Hymenoptera stings and serum tryptase.
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Anaphylaxis↗
Biomedical subjects
I Annila
Publications and source records attributed to I Annila.
ECG T-wave amplitude changes during thiopentone induction with or without alfentanil.
The T-wave amplitude of ECG is thought to reflect the sympathetic tone of the heart but anaesthesia studies on this topic are rare. Haemodynamic and ECG T-wave amplitude changes were studied during induction of anaesthesia in 24 ASA I-II patients. Twelve patients were given alfentanil 30 micrograms kg-1 at induction while physiologic saline was given to the rest (control). Thiopentone was then administered at the rate of 5 mg s-1 until eyelash reflex disappeared. Vecuronium 0.1 mg kg-1 was given thereafter. No anticholinergics were used. The lungs were ventilated with 40% oxygen in air. Haemodynamic parameters and T-wave amplitude were measured before induction, before intubation, 30 s, 3 min and 5 min after intubation. A significantly higher amount of thiopentone was needed to abolish the eyelash reflex in the control group than in the alfentanil group (P < 0.001). There were no changes in heart rate (HR) in the alfentanil group during the trial. Systolic and diastolic arterial pressures (SAP and DAP) were continuously below the preinduction levels in the alfentanil group. After baseline HR, SAP and DAP were significantly higher in the control group than in the alfentanil group at each data point. T-wave amplitude flattened significantly (P < 0.001) after intubation in the control group while no significant changes were seen in the alfentanil group. T-wave flattening correlated to the increases in HR (P < 0.01) and SAP (P < 0.01). Three control patients with flattened T-wave had a transient bigeminia period after intubation.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Double-injection method using peripheral nerve stimulator is superior to single injection in axillary plexus block.
BACKGROUND AND OBJECTIVES: Axillary block using a single-injection method does not always provide effective analgesia. This study examined whether a double axillary block injection technique is superior to a single injection axillary block. METHOD: Fifty patients were randomly allocated to two groups. In group I (single injection), the whole volume of local anesthetic (0.7 mL/kg) was injected after locating only one of the median, radial, or ulnar nerves. In group 2 (double injection), half of the volume was injected after locating one nerve and the other half after locating another peripheral nerve. Bupivacaine 0.5% and prilocaine 1% (1:1 volumes) were used as local anesthetic. A peripheral nerve stimulator was used to identify the nerves. Sensory block of seven nerves and motor block of four nerves were tested after 40 minutes. RESULTS: Complete sensory and motor block (scores 2 or 3 on scale 0-3) in all four main nerves (median, ulnar, radial, musculocutaneous) was achieved in 3 (12%) versus 20 (80%) patients in groups 1 and 2, respectively (P = .000001). Primary success rate (no need for supplemental nerve block) was 52% in group 1 and 92% in group 2 (P = .0016). CONCLUSIONS: A double-injection method in axillary block provides excellent analgesia and motor block compared with a single-injection method. Moreover, the need for supplemental nerve blocks is significantly decreased.
Adult↗
Bee venom induces high histamine or high leukotriene C4 release in skin of sensitized beekeepers.
Histamine is the principal mediator released in the skin during immediate bee venom allergy but the significance of cysteinyl leukotrienes in these reactions is not known. We measured skin histamine and cysteinyl leukotriene release induced by bee venom in six sensitized beekeepers with the skin microdialysis technique. The skin was dialyzed for 2 h after skin prick test with bee venom, and the release of histamine and leukotriene C4 (LTC4) into the microdialysis fractions was measured. Leukotriene E4 (LTE) and methylhistamine excretion into the urine was assayed and whole blood histamine release test was performed. The release of histamine in the skin was variable: either high delayed, high immediate and delayed, weak release or no marked release. The histamine releasability in the skin correlated with that in whole blood. The three subjects with low histamine release exhibited high LTC4 release in the skin as well as high LTE4 excretion into the urine. Thus, the histamine and LTC4 releases were inversely associated with each other. These differences may explain the variation in the clinical reaction by bee stings in sensitized beekeepers.
Animals↗
Lymphocyte subpopulations, cytokine release and specific immunoglobulin G in reactive and nonreactive beekeepers.
Although bee venom sensitization and systemic sting reactions are common among beekeepers, the prediction of the severity of reactions has not yet been possible with laboratory tests. The present study was designed to evaluate parameters that might be clinically useful in estimation of systemic reactivity, and parameters that could differentiate allergic beekeepers from sensitized subjects. Thirty-two beekeepers were selected and placed into the following three groups: anergic (n = 10), asymptomatic sensitized (n = 11), and allergic (n = 11). Peripheral blood lymphocyte subpopulations, venom-specific immunoglobulin (Ig) E and IgG and cytokine release by peripheral blood mononuclear cells were measured. The ratio of stimulated interleukin-4 to stimulated interferon-gamma was significantly higher in sensitized beekeepers than in allergic or anergic subjects. Venom-specific IgG correlated significantly with the number of annual stings (r = 0.575) and the years spent in beekeeping (r = 0.471). No significant differences in the subpopulations of peripheral blood lymphocytes were found between the study groups. We conclude that differences in the subpopulations of peripheral blood lymphocytes are not associated with sensitization or systemic reactivity. In asymptomatic sensitized beekeepers, T helper 2 T-cell dominance is more pronounced than in allergic subjects. Bee venom specific IgG correlates directly with the degree of exposure to bee venom.
Adolescent↗