The epidural postoperative analgesia after a major urological procedures--a comparison of trimecaine and morphine to bupivacaine and fentanyl.

OBJECTIVES: To compare the analgesic potency and side effects of epidural combination trimecaine with morphine and bupivacaine with fentanyl in postoperative analgesia after a major urological surgery. METHODS: We randomised 150 consecutive patients. In the trimecain/morphine group (n = 75) trimecaine 50 mg with 4 mg morphine was given epidurally in 8 hour intervals. In the bupivacain/fentanyl group (n = 75) the infusion of 0.25 % bupivacaine and fentanyl 2 microg/ml was administered at an infusion rate of 8 ml/h. RESULTS: The postoperative pain scores were lower in the trimecain/morphine group, the difference was significant during the first 6 hours after surgery, there was also a trend toward higher postoperative SpO2 values in this group, the difference was significant 36 hours after surgery. The total sum of postoperative complications and side effects was significantly higher in the bupivacian/fentanyl group (p = 0.002). CONCLUSION: The combination of epidural trimecaine with morphine after a major urological surgery provides a superior analgesia with fewer side effects when compared to epidurally delivered bupivacaine with fentanyl (Tab. 2, Fig. 5, Ref. 17). Full Text (Free, PDF) www.bmj.sk.

[Self-medication of the common cold]. / Samoterapie symptomu nemoci z nachlazení.

Self-medication can be useful in the multisymptomatic management of the common cold and other preferentially non-febrile flu-like symptoms, especially as at present multicomponent remedies are available, which may make self-medication significantly easier with consequent better compliance of adult patients. Children, on the contrary, are not suitable acceptants of self-medication mediated by their parents because the sickness exhibits in children nearly exclusively febrile progress. The procedure of the therapy to be really effective and safe must be necessarily concentrated into pharmacies, where safety and efficacy of therapy are ensured by the pharmacist as the last link of contact between the patient and the drug. Any other distribution of the OTC drugs is therefore strictly unacceptable. Patients suffering from the common cold usually exhibit simultaneously various symptoms of the disease. These different symptoms are, however, experienced during the day with different intensity. During the day and often also in the course of the labour process there is a need to concentrate on the most bothersome symptoms, notably the relief of the nasal congestion with the exploration of the safest and most effective drug, such as pseudoephedrine. In addition, it is necessary to administer an effective nonsteroidal anti-inflammatory drug, preferably ibuprofen, which provides relief from symptoms caused by release of inflammatory mediators. In the night time there is a need of a multisymptom therapy which may relieve cough and any other disturbing cold symptoms to allow satisfactory beneficial, continuous, and refreshing sleep.

[Effect of acute exposure to SO2 on cellular defense mechanisms in the lung (pilot study)]. / Ucinek akutní expozice SO2 na celulární obranné mechanismy plic (pilotní studie).

Sulphur dioxide is one of the most important and most frequent atmospheric pollutant of our environmental setting. In presented pilot-study we describe the influence of acute exposure to sulphur dioxide on alveolar macrophages of guinea pigs. The alveolar macrophages represent the main part of mononuclear phagocytic system, which is responsible for the defence of respiratory tract against foreign compounds. The experimental animals were exposed over three hours to sulphur dioxide with the concentration of about 400 ppm. After exposure we did not find significant changes in phagocytic activity of alveolar macrophages.

The effects of subchronical exposure to SO2 on biochemical and hematological parameters in guinea pigs.

The effects of subchronical exposure to SO2 (400ppm, 3 hours daily, 28 days) on biochemical and hematological parameters were investigated in guinea pigs. Mostly no significant changes in the values of biochemical parameters and no significant changes in hematological parameters were found. The levels of investigated ions (K+, Na+, Cl-, Ca++, Mg++ and phosphates), proteins (albumines, globulines, total proteins), enzymes (LD, ALT, AST, CK) and other biochemical parameters (urea, creatinine, bilirubin) were not significantly different between groups, with the exception of a significantly higher ALP concentration in the exposed group as compared with controls (2.17 mukat and 1.85 mukat, respectively. It can be concluded that a subchronical exposure to sulphur dioxide mostly did not induce any definite changes in biochemical and hematological parameters in guinea pigs.

[Oxygen radicals in the mechanism of lung injury caused by air pollutants]. / Kyslíkové radikály v mechanizmoch poskodenia pl'úc vyvolaného polutantmi ovzdusia.

