Hipermetabolismo cerebeloso mediante 18F-FDG PET/TAC con RM normal en un caso de degeneración cerebelosa paraneoplásica con anticuerpos negativos / Cerebellar hypermetabolism on 18F-FDG PET/CT with normal MRI in a case of paraneoplastic cerebellar degeneration with negative antibodies

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Characterization of gliclazide release from Isabgol husk hydrogel beads by validated HPLC method.

Isabgol husk, a medicinally important natural polysaccharide was applied for fabrication of hydrogel beads by ionic gelation method to incorporate gliclazide. Different strengths of Isabgol husk and sodium alginate were utilized for assessing the process variables on formulation performance. Aqueous solution of calcium chloride in 2, 5 and 8% w/v strength was used as cross-linker for polymeric blends of Isabgol husk and sodium alginate. The formulations were characterized for various parameters such as particle size, swelling index, entrapment efficiency, in vitro release, and release kinetics. The quantification of gliclazide throughout the study was performed by HPLC method which was validated according to ICH guidelines for system suitability, linearity, accuracy, sensitivity, precession, robustness, and ruggedness. The surface morphology of beads was observed by scanning electron microscopy. The formed beads were brown, free flowing, spherical, and irregular in structure. The size in different formulations varied from 752.83 +/- 0.630 to 838.62 +/- 0.741 microm. The beads remained for 2-3 h in alkaline phosphate buffer (pH 7.4), after that they showed disintegration. The formulations released up to 95% of loaded gliclazide in phosphate buffer (pH 7.4) within 8 h. No significant difference was observed in parameters studied such as particle size, entrapment efficiency and swelling index for hydrogel beads during accelerated stability study (p > 0.05). The regression equation developed by HPLC method was linear (r5 > 0.9990) over the range 2.5 to 10 microg/mL. The limit of detection (LOD) and limit of quantification (LOQ) were 0.037619 microg/mL and 0.113997 microg/mL, respectively. The observed values for number of theoretical plates (N > or = 2000), tailing factor (T < or = 2), asymmetry factor (AF < or = 1), and relative standard deviation (RSD < or = 1%) of applied method showed the reliability for gliclazide estimation in Isabgol husk hydrogel beads.

Study into the iron content of seminal plasma in normal and infertile subjects.

The iron content in seminal plasma of normal (n19), oligozoospermic (n11), azoospermic (n12), oligoasthenozoospermic (n19), and asthenozoospermic (n17) subjects was estimated by using atomic absorption spectrophotometer. The concentration of iron in normal seminal plasma varied from 265 to 365 mg%. The source of iron in seminal plasma seems to be the adnexal glands and not spermatozoa, as azoospermic semen also contained it. A statistically highly significant difference was seen when normal was compared with azoospermia and with asthenozoospermia. The necessary average wastage of iron through semen is calculated as 2.52 mg/day. This value is highly variable according to the seminal volume and frequency of ejaculation.

The newer unconventional indications of permanent pacemakers.

In recent years, the indications for permanent pacemakers have expanded. The interest has focussed on hypertrophic cardiomyopathy, dilated cardiomyopathy and a new entity called hypertensive hypertrophy with cavity obliteration (HHCO). Pacemaker therapy is establishing itself for the prevention of atrial fibrillation. Pacing for neurocardiogenic syncope with newer pacing mode has encouraging datas. Pacemaker for long QT syndrome, after cardiac transplant and for haemodynamic improvement in occasional cases of first degree atrio-ventricular block is getting attention. The AHA and ACC guidelines updated in 1998 for implantation of cardiac pacemakers, now include several of these newer indications.

Traumatic carotid cavernous fistula: anatomical variations and their treatment by detachable balloons.

Endovascular balloon occlusion has become a standard mode of therapy in carotid cavernous fistulas. Many angioarchitectural variations are, however, encountered in individual cases, some of which influence the therapeutic mode and outcome. We report on three patients with carotid cavernous fistulas treated by endovascular techniques.

How does experimental pulmonary embolism decrease CO2 elimination?

