Acupressure wristbands do not prevent postoperative nausea and vomiting after urological endoscopic surgery

PURPOSE

To evaluate the efficacy of acupressure wristbands in the prevention of postoperative nausea and vomiting (PONV).

METHODS

Two hundred ASA I-II patients undergoing elective endoscopic urological procedures were included in a randomized, prospective, double blind, placebo-controlled study. Spherical beads of acupressure wristbands were placed at the P6 points in the anterior surface of both forearms in Group I patients (acupressure group, n = 100) whereas, in Group 2 (control group, n = 100) they were placed inappropriately on the posterior surface. The acupressure wristbands were applied 30 min before induction of anesthesia and were removed six hours postoperatively. Anesthesia was induced with thiopental and maintained with nitrous oxide and oxygen, fentanyl, isoflurane and vecuronium. The tracheas were extubated on the operation table after patients received neostigmine and atropine. Post operative nausea and vomiting were evaluated separately as none, mild, moderate or severe at the time of patient's arrival in PACU, then at six hours and twenty-four hours after surgery by a blinded observer.

RESULTS

In the acupressure group, 25 patients had PONV compared with 29 patients in the control group (P = NS).

CONCLUSION

Application of acupressure wristbands at the P6 of both forearms 30 min before induction of anesthesia did not decrease the incidence of PONV in patients undergoing endoscopic urological procedures.

Expression of axolotl RNA-binding protein during development of the Mexican axolotl

Amphibians occupy a central position in phylogeny between aquatic and terrestrial vertebrates and are widely used as model systems for studying vertebrate development. We have undertaken a comprehensive molecular approach to understand the early events related to embryonic development in the Mexican axolotl, Ambystoma mexicanum, which is an exquisite animal model for such explorations. Axolotl RBP is a RNA-binding protein which was isolated from the embryonic Mexican axolotl by subtraction hybridization and was found to show highest similarity with human, mouse, and Xenopus cold-inducible RNA-binding protein (CIRP). The reverse transcriptase polymerase chain reaction (RT-PCR) analysis suggests that it is expressed in most of the axolotl tissues except liver; the expression level appears to be highest in adult brain. We have also determined the temporal and spatial pattern of its expression at various stages of development. RT-PCR and in situ hybridization analyses indicate that expression of the AxRBP gene starts at stage 10-12 (gastrula), reaches a maxima around stage 15-20 (early tailbud), and then gradually declines through stage 40 (hatching). In situ hybridization suggests that the expression is at a maximum in neural plate and neural fold at stage 15 (neurula) of embryonic development.

New-onset sustained ventricular tachycardia after cardiac surgery

BACKGROUND

The de novo occurrence of sustained ventricular tachycardia (VT) after CABG has been described, but the incidence, mortality rate, long-term follow-up, and mechanism are not well defined.

METHODS AND RESULTS

This prospective study enrolled consecutive patients undergoing CABG at a single institution. Patients were followed up for the development of sustained VT, and a detailed analysis of clinical, angiographic, and surgical variables associated with the occurrence of VT was performed. A total of 382 patients participated, and 12 patients (3.1%) experienced >/=1 episode of sustained VT 4.1+/-4.8 days after CABG. In 11 of 12 patients, no postoperative complication explained the VT; 1 patient had a perioperative myocardial infarction. The in-hospital mortality rate was 25%. Patients with VT were more likely to have prior myocardial infarction (92% versus 50%, P<0.01), severe congestive heart failure (56% versus 21%, P<0.01), and ejection fraction <0.40 (70% versus 29%, P<0.01). When all 3 factors were present, the risk of VT was 30%, a 14-fold increase. Patients with VT had more noncollateralized totally occluded vessels on angiogram (1.4+/-0.97 versus 0.54+/-0.7, P<0.01), a bypass graft across a noncollateralized occluded vessel (1.50+/-1.0 versus 0.42+/-0.62, P<0.01), and a bypass graft across a noncollateralized occluded vessel to an infarct zone (1.50+/-1.0 versus 0.17+/-0.38, P<0.01). By multivariate analysis, the number of bypass grafts across a noncollateralized occluded vessel to an infarct zone was the only independent factor predicting VT.

CONCLUSIONS

The first presentation of sustained monomorphic VT in the recovery period after CABG is uncommon, but the incidence is high in specific clinical subsets. Placement of a bypass graft across a noncollateralized total occlusion in a vessel supplying an infarct zone was strongly and independently associated with the development of VT.

