Effects of hypercapnia on the electroretinogram in sevoflurane and isoflurane anaesthetized dogs.

To evaluate the effects of induced hypercapnia on the electroretinogram (ERG) in beagle dogs anaesthetized with isoflurane and sevoflurane. Binocular, full-field flash photopic and scotopic ERGs were obtained from six healthy neutered female beagle dogs. In order to determine Vmax and the photopic negative response (PhNR), photopic ERG luminance-response curves were generated with 17 different light stimuli. Photopic flicker ERGs were obtained at 30-Hz temporal frequency. Scotopic ERGs were recorded after 35 min of dark adaptation. For all animals, this procedure was performed once in four different sessions: isoflurane + end-tidal [CO(2)] at 35 mmHg +/- 3 mmHg (ISON), isoflurane + end-tidal [CO(2)] at 65 mmHg +/- 3 mmHg (ISOH), sevoflurane + end-tidal [CO(2)] at 35 mmHg +/- 3 mmHg (SEVON), isoflurane + end-tidal [CO(2)] at 65 mmHg +/- 3 mmHg (SEVOH). In photopic conditions, b-wave amplitudes were significantly smaller in hypercapnic groups (ISON = 170.6 +/- 12.1 microV; ISOH = 132.6 +/- 24.9 microV; SEVON = 170.9 +/- 14.4 microV; SEVOH = 130.2 +/- 22.8 microV). Similarly, in scotopic conditions, b-wave amplitudes were significantly decreased when CO(2) was increased (ISON = 89.4 +/- 14.7 microV; ISOH = 58.2 +/- 17.6 microV; SEVON = 93.4 +/- 24.1 microV; SEVOH = 56.2 +/- 22.2 microV). Flicker peak times were significantly increased in hypercapnic groups (ISON = 25.9 +/- 0.4 ms; ISOH = 27.7 +/- 1.2 ms; SEVON = 25.9 +/- 1.5 ms; SEVOH = 27.2 +/- 0.7 ms). Our results clearly indicate that induced hypercapnia significantly alters the genesis of the electroretinogram at level of ON-pathway and suggest that OFF-pathway is unaffected and that ERGs obtained from isoflurane or sevoflurane anaesthetized dogs are almost identical. Control of hypercapnia must be taken into consideration when ERGs are performed under inhaled anaesthesia in dogs.

Effect of atorvastatin on bone mineral density in patients with acute coronary syndrome.

OBJECTIVE: The aim of this paper is to evaluate the effect of atorvastatin on bone mineral density in patients with acute ischemic heart disease. MATERIAL AND METHODS: Eighty-three patients (52 male and 31 female) with acute coronary syndrome were studied. They received treatment with atorvastatin using low doses (20 mg) and high doses (40 mg-80 mg). Initial and final cholesterol, triglyceride, calcium, phosphorus, 25-hydroxyvitamin D were obtained from every patient. Spine and hip bone mineral density were performed at the beginning and one year later. RESULTS: Atorvastatin treatment increases vitamin D (33%, p = 0.007) and decreases the individuals with vitamin D insufficiency. Bone mineral density increased in the spine (1.31%, p = 0.02), but it was significant only in male and patients presenting vitamin D levels higher than 30 nmol/l. CONCLUSION: Atorvastatin has a beneficial effect on bone metabolism in patients with acute ischemic heart disease (mainly males) by incrementing bone mineral density in which vitamin D levels are required to be higher than 30 nmol/l for the drug to be effective.

Really does temperature reduction and norepinephrine have similar effects on the energy metabolism in rat brown adipose tissue?

