Recovery from sevoflurane anesthesia: a comparison to isoflurane and propofol anesthesia

BACKGROUND: Sevoflurane has a lower blood:gas partition coefficient than isoflurane, which may cause a more rapid recovery from anesthesia; it also might cause faster emergence times than for propofol-based anesthesia. We evaluated a database that included recovery endpoints from controlled, randomized, prospective studies sponsored by Abbott Laboratories that compared sevoflurane to isoflurane or propofol when extubation was planned immediately after completion of elective surgery in adult patients. METHODS: Sevoflurane was compared to isoflurane in eight studies (N=2,008) and to propofol in three studies (N=436). Analysis of variance was applied using least squares method mean values to calculate the pooled mean difference in recovery endpoints between primary anesthetics. The effects of patient age and case duration also were determined. RESULTS: Sevoflurane resulted in statistically significant shorter times to emergence (-3.3 min), response to command (-3.1 min), orientation (-4.0 min) and first analgesic (-8.9 min) but not time to eligibility for discharge (-1.7 min) compared to isoflurane (mean difference). Times to recovery endpoints increased with increasing case duration with isoflurane but not with sevoflurane (patients receiving isoflurane took 4-5 min more to emerge and respond to commands and 8.6 min more to achieve orientation during cases longer than 3 hr in duration than those receiving sevoflurane). Patients older than 65 yr had longer times to orientation, but within any age group, orientation was always faster after sevoflurane. There were no differences in recovery times between sevoflurane and propofol. CONCLUSIONS: Recovery from sevoflurane was 3-4 min faster than with isoflurane in all age groups, and the difference was magnified in longer-duration surgical cases (> 3 hr).     

Endothelin 1 mediates ex vivo coronary vasoconstriction caused by exogenous and endogenous cytokines

Treatment of rats with cytokines has been associated with an increase in the circulating levels of endothelin 1 (ET-1). Here we show that administration of tumor necrosis factor alpha (TNF-alpha; 4 micrograms.kg-1) to anesthetized rats caused within 15 min a strong elevation in the circulating levels of ET-1. This was associated with a striking coronary vasoconstriction in hearts from these animals when they were removed and perfused in vitro by the Langendorff technique. This vasoconstriction was largely overcome by treatment with either the endothelin type A (ETA) receptor antagonist FR 139317 or antibody against ET-1. Furthermore, it was mimicked by in vivo exposure to exogenous ET-1. Endogenously produced TNF-alpha may also cause such a coronary vasoconstriction, for treatment with interleukin 2 (600 micrograms.kg-1) produced an increase in coronary perfusion pressure that correlated with the increases in circulating TNF-alpha. This coronary vasoconstriction was substantially reversed by treatment either with antibody against TNF-alpha or with FR 139317. We suggest, therefore, that cytokine-driven changes in the production of ET-1 are key events in the development of vascular pathologies.     

Functional morphology of nucleolus organizer regions of chromosomes and nucleoli in human multiple myeloma cell lines. I. Variation of the morphology and silver staining of nucleolus organizer regions of chromosomes in RMPI 8226 and U 266 cell lines with different level of differentiation of during 7 days after cell passage

The morphology and Ag-staining of nucleoli in human multiple myeloma cell lines RPMI 8226 and U 266, distinguished from each other in the differentiation degree, were quantitatively studied, and the production of immunoglobulins or their fragments by the line cells was evaluated throughout 7 days after cell seeding. The less differentiated cell line RPMI 8226 and the high differentiated cell line U 266 were revealed to differ in both the initial level of immunoglobulin production and dynamics of immunoglobulin accumulation in culture medium. The total number of Ag-stained nucleolar-organizer regions (AgNORs) per nucleus in cells RPMI 8226 was significantly higher than in cells U 266 in all times after seeding of the cells. In both cell lines changes in the quantity and shape of nucleoli and also in the total number of AgNORs per nucleus and pattern of AgNORs distribution within nucleoli correlated with the cell cycle phase. Relationships between morphofunctional changes in nucleoli and the differentiation degree and proliferative activity of the cells, and also between the number of Ag-positive nucleolar-organizing metaphase chromosomes and the functional activity of interphase AgNORs are discussed.     