Ozone and nitrogen oxides are environmental pollutants especially present in smog. They are oxidants potent to cause bronchial hyperreactivity, lung fibrosis, and emphysema. Other occupational hazards are mineral dust particles (asbestos, silica) which may cause the development of inflammation and fibrosis in the lungs. Inflammatory cells (neutrophils, eosinophils, monocytes, macrophages) become activated during inflammation and produce superoxide anion radicals. Reactive oxygen species developed e.g. in smog have been recognized--at least partly--to be responsible for the observed pulmonary tissue damage. Several mechanisms leading to toxicity, including disbalance of vegetative nervous control, damage of bronchial epithelium, role of mediators of inflammation and other issues are discussed. (Fig. 1, Ref. 32.)

Mechanisms of action of some air pollutants on the airways.

Common air pollutants (O3, SO2) exert their deleterious effects in several ways, mostly on the respiratory functions. Ozone causes formation of peroxides and aldehydes with subsequent release of inflammatory lipids and cytokines. Changes in the activity of neutral endopeptidase and release of neuropeptides may occur. As a result, bronchial hyperreactivity can be detected. In the mechanisms of the disturbances due to sulfur dioxide, cholinergic mechanisms and release of neuropeptides may be involved.

[Pharmacologic aspects of the effect of air pollutants on the respiratory system]. / Farmakologické aspekty pusobení nekterých polutantu ovzdusí na dýchací systém.

The principal pharmacologically acting pollutants of the atmosphere in this country are sulfur dioxide and ozone. Sulfur dioxide produces bronchial hyperreactivity, damages the bronchial epithelium and reflexively increases the secretion of phlegm. The explanation of pharmacological mechanisms of its effect can be activation of cholinergic or neuropeptidic reflex mechanisms, release of histamine, or other, for the time being less known mechanisms. Ozone increases the reactivity of the smooth muscle to the inhaled bronchoconstrictive substances most probably by releasing the mediators of inflammation.

[The role of platelet activating factor in the pathogenesis of asthma]. / Uloha faktora aktivujúceho trombocyty (PAF) v patogenéze astmy.

The work reviews knowledge about the function of PAF, the presupposed mediator of asthma. The PAF mediator evokes contraction of smooth muscles of respiratory passages, too in vivo as in vitro, by means of an indirect mechanism involving activated platelets which function as intermediaries. The constrictor released due to this process can be represented by histamine or a product of arachidonic acid. Mucous secretion is according to current knowledge stimulated by PAF. The PAF mediator appears to be a considerable chemotactic factor for eosinophils which by their cytotoxic effects on respiratory epithelium support the origin and development of bronchial hyperresponsiveness. PAF has an eminent effect on the growth of microvascular permeability. Antagonists of PAF inhibit some mentioned PAF effects. Their possible therapeutic utilization, excluding ketotiphen, are currently subjected to research. (Fig. 2, Ref. 17.).

Salicylate intoxication after use of topical salicylic acid ointment by a patient with psoriasis.

The authors describe a therapeutically well managed case of severe salicylate intoxication in a patient with psoriasis who treated himself with 40 percent salicylic ointment applied to approximately 41 percent of his body surface. Nineteen hours after the application of salicylic acid, his blood level of the agent was 6.04 mmol/liter. The patient underwent hemodialysis and was discharged after fourteen days in good general health.

[The effect of cyclophosphamide and methotrexate on gastric emptying and secretion in rats]. / Ucinky cyklofosfamidu a metotrexátu na vyprázdnovanie a sekréciu zalúdka potkana.

The effect of cyclophosphamide and methotrexate was studied in rats on the evacuation of 50% BaSO4 suspension from the stomach (doses: 50-200 mg.kg-1 and 5-20 mg.kg-1 s.c.) and on HCl secretion (doses: 100 mg.kg-1 and 10 mg.kg-1 s.c.) after stimulation with pentagastrin (25 micrograms.kg-1 s.c.). Both cytostatics were found to slow down gastric evacuation and to suppress the effect of pentagastrin on gastric secretion. The presented changes may relate to the adverse effects on the GIT observed in patients treated with the given cytostatics. (Fig. 4, Ref. 17.)

Effect of prostaglandin F2 alpha on the contractile tissues of the respiratory system of the cat in experimental airway inflammation.

The in vitro reactivity of the smooth musculature of the trachea and lungs to PGF2 alpha, was studied in control cats and cats with experimental airway inflammation induced by turpentine oil. No changes were found in the reactivity of the tracheal smooth muscle, but the reactivity of the pulmonary tissue was significantly raised compared with the controls. The results indicate that PGF2 alpha may play a role in the pathogenesis of bronchial hyperreactivity after airway inflammation.

