The effect of post-stroke hyperglycaemia on the levels of brain damage and repair-related circulating biomarkers: the Glycaemia in Acute Stroke Study II.

BACKGROUND AND PURPOSE: The aim was to identify whether post-stroke hyperglycaemia (PSH) influences the levels of circulating biomarkers of brain damage and repair, and to explore whether these biomarkers mediate the effect of PSH on the ischaemic stroke (IS) outcome. METHODS: This was a secondary analysis of the Glycaemia in Acute Stroke II study. Biomarkers of inflammation, prothrombotic activity, endothelial dysfunction, blood-brain barrier rupture, cell death and brain repair processes were analysed at 24-48 h (baseline) and 72-96 h (follow-up) after IS. The associations of the biomarkers and stroke outcome (modified Rankin Scale score at 3 months) based on the presence of PSH were compared. RESULTS: A total of 174 patients participated in this sub-study. Brain-derived neurotrophic factor (BDNF) at admission was negatively correlated with glucose levels. PSH was associated with a trend toward higher levels of endothelial progenitor cells (EPCs) at baseline. The EPCs in the PSH group then decreased in the follow-up samples (-8.5 ± 10.3) compared with the non-PSH group (4.7 ± 7.33; P = 0.024). However, neither BDNF nor EPC values had correlation with the 3-month outcome. Higher interleukin-6 at follow-up was associated with poor outcomes (modified Rankin Scale > 2) independently of PSH. CONCLUSION: Post-stroke hyperglycaemia appears to be associated with a negative regulation of BDNF and a different reaction in EPC levels. However, neither BDNF nor EPCs showed significant mediation of the PSH association with IS outcome, and only higher interleukin-6 in the follow-up samples (72-96 h) was related to poor outcomes, independently of PSH status. Further studies are needed to achieve definite conclusions.

Glycemia in Acute Stroke II study: a call to improve post-stroke hyperglycemia management in clinical practice.

BACKGROUND AND PURPOSE: The aim of the study was to analyze the effect of conventional glucose management, which aimed to maintain glucose levels <155 mg/dL (8.5 mmol/L), on glucose control and the outcomes of patients with acute ischaemic stroke (IS) in a clinical practice setting. METHODS: This was a multicenter, prospective cohort study of patients with acute IS. Patients were classified into four groups based on their initial 48-h capillary glucose levels and the administration of and response to corrective treatment: (i) untreated and maximum glucose levels <155 mg/dL (8.5 mmol/L) within the first 48 h; (ii) treated and good responders [glucose levels persistently <155 mg/dL (8.5 mmol/L)]; (iii) treated and non-responders [any glucose values ≥155 mg/dL (8.5 mmol/L) during the 24 h after the start of corrective treatment]; and (iv) untreated with any glucose value ≥155 mg/dL (8.5 mmol/L). The primary outcome was death or dependence at 3 months (blinded rater). RESULTS: A total of 213 patients were included. Ninety-seven (45.5%) patients developed glucose levels ≥155 mg/dL (8.5 mmol/L), 69 (71.1%) underwent corrective treatment and 31 patients underwent no corrective treatment at the physician's discretion [28 of whom had isolated values ≥155 mg/dL (8.5 mmol/L)]. Only 11 (16%) patients responded to conventional treatment, whereas 58 (84%) patients were non-responsive. Non-responders showed a twofold higher risk of death or dependence at 3 months (odds ratio, 2.472; 95% confidence interval, 1.096-5.576; P = 0.029). CONCLUSIONS: Lack of response to conventional treatment for glucose management in acute IS is frequent and associated with poor outcomes.

Exercise-induced asthma in asthmatic children. Predisposing factors.

