Randomized controlled trial of duration of analgesia following intravenous or rectal acetaminophen after adenotonsillectomy in children.

BACKGROUND: Doses of acetaminophen 40 mg kg(-1) rectally and 15 mg kg(-1) i.v. produce similar effect-site concentrations. However, the clinical effectiveness of these routes has not been compared. The aim of this study was to compare duration and efficacy of analgesia in children following adenotonsillectomy after acetaminophen either 40 mg kg(-1) rectally or 15 mg kg(-1) i.v. METHODS: Fifty children aged between 2 and 5 yr were recruited. They received a standardized anaesthetic, including 2 microg kg(-1) of fentanyl. Children were randomized to receive either rectal or i.v. acetaminophen. Postoperative pain was assessed regularly with the Children and Infants Postoperative Pain Scale score and rescue analgesia provided if scores were 4 or greater. The primary outcome measure was time to first analgesia. Results were plotted with a Kaplan-Meier analysis and median time to rescue analgesia compared between the groups. RESULTS: The protocol was successfully completed in 46 children. Forty-five children required rescue medication. The time to first rescue analgesia was longer in children receiving rectal acetaminophen (median 10 h, inter-quartile range 9-11 h) compared with those receiving i.v. acetaminophen (7, 6-10 h) with a P-value of 0.01 by log-rank test for equality in survivor function. Few children in either group required rescue analgesia within the first 6 h with differences between the groups being most prominent in the period from 6 to 10 h. CONCLUSIONS: Rectal acetaminophen 40 mg kg(-1) provides longer analgesia for moderately painful procedures when compared with 15 mg kg(-1) acetaminophen i.v.

Shielding properties of laser-induced plasmas in ocular media irradiated by single Nd:YAG pulses of different durations.

Shielding of laser pulses by plasmas generated in ocular media has been experimentally investigated using single Nd:YAG laser pulses of different durations, ranging from several nanoseconds (ns) to a few tens of picoseconds (ps), both in saline solution and extracted calf vitreous. At the respective threshold radiant exposures for breakdown in saline (259 mJ/cm2 for 7 ns, 20.5 mJ/cm2 for 220 ps and 4.7 mJ/cm2 for 30 ps pulses) the single pulse energy transmission is found to be about 74% for 7 ns, 55% for 220 ps and 50% for 30 ps, thus showing that shielding of laser-induced plasmas is more effective for shorter pulses than for longer pulses. Moreover, the decrease in transmission with increasing radiant exposure is faster in the picosecond case than in the nanosecond case. These results show that direct irradiation of the retina is, to some extent, present especially near threshold. In the case of picosecond pulses, a comparison with published results indicates that shielding between subsequent pulses in a train is likely to occur only to a very limited extent.

Nd:YAG laser irradiation of an eye model: experimental analysis.

This work reviews a series of experiments performed on an eye model to study physical effect relevant for a safe and effective use of the Q-switched Nd:YAG laser in ophthalmic microsurgery. The breakdown probability per laser pulse has been found to depend exponentially on the reciprocal laser field. This indicates that, as in transparent solids, electron avalanche ionization is likely the main mechanism for optical breakdown in liquids. Shielding of the retina, by the laser-induced plasma, is not very effective, but an appreciable degree of shielding is present, in burst operation, even after membrane disruption. A backscattered beam, which presents the typical properties of stimulated Brillouin scattering, has been observed in the eye model, with a threshold of approximately 5 X 10(9) W/cm2. This beam, which presents an irregular spatial structure with peaks of irradiance well above the average value, may produce damage of the internal wall of the cornea.

Time-resolved fluorescence spectroscopy of hematoporphyrin-derivative in human lymphocytes.

This paper reports on time-resolved microfluorimetric measurements on hematoporphyrin-derivative (HpD)-treated lymphocytes. HpD is at present widely used as a tumor-locating and photosensitizing drug. It is therefore of great importance to study the extent to which the HpD uptake process depends on cell functional and structural properties. Time-resolved fluorescence measurements in single cells are very useful in this respect, since they give information on the content of fluorescent molecules through fluorescence peak-intensity, and, indirectly, on the binding properties through the fluorescence decay times. In particular, we studied the dependence of HpD fluorescence on the cellular functional state. To this end, we performed in-cell fluorescence measurements on human lymphocytes, both in quiescent conditions and in the pre-replicative phase, after stimulation with phytohemagglutinin (PHA). We found a higher HpD content in stimulated lymphocytes. Moreover, we found a spectral band around 575 nm, corresponding to a particular porphyrin species, in which the differences between normal and stimulated lymphocytes are more striking. The porphyrin species emitting in this band seems to play a role in the specific interaction of HpD with tumors, since a similar emission band has also been found in tumor cells containing HpD.

