Disposition kinetics of ropivacaine in humans. Anesth Analg 1989;69:7364 The pharrnacokinetic characteristics of a new local anesthetic drug, ropivacaine, were determined after intravenous infusion of 50 mg of the hydrochloride salt into six healthy male volunteers. Results showed that the disposition of ropivacaine can be described by a biexponential function. Its blood clearance (0.72 2 0.16 Llmin) is intermediate between that of mepivacaine and bupivacaine. Plasma binding averaged 94% * 1 % and the volume of distribution at steady sfate based on blood drug concentration was 59 * 7 L. The terminal elimination half-life was 211 ? 62 min.

Adrenalectomy for melanoma metastatic to the adrenal gland provides good palliation of symptoms and is associated with prolonged survival in a selected cohort of patients. We report for the first time sustained complete regression of distant metastatic melanoma after bilateral adrenalectomy, suggesting a possible role for adrenal hormones in modifying melanoma progression in certain patients.

An error was identified in IOL power estimation with the ZIOLM, when using the manufacturer's recommended A-constant (recommended and previously optimized ultrasound A-constant 118.0; ZIOLM optimized A-constant 118.6). Serial modifications to the A-constant were successful in reducing the unexpected error to well within the tolerance limits of published international standards.

SummaryFifty outpatie?ts who underwent upper gas trointestinal endoscopy under midazolam sedation were allocated randomly into two equal groups qj25 in this double-blind study. After the endoscopy, and 30 minutes after administration of the sedative, patients in one group receivedflumazenil0.5 mg; those in the other group received a similar volume of vehicle only. Assessments of memory junction, psychomotor performance and coordination were carried out and these were repeated 3.5 hours later. Flumazenil produced a signijicant improvement ( p < 0.0001) immediately but no diflerence could be detected between flumazenil and placebo at 3.5 hours. However, patients in the flumazenil group reported, by means of linear analogue scales, a subjective feeling ojalertness at the time of discharge, which was greater than that reported by those in the placebo group ( p < 0.00s).

The human corpus luteum (hCL) is an active, transient, and dynamic endocrine gland. It will experience extensive tissue and vascular remodeling followed by 1) demise of the whole gland without any apparent scarring or 2) maintenance of structural and functional integrity dependent on conceptus-derived human chorionic gonadotropin (hCG). Because cortisol has well-characterized roles in tissue remodeling and repair, we hypothesized that it may have a role in controlling luteal dissolution during luteolysis and would be locally produced toward the end of the luteal cycle. Glucocorticoid-metabolizing enzymes [11beta-hydroxysteroid dehydrogenase (11betaHSD) types 1 and 2] and the glucocorticoid receptor (GR) were assessed in hCL and cultures of luteinized granulosa cells (LGC) using immunofluorescence and quantitative RT-PCR. Furthermore, the effect of cortisol on steroidogenic cell survival and fibroblast-like cell activity was explored in vitro. The hCL expressed 11betaHSD isoenzymes in LGC and nuclear GR in several cell types. hCG up-regulated the expression and activity of 11betaHSD type 1 (P < 0.05) and down-regulated type 2 enzyme (P < 0.05) in vitro and tended to do the same in vivo. Cortisol increased the survival of LGC treated with RU486 (P < 0.05) and suppressed the activity of a proteolytic enzyme associated with luteolysis in fibroblast-like cells (P < 0.05). Our results suggest that, rather than during luteolysis, it is luteal rescue with hCG that is associated with increased local cortisol generation by 11betaHSD type 1. Locally generated cortisol may therefore act on the hCL through GR to have a luteotropic role in the regulation of luteal tissue remodeling during maternal recognition of pregnancy.

No abstract

Our results were comparable to alternative materials in respect of recurrence and were superior in respect of both granuloma formation and infection. Silicone is superior to all listed materials in respect of ease of adjustment of the sling in cases where the ideal lid position was not achieved after primary surgery.

The transposed cheek flap is a useful technique in the reconstruction of lower lid lesions involving the lateral canthus. The majority of patients had a good cosmetic result and required no further intervention. The most frequent complications were bulky lids and ectropion.