BACKGROUND: Exercise-induced bronchoconstriction (EIB) has a high prevalence in children with asthma, and this is a common problem, even in case of controlled asthma, because of the high levels of physical activity in the childhood. OBJECTIVES: The aim of our study was to identify factors associated with the development of EIB in children with controlled asthma. METHODS: We studied children evaluated for asthma. A personal and familiar history was collected from each patient to estimate asthma severity, precipitating factors, exercise ability, immunotherapy treatment and atopic familiar disorders. Skin prick tests for inhalant allergens, pulmonary function tests (PFTs) and exercise challenge test (ECT) measurements were realized in every patient. We used the Chi Squared test to compare qualitative variables, the Student's-t test for quantitative variables and a logistic regression analysis to estimate the independent effect of the variables. RESULTS: We evaluated 132 asthmatic patients. Eighty-two, 6 to 14 years old (average 110 +/- 36.9 months), were included in the study. Forty one have coughing or wheezing with exercise at least three months ago, in addition to a positive ECT; 9 of these children had solitary EIB (group A), and 32 (group B) had controlled chronic asthma, 27 intermittent and 5 moderately persistent. Forty one controlled asthmatic children, 39 intermittent, 1 mildly persistent and 1 moderately persistent (group C) had a good tolerance for exercise with a negative ECT. No differences were found in familiar history, asthma severity or evolution time in B vs C group. We found that 35 patients (42,68 %) patients were sensitized to indoor allergens: 24 (58,53 %) were patients suffering EIB and 11 (26,8 %) allowed to group C. Precipitating factors of asthma were in group B: respiratory infections in 19 cases, pollen in 20 and in 10 indoor allergens exposure. In group C: 14 patients had asthmatic symptoms with viral respiratory infections, 32 with pollen and 2 with indoor allergens exposure. A patient from group A had allergy rhinitis after exposure to cats. Allergy to indoor allergens demonstrated an direct association to EIB suffering (p = 0,026). Twenty six patients with allergic asthma followed pollen immunotherapy treatment, 7 of group B (33,3 %) and 19 (59,3 %) of group C. This treatment was inversely associated with EIB suffering (p = 0,048). A logistic regression analysis confirmed the independence of both variables as predisposing and protecting factors in EIB suffering. CONCLUSIONS: Allergy to indoor allergens might be considered a risk factor for EIB. Immunotherapy treatment could be a protective factor against the development of EIB in children with allergic asthma.

Exercise-induced asthma in asthmatic children. Predisposing factors

Background: Exercise-induced bronchoconstriction (EIB) has a high prevalence in children with asthma, and this is a common problem, even in case of controlled asthma, because of the high levels of physical activity in the childhood. Objectives: The aim of our study was to identify factors associated with the development of EIB in children with controlled asthma. Methods: We studied children evaluated for asthma. A personal and familiar history was collected from each patient to estimate asthma severity, precipitating factors, exercise ability, immunotherapy treatment and atopic familiar disorders. Skin prick tests for inhalant allergens, pulmonary function tests (PFTs) and exercise challenge test (ECT) measurements were realized in every patient. We used the Chi Squared test to compare qualitative variables, the Student's-t test for quantitative variables and a logistic regression analysis to estimate the independent effect of the variables. Results: We evaluated 132 asthmatic patients. Eighty-two, 6 to 14 years old (average 110 ± 36.9 months), were included in the study. Forty one have coughing or wheezing with exercise at least three months ago, in addition to a positive ECT; 9 of these children had solitary EIB (group A), and 32 (group B) had controlled chronic asthma, 27 intermittent and 5 moderately persistent. Forty one controlled asthmatic children, 39 intermittent, 1 mildly persistent and 1 moderately persistent (group C) had a good tolerance for exercise with a negative ECT. No differences were found in familiar history, asthma severity or evolution time in B vs C group. We found that 35 patients (42,68 %) patients were sensitized to indoor allergens: 24 (58,53 %) were patients suffering EIB and 11 (26,8 %) allowed to group C. Precipitating factors of asthma were in group B: respiratory infections in 19 cases, pollen in 20 and in 10 indoor allergens exposure. In group C: 14 patients had asthmatic symptoms with viral respiratory infections, 32 with pollen and 2 with indoor allergens exposure. A patient from group A had allergy rhinitis after exposure to cats. Allergy to indoor allergens demonstrated an direct association to EIB suffering (p = 0,026). Twenty six patients with allergic asthma followed pollen immunotherapy treatment, 7 of group B (33,3 %) and 19 (59,3 %) of group C. This treatment was inversely associated with EIB suffering (p = 0,048). A logistic regression analysis confirmed the independence of both variables as predisposing and protecting factors in EIB suffering. Conclusions: Allergy to indoor allergens might be considered a risk factor for EIB. Immunotherapy treatment could be a protective factor against the development of EIB in children with allergic asthma

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[Effect of hygiene interventions on the thermal stability of extremely low-birth-weight newborns in the first two weeks of life]. / Repercusión del aseo en la estabilidad térmica del recién nacido de extremado bajo peso durante las primeras dos semanas de vida.

