Hypothalamic injection of morphine: Feeding and temperature responses

Morphine (2.7, 5.6 and 10.3 nmoles) and norepinephrine (10, 20 and 40 nmoles) were applied to the ventromedial hypothalamus of male rats through cannulae which were implanted stereotaxically. Food intake was enhanced by both drugs as compared with saline. Although intake peaked during the first hour following norepinephrine, it was more gradual following morphine. Both drugs also caused a rise in core temperature, but only with morphine did this persist throughout the 3-hour measurement period. Naloxone (10.6 nmoles) injected into the ventromedial hypothalamus 5 minutes before morphine (5.6 nmoles) caused a short-lived decrease in feeding and temperature when compared with a saline control. The same dose of naloxone given into this site 1 hour after morphine had no apparent effect on either parameter. Naloxone (2 and 10 mg/kg) given subcutaneously suppressed feeding and temperature changes produced by intrahypothalamic morphine. These results indicate that morphine can increase feeding and temperature at a site which is also responsive to norepinephrine, and that naloxone, given intracranially or subcutaneously, can suppress the effects induced by morphine to different degrees.     

CSF distribution of morphine, methadone and sucrose after intrathecal injection

The lumbar to cisternal CSF distribution of morphine and methadone were compared to C-14 sucrose, a standard marker of CSF bulk flow, after lumbar subarachnoid injections in a sheep preparation. Morphine appeared and peaked simultaneously with C-14 sucrose in cisternal CSF at 90 to 190 minutes. The mean peak cisternal CSF morphine concentrations were sustained for 30-40 minutes, and averaged 148 ng/ml, representing 0.3% of the administered dose. Methadone was not detectable in cisternal CSF up to 240-300 minutes after lumbar subarachnoid administration. The C-14 sucrose/morphine ratio was increased an average of 6.7 times in cisternal CSF as compared to the ratio of the two compounds injected into the lumbar subarachnoid space. These studies demonstrate that morphine, a hydrophilic opioid, given intrathecally moves rostrally and appears in cisternal CSF by bulk flow. Furthermore the rostral redistribution of morphine is associated with the clearance of morphine from CSF. Methadone, a lipophilic opioid, appears to be completely cleared from CSF before it reaches the cisterna magna. These pharmacokinetic studies support a contribution of supraspinal sites to the analgesic and adverse effects produced by morphine given by spinal routes of administration. In contrast methadone appears to exert its effects predominantly at spinal sites.     

The use of free groin flaps in children

The free groin flap is a well-established method of skin coverage. Although its use in children has been reported, there have been no published series specifically in such cases. The authors report 33 consecutive cases of free groin flaps in children in their unit over a period of 9 years (1992 to 2001). Tissue transfer was performed to provide soft-tissue coverage during reconstruction of congenital defects and tumor resection and following trauma. Twenty-six cases (79 percent) involved the upper limb, six cases (18 percent) involved the lower limb, and one case involved the head. The complication rate compares favorably with similar series published for adults, with only two complete failures (6 percent), three (9 percent) minor donor-site complications (superficial wound infection, hypertrophic scarring, and dog-ears), and nine flaps requiring debulking. The reexploration rate was 24 percent, with seven of the eight flaps undergoing reexploration surviving. The groin flap is a reliable flap that can be used safely in children, with minimal morbidity.     

Subcutaneous injection of an analog of neuropeptide FF precipitates morphine abstinence syndrome

Neuropeptide FF (NPFF) has been shown to exert various antiopiate actions, including precipitation of opiate abstinence syndrome by third ventricle injection in morphine dependent rats. In the present study, dansyl-Pro-Gln-Arg-Phe-amide, a lipophilic analog of NPFF, was injected into morphine dependent rats and appropriate sham controls at a dose of 9 mg/kg s.c. Comparison groups were injected with ethanol/water vehicle alone. The NPFF analog precipitated a vigorous opiate abstinence syndrome in morphine dependent rats, but not in sham controls.     

The use of fine-needle aspiration biopsy in children.

Fine-needle aspiration biopsy has become increasingly popular for evaluating both palpable and nonpalpable masses. Judging from the current body of literature, this procedure is underused by American pediatricians. We report a series of 84 pediatric patients--younger than 16 years--who underwent 92 fine-needle aspiration biopsies to evaluate a large variety of masses. The results of 51 (55%) were benign, and 33 (36%) biopsies revealed malignancy. In two cases (2%) the findings were suggestive of malignancy, and in six cases (7%), insufficient material was rendered for diagnosis. Either histologic or clinical follow-up or both were available for 85 procedures. Based on these cases, the sensitivity of 97% and the specificity was 95%, indicating that fine-needle aspiration biopsy is a good method for screening and observing patients for various malignant tumors in a variety of organs.     

