Prueba de Clements en contenido gástrico de recién nacidos en la predicción de madurez pulmonar / Clements' test in gastric aspirate of newborn infant inb the prediction of pulmonary maturity

Se estudió la madurez pulmonar neonatal mediante la prueba rápida de Clements para surfactante en 52 muestras de contenido gástrico de recién nacidos por intervención cesárea, obtenidas en los primeros minutos de vida. El aspecto físico, el grado de acidez, la citología y la prueba de Clements dieron resultados similares en estas muestras que en otras de líquido amniótico tomadas precozmente durante la cesárea. En el período neonatal ninguno de los 47 recién nacidos con prueba de Clements positiva en el contenido gástrico sufrió síndrome de dificultad respiratoria en contraste con 4 de 5, con resultados intermedios o negativos

Quantitative estimates of N-nitrosotrimethylurea formation in the porcine stomach.

Gastric formation of N-nitrosotrimethylurea (NTMU) was quantified by repeated sampling of the gastric contents of full-sized fistulated pigs after the addition of 250 mumol trimethylurea (TMU) and 25-125 mumol nitrite. Maximum gastric nitrite concentration was 100-500 microM based on the gastric volume and amount of added nitrite, which is within the range reported in human gastric contents. The total amount of NTMU formed over time was quantified by estimating both the NTMU concentration and gastric volume using multiple additions of polyethylene glycol. Administration of 25 mumol of nitrite resulted in the formation of 320 nmol of NTMU. The total amount of NTMU formed was linearly related to nitrite dose. Conversion of nitrite to NTMU was of the order of 1-3%. Potassium thiocyanate (200-2000 mumol) had no effect on NTMU formation when given immediately preceding 75 mumol nitrite. Ascorbic acid at 225 and 341 mumol (0.66 and 1.0 of the recommended dietary allowance) inhibited nitrosation of TMU by an average of 54 and 84%. A pig with an average gastric pH of 1.9 formed 4.5-fold more NTMU than did a second pig at pH 4.8. These results suggest that low micromolar amounts of N-nitrosoureas can be formed in the normal stomach when nitrite is consumed in amounts to which humans are commonly exposed.

Absorption of beta-casomorphins from autoperfused lamb and piglet small intestine.

beta-Casomorphins (beta-CMs) derived from milk beta-casein may exert various opiate activities in milk-fed infants. To assess the physiological significance of beta-CMs as a source of circulating opioids in infants, we measured absorption rates of several beta-CMs under near-physiological conditions using in situ autoperfused lamb intestine. The naturally occurring beta-CMs, beta-CM-7 and beta-CM-4-amide, were absorbed readily into blood with no transfer into lymph. Uptake peaked within several minutes of the luminal infusion of peptide but then declined sharply and stopped within a further 10-15 min. The recovery in blood, intestinal contents, and tissue at the end of the 30-min experiment was less than 1% of the infused dose. The low recovery was due to rapid proteolysis based on in vitro studies that demonstrated half-lives of less than 5 min in lamb blood, luminal contents, and lymph. The synthetic dipeptidyl peptidase IV-resistant analogue beta-[D-Ala2]CM- 4-amide was stable during incubation in blood, lymph, or luminal contents and was absorbed into blood at rates that were maximal within several minutes and remained steady for the 30-min period. We conclude that although natural beta-CMs are transferred across the lamb small intestine, rapid degradation within the intestinal lumen, gut epithelium, and blood would prevent entry into the circulation under normal conditions. Val-beta-CM-7, a putative stable precursor, had similar stability and kinetics of absorption to beta-CM-7, results that exclude Val-beta-CM-7 as a stable precursor for delivery of beta-CMs to the circulation. Essentially identical results to those in lambs were obtained in 7-day-old piglets.

Clear fluids three hours before surgery do not affect the gastric fluid contents of children.

This prospective, randomized, single-blind study of 121 healthy children aged 2 to 12 yr investigated the effect of clear fluids on gastric contents. Gastric fluid volume and pH were measured immediately following the induction of general anaesthesia and were not significantly affected by the ingestion of unlimited clear fluids up to three hours preoperatively. After a prolonged fast (mean fast 14 hr), gastric fluid volume was 0.39 +/- 0.37 ml.kg-1 and gastric pH was 1.7 +/- 0.4; after unlimited clear fluids (203 +/- 109 ml) up to three hours before surgery gastric fluid volume was 0.34 +/- 0.28 ml.kg-1 and gastric pH was 1.8 +/- 0.7 (mean +/- SD). Gastric fluid volume (ml.kg-1) increased in both the control and study groups as age increased, P less than 0.005. It is concluded that drinking clear fluid up to three hours before scheduled surgery does not have a measurable effect on gastric volume and pH of healthy children of ages 2 to 12 yr.