INTRODUCTION: A prospective study was performed of a cohort of extremely low-birth-weight (ELBW) premature neonates (birth weight 500 to 1,000 g) consecutively admitted to the neonatal intensive care unit. The aim of this study was to examine the thermal changes that occur during all the hygiene-related interventions in ELBW infants in the first 2 weeks of life. PATIENTS AND METHODS: The study was carried out for 10 consecutive months in the Neonatology Service of La Paz University Hospital. We studied all consecutively admitted ELBW infants who satisfied the following criteria: a) adequate weight for gestational age; b) survival for at least 1 week, and c) no major congenital malformations or dysmorphic features. The infants included in the study were managed according to a standard care protocol for maintaining thermal stability and preventing cold-induced stress. Central temperature (Tc) was measured in the axilla and peripheral temperature (Tp) was measured on the sole of the foot. Both temperatures were continuously monitored for a) a period of scheduled non-handling--baseline period--and b) during and after a series of "hygiene interventions". In each of these periods, Tc and Tp were continuously monitored and recorded at 10 min intervals for the first 30 minutes and then at 30 min intervals until completing a 180 min period. RESULTS: Although incubator temperature was raised by a mean of 3 degrees C during hygiene interventions, hygiene was accompanied by a change in body temperature that remained fairly constant throughout the study period; Tc and Tp decreased by a mean of 1 degrees C with respect to baseline temperature. A fall in axillary temperature to less than 36.5 degrees C was observed in 87.4 % of recordings and a fall to less than 36 degrees C was observed in 45.5 %; axillary temperature remained below 36.5 degrees C for a mean duration of almost 1 hour. The differential temperature (Td 5 Tc - Tp), an indicator of thermal stress, was more than 1 degrees C for a mean duration of more than 80 min and > 2 degrees C for more than 20 minutes in both the first and second weeks of life. CONCLUSIONS: During hygiene interventions, ELBW infants experienced a sharp fall in central and peripheral body temperature. After hygiene interventions, these neonates had a Td suggestive of prolonged thermal stress, despite the use of standardized care protocols designed to avoid or minimize the potential effects of hygiene interventions on neonatal temperature.

Repercusión del aseo en la estabilidad térmica del recién nacido de extremado bajo peso durante las primeras dos semanas de vida / Effect of hygiene interventions on the thermal stability of extremely low-birth-weight newborns in the first two weeks of life

El objetivo del estudio fue examinar los cambios térmicos que tienen lugar durante un conjunto de acciones agrupadas en relación con el aseo corporal en los RNEBP durante las primeras 2 semanas de vida. Pacientes y métodos. El estudio se realizó durante 10 meses consecutivos en el Servicio de Neonatología del Hospital Universitario La Paz. Se estudiaron todos los RNEBP ingresados consecutivamente que cumplieron los siguientes criterios: a) peso adecuado a la edad gestacional; b) sobrevivir al menos una semana, y c) no presentar malformaciones congénitas mayores o rasgos dismórficos. Los niños incluidos en el estudio fueron manejados según los protocolos de cuidado estándar dirigidos a mantener la estabilidad térmica y evitar el estrés por frío. La temperatura central (Tc) se midió en el hueco axilar y la periférica (Tp) en la planta de un pie. Ambas temperaturas se monitorizaron de forma continua durante: a) un período de no manipulación programada (período basal), y b) durante y después de un conjunto de intervenciones agrupadas que denominamos "aseo". Durante ambos períodos se monitorizaron de forma continua la Tc y la Tp, registrándose a intervalos de 10 min durante los primeros 30 min y posteriormente cada 30 min hasta completar un período de registro de 180 min. Resultados. A pesar que durante el aseo la temperatura de la incubadora se incrementó casi 3 °C por término medio, el aseo conllevó un patrón de cambio en la temperatura corporal similar durante todo el período de estudio; la Tc y la Tp descendieron aproximadamente 1 °C por término medio respecto a la temperatura basal. Se observó una caída de la temperatura axilar por debajo de 36,5 °C en el 87,4 % de los registros y por debajo de 36 °C en el 45,5 % y la temperatura axilar permaneció inferior a 36,5 °C durante prácticamente una hora por término medio. Además, la temperatura diferencial (Td 5 Tc ­ Tp), un indicador de estrés térmico, fue superior a 1 °C durante más de 80 min y a 2 °C durante más de 20 min por término medio, tanto en la primera como en la segunda semana de vida. Conclusiones. Durante el aseo de los RNEBP tiene lugar un marcado descenso de la temperatura corporal, tanto central como periférica. Tras el aseo, estos recién nacidos presentan una Td indicativa de estrés térmico, durante períodos prolongados. Estos cambios térmicos tienen lugar aun siguiendo protocolos de aseo estandarizados dirigidos a evitar o aminorar la potencial repercusión de este en la temperatura del recién nacido

