Prolonged mivacurium infusion in young and elderly adults

PURPOSE: This study was designed to evaluate pharmacodynamically and pharmacokinetically if the cis-cis isomer of mivacurium contributed to neuromuscular block during prolonged infusions lasting more than four hours in young adult and elderly (> 60 yr) patients. METHODS: The mechanomyogramic neuromuscular response of the adductor pollicis was recorded in 32 adults 18-59 yr. and 19 elderly (> 60 yr.) patients during N2O:O2:opioid anaesthesia. The mivacurium infusion rate was adjusted to maintain single twitch depression at 95 +/- 4% of control. Blood samples were taken every 30 min to determine the plasma concentration of cis-cis isomer of mivacurium. At the end of the surgical procedure, patients were allowed to recover spontaneously to at least 25% of control twitch response. RESULTS: The mean mivacurium infusion requirement to maintain 97 +/- 1 (mean +/- SD)% depression of the twitch response was 6.0 +/- 0.4 micrograms.kg-1.min-1 in young adults, and 4.3 +/- 0.3 micrograms.kg-1.min-1 in elderly patients (P < 0.001). The infusion requirement in patients with low plasma cholinesterase activity was the lowest 2.4 +/- 1.2 micrograms.kg-1.min-1. Plasma cis-cis isomer concentrations reached peak levels within one-two hours and remained relatively constant throughout the duration of infusion even in patients with low cholinesterase activity. There was no relationship between duration of infusion, plasma concentrations of cis-cis isomer and the early recovery indices of mivacurium (up to 25%). Neuromuscular transmission recovered adequately with or without antagonism in all patients. CONCLUSION: When the mivacurium infusion was titrated to maintain 95 +/- 4% twitch depression, the plasma concentration of the cis-cis isomer did not increase during prolonged infusions (four hours) and neuromuscular transmission recovers satisfactorily.     

The onset of rocuronium, but not of vecuronium or mivacurium, is modified by tourniquet inflation

A previous investigation showed that inflation of a tourniquet did not interrupt onset of vecuronium neuromuscular block. To test the hypothesis that this effect depended on potency, twitch tension was measured in an arm with a tourniquet inflated during onset and compared with a control arm in 30 patients under fentanyl-thiopental-nitrous oxide-isoflurane anesthesia. Patients were randomly allocated to receive either vecuronium 0.1 mg/kg (n = 10), rocuronium 0.6 mg/kg (n = 10), or mivacurium 0.2 mg/kg (n = 10). The electromyographic response of the first dorsal interosseus to single twitch stimulation of the ulnar nerve every 10 s was recorded in both arms. When neuromuscular block was 20% (i.e., twitch tension was 80% of control), the tourniquet was inflated to a pressure of 300 mm Hg. It was deflated 5 min later. In the vecuronium and mivacurium groups, the tourniquet did not influence onset of block. In the rocuronium group, maximum neuromuscular block was (mean +/- SD) 79% +/- 10% in the tourniquet arm, compared with 96% +/- 4% in the perfused arm (P < 0.05). The maximum rate of onset was half that of the perfused arm. The difference in maximum neuromuscular block between arms was 17% +/- 7%, 5% +/- 5%, and 0% +/- 2% in the rocuronium, vecuronium, and mivacurium groups (P < 0.05). To explain that onset of block continues in spite of interruption of blood flow, drug molecules must gain access to the neuromuscular junction via routes other than the circulation. The results of this investigation are consistent with the hypothesis that there is redistribution of drug from extrajunctional to junctional areas during onset of action of muscle relaxants and this process is more important for the more potent drugs (vecuronium and mivacurium) than for rocuronium.     

A study of introspectiveness in adolescents and young adults

The purpose of this study was to examine the relationship between introspectiveness and the theoretically related variables of close friend solidarity, self-esteem, and symptom patterns in early, middle, and late adolescents, as well as in young adults. Samples of early (n = 103), middle (n = 107), and late adolescents (n = 101) as well as young adults (n = 70) completed the Introspectiveness Scale, the Close Friend Solidarity Instrument, the Rosenberg Self-Esteem Scale, and the Symptom Pattern Scale in classroom settings. Hypotheses were tested using Pearson correlations, with a one-tailed test of significance. Introspectiveness was statistically, significantly, and positively related to close friend solidarity in all adolescents but not in young adults; introspectiveness was statistically, significantly, and inversely related to self-esteem in all adolescents but not in young adults. Finally, introspectiveness was statistically, significantly, and positively related to symptom patterns in all adolescents and in young adults.     