The effect of curcumin on human B-cell immortalization by Epstein-Barr virus

Cyclosporine is a commonly used immunosuppressant in solid-organ transplantation. It is, however, associated with an increased incidence of Epstein-Barr virus (EBV)induced post-transplant lymphoproliferative disorder (PTLD). In this study, human B lymphocytes isolated from healthy volunteers were immortalized in vitro with EBV. The effect of oxidative stress mediated by cyclosporine A or hydrogen peroxide on in vitro B cell immortalization was studied by coculturing immortalized B cells with cyclosporine A and hydrogen peroxide. Curcumin, a phenolic extract of the spice turmeric, was then used to observe its effect on this process. We found that in vitro B-cell immortalization with EBV was promoted by the oxidative stress induced by cyclosporine A and hydrogen peroxide, with the maximum effect seen at concentrations of 500 ng/ml and 100 microM, respectively. Curcumin blocked the B-cell immortalization in a dose-dependent fashion with nearly complete inhibition at 20 microM. We conclude that, because both hydrogen peroxide and cyclosporine A strongly promote in vitro B-cell immortalization with EBV (the putative process responsible for PTLD) and curcumin, an extract of a common spice is an effective inhibitor of this process; curcumin may be an effective adjunct in the prevention of PTLD in the patients undergoing therapy with cyclosporine A.     

Relation between insulin-like growth factor-I concentrations, osteoarthritis, bone density, and fractures in the general population: the Chingford study

OBJECTIVE: To assess the association between serum insulin-like growth factor-I (IGF-1) concentrations and osteoarthritis, and bone mineral density, and fractures in a large group of middle aged women from the general population. METHODS: 761 women aged 44-64 years from the Chingford study had serum IGF-I concentrations measured; hand, hip, spine, and anteroposterior weight bearing knee radiographs taken; and dual energy x ray absorptiometry (DEXA) scans of the hip and spine. X rays were scored using the Kellgren and Lawrence system. In addition knee x rays were scored using a standard atlas for individual features of osteophytes and joint space narrowing (both graded 0-3). IGF-I concentrations were adjusted for the effects of age. RESULTS: In the osteoarthritis analysis results were compared to a constant group of 155 subjects with no evidence of osteoarthritis at any site. There was no significant difference in serum IGF-I between these subjects and 606 subjects with osteoarthritis at any site. When individual sites were analysed, serum IGF-I was higher in those cases with more severe bilateral knee osteoarthritis and in those with distal interphalangeal (DIP) joint disease. There was no significant association between serum IGF-I and other forms of osteoarthritis or milder forms of knee osteoarthritis. There was no correlation between IGF-I concentrations and bone mineral density at the spine or hip, nor any difference between IGF-I concentrations in subjects with and without a history of non-traumatic fracture [22.8 (SD 6.6) v 23.1 (SD 6.6) nmol litre-1, P = 0.6] CONCLUSIONS: There is a modest association between IGF-I concentrations and the development of DIP osteoarthritis and more severe or bilateral knee joint osteoarthritis in women from the normal population, but no association with other forms of osteoarthritis, bone density, or fractures.     

CAG repeat expansion in autosomal dominant familial spastic paraparesis: novel expansion in a subset of patients

Autosomal dominant familial spastic paraplegia (FSP) is a genetically heterogeneous neurodegenerative disorder displaying anticipation for which three loci have been mapped to the chromosomal positions 14q11.2-q24.3 (SPG3), 2p21-p24 (SPG4) and 15q11.1 (SPG6). The repeat expansion detection (RED) method has been used to demonstrate expanded CAG repeats in some FSP families that map to SPG4. We analyzed 20 FSP families, including four for which there is evidence for linkage to SPG4, and found that in most cases the repeat expansion detected by RED is due to non-pathogenic expansions of the chromosome 18q21.1 SEF2-1 or 17q21.3 ERDA1 locus. Polymorphic expansions at SEF2-1 and ERDA1 appear frequent and may confound RED studies in the search for genes causing disorders demonstrating anticipation. In six FSP families, however, CAG repeat expansion was detected in a subset of affected and at-risk individuals that did not result from expansion of the SEF2-1 and ERDA1 loci. Overall, 11 of 37 (30%) of the FSP patients with a CAG/CTG repeat expansion are unaccounted for by the SEF2-1 and ERDA1 loci, compared with two of 23 (9%) of the unaffected at-risk individuals and none of 19 controls. In the majority of cases these novel expansions were shorter than those previously reported.