Ultra-low-dose CBCT: new cornerstone of paranasal sinus imaging.

BACKGROUND: This study evaluates the clinical image quality (IQ) and usability of a sinonasal ultra-low-dose (ULD) cone-beam computed tomography (CBCT) scan. The results are compared to those of a high resolution (HR) CBCT scan to identify the strengths and weaknesses of a ULD CBCT protocol. METHODOLOGY: Sixty-six anatomical sites in 33 subjects were imaged twice using two imaging modalities: HR CBCT (Scanora 3Dx scanner; Soredex, Tuusula, Finland) and ULD CBCT (Promax 3D Mid scanner; Plandent, Helsinki, Finland). IQ, opacification and obstruction, structural features and operative usability were assessed. RESULTS: The overall IQ in subjects with 'no or minor opacification' was excellent: 100% (HR CBCT) and 99% (ULD CBCT) of ratings were evaluated as sufficient for every structure. Increased opacification reduced the quality of both imaging modalities, resulting conchtoethmoidectomy, frontal sinusotomy, sphenotomy and posterior ethmoidectomy in cases with greater opacification. CONCLUSIONS: IQ of paranasal ULD CBCT is sufficient for clinical diagnostics and should be considered for surgical planning. We recommend it as the primary imaging protocol for all patients who meet imaging criteria due to recurrent or chronic nasal symptoms. Additional or conventional imaging might be needed for patients with extensive chronic rhinosinusitis and/or indications of frontal sinus involvement.

Adipokines played a limited role in predicting temporary growth differences between very low birthweight infants with and without bronchopulmonary dysplasia.

AIMS: This study explored whether growth was poorer among very low birthweight (VLBW) infants with bronchopulmonary dysplasia (BPD) and assessed adipokine levels as predictors of early growth. METHODS: We studied 53 VLBW infants born in Tampere University Hospital up to 12 months of corrected age (CA). The median gestational age of the 21 infants with BPD and 32 infants without BPD was 29 weeks, and the median birthweights were 930 (635-1470) and 1185 (650-1470) grams. Growth parameters, macronutrients intake and plasma levels of adipokines were measured. RESULTS: Bronchopulmonary dysplasia infants were lighter than controls until 36 weeks of CA, with catch-up growth achieved by three months of CA. Adipsin levels were lower in BPD infants at 28 days of postnatal age. High leptin levels seemed protective for low weight for height at nine months of CA. The duration of ventilator therapy predicted low weight for height, length for age and body mass index and BPD predicted low length for age at 12 months of CA. CONCLUSIONS: Catch-up growth in VLBW infants with BPD was achieved by three months of CA, but adipokines played a limited role in predicting growth. Shortening ventilator therapy could help growth in VLBW infants.

Dysphagia and dysphonia among persons with post-polio syndrome - a challenge in neurorehabilitation.

OBJECTIVE: To study the occurrence of dysphagia and dysphonia in persons with post-polio syndrome admitted into the centre for neurological rehabilitation in Finland. MATERIALS AND METHODS: Fifty-one persons with post-polio syndrome who were rehabilitated at Käpylä Rehabilitation Centre, Helsinki, Finland, in 2003-2004 were interviewed on problems with swallowing and voice production. Pulmonary function testing and grip strength measurement were performed. A clinical assessment of oral motor and laryngeal functions was carried out for those who reported daily problems with voice production or swallowing. RESULTS: Fifteen persons (29.4%) reported daily problems with swallowing or voice production. In the clinical assessment, the most commonly observed deficits in swallowing included decreased pharyngeal transit (n = 13) and the food catching in the throat (n = 4). The disturbance of co-ordination of breathing and voice production was seen in 12 persons. There were no significant differences in any of the potential predictors between the groups. CONCLUSIONS: Professionals need to be aware of the routine evaluation of dysphagia and dysphonia in patients with post-polio syndrome.

Genetic epidemiology of subclinical cardiovascular disease in the diabetes heart study.