Psychosocial functioning of children, adolescents, and adults following hypospadias surgery: a comparative study

Used standardized questionnaires to compare psychosocial functioning of 116 children and adolescents (9 to 18 years) and 73 adults (18 to 38 years) operated on for hypospadias, a congenital penile anomaly, with that of 88 and 50 age-matched comparison males, respectively, treated for an inguinal hernia. The relationships of coping with penile appearance, subject age, severity of hypospadias, number of operations, age at final surgery, and type of surgical procedure with psychosocial functioning were also investigated. Hypospadias patients did not exhibit a poorer psychosocial functioning and no significant relationships of various medical characteristics with psychosocial functioning could be discerned. Genital/body perception of hypospadias patients ages 9 to 18 years correlated positively with psychosocial functioning, albeit with low values. These findings are important for psychologists and specialists in the counseling process of hypospadias patients and their parents.     

Neuromuscular interaction between cisatracurium and mivacurium, atracurium, vecuronium or rocuronium administered in combination

We compared the dose-response relationships of cisatracurium, mivacurium, atracurium, vecuronium and rocuronium and examined the interactions of cisatracurium with mivacurium, atracurium, vecuronium and rocuronium in humans by isobolographic and fractional analyses. We studied 180 adult patients during nitrous oxide-fentanyl-propofol anaesthesia. Neuromuscular block was monitored using mechanomyography to detect the twitch response of the ulnar nerve at the wrist. The dose-response curves were determined by probit analysis. The calculated ED50 values and their 95% confidence intervals were 40.9 (38.1-43.7), 49.8 (47.0-52.6), 187.2 (175.1-199.3), 36.6 (34.7-38.5) and 136.4 (129.2-143.6) micrograms.kg-1 for cisatracurium, mivacurium, atracurium, vecuronium and rocuronium, respectively. Corresponding ED95 values were 57.6 (53.5-61.7), 91.8 (88.1-95.5), 253.1 (238.9-267.3), 52.9 (49.1-56.7) and 288.7 (276.2-301.2) micrograms.kg-1, respectively. The interaction between cisatracurium and mivacurium, vecuronium or rocuronium was found to be synergistic, but the interaction between cisatracurium and atracurium was found to be additive. Synergy between cisatracurium and vecuronium or rocuronium was greater than between cisatracurium and mivacurium.     

Multiple-risk behaviour in adolescents and young adults

OBJECTIVES: This article examines the prevalence of four risk behaviours among teenagers and young adults: smoking, binge drinking, sex with multiple partners, and sex without a condom. DATA SOURCE: The data are from a Health Canada-sponsored supplement to the 1994/95 National Population Health Survey. The analysis is based on 905 respondents aged 15 to 19 and 1,055 respondents aged 20 to 24. ANALYTICAL TECHNIQUES: Prevalence estimates of the four risk behaviours were calculated for males and females in each age group. An index of multiple-risk behaviour was derived by summing the four risk behaviours. Hierarchical multiple regression was used to examine how sets of variables are related to multiple-risk behaviour. MAIN RESULTS: Multiple-risk behaviour was higher among young people who had never married, who were not students, and who did not live with a parent. Feeling distressed was positively linked with multiple-risk behaviour, while regular attendance at religious services was negatively linked with such conduct.     

Psychosocial adaptation in adolescents and young adults with Marfan syndrome: an exploratory study

Endothelium-derived nitric oxide formed by endothelial constitutive nitric oxide synthase (ecNOS) mediates endothelium-dependent vasodilation and antithrombotic action. We analyzed the distribution of a polymorphism of ecNOS (27-bp repeat in intron 4) in 127 ischemic stroke patients (18 with atherothrombotic, 58 with lacunar, and 51 with silent lacunar stroke) and 91 control subjects. When we assigned the four repeats as allele a, and five repeats as allele b, there was no significant difference between the genotype distribution and allele frequencies in the stroke group and in the control group (0.862 versus 0.868 for the b allele frequency). Moreover, there was also no significant difference in the genotype distribution or allele frequencies among the three stroke subgroups (b allele frequency: 0.889 for atherothrombotic stroke; 0.862 for lacunar stroke; 0.853 for silent lacunar stroke). These findings suggest that there is no overt association between this ecNOS gene polymorphism and ischemic stroke. We found no evidence that this polymorphism may be a genetic factor for the onset of cerebrovascular disease in this Japanese population.     

Youth suicide in Norway, 1990-1992: a comparison between children and adolescents completing suicide and age- and gender-matched controls

In Norway 1990-1992, the suicide rate was 18.6 per 100,000 individuals per year for boys 15-19 years old and 6.3 for girls, and for 10-14 year olds the rate was 2.7 for boys and 0.5 for girls. Comparison of all completed suicides (N = 129) with gender- and age-matched control subjects identified depression (OR = 19.9; CI = 11.2, 35.5), disruptive disorders (OR = 6.0; CI = 3.1, 11.4), and previous suicidal behavior (OR = 3.4, CI = 2.0, 5.6) as main risk factors. Of the suicide completers, 74% had mental disorders. Suicidal intent was previously expressed by 48%, but few (24%) had received treatment, despite well-developed health services. A history of disruptive disorders (17%) and substance abuse (10%) were less frequently found than in previous studies, but binge drinking may contribute to the adolescent suicide rate.     