Differential signaling and hierarchical response thresholds induced by an immunodominant peptide of myelin basic protein and an altered peptide ligand in human T cells

Changes in peptide antigen concentration or structure can have a profound effect on T cell responsiveness by inducing selected T cell effector functions. In this study, we have compared the biological responses of an MBP83-99-specific human Th0 T cell clone (TCC) stimulated with increasing concentrations of native peptide or an altered peptide ligand (APL). Our results show that the hierarchy of response thresholds for proliferation and cytokine secretion is similar for native peptide and APL. However, because a much higher concentration of the APL is required to evoke the same degree of response, the cytokine profile is shifted towards a Th2-like response relative to the same concentration of native peptide. In addition, we observed qualitative differences in TCR signal transduction triggered by native peptide and a weak agonist APL even at concentrations that elicit similar biological responses. Thus, the relationship between TCR signaling and biological responses may be more complex than previously recognized.

Cloning, sequencing and expression of a novel homeobox gene AxNox-1 from the Mexican axolotl

We have cloned and sequenced a cDNA containing a homeobox gene, AxNox-1, from a stage 18 axolotl embryonic cDNA library which shows only moderate levels of similarity to other known homeobox genes. The nucleotide sequence of the cDNA has an open reading frame for 335 amino acids and besides the homeodomain, there is an acidic domain and a proline-rich domain present in the protein. The transcripts for this gene are detectable at stage 4 of embryonic development and, hence, there is a good possibility that the transcripts are maternally contributed. Expression levels for AxNox-1 reach maximum levels by stage 12 of development and thereafter decline to very low levels by stage 25. High levels of the transcript for AxNox-1 are later found in the brains of both neotenous and metamorphosing adult axolotls. Low amounts of the message are also found to be present in a number of other organs that were tested. In situ hybridization studies on whole mounts and sections suggest that this gene is expressed predominantly in neural tissue during development.

Cloning and sequencing of the cDNA for an RNA-binding protein from the Mexican axolotl: binding affinity of the in vitro synthesized protein

A full length cDNA for an RNA-binding protein (axolotl RBP) with consensus sequence (RNP-CS) from the Mexican axolotl, Ambystoma mexicanum, has been cloned from a subtraction library. In vitro translation with synthetic mRNA and subsequent hybrid-arrested translation with a specific antisense oligonucleotide confirms that the axolotl RBP cDNA encodes an approx. 16 kDa polypeptide. Computer-assisted analyses revealed amino acid similarities of 58-60% to various RNA-binding proteins and a 90 amino acid region at the amino-terminal end constituting the putative RNA-binding domain (RNP-CS) with two highly conserved motifs, RNP2 and RNP1. Phylogenetic analysis suggests that the putative RNA-binding protein from axolotl is unique. A binding assay with radiolabeled axolotl RBP showed that this RNA-binding protein bound strongly with poly(A) and to a lesser degree with poly(U), but not at all with poly(G), poly(C), or DNA.

Short peptide-based tolerogens without self-antigenic or pathogenic activity reverse autoimmune disease

An immunodominant epitope of myelin basic protein (MBP), VHFFKNIVTPRTP (p87-99), is a major target of T cells in brain lesions of multiple sclerosis (MS), and this peptide can trigger experimental autoimmune encephalomyelitis (EAE). We designed truncated peptides based on this pathogenic 13-mer that are not antigenic. These short peptides reduced production of IFN-gamma and TNF-alpha in vivo. Moreover, paraplegic rats given the 7-mer FKNIVTP in soluble form showed total reversal of paralysis in 24 h. Truncated peptides that are too small to stimulate antigenic responses to pathogenic regions of myelin basic protein are nevertheless effective tolerogens and are able to anergize autoreactive T cells. Short peptide-based tolerogens, devoid of immunogenic and pathogenic potential, may be attractive for therapy of autoimmune diseases.

The heart of metamorphosing Mexican axolotl but not that of the cardiac mutant is associated with the upregulation of Hox A5

The Mexican axolotl (Ambystoma mexicanum) is a facultative neotene which rarely undergoes metamorphosis in the wild. We now report for the first time a dramatic increase in the expression of HoxA5 in axolotl hearts as determined by RT-PCR and in situ hybridization analyses during spontaneous metamorphosis. The Mexican axolotl has a naturally occurring mutation called gene c which allows hearts in homozygous (c/c) embryos to form but never to beat. RT-PCR analysis has not shown any significant differences of HoxA5 expression in normal and mutant hearts. The predicted open reading frame of our already published partial cDNA clone of HoxA5 was confirmed by expressing it as a fusion protein with Glutathione transferase (GST fusion protein). Phylogenetic analysis with the deduced amino acid sequence of the isolated cDNA of the axolotl homolog of the murine HoxA5 shows that the axolotl sequence clusters more closely with the human and mouse HoxA5 homologs than with axolotl sequence. Western blot analysis revealed that anti-mouse HoxA5 antibody recognizes the axolotl HoxA5 protein.