To test how large pulmonary embolism changes non-steady state CO2 kinetics, the right pulmonary artery (RPA) was occluded in 5 anesthetized, ventilated, thoracotomized dogs. By 1 min after RPA occlusion, CO2 volume exhaled per breath (VCO2,br) decreased from 9.3 +/- 2.8 to 7.0 +/- 2.6 ml and end-tidal PCO2 (PETCO2) decreased from 28.7 +/- 4.2 to 21.8 +/- 3.3 Torr. During the ensuing 70 min, VCO2,br increased back to baseline but PETCO2 was still 13% less than baseline. Both PaCO2 (41.5 +/- 1.7 to 55.1 +/- 8.1 Torr) and PvCO2 (48.2 +/- 1.9 to 62.8 +/- 6.5 Torr) steadily increased and approached equilibrium by 45 min of RPA occlusion. Cardiac output did not significantly change. In summary, RPA occlusion immediately decreased VCO2,br by 25%, due mostly to increased alveolar VD (VDalv). Then, VCO2,br recovered back to baseline as CO2 accumulated in tissues and lung. In contrast, elevated VDalv caused persistent decreased PETCO2, which did not detect recovery of VCO2,br nor increase in PaCO2 during RPA occlusion.

Carbon dioxide elimination measures resolution of experimental pulmonary embolus in dogs.

Patients with severe pulmonary embolism can suffer progressive hypercapnia refractory to supramaximal mechanical ventilation, and may require open-thoracic or transvenous emergency embolectomy in addition to anticoagulation and/or thrombolysis. The functional recovery of gas exchange would be signaled by an increase in pulmonary CO2 elimination and decrease in CO2 retention; such data could guide the course of operative embolectomy. Accordingly, we studied five chloralose-urethane anesthetized, mechanically ventilated dogs with open thoraces in which the right pulmonary arteries (RPAs) were reversibly occluded with cloth snares. After waiting for steady state, we abruptly released the snare to restore RPA perfusion and experimentally simulate resolution of pulmonary embolism. For 70 min we serially measure the CO2 volume exhaled per breath (VCO2,br), arterial, mixed venous, and end-tidal PCO2 (PACO2, PVCO2, PETCO2), cardiac output (QT), and the alveolar dead space fraction (VDalv/VTalv = [PaCO2 - PETCO2/PaCO2). RPA reperfusion caused VCO2,br to significantly and abruptly increase from 8.9 +/- 2.7 to 11.6 +/- 3.6 mL; 70 min later VCO2,br had returned to baseline. PaCO2 and PVCO2 steadily decreased during 70 min of RPA reperfusion. PETCO2 increased from 25 +/- 5 to 33 +/- 5 mm Hg immediately after RPA reperfusion, as VDalv/VTalv decreased from 54% +/- 10% to 32% +/- 12%, but PETCO2 was still significantly greater than baseline at 70 min of RPA reperfusion. QT did not significantly change. We conclude that intraoperative measurement of VCO2,br should immediately detect and follow the resolution of CO2 retention in the lung and peripheral tissues after RPA reperfusion. PETCO2 could not detect the decrease of VCO2,br back to baseline because PETCO2 does not measure exhaled volume or the PCO2 waveform.

Measurement of blood CO2 concentration with a conventional PCO2 analyzer.

OBJECTIVES: CO2 content can be determined from the Pco2 in an acidified (forces all CO2 into solution) and diluted blood sample. However, Pco2 concentrations measured in conventional blood gas analyzers are only correct for samples with a significant buffer capacity (such as whole blood), so that mixing with the Pco2 in the rinse solution and tubing walls does not significantly change the sample Pco2. This study describes a calibration method and validation data for the Radiometer Medical ABL2 CO2 electrode system to accurately measure unbuffered blood samples used in the determination of blood CO2 content (or other aqueous fluids). DESIGN: Prospective, criterion standard. SETTING: Laboratory. MEASUREMENTS AND MAIN RESULTS: Blood samples (0.4 mL) were acidified and diluted with 0.2 M lactic acid. After measuring Pco2, CO2 content was calculated using the CO2 solubility coefficient and the dilution factor of 20. CO2 content was determined in a series of sodium carbonate (Na2CO3) solutions spanning the physiologic range of CO2 content. Regression of the measured vs. the actual CO2 content data generated a straight line with a slope of 0.796 and y-intercept of 12.5 (r2 = .99; n = 48). These coefficients were successfully used to correct CO2 content determined in blood samples into which graduated amounts of sodium carbonate were added. CONCLUSIONS: This calibration procedure allows accurate measurement of Pco2 in aqueous samples using the Radiometer ABL2 electrode system, and should be applicable to other blood gas analyzers. Necessary syringes and chemicals are readily available, the method is fast and simple, and the sample volume is small. In the practice of critical care medicine, accurate Pco2 measurement in aqueous acidified and diluted blood provides direct determination of blood CO2 content (useful in calculations of modified Fick cardiac output or tissue CO2 production). Determinations of absolute CO2 content in blood requiring complex methodology are not necessary. In addition, accurate measurement of aqueous gastric Pco2 can help determine gastric pH, which is an important marker of tissue perfusion.