Effects of atropine, acetylsalicylic acid, FPL 55712, and phentolamine on increased histamine responsiveness of cat lung strips under conditions of airway inflammation.

Our recent in vitro studies on airway smooth muscles of cats with turpentine oil inflammation showed an increase of isometric tension of the lung strips to histamine application. This communication describes the effect of atropine, acetylsalicylic acid, FPL 55712, and phentolamine on the histamine contractions of the lung strips derived from control and experimental groups of cats. Pretreatment of the lung strips with atropine and acetylsalicylic acid had no significant effect on histamine induced contraction. FPL 55712 significantly decreased the mean values of isometric contractions after the low doses of histamine in experimental groups of strips. The isometric contractions after higher doses of histamine were not affected by FPL 55712 in both groups of strips. The significant increase of histamine contractions of the lung strips induced by experimental inflammation was reduced by phentolamine. The role of alpha adrenergic receptors in the increased responsiveness of the inflamed lung tissues to histamine is discussed.

Effect of histamine on the airway smooth muscle of cats under control and inflammatory conditions.

Previous in vitro studies on airway smooth muscles of cats with turpentine oil-induced inflammation of the airways have shown an increased sensitivity of the lung strips to histamine application. This effect was abolished by pretreatment with phentolamine. This communication describes the effect of prazosin and yohimbine on histamine responsiveness of strips of control and inflamed lungs. Prazosin had no effect on histamine-induced contraction of the control lung strips. However, the histamine-induced contraction of the experimental strips was depressed. Yohimbine depressed histamine-induced tension even in control lung strips. The role of alpha 1-adrenergic receptors in the increased responsiveness of the inflamed lung tissues to histamine is discussed.

GABA-ergic mechanisms in the central control of cough.

The antitussive activity of gabalinoleamide (Gabalid U CB) was studied in 40 non-anaesthetized cats. The antitussive action of the substance was compared to that of codeine (Codein Spofa). Cough was induced by mechanical stimulation using a chronic tracheal cannula. Single cough parameters were evaluated from changes in the side tracheal pressure. When gabalinoleamide was administered in a dose of 100 mg/kg b.w. intramuscularly all the studied parameters of cough showed a statistically significant decrease, only the intensity of maximum cough effort remained unaffected. Gabalinoleamide administered in the same dose induced a statistically significant decrease of respiratory frequency and breathing amplitude, and prolonged the cycle of breathing by delaying the expiratory phase. Higher doses (200 and 300 mg/kg b.w.) did not have an increased cough suppressing effect. The quality and quantity of cough parameters were similar after codeine and gabalinoleamide.

Influence of experimentally induced airway inflammation on the reactivity of cat lung parenchymal strips to histamine and acetylcholine.

The reactivity of cat lung parenchymal strips to histamine and acetylcholine in vitro was studied at various stages of inflammation of the airways induced experimentally by the intratracheal administration of turpentine oil or Staphylococcus aureus, both in aerosol form. With histamine, the contractile responses of the lung strips were enhanced depending on the stage of turpentine oil inflammation. Similarly, the lung strips responded more to histamine in the staphylococcal inflammation. The reactivity of the lung strips to acetylcholine remained mainly unaffected by either type of inflammation.

Pharmacological analysis of reactivity changes in airways due to acute inflammation in cats.

Our recent in vitro studies on airways smooth muscles of the cat with turpentine oil inflammation showed the occurrence of a contractile response of tracheal preparations and a significant increase in the isometric tension of lung strips to histamine application. This study was aimed to establish whether histamine H2-receptors participated in the changed in vitro reactivity of the airways smooth muscles of cats suffering from experimentally induced airway inflammation. Pretreatment of control tracheal preparations, control and experimental groups of the lung strips by cimetidine did not change the character of the histamine response. Similarly, the amplitude of histamine relaxation, of the tracheal preparations partially contracted by carbachol was unchanged by experimental inflammation. Clemastine significantly shifted the histamine dose-response curves to the right in both groups of lung strips. However, significant differences in lung strip reactivity between control and experimental groups of cats were not eliminated. Our results do not support the role of histamine H2-receptors in the pathologically increased airway reactivity to histamine in vitro.

Age- and body-weight-dependent changes in the reactivity to histamine of the airways smooth muscles in cats.

The relation between age and body weight and the reactivity to histamine of the tracheopulmonary contractile tissues was studied in cats in vitro. The reactivity of the tracheal smooth muscle to histamine decreased with increasing age from the newborn (100%) and one-month-old (57%) to the adult (0%) cat, whereas the amplitudes of contractions of lung strips increased. The amplitudes in adult animals also increased moderately with increasing body weight.