Search

Summary Aims: The aims of this article were to discuss options for diagnosing interstitial cystitis (IC), to compare approaches and to encourage early diagnosis of this disorder in the primary care setting. Methods: Experts discussed the tools available to diagnose IC and the advantages and disadvantages of each approach. Treatment options, both pharmacological and non-pharmacological, were also discussed. The importance of patient follow-up was emphasised. Results: Diagnostic options for IC include a thorough history and physical examination, laboratory evaluations, symptom screening tools, cystoscopy with hydrodistention, bladder biopsy, potassium sensitivity testing, intravesical anaesthetic challenges, urodynamics and urinary markers. Treatment options include oral and intravesical medications, dietary modification and physical therapy. Patient follow-up can be an opportunity to educate and empower patients to participate in their treatment. Discussion: A thorough patient history, physical examination and laboratory evaluations are keys to the diagnosis of IC. Optional diagnostic approaches may help increase physician confidence in prescribing therapy for this disorder. Multimodal therapy with an emphasis on patient education can help ensure success in treating IC. Conclusion: Understanding the options available to diagnose IC may result in earlier identification and treatment for some patients.

Chronic pelvic pain (CPP) remains a clinical enigma whose origins are obscure and the treatment of which is generally unproven. Conventional disease-based models have consistently failed to explain chronic pain that is felt in the pelvis. Despite its uncertain aetiology, CPP is estimated to occur in two to ten percent of outpatient gynaecological referrals, and accounts for up to 35 percent of laparoscopic examinations. Reported rates for pelvic disease vary enormously in patients with CPP, and over one-third of patients have no demonstrable lesions. Chronic pelvic pain is defined as persistent pain, apparently of gynaecological origins, but for which no causative lesion is found. The presence of a pelvic lesion does not, de facto, explain the patient's pain, and often such lesions are coincidental. Also, surgical removal of organs that show pathological changes often fails to relieve pain. Clinicians should make a clear distinction between chronic pelvic lesions that are painful, including endometriosis, and chronic painful conditions for which so far no pathological basis has been identified. It is necessary to improve diagnostic accuracy to avoid inappropriate and needless therapies for patients with CPP. This review provides a summary of current information on the mechanisms of visceral pain, and proposes a new model of CPP based on neurochemical alterations within the central nervous system.

Background:Several factors may Influence the Incidences of postoperative nausea and vomiting. In women, one of these factors may be the timing of their surgery In relation to their menstrual cycle. The purpose of this study was to assess the effect of menstruation and efficacy of the antiemetic drop

This investigation determined mechanisms that caused earthquake damage to Uniform Wharf at Naval Base Guam. Navy vessel mooring is currently not allowed. Repairs were recommended that will allow full operational capability. Observed damage included deck subsidence, longitudinal fissures, and misaligned bulkhead. A subsurface excavation was conducted that exposed a tierod from the bulkhead to behind the anchor. In-situ and laboratory soil tests were conducted to determine fill properties. Groundwater and harbor water levels were measured and compared. Bulkhead lateral profile and surface elevations were surveyed. Exposed tierod and anchors were examined for defects, and alignments measured. Copyright 2010 ASCE.

The aims of this article were to discuss options for diagnosing interstitial cystitis (IC), to compare approaches and to encourage early diagnosis of this disorder in the primary care setting.Experts discussed the tools available to diagnose IC and the advantages and disadvantages of each approach. Treatment options, both pharmacological and non-pharmacological, were also discussed. The importance of patient follow-up was emphasised.Diagnostic options for IC include a thorough history and physical examination, laboratory evaluations, symptom screening tools, cystoscopy with hydrodistention, bladder biopsy, potassium sensitivity testing, intravesical anaesthetic challenges, urodynamics and urinary markers. Treatment options include oral and intravesical medications, dietary modification and physical therapy. Patient follow-up can be an opportunity to educate and empower patients to participate in their treatment.A thorough patient history, physical examination and laboratory evaluations are keys to the diagnosis of IC. Optional diagnostic approaches may help increase physician confidence in prescribing therapy for this disorder. Multimodal therapy with an emphasis on patient education can help ensure success in treating IC.Understanding the options available to diagnose IC may result in earlier identification and treatment for some patients.