CONTEXT: Heat generation by brown adipose tissue (BAT) in response to temperature reduction seems to be entirely related to sympathetic nervous stimulation. OBJECTIVE: To analyse if temperature reduction and norepinephrine may differently affect the expression of proteins related to energy metabolism in BAT. MATERIALS AND METHODS: Isolated rats BAT was incubated with/without norepinephrine (10-6 mol/L, 24 h at 32 °C and 37 °C). RESULTS: In BAT, 32 °C increased the protein expression levels of carnitine palmitoyltransferase-I and -II, mitochondrial uncoupling protein-1 (UCP-1) and the expression and activity of lactate dehydrogenase. Mitochondrial F1-ATP synthase α-chain expression was decreased at 32 °C compared to 37 °C. Norepinephrine and at 32 °C exposure, UCP-1 expression was increased but cytochrome-c oxidase and F1-ATP synthase α-chain expression was reduced with respect to 37 °C. DISCUSSION: Sympathetic stimulation seems not to be the only factor associated with heat generation. CONCLUSIONS: Temperature reduction by itself exerts some different effects on the expression of proteins related to the energy metabolism than norepinephrine.

[Iodine nutritional status in the school-aged population in Alicante (Spain)]. / Situación nutricional de yodo en la población escolar de Alicante.

BACKGROUND: According to the World Health Organization (WHO), goiter is endemic in Spain. The main cause of endemic goiter is iodine deficiency, which is also the principal cause of mental retardation and avoidable cerebral palsy throughout the world. MATERIAL AND METHODS: We conducted an observational study to determine the prevalence of endemic goiter and nutritional iodine status in the province of Alicante. Urinary iodine excretion was measured in a morning urine sample, and thyroid volume was measured by means of a thyroid ultrasound scan. A case of goiter was diagnosed if thyroid volume was above the 97th percentile adjusted by age, as published by the WHO. RESULTS: No cases of goiter were found. In addition, the median urinary iodine excretion levels adjusted by age were within the normal range, as defined by the WHO's criteria. CONCLUSIONS: Endemic goiter was not found in the province of Alicante and urinary iodine excretion values demonstrated adequate iodine intake. Further ultrasound studies are needed to establish reference thyroid volumes for our population.

Multiparametric optimization of a new high-sensitive and disposable mercury (II) electrochemical sensor.

An electrochemical sensor for mercury (II) determination was developed by modifying the surface of a commercial screen-printed carbon electrode (SPCE) with a polystyrene sulfonate-NiO-carbon nanopowder composite material. Mercury measurements were performed by differential pulse anodic stripping voltammetry (DPASV). Sensor composition and measurement conditions were optimized using a multivariate experiment design. A screening experiment by using a Plackett-Burman design was first performed in order to determine the main contributing factors to the electrochemical response. The most important factors were employed to establish the interactions between different experimental variables and get the best conditions for mercury determination. For this purpose, a five level central composite design and a response surface methodology were used. The optimized method using the developed NiO-PSS-SPCE sensor presents a very low limit of detection of 0.021 µg L(-1) and a linear response over two concentration ranges with two different slopes, from 0.05 to 2.0 µg L(-1) and between 2.0 and 75 µg L(-1). The sensor was successfully applied to mercury determination in water samples.

Metabolic differences between white and brown fat from fasting rabbits at physiological temperature.

It has been suggested that activated brown adipose tissue (BAT) shows increased glucose metabolic activity. However, less is known about metabolic activity of BAT under conditions of fasting and normal temperature. The aim of this study was to compare the possible differences in energetic metabolism between BAT and white adipose tissue (WAT) obtained from rabbits under the conditions of physiological temperature and 24 h after fasting conditions. The study was carried out on New Zealand rabbits (n=10) maintained for a period of 8 weeks at 23±2 °C. Food was removed 24 h before BAT and WAT were obtained. Protein expression levels of the glycolytic-related protein, glyceraldehyde-3-phosphate dehydrogenase, and pyruvate dehydrogenase were higher in WAT than that in BAT. The expression level of carnitine palmitoyltransferase 1 (CPT1) and CPT2, two fatty acid mitochondrial transporters, and the fatty acid ß-oxidation-related enzyme, acyl CoA dehydrogenase, was higher in BAT than in WAT. Cytosolic malate dehydrogenase expression and malate dehydrogenase activity were higher in WAT than in BAT. However, lactate dehydrogenase expression and lactate content were significantly higher in BAT than in WAT. In summary, this study for the first time, to our knowledge, has described how under fasting and normal temperature conditions rabbit BAT seems to use anaerobic metabolism to provide energetic fuel, as opposed to WAT, where the malate-aspartate shuttle and, therefore, the gluconeogenic pathway seem to be potentiated.