A genome-wide linkage scan of 357 European American (EA) and 72 African American (AA) pedigrees multiplex for type 2 diabetes mellitus (T2DM) was performed with multipoint nonparametric QTL linkage analysis. Four subclinical measures of cardiovascular disease (CVD): coronary artery (CCP), carotid artery (CarCP), and abdominal aortic calcified plaque (AACP) and carotid artery intima-media thickness (IMT) were mapped. Analyses were adjusted for age, gender, body mass index, and (if appropriate) ethnicity and diabetes status. Evidence for linkage was observed in EA T2DM subjects to CarCP near 16p13 (LOD=4.39 at 8.4 cM; P = 0.00001). When all EA subjects were included, the LOD score was 2.52, suggesting an amplification of the linkage by diabetes. Linkage analysis of a principal components measure of vascular calcium (LOD = 3.85 at 9.3 cM on 16p in EA T2DM subjects) and bivariate analysis of CarCP X IMT (LOD = 3.77 at 9.3 cM on 16p in EA T2DM subjects) were consistent with this linkage. In addition, evidence for linkage was observed with CCP near D15S1515 (LOD = 2.34) in EAs. Additional loci on chromosomes 1, 2, 7, 10, 13, and 21 had LODs > 2.0. The identification of trait-determining polymorphisms underlying these linkages will help delineate risk factors for CVD in T2DM and the general population.

The construction of a novel kind of non-viral gene delivery vector based on protein as core backbone.

BACKGROUND AND OBJECTIVES: A novel kind of non-viral gene delivery vector based on transferrin (Tf) as the core component was constructed with high transfection efficiency and low toxicity. MATERIALS AND METHODS: The synthesis vector of Tf-PEI600 was confirmed by different physicochemical methods, including (1)H nuclear magnetic resonance, gel permeation chromatography, X-ray and thermogravimetric analysis. The cytotoxicity and gene delivery efficiency of the synthesized vector were verified by in vitro experiments. RESULTS: The agarose gel electrophoresis assay indicated that the novel copolymer Tf-PEI600 could efficiently condense plasmid DNA and the condensed nanoparticles exhibited a spherical shape. As the weight ratio of Tf-PEI600 to DNA reached 15.0, the particle size (about 200 nm) and the zeta potential (about 20 mV) of the nanoparticles became optimal for gene delivery. The methylthiazolyl tetrazolium (MTT) assay showed the cytotoxicity of Tf-PEI600 to be similar to that of PEI600 and much lower than that of PEI25kDa. In gene-delivery experiments with COS-7 cells and HepG2 cells, the Tf-PEI600 showed about a 30- to 53-fold higher efficiency than PEI600 and nearly equal to that of PEI25kDa. CONCLUSIONS: These data suggest that Tf-PEI600, with the advantages of low toxicity and high gene-delivery efficiency, might have great prospects in the practice of gene delivery. The core-shell structure of Tf-PEI600 also provided a novel strategy for the construction of non-viral gene delivery vectors.

Advanced dental maturity in children with juvenile rheumatoid arthritis.

The subjects of the investigation comprised 95 girls and 73 boys with juvenile rheumatoid arthritis (JRA), and 102 girls and 66 boys representing healthy controls, all with a chronological age from 6.3 to 14.4 yr. The dental development was assessed from panoramic radiographs using a seven-tooth model. The radiographs were evaluated on three separate occasions with a minimum interval of one month in a randomized order, and blind with respect to absence or presence of JRA. In both JRA patients and healthy controls, dental maturity was ahead of chronological age. In addition, dental maturity was significantly advanced in JRA patients with 0.26 yr in girls and 0.28 yr in boys. It is tentatively suggested that the advanced dental development in JRA patients compared with healthy children was partly an effect of treatment with cortisone, while the influence of the disorder per se remains to be elucidated.

Long-term prognosis of reactive salmonella arthritis.

OBJECTIVES: Reactive joint complications triggered by salmonella gastroenteritis are increasingly reported, but the outcome and long term prognosis of the patients is incompletely known. This study looked at the prognosis of salmonella arthritis in patients hospitalised in 1970-1986. METHODS: Hospital records from two hospitals in southern Finland were screened for patients with the discharge diagnosis of salmonellosis or reactive, postinfectious arthritis or Reiter's disease. For the patients with confirmed diagnosis of reactive salmonella arthritis, data about the acute disease were collected from the hospital records. A follow up study was performed. RESULTS: There were 63 patients (28 women, 35 men, mean age 36.5 years) with salmonella arthritis. Urethritis occurred in 27%, eye inflammation in 13%, and low back pain in 44% of the patients. HLA-B27 was present in 88%. More men than women were HLA-B27 positive. HLA-B27 positive patients had higher erythrocyte sedimentation rate (mean 80.9 v 46.5 mm 1st h, p = 0.0180). Also, extra-articular features and radiological sacroiliitis were seen only in HLA-B27 positive patients. A follow up study was performed on 50 patients mean 11.0 (range 5-22 years) later. Twenty patients had recovered completely. Ten patients had mild joint symptoms, 11 patients had had a new acute transient arthritis, and five acute iritis. Eight patients had developed chronic spondyloarthropathy. Radiological sacroiliitis was seen in six of 44 patients, more frequently in male than in female patients (32% v 0%; p = 0.0289). Recurrent or chronic arthritis, iritis or radiological sacroiliitis developed only in HLA-B27 positive patients. CONCLUSION: Joint symptoms are common after reactive salmonella arthritis. HLA-B27 contributes to the severity of acute disease and to the late prognosis.