A prospective, stratified, randomized clinical trial of the safety and efficacy of four general anesthetic agents (enflurane, fentanyl, halothane, and isoflurane) was conducted in 17,201 patients (study population). Patients were studied before, during, and after anesthesia for up to 7 days. Nineteen patients died (0.11%), and in seven of these (0.04%) the anesthetic may have been a contributing factor. The rates of death, myocardial infarction, and stroke in the study population were so low (less than 0.15%) that no conclusions regarding the relative rates of these outcomes among the four anesthetic agents could be reached. The rates of 16 of 66 types of adverse outcomes in the study population were significantly different among the four study agents. Most of these outcomes were minor. However, severe ventricular arrhythmia (P less than 10(-6)) was more common with halothane, severe hypertension (P less than 10(-6)) and severe bronchospasm (P = 0.028) were more common with fentanyl, and severe tachycardia (P = 0.001) was more common with isoflurane. Recovery from anesthesia during the first 30 min was slowest in those patients who received halothane (P less than or equal to 0.001). In addition, patients who received fentanyl experienced less pain during the first hour in the recovery room (P less than 10(-6)). In conclusion, clinically important differences do exist for some outcomes among the four study agents.

Background Ketorolac is approved for the relief of postoperative pain but concerns have been raised over a possible risk of serious adverse effects and death. Two regulatory reviews in Europe on the safety of ketorolac found the data were inconclusive and lacked comparison with other non-steroidal anti-inflammatory drugs. The aim of this study was to compare the risk of serious adverse effects with ketorolac vs diclofenac or ketoprofen in adult patients after elective major surgery. Methods This prospective, randomized multicentre trial evaluated the risks of death, increased surgical site bleeding, gastrointestinal bleeding, acute renal failure, and allergic reactions, with ketorolac vs diclofenac or ketoprofen administered according to their approved parenteral and oral dose and duration of treatment. Patients were followed for 30 days after surgery. Results A total of 11 245 patients completed the trial at 49 European hospitals. Of these, 5634 patients received ketorolac and 5611 patients received one of the comparators. 155 patients (1.38%) had a serious adverse outcome, with 19 deaths (0.17%), 117 patients with surgical site bleeding (1.04%), 12 patients with allergic reactions (0.12%), 10 patients with acute renal failure (0.09%), and four patients with gastrointestinal bleeding (0.04%). There were no differences between ketorolac and ketoprofen or diclofenac. Postoperative anticoagulants increased the risk of surgical site bleeding equally with ketorolac (odds ratio=2.65, 95% CI=1.51–4.67) and the comparators (odds ratio=3.58, 95% CI=1.93–6.70). Other risk factors for serious adverse outcomes were age, ASA score, and some types of surgery (plastic/ear, nose and throat, gynaecology, and urology). Conclusions We conclude that ketorolac is as safe as ketoprofen and diclofenac for the treatment of pain after major surgery.

Inflammatory disorders of the scrotum vary in their presentation and etiology. This may range from relatively minor cutaneous infections to scrotal gangrene. Herein presented is a case of scrotal cellulitis secondary to cutaneous inoculation from a hot tub.

An adrenal cyst is a rare clinical finding with an incidence of approximately 0.06% in the general population. As the majority are clinically silent, adrenal cysts are usually discovered incidentally at autopsy or during surgery for an unrelated disease process. We report a case of a lymph-angiomatous adrenal cyst diagnosed in a 27-year-old female presenting with abdominal pain.

