PONV management in patients with QTc prolongation on the EKG.

Postoperative nausea and vomiting (PONV) is a commonly encountered problem in surgical practice. It delays discharge from the post-anesthesia care unit, requires additional resources to treat, and may increase the morbidity in some patients. Many effective drugs are available to treat or prevent PONV, however many of these drugs have the potential to prolong the QTc on the electrocardiogram (EKG) and increase the risk of serious ventricular arrhythmias, in particular, torsade de pointes. The QTc prolongation may be a manifestation of a genetic mutation resulting in abnormal myocyte repolarization or it may be acquired and associated with the use of various medications, electrolyte disorders, and physiological conditions. Patients predisposed to QTc prolongation presenting for surgery constitute a challenging group, since many drugs commonly used for PONV management will put them at risk for perioperative serious arrhythmias. This is an important topic, and our mini-review is an attempt to highlight the problem, summarize the existing experience, and generate recommendations for safe management of PONV for patients, who are at increased risk of QTc prolongation and arrhythmias. Focused prospective studies will help to find definitive answers to the discussed problems and challenges and develop specific guidelines for clinical application.

Pulp histology after Er:YAG laser cavity preparation in subhuman primates--a pilot study.

UNLABELLED: The aim of the study was to make a direct comparison of the pulpal effects of laser and turbine preparations in subhuman primates. One female baboon (Papio Ursinus ursinus), weighing 15 kg, was used. General anaesthesia was administered (ketamine 100 mg/ml/kg body weight) and maintained with acepromazine (10 mg/ml/kg body weight). Class V cavities were prepared buccally in a total of 28 teeth (7 in each quadrant). Teeth in the upper right and lower left quadrants were prepared using a conventional 330 carbide bur in a high-speed fibre-optic handpiece with copious water spray. Teeth in the upper left and lower right quadrants were prepared using an Er:YAG laser drill (Fotona Twinlight, Llubljana, Slovenia) delivering 500 mJ at a pulse rate of 10 Hz and a wavelength of 2940 nm. The animal was sacrificed after 25 days. After general anaesthesia as described before, perfusion fixation of the head was accomplished with 10% neutral buffered formalin, pumped through a catheter inserted into the left carotid artery. The jaws were removed and, using a 330 carbide bur in a high speed handpiece, a continuous groove was cut through the bone and the roots at the level of the middle third of all the roots to promote thorough fixation of pulpal tissue. Decalcification and grading of the severity of the pulpal responses were conducted according to standard procedures. RESULTS: Owing to procedural errors seven teeth, FDI numbers 23, 24, 31, 34, 35, 44 and 45, had to be eliminated. The turbine-prepared teeth (N = 11) had a mean remaining dentine thickness (RDT) of 0.77 mm (SD = 0.42) and the laser-prepared teeth (N = 10) had a mean RDT of 0.81 mm (SD = 0.60). All pulps appeared normal except in one turbine-prepared tooth (12 with RDT = 0.20) and one laser-prepared tooth (27 with RDT = 0.30, where irreversible damage was caused. The only other deviations from normal were seen in the laser-treated 41 (RDT = 0.69) and the turbine-treated 36 (RDT = 0.77) where moderate hyperaemia was seen. Within the limitations of this study it can be concluded that there is no significant difference between dental pulp of teeth where Class V cavities were prepared with an Er:YAG laser drill compared with those prepared with a standard turbine drill.

A sensitive sandwich enzyme immunoassay for measurement of insulin on microtiter plates.

A sensitive enzyme immunoassay for the measurement of insulin in human sera on microtiter plates was established. The assay is based on the sandwich technique with guinea pig anti-insulin IgG adsorbed at microtiter plate wells, human insulin as standard and the same anti-insulin IgG labeled with horseradish peroxidase. Standards used cover a range from 0 to 1200 pmol/l with a detection limit of 10 pmol/l. Coefficients of variation between 3-7% for intraassay precision and 5-11% for interassay precision were obtained over the concentration range of 80-1000 pmol/l. The correlation of EIA-data with those of a commercially available double antibody radioimmunoassay (r = 0.98) could be expressed by the equation: EIA = 0.97 RIA - 57 pmol/l. Normal fasting serum insulin concentrations in healthy subjects ranged from 11-165 pmol/l. In subjects with potentially diminished basal values concentrations of 10-79 pmol/l were determined. The insulin response in oral glucose tolerance tests of children was discussed, who had a constitutional tall stature or Turner's syndrome, respectively.

[Rapid determination of C-reactive protein using latex agglutination]. / Die schnelle Bestimmung des C-reaktiven Proteins mittels Latex-Agglutination.

A simple and fast Latex agglutination assay for the determination of C-reactive protein (CRP) is described. The decision range of the assay presented is 7 mg/l; the measuring range extend from 7 mg/l up to 8,000 mg/l. Presented assay allows the cyto-determination of CRP in clinical routine work and therefore is suitable for the early diagnosis of infections in gynecology and obstetrics.

The presence of steroids in larval and mature brook lampreys (Lampetra planeri Bloch).

The presence of steroids was investigated by radioimmunoassay - mass spectrometry in serum and homogenates of gonads and presumed adrenocortical (pro- and opisthonephric) tissue of larval and mature brook lampreys (Lampetra planeri Bloch) of both sexes. Pregnenolone was detected in all tissue samples studied whereas androstenedione could be identified only in presumed adrenocortical tissue from male and female mature animals as well as in testis. Testosterone was present in testis of adult lampreys and in sera of larval and adult animals.