Effect of antihypertensives on plasma potassium in end stage renal disease: a retrospective study

The antihypertensive drug therapy and the peri-operative plasma potassium trend in end stage renal disease (ESRD) patients undergoing renal transplant were analysed. Out of consecutive 107 live related donor renal transplant, complete data available for 74 patients between June 1991 and March 1993, were entered in proforma and analysed. On the basis of antihypertensive or no antihypertensive drugs prescribed, patients were grouped in 6 categories. Group I patients taking no antihypertensives were taken as control. All patients were comparable for their age, sex, weight, immunosuppressive therapy, anaesthetic and fluid management during surgery. At the time of induction of anaesthesia, patients taking atenolol (plasma K+ levels being 5.34 +/- 0.75 mmol/l in group II and 5.44 +/- 0.63 mmol/l in group III) or captopril (serum K+ level being 5.05 +/- 0.94 mmol/l in group V) in combination with nifedipine and with or without clonidine had significant hyperkalaemia than the patient without antihypertensives (serum K+ level being 4.49 +/- 0.71 mmol/l). Patients, on these two antihypertensives, frequently needed active treatment of alarming hyperkalaemia (blood K+ more than 5 mmol/l and tall 'T' wave in lead II) and cardiac arrhythmias. In conclusion, ESRD patients taking atenolol or captopril are needed to be frequently monitored for blood potassium levels and it would be advisable to avoid these drugs to control hypertension in ESRD patients, especially, when scheduled for renal transplantation.

Accidental subdural injection of local anaesthetic: diagnosis by pressure measurement and response to aspiration of injectate

A healthy 22-year-old man received an initial injection of 12 mL of lignocaine/bupivacaine solutions (2 mL test, then 10 mL) into an epidural catheter. This produced a satisfactory regional blockade that seemed to be epidural but, when a supplementary 6 mL injection was given 1 h later, the patient developed impaired motor function as far as the upper cranial nerves, with loss of pinprick sensation to the shoulder. The emergence of fluid dribbling freely from the catheter prompted measurement of the pressure, which was 36 mmHg. The fluid was proved not to be cerebrospinal fluid (CSF) by the absence of glucose (on dextrostix), by the appearance of turbidity with added thiopentone, and later by microscopy. Slow aspiration of 7 mL of the presumed injectate reduced the pressure in the catheter to 8 mmHg, which promptly reversed the additional excessive blockade, allowing surgery to proceed uneventfully. The retrieval of injectate argues strongly that the catheter tip had found its way subdurally, and the promptness of the reversal with aspiration argues for a mechanical rather than a pharmacological cause for the extensive neurological dysfunction after the second injection. Pressure measurement and aspiration may be helpful in other similar cases.

Amelioration of relapsing experimental autoimmune encephalomyelitis with altered myelin basic protein peptides involves different cellular mechanisms

T-cells specific for a region of human myelin basic protein, amino acids 87-99 (hMBP87-99), have been implicated in the development of multiple sclerosis (MS) a demyelinating disease of the central nervous system. Administration of soluble altered peptide ligand (APL), made by substituting native residues with alanine at either positions 91(91K > A or A91) or 97 (97R > A or A97) in the hMBP87-99 peptide, blocked the development of chronic relapsing experimental autoimmune encephalomyelitis (R-EAE), in the SJL mouse. The non-encephalitogenic APL A91, appears to induce cytokine shifts from Th1 to Th2 in the target T-cells, whereas the encephalitogenic superagonist APL A97 causes deletion of the MBP87-99 responsive cells. Thus, single amino acid changes at different positions in the same peptide epitope can lead to APL capable of controlling auto-immune disease by different mechanisms.

Immunosuppressive phenotype of corticotropin-releasing factor transgenic mice is reversed by adrenalectomy

Stress elicits a wide range of physiological changes involving the nervous, endocrine, and immune systems. Corticotropin-releasing factor (CRF) plays a key role in orchestrating this response, activating both the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis, resulting in release of corticosteroids. The present study examines the immunological phenotype and responsiveness of CRF-transgenic (CRF-Tg) mice. The immune system of the CRF-Tg animals has profound changes compared to littermate controls, including a marked reduction in both cell number and immune responsiveness. There were also phenotypic changes in the lymphocytic composition of the various lymphoid organs, most notably in the spleen, where CRF-Tg mice had a greater percentage of T lymphocytes compared to littermate controls. Adrenalectomy of CRF-Tg reversed the immunological phenotype observed and restored immune responsiveness. These results demonstrate that CRF overexpression leads to profound impairment on lymphocyte development and function mediated via corticosteroids.

