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Purpose: When using strong oral opioids for postoperative pain management, demand titration is desirable. A device for patient controlled oral analgesia (PCORA) and first results of its use for oral titration of morphine are presented.Methods: The PCORA-device is a modified Baxter-PCA-on-demand system (maximum bolus volume: 0.5 ml; flow rate for filling bolus volume: 0.5 ml.hr-1). The demand PCORA-volumes were measured at specific time intervals and PCORA was compared with customarily prescribed pain therapy (CPPT) for postoperative pain management. On the first postoperative day, 20 orthopaedic ASA I or II patients received, in a randomised, cross-over trial, either PCORA (300 min) followed by CPPT (300 min) (Group I) or vice versa (Group II). The PCORA-device permitted a maximum dose of 15 mg morphine per 60 min and CPPT was performed by the ward doctor or nurse. Pain intensity (101-point numerical rating scale) and side effects were evaluated at 30 min intervals.Results: The accuracy of the bolus volume delivered by the PCORA-device was 89.2 +/- 0.85% (mean +/- SEM), of manufacturer's specifications. PCORA pain intensity decreased over time whereas CPPT pain intensity did not (P < 0.001). PCORA-morphine requirements were 61.5 +/- 5.2 mg (Group I) and 52.5 +/- 8.5 mg (Group II) (NS; mean +/- SEM). The handling of the PCORA-device presented no problem to any patient.Conclusion: Patient controlled oral analgesia is an effective and non-invasive mode of postoperative pain management. The PCORA-device is reliable and easy to use. [ABSTRACT FROM AUTHOR]

The prevalence of chronic alcoholism in patients with carcinomas of the upper digestive tract exceeds 60%. The patient's history and laboratory markers, preoperatively, are often not sensitive or specific enough to detect alcohol-dependent patients, preoperatively, who are at risk of developing alcohol withdrawal syndrome (AWS) during their postoperative intensive care unit (ICU) stay. Previously, it was found that plasma norharman was elevated in chronic alcoholics, suggesting marker characteristics for chronic ethanol misuse and possibly alcohol dependence. We investigated whether β-carbolines (i.e., harman and norharman) were different between chronic alcoholics and nonalcoholics with carcinoma, and how the levels change in alcohol-dependent patients during their hospital stay. Ninety-seven patients with oral, pharyngeal, laryngeal, or esophageal carcinomas were evaluated regarding their drinking habits. Sixty patients were transferred to the ICU following tumor resection. Chronic alcoholics met the DSM-III-R and ICD-10 criteria for alcohol dependence or chronic alcohol abuse/harmful use. The daily ethanol intake in chronic alcoholics was ≥60 g. Blood samples were collected on admission to the hospital, preoperatively, on admission to the ICU and on days 2, 4, and 7 in the ICU. Harman and norharman were determined by HPLC. Elevated norharman was found in chronic alcoholics on admission to the hospital, whereas harman did not differ between groups. On admission, the area under the receiver operating characteristics curve was significantly larger for carbohydrate-deficient transferrin and preoperatively for norharman. The preoperative norharman levels were significantly correlated with the period of mechanical ventilation and the length of ICU stay. Postoperatively, norharman decreased in all patients, except a group of 11 alcohol-dependent patients who developed AWS during their ICU stay. The finding that elevated norharman levels were found in chronic alcoholics on admission to the hospital and preoperatively supports the view of a specific marker for alcoholism. Preoperative norharman was superior to carbohydrate-deficient transferrin and was associated with a prolonged ICU stay and a prolonged period of mechanical ventilation. Further studies are required to determine whether norhaman aids in the preoperative diagnosis of chronic alcohol misuse with respect to the prevention of postoperative complications. [ABSTRACT FROM AUTHOR]

Alterations in the fine structures of female Brugia spp. and Litomosoides carinii were investigated after in vivo treatment with curative doses of 4 compounds: CGP 20376 [2-tert-butyl-benzothiazole-5-methoxy-6-dithiocarbamic- S-(2-carboxyethyl)-ester], CGP 21833 (2-tert-butyl-benzothiazole-5-methyl-6- N-methylamino-piperazinylthiocarbonylamide), CGP 6140 [4-Nitro-4′-( N-methyl-piperazinylthiocarbonylamido)-diphenylamine] and amoscanate (4-isothiocyanato-4′-nitrodiphenylamine). All compounds caused early alterations in the somatic muscle cells. These alterations usually appeared within 24 h after treatment; they occurred later only after treatment of L. carinii with amoscanate. In Brugia spp., swelling of the muscle cells occurred in which the glycogen deposits considerably increased in size. The electron density of the cytoplasm surrounding the myofilaments in the fibrillar protion of the muscle cells increased, and light zones appeared between the fibrils. The muscle cell mitochondria swelled, particularly their inner matrix, which became more electron-lucent, with some dense spots. In L. carinii the muscle cells were not increased in size, but their mitochondria were considerably swollen before disintegration; this was followed by disintegration of the myofilaments and vacuolization of the cytoplasm. Vacuolization before mitochondrial swelling was observed only after treatment with CGP 6140. Other tissues of this species were not altered before the 2nd day after treatment. In Brugia spp., electron-lucent areas appeared in the hypodermis either simultaneously with the alterations in the muscle cells or a few hours later. At 24 h after treatment with amoscanate, blebs were formed on the luminal side of the intestinal membrane. Although the pathological pattern is slightly different in the two species, the characteristic and very early alterations in the muscle mitochondria indicate that all compounds interfere with the energy metabolism of the filariae, which is particularly high in the very actively working muscle cells. The variations in sensitivity of hypodermal structures of Brugia spp. to the various compounds may be due to compound differences. [ABSTRACT FROM AUTHOR]

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