Perioperative myocardial ischaemia is a predictor of postoperative cardiac morbidity (PCM). Epidural anaesthesia and adequate perioperative analgesia have been shown to improve myocardial oxygen dynamics due to interruption of pain and sympathetic pathways. The aim of the present study was to compare the incidence of ischaemia after either general anaesthesia followed by parenteral analgesia with morphine or combined epidural/general anaesthesia followed by analgesia with epidural morphine. In a prospective observer-blinded analysis of the occurrence of ischaemia, 55 patients (epidural = 29/parenteral = 26) scheduled for elective surgery with defined risks for ischaemic cardiac disease were entered and followed for 24 hr after surgery with two-lead continuous Holter monitoring. Groups were similar with respect to age, weight, modified Goldman (Detsky) risk classification and the use of cardiac medications. Fewer patients receiving the epidural anaesthesia/analgesia had ischaemic episodes (17.2 vs 50.0%, P = 0.01), and tachyarrhythmias (20.7 vs 50.0%, P0.05). Epidural patients had a four-fold reduction of the relative risk for either event (P0.001). All ischaemic events were asymptomatic and unrecognized (silent). All major morbid events (n = 5) (MI, congestive heart failure and death) occurred in patients who had perioperative episodes of ischaemia. There were three distinct peaks in onset of ischaemia, at 1-4 hr, 9-12 hr and 22-24 hr postoperatively. One third of postoperative ischaemic events occurred within the first four hours after operation and lasted from 1 to 31 min. Forty-two percent of ischaemic episodes were associated with a heart rate100 bpm, or an increase of 20% over the baseline heart rate. We conclude that epidural anaesthesia/analgesia reduces but does not eliminate the risk of myocardial ischaemia and tachyarrhythmia. We were unable to determine any associated reduction in the risk of PCM.

Several factors may influence the incidences of postoperative nausea and vomiting. In women, one of these factors may be the timing of their surgery in relation to their menstrual cycle. The purpose of this study was to assess the effect of menstruation and efficacy of the antiemetic droperidol on postoperative nausea and vomiting.In a prospective randomized double-blind clinical trial, 100 female patients who were scheduled for laparoscopic tubal sterilization were stratified on the basis of the date of their last menses into menstrual (days 1-8) and nonmenstrual (days 9-28) groups. Patients in both groups were then randomized to receive placebo or 10, 20, or 30 micrograms/kg droperidol before induction of anesthesia, and data were obtained for 24 h after completion of their surgery.Nausea and vomiting were reported in 55 patients, and the risk was 2.92 times greater in the menstrual group (71.4%) than in the nonmenstrual group (46.2%; (P = .013). Droperidol (30 micrograms/kg) reduced the incidence of vomiting from 47.1% (placebo) to 13.3% in the nonmenstrual group (P = .045) but had no effect in the menstrual group. Five prognostic variables (menstrual stratum, droperidol, age 30 yr or younger, weight 65 kg or less, and history of nausea and vomiting) for postoperative nausea and vomiting were tested by stepwise logistic regression. Menstrual stratum was the only variable identified as a significant (P = .017) predictor, having a percent probability equal to 2.21.The risk of postoperative nausea and vomiting is increased in women undergoing laparoscopic tubal sterilization during the first 8 days of their menstrual cycle, and droperidol up to 30 micrograms/kg is not as effective in these patients.