Cloning of Murine T Cells

T-cell clones have been extremely useful in studying the cellular arm of the mammalian immune response. A method for generating homogeneous long-term, antigen-specific cultures of murine T cells is discussed, with emphasis on obtaining CD4(+) T-cell clones. Some procedures and assays that will be helpful in characterizing the T-cell clones are also included.

Expression of myosin heavy chain transcripts in normal and cardiac mutant Mexican axolotls

In this study, we have cloned a 1.0 kb myosin heavy chain (MHC) cDNA by screening an axolotl heart cDNA library with the monoclonal antibody MF20 against a light meromyosin (LMM) region of MHC. The nucleotide sequence analysis shows 85-86% homology at the amino acid and 78-81% homology at the nucleic acid level with MHC from other vertebrates. Phylogenetic analyses suggest that axolotl beta-MHC forms a cluster with the myosin II group of vertebrate striated muscles. Within the myosin II cluster, axolotl beta-MHC forms a distinct subclade from avian MHC and is instead closer to mammalian MHC. RT-PCR analyses show that transcripts of beta-MHC are present at stage 2 and the onset of the MHC gene expression is at stage 8-10 (gastrulation). Expression increases with embryonic development and reaches a maximum at stage 20. Beyond stage 35, the heart-beat initiation stage, the expression level of beta-MHC is higher in cardiac muscle than in skeletal muscle. We could not detect significant differences in the levels of expression of MHC transcripts in normal and cardiac lethal mutant (c/c) axolotls (Ambystoma mexicanum).

Treatment of experimental encephalomyelitis with a peptide analogue of myelin basic protein

Following induction of experimental encephalomyelitis with a T-cell clone, L10C1, that is specific for the myelin basic protein epitope p87-99, the inflammatory infiltrate in the central nervous system contains a diverse collection of T cells with heterogeneous receptors. We show here that when clone L10C1 is tolerized in vivo with an analogue of p87-99, established paralysis is reversed, inflammatory infiltrates regress, and the heterogeneous T-cell infiltrate disappears from the brain, with only the T-cell clones that incited disease remaining in the original lesions. We found that antibody raised against interleukin-4 reversed the tolerance induced by the altered peptide ligand. Treatment with this altered peptide ligand selectively silences pathogenic T cells and actively signals for the efflux of other T cells recruited to the site of disease as a result of the production of interleukin-4 and the reduction of tumour-necrosis factor-alpha in the lesion.

Identification and expression of a homologue of the murine HoxA5 gene in the Mexican axolotl (Ambystoma mexicanum)

An excellent model for studying heart development in vertebrates is the cardiac non-function lethal mutant (gene c) Mexican axolotl, Ambystoma mexicanum. In order to facilitate our analyses of the mutant system, we have undertaken a search for stage-specific molecular markers during embryonic development of the axolotl. We have concentrated on homeobox genes as suitable candidates for monitoring molecular changes during development. A 270-bp probe encoding a portion of the axolotl homeobox gene Ahox-1 was generated by PCR from a stage-18 axolotl embryonic cDNA library. 32P-labelled PCR-amplified Ahox-1 DNA was used as the probe for screening a lambda AM18 cDNA library using moderately stringent conditions. We isolated six clones and determined their partial nucleotide (nt) sequences. One of the clones, which has very high homology to human, mouse and rat Hox A5 (83 and 99% at the nt and amino-acid levels, respectively, in the homeodomain region), was analyzed further. RT-PCR analyses show that the level of expression of HoxA5 is very low at stage 11 of embryonic development (gastrula). The level of expression reaches maximum at stage 25 (tailbud) and then plateaus at stages 30 and 35 (heartbeat onset). Although the expression of Ahox-1 was also found to start at stage 11, it reaches a maximum level at stage 25 and declines at stage 35. We have also studied, using RT-PCR, the tissue-specific expression of HoxA5 and Ahox-1 in juvenile axolotl.

Unintentional combined epidural and subdural block. Case report

BACKGROUND AND OBJECTIVES

Unintentional subdural block, while attempting an epidural anesthetic, is a rare but known complication. The authors describe a radiologically confirmed case of an unintentional combined epidural and subdural block while attempting to perform an epidural block for transurethral resection of prostate in a middle-aged man.

