Hemorrhagic cytitis after bone marrow transplantation.

OBJECTIVES: Hemorrhagic cystitis (HC) presenting with gross hematuria, bladder pain and urinary frequency develops in 13-38% of patients following bone marrow transplantation (BMT). The objective of the study was to study the characteristics of patients suffering hemorrhagic cystitis after hematopoietic stem cell transplantation in our center. METHODS: We conducted a retrospective chart review of all patients who underwent BMT at our institution between January 1996 and August 2012. We recorded the age, sex, diagnosis, conditioning regimen, interval between BMT and development of symptoms of cystitis and treatment instituted. RESULTS: Five hundred patients underwent BMT in the period of time studied. 52 of them developed hemorrhagic cystitis. The mean age of the affected patients was 39 years; there were 34 males and 18 females. The diagnoses include AML (n=11), ALL (n=8), CML (n=6), MDS (n=11), CLL (n=5), NHL (n=1), HD (n=5), MM (n=2), Medular aplasia((n=3). HC appeared 59.48 days after BMT. There were no differences between sexes. Mortality among the 52 patients was 51.14% but HC was not the cause of death in any patient. Polyomaviruses were detected in the urine of 78.94 % of survivors. CONCLUSIONS: Polyomavirus infection with BK and JC types is usually acquired in infancy and the virus remains latent in renal tissue. Immunosuppression facilitates reactivation of the renal infection and replication of the virus responsible for the clinical manifestations of HC. The differential diagnoses include other urinary infections, lithiasis, thrombocytopenia and adverse effects of pharmacological agents. The urologist plays a limited role in the management of this disease.

Coagulopatía dilucional en obstetricia. Tromboelastografía Rotem® / Dilutional coagulopathy in obstetrics. Rotem® tromboelastography

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[Low-dose 0.25% spinal levobupivacaine with epidural extension for cesarean section: comparison with 0.5% hyperbaric bupivacaine]. / Dosis bajas de 1-bupivacaína 0,25% espinal con extensión con salino epidural para cesárea: comparación con bupivacaína 0,5% hiperbárica.

INTRODUCTION: When low doses of local anesthetic are used in combined spinal-epidural anesthesia for cesarean section, an epidural catheter can be used to enhance a possibly incomplete block or insufficient dose. OBJECTIVE: To compare the efficacy of spinal 0.5% hyperbaric bupivacaine with fentanyl (20 microg) at a conventional high dose of 0.07 mg cm(-1) (group 1) vs 0.25% levobupivacaine at a low dose of 7.6 mg with fentanyl (20 microg) and epidural volume extension with 6 mL of saline through an epidural catheter (group 2). MATERIAL AND METHODS: A randomized clinical trial enrolling patients scheduled for elective cesarean section. RESULTS: Sixty-two patients were studied (31 in each group). Characteristics in the groups were comparable at baseline and the maximum level of sensory block achieved was sufficient for all but 1 patient in group 2 who required general anesthesia. The bupivacaine dose in group 1 ranged from 10.5 to 12 mg. The motor block and duration was less intense in group 2 (P<0.0001) and patients in that group could be transferred out of the postanesthetic care unit earlier. CONCLUSIONS: The use of low doses of levobupivacaine with an opiate in combination with volume extension through an epidural catheter in the context of combined spinal-epidural anesthesia is a safe, effective technique that may allow the doses and motor block to be reduced when hyperbaric levobupivacaine is administered, without adverse events for patients.

Réplica de los autores a la carta "estudio comparativo de bajas dosis de bupivacaína hiperbárica versus convencionales para cesárea programada: reflexiones" / Author’s reply to “On the randomized trial comparing low dose and conventional hyperbaric bupivacaine for cesarean section”

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[Randomized controlled trial comparing a low dose to a conventional dose of hyperbaric bupivacaine for scheduled cesarean section]. / Estudio comparativo de dosis bajas de bupivacaína hiperbárica versus convencionales para cesárea programada.

INTRODUCTION: Spinal anesthesia is the technique most often applied in cases of scheduled cesarean section. Many authors have tried decreasing the local anesthetic dose by adding opioids to achieve adequate analgesia with greater hemodynamic stability, although the ideal dose remains to be established. Our aim was to analyze hemodynamic stability and quality of analgesia with 2 different regimens for administering spinal hyperbaric bupivacaine. METHODS: We designed a controlled, double-blind trial comparing 2 doses of spinal hyperbaric bupivacaine with fentanyl in 42 patients undergoing elective cesarean section randomized to 2 groups to receive either the low dose or the conventional one. One group received an 11 mg dose of bupivacaine and the other group received a 6.5 mg dose, combined with 20 microg of fentanyl in both cases. RESULTS: The hemodynamic profile and the level of maximum sensory block obtained were similar in the two groups. The motor block was less intense in patients receiving the lower dose and it was necessary to convert 2 patients (10%) to general anesthesia in that group. CONCLUSIONS: Spinal anesthesia with low doses of bupivacaine and fentanyl provides acceptable intraoperative conditions for a high percentage of patients undergoing cesarean section, with a similar incidence of hypotension. The low dose generates a less intense intraoperative motor blockade with similar spread of the sensory block. The low dose was not efficacious for 10% of the patients who received it.

