Articles: function.
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Acta Anaesthesiol Scand · Jul 2014
Case ReportsRecombinant human growth hormone improves cognitive capacity in a pain patient exposed to chronic opioids.
During recent decades, the increasing use of opioids for chronic non-cancer pain has raised concerns regarding tolerance, addiction, and importantly cognitive dysfunction. Current research suggests that the somatotrophic axis could play an important role in cognitive function. Administration of growth hormone (GH) to GH-deficient humans and experimental animals has been shown to result in significant improvements in cognitive capacity. ⋯ In the right hippocampus, the N-acetylaspartate/creatine ratio (reflecting nerve cell function) was initially low but increased significantly during rhGH treatment, as did subjective cognitive, physical and emotional functioning. This case report indicates that rhGH replacement therapy could improve cognitive behaviour and well-being, as well as hippocampal metabolism and functioning in opioid-treated patients with chronic pain. The idea that GH could affect brain function and repair disabilities induced by long-term exposure to opioid analgesia is supported.
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Reg Anesth Pain Med · Jul 2014
Ultrasound-Guided Injection of the Intrapelvic Portion of the Obturator Internus in a Cadaver Model.
Musculoskeletal dysfunction of the pelvic floor is common. One of the intrapelvic muscles, the obturator internus (OI), can be substantially stressed during its sharply angulated exit from the pelvis. However, there may be considerable overlap between symptoms and signs arising from the OI and other potential pain generators including the levator ani in the pelvic region. Accurate diagnosis for the OI might permit more efficient treatment combined with OI-specific exercise and behavior modification. Therefore, we hypothesized that ultrasound (US)-guided needle insertion in the intrapelvic portion of the OI would be accurate when a pararectal approach is used for diagnostic and therapeutic purposes. ⋯ The newly developed US-guided pararectal approach allowed accurate insertion of a needle into the intrapelvic portion of the OI. This US-guided method facilitated a more precise approach to the intrapelvic portion of the OI and may help differentiate conditions or symptoms caused by other structures.
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Variability in labor pain has been associated with demographic, clinical, and psychological factors. Polymorphisms of the β2-adrenergic receptor gene (ADRB2) influence sensitivity to experimental pain in humans and are a risk factor for chronic pain. The authors hypothesized that polymorphisms in ADRB2 may influence labor pain. ⋯ ADRB2 genotype correlates with labor pain but explained less than 1% of the intersubject variance in the model.
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Short telomeres are frequently identified in patients with idiopathic pulmonary fibrosis (IPF) and its inherited form, familial interstitial pneumonia (FIP). We identified a kindred with FIP with short telomeres who did not carry a mutation in known FIP genes TERT or hTR. We performed targeted sequencing of other telomere-related genes to identify the genetic basis of FIP in this kindred. ⋯ Polymerase chain reaction-based sequencing of NOP10 , TINF2 , NHP2 , and DKC1 revealed that both affected siblings shared a novel A to G 1213 transition in DKC1 near the hTR binding domain that is predicted to encode a Thr405Ala amino acid substitution. hTR levels were decreased out of proportion to DKC1 expression in the T405A DKC1 proband, suggesting this mutation destabilizes hTR and impairs telomerase function. This DKC1 variant represents the third telomere-related gene identified as a genetic cause of FIP. Further investigation into the mechanism by which dyskerin contributes to the development of lung fibrosis is warranted.
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Am. J. Respir. Crit. Care Med. · Jul 2014
STudy of Active Duty Military for Pulmonary Disease Related to Environmental Deployment Exposures (STAMPEDE).
Because of increased levels of airborne particulate matter in Southwest Asia, deployed military personnel are at risk for developing acute and chronic lung diseases. Increased respiratory symptoms are reported, but limited data exist on reported lung diseases. ⋯ Evaluation of new respiratory symptoms in military personnel after service in Southwest Asia should focus on airway hyperreactivity from exposures to higher levels of ambient particulate matter. These patients may be difficult to diagnose and require close follow-up.