Identification of nociceptin in human cerebrospinal fluid: comparison of levels in pain and non-pain states.

We have measured plasma and cerebrospinal fluid (CSF) concentrations of nociceptin, the endogenous agonist of the orphan opioid receptor-like receptor (ORL-1). We studied two groups of ten patients presenting for elective Caesarean section (Group E) or in established labour and requiring combined spinal epidural anaesthesia for pain relief (Group L). Nociceptin was identified in all CSF samples with mean +/- SD concentrations of 52.49 +/- 34.25 and 63.39 +/- 33.26 pg/ml in groups E and L, respectively. Nociceptin was identified in 16/20 plasma samples with mean +/- SD concentrations of 7.59 +/- 21.58 and 13 73 +/- 23.79 pg/ml in groups E and L, respectively. CSF concentrations were significantly higher than plasma concentrations and there were no differences between groups E and L. These data report the first measurements of CSF nociceptin in man and show no association with the acute pain of labour.

Lymphadenopathy in a family practice.

This paper presents data on the incidence and clinical spectrum of lymphadenopathy, then offers guidelines for clinical decision making in regard to this problem. Eighty cases were identified and reviewed, for an annual incidence of 0.5% in the study population. Most (70%) cases were discovered by patients themselves. Several clinical parameters important to the evaluation of lymphadenopathy were incompletely recorded in the medical record. Excepting node enlargement, few associated physical and laboratory findings were discovered. Isolated cervical nodes accounted for 44% of all cases while 24% of patients had enlarged nodes in more than one anatomic region. The most frequently performed laboratory test was the complete blood count (34%), and the most frequently positive test was the throat culture (30%). Twenty percent of patients received antibiotics. No cases of malignancy were discovered. A four-level model is proposed for clinical decision making in the investigation of lymphadenopathy. This takes into account: (1) knowledge of the problem's natural history, (2) key initial findings, (3) the value of time, and (4) costs and usefulness of laboratory studies.