Range of motion physiotherapy reduces the force deficit in antagonists to denervated rat muscles.

BACKGROUND: We used a rat hindlimb model of tibial nerve transection to determine if a loss of mechanical function exists in innervated antagonists compared with denervated muscles. We tested two hypotheses: (1) denervation of the rat ankle plantar flexors results in decreased force production of the ankle dorsiflexors, and (2) daily passive ankle range of motion (ROM) physiotherapy prevents or reduces the force deficit. METHODS: Adult Lewis rats were assigned to one of three groups: (1) a sham (S) group, in which the tibial nerve was exposed but not transected; (2) a no rehabilitation (NR) group, in which a 2-cm segment of tibial nerve was excised at midthigh to denervate the ankle plantar flexors; or (3) a rehabilitation (R) group, in which a 2-cm segment of tibial nerve was excised and the animals were subjected to ankle passive ROM physiotherapy for two 5-min sessions each day. After 14 days, maximum isometric tetanic force (F(0)) and specific force (sF(0)) were measured in the extensor digitorum longus (EDL) muscle, an ankle dorsiflexor. RESULTS: Compared with those from animals in the S group, EDL muscles from animals in the NR group demonstrated a 22% decrease in both F(0) and sF(0). In the EDL from animals in the R group, daily passive ROM physiotherapy diminished the deficit in F(0) but not in sF(0). CONCLUSIONS: These data support the hypotheses that nerve injuries result in impaired mechanical function in the innervated antagonists to denervated muscles and that passive ROM physiotherapy can improve force production in these muscles.

Gastric distension and ventilation during laparoscopic cholecystectomy: LMA-Classic vs. tracheal intubation.

PURPOSE: The standard laryngeal mask airway LMA-Classic was designed as an alternative to the endotracheal tube (ETT) or the face mask for use with either spontaneous or positive pressure ventilation. Positive pressure ventilation may exploit leaks around the LMA cuff, leading to gastric distension and/or inadequate ventilation. We compared gastric distension and ventilation parameters with LMA vs ETT during laparoscopic cholecystectomy. METHODS: One hundred and one, ASA I-II adults scheduled for elective laparoscopic cholecystectomy were randomly assigned to LMA-Classic or ETT. Patients with BMI >30 kg x m(-2), hiatus hernia or gastroesophageal reflux were excluded. Following induction of anesthesia, an in-and-out orogastric tube was passed to decompress the stomach before insertion of the LMA (women size #4, men size #5) or ETT (women 7 mm, men 8 mm). Anesthesia was maintained with isoflurane in nitrous oxide and oxygen (FIO2 0.3-0.5), rocuronium and fentanyl. The surgeon, blinded to the type of airway, scored gastric distention 0-10 at insertion of the laparoscope and immediately before removal at the end of the surgical procedure. RESULTS: Incidence and degree of change in gastric distension were similar in both groups. Ventilation parameters during insufflation (mean +/- SD) for LMA and ETT were: S(P)O2 98 +/- I vs 98 +/- I, P(ET)CO2 38 +/- 4 vs 36 +/- 4 mm Hg and airway pressure 21 +/- 4 vs 23 +/- 3 cm water. CONCLUSION: Positive pressure ventilation with a correctly placed LMA-Classic of appropriate size permits adequate pulmonary ventilation. Gastric distension occurs with equal frequency with either airway device.

The intubating laryngeal mask airway in failed fibreoptic intubation.

PURPOSE: Prediction of difficult tracheal intubation is not always reliable and management with fibreoptic intubation is not always successful. We describe two cases in which blind intubation through the intubating laryngeal mask airway (ILMA FasTrach) succeeded after fibreoptic intubation failed. CLINICAL FEATURES: The first patient, a 50 yr old man, was scheduled for elective craniotomy for intracerebral tumour. Difficulty with intubation was not anticipated. Manual ventilation was easily performed following induction of general anesthesia, but direct laryngoscopy revealed only the tip of the epiglottis. Intubation attempts with a styletted 8.0 mm endotracheal tube and with the fibreoptic bronchoscope were unsuccessful. A #5 FasTrach was inserted through which a flexible armored cuffed 8.0 mm silicone tube passed into the trachea at the first attempt. The second patient, a 43 yr old man, presented with limited mouth opening, swelling of the right submandibular gland that extended into the retropharynx and tracheal deviation to the left. He was scheduled for urgent tracheostomy. Attempted awake fibreoptic orotracheal intubation under topical anesthesia showed gross swelling of the pharyngeal tissues and only fleeting views of the vocal cords. A #4 FasTrach was easily inserted, a clear airway obtained and a cuffed 8.0 mm silicone tube passed into the trachea at the first attempt. CONCLUSION: The FasTrach may facilitate blind tracheal intubation when fibreoptic intubation is unsuccessful.

Influence of ionizing radiation on proliferation, c-myc expression and the induction of apoptotic cell death in two breast tumour cell lines differing in p53 status.

