The oxidative stress, antioxidant profile and acid-base status in preterm and term canine neonates.

During the initiation of neonatal pulmonary respiration, there is an exponential increase in reactive oxygen species that must be scavenged by antioxidant defences. However, neonate and preterm newborns are known to possess immature antioxidant mechanisms to neutralize these toxic effects. The purposes of this study were to compare the development of antioxidant system between preterm and term canine neonates and to evaluate the magnitude of acid-base balance during the initial 4 h of life. A prospective study was conducted involving 18 neonatal puppies assigned to Term Group (63 days of gestation; n = 5), Preterm-57 Group (57 days of gestation; n = 8) and Preterm-55 Group (55 days of gestation; n = 5). Neonates were physically examined through Apgar score and venous haemogasometry within 5 min, 2 and 4 h after birth. No difference on amniotic fluid and serum superoxide dismutase (SOD), glutathione peroxidase (GPx) and the marker of oxidative stress (thiobarbituric acid reactive substances; TBARS) was verified. Irrespective of prematurity, all neonates presented low vitality, hypothermia, acidosis, hypoxaemia and hypercapnia at birth. However, term puppies clinically evolved more rapidly than preterm newborns. During the course of the study, premature neonates presented more severe complications, such as prolonged hypoxaemia and even death. In conclusion, premature puppies have no signs of immature enzymatic mechanisms for controlling oxidative stress, although SOD and GPx may participate in achieving acid-base balance. Aside from initial unremarkable symptoms, premature puppies should be carefully followed up, as they are at high risk of succumbing to odds of prematurity.

Alteration of interleukin 4 production results in the inhibition of T helper type 2 cell-dominated inflammatory bowel disease in T cell receptor alpha chain-deficient mice.

T cell receptor alpha chain-deficient (TCR-alpha(-/-)) mice are known to spontaneously develop inflammatory bowel disease (IBD). The colitis that develops in these mice is associated with increased numbers of T helper cell (Th)2-type CD4(+)TCR-betabeta (CD4(+)betabeta) T cells producing predominantly interleukin (IL)-4. To investigate the role of these Th2-type CD4(+)betabeta T cells, we treated TCR-alpha(-/-) mice with anti-IL-4 monoclonal antibody (mAb). Approximately 60% of TCR-alpha(-/-) mice, including those treated with mock Ab and those left untreated, spontaneously developed IBD. However, anti-IL-4 mAb-treated mice exhibited no clinical or histological signs of IBD, and their levels of mucosal and systemic Ab responses were lower than those of mock Ab-treated mice. Although TCR-alpha(-/-) mice treated with either specific or mock Ab developed CD4(+)betabeta T cells, only those treated with anti-IL-4 mAb showed a decrease in Th2-type cytokine production at the level of mRNA and protein and an increase in interferon gamma-specific expression. These findings suggest that IL-4-producing Th2-type CD4(+)betabeta T cells play a major immunopathological role in the induction of IBD in TCR-alpha(-/-) mice, a role that anti-IL-4 mAb inhibits by causing Th2-type CD4(+)betabeta T cells to shift to the Th1 type.

Influence of prenatal maternal corticosteroid therapy on clinical and metabolic features and pulmonary function of preterm newborn puppies.

Although the effects of antenatal corticosteroid therapy in clinical improvement and pulmonary maturation in preterm have been described, little is known on premature newborn puppies. This study aimed to evaluate the effect of maternal administration of a single dose of prenatal betamethasone on lung function of preterm newborn puppies in the first hours of life, especially from the clinical point of view and acid-base balance. A prospective study was conducted involving 21 puppies allocated into three experimental groups: Term Group (63 days post-ovulation), Preterm-Treated Group (57 days post-ovulation and maternal administration of a single dose of 0.5 mg/kg of betamethasone) and Preterm-Control Group (57 days post-ovulation). Puppies were analyzed clinically through the Apgar score, heart rate, respiratory rate and neurological tests (muscular tone and irritability reflex) and for oximetry and blood acid-base balance in distinct experimental moments. Premature puppies had marked degree of prematurity, reversed by maternal administration of betamethasone. Prenatal corticosteroid therapy promoted better pulmonary and metabolic condition, with more efficient compensatory response to acid-base imbalance and better pulmonary gas exchange capacity. Therefore, prenatal treatment with betamethasone can be adopted as clinical lung maturation protocol for pregnancies at risk in order to prevent low vitality and increase neonatal survival.

Oligoclonal Th2-biased betabeta T cells induce murine inflammatory bowel disease.