Estudio comparativo de dosis bajas de bupivacaína hiperbárica versus convencionales para cesárea programada / Randomized controlled trial comparing a low dose to a conventional dose of hyperbaric bupivacaine for scheduled cesarean section

INTRODUCCIÓN: La anestesia espinal es la técnica más utilizada para la realización de cesáreas programadas. Numerosos estudios han intentado disminuir las dosis de anestésico local añadiendo opiáceos con el objetivo de conseguir analgesia suficiente con mayor estabilidad hemodinámica aunque la dosis ideal está aún por establecer. Nuestro objetivo es analizar la estabilidad hemodinámica y la calidad de la analgesia de dos pautas diferentes de bupivacaína hiperbárica por vía espinal. METODOLOGÍA: Hemos diseñado un estudio prospectivo aleatorizado y doble ciego en dos grupos de 42 pacientes sometidas a cesárea electiva con dos pautas diferentes de bupivacaína hiperbárica vía espinal con fentanilo. Grupo 1:11 mg bupivacaína +20 g de fentanilo y grupo 2:6,5 mg de bupivacaína +20 mg de fentanilo. RESULTADOS: El perfil hemodinámico en ambos grupos es similar y en el nivel sensitivo máximo no se encuentran diferencias entre los grupos. La intensidad del bloqueo motor es menor en las pacientes del grupo 2. Fue necesario convertir a anestesia general dos pacientes del grupo 2. CONCLUSIONES: La anestesia espinal con bajas dosis de bupivacaína y fentanilo proporciona unas aceptables condiciones intraoperatorias a un buen porcentaje de las pacientes intervenidas de cesárea, con una incidencia similar de hipotensión y genera menor bloqueo motor intraoperatorio con similar extensión del bloqueo sensitivo. La dosis baja no fue eficaz en 2 pacientes (10%de los casos)

INTRODUCTION: Spinal anesthesia is the technique most often applied in cases of scheduled cesarean section. Many authors have tried decreasing the local anesthetic dose by adding opioids to achieve adequate analgesia with greater hemodynamic stability, although the ideal dose remains to be established. Our aim was to analyze hemodynamic stability and quality of analgesia with 2 different regimens for administering spinal hyperbaric bupivacaine. METHODS: We designed a controlled, double-blind trial comparing 2 doses of spinal hyperbaric bupivacaine with fentanyl in 42 patients undergoing elective cesarean section randomized to 2 groups to receive either the low dose or the conventional one. One group received an 11 mg dose of bupivacaine and the other group received a 6.5 mg dose, combined with 20 g of fentanyl in both cases. RESULTS: The hemodynamic profile and the level of maximum sensory block obtained were similar in the two groups. The motor block was less intense in patients receiving the lower dose and it was necessary to convert 2 patients (10%)to general anesthesia in that group. CONCLUSIONS: Spinal anesthesia with low doses of bupivacaine and fentanyl provides acceptable intraoperative conditions for a high percentage of patients under- going cesarean section, with a similar incidence of hypo- tension. The low dose generates a less intense intraoperative motor blockade with similar spread of the sensory block. The low dose was not efficacious for 10% of the patients who received it

Influence of pH on the transition from yeast-like cells to chlamydospores in Aureobasidium pullulans.

When A. pullulans is grown on a glucose medium with a limiting nitrogen source and low buffer capacity, the yeast-like cells that are originally present undergo a transition to chlamydospores. The initial pH must be around 6 for the transition to take place under optimal conditions. On the above-mentioned medium pH decreases to values below 2 in the first two days; if this decrease is prevented, either by buffering the medium or by repeatedly adjusting the pH to its original value no chlamydospores form.

Influence of carbon and nitrogen sources on the transition from yeast-like cells to chlamydospores in Aureobasidium pullulans.

The transition from yeast-like cells to chlamydospores of Aureobasidium pullulans can be induced by growing the microorganism on a glucose medium with a limiting nitrogen source and a low buffer capacity. When glucose is used as the carbon source, a concentration higher than 3% (w/v) is required to induce the transition. On the other hand, growth limiting concentrations of the N source (ammonium sulphate) are not required, and higher concentrations actually stimulate the appearance of chlamydospores. Other N sources, such as glutamate or ammonium phosphate, do not induce the transition from yeast-like cells to chlamydospores.