Spectroscopic studies of hematoporphyrin-derivative in culture medium.

This work reports on studies of hematoporphyrin-derivative (HpD) behaviour in culture medium. Absorption, excitation and emission spectra, together with time-resolved fluorescence measurements, were performed. In previous works, similar studies had been carried out on HpD in saline and in lymphocytes: a new porphyrin species (NPS) and the environmental conditions for its formation in saline were studied. A fluorescent emission similar to that presented by the NPS is reported to be more likely in tumor rather than in normal HpD-treated cells, it was also found in greater amounts in lymphocytes in the pre-replicative phase, as compared with quiescent ones. The higher NPS content in stimulated rather than in quiescent lymphocytes may be due either to a differential uptake, as compared with other HpD components, or to a differential formation rate in cells, because of different microenvironmental conditions. To distinguish between these two main assumptions, the formation of NPS in culture medium was studied. The process was very slow: no NPS appeared within the first 40 h. The incubation time of lymphocytes in culture medium added with HpD in the experiments performed was only 1 h and therefore a differential formation rate of NPS may explain the higher content found in stimulated lymphocytes.

An automatic pulsed laser microfluorometer with high spatial and temporal resolution.

The paper describes an automatic pulsed laser microfluorometer with high spatial and temporal resolution, developed in our laboratories. The instrument consists of: (i) a nitrogen-laser-pumped dye-laser for the excitation of the fluorescence, (ii) a microscope with additional optics to focus the excitation beam on the sample and to collect the fluorescence, (iii) filters or monochromators to select the output wavelength, (iv) a fast photomultiplier tube to detect the signal, and (v) a dual time-scale microprocessor-controlled signal averager for the acquisition and processing of the signal. Examples are given that show the potential of the time-resolved fluorescence microscopy in studying, quantitatively and qualitatively, the properties of fluorescent molecules.

The time-dependent behaviour of hematoporphyrin-derivative in saline: a study of spectral modifications.

Hematoporphyrin-Derivative (HpD), a widely-used tumor-specific photosensitizer, is a complex mixture of porphyrins whose composition has yet to be clarified. This paper reports on the behaviour of HpD in saline. From a spectroscopic point of view, the fresh solution is characterized by two main absorption peaks, attributable to monomeric and dimeric forms. With aging, a new porphyrin species (NPS) appears. To define the NPS, absorption, excitation and emission spectra were measured in different conditions and time-resolved fluorescence measurements were also performed. This species exhibits an absorption/excitation peak at 405 nm, an emission peak at 575 nm and a fluorescence decay time of approximately 3.5 ns. Its formation is strongly influenced by many environmental factors: in particular, gases diluted in the solution, temperature, pH and concentration. The presence of Oxygen and a pH value outside the 6-8 range may be considered inhibiting factors. The NPS seems to be quite important in the understanding of HpD tumor-specificity, since the presence of an emission band similar to the NPS one seems to be favoured in tumor cells as compared with normal cells.

In situ evaluation of the functional state of chromatin by means of Quinacrine Mustard staining and time-resolved fluorescence microscopy.

A pulsed laser microfluorometer with high spatial and temporal resolution was employed to study the functional state of chromatin, using Quinacrine Mustard as the fluorescent probe. Corresponding segments of polytene chromosomes of embryo suspensor cells of Phaseolus coccineus and parenchymal cells of Helianthus tuberosus, in phases not involving DNA synthesis, were selected as models. The fluorescence decay time turned out to be a discriminating parameter for the chromatin fractions of differing functional engagement. The results were interpreted on the basis of a different accessibility of the DNA to the intercalating agent, as a result of the different structural situation of the chromatin. This fact determines modifications of the energy transfer rates between dye molecules in different quantum efficiency conditions, which results in variations of fluorescence decay times.

Time-resolved fluorescence microscopy of hematoporphyrin-derivative in cells.

This work presents measurements of time-resolved fluorescence microscopy of hematoporphyrin-derivative (HpD) in single cells of mice tissue (both tumor and normal cells), in HeLa Cells, and in solution. The measurements were performed using a pulsed-laser microfluorometer with high spatial and temporal resolution. In agreement with the results obtained with other techniques, it has been found that the tumor cells examined present an HpD uptake about five times higher than that of the normal cells of the corresponding tissue and that, within a cell, HpD become localized mainly in the cytoplasm. It has also been found that the fluorescence decay time is different in cells as compared with solution, and that the presence of HpD stabilizes cell auto-fluorescence. These results are discussed.