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An observational study examining the effects of a surgically induced inflammatory response on the distribution of morphine and its metabolites into cerebrospinal fluid

AbstractPurpose Morphine is administered intravenously for pain management in the perioperative period. The effect of the inflammatory response to surgery on morphine distribution across the blood-brain barrier (BBB) in humans was investigated. We hypothesized that a graded surgically induced, systemic inflammatory response alters cerebrospinal fluid (CSF) levels of morphine, morphine-3-glucuronide (M3G), and morphine-6-glucuronide (M6G) through a temporary reduction in BBB drug efflux transporter function.MethodsWe conducted a prospective pharmacokinetic study of the plasma and CSF distribution of the P-glycoprotein (PGP) substrate morphine in 33 patients undergoing open thoracic (n = 18) or endovascular (n = 15) aortic aneurysm repair. Morphine was administered with induction of anesthesia and in the intensive care unit. Plasma and CSF concentrations of interleukin (IL)-6, morphine, M3G, M6G, and albumin were measured prior to surgery (baseline), during surgery, and postoperatively every six hours until removal of the CSF drain. The area under the curve (AUC) was determined for plasma and CSF IL-6, morphine, M3G, and M6G concentrationsvs time. The primary endpoint measures were the correlations between the morphine, M6G, and M3G AUC CSF/plasma ratios and systemic inflammation as quantified by the time-normalized IL-6 exposure, which was calculated for each individual by dividing the total exposure (AUC) by time (t). A Bonferroni correctedP 
Source: Canadian Journal of Anesthesia - Category: Anesthesiology Source Type: research

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Discussion This resident's case problem provides an opportunity to discuss the differential diagnosis, clinical reasoning, and outcome of a patient who presented with both systemic and neuromusculoskeletal pathology. Level of Evidence Differential diagnosis, level 5. J Orthop Sports Phys Ther, Epub 6 Feb 2018. doi:10.2519/jospt.2018.7652. PMID: 29406836 [PubMed - as supplied by publisher]
Source: Physical Therapy - Category: Physiotherapy Authors: Tags: J Orthop Sports Phys Ther Source Type: research
Publication date: Available online 1 February 2018 Source:Journal of Cardiology Cases Author(s): Manabu Yamasaki, Jun Hashimoto, Kunihiko Yoshino, Kohei Abe, Hiroyasu Misumi There are no previous reports of intraabdominal sarcoma with metastasis to the thoraco-abdominal aorta causing rupture. Here we present the case of a previously healthy 50-year old male who presented to our institution with sudden, sharp back pain. Chest and abdominal computed tomography revealed aortic rupture at the twelfth thoracic level as well as a giant mass in the left upper abdomen. We performed thoracic endovascular aortic aneurysm repair. Hi...
Source: Journal of Cardiology Cases - Category: Cardiology Source Type: research
Regional procedures for postthoracotomy pain control have classically focused on paravertebral blocks and thoracic epidurals; however, these techniques may be challenging in an increasingly obese population and contraindicated with numerous anticoagulant and antiplatelet agents. While less studied, truncal blocks allow analgesic intervention for this growing patient cohort. This case report describes placement of a deep serratus anterior plane catheter in an intubated, morbidly obese patient with a lumbar drain who failed extubation secondary to acute postthoracotomy pain. The serratus plane catheter facilitated extubation...
Source: A&A Case Reports - Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research
Medtronic (NYSE:MDT) said today it launched an FDA investigational device exemption study of its Abre venous self-expanding stent system, looking to explore the use of the device in subjects with iliofemoral venous outflow obstruction. The first procedure in the study was performed last month by national principal investigator Dr. Erin Murphy of Charlotte, N.C.’s Sanger Heart &Vascular Institute, the Fridley, Minn.-based company said. “The launch of the Abre IDE Study marks the beginning of an important journey to establish new options for the treatment of deep venous disease. The first procedure ...
Source: Mass Device - Category: Medical Devices Authors: Tags: Clinical Trials Stents Vascular Medtronic Source Type: news
A 66-year-old man presented with lumbar pain and low-grade fever that had persisted for 2 months. 5 years before this admission, he had been treated for an abdominal aortic aneurysm with an aortic stent graft. Clinical examination and inflammatory biomarkers were normal. A CT scan revealed bilateral paravertebral and psoas muscle abscesses (figure), spondylitis with destruction of the second and third lumbar vertebral bodies (figure), and a distal migration of the stent, which was embedded in the third lumbar vertebral body (appendix).
Source: The Lancet Infectious Diseases - Category: Infectious Diseases Authors: Tags: Clinical Picture Source Type: research
Acute aortic dissection may be present in only about one in ten thousand patients presenting to the emergency department. But missing an aortic dissection can be catastrophic. At the same time submitting all patients with suspected dissection to imaging studies may not be feasible in view of the cost and potential risks. Hence a good clinical bedside risk score may be useful, in addition to diligent clinical evaluation. Aortic Dissection Detection Risk Score (ADD Risk Score) was formulated by IRAD investigators using the International Registry of Acute aortic Dissection. Three groups of high risk features have b...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: General Cardiology Source Type: blogs
The objective of our study was to assess the diagnostic accuracy of clinical and laboratory findings for AAD, in confirmed cases of AAD and in a low‐risk control group. MethodsThis was a historical matched case–control study: participants were adults > 18 years old presenting to two tertiary care emergency departments (EDs) or one regional cardiac referral center. Cases were patients with new ED or in‐hospital diagnosis of nontraumatic AAD confirmed by computed tomography or echocardiography. Controls were patients with a triage diagnosis of truncal pain (
Source: Academic Emergency Medicine - Category: Emergency Medicine Authors: Tags: Original Contribution Source Type: research
We report the case of a patient with a ruptured, confined abdominal aortic aneurysm. PMID: 29311402 [PubMed - in process]
Source: Annals of Hepatology - Category: Gastroenterology Tags: Ann Hepatol Source Type: research
AbstractAbdominal aortic aneurysm (AAA) is most commonly defined as a maximal diameter of the abdominal aorta in excess of 3 cm in either anterior-posterior or transverse planes or, alternatively, as a focal dilation ≥ 1.5 times the diameter of the normal adjacent arterial segment. Risk factors for the development of AAA include age>  60, tobacco use, male gender, Caucasian race, and family history of AAA. Aneurysm growth and rupture risk appear to be associated with persistent tobacco use, female gender, and chronic pulmonary disease. The majority of AAAs are asymptomatic and detected incidentally on vario...
Source: Abdominal Imaging - Category: Radiology Source Type: research
An 85 year old man was admitted to hospital complaining of dull left flank pain. Three years previously, he had been subjected to endovascular repair of an abdominal aortic aneurysm. Non-contrast computed tomography showed an oedematous left psoas muscle and indicated dislocation of a tubular endograft. Subsequently, intravascular contrast revealed contained rupture of the aneurysm sac with haemorrhage into the left psoas muscle (panel A) and protrusion of the endograft from within the former (panel B).
Source: European Journal of Vascular and Endovascular Surgery - Category: Surgery Authors: Tags: Coup D'Oeil Source Type: research
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