How does positive end-expiratory pressure decrease CO2 elimination from the lung?

Six chloralose-urethane anesthetized dogs (23 +/- 2 kg) underwent median thoracotomy (open pleural spaces) and constant mechanical ventilation with O2. We conducted measurements at baseline and during 25 min of ventilation with 3.3 cmH2O positive end-expiratory pressure (PEEP3) or 10.7 cmH2O PEEP (PEEP 11), including breath-by-breath values in the first 2 min after PEEP began. PEEP 11 immediately decreased pulmonary CO2 elimination per breath (VCO2,br, digital integration and multiplication of exhaled flow and FCO2) from 8.4 +/- 2.0 to 4.5 +/- 1.6 ml (P < 0.05) by significantly decreasing alveolar ventilation (VA) (29% increase in anatomical dead space (VDana) and generation of high VA/Q regions) and by decreasing alveolar PCO2 (PACO2) from 42.5 +/- 3.5 to 35.9 +/- 3.5 Torr (decreased CO2 transfer to the lung as electromagnetic aortic cardiac output (QT) decreased by 51%). The immediate dilution of alveolar gas and PACO2 by fresh gas as PEEP increased functional residual capacity by 1152 +/- 216 ml was offset by simultaneous decreased expiratory volume and, hence, CO2 accumulation. Compared to baseline, the 17% reduction in VCO2,br was sustained at 25 min after addition of PEEP 11 because VA remained depressed. Then, VCO2,br could only be restored to baseline if PACO2 sufficiently increased. However, CO2 transport was still in unsteady state at 25 min of PEEP. Peripheral tissue retention of CO2 and the significant increase in mixed venous PCO2 (PVCO2, 62.4 +/- 6.2 Torr) were not enough to normalize CO2 transfer to the lung and to sufficiently increase PACO2, especially during the continued depression in QT that occurred at higher PEEP. The sustained decrease in VCO2,br during PEEP was not mirrored by changes in end-tidal PCO2 (PETCO2).

Comparison of end-tidal PCO2 and average alveolar expired PCO2 during positive end-expiratory pressure.

The measurement of average alveolar expired PCO2 (PAECO2) weights each PCO2 value on the alveolar plateau of the CO2 expirogram by the simultaneous change in exhaled volume. PAECO2 can be determined from a modified analysis of the Fowler anatomic dead space (VDANAT). In contrast, end-tidal PCO2 (PETCO2) only measures PCO2 in the last small volume of exhalate. In conditions such as mechanical ventilation with positive end-expiratory pressure (PEEP), where the alveolar plateau can have a significant positive slope, we questioned how much PETCO2 could overestimate PAECO2. Accordingly, in six anesthetized ventilated dogs, we digitally measured and processed tidal PCO2 and flow to determine VDANAT. We determined PETCO2 and PAECO before and after the application of 7.6 cm H2O PEEP. Alveolar dead space to tidal volume fraction (VD/VT) was determined by [arterial PCO2- alveolar PCO2]/arterial PCO2, where alveolar PCO2 was determined by either PETCO2 or PAECO2. During baseline ventilation, PETCO2 was 3.4 mm Hg (approximately 11%) greater than PAECO2. Because PEEP significantly increased the slope of the alveolar plateau from 28 to 74 mm Hg/L, the difference between PETCO2 and PAECO2 significantly increased to 6.6 mm Hg (approximately 20% difference). The concurrent increase in VDANAT during PEEP decreased alveolar tidal volume and tended to limit the overestimation of PETCO2 compared to PAECO2. When alveolar PCO2 was estimated by PETCO2, alveolar VD/VT was 18%, compared to an alveolar VD/VT of 26% when alveolar PCO2 was estimated by PAECO2. This difference was significantly magnified during PEEP ventilation. The overestimation of PAECO2 by PETCO2 can result in a falsely high assessment of overall alveolar PCO2. Moreover, the use of PETCO2 to estimate alveolar PCO2 in the determination of the alveolar dead space fraction can result in falsely low and even negative values of alveolar dead space.

