ABSTRACT
INTRODUCTION: Interstitial cystitis, a chronic inflammatory disorder of the bladder wall, is highly painful and incapacitating. Urinary frequency and urgency develop, as well as nocturia, dysuria, perineal pain and reduction of bladder capacity. The condition seems to arise from a variety of factors with multiple and diverse pathogenic mechanisms and is refractory to medical and surgical treatment. Because treatments are ineffective and recent studies have implicated an inflammatory neurogenic mechanism in the pathogenesis of interstitial cystitis, neuromodulation by epidural spinal cord stimulation has been suggested for treating patients in whom other measures have failed. CASE DESCRIPTION: A 66-year-old woman with a 9-year history of urinary incontinence, urinary urgency and suprapubic pain was diagnosed of interstitial cystitis. She was referred to our pain clinic with persistent symptoms after repeated attempts to treat the condition medically. After implantation of a cephalocaudal (retrograde) epidural spinal cord stimulator, pain decreased 80% and the improvement has been maintained with no complications. CONCLUSION: Results from this and previous reports allow us to state that retrograde epidural spinal cord stimulation seems to be a relatively non-invasive therapeutic approach for treating interstitial cystitis that is refractory to conventional treatments.
Subject(s)
Cystitis, Interstitial/therapy , Electric Stimulation Therapy , Spinal Cord/physiopathology , Aged , Electrodes, Implanted , Epidural Space , Female , Humans , Pain/etiology , Pain Management , Remission InductionABSTRACT
The effects of thiopental and propofol on lymphocyte suppressor T activity were studied in the basal state and after 20 min, 24 hours, and 4 days of anesthesia induction in 20 patients undergoing gynaecologic surgery. Both drugs induced a decrease in lymphocyte suppressive T activity which recovered after 4 days and tended to be larger, although not significantly, with thiopental. Serum noradrenaline concentration significantly increased after two hours of propofol anesthesia and after 20 min and 2 hours of thiopental administration. These results demonstrate that the relationship between lymphocyte suppressive T activity and noradrenaline corresponds theoretically to anesthesia deepness.
Subject(s)
Norepinephrine/metabolism , Propofol/pharmacology , T-Lymphocytes, Regulatory/drug effects , Thiopental/pharmacology , Female , Humans , Norepinephrine/blood , Time FactorsABSTRACT
We have studied the pharmacokinetics of ketamine administered rectally in a dose of 10 mg kg-1 to five children aged 6-9 yr and mean weight 28.80 (SD 6.55) kg. An acceptable level of anaesthesia was not obtained in any patient. Despite this, the degree of analgesia obtained was good and no child required further administration of analgesics during the postoperative period. Tolerance to the suppositories was excellent. The absorption of ketamine was found to be relatively fast, with a median peak concentration of 160 ng ml-1 (range 96-250 ng ml-1) at 0.75 h (range 0.50-1.00 h) after administration. The plasma concentrations of norketamine were greater than those of the parent drug, with a maximum of 510 ng ml-1 (range 450-810 ng ml-1) at 0.81 h (range 0.50-1.00 h) after administration. The medians of the half-lives of ketamine and norketamine were 3.15 h and 2.56 h, respectively (range 1.57-4.95 h and 1.47-5.30 h, respectively).