Introduction. A prospective study was performed of a cohort of extremely low-birth-weight (ELBW) premature neonates (birth weight 500 to 1,000 g) consecutively admitted to the neonatal intensive care unit. The aim of this study was to examine the thermal changes that occur during all the hygiene-related interventions in ELBW infants in the first 2 weeks of life. Patients and methods. The study was carried out for 10 consecutive months in the Neonatology Service of La Paz University Hospital. We studied all consecutively admitted ELBW infants who satisfied the following criteria: a) adequate weight for gestational age; b) survival for at least 1 week, and c) no major congenital malformations or dysmorphic features. The infants included in the study were managed according to a standard care protocol for maintaining thermal stability and preventing cold-induced stress. Central temperature (Tc) was measured in the axilla and peripheral temperature (Tp) was measured on the sole of the foot. Both temperatures were continuously monitored for a) a period of scheduled non-handling ­baseline period­ and b) during and after a series of "hygiene interventions". In each of these periods, Tc and Tp were continuously monitored and recorded at 10 min intervals for the first 30 minutes and then at 30 min intervals until completing a 180 min period. Results. Although incubator temperature was raised by a mean of 3 °C during hygiene interventions, hygiene was accompanied by a change in body temperature that remained fairly constant throughout the study period; Tc and Tp decreased by a mean of 1 °C with respect to baseline temperature. A fall in axillary temperature to less than 36.5 °C was observed in 87.4 % of recordings and a fall to less than 36 °C was observed in 45.5 %; axillary temperature remained below 36.5 °C for a mean duration of almost 1 hour. The differential temperature (Td 5 Tc ­ Tp), an indicator of thermal stress, was more than 1 °C for a mean duration of more than 80 min and > 2 °C for more than 20 minutes in both the first and second weeks of life. Conclusions. During hygiene interventions, ELBW infants experienced a sharp fall in central and peripheral body temperature. After hygiene interventions, these neonates had a Td suggestive of prolonged thermal stress, despite the use of standardized care protocols designed to avoid or minimize the potential effects of hygiene interventions on neonatal temperature

Digestive haemorrhage in patients with anti-Anisakis antibodies.

OBJECTIVE: Anisakis simplex parasite causes anisakidosis, a disease that often mimics other gastrointestinal diseases such as peritonitis, appendicitis, Crohn's disease, ulcer, etc. Patients with digestive haemorrhage caused by ulcers, varices or Mallory syndrome were analysed for antibodies to the worm A. simplex. METHODS: Antibody detection was carried out by enzyme-linked immunosorbent assay (ELISA) and immunoblot using crude extracts of antigen and excretory/secretory products. Total immunoglobulin (Ig), IgG, IgM, IgA and IgE were studied. RESULTS: Eighty-seven patients were studied. The following prevalence rates were found with crude antigen: total Ig 30% (95% confidence interval 21-40), with values for IgG, IgM, IgA and IgE of 22 (CI 14-31), 17 (CI 10-26), 37 (CI 27-47) and 12% (CI 6-20), respectively. Twenty-four positive sera for total Ig response and crude products were selected for determination of specific antibodies with excretory/secretory antigens. We obtained 8, 13, 3 and 16 positive cases for total Ig, IgG, IgM and IgA respectively. The percentages of positivity within the varices and Mallory groups of patients were higher although differences were not significant (35 and 50% respectively). In a healthy population, the prevalence for total Ig is much lower (6%). Twenty-five positive sera for total Ig response were tested by means of immunoblot analysis against crude larval antigen. Concerning total Ig antibody response, 12 of the sera showed an immuno-recognition pattern concordant with the human anisakidosis reference serum (E17). Specific IgG bands were visualized in 30 sera; specific IgM and IgA in 6 and 12, respectively. Different clinical variables of these patients were studied: leucocytes, eosinophils, haemoglobin, prothrombin activity, thromboplastin time, fibrinogen, platelets and erythrocyte sedimentation rate. There were a few significant differences: for total Ig in prothrombin activity and platelets, and for IgM in eosinophils. CONCLUSIONS: The prevalence of detectable antibodies against A. simplex is higher in patients with digestive haemorrhage than in the healthy population.