Capnometer transport delay: measurement and clinical implications.

The sidestream capnogram is delayed behind real time by transport delay (TD; time to aspirate gas through the sampling tubing) and by the dynamic response (DR) of the measurement cuvette. In six capnometers, we measured TD and DR by plunging the end of the sample tubing into a flask containing CO2 and then digitally analyzing the capnogram. TD ranged from 0.6 to 5.0 s and accounted for 89% or more of the total response time (TD + DR) of the capnometer. TD was generally not reported in the manufacturers' specifications. TD was further prolonged by low aspiration rates or by sampling tube extensions. During a series of quick breaths after endotracheal intubation, long TD can delay the appearance of CO2 and result in a false diagnosis of esophageal intubation. Also, long TD can prolong DR, which can result in underestimation of end-tidal PCO2 during rapid ventilation in pediatric anesthesia.

Preliminary study to assay plasma amethocaine concentrations after topical application of a new local anaesthetic cream containing amethocaine.

Plasma concentrations of amethocaine were measured after topical application of amethocaine cream 2 g (5% w/w) to the dorsum of the right hand of 10 adult volunteers. The cream was applied for 240 min and plasma was assayed for amethocaine and its metabolite p-n-butylaminobenzoic acid at 0, 30, 60, 90, 120 and 240 min in all 10 volunteers, and at 360 min in seven volunteers, by high pressure liquid chromatography. No amethocaine was detected in the plasma of seven volunteers. Plasma concentrations of amethocaine up to 0.20 mg litre-1 were observed in three volunteers. No significant side effects were seen and pain scores on insertion of a 16-gauge cannula were 0 in all subjects. We conclude that the absence of clinical toxicity in the 10 healthy volunteers was a reflection of slow absorption and tissue hydrolysis of amethocaine after topical dermal application.

The effect of changes in arm temperature on neuromuscular monitoring in the presence of atracurium blockade.

This study was designed to investigate the relationship between arm temperature and the degree of blockade as monitored by peripheral nerve stimulation by a comparison of both arms of each patient; one exposed to the environment and the other wrapped to maintain its temperature. The decrease in the temperatures of the exposed arms were significantly more than the wrapped arms. A discrepancy was noted proportional to the temperature difference between the two arms, when the train-of-four counts were compared. A recommendation is made to maintain the temperature of the monitored arm above 32 degrees C.

[Zinc in the seminal fluid]. / Le zinc dans le plasma séminal.

The authors review the literature concerning analytical and experimental studies of zinc in seminal fluid: its origins, its secretion, its measurement, its usefulness and its pathology.

Interdependence of count and motility of spermatozoa.

The importance of the selection of two parameters namely total sperm count and percentage of sperm motility in the study of semen is discussed. The statistical analysis of the data of these two variants in normozoospermic, oligozoospermic, oligoasthenozoospermic and asthenozoospermic groups was done. A direct linear relationship between the two variants was found in normozoospermia and in oligoasthenozoospermia. Thus, the prediction of one of the variables is made possible, if the other is known in these groups.

Correlation of sodium and potassium in human seminal plasma with fertilizing capacity of normal, and infertile subjects.

An optimum level for sodium and potassium in seminal plasma for normal sperm motility is observed. A change in the level of any of the two electrolytes leads to disturbance in the motility of sperm and thus into the viability of it.