Changes in the rumen and colon microbiota and effects of live yeast dietary supplementation during the transition from the dry period to lactation of dairy cows.

The first objective of this study was to evaluate the dynamics and their potential association with animal performance of the microbiota in both the rumen and colon of dairy cows as they move from a nonlactation to a lactation ration. The second objective was to assess the potential effects on the microbiota of live yeast supplementation. Twenty-one Holstein cows were split in 2 treatments consisting of 1 × 1010 cfu/d of live yeast (LY; n = 10) or no supplementation (control; n = 11) starting 21 d before until 21 d after calving. At 14 d before and 7 and 21 d after calving, samples of rumen and colon digesta were obtained from each cow using an endoscope. Total DNA was extracted and submitted to high-throughput sequencing. Shannon diversity index, in both the rumen and colon, was unaffected by LY; however, in the rumen it was lowest 7 d after calving and returned to precalving values at 21 d in milk, whereas in the colon it was greatest 14 d before calving but decreased after calving. In the rumen, LY supplementation increased the relative abundance (RA) of Bacteroidales (group UCG-001), Lachnospiracea (groups UCG-002 and UCG-006), and Flexilinea 14 d before calving, and increased RA of Streptococcus 21 d after calving compared with control cows. However, changes in the ruminal microbiota were more drastic across days relative to calving than as influenced by the dietary treatment, and the effect of LY in the colon was milder than in the rumen. The ruminal RA of several genera was associated with postcalving DMI, and that of Gastranaerophilales was the only order positively associated with milk yield. Several genera were positively correlated with feed efficiency, with Clostridiales (unclassified) being the only genus negatively associated with feed efficiency. In the colon, Prevotellaceae (group Ga6A1) was the only genus positively associated with feed efficiency. The ruminal RA of Prevotella 7 and Ruminobacter 14 d precalving was negatively correlated with dry matter intake and milk yield postcalving. The RA of Parabacteroides in the colon 14 d before calving was negatively correlated with milk yield, whereas the RA of Eggerthellaceae (unclassified) and Erysipelotrichaceae (groups c and unclassified) were positively correlated with feed efficiency. Interestingly, LY supplementation doubled the RA of Eggerthellaceae (unclassified) in the colon. It is concluded that microbial diversity in the rumen experiences a transient reduction after calving, whereas in the colon, the reduction is maintained at least until 21 d in milk. Most of the effects of LY on rumen microbiota were observed before calving, whereas in the colon, LY effects were more moderate but consistent and independent of the stage of production. The microbial community of the rumen after calving is more associated with feed intake, milk yield, and feed efficiency than that of the colon. However, the colon microbiota before calving is more associated with feed efficiency after calving than that of the rumen.

Extracolonic Cancer in Inflammatory Bowel Disease: Data from the GETECCU Eneida Registry.

OBJECTIVES: The objective of this study was (a) To know the prevalence and distribution of extracolonic cancer (EC) in patients with inflammatory bowel disease (IBD); (b) To estimate the incidence rate of EC; (c) To evaluate the association between EC and treatment with immunosuppressants and anti-tumor necrosis factor (TNF) agents. METHODS: This was an observational cohort study. INCLUSION CRITERIA: IBD and inclusion in the ENEIDA Project (a prospectively maintained registry) from GETECCU. EXCLUSION CRITERIA: Patients with EC before the diagnosis of IBD, lack of relevant data for this study, and previous treatment with immunosuppressants other than corticosteroids, thiopurines, methotrexate, or anti-TNF agents. The Kaplan-Meier method was used to evaluate the impact of several variables on the risk of EC, and any differences between survival curves were evaluated using the log-rank test. Stepwise multivariate Cox regression analysis was used to investigate factors potentially associated with the development of EC, including drugs for the treatment of IBD, during follow-up. RESULTS: A total of 11,011 patients met the inclusion criteria and were followed for a median of 98 months. Forty-eight percent of patients (5,303) had been exposed to immunosuppressants or anti-TNF drugs, 45.8% had been exposed to thiopurines, 4.7% to methotrexate, and 21.6% to anti-TNF drugs. The prevalence of EC was 3.6%. In the multivariate analysis, age (HR=1.05, 95% CI=1.04-1.06) and having smoked (hazards ratio (HR)=1.47, 95% confidence interval (CI)=1.10-1.80) were the only variables associated with a higher risk of EC. CONCLUSIONS: Neither immunosuppressants nor anti-TNF drugs seem to increase the risk of EC. Older age and smoking were associated with a higher prevalence of EC.

A nanomedicine to treat ocular surface inflammation: performance on an experimental dry eye murine model.

