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Blood pressure, rate of respiration of each women and foetal heart rate were recorded before spinal anaesthesia. After pre-loading with Ringer's lactate soluation 20 mlkg-1, spinal anaesthesia was administered in the sitting position with 0.5% hyperbaric bupivacaine 2.5 mL ; with 25 gauge Quincke's lumbar puncture needle at the interspace between L3-4. After administration of spinal anaesthesia, women were put in the supine position with a 150 wedge under the right hip for left uterine displacement and supplementation of oxygen 3 L flow per minute was administered through polymask. Following confirmation of spinal block by loss of sensation to cold and pinprick, to T4-5 level, surgery was started. Syntocinon 10 units ; was administered through intravenous infusion at the time of umbilical cord clamping. Oxygen saturation, pulse rate, respiratory rate and arterial blood pressure of each women were monitored and recorded every 10 minutes during the surgery and post-operatively every 30 minutes during the study period. The decrease in systolic blood pressure more than 20% of baseline value and or less than 90 mm of after spinal anaesthesia was treated by increasing the rate of intravenous fluid administration and 3 mg increaments of ephedrine administered intravenously every 3-5 minutes ; until resolution of hypotension. Emetic episodes nausea and or vomiting ; experienced by women were recorded intra-operatively and up to 4 hours post-delivery period in the post-operative ward by anaesthesiologist who was blinded to the treatment patient had received. If two or more episodes of emesis occurred in each observation period 0-4 hrs ; , 4 mg inj ondansertron intravenously was administered as rescue antiemetic to the patient. Request for pain relief during post-operative period was complied with 75 mg of diclofenac sodium given through intramuscular route along with inj ranitidine 50 mg administered intravenously. The incidences of nausea and vomiting were compared in different groups and the differences were tested for significance by calculating z value. A p value 0.05 was considered significant. Observation and results A total 80 patients were studied in four groups. The age, weight, ASA status, duration of surgery were all comparable in all groups of patients, as shown in table I. Incidence of post-operative nausea was noted 40% in placebo group, whereas 10% in glycopyrrolate group, 10% in dexamethasone group and 20% in metoclopramide group shown in table II.
FIGURE 6. Role of AP-1 NF-AT and NF- B in regulating CD154 expression by activated peripheral B cells. Highly purified peripheral blood B cells 1 105 ; were cultured with medium alone, 10 g ml anti-Ig, or membranes from Sf9 cells expressing recombinant mCD154 in the presence or absence of the 100 ng ml Cy, 200 M PD98059, 30 M lactacystein, or 1 g ml cycloheximide. Human CD154 expression was assessed by A ; FACS analysis after staining cells with FITC-conjugated anti-CD19 and PE-conjugated antihCD154 8976 ; or by B ; RT-PCR and Southern blotting of isolated mRNA. Data in A are expressed as the mean of two to seven experiments SEM. Significance was determined by paired two-sample Student's t test. The blot in B is representative of three experiments with similar results.
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32. Berger H, Kirstein CG, Orthner CL: Pharmacokinetics of activated protein C in guinea pigs. Blood 77: 2174, 1991 Espana F, Gruber A, Heeb MJ, Hanson SR, Harker LA, Griffin JH: In vivo and in vitro complexes of activated protein C with two inhibitors in baboon. Blood 77: 1754, 1991 Griffin JH, Evatt B, Zimmerman TS, Kleiss AJ, Wideman C: Deficiency of protein C in congenital thrombotic disease. J Clin Invest 68: 1370, 1981 Marlar RA: Protein C in thromboembolic disease. Semin Thromb Hemost 11: 387, 1985 Okajima K, Koga S, Kaji M, Inoue M, Nakagaki T, Funatsu A, Okabe H, Takatsuki K, Aoki N: Effect of protein C on coagulation and fibrinolysis in normal human subjects. Thromb Hemost 63: 48, 1990 Richardson MA, Gerlitz B, Grinnell BW: Enhancing protein C interaction with