Ultrasonography and colour Doppler flow in the testes of adult patients after treatment of cryptorchidism.

OBJECTIVE: To analyse the prevalence of post-operative structural, parenchymal and vascular testicular abnormalities and the incidence of epididymal abnormalities in adult men treated for undescended testes in childhood. PATIENTS AND METHODS: The testes and epididymi of 76 adult men treated for cryptorchidism in childhood were evaluated 16 to 27 years after treatment, using colour Doppler ultrasonography. RESULTS: The 61 spontaneously descended testes were significantly (P < 0.01) larger (mean [SD], 22 [8] mL) than the 90 undescended testes (13 [6] mL). The echo pattern in all the spontaneously descended testes was normal, whereas in 15 cases (17%) the testicular tissue was abnormal after cryptorchidism. In 12 of these 15 cases, the echo pattern was very irregular, and two other cases had microlithiasis of the testicular parenchyma, one of them bilaterally. No normal testicular artery was detected in two cases (3%) of normally descended testes, against 18 (20%) amongst those with undescended testes. Epididymal abnormalities were found in two (3%) of the group of normally descended testes against 32 (36%) in the undescended group. CONCLUSIONS: Infertility in patients with cryptorchidism may be a result not only of primary parenchymal degenerative changes of the testis directly due to the condition, but also of operative vascular trauma and epididymal anomalies. Operative trauma may be more common than has generally been believed. Ultrasonography is a suitable method to evaluate post-operatively the prevalence of the testicular abnormalities analysed in the present study.

Painful ankle region in rheumatoid arthritis. Analysis of soft-tissue changes with ultrasonography and MR imaging.

PURPOSE: To establish the diagnostic usefulness of ultrasonography (US) and MR imaging in patients with rheumatoid arthritis (RA) suffering from prolonged pain in the ankle region, where plain radiography did not demonstrate any changes. MATERIAL AND METHODS: Seventeen patients were studied with 0.1 T MR imaging and with high-frequency US. Talocrural and subtalar joints (including talonavicular joints), and medial, lateral, and extensor tendons and their synovial sheaths were examined by MR and US. RESULTS: Abnormal findings were found by MR imaging and US in altogether 76% of the patients, by MR alone in 53%, and by US alone in 59%. In 41% of the patients, lesions were demonstrated only by one method. Talocrural and subtalar joints were the most often affected sites (41% each), followed by the peroneus tendon (23%). In the joints, the abnormal findings were interpreted as synovitis; in the tendon areas, mostly as tenosynovitis. MR and US were highly significantly concordant (p < 0.0001), but correlation with clinical features was poor. CONCLUSION: In patients with pain in the ankle region, US and MR imaging can contribute to the diagnosis and localization of the abnormality when the plain radiography is normal. Easily available and inexpensive US can be recommended as the first imaging method after plain radiography. Some divergence seems to exist between US and MR, and in complicated cases both methods are recommended.

Persistence of enthesopathic changes in patients with spondylarthropathy during a 6-month follow-up.

The persistence of enthesopathic changes was studied by ultrasound (US) in 23 patients with spondylarthropathy during a 6-month prospective trial with sulphasalazine (Salazopyrin). During the follow-up significant improvement was seen in the joint symptoms and in the laboratory variables. By US 78% of the patients had enthesopathy at entry and 74% after 6 months of follow-up. The plantar fascia was the enthesis most frequently affected. Treatment with sulphasalazine had no obvious influence on the persistence of enthesopathy. Enthesopathy is as a rule a constant phenomenon and is probably caused by chronic enthesitis. A parallel resolution of anatomic soft tissue changes and the clinical status was not seen on US. There was also no evidence of a favourable effect of sulphasalazine on enthesopathy in the 6-month follow-up.

