous diazepam administration. However, more than 200 cases were reported to the United States Department of Health, Education and Welfare during a 7-year period. The systemic complications have been categorized by the authors, and common contributing factors are emphasized. The information obtained from these reports provides further knowledge of both the avoidance and the treatment of such complications and emphasizes the importance of reporting the adverse effects of any drug to a central body.

Efficacy and safety of nitrous oxide in alleviating pain and anxiety during painful procedures.

AIMS: To evaluate the efficacy and safety of nitrous oxide for children undergoing painful procedures. METHODS: Ninety children requiring repeated painful procedures (lumbar puncture, bone marrow aspirate, venous cannulation, or dressing changes) were given nitrous oxide at a variable concentration of 50-70%. Procedure related distress was evaluated using the Observational Scale of Behavioral Distress-Revised (OSBD-R). OSBD-R scores were obtained for each of the following phases of the procedure: phase 1a, waiting period; phase lb, during induction with nitrous oxide; phase 2, during positioning and cleaning of the skin; phase 3, during the painful procedure; and phase 4, immediately following the procedure and withdrawal of nitrous oxide. Side effects were monitored and recorded by a second observer. RESULTS: OSBD scores reached a maximum during the induction phase with lower scores during subsequent phases. Children over the age of 6 showed a lower level of distress during nitrous oxide administration and the painful procedure. Eighty six per cent of patients had no side effects. The incidence of vomiting, excitement, and dysphoria was 7.8%, 4.4%, and 2% respectively. Eight patients developed oxygen desaturation (SaO(2) < 95%), but none developed hypoxia, airway obstruction, or aspiration. Ninety three per cent of patients fulfilled the criteria for conscious sedation, and 65% had no recollection of the procedure. Mean recovery time was three minutes. CONCLUSIONS: Inhalation of nitrous oxide is effective in alleviating distress during painful procedures, with minimal side effects and short recovery time.

Induction of pseudoseizures with intravenous saline placebo.

For a 2-year period, all patients admitted to the inpatient adult EEG videotelemetry unit of the University of Miami School of Medicine underwent attempted event induction with intravenous normal saline placebo. Of 175 patients monitored during that period, 101 underwent attempted placebo saline induction, whereas 58 patients were either in the pediatric age group, were undergoing a repeat hospitalization (i.e., depth electrode monitoring), or refused induction. The final diagnosis in each patient was established after review of the history; physical, interictal, and ictal EEG findings; brain imaging studies; interictal and postictal brain single photon emission computed tomography (SPECT) and serum prolactin levels; psychiatric and psychological evaluations; and detailed neuropsychological testing. Final diagnoses were separated into epilepsy alone, pseudoseizures, epilepsy and pseudoseizures, and other (neither epilepsy nor pseudoseizures). No patient with an eventual diagnosis of epilepsy alone was inducible. Forty-one patients with a diagnosis of epilepsy were not inducible. Of 32 patients with an eventual diagnosis of pseudoseizures, 29 were inducible. One of these 29 was also diagnosed with epilepsy. Three patients with an eventual diagnosis of pseudoseizures were not inducible; 90.6% of patients with an eventual diagnosis of pseudoseizures were inducible, i.e., had events identical to those reported by history, after injection of saline placebo. Placebo saline injection is a safe and effective means of distinguishing epilepsy from pseudoseizures.