A linkage disequilibrium between the two TNF polymorphisms was found. This study revealed a significant association between genotype and phenotype for both TNF polymorphisms. Heterozygosity for both TNF polymorphisms is associated with an increased TNF-alpha response.

The purpose of this study was to investigate the effect of different pain-relief methods (regional and systemic) following thoracotomies on the cardiovascular system, pulmonary gas exchange, various endocrine parameters and subjective perception. A further aspect was to evaluate the benefits of interpleural analgesia as a new regional technique against already established regional techniques, such as intercostal nerve block and thoracic epidural block. All postoperative pain methods led to a significant time-dependent reduction of the adrenaline concentrations in plasma while the noradrenaline concentrations did not change significantly. There were no statistical differences in catecholamine concentrations among the different study groups, although the mean concentrations of adrenaline in patients having a thoracic epidural block for pain relief were lower in comparison to the findings in other groups. The plasma concentrations of the "stress metabolites", such as glucose, free fatty acids and lactate, as well as the haemodynamic (mean arterial pressure, heart rate) and pulmonary parameters (blood gas analyses), showed no significant differences among groups. In contrast to the other pain-relieving methods, interpleural analgesia did not lead to sufficient pain relief in that 7 out of 10 patients needed supplementary systemic opioid therapy. Therefore, interpleural analgesia for pain relief following thoracotomies cannot be recommended.

Compared with general anesthesia and postoperative IV patient-controlled analgesia with morphine, epidural anesthesia and analgesia with the new local anesthetic ropivacaine enables patients to be discharged sooner from a postanesthesia care unit and provides superior pain relief during the first 24 h after hip replacement.

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Background and objective: To assess incidence and intensity of pain on intravenous injection of propofol (CAS 2078-54-8) in an emulsion of medium-chain / long-chain triglycerides (MCT/LCT, 50:50) in patients undergoing different elective surgical interventions.Methods: The new solvent was used for induction of general anesthesia. Spontaneous pain reactions and pain elicited upon questioning were assessed. Patients were asked to grade the pain as mild, moderate or severe. Co-medication with sedative or analgesic drugs, size of the intravenous cannulae, site of injection and administration as a single bolus or in divided doses were recorded.Results: Overall incidence of pain was 28.4 % (390 out of 1375 patients). Twelve percent of the patients complained spontaneously and 16.4 % reported pain after questioning. Pain intensity was graded as mild by 16.7 % of the patients. The incidence of pain was significantly less when using an antecubital vein compared with a forearm or dorsal hand vein (p = 0.017 spontaneously reported pain, p = 0.001 pain elicited upon questioning). The number of patients complaining spontaneously of pain was significantly lower (p = 0.006) for large size than for small and medium size cannulae. Conclusions: The incidence of pain on injection of a medium-/ long-chain tri-glyceride propofol formulation was 28.4 % with 16.7 % of the patients reporting mild pain. The use of an antecubital vein or a large size venous cannula appears to reduce the injection pain. Anesthetics CAS 2078-54-8 Propofol, new solvent Propofol- Lipuro, injection pain, observational study Arzneim.-Forsch./Drug Res. 53, Nr. 9, 621−626 (2003) Arzneim.-Forsch./Drug Res. 53, No. 9, 621−626 (2003) Bachmann-Mennenga et al. − Propofol Arzneim.-Forsch./Drug Res. 53, No. 9, 621−626 (2003) Bachmann-Mennenga et al. − Propofol

Background Hypertrophic cardiomyopathy (HCM) is a genetic cardiomyopathy with a prevalence of about 1:200. It is characterized by left ventricular hypertrophy, diastolic dysfunction and interstitial fibrosis; HCM might lead to sudden cardiac death (SCD) especially in the young. Due to low autopsy frequencies of sudden unexplained deaths (SUD) the true prevalence of SCD and especially of HCM among SUD remains unclear. Even in cases of proven SCD genetic testing is not a routine procedure precluding appropriate risk stratification and counseling of relatives. Methods Here we report a case of SCD in a 19‐year‐old investigated by combined forensic and molecular autopsy. Results During autopsy of the index‐patient HCM was detected. As no other possible cause of death could be uncovered by forensic autopsy the event was classified as SCD. Molecular autopsy identified two (probably) pathogenic genetic variants in FHL1 and MYBPC3. The MYBPC3 variant had an incomplete penetrance. The FHL1 variant was a de novo mutation. We detected reduced FHL1 mRNA levels and no FHL1 protein in muscle samples suggesting nonsense‐mediated mRNA decay and/or degradation of the truncated protein in the SCD victim revealing a plausible disease mechanism. Conclusion The identification of the genetic cause of the SCD contributed to the rational counseling of the relatives and risk assessment within the family. Furthermore our study revealed evidences for the pathomechanism of FHL1 mutations.

Premixing propofol medium-chain triglyceride/long-chain triglyceride with lidocaine is one of the most effective measures currently available to reduce the incidence of injection pain in sedated patients during regional anaesthesia.

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