[Amino acid changes in blood of children with severe liver disease. The evaluation of differences according to distinct physiopathology]. / Alteraciones de los aminoácidos en sangre en niños con enfermedad hepática severa. Valoración de las diferencias en relación a la distinta fisiopatología.

OBJECTIVE: The aim of this study was to know the serum amino acid profiles in children with terminal hepatic diseases and to assess the differences between the two main physiopathological groups of hepatic damage: cholestasis and cellular necrosis. PATIENTS AND METHODS: We studied twenty-six pediatric patients with severe hepatic diseases admitted to the Pediatric Intensive Care Unit. Patients were divided into two groups according to the predominant hepatic lesion: cellular damage (fourteen children) and cholestasis damage (twelve cases). RESULTS: Overall, there is a significant increase in the aromatic amino acids (AAA) phenylalanine (p < 0.04) and tyrosine (p < 0.0003) and a decrease in the branched-chain amino acids (BCAA) leucine, isoleucine and valine (p < 0.00001), with a reduction in the BCAA/AAA ratio (p < 0.00001). However, we found a significant decrease in glutamine, cysteine, taurine, serine, threonine, tryptophan, total amino acids and essential amino acids, together with higher levels of glutamic acid, ornithine and citrulline, which reflects a more complex metabolic disturbance. The group with cholestatic damage shows very low taurine levels (p < 0.0003). Patients with predominantly cellular damage have higher increases in tyrosine (p < 0.01), phenylalanine and hydroxyproline (p < 0.01). CONCLUSIONS: These findings may help us to better understand the complex physiopathology of amino acid metabolism in different liver diseases. Moreover, the extremely low levels of taurine found prompted us to recommend additional dietary support particularly in children with cholestatic hepatopathy.

[The metabolic syndrome: its detection with the 50-gram glucose test]. / Síndrome metabólico: su detección con el test de 50 gramos de glucosa.

OBJECTIVE: Epidemiological evidence suggests that resistance to insulin is the common nexus of the accumulation of factors in patients at high cardiovascular risk. To find a test which enables resistance to insulin to be identified in large populations will allow preventive and therapeutic measures to be taken. DESIGN: Crossover. SETTING: Carrascosa del Campo and Cuenca Health Centres. PARTICIPANTS: 408 patients (154 men and 254 women), all the non-diabetic obese patients at the two health centres, were studied. MEASUREMENTS AND MAIN RESULTS: Levels of cholesterol, triglycerides and uric acid were measured. Patients were medically examined, and blood pressure, waist and hip measurements, toxic habits and cardiovascular history were found. They were classified by pathology and normograms. The O'Sullivan and microalbuminuria tests were performed, and all the statistical associations with biochemical and medical characteristics were studied. The O'Sullivan test was significantly associated (p < 0.01) with cardiovascular risk and insulin-resistance factors such as hypercholesterolaemia (RR 1.63), hypertension (RR 1.92), hypertriglyceridaemia (RR 2.47), hyperuricaemia (RR 1.80), with the Berglund resistance index (RR 1.52) and the microalbuminuria test (RR 1.83). The association was more consistent when there were a number of factors combining. There was no relationship with the waist/hip index found. CONCLUSION: The O'Sullivan test, on its own or with the microalbuminuria test, seems very useful for identifying obese subjects with resistance to insulin.

[Nosocomial infection at an intensive care unit: multivariate analysis of risk factors]. / Infección nosocomial en una unidad de cuidados intensivos: análisis multivariante de los factores de riesgo.