The use of CP/MAS 13C-NMR for evaluating starch degradation in injection molded starch-plastic composites

Summary Cross-polarization/magic angle spinning (CP/MAS) ¹³C solid-state-NMR was utilized to evaluate the extent of hydrolysis and structure of starch in enzymatically digested injection molded starch-polyethylene-co-acrylic acid (EAA)-polyethylene (PE) plastic composites. It is a simple, quick and semi-quantitative method. Results are in agreement with reducing sugar assays routinely used for measuring starch degradation.     

Proteomic analysis of spinal protein expression in rats exposed to repeated intrathecal morphine injection

Repeated administration of morphine for treating severe chronic pain may lead to neuroadaptive changes in the spinal cord that are thought to underlie molecular mechanisms of the development of morphine tolerance and physical dependence. Here, we employed a 2-D gel-based proteomic technique to detect the global changes of the spinal cord protein expression in rats that had developed morphine tolerance. Morphine tolerance at the spinal cord level was induced by repeated intrathecal injections of morphine (20 microg/10 microL) twice daily for 5 days and evaluated by measurements of paw withdrawal latencies and maximal possible analgesic effect at day 5. After behavioral tests, the lumbar enlargement segments of spinal cord were harvested and proteins resolved by 2-DE. We found that eight proteins were significantly up-regulated or down-regulated in spinal cord after morphine tolerance development, including proteins involved in targeting and trafficking of the glutamate receptors and opioid receptors, proteins involved in oxidative stress, and cytoskeletal proteins, some of which were confirmed by Western blot analysis. Morphine-induced expressional changes of these proteins in the spinal cord might be involved in the central mechanisms that underlie the development of morphine tolerance. It is very likely that these identified proteins may serve as potential molecular targets for prevention of the development of morphine tolerance and physical dependence.     

Intracerebral distribution pattern of radioactive morphine and morphine-like drugs after intraventricular and intrathecal injection

Summary The intracerebral distribution patterns of ¹⁴C-morphine, ³H-dihydromorphine, and ³H-fentanyl after intraventricular injection were studied autoradiographically in rats and rabbits. The extent of permeation into the ventricular wall was measured at different times after injection. The hydrophilic morphine and dihydromorphine could be demonstrated within the tissue up to 4 hours. They seemed to be retained within the gray matter and hindered in crossing fiber bundles. On the other hand, the lipophilic fentanyl was quickly removed from the brain but remained relatively longer demonstrable within the white matter. Also, after intrathecal injection of ¹⁴C-morphine a time dependent spread from the injection site was observed. The use of autoradiography in pharmacological experiments as described was found advantageous. Thus, it is possible to correlate directly, the time course of the pharmacological effect and the respective distribution pattern of the drug applied. This may lead to better information about the probable sites of drug action.     

The Cedar Project: risk factors for transition to injection drug use among young, urban Aboriginal people

Background:

Studies suggest that Aboriginal people in Canada are over-represented among people using injection drugs. The factors associated with transitioning to the use of injection drugs among young Aboriginal people in Canada are not well understood.

Methods:

The Cedar Project is a prospective cohort study (2003–2007) involving young Aboriginal people in Vancouver and Prince George, British Columbia, who use illicit drugs. Participants’ venous blood samples were tested for antibodies to HIV and the hepatitis C virus, and drug use was confirmed using saliva screens. The primary outcomes were use of injection drugs at baseline and tranisition to injection drug use in the six months before each follow-up interview.

Results:

Of 605 participants, 335 (55.4%) reported using injection drugs at baseline. Young people who used injection drugs tended to be older than those who did not, female and in a relationship. Participants who injected drugs were also more likely than those who did not to have been denied shelter because of their drug use, to have been incarcerated, to have a mental illness and to have been involved in sex work. Transition to injection drug use occurred among 39 (14.4%) participants, yielding a crude incidence rate of 19.8% and an incidence density of 11.5 participants per 100 person-years. In unadjusted analysis, transition to injection drug use was associated with being female (odds ratio [OR] 1.98, 95% confidence interval (CI) 1.06–3.72), involved in sex work (OR 3.35, 95% CI 1.75–6.40), having a history of sexually transmitted infection (OR 2.01, 95% CI 1.07–3.78) and using drugs with sex-work clients (OR 2.51, 95% CI 1.19–5.32). In adjusted analysis, transition to injection drug use remained associated with involvement in sex work (adjusted OR 3.94, 95% CI 1.45–10.71).