This study was designed to determine the effect of prolonged infusion on the ease of reversal of atracurium and vecuronium, and whether factors which potentiate the block delayed reversal. In phase one, 40 patients were randomized (double blind) to determine the steady state conditions for atracurium and vecuronium. Fourteen atracurium patients and 17 vecuronium patients were evaluable. The unblinded second phase involved the steady state conditions using halothane or isoflurane and atracurium infusions. The infusion required for 95% twitch depression (TD95)for atracurium was 7.6 ± 1.1 μg · kg−1 · min−1. The requirement for vecuronium changes with time: TD95 at 30 min was 1.01 ± 0.16, at 60 min 0.89 ± 0.12 and after 90 min 0.85 ± 0.17 μg · kg−1 · min−1 (P < 0.05). The mean TD95 was 0.94 ± 0.23μg · kg−1 · min−1. Multivariate regression analysis of the infusion data revealed a vecuronium model predicting TD95 by the duration of infusion (P < 0.05) and weight (P = 0.05). Atracurium TD95 was predicted by age (P = 0.05,). The addition of an inhalation agent to atracurium reduced the infusion rate by 2.01 ± 0.28 μg · kg−1 · min−1 (P = 0.0001) for each increase in MAC. The mean reversal times for atracurium with three different anaesthetics and for vecuronium were not different. Reversal of pancuronium blockade, from less profound twitch depression (86.4 vs 95%) took twice as long as for atracurium and vecuronium for which the following predictors were identified: age, weight, duration of infusion, level of blockade, and type of anaesthetic, usingastepwise regression model. For vecuronium: age (coeff2.84 ± 0.51 P = 0.0001) and duration of infusion (coeff0.12 ± 0.02 P = 0.0002) were significant predictors. Age was the only predictor of the time to reverse block after atracurium blockade with all types of anaesthetic (P = 0.05).

Postoperative nausea and vomiting is a major cause of postoperative morbidity. It can lead to increased recovery time, delaying patient discharge and an increase in hospital costs. Past studies have shown that postoperative nausea and vomiting is more frequent in women than men, appears to elevate around the time of menarche and is reduced around the time of menopause. This retrospective review of a one-year experience of laparoscopic tubal ligation at our institute examined the effect of menstrual cycle on postoperative nausea and vomiting. The anaesthetic and surgical techniques were consistent for all patients. Patient data included age, weight, last day of menstrual cycle, the length of anaesthetic, the dose of inhalational agent, the dose of narcotic, emesis on emergence and whether or not droperidol was used. Of the the 235 patients in the study, the incidence of nausea and vomiting was 28%. One hundred fifty-eight had had no preoperative antiemetic and 77 had received droperidol. These two groups were analyzed separately. The incidence in the group not receiving droperidol was 33.5% and in the droperidol group, 16.9% (P less than 0.01). The incidence of nausea and vomiting was higher on the first eight menstrual days (51.6 vs 21.6, P less than 0.001), was highest on day five of the menstrual cycle and lowest on days 18, 19, and 20 where there was no nausea and vomiting. Droperidol reduced the incidence of postoperative nausea and vomiting but the variation in postoperative nausea and vomiting during the cycle persisted.(ABSTRACT TRUNCATED AT 250 WORDS)

A prospective randomized clinical trial of enflurane, fentanyl, halothane, and isoflurane is described. The 17,201 patients were stratified into two groups (preanesthetic medication and no preanesthetic medication) and were randomized to one of four study agents: enflurane, fentanyl, halothane, and isoflurane. Fifteen university-affiliated hospitals in the United States and Canada participated. All patients were first assessed preoperatively. Data were collected during anesthesia, in the immediate recovery period, and for up to 7 days after anesthesia/surgery. The mean age of the patients was 43 yr, the mean height 167 cm, and the mean weight 68 kg. Sixty-five percent of patients were female. In this study 90.7% of patients were classified as ASA Physical Status 1 or 2, and 34.7% of patients smoked. It is concluded that pooling of data across institutions was valid and does allow determination of the efficacy and relative safety of the four study agents.

Infection following surgery is not uncommon. Human leucocytes play a vital role in the body's defense against infection. In order to decrease perioperative morbidity and mortality from infection, it is important to define the comparative effects of different anaesthetic agents on the leucocyte function. Therefore, the effect of equipotent concentrations (MAC 1) of isoflurane, enflurane, halothane, methoxyflurane and 70 per cent nitrous oxide, on the leucocyte chemotactic migration was investigated in vitro. The chemotactic migration of neutrophils and monocytes, with and without equilibration with MAC 1 concentrations of different volatile anaesthetics and 70 per cent nitrous oxide, was compared by using a modification of Boyden's method. Chemotactic migration of both cell types was unaffected by isoflurane, but a significant depression of chemotactic migration was observed with enflurane, halothane, methoxyflurane and nitrous oxide (p less than 0.05). The severity of depression of migration was maximal with nitrous oxide, followed by methoxyflurane, halothane and enflurane in order. It is concluded that equipotent concentrations of various anaesthetic agents produce different degrees of depression of leucocyte chemotactic migration in vitro.

