Medical management of facial pain.

This article describes some of the means used to manage facial pain once serious pathology or any treatable cause has been excluded. It includes pharmacological, physical and psychological therapies.

Glutathione transferase isozyme genotypes in patients with prostate and bladder carcinoma.

Genotype distributions for GSTP1, GSTM1, and GSTT1 were determined in 91 patients with prostatic carcinoma and 135 patients with bladder carcinoma and compared with those in 127 abdominal surgery patients without malignancies. None of the genotypes differed significantly with respect to age or sex among controls or cancer patients. In the group of prostatic carcinoma patients, GSTT1 null allele homozygotes were more prevalent (25% in carcinoma patients vs. 13% in controls, Fisher P =0.02, chi2 P=0.02, OR=2.31, CI = 1.17-4.59) and the combined M1-/T1 -null genotype was also more frequent (9% vs. 3%, chi2 P=0.02, Fisher P = 0.03). Homozygosity for the GSTM1 null allele was more frequent among bladder carcinoma patients (59% in bladder carcinoma patients vs 45% in controls, Fisher P=0.03, chi2 P=0.02, OR=1.76, CI=1.08-2.88). In contrast to a previous report, no significant increase in the frequency of the GSTP1b allele was found in the tumor patients. Except for the combined GSTM1-/ T1-null genotype in prostatic carcinoma, none of the combined genotypes showed a significant association with either of the cancers. These findings suggest that specific single polymorphic GST genes, that is GSTM1 in the case of bladder cancer and GSTT1 in the case of prostatic carcinoma, are most relevant for the development of these urological malignancies among the general population in Central Europe.

Cytotoxicity of ochratoxin A and citrinin in different cell typesin vitro.

Cytotoxic effects resulting from the two mycotoxins ochratoxin A (OTA) and citrinin were evaluatedin vitro using cell cultures of different origin. Cytotoxicity was estimated by the neutral red (NR) uptake assay which allows to determine the viability of cells by detecting dye uptake into the cells and its storage in the lysosomes. The assay was performed with primary cell cultures derived from isolated porcine urinary bladder epithelial cells (PUBEC), which are competent in metabolism of xenobiotics, and with V79 hamster fibroblasts, a well established and frequently used cell line. In both systems, OTA was more cytotoxic compared to citrinin. When both mycotoxins were applied simultaneously no additive or synergistic effects were detected. Obviously, the primary cell culture system which represents a target tissue of the mycotoxins was more susceptible to the toxins, expressed in lower IC50-values. These results indicate that origin of a cell system and its competence in metabolism of xenobiotics have to be considered inin vitro investigations particularly when different systems were used.

A survey of the practice of thoracic epidural analgesia in the United Kingdom.

A postal survey of the practice of thoracic epidural analgesia was sent to 275 hospitals in the United Kingdom. Responses were received from 70% of hospitals. Informed consent is rarely adequately obtained, with only 28% of respondents mentioning even the most common complications. Epidural cannulation is most often (60%) performed following induction of general anaesthesia, rather than in the awake patient. A test dose of local anaesthetic without adrenaline is usual. Neither aspirin nor low-dose heparin are considered a contraindication. The majority of respondents used a combination of bupivacaine with fentanyl (51%) or diamorphine (40%), usually administered by continuous infusion. Drugs were frequently prepared and adjusted by anaesthetic staff. The majority of epidurals (63%) are nursed in intensive care units postoperatively. Properly funded pain management teams, at present unusual, would facilitate ward-based epidural management and release intensive care resource. A central register of epidural complications is required to provide valuable evidence for the optimum practice of thoracic epidural analgesia.

Effect of anaesthesia on lung function in children with asthma.

Spirometry was performed before operation, soon after recovery ("early") and the day after ("late") general anaesthesia for elective surgery in 20 children with asthma and 20 matched children without asthma. Pulse oximetry was recorded on the first postoperative night. The mean early peak expiratory flow rate (PEFR) decreased in the asthmatics by 19.91 (95% confidence intervals (CI) 10.84-28.97)% and in the controls by 19.25 (10.70-27.80)%. The mean early FEV1 decreased in the asthmatics by 16.02 (9.29-22.75)% and in the controls by 11.03 (2.86-19.19)%. The mean late decrease from baseline PEFR for the asthmatics was 18.55 (11.23-25.87)% but only 14.93 (7.89-21.97)% for the controls. The mean late FEV1 was 8.2 (0.83-15.56)% below baseline in the asthmatics but only 6.82 (-0.79 to 14.42)% in the controls. There were no differences in overnight pulse oximetry. We conclude that healthy children exhibited a decrease in FEV1 and PEFR after general anaesthesia for elective surgery, but this decline did not appear to be any greater in well controlled asthmatic children compared with children who did not have asthma.