Is veno-occlusive disease a specific syndrome or the exacerbation of physiopathologic hemostatic changes in hematopoietic stem cell transplantation (HSCT)?

The objective of the present study was to analyze whether veno-occlusive disease (VOD) is based on specific findings or whether this syndrome is the exacerbation of changes in hemostatic parameters that develop following hematopoietic stem cell transplantation (HSCT). 40 patients undergoing HSCT were enrolled (6 allogeneic bone marrow transplantation and 34 peripheral stem cell rescue-2 allogeneic, 32 autologous). Measurements of hemostatic parameters (endothelial, hypercoagulability and fibrinolytic markers) were obtained prior to chemotherapy and weekly thereafter for 3 weeks. The incidence of VOD was 15%. HSCT showed a state of moderate hypercoagulability (increase of thrombin-antithrombin complex and fibrinogen, and decrease of Factor VII, Protein C, and antithrombin-III), probably as a consequence of marked endothelial damage (increase of von Willebrand Factor and tissue plasminogen activator). All these alterations create a potentially prothrombotic state, more pronounced in VOD. The decreasing incidence of VOD and the moderate disease in all patients suggest that increasing improvements in transplant strategies have reduced the risk and severity of a syndrome that at the beginning of the transplantation era was a leading cause of morbidity/mortality.

Efficacy of the Komesaroff anaesthetic machine for delivering isoflurane to dogs.

The Komesaroff machine is a low-flow, closed-circle circuit with a low resistance vaporiser, of the Goldman type, in circuit. This trial assessed the mechanical consistency of the delivery of isoflurane by the vaporisers, and used six dogs to compare the in vivo cardiorespiratory effects of the anaesthetic agent delivered by the Komesaroff machine with the effects of a circle system with high flows in the semi-closed mode. The delivery of isoflurane was constant for each vaporiser setting and no potentially dangerous concentrations of isoflurane were observed. The mean (sem) percentages of isoflurane were 0.18 (0.019) at setting I, 1.46 (0.055) at setting II, 3.12 (0.066) at setting III and 3.01 (0.047) at setting IV. There were no significant differences between the two types of circuit in vivo, and the measured haemodynamic variables were satisfactory throughout the experiments.

Anaesthetic potency of isoflurane in cattle: determination of the minimum alveolar concentration.

OBJECTIVE: To determine the minimum alveolar concentration (MAC) of isoflurane in cattle. STUDY DESIGN: Prospective study. ANIMALS: Sixteen healthy adult female Holstein-Friesian cattle weighing 612 ± 17 kg (× ± SEM) and aged 5.7 ± 0.9 years old. METHODS: The unsedated cattle were restrained in right lateral recumbency using a rope harness technique. Anaesthesia was induced with isoflurane (ISO) in oxygen via a face mask connected to a large-animal, semiclosed anaesthetic circle system. Each cow was intubated with a cuffed orotracheal tube (25 mm ID). Inspired and end-tidal ISO were monitored using a calibrated infra red analyser with a methane filter. The MAC of ISO that prevented gross purposeful movement in response to a tail and dewclaw clamp was determined. The time from the start of ISO administration to intubation, the time interval between discontinuance of ISO and the time the animal regained sternal recumbency, were recorded. Time to standing and quality of recovery were also recorded. RESULTS: The time from the start of ISO administration to tracheal intubation was 18.68 ± 2.77 minutes. The MAC of ISO in these cattle was 1.27 ± 0.03% (1.14 ± 0.01% corrected to sea level). Time to sternal recumbency after 90 ± 16 minutes of anaesthesia from intubation was 4.60 ± 0.58 minutes and time to standing was 6.70 ± 1.02 minutes. All cattle were extubated when they regained sternal recumbency. CONCLUSION: The MAC of isoflurane in these cattle was 1.27 ± 0.03% (1.14 ± 0.01% corrected to sea level). ISO provided a smooth induction to, and rapid recovery from, anaesthesia. CLINICAL RELEVANCE: Knowledge of the MAC of ISO in cattle will facilitate its appropriate clinical use.

