Nonsteroidal anti-inflammatory drugs increase expression of inducible COX-2 isoform of cyclooxygenase in spinal cord of rats with adjuvant induced inflammation.

Several lines of evidence have accumulated that release of excitatory amino acids, nitric oxide and prostaglandin E2 (PGE2) play a critical role in the development of peripheral tactile and thermal hypersensitivity in chronic inflammatory pain models. Synthesis of PGE2 is controlled by cyclooxygenase (COX), either the COX-1 or COX-2 isoform. COX-2 plays a central role in the inflammatory reactions. The relationship between central sensitization of a complete Freund's adjuvant (CFA) induced inflammation and expressions of COX-2 were assessed in a rat model of CFA injection induced inflammation. Moreover, the time course of analgesia and spinal COX-2 expression following intrathecal (IT) injection with a nonspecific COX inhibitor (ketorolac) and COX-2 inhibitor (celecoxib) were determined using Western blot and immunohistochemistry. COX-2 protein was slightly increased in the lumbosacral spinal cord at 24 h following subcutaneous injection of CFA in the plantar surface of the left hindpaw (p > 0.05). COX-1 was not detected in normal and CFA injection rats. Surprisingly, IT ketorolac or celecoxib significantly increased spinal COX-2 levels at 1 h post-IT injection (p < 0.05) both in inflamed and non-inflamed rats. Then, spinal COX-2 levels declined at 3 and 6 h post-IT injection. These results provide strong in vivo evidence that COX-2 activity but not level may play a central role in the Freund's adjuvant-induced inflammation. However, spinal COX-2 level was upregulated following IT ketorolac and celecoxib injection. These data implies that suppression of PGE2 activity may induce the expression of spinal COX-2 in Freund's adjuvant-induced pain model. Our study concludes that IT administration of COX-2 inhibitor or nonspecific COX inhibitor is associated with significant short-term increase in spinal COX-2 expression.

The neuromuscular effects of mivacurium in adults with priming technique during nitrous oxide-fentanyl anesthesia: a randomized comparative study with succinylcholine.

BACKGROUND: We investigated the neuromuscular effects of equipotent dose (3 x ED90) of mivacurium either given as a single bolus or under the influence of priming technique, comparing with that of succinylcholine in adults undergoing elective surgery during nitrous oxide-narcotic anesthesia. METHODS: Sixty ASA class I patients of either sex with age between 16 to 49 years were randomly assigned to 3 groups for a trial of mivacurium under nitrous oxide-narcotic anesthesia. Group I (non-priming group, n = 20) received mivacurium 0.25 mg/kg straight as a single intubating dose; Group II (priming group, n = 20) received an intubating dose of 0.225 mg/kg mivacurium which was preceded by 0.025 mg/kg 3 min earlier; and Group III received an intubating bolus of succinylcholine 1 mg/kg. Thenar electromyogram response to supramaximal train-of-four stimulation of the ulnar nerve at 12-s intervals was used to determine neuromuscular blockade. Blood pressure and heart rate were recorded before and at 1-min interval for 3 min after injection of drugs. Data were presented as mean +/- standard deviation. P value < 0.05 was considered statistically significant. RESULTS: The onset time of mivacurium was accelerated by priming procedure in comparison with the nonpriming technique (2.0 min vs. 2.7 min), but it was much slower than that of succinylcholine (0.8 min). The priming procedure did not influence the duration of action or recovery. Side effects of mivacurium, such as cutaneous flushing and hypotension, were minimal at this dose in our patients. CONCLUSIONS: Priming technique (with 10% of the total dose as the priming dose, and 3 min as the priming interval) can hasten the onset of mivacurium in adults during nitrous oxide-narcotic anesthesia without influencing the duration of action and recovery time.

Successful microsurgical tissue transfer in a patient with postsplenectomy thrombocytosis treated with platelet-phoresis.

With the use of platelet-phoresis, two microsurgical free-tissue transfers were successfully undertaken in a patient with postsplenectomy thrombocytosis that had initially caused flap failure. Rapid reduction in the platelet count allowed free-tissue transfer in this patient who required early wound coverage.

Going deep into chemical burns.

This is a five year retrospective study of chemical burn injury in our burn center between 1 January 1987 and 31 December 1991. Of the 1,226 total burn cases, 131 patients had chemical burns. We noted a constant prevailing incidence of 10.7% per year. Males (72%) are more common than females (28%). Most of those injured are in the working age group (65%). Majority of cases had deep full thickness burn involving less than 10% of their total body surface area. Sulfuric acid is the most common chemical agent encountered. We had three mortality cases with deep third degree burns covering 60% of their total body surface area. Some clinical cases are demonstrated. Lastly, proposed solutions for the prevention of chemical burns are cited.