The activated clotting time in cardiac surgery: should Celite or kaolin be used?

Objectives: Both kaolin- and Celite-activated clotting times (ACT) are used to guide anticoagulation during cardiopulmonary bypass. It is unknown whether these methods lead to similar management procedures for anticoagulation in patients and are thus interchangeable in terms of bias, precision and variability. Methods: We randomized 97 patients undergoing coronary artery bypass grafting or aortic valve replacement to either kaolin- or Celite-guided anticoagulation. The ACT was measured simultaneously with the other method. We administered 300 IU/kg heparin to obtain initial ACT values greater than 400 s and additional heparin in each group using the minimum value of duplicate measurements according to a predefined protocol. The primary end point was the total heparin dose and the number of heparin supplements. Results: The total heparin dose per patient in the 48 Celite-guided patients was 35 271 ± 12 406 IU with 51 supplements and in the 49 kaolin-guided patients, 35 997 ± 11 540 IU ( P = 0.77) with 56 supplements ( P = 0.53). Postoperative thrombin generation time, fibrinolytic response time, chest tube loss and transfusion requirements were not different between the two groups. However, the methods differed in individual patients with regard to supplemental heparin ( P = 0.002). Bias between methods at baseline was +10.3%, Celite being higher, and changed to a value of -12.9% at 2 h bypass. The coefficient of variation at baseline for individual patients was 2.6 times larger with kaolin than with Celite ( P < 0.001). Correlation between ACT values at baseline was only 45%. Conclusions: Kaolin- and Celite-guided management of anticoagulation is clinically not different, but the methods are not interchangeable. Clinical registration number: www.trialregister.nl identifier 1738.

Housing and dustbathing effects on northern fowl mites (Ornithonyssus sylviarum) and chicken body lice (Menacanthus stramineus) on hens.

Hen housing (cage or cage-free) did not impact overall abundances of northern fowl mites, Ornithonyssus sylviarum (Canestrini & Fanzago) (Acari: Macronyssidae), or chicken body lice, Menacanthus stramineus (Nitzsch) (Phthiraptera: Menoponidae). Cage-free hens received a dustbox with sand plus diatomaceous earth (DE), kaolin clay or sulphur. Weekly use varied from none to 100% of hens; 73% of hens used the dustbox at least once. Ectoparasite populations on dustbathing hens (users) were compared with those on non-user cage-free and caged hens. All materials reduced ectoparasites on user hens by 80-100% after 1 week of dustbox use. Diatomaceous earth and kaolin failed to reduce ectoparasites on non-user hens, and ectoparasites on user hens recovered after dustbox removal. A sulphur dustbox eliminated mites from all hens (including non-users) within 2-4 weeks. Residual sulphur controlled mites until the end of the experiment (up to 9 weeks), even after the dustbox was removed. Louse populations on hens using the sulphur dustbox were reduced in 1-2 weeks. Residual sulphur effects were less evident in lice, but the use of a sulphur dustbox by a higher proportion of hens extended louse control to all hens. This is the first experimental study to show that bird dustbathing in naturally and widely available dust materials (particularly kaolin) can suppress ectoparasites and thus the behaviour is probably adaptive.

[Paraquat poisoning and hemoperfusion with activated charcoal]. / Envenenamiento por Paraquat y hemoperfusión con carbón activado.

Paraquat is a common herbicide in Spain. In our country there are a few cases of this intoxication and it presents a high mortality even if the patients ingest a minimal amount. We present two cases of accidental poisoning with paraquat. These patients were admitted three hours after ingestion of toxin. They were treated with with orogastric lavage, activated charcoal, N-acetylcysteine, Fuller's earth, cathartics, support measures and hemoperfusion with activated charcoal. With these treatments both patients had a undetectable levels of paraquat 48 hours after and improvement of their symptoms, gastric and intestinal predominantly . We present the graphics of evolution of the plasma and urine levels of paraquat in both patients. We review the different aspects of treatment and update of this poisoning.

Colonization by diatoms and antirheumatic activity of thermal mud.

We have identified diatoms among other thermophilic microorganisms as the main agents for the colonization of thermal mud resulting in a 'maturation' which renders the mud suitable to be used for mud-pack treatment of osteoarthrosis patients. The main effects of the diatom growth are the progressive enrichment of mud extracts in chlorophyll a parallel to the building up of a sulfoglycolipid endowed with an anti-inflammatory action. The sulfoglycolipid was also produced by diatoms isolated from the mud and cultivated in vitro.

The usefulness of celite-activated thromboelastography for evaluation of fibrinolysis.

PURPOSE: Although thromboelastography is useful for measuring both coagulability and fibrinolysis, it takes about two hours to measure all parameters including fibrinolytic rate. The present study aimed to investigate the usefulness of celite-activated thromboelastography (TEGc) to evaluate fibrinolytic status in non-cardiac surgery. METHODS: Whole blood samples were obtained from 30 patients for non-cardiac surgery, and used for measurements of both native TEG (TEGn) and TEGc. The final concentration of 1% (w/v) celite was used for TEGc. RESULTS: Time for measurement of the fibrinolytic rate (FR) of TEGc in patients (56.7 +/- 4.0 min) was less than half that of FR of TEGn (123.3 +/- 15.6 min) (P < 0.05), suggesting a more rapid assessment of fibrinolytic status. A linear relationship was observed between FR values of TEGc and those of TEGn (r = 0.93, P < 0.0001), suggesting the usefulness of the fibrinolytic parameter of TEGc. CONCLUSION: TEGc is a useful technique for a more rapid assessment of fibrinolytic status.

The effect of strontium chloride hexahydrate dentifrices on plaque accumulation and gingival inflammation.

2 strontium chloride hexahydrate-containing dentifrices (SCH), similar except for their respective abrasive systems, diatomaceous earth or silica-based, were compared for their effects on plaque accumulation and gingival inflammation as part of a 2-month randomised double-blind parallel clinical study. No attempt was made to change the patients' oral hygiene prior to participation in the study. Plaque was assessed using the Silness & Löe index and the gingival condition by the Löe & Silness index GI. There was a slight and non-significant increase in plaque accumulation at 2 weeks from baseline, but relatively negligible change thereafter, the effect being identical in both groups. Similarly, the gingival condition showed a slight index change from baseline, although it tended to be slightly higher in the diatomaceous earth group. The results do not support the conclusions of previous studies which indicated that SCH dentifrices increased plaque accumulation. Neither plaque accumulation nor gingival condition significantly changed from baseline levels during the course of the study.

Dentifrice abrasivity and cervical dentinal hypersensitivity. Results 12 weeks following cessation of 8 weeks' supervised use.

Following an 8-week controlled investigation of 2 strontium chloride hexahydrate dentifrices (SCH) of differing abrasivity, 2 groups of 20 subjects each, with cervical dentinal hypersensitivity, were re-examined at 20 weeks; that is, 12 weeks after the active period. The examination procedures were conducted in the same manner as in the main clinical trial. Sensitivity levels were assessed by 2 instrument methods: tactile (Yeaple probe), and cold air (dental air syringe), and by subjective perception of pain by means of a Visual Analogue Scale. The results from these methods of assessment demonstrated that 12 weeks following the cessation of 8 weeks' controlled use of standard and low abrasive SCH dentifrices, sensitivity levels reversed on slightly in both groups and, overall, sensitivity remained significantly lower than at baseline. The abrasivity of the dentifrice did not affect the desensitivity activity.