Morphometric measurements at the electron microscope level were carried out on three categories of mesenteric arteries representing elastic (superior mesenteric), muscular and arteriolar vessels, from 10- to 12-week-old spontaneously hypertensive rats (SHR) and age-matched Wistar-Kyoto normotensive rats (WKY). Changes were observed only in muscular and arteriolar vessels of SHR, mainly as thickening of the vessel wall due to hypertrophy of the media. In muscular arteries, hypertrophy of the endothelial cells, widening of the subendothelial space, increased volume of the internal elastic lamina (IEL), and both hyperplasia and hypertrophy of the smooth muscle cells (SMC) in the media contributed to the wall thickening. In arteriolar vessels, increase in the subendothelial space and IEL, and hyperplasia of the SMC in the media were involved in the increased thickness of the vessel wall. There was no difference in the collagen content in all vessels, but elastin was increased in the muscular and arteriolar vessels of SHR. Nerve density was also increased in arteriolar vessels of SHR. These changes, especially the increase of SMC in muscular and arteriolar vessels, may be related to the elevated blood pressure in SHR.

The objective of this research was to determine if experimental cryptorchidism causes significant changes in the rat blood-testis barrier. Micropuncture of the seminiferous tubules of normal, sham-operated, or surgicaily-cryptorchid rats was performed after intravenous infusion of [3H]-inulin or subtunica injection of [3H]-horseradish peroxidase. Concentration of the isotopes in the lumen of the seminiferous tubule was determined. Normal, sham, and cryptorchid tissues were also immersed in hypertonic (.75 M) LiCI and prepared for observation by light microscopy. Micropuncture experiments demonstrated that cryptorchidism significantly increased the penetration of the blood testis barrier by [3H]-inulin and [3H]-horseradish peroxidase. The LiCI emersion techniques, a histological method of visually detecting the presence of an intact blood-testis barrier, also demonstrated partial disruption of the blood-testis barrier in the cryptorchid testis. In spite of these alterations, the seminiferous tubules of the experimentally-cryptorchid testes retained a large proportion of their capacity to exclude macromolecules.

Thirty-seven patients with long-standing post-herpetic neuralgia and 27 with post-traumatic neuralgia (PTN) were treated with three epidural injections each of methylprednisolone acetate (Depo Medrol) given at weekly intervals. Differential subarachnoid or epidural block was done in all patients and placebo responders were excluded from the study. Mean age, duration of symptoms, and pain intensity measured by visual analogue scale were similar in both groups. Visual analogue scale ratings were reduced one month after treatments from both groups. Visual analogue scale ratings were reduced one month after treatments from pretreatment values of 84.4 and 78.7 to 9.6 and 15.2 in the post-herpetic and post-traumatic groups respectively, and were further reduced to 4.6 and 11.6 respectively after one year when 89 per cent of patients in the post-herpetic group and 59 per cent of patients in the post-traumatic group were completely pain free. Side effects were minor in all cases. It is suggested that this is the treatment of choice in post-herpetic and post-traumatic neuralgia where steroid administration is not contraindicated.