Occurrence of gastroesophageal reflux on induction of anaesthesia does not correlate with the volume of gastric contents.

In an attempt to explain the discrepancy between the high number of patients said to be at risk of aspiration pneumonitis and the low reported incidence of this anaesthetic complication, 100 ASA physical status I-II elective surgical patients were studied. The volume of fluid present in the stomach at the time of induction of anaesthesia was correlated with gastroesophageal reflux (GER) detected by visual inspection of the pharynx and by continuous measurement of upper oesophageal pH. Mean gastric volume was 30 +/- 28 ml (range 0-210 ml). Gastric fluid volume greater than or equal to 0.4 ml.kg-1 at pH less than or equal to 2.5 was present in 46 patients. No GER was detected during induction of anaesthesia in our sample of 100 patients. Furthermore, patient age, duration of preoperative fasting, body mass index, cigarette smoking, alcohol consumption, preoperative anxiety, and a history of preoperative GER were not correlated with significant modifications of gastric volume or pH. We conclude that the low incidence of aspiration pneumonitis in elective surgical patients may be explained in part by the very low risk of GER, despite gastric fluid volumes of more than 0.4 ml.kg-1 in a high proportion of this patient population.

Effect of ingestion of fat on ileostomy effluent.

Infusion of fat into the ileum slows small bowel transit and increases absorption of a carbohydrate meal. Paired studies were undertaken to investigate the effect of adding fat to the diet on gastrointestinal transit and absorption in eight people with terminal ileostomies. Each subject ate a daily diet that contained either low or high levels of fat but equivalent amounts of carbohydrate, protein, and fibre. Solid and liquid markers were added to the food to measure transit times. The ileostomy outputs after the meals were analysed for protein, fat, carbohydrate, polyethylene glycol, and the delivery of solid markers. All subjects produced more ileal effluent while taking the high fat diet compared with the low fat diet. Fat and protein outputs were significantly higher on the high fat days, but a greater proportion of the fat was absorbed during the high fat diet compared with the low fat diet. The output of carbohydrate on the two diets was not significantly different. The incorporation of fat in the diet produced no significant differences in the transit times of the first marker, but a slight prolongation of the transit time of the second marker. Increasing the fat content of the diet did not slow small bowel transit or increase nutrient absorption. The increase in protein and water output could be explained by an increased secretion of pancreatic enzymes.

Influence of grain and monensin supplementation on ruminal fermentation, intake, digesta kinetics and incidence and severity of frothy bloat in steers grazing winter wheat pastures.

Three 10-d collection periods (April 4 to 14, early April, EApr; April 23 to May 3, late April, LApr; May 10 to 20, 1984, mid-May, MMay) were conducted to evaluate effects of no supplement (C), .5 kg-head-1.d-1 (as-fed basis) supplemental grain (steam-flaked milo, G) or G plus 170 mg monensin.head-1.d-1 (M) on forage intake and digestion by 12 ruminally cannulated beef steers (four/treatment; avg initially BW = 393 kg) grazing irrigated winter wheat pasture. Ruminal pH was greater (P less than .01) for M than for C or G during EApr but was not altered by treatments in LApr or MMay. Compared with C, ruminal NH3 was decreased (P less than .10) by G and M (5 h after supplementation) in EApr, decreased (P less than .05) by G (2h) and increased (P less than .05) by M (8 h) in LApr and decreased (P less than .10) by G (-1h) in MMay. Treatments had little influence on total VFA concentrations or on molar proportions of acetate and propionate. Butyrate molar proportion was decreased (P less than .10) by M during EApr and LApr, but not during MMay. Monensin increased (P less than .05) fluid passage rate compared with C and G in EApr but not in other periods, Particulate passage measurements did not differ (P greater than .10) among treatments within periods. Forage DM intake was not influenced (P greater than .10) by supplementation during any period. Extent of in situ forage DM disappearance was greater (P less than .10) for M than for C or G during EApr (12 and 30 h of incubation) but was not different (P greater than .10) in LApr or MMay. Incidence of frothy bloat was decreased (P less than .05) by M during EApr; this reduction may have been related to effects of M on ruminal pH, forage digestion and fluid passage.

