ABSTRACT
OBJECTIVE: To assess the efficacy and safety of periprostatic lignocaine injection in trans-rectal ultrasound (TRUS) -guided biopsy of the prostate gland. METHODS: Ninety-six men (mean age 65 years, range 47-74) undergoing TRUS biopsy were randomised into the local anaesthetic (LA) or placebo group. Six to twelve biopsy cores were taken, the majority being 10 cores. Patients were asked to fill in the expected pain score on a visual analogue scale (VAS) prior to the procedure. They also completed the actual pain experienced on VAS after the biopsy. The incidence of complications was documented. RESULTS: The age, mean prostate specific antigen (PSA) were comparable in both groups. The expected pain score was also comparable (5.2 +/- 1.6 in LA, 5.0 +/- 1.4 in Placebo). In the LA group, the mean actual pain score was 3.0 +/- 1.8 and in the placebo group it was 6.5 +/- 2.2 (P = 0.0001). When patients were asked whether they would undergo the procedure again in the same way, 100% of the LA group and only 64% of the placebo group responded 'yes' (P = 0.002 using Fisher's test). The complication rates were not significantly different between the two groups. CONCLUSION: Peri-prostatic injection of local anaesthetic is safe and reduces discomfort significantly, and should be routinely offered to patients.
Subject(s)
Anesthesia, Local/methods , Anesthetics, Local/administration & dosage , Biopsy/methods , Lidocaine/administration & dosage , Prostatic Neoplasms/pathology , Aged , Anesthesia, Local/adverse effects , Humans , Male , Middle Aged , Pain Measurement , Postoperative Complications , Prospective Studies , Statistics, NonparametricABSTRACT
Rabbit urethral smooth muscle cells were studied at 37 degrees C by using the amphotericin B perforated-patch configuration of the patch-clamp technique, using Cs(+)-rich pipette solutions. Two components of current, with electrophysiological and pharmacological properties typical of T- and L-type Ca(2+) currents, were recorded. Fitting steady-state inactivation curves for the L current with a Boltzmann equation yielded a V(1/2) of -41 +/- 3 mV. In contrast, the T current inactivated with a V(1/2) of -76 +/- 2 mV. The L currents were reduced by nifedipine (IC(50) = 225 +/- 84 nM), Ni(2+) (IC(50) = 324 +/- 74 microM), and mibefradil (IC(50) = 2.6 +/- 1.1 microM) but were enhanced when external Ca(2+) was substituted with Ba(2+). The T current was little affected by nifedipine at concentrations <300 nM but was increased in amplitude when external Ca(2+) was substituted with Ba(2+). Both Ni(2+) and mibefradil reduced the T current with an IC(50) = 7 +/- 1 microM and approximately 40 nM, respectively. Spontaneous electrical activity recorded with intracellular electrodes from strips of rabbit urethra consisted of complexes comprising a series of spikes superimposed on a slow spontaneous depolarization (SD). Inhibition of T current reduced the frequency of these SDs but had no effect on either the number of spikes per complex or the amplitude of the spikes. In contrast, application of nifedipine failed to significantly alter the frequency of the SD but reduced the number and amplitude of the spikes in each complex.
Subject(s)
Calcium Channels, T-Type/physiology , Urethra/physiology , Action Potentials/drug effects , Animals , Barium/pharmacology , Calcium/pharmacology , Calcium Channel Blockers/pharmacology , Calcium Channels, L-Type/drug effects , Calcium Channels, L-Type/physiology , Calcium Channels, T-Type/drug effects , Electric Conductivity , Female , In Vitro Techniques , Male , Mibefradil/pharmacology , Models, Biological , Nickel/pharmacology , Nifedipine/pharmacology , Patch-Clamp Techniques , Rabbits , Urethra/metabolismABSTRACT
In two experiments, we examined the influence of semantic activation on the generation of a phonological code, testing the interactivity assumption common to both dual-route and interactive-activation models. In Experiment 1, subjects named regular and irregular targets preceded by related and unrelated primes. In Experiment 2, these variables and target imageability were manipulated. Both relatedness and imageability interacted with regularity, indicating that semantic activity speeds access to a phonological code.
Subject(s)
Crisis Intervention , Parents/psychology , Sudden Infant Death , Emotions , Humans , Infant , Nursing Staff, Hospital/psychology , Social SupportABSTRACT
Courses on death and related topics are frequently considered nonessential in medical school curricula; however medical students and residents often express their feelings of unpreparedness to cope with deaths of their patients, surviving family members and their own feelings about death. This paper describes a short, elective course taught by a single instructor who, by writing about it, wishes to encourage others to begin to fill this gap in medical education. Student evaluations and representative reaction comments are included.
