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AIMS: To investigate the effects of morphine on mechanical allodynia following compression of the trigeminal ganglion in the rat. METHODS: Experiments were carried out on male Sprague-Dawley rats weighing between 250 and 260 g. For compression, a 4% agar solution (8 microL) was injected into the trigeminal ganglion. In the control group, rats were sham operated without agar injections. The authors evaluated the effects of intraperitoneal or intracisternal administration of morphine on mechanical allodynia evoked by air-puff stimulation of the vibrissa pad area 14 days following compression of the trigeminal ganglion. RESULTS: Mechanical allodynia was established within 3 days and lasted beyond postoperative day 24. Intraperitoneal administration of morphine (2 or 5 mg/kg) significantly blocked mechanical allodynia ipsilateral to the compression of the trigeminal ganglion. Intraperitoneal administration of morphine also inhibited mechanical allodynia on the contralateral side. Moreover, intracisternal administration of morphine (5 microg) strongly suppressed both ipsilateral and contralateral mechanical allodynia. The antiallodynic effects of morphine were blocked by pretreatment with naloxone, an opioid receptor antagonist. CONCLUSION: These results suggest that the application of a high dose of morphine may be of great benefit in treating trigeminal neuralgia-like nociception. [ABSTRACT FROM AUTHOR]

PURPOSES: The aim of this study was to evaluate the usefulness of the whole-blood interferon-gamma assay (enzyme-linked immunosorbent assay [ELISA]) and interferon-gamma enzyme-linked immunospot assay (ELISPOT) based on early secretory antigenic target 6 and culture filtrate protein 10 in the diagnosis of active pulmonary tuberculosis (TB) in routine clinical practice. METHOD: We conducted a prospective study enrolling 144 participants with suspected pulmonary TB in a tertiary referral hospital in Seoul, South Korea, to investigate the diagnostic sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of these tests. Clinical assessment, tuberculin skin test (TST), whole-blood interferon-gamma ELISA (QuantiFERON-TB Gold [QFT-G]; Cellestis Ltd; Victoria, Australia), and an ELISPOT assay (T SPOT.TB; Oxford Immunotec; Oxford, UK) were performed. Test results were compared with the final confirmed diagnoses. RESULTS: Active pulmonary TB was diagnosed in 67 of 144 participants (47%). Sensitivities of QFT-G and T SPOT.TB for active pulmonary TB were 89% (95% confidence interval [CI], 79 to 96%) and 92% (95% CI, 83 to 97%), respectively; and specificities were 49% (95% CI, 37 to 61%) and 47% (95% CI, 36 to 59%). NPVs of QFT-G (84%; 95% CI, 69 to 93%) and T SPOT.TB (87%; 95% CI, 73 to 96%) were higher than that of TST (64%; 95% CI, 51 to 76%) [p = 0.001 and p < 0.001, respectively]. CONCLUSION: High NPVs of QFT-G and T SPOT.TB for the diagnosis of active TB suggest the supplementary role of these tests for the diagnostic exclusion of active TB, although the low PPV limits their usefulness in routine clinical practice in South Korea, where the prevalence of latent TB infection is considerable. [ABSTRACT FROM AUTHOR]

Context: A recently developed whole-blood interferon gamma (IFN-gamma) assay based on stimulation with the Mycobacterium tuberculosis-specific antigens early secreted antigenic target 6 and culture filtrate protein 10 shows promise for the diagnosis of latent tuberculosis (TB) infection.Objective: To compare the tuberculin skin test (TST) and the whole-blood IFN-gamma assay in the diagnosis of latent TB infection according to the intensity of exposure.Design and Setting: A prospective comparison between the whole-blood IFN-gamma assay and the TST using a 2-TU dose of purified protein derivative RT23 in a population with intermediate TB burden was conducted sequentially between February 1, 2004, and February 28, 2005, in a Korean tertiary referral hospital.Participants: Of 273 participants, 220 (95.7%) had received BCG vaccine. Participants were grouped according to their risk of infection: group 1, no identifiable risk of M tuberculosis infection (n = 99); group 2, recent casual contacts (n = 72); group 3, recent close contacts (n = 48); group 4, bacteriologically or pathologically confirmed TB patients (n = 54).Main Outcome Measures: Levels of agreement between the TST and the IFN-gamma assay and the likelihood of infection in the various groups.Results: For the TST with a 10-mm induration cutoff, the positive response rate in group 1 was 51%; group 2, 60%; group 3, 71%, and group 4, 78%. For the IFN-gamma assay, the positive response rate in group 1 was 4%; group 2, 10%; group 3, 44%; and group 4, 81%. The overall agreement between the TST and the IFN-gamma assay in healthy volunteers was kappa = 0.16. The odds of a positive test result per unit increase in exposure across the 4 groups increased by a factor of 5.31 (95% confidence interval [CI], 3.62-7.79) for the IFN-gamma assay and by a factor of 1.52 (95% CI, 1.20-1.91) for the TST (P<.001). Using a 15-mm induration cutoff for the TST did not make a substantial difference to the test results.Conclusion: The IFN-gamma assay is a better indicator of the risk of M tuberculosis infection than TST in a BCG-vaccinated population. [ABSTRACT FROM AUTHOR]

Study Objectives: To assess the clinical characteristics of fever after fiberoptic bronchoscopy (FOB) and to identify the independent risk factors of postbronchoscopy fever.Study Design: Prospective study.Setting: Tertiary care university hospital.Study Subjects: Immunocompetent adults undergoing FOB between July 2001 and April 2002.Measurements and Results: Five hundred eighteen adults were included in this study. The incidence of postbronchoscopy fever was 5%, and the mean onset time of the fever was 8.7 +/- 1.1 h after FOB (mean +/- SEM). In most cases, the fever subsided spontaneously within a day, with a mean fever duration of 14.0 +/- 3.1 h. No organisms were isolated from blood culture specimens drawn at the time of fever, although significant increases in total leukocytes and neutrophil counts were observed in the peripheral blood at the time of fever compared to levels prior to FOB. Univariate analysis showed that fever was related to multiple factors, such as the radiologic extent of involvement, consolidation, abnormal bronchoscopic findings, biopsy, lavage, the amount of saline solution or drug administered, the duration of the procedure, the severity of bleeding, and a final diagnosis of pulmonary tuberculosis. However, after multivariate analysis, the final diagnosis of pulmonary tuberculosis and the severity of bleeding were identified as independent risk factors.Conclusions: Fever after FOB occurs relatively frequently but transiently in immunocompetent adults. Independent risk factors for the development of this complication seem to be related to the diagnosis of pulmonary tuberculosis and the severity of bleeding during FOB. [ABSTRACT FROM AUTHOR]