BACKGROUND: Nosocomial infections, especially in the intensive care unit, are a very important problem due to their frequency and important consequences (morbility and mortality). On the other hand there are some risk factors and some preventive measures which are involved in the appearance of the nosocomial infections. The purpose of this work was to recognize these risk factors and to identify the preventive measures which are effective, and also to quantify the participation of each risk factors/preventive measures in the development of the nosocomial infections. PATIENTS AND METHODS: Follow-up of a cohort of patients admitted to the intensive care unit of the General Hospital of La Paz (Madrid, Spain) during a year and with a stay of at least 48 hours. RESULTS: We have found a cummulative incidence of patients with nosocomial infection of 32.8%. More than 80% of the patients received antibiotic treatment during their stay in the intensive care unit. The stay of the patients no infected was 4 days while the stay of infected patients was 20 days. We have found a mortality of 29.5%, which was greater in the patients who were infected (42%). In the multivariate analysis we have developed an equation to predict the development of the nosocomial infection. The following variables were identified: six or more instrumentations (OR, 4.75; 95% CI, 2.75-8.19), more of ten days of hospitalization previous to the appearance of the first nosocomial infection (OR, 4.17; 95% CI, 2.60-6.70), administration of muscle relaxing drugs (OR, 2.25; 95% CI, 1.43-3.55), nasogastric tube (OR, 2.19; 95% CI, 1.25-3.84), and altered consciousness (OR, 2.19; 95% CI, 1.25-3.84). Therefore, those patients who present some of these characteristics should be monitored in a special way due to their high risk of development of a nosocomial infection. CONCLUSIONS: Several factors play an important role in the development of a nosocomial infection in the intensive care unit; these are not only intrinsec (especially the altered consciousness) but also extrinsec (instrumentations and drugs), as well as the stay at the hospital previous to the appearance of the first nosocomial infection.

Intracellular (polymorphonuclear) magnesium content in patients with bronchial asthma between attacks.

Previous studies have demonstrated the role of polymorphonuclears in asthma, the importance of increases in intracellular concentrations of ionized calcium in the release of chemical mediators, the role of magnesium as natural calcium channel blocker, and the importance of magnesium deficiency in plasma histamine concentration and in tissue prostanoid concentration. The objective of our study was to measure the polymorphonuclear magnesium content in patients with asthma in the interval between attacks. We measured the polymorphonuclear magnesium content, and serum and erythrocyte sodium, calcium, and magnesium concentrations in 21 healthy volunteers and 50 patients with different types of asthma. In our patients, the polymorphonuclear magnesium content was lower than in the control group (P < 0.001), while magnesium levels in erythrocytes and serum and the levels of other ions in erythrocytes and serum were normal. This is the first report to document low polymorphonuclear magnesium content in patients with bronchial asthma. The reduction of polymorphonuclear magnesium content may have an important role in the pathogenesis of asthma.

Direct atrioventricular versus atriopulmonary connection: a comparative experimental study.

A study of 31 dogs, divided into two groups, was conducted to compare direct atrioventricular with atriopulmonary connection using a valved conduit to treat tricuspid atresia. The first group (n = 9) acted as controls. In the second group (n = 22), an experimental model was established for direct atrioventricular connection that could be converted to atriopulmonary connection. In subgroup A (n = 11), the blood from the right atrium (RA) was conducted to a haemodynamically effective residual right ventricle (RV), whereas in subgroup B (n = 11) the blood was conducted from the RA to an ineffective residual RV. There were haemodynamic advantages of atrioventricular connection in subgroup A. No such differences were found between the two surgical techniques in subgroup B. In both subgroups, light external compression of the pulmonary artery produced a profound deterioration in the haemodynamic state. The technique of direct atrioventricular connection does not appear to offer any advantages as a method of atriopulmonary bypass.

Does a critical hemodynamic situation develop from right ventriculotomy and free wall infarct or from small changes in dysfunctional right ventricle afterload?

An experimental model for right ventricle free wall infarct associated with double ventriculotomy and tricuspid insufficiency was created to evaluate whether right ventricle failure can cause profound refractory heart failure or whether modifications in right ventricular afterload are more influential in this regard. In our model, the left ventricle, interventricular septum and right atrial wall were maintained intact and pulmonary banding made it possible to modify right ventricular afterload during the experiment. The results of our study showed that pure right ventricular failure does affect the hemodynamic state negatively, but it is not itself, a cause of death in dogs. A slight increase in the dysfunctional right ventricular afterload produced a profound deterioration in the hemodynamic state that required pulmonary artery debanding within no more than 10 minutes.