METHODS

Loss of resistance to air injection was used for identifying the epidural space prior to catheter placement. Following the epidural injection of 20 mL of a 1.5% lidocaine and 0.5% bupivacaine mixture, the patient developed rapid, intense, prolonged, and extensive bilateral motor block up to C2 level.

RESULTS

The patient had aphonia and respiratory paralysis requiring endotracheal intubation and controlled ventilation for 3 hours.

CONCLUSIONS

Postoperative radiologic examination revealed the spread of the dye in both epidural and subdural spaces, causing the extensive sensory and motor block.

Lipid components of mustard seeds (Brassica juncea L.) as influenced by cadmium levels

In a pot experiment the soil application of different levels of Cd2+ (0, 10, 20, 30, 40 and 60 micrograms g-1 soil) affected the lipid components of mustard seeds (Brassica juncea L. Cv. RH-30) markedly. Total lipids declined with the Cd2+ levels regularly while phospho and glycolipids increased only at higher levels. Fatty acids profile of total, neutral and polar lipid fractions were affected considerably. Erucic acid in total and neutral lipids was observed to increase while it decreased in polar lipids with Cd2+ as compared to control. On the other hand palmitic, oleic and linoleic acids had reverse trend. Cadmium concentration increased consistently with increasing levels of Cd2+. Plant dry weight was also decreased significantly with Cd2+ levels.

Changes in phospholipids, fatty acids, oxidative enzymes, phenolics and protein levels during growth of normal and habituated tissues of Cocculus pendulus

Cultures of C. pendulus were maintained on hormone free and hormone supplemented (NAA 1.0 mg/l and kinetin 0.5 mg/l) Murashige and Skoog medium. During the growth period, hormone free cultures had higher phenolic content, polyphenol oxidase activity and less protein content, peroxidase and IAA oxidase activity. Activity of all the three oxidising enzymes and phenolic content were high at 16 days growth. Total lipid content was higher (2.7-folds at 15 days) in hormone free cultures. Phospholipid content of both cultures was not markedly dissimilar except PC and DGDG contents. Thus it is evidenced that both the tissues were similar metabolically.

Bancroftian filarial pleural effusion

This paper describes a case of filarial pleural effusion, the fifth such to be reported. Microfilariae of Wuchereria bancrofti were detected in the pleural fluid on cytological examination. There was a prompt and complete response to treatment with diethylcarbamazine. There were, however, no symptoms and signs of tropical pulmonary eosinophilia nor any peripheral eosinophilia.

Induction of relapsing paralysis in experimental autoimmune encephalomyelitis by bacterial superantigen

The role of infection in the pathogenesis of clinical relapses that occur in most autoimmune diseases, including multiple sclerosis, remains to be established. Experimental autoimmune encephalomyelitis (EAE) serves as a model for multiple sclerosis, with episodes of relapsing paralysis. In certain strains of mice, T-lymphocytes expressing the V beta 8 T-cell receptor (TCR) engage the amino-terminal epitope Ac1-11 of myelin basic protein, leading to EAE. The bacterial superantigen staphylococcal enterotoxin B (SEB) activates V beta 8-expressing T cells. Here we show that after immunization with Ac1-11, or after transfer of encephalitogenic T-cell lines or clones reactive to Ac1-11, SEB induces exacerbation or relapses of paralytic disease in mice that are in clinical remission following an initial episode of paralysis, and triggers paralysis in mice with subclinical disease. Tumour necrosis factor has a critical role in the mechanism underlying SEB-induced exacerbation of disease, because anti-tumour necrosis factor antibody given in vivo delays the onset of paralysis triggered by SEB. On reactivation of autoaggressive cells through their T-cell receptor, superantigens may induce clinical relapses of autoimmune disease.

Rectal nifedipine for the management of intraoperative hypertension

The effect of rectal administration of nifedipine for the management of intraoperative hypertension was studied in 12 adult neurosurgical patients, physical status II and III. A rise in mean arterial pressure (MAP) of > 20 mm Hg over the preoperative value was taken as the point at which rectal nifedipine (150 micrograms kg-1) was administered. Onset of action of nifedipine was observed in 4.5 +/- 1.5 min (mean +/- SD) with a peak effect at 30.8 +/- 10.7 min. MAP decreased from 124 +/- 4.5 mm Hg to 97 +/- 2.4 mm Hg. Heart rate and central venous pressure were unchanged. Endoscopic examination of the rectal mucosa 48 h after administration of nifedipine did not show any abnormality. Rectal nifedipine was found to be effective and safe for the management of intraoperative increases in arterial blood pressure as well as being convenient to administer to patients undergoing neurosurgical procedures.