Ingestion of liquids compared with preoperative fasting in pediatric outpatients.

The preoperative fast is often an unpleasant preoperative experience that might be alleviated by allowing children to drink clear liquids. The authors compared gastric fluid volume and pH in two groups of children, one of whom was permitted clear liquids until 2 h before surgery (study group) and the other followed routine preoperative fasting orders (control group). The study group was not limited in the quantity of clear liquid allowed with the exception that the last intake prior to surgery was limited to 8 ounces. The study group (n = 53) averaged 5.9 +/- 5 yr and weighed 23.6 +/- 17 kg, while the control group averaged 7.3 +/- 4.6 yr and weighed 29 +/- 17.7 kg (P = NS). Gastric contents were aspirated following induction of anesthesia. Gastric fluid volume averaged 0.44 +/- 0.51 ml/kg for study group and 0.57 +/- 0.51 ml/kg in the control group (P = 0.12). Of the study patients, 48% had a measured gastric fluid volume greater than or equal to 0.4 ml/kg compared with 58% of the control patients (P = 0.77). Eighty three patients had sufficient gastric fluid for pH determination; of these 34/35 (97%) in the study group and 44/48 (92%) in the control group had a gastric fluid pH less than or equal to 2.5. Using a linear analog scale parents rated the children in the study group to be less irritable (P less than 0.001) and to have had a better overall preoperative experience (P less than 0.01) compared with the control patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of ginger & garlic on DNA content of gastric aspirate.

DNA content of gastric aspirates was studied before and after intragastric infusions of three doses of ginger (2, 4, 6 g) and four doses of garlic (0.3, 0.75, 1.5, 3 g) on different days in volunteers. Only one dose was administered on any day. The mean changes of DNA-p/min in gastric aspirates after intragastric infusions of 2 and 4 g ginger were -1.37 +/- 2.3 and 6.74 +/- 3.06 respectively, which were not significant statistically. However, 6 g ginger given intragastrically showed a mean significant increase in DNA-p/min of 3.23 +/- 1.02 (P less than 0.05). Intragastric infusion of 0.3 g uncooked garlic showed a non-significant increase in DNA-p/min of 0.307 +/- 0.59. On the other hand, infusion of 0.75, 1.5 and 3 g of uncooked garlic each caused significant increase in DNA-p/min of 5.47 +/- 1.63 (P less than 0.01), 10.42 +/- 3.46 (P less than 0.01) and 29.26 +/- 4.55 (P less than 0.001) respectively. Infusion of 3 g of cooked garlic also showed significant increase in DNA-p/min of 21.43 +/- 4.62 (P less than 0.001). There was no significant difference between the effect of cooked and uncooked (3 g) garlic. Ginger in quantities of 6 g or more and garlic in quantities of 0.75 g or more cause a significant increase in exfoliation of gastric surface epithelial cells in human subjects.

A dextromoramide-related fatality.

A 38-year-old man was found in his car suffering from a heart attack. Serum analysis by capillary gas chromatography and mass spectrometry confirmed the presence of dextromoramide (Palfium), methadone, and lidocaine. The serum concentrations at admission to the hospital were: 1.9 micrograms/mL of dextromoramide, 0.4 micrograms/mL of methadone, and 0.4 micrograms/mL of lidocaine. A serum alcohol analysis performed using headspace gas chromatography was negative.

[Changes in pancreatic secretion in alcoholic liver disease]. / Modificaciones de la secreción pancreática en la enfermedad hepática alcohólica.