The effect of priming with vecuronium and rocuronium on young and elderly patients

The priming principle consists of administering a subparalyzing dose of nondepolarizing neuromuscular blocking drug 3-6 min before giving a second dose for tracheal intubation. This study was performed to observe the effects of priming doses of vecuronium and rocuronium on pulmonary function tests and muscular weaknesses in young (25-35 yr of age) and elderly (65-73 yr of age) patients. Ten young and 10 elderly patients were each placed in vecuronium and rocuronium groups. Oxygen saturation and train-of-four (TOF) ratio were determined, and pulmonary function tests were performed. Then 20% of the 95% effective dose (ED95) of the muscle relaxants was given intravenously. All tests were performed again 4 min after vecuronium and 3 min after rocuronium. Other signs of muscular weaknesses were also recorded. Elderly patients showed more signs of muscle weakness in both groups. The TOF ratio was 0.77 and 0.79 in the elderly rocuronium and vecuronium groups, respectively, and 0.89 and 0.90 in the young rocuronium and vecuronium groups, respectively. Dynamic spirometry revealed decreases in forced expiratory volume in 1 s and forced vital capacity in both groups, and no significant changes in peak expiratory flow rate. The expiratory reserve volume was reduced more in the elderly groups. Oxygen saturation decreased in both groups. We conclude that oxygen saturation, pulmonary function, and muscle strength decrease more in the elderly than in their younger counterparts from priming doses of vecuronium or rocuronium. IMPLICATIONS: The priming principle consists of giving a subparalyzing dose of muscle relaxant 3-6 min before giving a second dose for tracheal intubation. We found that priming doses of vecuronium and rocuronium produced greater decreases in oxygen saturation and pulmonary function in the elderly (aged 65-73 yr) than their younger (aged 25-35 yr) counterparts. Priming may not be a safe approach in elderly patients.     

DSM-IV alcohol disorders in a general population sample of adolescents and young adults

AIMS/DESIGNS: As part of the Early Developmental Stages of Psychopathology (EDSP) study, results from the baseline cross-sectional assessment of DSM-IV alcohol disorders are presented for a sample of 14-24-year-olds residents in Munich, Germany (N = 3021; 71% response rate). FINDINGS: Life-time prevalence of DSM-IV alcohol abuse (men: 15.1%; women; 4.5%) was found to be considerably more prevalent than dependence (men: 10.0%; women 2.5%) with few cases among respondents younger than 16 years of age; 12-month prevalence of abuse was 8.4% among men and 2.7% among women and of dependence was 7.3% among men and 2.2% among women. Results show that peak incidence of alcohol disorders occurs at 16-17 years of age and that early initiation into alcohol use is associated with an increasing odds of disorder onset, especially for dependence among women. Exploratory analysis of retrospectively assessed diagnostic stability show: a temporal progression to abuse and then dependence, that nearly half of past abuse diagnoses are in remission, abuse remission is more common than progression to dependence, and dependence is highly persistent, especially among women. CONCLUSIONS: Alcohol disorders are frequent in adolescent and young adults being characterized by transient abuse and less prevalent but persistent dependence syndromes. The relatively high prevalence of dependence diagnoses in this young population wit few years of alcohol use is discussed with regard to the clinical validity of DSM-IV criteria in adolescents and young adults.     