thrombin results in a clot-activated anticoagulant. Nature 360: 261, 1992 Grinnell BW, Walls JD, Gerlitz B, Berg DT, McClure DB, Ehrlich H, Bang NU, Yan SB: Native and modified recombinant human protein C: Function, secretion, and post-translational modifications, in Bruley D, Drohan W eds ; : Protein C and Related Anticoagulants. Houston, TX, Gulf Publishing Co, 1990, p 29 39. Yan SCB, Razzano P, Chao YB, Walls JD, Berg DT, McClure DB, Grinnell BW: Characterization and novel purification of recombinant human protein C from three mammalian cell lines. Bio Technology 8: 655, 1990 Smith JR, White AM: Fibrin, red cell and platelet interactions in an experimental model of thrombosis. Br J Pharmacol 77: 29, 1982 Ashida S, Sakuma K, Abido Y: Antithrombotic effects of ticlopidine, acetylsalicylic acid and dipyridamole in vascular shunt model in rats. Thromb Res 17: 663, 1980 Grinnell BW, Walls JD, Gerlitz B: Glycosylation of human protein C affects its secretion, processing, functional activities and activation by thrombin. J Biol Chem 226: 9778, 1991 Gruber A, Griffin JH: Direct detection of activated protein C in blood from human subjects. Blood 79: 2340, 1992 Lollar P, Owen WG: Clearance of thrombin from circulation in rabbits by high-affinity binding sites on endothelium: Possible role in the inactivation of thrombin by antithrombin III. J Clin Invest 66: 1222, 1980 Lollar P, MacIntosh SC, Owen WG: Reaction of antithrombin III with thrombin bound to vascular endothelium: Analysis in a recirculating perfused rabbit heart preparation. J Biol Chem 259: 4335, 1984 Olson ST, Bjork I: Regulation of thrombin activity by antithrombin III and heparin. Semin Thromb Hemost 20: 373, 1994 Moore KL, Esmon CT, Esmon NL: Tumor necrosis factor leads to the internalization and degradation of thrombomodulin from the surface of bovine aortic endothelial cells in culture. Blood 73: 159, 1989 Drake TA, Cheng J, Chang A, Taylor FB: Expression of tissue factor, thrombomodulin and E-selectin in baboons with lethal E. coli sepsis. J Pathol 142: 1458, 1993 Esmon CT: The protein C anticoagulant pathway. Arterioscler Thromb 12: 135, 1992.
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By Pam Bacher The morning and evening Great Decisions discussion groups will have a short joint meeting on Saturday, Jan. 20, 10 a.m. to kick off the new Great Decisions year. The meeting will be at Pam Bacher's home; participants will be able to pick up their 2007 briefing book and each group can schedule their meetings for the year. A reminder will be e-mailed after the first of the year. All members of the branch are welcome to join the Great Decisions discussion groups. Members are welcome to attend either the morning or the evening group as schedules dictate. Please contact Pam Bacher prbacher cox , 703 2812595 ; if you are interested and have not already reserved a briefing book. A few books are available at the discount cost of .20. Morning Lit and goldenseal.
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DETERMINE THE EXTENT OF HISTORY OBTAINED: The levels of E M services recognize four types of history that are defined as follows: Problem Focused -- chief complaint; brief history of present illness or problem. Expanded Problem Focused -- chief complaint; brief history of present illness; problem pertinent system review. Detailed -- chief complaint; extended history of present illness; problem pertinent system review extended to include review of a limited number of additional systems; pertinent past, family and or social history directly related to patients problems. Comprehensive -- chief complaint; extended history of present illness; review of systems which is directly related to the problem s ; indicated in the history of the present illness plus a review of all additional body systems; complete past, family and social history. The comprehensive history obtained as part of the preventive medicine evaluation and management service is not problem-oriented and does not involve a chief complaint or present illness. It does, however, include a comprehensive system review and comprehensive or interval past, family and.