Effect of povidone iodine and chlorhexidine on the mortality and bacterial clearance in the abdominal cavity of peritonitis rats.

Peritonitis was induced in Wistar rats by intraperitoneal inoculation of pure Escherichia coli. The mortality rate in the untreated control group was 36% (18/50). Rats in which 2 ml 1% povidone iodine had been injected intraperitoneally 5 min after the bacterial challenge, had a significantly increased mortality rate (43/50, 86%) (p less than 0.01). When the same experiment was done with 2 ml of 0.05% chlorhexidine the mortality rate decreased significantly to 16% (8/50) (p less than 0.05). Povidone iodine did not have any bactericidal effect; on the contrary, the number of colonies of bacteria had increased in all the animals 12 and 24 hours after challenge. Chlorhexidine, on the other hand, had sufficient bactericidal effect to cause a progressive decrease in the concentration of intraperitoneal bacteria.

[Experimental evaluation of the role of the coronary sinus pressure in the regulation of coronary return volume via the coronary sinus. Surgical considerations in atrio-pulmonary diversion procedures]. / Valoración experimental del papel de la presión en seno coronario en la regulación del volumen de retorno vía seno coronario. Consideraciones quirúrgicas en las técnicas de derivación atriopulmonar.

In order to find out the validity of the vascular waterfall mechanism in coronary venous circulation, the role of coronary sinus pressure in the regulation of coronary return volume via the coronary sinus is studied in healthy animals. An experimental model of pressure regulation in the coronary sinus was prepared, and aortic pressure, EKG and the cardiac output (measured by thermodilution) were recorded. The return volume via the coronary sinus was measured at coronary sinus pressure of 10 or less, 15, 20, and 25 mmHg or more, for a total of 36 determinations. Increased coronary sinus pressure did not produce significant changes in aortic pressure, heart rate, cardiac index or coronary return volume via coronary sinus. When coronary sinus pressure was 25 mmHg or more, there was a significant decline in the average of coronary return volume via coronary sinus. Nevertheless, stepwise variant regression showed that the coronary sinus pressure per se does not condition the volume of coronary return via the coronary sinus. Our results suggest that in the healthy animals, the vascular waterfall mechanism in coronary venous circulation is not valid. Our results suggest that in the correction of congenital cardiac malformations using atriopulmonary anastomosis procedures, employing techniques that ensure coronary sinus drainage into the left atrium, in order to avoid the hemodynamic repercussions attributable to the vascular waterfall mechanism, is not justified.

[Prospective immunologic study of mothers of HIV positive children]. / Estudio inmunológico prospectivo en madres e hijos VIH positivos.

From a cohort of 162 children born to 161 mothers belonging to risk groups for human immunodeficiency virus (HIV) infection, we have studied 32 asymptomatic HIV seropositive and 19 HIV seronegative mothers and their offspring seropositive mothers when compared with the seronegative group had lower counts of leukocytes, lymphocytes, CD4+ cells and CD4+/CD8+ ratio as well as higher IgG and IgM serum levels. The offspring from HIV seropositive mothers differed from children born to HIV seronegative mothers in having higher lymphocyte counts, serum IgG level and spontaneous in vitro IgG production. The number of lymphocytes and the IgG serum level correlated in the child HIV seropositive mother pairs. Two children born to HIV seropositive mothers had a CD4+/CD8+ ratio below 0.8. The significance of these abnormalities and its possible relationship with active HIV infection in children is at present unknown.

Experimental evaluation of atriopulmonary anastomosis in the presence of high pulmonary resistance.

We studied pulmonary resistance as a surgical criterion for atriopulmonary shunt. We created a model of experimental pulmonary hypertension by establishing a systemic-pulmonary shunt in 11 dogs. Two to 3 months after the shunt operation, total pulmonary resistance was calculated before (7.24 +/- 1.54 U . m2) and after (3.50 +/- 1.54 U . m2) ligation of the shunt. An atriopulmonary anastomosis technique was then performed and the hemodynamic status of the dogs during the first 2 postoperative hours was evaluated. Pathologic study of the lungs disclosed no arterial lesions. From our experimental work, we conclude that the surgical criterion for establishing the indication for this operation should be pulmonary resistance, which is conditioned by the state of the intrapulmonary vessels. We propose a procedure for determining real pulmonary resistance in the course of preoperative catheterization.