Conjugation of triaziquinone to immunoglobulin G by a thiolation procedure catalyzed by 2-pyridinealdoxime methiodide.

Thiolation of immunoglobulin G (IgG) with DL-N-acetylhomocysteinethiolactone, catalyzed by 2-pyridinealdoxime methiodide, incorporated new sulfur groups into IgG. Triaziquinone was subsequently conjugated to the sulfur groups. Triaziquinone-IgG complex retained the alkylating activity of the drug and the immunological activity of the antibody. The conjugation procedure was inhibited by the thiol-blocking agent methyl methanethiolsulfonate.

Bound immunoglobulin and foreign antigen in lungs of sudden infant death syndrome victims.

Lung sections from 33 infants who died suddenly and unexpectedly and were diagnosed by medical examiners as sudden infant death syndrome (SIDS) gave evidence of bound immunoglobulin G (IgG) when examined by direct fluorescent antibody technique. Ten tissues from appropriate control infants were negative. Specimens containing IgG exhibited no IgA or IgE, but three contained IgM. Sixty-one percent of lung sections with IgG contained either K or lambda antigens; the remainder contained both. The indirect fluorescent antibody technique gave similar results. Blood sera of some individuals in the study which were tested all contained both K and lambda antigens. Fluorescent-labeled immunoglobulin from one SIDS victim stained 7 of 17 SIDS lung sections tested, including his own. Labeled immunoglobulin from three mothers of SIDS victims exhibited differential selectivity in reaction with antigen in lungs of a group of 18 SIDS infants. They did not react with 10 control infant tissues. Various labeled adult sera, cord sera, and serum from an apneic child did not react with the various lungs of SIDS victims in the study.

[Grafting of preserved homogenous cancellous bone. Results of 90 operations (author's transl)]. / Transplantation von konservierter, homogener Spongiosa (Resultate von 90 Operationen).

Description of a simple technique for the removal of homogeneous cancellous bone from heads of femur removed during replacement of the hip-joint. The material has been preserved for one year at -20 degrees C and can be used after simple washing. Results in 89 grafts are analysed: They all took perfectly at the site of grafting. There was no rejection, no local or general allergy. Risk of infection was not increased. The technique is simple and useful where much cancellous bone is needed.

Characterization of extracellular particles released from continuous cell cultures derived from human leukemia.

Extracellular particles, with a density of 1.18-1.22 g/cm3 in sucrose, were detected in the culture medium of a continuous cell line (JIII) derived from a patient with monocytic leukemia. These particles contained RNA, DNA, and a DNA polymerase. They synthesized DNA with endogenous templates and primers and also used exogenous DNA but not poly(rC) oligo(dG) as a template. Pretreatment with Nonidet P-40 stimulated DNA polymerase activity while treatment with ribonuclease partially inhibited the enzyme activity. Fluorescent antibodies made to the particles stained both JIII and Z-597 cells derived from human leukemias but not other types of human or nonhuman cultured cells tested. The particles do not appear to be oncornaviruses but may be a particulate antigen associated with malignant cells of hemopoietic and lymphoid origin.

Occurrence in human bone marrows of an antigen released from continuous cell cultures derived from human leukemia.

Fluorescent antibodies prepared against extracellular particles from a continuous culture of cells derived from a monocytic leukemia stained JIII cells but not cells infected with Rauscher leukemia virus or simian sarcoma virus. These antibodies reacted with 38% of bone marrow preparations from patients with lymphoma, 26% of preparations from patients with nonmalignant blood disorders and 6% of preparations from patients with leukemia. Bone marrow films from patients with lymphoma over the age of 50 stained less frequently than those from patients under 50. These particles released from JIII cells are not antigenically related to two of the commonly studied oncornaviruses, but may be indicative of the etiology or disease process of lymphoma in young patients.

The inhibitory effects of MgCl2 on the inactivation kinetics of poliovirus by urea.

By analyzing the inhibitory effects of Mg-2+ on the three-stage urea inactivation curve of poliovirus, it was concluded that urea inactivates poliovirus via a two-step reaction as follows: urea initially converts the native virus into an intermediate state which is still infectious but is now highly sensitive to inactivation. This reaction is unaffected by Mg-2+ and is reversible. In the subsequent reaction, the sensitized virus is either irreversibly inactivated by urea or reversibly stablized by Mg-2+. In addition, the inactivation curve revealed that a fraction of relatively stable virus population was established in the presence of urea and that the size of this persistent virus population depended on the concentration of urea. It was not determined whether urea induced the formation of this stable fraction of virus or merely selected for a preexisting stable population of virus. However, evidence was presented that (1) the persistent virus population was not due to the depletion or inactivation of urea in the sample, (2) whatever stabilized the virus, it could not be removed or reversed by simple dilution as in the case of Mg-2+, (3) no excess stabilizing material was made to stabilize the addition of untreated virus and finally (4) the persistent virus population was resistant to that concentration of urea in which it was observed but could be further inactivated by a higher concentration of urea, only to result in a smaller fraction of persistent virus population.

Evidence for conformational states of poliovirions: effects of cations on reactivity of poliovirions to guanidine.

The kinetics of inactivation of poliovirions were determined in the presence of various concentrations of monovalent and divalent ions, methionine, guanidine and combinations of these at various temperatures. Four states of the virion, under control of the ionic environment, could be recognized which were reversibly interchangeable and yet retained infectious potential. These states were detected by differential sensitivity of the virion to inactivation of infectivity by heat, urea and guanidine. The data are interpreted in terms of conformational structural changes under control of the ionic environment. It is proposed that these various structural conformations are meaningful to the various biologic functional states of the virus.