A population of CD4+ T cells with TCR beta-chain without TCR alpha-chain (CD4+, betabeta T cells) producing Th2-type cytokines increased in the mucosal and peripheral tissues of TCR alpha-chain deficient mice with inflammatory bowel disease (IBD). Analysis of TCR-beta immunoprecipitates by two-dimensional electrophoresis and RT-PCR revealed TCR of the CD4+ T cells was a homodimer of TCR beta-chains. Polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) analyses of TCR Vbeta-chain transcripts of the betabeta T cells revealed monoclonal to oligoclonal accumulation of the cells in the colon, suggesting clonal expansion of the mucosal betabeta T cells upon the stimulation with gut-derived antigens. The homodimer of TCR beta-chains on the betabeta T cells was a biologically functional receptor that transduced activation signals provided by MHC-class II-associated peptidic antigens and superantigens. Treatments of the mutant mice with mAb against TCR beta or IL-4 suppressed the onset of IBD. These findings suggest that the generation of oligoclonal Th2-type betabeta T cells plays a critical role for the development of IBD.

Drug-related illness in emergency department patients.

Drug-related illnesses (DRIs) associated with visits to a hospital emergency department (ED) were identified and classified, and the cost of these DRIs was analyzed. A pharmacist reviewed all available ED log forms on file at a 560-bed teaching hospital for October 1994. The following information was collected from these forms and, for patients with documented or suspected DRI, the medical record: medication and allergy history, drug involved in and cause of DRI, diagnosis, patient compliance, serum drug concentrations, and length of hospital stay. A patients was identified as having had a DRI if he or she was taking a drug before the ED visit and if a DRI was documented on the ED log form or suspected by the pharmacist. DRIs were classified as having been caused by inappropriate prescribing, patient noncompliance, an adverse drug reaction (ADR), or a drug interaction. DRIs were considered preventable if they could have been avoided through appropriate prescribing, outpatient monitoring, or compliance. A cost analysis was performed. Of 1260 ED log forms reviewed, 565 (45%) described patients receiving drugs before the ED visit. A total of 50 DRIs were discernible in 49 log forms (3.9% of all 1260 forms, and 8.6% of the 565 forms describing patients taking medication before the visit). Noncompliance, inappropriate prescribing, and ADRs accounted for 58%, 32%, and 10% of the DRIs, respectively. The drugs most frequently involved were albuterol, insulin, and warfarin. Thirty-three (66%) of the DRIs were considered to have been preventable; these DRIs accounted for an estimated $391,342 in annual ED and hospital costs. Many DRIs seen in the ED patients were preventable, and these preventable illnesses contributed substantially to ED and hospital costs.

[Clinical use of gentamicin in the field of surgery (author's transl)].

Gentamicin (GM) was intramuscularly administered to 24 patients with various infections (including 1 for prophylaxis of a postoperative infection) in the dose of 40 mg X 2/day for 4-26 days. In children, the maximum daily dose was 3.4 mg/kg and the minimum was 1.2 mg/kg (mean: 2-3 mg/kg). The results obtained are as follows: 1) Clinical efficacy of GM was excellent in 2, good in 9, fair in 4, null in 4 and indeterminate in 5, out of 24 cases. The effective rate was 57.9% (11/19). 2) In 21 strains isolated in 13 cases out of 24, efficacy of GM was good in 10, fair in 5, null in 3 and indeterminate in 3. The effective rate was 55.6% (10/18). 3) No significant side effect was observed in this clinical study.

[Partial colpocleisis for vesicovaginal fistulas].

Four patients with a vesicovaginal fistula were operated upon transvaginally using the Latzko technique of partial colpocleisis. In 3 of the 4 patients, the fistulas had been formed after total hysterectomy for myoma uteri or endometriosis. The periods from fistulization-to-surgery intervals in these 3 patients were 4 months, 12 months, and 4 years and 4 months, respectively. The fistulas in the remaining one patient had been formed after forceps delivery. The patient underwent surgery 8 days after delivery. An indwelling catheter was retained for 3 to 14 days after surgery. The 4 patients were all cured of vesicovaginal fistulas after a single operation. This paper describes our partial colpocleisis technique and discusses its clinical utility. The partial colpocleisis has the advantages of dispensing with such procedures as fistula excision, fistula opening suture, and suturation of the bladder musculature, and of closing the fistulas using a demucosated vaginal wall. Having minimal surgical invasiveness and being easy to perform and reliable, the technique appears to be excellent for coping with vesicovaginal fistulas.

[Computed tomography in the diagnosis of transitional cell carcinoma of the renal pelvis].

CT scans were carried out on 25 patients with transitional cell carcinoma of the renal pelvis. Of the 25 patients, tumors were identified in 24 patients (96%) and not in one patient on CT scan. Of the 24 patients the tumor was delineated as a solid mass in the renal pelvis and/or calyx in 15 and as an infiltrating mass in the renal parenchyma in 8 on CT scan. The depth of invasion was correctly estimated by CT in 18 of the 25 patients (72%). Whereas the tunica muscularis of the renal pelvis or the renal parenchyma was found involved in 3 of 10 patients (30%) in whom the diagnosis was made that the tumor was limited to the renal pelvic mucosa, the correct diagnosis was possible in 22 of 25 patients (88%) in whom the tumor was confined to the renal pelvic wall (pTa-pT2) or more invasive (pT3-pT4). In 6 of 7 patients with lymph nodes matastases enlarged lymph nodes were seen on the CT scan. In all 7 cases the primary tumor was classified as a pT3 or pT4 invasive disease. Based on the results presented above, it may be concluded that CT scan is valuable in making the diagnosis of transitional cell carcinoma of the renal pelvis and also in determining whether the tumor has invaded beyond the renal pelvic wall, thereby providing guidelines for the adequate treatment.

