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Biomedical subjects

D Fletcher

Publications and source records attributed to D Fletcher.

98 records · Page 6Linked to original sources
PubMed1980

Neural and humoral factors in postoperative ileus.

Two inhibitory mechanisms in the human colon which may contribute to postoperative ileus have been studied. Dopamine, a possible peripheral neurotransmitter, inhibited isolated colonic smooth muscle strips by a direct effect in longitudinal muscle any by a nerve-mediated mechanism as circular muscle. Plasma motilin levels were suppressed pre- and per- operatively and elevation of levels postoperatively correlated with the return of normal motility and the severity of the operation.

Cholecystectomy↗
PubMedDate not supplied

Additivity of bupivacaine and morphine for peripheral analgesia in rats.

Infiltration of the surgical wound is a classical technique for post-operative analgesia. Recent studies have suggested that local anaesthetic may be combined with other drugs such as opioids. This study has evaluated, in rat, the infiltration with morphine, bupivacaine and their combination. In all groups, the two hind paws were injected with carrageenin. The left hind paw was used as control. The vocalisation threshold to paw pressure (VTPP) of both hind paws was evaluated 2 h after induction of carrageenin inflammation (baseline value), then every 10 min until the return to baseline value after injection of analgesic drugs. The development of oedema was evaluated in both hind paws by measurement of paw circumference (PC) before, then after, carrageenin injection. All analgesic drugs were injected in the right inflamed paw diluted in 0.2 mL of normal saline. The analgesic effect of bupivacaine (0.1, 0.25 and 0.5%), morphine (25, 50 and 100 microg) and their combination (bupivacaine 0.1%/morphine 20 microg, bupivacaine 0.2%/morphine 40 microg and bupivacaine 0.4%/morphine 80 microg) was tested. The effect of naloxone on morphine induced analgesia was tested. The interaction between bupivacaine and morphine was evaluated with an isobolographic analysis. Bupivacaine produced a dose-dependent antinociceptive effect. Morphine infiltration produced a peripheral, dose-dependent analgesic effect antagonised by naloxone. This analgesic effect of morphine was associated with an anti-inflammatory effect. The isobolographic analysis revealed only additivity between bupivacaine and morphine. The infiltration with morphine offers a peripheral analgesic effect which is additive with the effect of bupivacaine. An anti-inflammatory effect of morphine participates in this peripheral analgesic effect.

Analgesics, Opioid↗
PubMedDate not supplied

Atlanto-occipital joint pain. A report of three cases and description of an intraarticular joint block technique.

BACKGROUND AND OBJECTIVES: The atlanto-occipital (AO) joint is a true, innervated synovial joint with the potential to cause pain. METHODS: A detailed description of an AO joint injection technique is provided, as none was found on review of the literature. RESULTS: Using this technique, three illustrative cases provide preliminary evidence that intraarticular injection of the AO joint may have both diagnostic and therapeutic value for the treatment of upper cervical pain and headaches. CONCLUSIONS: Although AO joint injections may prove to be an effective adjunct to more traditional forms of conservative treatment, additional prospective studies are needed to better define the role of intraarticular AO joint injections in the diagnosis and treatment of head and neck pain.

Adult↗
PubMedDate not supplied

Addition of fentanyl to 1.5% lidocaine does not increase the success of axillary plexus block.

BACKGROUND AND OBJECTIVES: This randomized, double-blind study was designed to evaluate the effects of the addition of fentanyl (F) to lidocaine (L) on the onset, duration, and success rate of axillary brachial plexus block. METHODS: After institutional approval and informed consent, 53 ASA 1 and ASA 2 patients scheduled for orthopedic surgery using brachial plexus anesthesia were included in the study. Axillary brachial plexus block was performed using a peripheral nerve stimulator to localize one nerve of the major plexus. The patients were randomly allocated to two groups. The L + F group (n = 27) were administered 38 mL of 1.5% L with 1/200,000 epinephrine and 100 micrograms of F, and the L + S group (n = 26) were administered 38 mL of 1.5% L with 1:200,000 epinephrine and 2 mL of normal saline. The onset (monitored every 5 minutes) and duration (monitored every 30 minutes) of surgical anesthesia, defined as the total abolition of the pinprick response, were evaluated in each nerve territory. RESULTS: The patients were similar with regard to demographic data and the nerve trunks stimulated. In the L + F group, the onset time was only reduced (P = .012) for the musculocutaneous nerve. The duration of surgical anesthesia and the motor block were similar in both groups. The frequency of complete plexus block and the frequency of anesthesia for each nerve trunk were similar in both groups. CONCLUSION: There is no clinical benefit resulting from the addition of fentanyl to the local anesthetic for axillary brachial plexus block.

Adult↗
PubMedDate not supplied

Prednisone and piroxicam for treatment of primary Sjögren's syndrome.

Primary Sjögren's syndrome is a systemic autoimmune exocrinopathy characterized by a lymphoplasmacytic infiltrate and destruction of salivary and lacrimal glandular tissues. There is no widely accepted or effective systemic therapy for this disorder. The purpose of this 6-month randomized, double-blinded, placebo-controlled study was to examine the effects of prednisone (30 mg, alternate days), piroxicam (20 mg, daily), or placebo on the salivary, lacrimal and immunologic alterations of primary Sjögren's syndrome. Eight patients were enrolled in each group. Salivary and lacrimal function were assessed at entry and at the completion of treatment. Labial minor salivary gland tissue was obtained at these times and examined for intensity of infiltration (focus scores) and for the relative proportion of glandular elements. Serologic and subjective evaluations were done as well, and patients were monitored for therapy-related side effects. Neither active treatment led to significant improvement in salivary or lacrimal function, although prednisone improved salivary flow in selected patients and was associated with positive subjective responses. Prednisone also significantly decreased the serum total protein, IgG, IgA, and sedimentation rate and increased the white cell count. There were no significant alterations in either focus scores or the percentage of glandular component tissues of minor glands with either active treatment. This study demonstrated that 6 months of prednisone or piroxicam at the doses utilized failed to improve the histological or functional parameters of salivary and lacrimal glands in primary Sjögren's syndrome.

Adult↗