The renal vasculature of Wistar Kyoto spontaneously hypertensive rats (SHR), prior to (4-5 week) and during established hypertension (21 week) and those of age-matched Wistar Kyoto normotensive rats (WKY) were morphometrically and pharmacologically studied. Under dilated conditions, the vascular resistances (RVR) of the isolated kidneys of young and adult SHR were similar to WKY. Morphometric measurements of renal vasculature indicated that the cross-sectional area of the intima and adventitia and its subcomponents were similar in adult SHR and WKY. With the exception of the preglomerular arterioles, all the renal arteries of adult SHR exhibited elevated cross-sectional quantities of total media, medial smooth muscle cells (SMCs), and extracellular space. Analysis of the SMCs indicated the presence of increased numbers of SMC layers and/or an increase in the SMC volume-to-surface area ratio in arteries sampled from adult SHR. Vascular contraction produced by infusing norepinephrine, BaCl2, angiotensin II, or by stimulating the renal nerves elevated the RVR to a greater degree in adult SHR than in WKY. The sensitivity of the renal vasculature to the various contractile agents was similar in adult SHR and WKY. When compared with WKY, prehypertensive SHR also exhibited increased cross-sectional quantities of arterial media and elevated amplitudes of RVR change in response to norepinephrine and renal nerve stimulation. However, the vascular contractile sensitivity to norepinephrine was reduced. Our results indicate that renovascular wall thickening and the hypercontractile reactivity associated with such a change precedes hypertension in SHR. In prehypertensive SHR, elevations in RVR might be counterbalanced by a decreased norepinephrine sensitivity. An increase in the norepinephrine contractile sensitivity and further vascular thickening with age could elevate the RVR and establish hypertension.

The death of an adolescent after deliberate inhalation of the domestic fluorocarbon--lipid spray, PAM, triggered an investigation of the effects of this product on mammalian lung. Some of its constituents are known to destroy the lung-surfactant system, but death from its inhalation by earlier victims was usually attributed to the fluorocarbon's cardiac arrhythmogenic properties. In the present study, we applied methods and experimental models not previously used to study the effects of this aerosol material on the lung surfactant. We found morphological and functional acute disintegration of normal alveolar surfactant, leading to extensive alveolar collapse, with sustained and elevated surface tensions in vitro. This could result in fatal hypoxaemia at inspired concentrations of fluorocarbons insufficient to cause cardiac arrhythmias, and may explain at least partly the large number of deaths associated with inhalation of such product.

Structural changes of blood vessels from hypertensive animals during contraction were studied using light and transmission microscopy. In the arteries, maximally contracted with norepinephrine, vacuoles were found in the media of three categories of mesenteric arteries from two age groups (10–12, 28–30 weeks) of spontaneously hypertensive (SHR) and age-matched normotensive Wistar-Kyoto (WKY) rats. These vacuoles were related to contraction of the smooth muscle cells involving shape change, as they were absent in relaxed vessel walls, and also in muscles that underwent isometric contraction. In the SHR, the number of vacuoles/1,000 μm2 of media was positively correlated with the degree of contraction of the vessels. Electron microscopic examination of these vacuoles showed that they were the result of herniation (or evagination) of smooth muscle cells into the intercellular space as well as into the neighbouring cells. When the number of herniae per unit cross-sectional area of the contracted media was used as the basis for comparison between SHR and WKY, we found no difference between the two strains of rats at 10–12 weeks of age. At 28–30 weeks, however, the number of herniae was significantly lower in the SHR as compared with age-matched WKY and younger SHR, suggesting that functional changes, probably related to the physical property of the plasma membrane in the smooth muscle cells, have taken place in older SHR.

1. A technique is described by which living anaesthetized guinea-pigs were artificially ventilated with a positive and negative pressure cycle, and rapidly frozen at the instant of cessation of ventilation at a preselected point on the respiratory cycle. 2. The dimensions of alveoli and alveolar ducts were measured by histological morphometric methods, and related to the degree of lung inflation at the instant of freezing. 3. The alveolar volume fraction increased from 0·52 at low lung volumes, up to 0·62 at lung volumes in the mid-inflation range, then decreased to 0·51 at high lung volumes. The alveolar duct volumetric fraction remained constant at all lung volumes. 4. The total volume of alveoli increased linearly with increase in lung volume. The total alveolar duct volume increased little until the lungs were 40% inflated, above which it increased steeply. 5. The total number of alveoli was linearly related to the body weight. 6. The total alveolar surface area increased steeply between lungs of low lung volume and those which were up to 50% inflated, above which the increase levelled off. The absolute values of total alveolar surface depended on the body weight as well as the degree of lung inflation. 7. The mean alveolar duct diameter was 40% greater, and the mean alveolar mouth diameter 35% greater in lungs which were fully inflated than in lungs which were nearly collapsed. The average geometrical shape of alveoli was not related to the degree of lung inflation. 8. The harmonic mean thickness of the air—blood barrier was 33% less in lungs which were fully inflated than in lungs which were nearly collapsed. The alveolar surface membrane was smooth whether the lungs were fully inflated or collapsed.