By means of consecutive pancreatic stimulation, we have investigated the presence of changes of pancreatic function in alcoholic patients, with and without alcoholic liver disease, in order to detect functional alterations and possible association of hepatic and pancreatic disease. The patients were 49 chronic alcoholics (8 patients without liver disease, 11 hepatic steatosis, 9 alcoholic hepatitis and 21 alcoholic cirrhosis) and 15 non alcoholic subjects (8 normal controls and 7 cases of non alcoholic cirrhosis). In all the cases two consecutive stimulations were carried out: first with secretin and cholecystokinin (CCK) and second with CCK alone. The total volume and concentration as well as the output of bicarbonate, trypsin, amylase and total proteins were measured in the duodenal juice. Patients with alcoholic cirrhosis had larger volumes of duodenal juice and lower concentrations of bicarbonate, enzymes and proteins. There was also a tendency to larger volume and lower bicarbonate concentration as the hepatic lesion was more severe. Bicarbonate output was significatively higher in patients with alcoholic cirrhosis but for the remaining parameters the outputs were similar in all the groups. In conclusion, the alterations in pancreatic function parallel the severity of the liver disease. None of the patients had changes consistent with chronic pancreatitis.

[The occurrence of feed-induced stomach ulcers in horses]. / Beobachtungen zum Vorkommen fütterungsbedingter Magenulcera beim Pferd.

Ponies were fed hay (n = 21) or mixed feed (n = 27; 128 g crude protein, 175 g crude fibre/kg dry matter) for at least 14 days (treatment against parasites with ivermectin before the experimental period). The feeding level was 18 g dry mater/kg body weight/day. After the feeding period (the experiments were conducted to investigate the water and electrolyte content of the alimentary tract in dependence on feed, feeding time and physical exercise) the ponies were slaughtered and the stomachs were visually controlled for the occurrence of ulcers. In the hay group no gastric ulcers were observed, but from the 27 ponies given mixed feed 10 (chi 2 = 7.71) animals showed ulcers on the cutaneous mucosa of the pars oesophagea localized along the margo plicatus. At 3.5 hours postprandial the percentage of dry matter in gastric contents of concentrate fed ponies was higher than in those which consumed hay; 12 hours after feeding the opposite took place. The gastric fill was rather similar, while the amount of chlorine and the pH-value respectively were 37 (+/- 16) mg/kg BW and 3.83 (+/- 0.83; n = 8) respectively in hay fed animals compared to 45 (+/- 17) mg/kg BW and 4.84 (+/- 0.55; n = 11) respectively in ponies, which consumed the mixed feed.

[Tablet residues in gastrointestinal contents? A polarization microscopy screening method for rapid evaluation at the autopsy table]. / Tablettenreste im Magen-Darminhalt? Eine polarisationsmikroskopische Suchmethode zur raschen Aussage am Sektionstisch.

When tablet residues are found in the gastrointestinal tract during autopsy, this does not only indicate the possible presence of intoxication, but may also provide indications with the regard to the kind of intoxication (e.g. suicide) if the amount of tablets is considered. If tablets have already dissolved and thus large portions can no longer be detected with the naked eye, a definitive appraisal with regard to the presence of tablet residues is often difficult or even impossible on the autopsy table. A polarization microscopic screening method is described which enables identification of characteristic tablet auxiliary substances (maize starch, sodium carboxymethyl starch, microcristalline cellulose or sodium carboxymethyl cellulose) to be identified immediately and simply in the gastrointestinal contents. It also enables a rapid orientative screening for tablet residues in glasses found or the fluid these contained as well as in aspirated material and vomit. If the active agent of the tablet can be detected by chemical toxicology, the polarization microscopic diagnosis of abundant tablet auxiliary substances is compatible with intake of large amounts of drugs, which makes self-administration highly probable.

Factors affecting the potassium concentration at the mucosal surface of the proximal and the distal colon of guinea pig.

K+ concentrations were measured in vitro with K+ sensitive microelectrodes in the microclimate at the luminal cell surface of the colon of guinea pigs. The serosal K+ concentration was mostly 5.4 mmol/1, the mucosal K+ concentrations were changed (0, 5, 50, or 70 mmol/l). Under control conditions K+ concentrations in the microclimate of the proximal colon were also low (6-9 mmol/l) and rather independent from K+ concentrations in the bulk luminal solution. In the distal colon K+ concentrations in the microclimate increased from 3.7 mmol/l when no K+ was in the luminal solution, up to 22 mmol/l when the mucosal K+ concentrations was 70 mmol/l. Attempts to decrease K+ conductance of the apical membrane with Ba++, to impair K+ transport with ouabain and to increase the paracellular shunt with deoxycholic acid did not affect K+ concentrations in the microclimate of the proximal colon but decreased K+ concentrations in the distal colon. When valinomycin or triaminopyrimidine were added to the mucosal solution at high K+ concentrations in the luminal solutions the K+ concentration in the microclimate was raised. At low luminal K+ concentrations valinomycin had no effect, triaminopyrimidine significantly diminished K+ concentrations at the cell surface. Regional differences in paracellular shunt conductance and in the preepithelial diffusion barrier are thought to be responsible for the observed differences between the proximal and the distal colon. Obviously, however, further unknown mechanisms have to be involved.