Vaginal replacement in children and young adults

PURPOSE: Absence of the vagina in the pediatric population most commonly results from congenital abnormalities, such as the Mayer-Rokitansky syndrome but it may also be seen after treatment for pelvic tumors, such as rhabdomyosarcoma, and in patients who have had previous gender reassignment. We review our experience using bowel for vaginal replacement in a group of children and young adults to assess outcome and satisfaction. MATERIALS AND METHODS: From 1980 to 1996 we evaluated 31 patients 1 to 20 years old who required vaginal replacement. Presenting diagnoses included müllerian failure (the Mayer-Rokitansky syndrome) in 20 patients, androgen insensitivity syndrome in 5, rhabdomyosarcoma in 3, penile agenesis in 1, cloacal exstrophy in 1 and 1 previously separated conjoint twin. A questionnaire was given to 26 of the 31 patients to assess postoperative sexual function and satisfaction. RESULTS: A total of 33 bowel segments in 31 patients were used for vaginal reconstruction, including sigmoid colon in 20, ileum in 8 and cecum in 5. Of the 31 patients 20 were sexually active, 8 were married and 3 had been previously married and divorced. Only 1 patient described chronic dyspareunia. Three patients were on chronic home dilation, while 4 required sanitary pads for vaginal secretions. There were 8 complications in the 31 patients, including stenosis of the bowel segment in 6. Three patients required a second procedure after total stenosis of the small bowel vagina (2) and prolapse of the neovagina (1), which required retroperitoneal fixation. CONCLUSIONS: Experience with this group of patients leads us to believe that isolated bowel segments provide excellent tissue for vaginal replacement. Furthermore, we believe that colon segments, particularly sigmoid, are preferable to small bowel for creation of the neovagina. In many instances the small bowel mesentery may be too short to provide an adequate, tension-free anastomosis in the perineum, particularly in obese patients. Our results would also suggest that sexual activity is more compatible with isolated bowel segments for vaginal replacement than with any of the more traditional methods, such as passive dilations and split thickness skin graft vaginoplasty.     

Clinical profile of primary hyperparathyroidism in adolescents and young adults

The development of new strategies on chemotherapy of parasitic protozoan diseases is one of the most exciting research fields of recent years. World Health Organization (WHO) reports have recognized that the physiology and biochemistry of protozoan parasites and the host-parasite relation are the main targets for the design of new drugs that can be used in the future against these diseases.     

Odor learning, recall, and recognition memory in young and elderly adults.

Use of an odor learning test and the California Verbal Learning Test in young and elderly adults enabled comparison of age-related effects on recall and recognition memory. Assessment of odor identification further enabled study of which odor function (recall, identification, recognition) is most affected by aging, the odor functions' interrelationships, and predictors of odor recall. Results suggested that both recall and recognition were significantly affected by aging and that the odor-recall decline cannot simply be referred to poor identification. Very similar age-related effect sizes were found for the 3 types of odor functions. Finally, the combined ability to encode, store, and retrieve odors appears to predict overall recall performance (including its identification component) better than do identification and recognition. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Body composition, nutrition and nutritional habits of young and elderly adults

After the unification of East and West Germany the living conditions and the nutritional habits of the East German population changed considerably. The effects of these changes on nutritional status, physique and body composition are examined by a comparison of the representative sample of Greil taken from the East German population before the reunification of Germany with the sample of Trippo measured in the East German town of Potsdam between 1995 and 1997. The comparison of the samples of Greil and Trippo gives no indication of any increase in overweight subjects or adiposity during the last few years amongst the older test persons. However, the body mass of younger subjects shows a slight increase. Comparison of the estimates of total body fat showed considerable variation in results for skinfold thickness measurements and bioelectrical impedance analysis depending on the formula used.     

Fears in American, Australian, Chinese, and Nigerian children and adolescents: a cross-cultural study

The control of reproductive seasonality was studied in farmed adult red deer hinds that had been either ovariectomized or ovariectomized and oestradiol-treated (s.c. implants). The breeding season, delineated by progesterone secretion in intact hind herdmates, was characterized by high (mean 0.6, range 0.1-2.5 ng ml-1 plasma) LH concentrations in ovariectomized oestradiol-treated hinds. In contrast, during the non-breeding season plasma LH concentrations in these animals were significantly lower (mean 0.1, range 0-0.9 ng ml-1 plasma). LH secretion in ovariectomized untreated hinds also displayed a marked seasonal pattern, approximately the inverse of daily photoperiod (that is, a winter peak and summer trough). The pituitary LH response to 10 micrograms exogenous GnRH was also maximal during the breeding season in ovariectomized (mean 7.4, range 1.2-14.6 ng ml-1) and ovariectomized, oestradiol-treated (mean 16.4, range 1.4-32.3 ng ml-1) hinds. These results indicate that LH secretion in the hind is regulated by both steroid-dependent and -independent mechanisms.     

Temporal coding by young and elderly adults: A test of the Hasher-Zacks model.

Reports 2 experiments that examine the "automatic" nature of temporal coding. 70 elderly (aged 60–75 yrs) and 103 young (aged 17–29 yrs) women participated. In Exp I, Ss listened to a list of 50 words and were then required to give their best estimate of the 10th of the list in which they had heard each word. As predicted by the model of L. Hasher and R. T. Zacks (1979), awareness of the location requirement had no effect on performance. Although the younger Ss exhibited superior location memory, this was attributed to a pronounced tendency on the part of the elderly to be conservative with respect to assigning words to early and late locations. The effects on performance of this response bias were eliminated in Exp II by the use of M. Toglia and G. Kimble's (1976) Adjusted Index of Location Scores. No age differences in location memory were observed. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)