SUMMARY The effect of IPPV with and without hyperventilation was studied in five groups of living anaesthetized guineapigs. The respiratory frequency used was in all cases 32 per min and the tidal volume was equal to either 15 per cent of the predicted vital capacity for a period of 15 min or to 75 per cent of the predicted vital capacity for a period of 2 breaths, 5 min, 10 min, or 15 min. Pressure/volume manoeuvres were done on the lungs of each animal at the end of the ventilation period and samples of lung tissue taken for measurement of the stability ratio of expressed lung bubbles. There was a small but non-significant fall in lung compliance and lung stability index following normal ventilation for 15 min. Hyperventilation reduced lung compliance, lung stability index, total lung volume and the bubble stability ratio to a degree which was related to the duration of ventilation. The opening pressure of the lungs and the pressure required to maximally inflate the lungs were increased following hyperventlation.

Cyanoacrylic glue (Eastman 910) was used to affix small pieces of nasal scrapings to lens paper immediately before fixation in the glutaraldehyde. The lens paper not only served to hold specimens together so that they were not lost during tissue processing, but also functioned as a 'landmark' for the specimens, so that specimens could be oriented in a specific manner during embedding and subsequent sectioning.

Ciliary motility was studied in three patients with Kartagener syndrome who had previously been found to have absent nasal and pulmonary mucociliary transport and missing dynein arms in nasal cilia. A video system was used to record movement of cilia obtained by nasal brushings for analysis of wave form and beat frequency. Two patterns of abnormal ciliary beat were observed; an oscillating and a rotating type of motion. There was no evidence of planar coordination of metachronicity. This abnormal motion was present in up to 40 percent of cells and the remainder were totally immotile. Thus, in Kartagener syndrome many ciliated cells are motile, but the motion is abnormal. We suggest that "immotile cilia syndrome" is a misnomer, and recommended it be renamed "dyskinetic cilia syndrome."

In a double-blind placebo-controlled trial, 154 subjects, having intraperitoneal surgery or Caesarean section, and 53 patients undergoing lower limb orthopaedic surgery, received epidural morphine, 5 mg in 10 ml 0.9 per cent NaCl, or placebo, 10 ml 0.9 per cent NaCl, intraoperatively to determine duration of action and efficacy in preventing postoperative pain. Epidural morphine gave significantly longer postoperative analgesia (greater than 11 h) than placebo (3-6 h) in both groups (p less than 0.05) and patients who received morphine required less postoperative analgesic. Obstetric subjects experienced longer pain relief (18.3 +/- 1.3 h) than patients undergoing non-obstetric intraperitoneal surgery (9.2 +/- 1.2 h) (p less than 0.001). Generally mild pruritus affected more than 40 per cent of those receiving morphine, but over 90 per cent of obstetric patients receiving morphine. Respiratory depression occurred in 2-7 per cent of subjects who received morphine; unpredictable in onset, it responded rapidly to naloxone. Epidural bupivacaine, if employed for the surgical procedure, appeared to prolong epidural morphine analgesia. We consider epidural morphine useful in preventing postoperative pain, but its use demands close observation of respiratory rate in a high density nursing area.

