Recovery from prolonged anesthesia might be compromised in elderly patients. Desflurane (DES) may be particularly well suited to achieve a rapid postoperative recovery because of its low lipid ...solubility. Postoperative recovery was compared in 45 elderly patients randomized to receive either DES, isoflurane (ISO), or propofol (PRO) to maintain anesthesia. Anesthesia was induced with PRO, vecuronium, and fentanyl and maintained with N2O, fentanyl, and the study drug. Times from end of anesthesia to tracheal extubation, eye opening and hand squeezing on command, and ability to state name and date of birth were recorded. Sedation and psychometric evaluation were tested 0.5, 1, 1.5, 2, and 24 h postoperatively. Results are given as means +/- SD. Differences among were analyzed by chi2 or analysis of variance. P < 0.05 compared with DES was considered significant. After a prolonged anesthesia (199 +/- 57 min with DES), immediate recovery times were significantly shorter with DES than with ISO or PRO (times to eye opening: 5.6 +/- 3.4 min, 11.5 +/- 8.4 min, and 11.9 +/- 7.6 min; times to extubation: 6.9 +/- 3 min, 13.1 +/- 8.9 min, 9.9 +/- 6.5 min for DES, ISO, and PRO, respectively). Intermediate recovery, as measured by psychometric testing, sedation levels, and time to discharge from the postanesthesia care unit, was similar in the three groups. In this study, DES provided a transient advantage compared with ISO or PRO with respect to early recovery after prolonged general anesthesia in elderly patients.
Recovery from prolonged anesthesia can sometimes be problematic in elderly patients. We evaluated 45 elderly patients who received either desflurane, isoflurane, or propofol for anesthesia. We found that desflurane provided a transient advantage in terms of postoperative recovery, but whether this difference is clinically important remains to be demonstrated.
Human telomeres are protected from DNA damage by a nucleoprotein complex that includes the repeat-binding factor TRF2. Here, we report that TRF2 regulates the 5' exonuclease activity of its binding ...partner, Apollo, a member of the metallo-b-lactamase family that is required for telomere integrity during S phase. TRF2 and Apollo also suppress damage to engineered interstitial telomere repeat tracts that were inserted far away from chromosome ends. Genetic data indicate that DNA topoisomerase 2a acts in the same pathway of telomere protection as TRF2 and Apollo. Moreover, TRF2, which binds preferentially to positively supercoiled DNA substrates, together with Apollo, negatively regulates the amount of TOP1, TOP2a, and TOP2b at telomeres. Our data are consistent with a model in which TRF2 and Apollo relieve topological stress during telomere replication. Our work also suggests that cellular senescence may be caused by topological problems that occur during the replication of the inner portion of telomeres.
Human telomeres are protected from DNA damage by a nucleoprotein complex that includes the repeat-binding factor TRF2. Here, we report that TRF2 regulates the 5' exonuclease activity of its binding ...partner, Apollo, a member of the metallo-beta-lactamase family that is required for telomere integrity during S phase. TRF2 and Apollo also suppress damage to engineered interstitial telomere repeat tracts that were inserted far away from chromosome ends. Genetic data indicate that DNA topoisomerase 2alpha acts in the same pathway of telomere protection as TRF2 and Apollo. Moreover, TRF2, which binds preferentially to positively supercoiled DNA substrates, together with Apollo, negatively regulates the amount of TOP1, TOP2alpha, and TOP2beta at telomeres. Our data are consistent with a model in which TRF2 and Apollo relieve topological stress during telomere replication. Our work also suggests that cellular senescence may be caused by topological problems that occur during the replication of the inner portion of telomeres.
The mechanism of action of recombinant interferon-alpha (rIFN alpha) treatment in chronic hepatitis C is not fully understood, and may include modulation of the immune system as well as a direct ...antiviral effect. We have therefore evaluated the plasma concentrations of pro- and anti-inflammatory cytokines in patients with chronic hepatitis C before and during treatment with rIFN alpha.
Twenty-three patients were studied. Plasma concentrations of IL-1 beta, IL-6, TNF, IL-1 receptor antagonist (IL-1RA) and soluble TNF receptors (sTNFRs) type I and type II were determined twice before rIFN alpha treatment (on day -11 and day 1), and on days 11, 32 and 120 of treatment.
IL-1 beta, IL-6 and TNF plasma concentrations were rarely increased before treatment (in one, six and seven patients, respectively), and usually declined during treatment. sTNFRs I and II plasma concentrations were not increased either before or during treatment. This was not the case for IL-1RA. In untreated patients, the plasma concentration of IL-1RA was higher than normal in 16 out of 23 patients. When rIFN alpha treatment was initiated, there was a constant and dramatic increase in IL-1RA levels, which reached 8 times the upper limit of the normal range (p < 0.001 as compared to pretreatment values). This increase was sustained up to day 120.
These results indicate that induction of an anti-inflammatory status through modulation of the IL-1/IL-1RA balance may be a key mechanism of action of rIFN alpha treatment in chronic hepatitis C.
Duodeno-pancreatic biochemically polyfunctional endocrine tumour is a well known entity. Usually, only one hormone is responsible for the clinical features. We report a case of aggressive combined ...glucagonoma and gastrinoma tumour without metastases, causing respectively diabetic ketoacidosis and fulminant peptic ulcer, and death. Occasional patients can present with clinical features of both glucagonoma and gastrinoma. Diabetic patients exhibiting migratory skin lesions should be suspected of glucagonoma. In addition, a multidisciplinary approach to such patients including dermatologists, surgeons, radiologists and endoscopists is mandatory.
PDF
