Cerebrovascular, cardiovascular and renal hypertensive disease after hypertensive disorders of pregnancy.

BACKGROUND: Strong associations have been established in nationwide registry studies between hypertensive disorders of pregnancy (HDP) and later vascular morbidities and mortality. The aim of this case-control study is to examine the interdependent relationships of different predictive factors for vascular disease and HDP, because they are not clearly elucidated due to lack of detail in registries. METHODS AND RESULTS: We assembled three different case groups of women who had cerebrovascular, cardiovascular, or hypertensive kidney disease before the age of 55. The control group consisted of age-matched women who underwent hysterectomy for benign reasons. We assessed the occurrence of HDP in previous pregnancies. The strength of the association with vascular morbidities was tested with multivariable logistic regression in comparison with classic vascular risk factors. In all case groups, previous HDP occurred more frequent than in the control group. In logistic regression analysis, previous HDP were the strongest predictor in the cerebrovascular group (OR 4.2; 95% confidence interval [CI] 1.6-11.0). In the cardiovascular group and the kidney failure group a similar association was found, however, this was not statistically significant (OR 4.4 (95% CI 0.82-4) and 2.9 (95% CI 0.61-14), respectively). CONCLUSIONS: Previous hypertensive disorders of pregnancy are a strong predictor for later vascular morbidity. This is partially mediated through the presence of classic vascular risk factors, but our data suggest it is also an independent predictor.

Mesangio-capillary processes and their reactivo-mobile potentials in extreme exertion on the kidney.

3 types of mesangiocyte processes have been distinguished in the mesangium of a rat kidney by means of electron-microscopic investigation. Processes of type I contact with proliferations of glomerular capillary endothelium, those of type II begin prolabbing to the capillary, and processes of type III penetrate its lumen. In extreme conditions (simulating in rats of acute ischemia of the kidney with recirculation, compensatory hypertrophy of the remaining kidney) increase of the number and hypertrophy of mesangiocapillary processes of type is observed. Cases of complete displacement of a whole mesangial cell into the capillary have been described. The problem of functional significance of mesangio-capillary processes is being discussed.

Regional anesthesia in children.

Regional anesthesia employing the spinal, epidural, or caudal approach was used to anesthetize 200 children, varying in age from 17 days to 15 years. Lidocaine in concentrations varying according to age was used. Ketamine (1 to 2 mg./kg.) was given in the majority of cases to ensure a quiet patient prior to block. No major anesthetic complications or deaths were attributable to the anesthetic technic. The caudal approach proved easiest.

[Effect of fasting and maintenance solutions on perioperative blood glucose in children]. / Influencia del ayuno y soluciones de mantenimiento sobre la glucemia perioperatoria en el paciente pediátrico.

The effects of fasting on preoperative glycemic levels and the influence of different intravenous solutions on postoperative sugar levels are discussed. Sugar levels were determined in 90 children, randomly placed in three groups, (according to the solution they were administered-A: Ringer-lactate, B: glucose at 5%, C: mixed-2 x 1) at the time they entered the hospital, after fasting previous to the anesthetic induction, and in the immediate postoperative period. In 14.4% of the cases hypoglycemia was found during the anesthetic induction, increasing as the fasting period was prolonged. The postoperative hyperglycemia seen in Group B was important, the other groups showed no significant changes. We recommend that the fasting period be no longer than 12 hours and to immediately start intravenous restitution if this period is extended further. Also, only Ringer's lactate solution or a 2 to 1 mixture is recommended to be used during surgery in order to avoid preoperative hypoglycemia and postoperative hyperglycemia. Glycemia; fasting; perioperative solutions.

Fibreoptic nasal intubation in children with anticipated and unanticipated difficult intubation.

The establishment of a tracheal airway with direct laryngoscopy can be either a very difficult or an impossible task in children with congenital or acquired facial malformations. Out of 46 patients categorized as difficult tracheal intubation, fibreoptic laryngoscopy was used successfully in 44 children anaesthetized by mask with sevoflurane and oxygen or by an intravenous infusion of propofol and mask oxygenation. There were two failures (4.3%). One was due to excessive bleeding and secretions produced by the multiple attempts to intubate with direct laryngoscopy and the other failure in a patient with Pierre Robin syndrome and very small nasal passages that precluded the introduction of the endoscope. Fibreoptic laryngoscopy was successful in 37 cases (80.4%) on the first attempt to intubate and in seven (15.2%) on a second or third attempt. We conclude that fibreoptic laryngoscopy in anaesthetized children with difficult anticipated or unanticipated tracheal intubation in trained hands is a safe technique that can be lifesaving. Therefore, we urge all anaesthesia trainees to become proficient in fibreoptic tracheal intubation.

Ultrastructural characteristics of renal corpuscle evolution in vertebrates.

Peculiarities of renal corpuscle's structural organization of a number of animals representing various classes of vertebrates have been studied on submicroscopic level at the stages of excretory organs formation: pronephros, mesonephros and metanephros. The fact has been established that side by side with the common structure there have been specific peculiarities due to the level of evolutional development and character of habitat.