[Von Willebrand disease: characteristics and response to desmopressin. Study of 103 cases]. / Enfermedad de Von Willebrand: características y respuesta a desmopresina. Estudio de 103 casos.

BACKGROUND: To describe the main characteristics and response to desmopressin infusion in 103 patients suffering from von Willebrand disease (vWD). PATIENTS AND METHODS: The criteria for diagnosis were (except for type 2N) the coexistence of von Willebrand factor ristocetin cofactor (vWF:RCo) activity < 50 U/dl with bleeding disease or one of the following data: von Willebrand factor antigen (vWF:Ag) activity < 50 U/dl, factor VIII (FVIII) activity < 50 U/dl or the existence of a increased bleeding time (BT). Multimeric studies of vWF were performed in 51 cases and ristocetin induced platelet aggregation (RIPA) was also performed. RESULTS: Spontaneous bleeding was found in 36 patients, while in 18 cases the diagnosis was done after surgical bleeding. Thirteen patients (6 presenting with mild bleeding) were studied for abnormalities in the routine preanestesic tests. Other 22 patients were diagnosed with vWD by familial studies. There were 3 patients with type 2B, 1 case with type 2N and other patient with type 3. BT was found increased in 26 out of 58 patients. The activities of vWF:CoR and vWF:Ag were 38.4 (9.4) U/dl and 45.8 (23.2) U/dl, respectively, while the activity of FVIII was 49.9 (20.8) U/dl. Prophylactic DDAVP (desmopressin) was infused in 32 patients. After 1 h, basal activities of vWF:CoR and vWF:Ag were increased by 3.1 (3.2) and 3.4 (3.1) times, respectively, and maintained for 3 h. FVIII activity increased 3.6 (2.3) times the basal levels decreasing after 3 h (2.9 [2.1]; p < 0.01). The BT was corrected in 8 out of ten patients. CONCLUSIONS: vWD is a major cause of surgical bleeding. Preanestesic anamnesis and coagulation tests can be useful to identify vWD. Many patients with vWD have normal BT. A failure in the response to desmopressin infusion is unusual.

[National prostate cancer registry 2010 in Spain]. / Registro nacional de cáncer de próstata 2010 en España.

OBJECTIVES: To estimate the 2010 incidence of PCa in Spain and describe the clinical profile of newly-diagnosed cases using a nationwide hospital-based registry. MATERIAL AND METHODS: National epidemiological study in 25 public hospitals with a specific reference population according to the National Health System. Sociodemographic and clinical variables of all newly diagnosed, histopathological confirmed PCa cases were collected in 2010, in the area of influence of each centre. The age-standardised PCa incidence was determined based on the age distribution of the Spanish population in Spain and in 3 regions: Andalusia, Catalonia and Region of Madrid. RESULTS: 4,087 new cases of PCa were diagnosed for a reference population of 4,933,940 men (21.8% of the Spanish male population). The estimated age-standardised PCa incidence was 82.27 cases per 100,000 men in Spain, 70,38 in Andalusia, 85,70 in Catalonia and 92,29 in the Region of Madrid. Mean age at diagnosis was 69 years. Median PSA was 8 ng/ml. Gleason score was ≤6 in 56.5%, 7 in 26.7% and >7 in 16.8% of patients. At diagnosis, 90% had localised disease. CONCLUSIONS: In the 3 Regions analyzed, around 80-90% of the cases are diagnosed in a clinical localised stage. The incidence rates in Andalusía, Catalonia and Region of Madrid show a great difference between them due to several factors.

[Impact of nocturia on sleep quality in patients with lower urinary tract symptoms suggesting benign prostatic hyperplasia (LUTS/BPH). The NocSu Study]. / Impacto de la nocturia en la calidad del sueño en pacientes con síntomas del tracto urinario inferior sugestivos de hiperplasia benigna de la próstata. Estudio NocSu.

