Two SusD-like proteins encoded within a polysaccharide utilization locus of an uncultured ruminant Bacteroidetes phylotype bind strongly to cellulose.

We demonstrate that two characteristic Sus-like proteins encoded within a polysaccharide utilization locus (PUL) bind strongly to cellulosic substrates and interact with plant primary cell walls. This shows associations between uncultured Bacteroidetes-affiliated lineages and cellulose in the rumen and thus presents new PUL-derived targets to pursue regarding plant biomass degradation.

Midazolam-flumazenil versus propofol anaesthesia for scoliosis surgery with wake-up tests.

BACKGROUND: Wake-up tests may be necessary during scoliosis surgery to ensure that spinal function remains intact. METHODS: Intra- and postoperative wake-up tests were performed together with somatosensory cortical evoked potentials (SCEPs) monitoring in 40 patients randomized to either midazolam (M) or propofol (P) infusions for scoliosis surgery. Other anaesthetic medication was similar in both groups. At the surgeon's request, N2O was turned off and midazolam or propofol infusions were discontinued. In the M group, flumazenil was given in refracted doses. Patients were asked to move hands and feet. The test was repeated immediately after the end of surgery. RESULTS: The median intraoperative wake-up times were 2.9 min in the M group and 16.0 min in the P group. The respective postoperative wake-up times were 1.8 and 13.9 min. The quality of both intra- and postoperative arousals was significantly better in the M group. Twelve patients in the P group could not be awakened intraoperatively within 15 min and were given naloxone. One of these patients woke up violently and dislodged the endotracheal tube. Another patient in the P group had explicit recall of the test, but no pain. Five patients in the M group became resedated in the recovery room. Cost of anaesthetic drugs was similar in both groups. Satisfactory intraoperative SCEPs were recorded from 17 patients in each group. There were no neurological sequelae. CONCLUSIONS: Wake-up tests can be conducted faster and better with midazolam-flumazenil sequence compared with propofol.

Readiness for surgery after axillary block: single or multiple injection techniques.

We have assessed prospectively the time to readiness for surgery following axillary block (sum of block performance and latency times) in 80 patients. The brachial plexus was identified using a nerve stimulator, and anaesthetized with 45 mL of mepivacaine 1% with adrenaline 5 micrograms mL-1. In group 1 (single injection) the whole volume of mepivacaine was injected after locating only one of the plexus nerves. In group 2 (multiple injections) at least three plexus nerves were located, and the volume of mepivacaine was divided between them. Sensory block was assessed by a blinded observer every 10 min. Patchy analgesia was supplemented after electrolocating the unblocked nerves after 20, 30 or 40 min. The patient was pronounced ready for surgery when analgesia was present in all areas to be operated upon, which always included the three nerves to the hand. The single injection technique required less time for block performance (mean 5.5 min) than multiple injections (mean 9.5 min), P < 0.0001. However, latency of the block was longer and the requirement for supplemental nerve blocks was greater, after single injections (33 min and 57%) than after multiple injections (15.5 min and 7%, respectively), P < 0.0001. As a result, readiness for surgery was achieved faster in group 2 (25 min), than in group 1 (38.5 min), P < 0.0001. After supplementation, block effectiveness was 100% in group 1 and 98% in group 2 (NS). The frequency of adverse effects (vessel puncture or paraesthesia) was similar in both groups. No neurological sequelae were observed. We conclude that the multiple injection technique takes longer to perform than single injection, but that readiness for surgery is faster because of shorter block latency and better spread of analgesia.

Effect of digital pressure on the neurovascular sheath during perivascular axillary block.

We have assessed prospectively the influence of digital pressure on the effectiveness of perivascular axillary block using a catheter technique in two groups of patients. Ninety-eight patients received axillary injections of 2% mepivacaine with adrenaline 20 ml mixed with contrast agent 20 ml. During injection firm digital pressure was applied either on the neurovascular sheath (group 1) or 6-8 cm below it (group 2). The patient's arm was then adducted. Axillary radiographs were obtained in 90 patients after 30 min. In the last eight patients radiographs were obtained after injecting 2, 20 and 40 ml of the mixture to study the dynamics of spread. There were no statistically significant differences in proximal flow of mepivacaine or in the success rate of the block between the groups. Signs of flow obstruction by the head of the humerus were seen in only eight patients. In the majority of patients local anaesthetic spread above the coracoid process, which increased the success rate of the block, but did not guarantee an effective block.

Intra-arterial regional anaesthesia for hand surgery with alkalinized 0.5% lignocaine.

