A novel form of subcutaneous nerve stimulation (SCNS) was recently introduced for the relief of chronic pain. We present a study using this form of SCNS applied over the radial, median and saphenous nerves in patients with clinically diagnosed osteoarthritis of the hip. Acceptable pain relief was obtained in 60% of patients receiving stimulation, however, comparable analgesia was achieved in a control group, who received no electrical stimulation through similarly placed needles. We suggest that these results may be explained by the ability of SCNS to evoke a placebo response. The efficacy of the placebo effect and the ethical implications of its use in clinical practice are discussed.
Human platelets were tested for the presence of proteins immunologically cross-reactive with red cell spectrin and protein 4.1. As assessed by indirect immunofluorescence microscopy, platelets were specifically reactive with affinity-purified rabbit antisera against red cell spectrin and protein 4.1. The immunoreactive platelet constituents were further analyzed by sodium dodecyl sulfate- polyacrylamide gel electrophoresis, followed by electrophoretic transfer to nitrocellulose paper and immunoperoxidase staining. We found that whole platelets, membranes, and cytoskeletal preparations isolated by Triton X-100 extraction contain small amounts of proteins reacting with anti-spectrin or anti-protein 4.1 antiserum. The immunoreactive spectrin-like platelet protein has an apparent molecular weight of 240,000 and comigrates with the alpha-subunit of red cell spectrin. The major immunoreactive protein 4.1-like constituent has an apparent molecular weight of 78,000, which is slightly less than that of red cell protein 4.1. We conclude that platelets contain a spectrin- like protein which, by analogy with red cell spectrin, may have a role in membrane-cytoskeletal attachment. The properties and function of the platelet protein 4.1-like constituent are not yet known.
SummaryThe efsects of cardiopulmonary bypass and hypothermia were studied on the plasma concentration and metabolism of a continuous infusion of etomidate in six patients. Continuous etomidate infusions (20 pgglkglminute) with analgesic cover may be a suitable anaesthetic for cardiac surgery. This rate of infusion provides adequate plasma concentrations, and it would appear unnecessary from the results to alter the rate of infusion during cardiopulmonary bypass and hypothermia. Key wordsAnaesthetics, intravenous; etomidate. Surgery; cardiopulmonary bypass.Maintenance of anaesthesia during the period of cardiopulmonary bypass presents special problems in patients undergoing cardiac surgery. Inhalational agents can be administered into the extracorporeal system, but during changes in blood flow through the oxygenator it is difficult to control blood levels accurately, and considerable cardiovascular depression may occur. Neuroleptanaesthesia, or large dose narcotic techniques, although providing cardiovascular stability may result in awareness or unpleasant dreaming' during bypass if not supplemented with an hypnotic agent. An intravenous technique, however, would offer advantages in these circumstances, but should be simple and easily controlled.This study was designed to investigate the use of etomidate and fentanyl for routine cardiopulmonary bypass operations. Since etomidate is metabolised by the liver2 and maintains good cardiovascular stability,'~~ it may well be a suitable agent for use by infusion in these patients. We have also observed how cardiopulmonary bypass and hypothermia affects the overall metabolism and dose requirements of etomidate. MethodSix patients undergoing open heart surgery for valve replacement or coronary artery bypass grafts were studied. Their ages ranged from 39-42 years and weights from 55-9 1 kg. Several patients had some degree of heart failure but none had clinical or biochemical evidence of hepatic failure. Each patient was premedicated with oral lorazepam 2-3 mg the night before surgery, followed by an intramascular dose of papaveretum 0.3 mg/kg to a maximum of 20 mg given 1 hour before surgery.
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