M. Patricia Leuschen

Fentanyl citrate analgesia during labor

Fentanyl citrate is a potent short-acting narcotic reported to cause less nausea and sedation than morphine or meperidine hydrochloride. The purpose of this prospective investigation was to determine whether a safe but adequate intrapartum dosing schedule is possible. A total of 137 women with uncomplicated term pregnancies were offered a standard intravenous dose (50 mcg or 100 mcg hourly as needed) of fentanyl citrate during active labor. Temporary analgesia and mild sedation were apparent in each case. The cumulative dose varied in accordance with maternal needs (mean, 140 ± 42 µg; range, 50 mcg to 600 µg). Apart from a brief decrease in fetal heart rate variability that lasted 30 minutes, no worrisome pattern was apparent from exposure to fentanyl citrate. Pediatric examinations were performed without knowledge of analgesic therapy on infants exposed to fentanyl citrate and those not exposed to analgesics. No differences were found in frequencies of newborn depressed respirations, low Apgar scores, or neurologic and adaptive capabilities at two hours and 24 hours postnatally. With the use of the described dosing schedule, fentanyl citrate was helpful during labor and did not cause immediate or prolonged hazards to the mother and unborn infant.

Risk of hypoventilation in premature infants in car seats

We examined 30 newborn infants for respiratory compromise before, during, and after placement in a recommended car seat restraining device. Twelve infants were premature with a history of apnea, eight were premature without known apnea, and 10 were born at term. Both premature groups had significant decreases in oxygen saturation while in the car seat (P less than 0.01) and more frequent desaturation episodes less than 80% (P less than 0.001). Premature infants with a history of apnea had more bradycardia events (P less than 0.05). No normal term infant had any of these problems. In addition, oxygen saturation trended downward from baseline for all premature infants during the recovery interval (P = 0.07). We conclude that currently available car seats may place premature infants at risk for significant hypoxia and ventilatory compromise.

Postconceptional age and gentamicin elimination half-life

We examined the correlation between the elimination half-life of gentamicin and postnatal or postconceptional age in 104 infants greater than 24 weeks to less than or equal to 48 weeks postconceptional age. A weak correlation was observed between half-life and postnatal age (R = -0.353). A better correlation existed between postconceptional age and half-life (R = -0.572). A plot of the log of the mean half-life against postconceptional age was virtually linear. We conclude that postconceptional age is a major determinant of an infants ability to excrete gentamicin, and speculate that the relationship between half-life and decreasing postconceptional age is exponential.

Improvement in strength following resistance training in MS patients despite varied disability levels

Strength and endurance data from 67 participants with multiple sclerosis (MS) were compared before, during and after a 6-month program of standardized resistance training. The hypothesis was that a standardized, structured resistance training exercise program improves strength in MS patients with different levels of disability. The range of EDSS scores was 1-8: (40% - EDSS of 1-4.5), (35% - EDSS of 5-7) (25% - EDSS of 7.5 or higher). This unique study evaluated patients with differing levels of disability for a change in strength and endurance following a 6-month training program. Data were analyzed by repeat measures and analysis of variables using Proc GLM in SAS to account for variability between subjects, and within subjects, due to repeated measures at 3 time points. Each treatment was blocked by disability class. Every within-treatment analysis was significant. Each exercise showed significant improvement in strength for participants, despite disability levels. Increases in strength followed parallel improvement pathways, at all disability levels. All but one treatment displayed highly significant improvement (p-value < 0.0001). The results demonstrated that all individuals with MS, despite disability levels, show parallel improvement in strength and endurance. This study supports the use of exercise, including resistance programs, for all MS patients.

Modification of CAPS-1 for diagnosis of PTSD in Afghan refugees

A DSM-III-R based instrument for the assessment of posttraumatic stress disorder (PTSD), the Clinician-Administered PTSD Scale (CAPS-1), was modified to accommodate cultural differences and translated into the Afghan languages Pushto and Farsi (Dari) and administered to 30 Afghan refugees living in the United States. The modified CAPS-1 was found to be practical and reliable. Inter-item correlations were calculated on the frequency and intensity scores for the 17 cardinal symptoms and the eight associated features items of the modified CAPS-1. The four reexperiencing items demonstrated significant independence from the avoidance and arousal symptom clusters. However, the avoidance and arousal symptom clusters were not found to be independent cardinal components of PTSD in our participants. The CAPS-1 criteria for diagnosis of PTSD were met by 50% of the subjects evaluated.

A randomized open label study of pain medications (naproxen, acetaminophen and ibuprofen) for controlling side effects during initiation of IFN β-1a therapy and during its ongoing use for relapsing-remitting multiple sclerosis