Intra-arterial regional anaesthesia (IARA) for hand surgery is an old, forgotten technique. One of the causes of low popularity may be a scalding sensation in the hand during intra-arterial injection of lignocaine, which may be caused by low pH of lignocaine's solution. In this randomized, double-blind study, normal (pH 5.2-5.3) or alkalinized (pH 7.2-7.3) preservative-free 0.5% lignocaine 1.5 mg kg-1 was injected into the radial arteries of forty adult patients to produce anaesthesia for ambulatory hand surgery. Scalding sensation in the hand during intra-arterial injection (VAS) was less pronounced with alkalinized lignocaine (P = 0.04). The time of onset and regression of analgesia was similar in both groups. Four patients in group 1 (normal lignocaine) and six patients in group 2 (alkalinized lignocaine) needed supplemental analgesia at the start of surgery (NS). Cannulation time, operating conditions, motor blockade, surgical-, and tourniquet pain scores (VAS) and patient's acceptance were similar. Three patients (two in group 1 and one in group 2) had minor systemic adverse effects after tourniquet release (NS). Nine patients in group 1 and seven in group 2 developed minor bruises after cannulation (NS). No other sequelae of intra-arterial injections were observed. We conclude that alkalinized 0.5% lignocaine was less painful on injection than normal lignocaine and should be preferred for intra-arterial anaesthesia for hand surgery.

Flumazenil facilitates intraoperative arousal during scoliosis surgery: a randomized, double-blind, placebo-controlled study.

Intraoperative arousal was evaluated in 24 patients (median age 16.5 years), undergoing spondylodesis with Cotrel-Dubousset or Harrington-Luque instrumentation. Flumazenil and placebo groups of 12 patients each were similar with respect to age, body weight, dosage of anaesthetic drugs and surgery times. Premedication consisted of diazepam 0.2-0.3 mg kg-1 orally. Anaesthesia was induced with thiopentone 5-7 mg kg-1, and maintained with 66% nitrous oxide in oxygen, and repeated doses of fentanyl, midazolam and atracurium. After placement and fixation of the metal rods, N2O was switched off, and either flumazenil or placebo was given in refracted doses until the patient responded to command. Intraoperative motor response times (medians with ranges), defined as the time from the injection of the first dose until the patient responded to command, were 2.5 min (1.0-5.2 min) after flumazenil, and 8.0 min (1.7-28.5 min) after placebo (P = 0.02). Five patients in the placebo group did not wake up within 10 min and received naloxone. The quality of awakening was similar in both groups. Two patients (one in each group) woke up violently and needed physical restraint. Postoperatively, motor responses were assessed after 12.0 min (5-42 min) in the flumazenil group, and after 15.2 min (4-40 min) in the placebo group (NS). Recovery from anaesthesia took 27.5 min (7-415 min) in the flumazenil group, and 25.0 min (8-160 min) in the placebo group (NS). One patient given flumazenil and one patient given placebo remembered moving their feet, but neither of them could recall anything unpleasant.(ABSTRACT TRUNCATED AT 250 WORDS)

Intra-arterial regional analgesia of the hand.

Fifteen millilitre of 0.5% lignocaine was injected into the radial artery to provide analgesia for hand surgery in an elderly arthritic female patient. She experienced only minimal discomfort during injection and analgesia was excellent. No untoward effects were observed. This technique is recommended when other methods of regional analgesia are unavailable.

Is diathermy safe in women with copper-bearing IUDs?

Ultrasound and short-wave diathermy are widely used in physiotherapy to induce heating of deep tissues, since this causes a concomitant increase in local blood flow. A metallic implant in the treated field is generally regarded as a contra-indication to diathermy because of the risk of thermodamage to surrounding tissues. It is not certain, however, if copperbearing IUDs contain sufficient metal as to constitute a risk. In order to exclude the possibility that diathermy might lead to intra-uterine burns in women using copperbearing IUDs a technique was devised of measuring temperatures in the copper wire of an IUD in situ during short-wave an ultrasonic therapy. The results indicate diathermy to be perfectly safe in women whit copper-bearing IUDs.

PIP: Physicians at the hospital in Tonder, Denmark performed a dilation and curettage (D&C) procedure on 8 44-58 year old women who were experiencing perimenopausal bleeding problems. Prior to the D&C, the physicians 1st inserted a glass/ethanol thermometer with a Multiload copper 250 IUD attached then a thermometer with no copper IUD attached into the uterus to measure the temperature during short wave or ultrasonic diathermy. Since diathermy induces therapeutic tissue temperatures and increases blood flow, it is used to treat several conditions in women of childbearing age. So the physicians wanted to determine if diathermy in women bearing copper IUDs results in thermogenic damage to the uterine lining. Short wave diathermy at recommended dose intensity of minode 3 (maximum 400 W) resulted in a small increase in intrauterine temperature when a noncopper bearing thermometer was used (36.4 degrees Celsius-37 degrees Celsius). The corresponding temperatures for the thermometer with a copper bearing IUD attached were slightly higher (36.8 degrees Celsius-37.6 degrees Celsius) perhaps due to the metallic content of the thermometer. Ultrasonic diathermy at recommended dose intensity of 1.5 W/square cm) resulted in an insignificant increase in intrauterine temperature (patient 1, 36.1 degrees Celsius-37 degrees Celsius; patient 2, 36.5 degrees Celsius-37.3 degrees Celsius.) The physicians suggested that this minute rise may reflect ultrasonic diathermy's insufficient penetration of the uterine cavity. None of these temperatures reached the level needed to induce a protective increase in blood flow (38.1 degrees Celsius). Indeed none reached harmful levels. Therefore diathermy at dose intensities within the normal therapeutic range can be safely used to treat women with copper bearing IUDs.