Use of angulation in the detection of tendinitis with US.

The purpose of the study was to examine the possible benefit of the longitudinal probe angle deviation in the detection of tendinitis. The influence of the ultrasound beam angle in longitudinal view on the echo intensity was studied on a bovine tendon in vitro, and in vivo on symptomatic human Achilles tendons, one of which was operated on the following day. Five other consecutive patients with clinically unilateral tendinitis in the Achilles tendon, were treated conservatively. Experimental tendinitis was induced in the bovine tendon by injecting saline water inside the tendon with subsequent swelling of the tendon and separation of the collagen bundles, thus disrupting the anisotropic intratendinous structure. The echogenicity of the intact and injected bovine tendons was studied perpendicularly and with slight angulation of 7-10 degrees. The symptomatic Achilles tendons were studied in a similar way using the asymptomatic tendon as comparison. For in vivo studies, the asymptomatic tendons were used as comparison in clinical and sonographic studies. When increasing the longitudinal probe angle up to 7-10 degrees the normal tendons became hypoechoic, but tendinitic tendons did not lose their echogenicity as rapidly. Moreover the anterior peritenon was seen more clearly in tendinitic tendons compared to the normal side. The method is very useful especially in diagnosing early stage tendinitis, where the treatment should be more effective than in more severe and chronic stages.

Sonographic analysis of enthesopathy in the lower extremities of patients with spondylarthropathy.

OBJECTIVE: Enthesopathy is one of the features characterizing patients with spondylarthropathies. Its diagnosis is usually based on clinical symptoms such as the presence of calcanear pain or tenderness at the insertion(s) of ligaments. More objective ways to estimate the presence and nature of enthesopathy are needed. Therefore, we analysed both by clinical and sonographic methods the presence of enthesopathy in the lower extremities of patients with spondylarthropathy. METHODS: 31 consecutive patients with spondylarthropathies (15 with reactive arthritis, 12 with ankylosing spondylitis, and 4 with psoriatic arthritis) were studied for the presence of enthesopathy in the lower extremities, independently by clinical examination and by high resolution sonography. RESULTS: Sonography detected inflammatory lesions in 44 entheses of 20 patients. Oedema at the insertion of the tendon was the most common finding. Signs of enthesitis were more common in the lower portion of the leg. In addition to enthesitis, bursitis was a common finding by sonography. By clinical examination, enthesitis was diagnosed in 56 sites in 20 patients, most frequently at the insertions of the Achilles tendon and the plantar fascia. Bursitis around the calcaneus and synovitis/pain in the hip and knee joints were most frequently misinterpreted to indicate enthesopathy at the clinical examination. In addition, half of the insertions with only oedema at sonography were clinically asymptomatic. CONCLUSIONS: Sonographic examination of ligamentous insertions offers morphologic information which is unobtainable by the clinical judgement of tenderness in the estimation of enthesopathy in patients with spondylarthropathies.

Percutaneous interstitial laser hyperthermia in clinical use.

Twelve patients were treated with laser-induced hyperthermia. Eight had liver metastases from breast cancer or colorectal cancer, and four were treated for a primary tumour, two in the liver, one in the biliary tract and one in the pancreas. The mean diameter of the metastases was 2.5 cm and of the primary tumours 4 cm. One patient was given ethanol injections before the treatment, and seven were treated with chemotherapy before and two after the treatment. At the time of writing this report, all the patients are still alive. The follow-up times vary from six months to five years. Treatment was technically possible in all cases. The smallest metastasis disappeared totally and, with the exception of a few larger tumours, they were reduced in size. There were no serious complications. The patients were treated percutaneously under ultrasonographic imaging in real time. Only minor side effects were seen, and the method is safe. Technically, laserthermia is easy to perform. A skillful radiologist is needed, and the presence of an anaesthetist makes it possible to safely treat tumours that can be reached only when respiration is controlled mechanically. Controlled, randomized studies are now needed to evaluate the method in comparison with other palliative treatment modalities.

Sonography of Achilles tendon correlated to operative findings.