Multiple sclerosis (MS) patients initiating IFN b-1a, Avonex, therapy (Group 1, n-30) or experiencing side effects after 6 months on therapy (Group 2, n-30) were randomized for 5 weeks open label adjunct therapy to naproxen (Aleve®), acetaminophen (Tylenol®)or ibuprofen (Advil®). Our hypothesis was that non-prescription pain medications are effective in decreasing or alleviating the side effects associated with IFN b-1a therapy. Contrary to the hypothesis, most patients in both groups continued to report side effects on all pain medications. After 5 weeks, headache, fever, chills and injection site pain were low in5-50% of patients. Moderate to significant fatigue, muscle or joint pain continued in most patients. As a quality of life measure, the Modified Fatigue Impact Scale (mFIS) improved for Group 1 on naproxen or ibuprofen with greatest improvement in physical subset (P-0.002 for naproxen and PB-0.01 for ibuprofen). Total mFIS for Group 1 on acetaminophen improved (P-0.04) due to improved cognitive subset rather than physical subset. Group 2, with side effects initially, reported less significant fatigue (severity 5-10) but more moderate fatigue (severity 2-4) at study end for all three medications. All medications improved cognitive subset (P=0.05). Physical mFIS subset did not improve for Group 2 on acetaminophen, but did with naproxen (P=0.05) or ibuprofen (P=0.03). Naproxen and ibuprofen were more effective than acetaminophen in minimizing physical side effects of IFN b-1a. None of the three pain medications tested were as effective as hypothesized for minimizing fatigue or muscle and joint pain.

Cytochemical analysis of intracellular calcium distribution in the anterior pituitary of the rat

SummaryIn an attempt to assign morphologic identities to previously distinguished functional calcium compartments in the anterior pituitary of the rat, we employed the potassium pyroantimonate technique for cation localization. Tissues were incubated for In at 37°C in control medium; with 10mM theophylline; or with depolarizing amounts of potassium. Precipitate was quantified on photomicrographs of tissue prepared for electron microscopy with a Talos Systems Digitizer. The nature of the electron dense precipitate was dependent on the experimental state of the tissue. Treatment with 5 mM EGTA abolished the dense precipitate. Electron microprobe analysis also confirmed that calcium was the predominant cation in the observed precipitate. The most significant changes in precipitate deposition occurred along the plasma membrane, the limiting membrane of secretory granules and within mitochondria. Dense precipitate was present along the plasma membrane only in cells treated with potassium. Control tissue exhibited higher levels of precipitate associated with the limiting membrane of secretory granules than either theophylline-treated or potassium-treated tissue. Mitochondria contained more precipitate in potassium-treated tissue than in controls; the mitochondria of theophylline-treated tissue contained intermediate levels of precipitate. Addition of either theophylline or depolarizing amounts of potassium has been associated with hormone secretion in anterior pituitary tissue of normal rats. Kinetic studies in our laboratory indicate that intracellular calcium shifts occur. The pyroantimonate technique is useful in verifying morphologically the calcium compartments involved in shifts in intracellular calcium.

Impact of Resistance Training on Balance and Gait in Multiple Sclerosis

Multiple sclerosis (MS) is an incurable neurodegenerative disease whose symptoms are only partially relieved by pharmaceutical intervention. Disability due to this disease process can impede activities of daily living and decrease quality of life, both for MS patients and for their care partners and families. A nonrandomized, nonblinded prospective cohort study of 45 patients with MS was undertaken to investigate the impact of an exercise program emphasizing resistance training on balance and gait. This article presents data for the first 33 participants to complete the study protocol. The exercise program consisted of twice-weekly 50-minute sessions for 6 months. At 3 months and 6 months, statistically significant improvements (P < .05) from baseline were observed for the following measures: Nine-Hole Peg Test, 2- and 3-second Paced Auditory Serial Addition Test, Modified Fatigue Impact Scale, NeuroCom Balance Master (NeuroCom International, Inc, Clackamas, OR), Timed Up and Go test, and Berg Balance Sca...

Discordant functional and inflammatory parameters in multiple sclerosis patients after autologous haematopoietic stem cell transplantation

This article describes outcomes in four patients with advanced multiple sclerosis up to two years after autologous haematopoietic stem cell transplantation using a total-body irradiation-based preparative regimen. MRI and C SF analyses demonstrated clear suppression of the inflammatory processes. The results demonstrate however, a dissociation of inflammation parameters and functional disability findings raising questions about optimal future stem cell transplantatio n strategies for this disease.

Comparative evaluation of antepartum and postpartum platelet function in smokers and nonsmokers

Platelet aggregation was analyzed during normal pregnancy by evaluation of the same patient cohort (n = 19) on two separate prenatal visits and at 4 weeks post partum. To analyze platelet aggregation five different parameters were evaluated in platelet-rich plasma and whole blood (by impedance aggregometry) with the use of four different aggregating agents: adenosine diphosphate, collagen, sodium arachidonate, and epinephrine. Plasma levels of beta-thromboglobulin, thromboxane B2, and 1,6-keto-prostaglandin F1 alpha were also analyzed. Platelet counts rose 19% after delivery. Plasma levels of beta-thromboglobulin and thromboxane B2 were not significantly changed during the two antepartum visits, but B-thromboglobulin levels were modestly elevated post partum. Levels of 1,6-keto-prostaglandin F1 alpha decreased significantly from a mean of 125 pg/ml before delivery to 50 pg/ml post partum. All antepartum parameters on whole blood aggregation that were significantly different from postpartum values showed enhanced antepartum reactivity. In platelet-rich plasma, pregnancy was associated with greater platelet reactivity except for two variables, time to half-maximal aggregation for epinephrine and the extent of aggregation by collagen, both noted during the first antepartum evaluation. When the patient cohort of 19 was subdivided according to smoking status, all aggregation parameters of significance (p less than 0.05) demonstrated increased platelet reactivity during pregnancy compared with postpartum values. Smoking women accounted for a disproportionate number of significantly enhanced reactivity (seven variables versus three).