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That the transverseimage planesof the CT accuracydependsmoston the ability of the operatorto align methodassumes the surfaces of the vessels and to a lesser degree on the are parallel to the transverseimaging planesof the SPECT ability of the operator to identify and segment vessels on scan. In addition, the method requires the bony anatomy positions to be the same for both studies. Despite these both the CT and SPECT images. Because the entire surface difficulties and the fact that this method does not provide of each vascular structure is used for alignment, segmenting errors on any particular transverse image are not very true three-dimensional registration, the authors found satis significant to the final result. The method is more sensitive to factory results. differences in the geometric shapes of the vessels at the time of CT and SPECT imaging. Standard, but different, imaging CONCLUSION protocols were used for CT and SPECT data acquisition. Our registration method enables full three-dimensional Despitethesedifferences, acceptablevascularregistrationof registration of ~ MoAb 7Ell.C5 SPECT and CT ana ~ ~In CT and SPECT was achieved. However, differences in tomic data. We expect that our method will improve the bladder and rectal filling were observed to be significant. A detectionof the spreadof diseasein prostatecancerpatients uniform imaging protocol for both CT and SPECT is needed by increasing the specificity of ~ MoAb exams. Further ~ ~In to eliminate these differences. more, our method can aid radiation oncologists in the Our method is quick and easy to implement in a clinical treatment of prostate cancer patients postprostatectomy by service. The entire registration process, including segment identifying regionsof high ~ MoAb activity in the pelvis. ~ ~In ing, takes approximately 2 h once the digital data are The SPECT-CT transferredto the workstation.An experiencedprofessional of small bowel that may contain ~ ~ ~InMoAb activity, staff member, such as a radiation therapy dosimetrist, could allowing discrimination between this activity and increased be trained to use our software in 4 h. different approach to pelvic node activity. In the future, this method may be used register CT with SPECT in the pelvis using bony anatomy for image-based dosimetry to guide doses for radioimmuno was previously described 7 ; . In this method, dual-isotope therapy. SPECT acquisition of a bone scintigraph BS ; using mTc hydroxymethylene diphosphonate HMDP ; and an immuno REFERENCES scintigraph using oeIn-labeled MoAb were performed on 1. Babaian Ri, Lamki LM. Radioimmunoscintigraphy of prostate cancer. Semin Nucl colorectal and ovarian cancer patients. The colorectal can Med. 1989: 19: 309"326. cer patients were given an oeIn-labeled carcinoembryonic 2. Kahn D, Williams RD. Seldin DW, et al. Radioimmunoscintigraphy with HIn labeled CYT-356 for the detection of occult prostate cancer recurrence. J Urn!. antigen-specific MoAb whereas the ovarian cancer patients 1994: 152: 1490"1495. were given oeIn-labeled0C125 MoAb. The BS was used to 3. Babaian Ri, Sayer J, Podoloff DA, Steelhammer LC, Bhadkamkar VA, Gulfo JV. register CT with SPECT in the pelvis. The method required Radioimmunoscintigraphy of pelvic lymph nodes with ~~In labeled monoclonal antibody CYT-356. J Urn!. l994; 152: l952"1955. an operator to match two transverse CT slices with the BS 4. Sychra JJ, Lin Q, Blend Mi. The detection of metastatic prostate cancer with from which axial translation and scaling were determined. simultaneous dual radioisotope SPECT images. RSNA-EJ 1997; 1. Next, the operator was required to select a set of homolo 5. Pelizzari CA, Chen GTY, Spelbring DR. Weichselbaum RR, Chen CT. Accurate three-dimensional registration of CT, PET, and or MR images of the brain. J gous points on one or more of the CT and BS slices. The ComputAssisted Tomogr 1989: 13: 20"26. translation, scaling factor and rotation angle in the trans 6. Vijayakumar 5, Hellman 5. Advances in radiation oncology. Lance: 1997: 349S2: 5111"5113. verse plane were determined by finding the transformation 7. Liehn i-C, Loboguerrero A, Perault C, Demange L. Superimposition of computed between the CT and BS defined set of points. This method tomography and single photon emission tomography immunoscintigraphic images relies strongly on the ability of the operator to match two in the pelvis: validation in patients with colorectal or ovarian carcinoma recurrence. particular pairs of transverse images and then to identify a EurfNuclMed. 1992: 19: 186"194. Schoeneman PH. A generalized solution of the orthogonal Procrustes problem. set of homologous points on each image. Errors are expected Psvchometrika. 1966: 31: 1"10. to arise from the choice of threshold and difficulty in 9. Schoeneman PH, Carroll RM. Fitting one matrix to another under choice of a uniquely identifying specific points on SPECT images. This central dilation and a rigid motion. Psychometrika. 1970: 35: 245"254.
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Two diets generally accepted as being cariogenic for hamsters were also studied in a series of three experiments to obtain information concerning their relative cariogenicity and reproducibility. The Syrian hamster Cricetus auratus ; was used as the experimental animal in this work. The various process in this animal more closely resembles that found in human subjects than does the various process occurring in the rat. This advantage, however, must be balanced against the lack of knowledge of nutritional factors for the hamster as compared with the rat and grepafloxacin.