Ultrasound examination (US) with a 5 MHz linear array probe was used to examine 30 patients (34 Achilles tendons) with overuse injuries. The results were compared with surgical findings in all cases. Most of the patients had two or more sonographical findings. In this study US had an overall sensitivity of 0.96 in the detection of Achilles tendon pathology. Partial Achilles tendon rupture was suspected in ten tendons. During an operation ruptures were found in eleven tendons, of which two were fibrotic scars. Changes in inflammatory tendopathy (tendinitis, paratenonitis and paratenonitis with tendinosis) were found by US in 28 tendons and in the operation in 27 tendons. US showed tendinitis in 21 cases, of which four had a positive operative finding. In the seventeen negative cases, the surface of the tendon looked normal during the operation. Most of these cases (14 out of 17) were classified as paratenonitis during the operation. In three cases, paratenonitis with tendinosis was classified as paratenonitis in the operation and in one case the findings were similar in US and in surgery. US was underdiagnostic in paratenonitis and overdiagnostic in tendinitis. Bursitis was detected during the operation in ten cases, but only in three cases by US. False positive bursitis was diagnosed three times in US compared to the operative finding. In chronic bursitis, the bursa can be small, thickened by its wall and undetectable by US. High-resolution sonography is a relatively reliable diagnostic method in Achillodynia and mainly useful as a preoperative study to differentiate a partial rupture from inflammatory states.

Intramuscularly administered dexmedetomidine attenuates hemodynamic and stress hormone responses to gynecologic laparoscopy.

The hemodynamic and endocrine effects of three different doses of dexmedetomidine (0.6, 1.2, and 2.4 micrograms/kg), oxycodone (0.13 mg/kg), and saline solution, injected intramuscularly 45-60 min before induction of general anesthesia, were compared in a double-blind, randomized study involving 100 women undergoing gynecologic diagnostic laparoscopy. Anesthesia was induced with thiopental (4.5 mg/kg) and maintained with 0.3% end-tidal isoflurane and 70% nitrous oxide in oxygen. Arterial blood pressure and heart rate increased after endotracheal intubation and during laparoscopy in all groups, but the maximal mean arterial pressure after tracheal intubation was lower in the dexmedetomidine 2.4-micrograms/kg group (104 mm Hg [SD 19]) than in the saline solution group (130 mm Hg [SD 12]). Dexmedetomidine (2.4 and 1.2 micrograms/kg) attenuated the maximal heart rate after intubation (84 [SD 11] and 101 beats/min [SD 15], respectively) compared with saline solution (116 beats/min [SD 19]). On the other hand, 40% of the patients in the dexmedetomidine 2.4-micrograms/kg group received atropine in the postanesthesia care unit for bradycardia (heart rate < or = 40 beats/min). Preoperative anxiety and sedation before and after preanesthetic medication were evaluated by the patients with the aid of a profile of mood-state questionnaire; only dexmedetomidine 2.4 micrograms/kg produced significant anxiolysis and sedation. Plasma concentrations of norepinephrine, epinephrine, 3,4-dihydroxyphenylglycol, cortisol, and beta-endorphin increased less in the dexmedetomidine 2.4-micrograms/kg group in response to tracheal intubation and surgery than in the saline solution group.

Nausea and vomiting after gynaecological laparoscopy depends upon the phase of the menstrual cycle.

Postoperative nausea and vomiting were compared in 68 women with regular menstrual periods undergoing gynaecological laparoscopy. The patients were divided into four group on the basis of the phase of the menstrual cycle as follows: premenstrum-menstrum (pre + menstrum) (Pd 25-6), early follicular phase (Pd 8-12), ovulatory phase (Pd 13-15) and luteal phase (Pd 20-24). The overall incidence of nausea and vomiting was 46%. Statistically significant differences in the incidence of nausea and retching were found among the groups by regression analysis. The incidence of nausea and vomiting was highest in women undergoing laparoscopy during the luteal phase (77%), which was greater than during the follicular phase (32%) or during pre + menstruation (18%). The need for antimetic was highest in women undergoing laparoscopy during the luteal phase (69%) and this was different from the follicular (18%, P less than 0.01) and pre + menstrum (19%, P less than 0.01) phases. It is concluded that the highest incidence of postoperative nausea and vomiting after gynaecological laparoscopy occurs during the luteal phase.

Effect of intravenously administered dexmedetomidine on pain after laparoscopic tubal ligation.