The effects of postweaning stressors on pig weight change, blood, liver and digestive tract characteristics.

Postweaning growth lag in baby pigs weaned at 28 d was studied by using three weaning stress treatments. Treatments consisted of a control in which pigs continued to nurse the dam, had access to a dry feed at 14 d of age and were not weaned until after the study. Pigs were adjusted to liquid and dry feeds at 14 d of age in Treatments 2 and 3, but sows were removed from the pens at 28 d of age in Treatment 2, whereas sows were removed and room temperature lowered to 13 degrees C in Treatment 3. In Treatment 4, sows were removed but pigs were fed the dry diet only from 28 d of age. Blood and tissue were collected and evaluated every 12 h for 48 h on slaughtered pigs and blood was sampled every 12 h for 132 h from pigs catheterized in the vena cava. Pigs weaned with a dry diet in Treatment 4 were the only pigs to lose weight (P less than .01) and have typical symptoms of postweaning growth lag. These pigs had the lowest (P less than .01) mean plasma glucose, highest (P less than .01) free fatty acids and the highest (P less than .05) cortisol concentrations. Their mean duodenal pH also was higher (P less than .01), whereas pigs given both milk and dry diets and stressed by weaning in a warm or cool room (Treatments 2 and 3) had lower (P less than .01) duodenal pH values than pigs continuing to nurse the sow. In this study, pigs having access to milk and dry diets prior to weaning had no adverse symptoms when the sow was removed regardless of whether or not they were exposed to cold after weaning. However, pigs that were abruptly weaned with a dry diet had slow growth, low plasma glucose, high free fatty acids and low liver glycogen.

Pharmacokinetics and metabolism of fenbendazole in channel catfish.

Fenbendazole (FBZ) was administered intravenously (1 mg/kg) and orally (5 mg/kg) to catheterized, confined channel catfish. Blood samples were collected for 72 h, and resulting FBZ plasma concentrations were pharmacokinetically modelled. Following intravenous administration t 1/2 alpha was 0.51 h, t 1/2 beta was 16.8 h, body clearance (C1B) was 0.0598 L/kg/h, and Vd (area) was 1.45 L/kg. After oral administration the t 1/2 (abs) was 1.47 h, the t 1/2 beta was 20.1 h, and the tlag was 0.1 h. Following oral administration of 5 mg FBZ/kg body weight, the following tissues and body fluids were sampled for concentrations of FBZ, oxfendazole (FBZ-SO), sulphone metabolite (FBZ-SO2) and hydroxy metabolite (FBZ-OH): liver, posterior kidney, fat, muscle, bowel contents and urine. Fenbendazole was detected in the highest concentrations in abdominal fat, whereas oxfendazole was found primarily in the kidney, liver and abdominal fat. The sulphone metabolite was detected only in urine and bowel contents, while the hydroxy metabolite was found most often in the liver and abdominal fat samples.

Volume and acidity of residual gastric fluid after oral fluid ingestion before elective ambulatory surgery.

We studied 211 unselected, healthy, adult patients scheduled to undergo elective ambulatory surgery to determine whether the volume or pH of gastric fluid at induction of anesthesia is correlated with the duration of the preoperative fluid fast. Patients were instructed that they must not eat any solid food after midnight but that they were permitted to drink 150 ml of tea, coffee, apple juice or water until 3 hours before their scheduled time of surgery. Patients with gastric disorders and those taking medications that affect gastric motility or secretion were excluded. No premedicant drugs were given. Following induction of general anesthesia the gastric fluid was aspirated through an orogastric tube, its volume recorded and its pH measured with a calibrated pH meter. The patients were retrospectively assigned to one of four groups according to the interval from last fluid ingestion until induction of anesthesia (less than 3 hours, 3 to 4.9 hours, 5 to 8 hours and nothing after midnight). The mean values and extremes for gastric fluid volume and pH were similar in the four groups. We conclude that healthy patients should be allowed to ingest fluid until 3 hours before elective ambulatory surgery.