PURPOSE: To determine the capacity of ionizing radiation to inhibit proliferation, to suppress c-myc expression and to induce apoptotic cell death in the p53 wild-type MCF-7 cell line and the p53 mutated MDA-MB231 cell line. MATERIALS AND METHODS: Growth inhibition and cell killing were determined by cell number and trypan blue exclusion. Apoptosis was assessed through cell morphology and fluorescent end-labelling. c-myc expression was monitored by Northern blotting. RESULTS: Inhibition of cell proliferation by ionizing radiation was similar in both cell lines. MDA-MB231 cells accumulated in G2 while MCF-7 cells accumulated in both the G1 and G2 phases of the cell cycle after irradiation. There was no evidence of apoptosis in either cell line. In MCF-7 cells, growth inhibition correlated closely with an early dose-dependent suppression of c-myc expression; in MDA-MB231 cells, there was no correspondence between growth inhibition and a transient, dose-independent reduction in c-myc message. CONCLUSIONS: These findings suggest that in the absence of classical apoptotic cell death, radiosensitivity is not predictably related to the p53 status of the cell. While both p53 and c-myc may be linked to the DNA damage response pathway, neither p53 nor c-myc are essential for growth arrest in response to ionizing radiation.

Ionizing radiation and teniposide increase p21(waf1/cip1) and promote Rb dephosphorylation but fail to suppress E2F activity in MCF-7 breast tumor cells.

Ionizing radiation and the topoisomerase II inhibitor, teniposide (VM-26) both increase levels of the cyclin dependent kinase inhibitor, p21(waf1/cip1) and promote dephosphorylation of the retinoblastoma tumor suppressor protein, Rb, in MCF-7 breast tumor cells, perturbations associated with suppression of the activity of the transcription factor, E2F. However, studies using an E2F binding site-luciferase reporter plasmid transfected into MCF-7 cells failed to demonstrate a reduction in E2F activity in response to VM-26 or to ionizing radiation. In contrast, E2F activity (both basal and E1A stimulated) could be suppressed by transfection with a plasmid expressing Rb, indicating that the capacity of E2F to bind to Rb and to be inactivated by Rb is functionally intact in MCF-7 cells. These findings in MCF-7 breast tumor cells suggest that E2F activity may not be directly susceptible to modulation by endogenous p21(waf1/cip1) and Rb.

Radiosensitization of HL-60 human leukaemia cells by bryostatin-1 in the absence of increased DNA fragmentation or apoptotic cell death.

Ionizing radiation produced a dose-dependent reduction in the proliferative capacity of HL-60 human promyelocytic leukaemia cells. A small percentage of the cell population demonstrated morphological evidence of apoptosis at 24h following radiation doses of > or = 5 Gy (i.e. 8% at 5 Gy and 16% at 10 Gy respectively) and produced a laddered oligonucleosomal pattern of DNA fragments by static-field gel electrophoresis. The antiproliferative effects of 1 and 2.5 Gy ionizing radiation were significantly enhanced by preincubating cells with bryostatin-1 at a concentration (10 nM) and time frame (24h) associated with down-regulation of total cellular protein kinase C (PKC) activity. Potentiation by bryostatin-1 of the radiation effect on proliferation was not associated with a concomitant increase in internucleosomal DNA fragmentation, in the fraction of cells exhibiting apoptotic morphology, or in the extent of radiation-induced single- or double-strand breaks in bulk DNA. Staurosporine, a potent but nonspecific inhibitor of PKC, was ineffective in altering the radiosensitivity of HL-60 cells or the degree of DNA fragmentation induced by ionizing radiation. These findings indicate that bryostatin 1 increases the sensitivity of human myeloid leukaemic cells to low radiation doses without enhancing DNA fragmentation or apoptosis, and that this capacity may involve factors other than, or in addition to, down-modulation of PKC activity.

The laryngeal mask airway: clinical appraisal in 250 patients.

The laryngeal mask airway consists of a tubular oropharyngeal airway to the distal end of which is sealed a silicone laryngeal mask with an inflatable rim which provides an airtight seal around the larynx. It provided a clear airway in 238 of 250 elective and emergency non-obstetrical patients for a wide variety of surgical procedures, ranging from minor gynaecological and urological procedures to major abdominal and orthopaedic surgery with either spontaneous respiration or intermittent positive pressure ventilation. Anaesthetic techniques and drugs were similar to those which would have been used for the same procedures if face-mask or tracheal intubation had been employed. Blind insertion of the laryngeal mask airway was successful at the first attempt in 187 patients, some manipulation was required in 61 patients, and insertion was impossible in two patients, each of whom had a small mouth. In ten patients tracheal intubation was required because of airway obstruction or a large gas leak. The LM airway does not require laryngoscopy for its insertion, it relieves the anaesthetist's hands from holding a face-mask, it cannot be misplaced in the oesophagus, and it is well tolerated during emergence from anaesthesia.

Large dose epidural sufentanil. Management of postoperative pain with few side effects.

The postoperative analgesic management of a patient who was intolerant of morphine and pethidine is described. An epidural infusion of fentanyl up to 1 microgram/kg/hour was ineffective for analgesia in the first 18 hours. Subsequently, 50-micrograms boluses and an infusion of 0.5 microgram/kg/hour sufentanil provided satisfactory analgesia with minimal side effects for 28 hours.