Ninety-six women undergoing laparoscopic tubal ligation were randomized to receive intravenously either 0.2 or 0.4 microgram/kg of dexmedetomidine, 60 micrograms/kg of oxycodone, or 250 micrograms/kg of diclofenac for postoperative pain in a double-blind study design. The study drugs were administered in the recovery room for moderate or severe pain and were repeated until pain subsided or disappeared. In the group receiving diclofenac, 83% of the patients required analgesic supplementation with morphine. This contrasted (P less than 0.01) with 33% of the patients receiving either oxycodone or the higher dose of dexmedetomidine. After the first dose of oxycodone was injected, the visual analogue scale for pain (0%-100%) was reduced from 58% to 33%, whereas corresponding pain relief was only achieved after the third injection of 0.4 microgram/kg of dexmedetomidine. Repeated doses of 0.2 microgram/kg of diclofenac or dexmedetomidine did not reduce the visual analogue scale value by more than 17%. More sedation was seen with the higher dose of dexmedetomidine than with either diclofenac or oxycodone (P less than 0.001). Both doses of dexmedetomidine decreased heart rate when compared with diclofenac (P less than 0.001). In the group given 0.4 microgram/kg of dexmedetomidine, 33% of the patients required atropine for bradycardia. The authors conclude that after laparoscopic tubal ligation, intravenously administered dexmedetomidine relieves pain and reduces opioid drug requirement but is attended by sedation and a high incidence of bradycardia.

The effect of intravenously administered dexmedetomidine on perioperative hemodynamics and isoflurane requirements in patients undergoing abdominal hysterectomy.

The effects of two doses of dexmedetomidine (0.3 or 0.6 micrograms.kg-1), fentanyl 2.0 micrograms.kg-1, or saline as a single intravenous bolus administered 10 min prior to the induction of anesthesia were assessed in double-blind, randomized study in 96 women undergoing abdominal hysterectomy. In each patient, anesthesia was induced with thiopental 4.0 mg.kg-1, and after the effect of succinylcholine had dissipated, isoflurane 0.3% end-tidal concentration in 70% nitrous oxide was begun to maintain anesthesia. The isoflurane concentration was adjusted to maintain blood pressure and heart rate within 20% of preoperative values, and fentanyl was given if the end-tidal isoflurane concentration exceeded 1.5%. In all groups, blood pressure and heart rate increased after tracheal intubation. However, the increase in blood pressure and heart rate was significantly less in the higher dexmedetomidine (0.6 micrograms.kg-1) group than in the saline group (P less than 0.01). Also, the postintubation increase in heart rate was significantly less (P less than 0.05) in the dexmedetomidine 0.6 micrograms.kg-1 group (increase of 18 +/- 3 beats per min) compared to the fentanyl group (increase of 26 +/- 3 beats per min). In patients receiving dexmedetomidine 0.3 micrograms.kg-1, the increase in blood pressure or heart rate did not differ from that of the saline group. The mean end-tidal isoflurane concentration was significantly less in the women receiving the higher dose of dexmedetomidine (0.35%) than in those receiving saline (0.47%) or fentanyl (0.48%), although the reduction was not clinically important.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of orally administered diazepam and midazolam on plasma beta-endorphin, ACTH and preoperative anxiety.

Ninety-five women undergoing induced abortion were randomly premedicated with oral diazepam, 5 or 10 mg, midazolam 15 mg, or intramuscular placebo, 40-60 min before the induction of anesthesia. Prior to premedication and again prior to the procedure, the women completed the questionnaire sheet for the Profile of Mood States (POMS), and plasma samples for immunoreactive beta-endorphin (ir beta-E) and ACTH were taken. The Oblique Tension-Anxiety (T-A) Factor scores derived from POMS correlated with plasma concentrations of ir beta-E and ACTH after premedication. The T-A scores decreased in women premedicated with diazepam, 5 and 10 mg, or midazolam, 15 mg, but not in women treated with placebo. The women premedicated with midazolam, 15 mg, became more fatigued after premedication. The changes in blood pressure after premedication correlated with T-A scores. A positive correlation was found between heart rate and plasma beta-endorphin concentration. The changes in ir beta-E and ACTH did not correlate with the changes in T-A scores. We conclude that POMS T-A scores are useful for assessment of preoperative anxiety and the effect of premedication. The present study did not provide any reliable proof to confirm the hypothesis of a relationship between plasma concentrations of ir beta-E or ACTH and preoperative anxiety. Since many factors modulate endorphin and ACTH secretion prior to operation, the measurement of endogenous opiates may be of limited value in assessment of the effects of preanesthetic medication.