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Been obtained sensory level at the fourth thoracic dermatome ; . Patients were instructed to report the presence of nausea at any time and asked directly at 3-min intervals to grade the severity of nausea using a verbal scoring system 0 no nausea, 1 mild, 2 moderate, 3 severe, 4 vomiting ; . An overall nausea score was calculated by adding together the individual severity scores to give a total score that took account of both the frequency and severity of nausea episodes. Nausea, vomiting and hypotension decrease in systolic arterial pressure of 20% or more from baseline values or absolute decrease to less than 100 mm Hg ; were treated by increasing the rate of fluid administration and 3-mg increments of i.v. ephedrine every 3 min ; until resolution of hypotension. Ephedrine requirements, maximum block height, speed of onset of block and Apgar scores were recorded. All women received a bolus dose of Syntocinon 10 u. and cefuroxime 1.5 g over 5 min after delivery. Data were analysed using SPSS 7.0 Microsoft Corporation ; . Patient data were compared using the unpaired t test, chi-square test for frequency data and the Mann Whitney U test or unpaired t test for inferential analysis depending on the normality of the data. One woman in the glycopyrrolate group refused subarachnoid anaesthesia after the study drug had been given and was withdrawn, leaving 24 women in this group. There were no block failures. Patient data were similar in both groups. In the glycopyrrolate group, 10 of 24 42% ; women developed nausea during the procedure compared with 17 of 25 68% ; in the placebo group Table 1 ; . Patients in the glycopyrrolate group had fewer episodes of nausea than those in the placebo group P 0.02 ; . Total nausea scores.
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Disordered movement and dementia are the clinical hallmarks of the disease. Movement abnormalities can involve the extremities, trunk, face, eyes, mouth, oropharynx and respiratory muscles, thereby leading to an increased risk of aspiration pneumonitis and consequently antiaspiration manoeuvers must be used. The disease progresses for several years and accompanying mental depression makes suicide a frequent occurrence.2 Experience with the management of anaesthesia in Huntington'chorea is too limited to propose specific drugs or techniques.Reported anaesthesia experience in patients with Huntington's disease is largely anecdotal and consists of a small number of case reports and letters.3-11 Although there are no specific contraindications to using intravenous or inhaled anaesthetics, delayed awakening and generalized tonic spasms have been reportd after administration of Thiopental.7 In contrast, a normal response with rapid recovery has been reported with propofol in patients with Huntington's disease.12-14 It has been suggested that these patients may be sensitive to the effects of non-depolarizing muscle relaxants although the reported response to atracurium has been normal.13, 15 Interestingly, the incidence of decreased pseudocholinesterase activity is substantially higher in Huntington's disease patients than in normal population.5 This may explain the single report of prolonged response to succinylcholine. The use of sevoflurane and mivacurium for general anaesthesia in patients suffering from Huntington's disease seems to be effective and safe.16 We used glycopyrrolate in this case periopertively since central anticholinergic effects may exacerbate choreiform movements. Patients with Huntington's disease are at higher risk of intraoperative complications, including pulmonary aspiration, 3, 14 prolonged response to succinylcholine5 and thiopental7 and increased sensitivity to midazolam.8 The primary goal in general anaesthesia for these patients is to provide airway protection and a rapid and safe recovery. The recently introduced inhalational agent sevoflurane could eliminate the problem of prolonged recovery because of its favourable pharmacokinetic profile.16 We used isoflurane instead, since we had no sevoflurane in our hospital at that time. Prolonged apnea following suxamethonium can be averted by using rocuronium when rapid sequence induction becomes necessary.17 For lower abdominal and perineal surgery, spinal anaesthesia is a tangible alternative although achieving proper position and avoidance of trauma remains difficult in these patients.11 Factors of considerable concern to the anaesthesiologist who treats patients with Huntington's disease may.
1. 2. Johnson AL, Probst CW, DeCamp CE, et al. Comparison of the trochlear block recession and trochlear wedge recession for canine patellar luxation using a cadaver model. Veterinary Surgery 30: 140-150, 2001. Talcott KW, Goring RL, deHann JJ. Rectangular recession trochleoplasty for treatment of patellar luxation in dogs and cats. Veterinary Comparative Orthopaedics and Traumatology. 2000; 13: 39-43 and guanethidine.
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