Interpretation:

The initiation rate for injection drug use of 11.5 participants per 100 person-years among participants in the Cedar Project is distressing. Young Aboriginal women in our study were twice as likely to inject drugs as men, and participants who injected drugs at baseline were more than twice as likely as those who did not to be involved in sex work.Aboriginal leadership in Canada is deeply concerned about substance use, more specifically injection drug use and its association with the spread of HIV and the hepatitis C virus among Aboriginal young people.^1,2 Recent studies in Canada suggest that Aboriginal people are over-represented among people who use injection drugs.^3,4 For Aboriginal young people in Canada under the age of 24 years, injection drug use accounts for the majority of infections with the hepatitis C virus (70%–80%)^5,6 and over half (59%) of HIV infections.⁷Indigenous scholars have stated that research on substance use within Aboriginal communities must consider the context of colonization, including the intergenerational impacts of the residential school and child welfare systems.^8–11 It is now well documented that Aboriginal children experienced extensive psychological, sexual, physical and emotional abuses within those systems.^12,13 As former students of residential schools raise children and grandchildren, the intergenerational effects of abuse and familial fragmentation are evident in communities where interpersonal violence and drug dependence are pervasive.^14–16A priority for preventing infections with HIV and hepatitis C among young Aboriginal people is the development of programs and rights-based,^18,19 youth-informed¹⁷ policies aimed at preventing the use of injection drugs. However, research to date has not provided sufficient evidence to inform such development.^2,19 Concerns over this paucity of information led to the launch of a two-city cohort study in 2003 to address HIV-related vulnerabilities among young Aboriginal people in British Columbia — a unique study centred on at-risk youth and supported by and partnered with Aboriginal investigators and collaborators.We report here baseline and longitudinal data on the factors associated with injection drug use and the transition to injection drug use to inform the development of prevention programs and policies.     

The use of differential measurements with a glucose biosensor for interference compensation during glucose determinations by flow injection analysis

A novel detection system for the determination of glucose in the presence of clinically important interferents, based on the use of dual sensors and flow-injection analysis (FIA), is described. The normalisation methodology involves measurement of the interference signal at a reference sensor; this signal can then be subtracted from the glucose sensor signal (post-run) to give a corrected measurement of the glucose concentration. The detection system consists of a thin layer cell with dual glassy carbon working electrodes. One electrode was surface modified to act asglucose biosensor by immobilisation of glucose oxidase (GOx) (from Aspergillus niger) with 1% glutaraldehyde and bovine serum albumin. The second electrode (glucose oxidase omitted) was utilised to measure the interference signal responding only to electroactive species present in the injected sample. A computer controlled multichannel potentiostat was used for potential application and current monitoring duties. The sensor responses were saved in ASCII format to facilitate post-run analysis in Microsoft Excel. Cyclic voltammetry (CV) was utilised to investigate the manner in which the interference signal contributed to the total signal obtained at the biosensor in the presence of glucose. The kinetic parameters I_max and the apparent Michaelis-Menten constant, K′_m, were calculated for the sensor operating under flow-injection conditions.     

Improved pain relief after thoracotomy: use of cryoprobe and morphine infusion.

In a randomised controlled trial carried out during the first to days after thoracotomy patients who had had intercostal nerves frozen with a cryoprobe or were given morphine by continuous intravenous infusion had significant less pain at rest than patients given intramuscular morphine. Differences between the groups with respect to pain on movement and during physiotherapy were not significant. Pain was estimated using visual analogue scales, and an arc sine transformation was carried out on values obtained from these scales before comparison using an analysis of variance. The trial did not distinguish between the cryoprobe and infusion treatment. The simplicity of the cryoprobe had much to commend it, but in units without access to this equipment a small infusion pump offers a satisfactory alternative.     

Characteristics of antibiotic use in children

In antibiotic therapy of children bacteriological findings should be considered. The choice of antibiotic doses depends on the drug pharmacokinetics and damaging effect, the state of the excretory organs and some other factors. Antibiotic elimination in children during the postnatal period is limited: there is a relationship between the gestation term and intensity of drug elimination. Antibiotics penetrate through the placental barrier. They are detected in the mother milk. The damaging effect of antibiotics in many respects depends on their properties, dosage and administration route. Children are more sensitive to the direct toxic action of antibiotics as compared to adults. Development of dysbacteriosis in children is frequent. Allergic reactions with diverse clinical signs are possible in children. Combined antibiotic therapy with observation of definite requirements is more efficient. Still, because of the antibiotic damaging effect monotherapy is more preferable in all possible cases.