INTRODUCTION: Nocturia is one of the main symptoms associated to BPH, causing significant sleep disturbances, including sleep interruptions. Such sleep interruptions may significantly impair quality of life. MATERIALS AND METHODS: A multicenter, observational, cross-sectional, epidemiological study was conducted in patients with LUTS/BPH aged 60 years or over. In the study visit, demographic and clinical data were collected and quality of sleep questionnaires (MOS-Sleep Scale and COS) were administered. RESULTS: Among the total 249 patients recruited, 205 had nocturia (82.3%) and 44 (17.7%) had no nocturia. All patients should have an I-PSS score ?13, and patients with mild symptoms were therefore excluded (62.9% had moderate and 37.1% severe symptoms). Patients with nocturia were seen to have more sleep problems than those without nocturia (more sleep disturbances, less sleep adequacy, more daily sleepiness, greater concern about their social and occupational functioning, etc). DISCUSSION: Patients with nocturia reported a worse quality of sleep than patients with LUTS/BPH but no nocturia. Nocturia resulted in frequent sleep interruptions, causing malaise and diurnal fatigue in affected patients. Use of therapeutic approaches to relieve or eliminate this undesirable effect may lead to an improvement in sleep quality and quality of life in BPH patients.

Oral anticoagulant treatment: risk factors involved in 500 intracranial hemorrhages.

Intracranial bleeding is the most severe complication caused by anticoagulant or antiplatelet treatment. The increasing use of this therapy, especially in older people, makes the balance between clinical benefit and bleeding risk an important consideration. A retrospective study of all consecutive 500 intracranial hemorrhages in the West Valladolid area, approximately 220,000 people, during the period 1998 to 2004, was performed. In relation to mortality, predisposing conditions were included, such as age, antithrombotic treatment, arterial hypertension, cancer, blood diseases, vascular malformations, and traumatisms. The incidence of intracranial hemorrhage was 310 per 100,000 per year with a mortality of 30%. Higher mortality was found in antiplatelet-treated patients (44.9%) than in anticoagulated patients (31.1%). This may be related to a different mean age of 78 vs. 71 years. Arterial hypertension was the most frequent risk factor (45.1% in nontreated patients, 60% anticoagulated, and 75.5% antiplatelet). The relative risk of intracranial bleeding in anticoagulated patients was 11.2 (p < 0.001) with an incidence of 0.03% and a median of 14 months since treatment began. The median INR was 3.3. In 40% of the patients the previous five controls were in range. Strict consideration of indications criteria joined to a better control of risk factors may avoid intracranial bleeding episodes.

Mantle cell lymphoma with amyotrophic lateral sclerosis (motor neuron disease)

We describe a previously unreported case of mantle cell lymphoma (MCL) associated to amyotrophic lateral sclerosis (ALS) in a 63-year-old woman with a 1-year history of weakness of arm and leg muscles. The both molecular-genetic and flow cytometry analysis of lymphocytes of peripheral blood (PB) demonstrated leukemic phase of MCL.

[Practical usefulness of genogram in the handicapped patient care]. / Utilidad práctica del genograma en la atención al paciente inmovilizado.

OBJECTIVE: To know the practical use of genogram in the handicapped patient care, describing their characteristics and those of their families and to obtain the prevalence of bad care immobilized patients belonging to the health centre. DESIGN: Descriptive observational. SETTING: Urban health centre. PARTICIPANTS: People of both sexes registered at the health centre, immobilized in their houses, with a disability score of three or more in the physical disability scale of the Red Cross. MEASUREMENTS AND RESULTS: The most important features of our immobilized people, obtained from the genogram, are: women (63.5%), with mean age of 78.8 +/- 13.2 years old (CI, 76.5-81.17), with disability score of 3 (46.8%), immersed in a nuclear family (34.9%), in phase VI of dissolution of the vital cycle (45.2%), with very closed relations (45.2%), with arthrosis (23.8%) as the most frequent immobilized cause, and with one unique home career only (72%). The prevalence of bad care immobilized patients was 25.4%. CONCLUSIONS: The genogram is an excellent tool for describing immobilized people and their family nucleus, allowing the definition of an immobilized profile. If the patient is bad cared, he will need an special consideration. The immobilized score and the family relations ship may complicate their care, conditioning a worse prognosis. We wish to emphasize the importance of carrying out the genogram in the initial moment of the immobilization, because it establishes a dialogue route between the families and the sanitary professionals to improve the attention of these patients.