Morphometric measurements at the electron microscope level were carried out on three categories of mesenteric arteries representing elastic (superior mesenteric), muscular and arteriolar vessels, from 10- to 12-week-old spontaneously hypertensive rats (SHR) and age-matched Wistar-Kyoto normotensive rats (WKY). Changes were observed only in muscular and arteriolar vessels of SHR, mainly as thickening of the vessel wall due to hypertrophy of the media. In muscular arteries, hypertrophy of the endothelial cells, widening of the subendothelial space, increased volume of the internal elastic lamina (IEL), and both hyperplasia and hypertrophy of the smooth muscle cells (SMC) in the media contributed to the wall thickening. In arteriolar vessels, increase in the subendothelial space and IEL, and hyperplasia of the SMC in the media were involved in the increased thickness of the vessel wall. There was no difference in the collagen content in all vessels, but elastin was increased in the muscular and arteriolar vessels of SHR. Nerve density was also increased in arteriolar vessels of SHR. These changes, especially the increase of SMC in muscular and arteriolar vessels, may be related to the elevated blood pressure in SHR.

We have on several occasions studied the nasal respiratory epithelium of an infant with hyaline membrane disease that evolved into bronchopulmonary dysplasia and observed an association between the clinical status and naso-ciliary motion and ultrastructure. At 4 months of age, when the patient had significant respiratory disease, few cilia were present and they beat with a slow dyskinetic motion. The specimens contained primarily necrotic and squamous epithelial membranes; the occasional cilia present had swollen or ruptured membranes. Partial recovery of the epithelium was noted at 4.5 months, with 45% of the cilia having normal ultrastructure. The beat frequency was 15.2 +/- 1.5 Hz (mean +/- SD), and although some degree of dyskinesia was evident, primarily normal ciliary motion was observed. By 10 months of age, significant clinical improvement had occurred and the nasal epithelium had regenerated; 96% of the cilia had normal ultrastructure, and the ciliary beat frequency (12.4 +/- 1.2 Hz) and motion were normal.

Twenty-eight patients presenting with typical dorsal root pain of more than six months’ duration were given a series of three epidural injections of methylprednisolone acetate. The patients were grouped according to known aetiologic factors. Improvement in symptoms was most marked in the post-herpetic group where 86 per cent were free of pain after six months. In the post-trauma/surgical group, 50 per cent of patients were free of pain after six months, while in the idiopathic group only minimal improvement occurred. The side-effects of steroid administration into the epidural space were in all cases minor.

The histometric method is often used in hypertension studies in order to reconstruct, from cross-sectional profiles of vessels in the contracted state, a hypothetical relaxed state of the vessels based on the measured length of the internal elastic lamina (IEL). In this study, the accuracy of the histometric method was tested by comparing values obtained with the histometric method from contracted vessels versus values from morphometric measurements of vessels of the same calibre but maximally relaxed. Mesenteric arteries from spontaneously hypertensive and normotensive Wistar-Kyoto rats were used. We found that the lumen size of the vessels was dependent on the methods of measurement and preparation. Lumen size, determined with the histometric method from contracted vessels, tended to be underestimated mainly because the IEL became shortened during contraction of the vessels. When vessels were prepared by perfusion fixation, a high perfusion flow rate (7.6 ml/min) caused expansion of the lumen in muscular (lumen diameter 120--250 microns) and arteriolar vessels (40--100 microns), but not in the elastic arteries (400--700 microns). The cross-sectional area of the vessel wall, however, remained unchanged when the vessels were either contracted with norepinephrine or expanded with high transmural pressure, so morphometric measurements of the vessel wall and its components can be done on both contracted and relaxed vessels. Our results suggest that the use of the histometric method for the estimation of relaxed lumen size from the contracted vessels is of very limited value. We also suggest that, for an accurate comparison of vessel wall dimensions between hypertensive and normotensive animals, cross-sectional area should be used instead of wall thickness alone.

A simple technique for catheterization of the pulmonary artery in small mammals is described. An angled polypropylene introducer is used to allow easy placement of Swan--Ganz and triple lumen thermistor tipped catheters for haemodynamic evaluation. Hitherto such information has been unavailable because of difficulties in placement of catheters as well as an unacceptably high mortality rate. In an extensive experience with this new technique no instances of cardiac arrhythmia or of death have so far been encountered.