[Dor operation and quadruple coronary artery bypass grafting combined with endarterectomy].

For ischemic cardiomyopathy, both left ventricle (LV) reconstruction and coronary revascularization are necessary. A 58-year-old man with ischemic cardiomyopathy [end diastolic volume index (EDVI)/end systolic volume index (ESVI) = 214/157 ml/m2, ejection fraction (EF) 26%] underwent left ventricular reconstruction using endoventricular circulatory patch plasty (Dor operation) and quadruple coronary artery bypass grafting combined with endarterectomy, which was used for complete coronary revascularization. For the Dor operation, in order to minimize arrest time and to determine the purse-string suture line, palpation of contractility of the left ventricular muscle from inside under the beating heart was performed. And to avoid insufficient postoperative LV volume, a balloon was used. The surgery was performed without blood transfusion or intraaortic balloon pumping (IABP) support. Postoperative cardiac function was excellent (EDVI/ESVI = 128/68 ml/m2, EF 46%).

Impact of clinical pharmacy services on prescribing on a cardiothoracic/vascular surgical unit.

A multi-faceted approach was used to study the impact of clinical pharmacy services on the cost of drug therapy on a cardiothoracic and vascular surgical service. Physician and nursing attitudes about the usefulness and likely effect of clinical pharmacist recommendations were also assessed. A cross-sectional design with a temporal factor was used to study physician prescribing of all pharmacologic classes, and particularly of antibiotics. Measurements were taken for nine months before the institution of clinical pharmacy services, 12 months during a clinical pharmacy service period, and for six months after the cessation of the services. A trend toward reduction in drug costs per patient day was observed on both services. This was observed for all pharmacologic classes, and when antibiotics were analyzed alone. The difference was significant when antibiotics were specifically analyzed on the vascular surgical service. The pharmacist's log and a survey of physicians' and nurses' attitudes toward clinical pharmacy services supported the above results.

Pharmacist-managed drug therapy in California hospitals.

To assess the effect of state legislation expanding the scope of pharmacy practice in health-care institutions, California hospitals were surveyed in 1982 and 1986 about pharmacists' regulation of drug therapy. Questionnaires were mailed to pharmacy directors at all hospitals in the state. The survey form explained that in pharmacist-regulated drug therapy, the pharmacist, under order or authorization of the prescriber, requests laboratory tests and initiates or adjusts drug dosage to obtain the desired therapeutic response; the questions were based on this definition. The response rates were 51.4% (292 of 568) in 1982 and 56.2% (329 of 585) in 1986. For the responding hospitals of most sizes and types, the percentage having pharmacist regulation of drug therapy increased; the largest increase was in the for-profit chain hospitals. In 1986, pharmacists were involved in regulating maintenance dosages in more than half of the responding hospitals (from 52% of hospitals with 50 or fewer beds to 86% of hospitals with 400-499 beds). The responses indicated that at least 50% of patients receiving aminoglycoside or warfarin therapy or total parenteral nutrition had their maintenance dosages regulated by pharmacists. The two surveys indicate that between 1982 and 1986 pharmacists became more involved in regulating drug therapy in California hospitals.

Effect of clinical pharmacy services on prescribing on an orthopedic unit.

Prescribing patterns of physicians on a university-hospital orthopedic unit before, during, and after a clinical pharmacist's intervention were monitored and compared with patterns on a similar unit without clinical pharmacy services at another university hospital. The experimental and control groups consisted of 10% random samples of all patients on the study wards. Mean drug cost, number of doses, and number of courses of therapy for all drugs and for antibiotics were calculated. The data collection period consisted of 9 months (phase 1) before, 12 months (phase 2) during, and 6 months (phase 3) after clinical pharmacy services. Prescribing of postoperative prophylactic antibiotics was evaluated for compliance with guidelines of the experimental hospital's pharmacy and therapeutics committee. In the experimental group there was a consistent reduction from phase 1 to phase 2 in overall and antibiotic drug costs, number of doses, and number of courses of therapy per patient-day, but the differences were not significant. Length of stay decreased from phase 1 to phase 2, but the patterns were not significant over time or between experimental and control groups. For the experimental group, there was a significant reduction during phase 2 in the number of hours of antibiotic prophylaxis after removal of surgical drains, but prescribers' overall compliance with guidelines for postoperative antibiotic prophylaxis did not change significantly over time. In a subgroup receiving antibiotics, drug costs per patient-day at the experimental site were reduced from phase 1 to phase 2 for all drugs and for antibiotics. Of 1196 consultations, 76% were unsolicited; 83% of antibiotic-related problems were identified by the pharmacist.(ABSTRACT TRUNCATED AT 250 WORDS)