MUC5AC is a glycoprotein with gel-forming properties, whose altered expression has been implicated in the pathogenesis of dry eye disease. The aim of our study was to achieve an efficient in vivo transfection of MUC5AC, restore its normal levels in an inflamed ocular surface and determine whether restored MUC5AC levels improve ocular surface inflammation. Cationized gelatin-based nanoparticles (NPs) loaded with a plasmid coding a modified MUC5AC protein (pMUC5AC) were instilled in healthy and experimental dry eye (EDE) mice. MUC5AC expression, clinical signs, corneal fluorescein staining and tear production were evaluated. Ocular specimens were processed for histopathologic evaluation, including goblet cell count and CD4 immunostaining. Neither ocular discomfort nor irritation was observed in vivo after NP treatment. Expression of modified MUC5AC was significantly higher in ocular surface tissue of pMUC5AC-NP-treated animals than that of controls. In healthy mice, pMUC5AC-NPs had no effect on fluorescein staining or tear production. In EDE mice, both parameters significantly improved after pMUC5AC-NP treatment. Anterior eye segment of treated mice showed normal architecture and morphology with lack of remarkable inflammatory changes, and a decrease in CD4+ T-cell infiltration. Thus, pMUC5AC-NPs were well tolerated and able to induce the expression of modified MUC5A in ocular surface tissue, leading to reduction of the inflammation and, consequently improving the associated clinical parameters, such as tear production and fluorescein staining. These results identify a potential application of pMUC5AC-NPs as a new therapeutic modality for the treatment of dry eye disease.

[Caso clínico: síndrome de DRESS por hidroxicloroquina].

Background: DRESS syndrome (Drug reaction with eosinophilia and systemic symptoms) is an idiosyncratic reaction characterized by peripheral eosinophilia and systemic symptoms: fever, exanthema, lymphadenopathy, hepatitis, atypical lymphocytes and elevated liver enzymes. The incidence is 1 per 10,000 exposures, mortality 10-20%. Treatment is based on suspension of the suspected drug and steroids. Case report: A 42-year-old male with the following important antecedents. AHF: mother and father with Diabetes Mellitus type 2. APP: Arterial Hypertension, Diabetes Mellitus type 2, and bee sting allergy. Current Condition: He started 8 days after ingestion of hydroxychloroquine for probable SARS-COV-2 infection, with headache, facial and neck edema, desquamative dermatosis on trunk and upper extremities, went to private clinic with torpid evolution sent to third level for increased facial and neck edema, which merited orotracheal intubation, management with intravenous steroids and antihistamines. Labs on admission: Leukocytes 20090, platelets 322 thousand, eosinophilia (5%), elevated liver enzymes and acute kidney injury, fulfilling J-SCAR criteria. The patient was discharged due to adequate evolution with follow-up by Allergy and Clinical Immunology, the patient persists with desquamative lesions after 4 weeks and normalization of laboratory parameters. Conclusions: DRESS is a delayed adverse reaction. It is important the diagnostic presumption and the causal relationship with the drugs due to the high mortality rate.

Antecedentes: El síndrome DRESS (Drug reaction with eosinophilia and systemic symptoms) es una reacción idiosincrática, se caracteriza por eosinofilia perifé- rica y síntomas sistémicos: fiebre, exantema, linfadenopatía, hepatitis, linfocitos atípicos y elevación de enzimas hepáticas. La incidencia es de 1 por cada 10,000 exposiciones, mortalidad de 10 a 20%. El tratamiento se basa en la suspensión del fármaco sospechoso y en la aplicación de esteroides. Reporte de caso: Masculino de 42 años con los siguientes antecedentes de importancia. AHF: madre y padre con Diabetes Mellitus tipo 2. APP: Hipertensión Arterial, Diabetes Mellitus tipo 2, y alergia a picadura de abeja. Padecimiento Actual: Lo inicia posterior a 8 días tras la ingesta de hidroxicloroquina por probable infección por SARS-COV-2, con cefalea, edema facial y de cuello, dermatosis descamativa en tronco y extremidades superiores, acude a clínica particular con evolución tórpida enviado a tercer nivel por aumento de edema facial y cuello, que amerito intubación orotraqueal, manejo con esteroides intravenosos y anti- histamínicos. Laboratorios a su ingreso: Leucocitos 20090, plaquetas 322 mil, eosinofilia (5%), elevación de enzimas hepáticas y lesión renal aguda, cumpliendo criterios J-SCAR. Se egresa por adecuada evolución con seguimiento por Alergia e Inmunología Clínica, el paciente persiste con lesiones descamativas posterior a 4 semanas y normalización de parámetros de laboratorios. Conclusión: DRESS es una reacción adversa retardada. Es importante la presunción diagnóstica y la relación causal con los fármacos por la alta tasa de morta- lidad.

[Our experience in the diagnosis and treatment of cerebral pseudoaneurysms]. / Nuestra experiencia en el diagnóstico y tratamiento de los seudoaneurismas cerebrales.

OBJECTIVE: To present our experience in the diagnosis and intravascular treatment of cerebral pseudoaneurysms. MATERIAL AND METHODS: We present 11 pseudoaneurysms (2 traumatic, 2 mycotic, 3 iatrogenic, and 4 with other causes). We analyze the methods and diagnostic criteria, radiological and clinical outcome, the criteria used in making decisions about treatment, the method of treatment, and the complications. RESULTS: Digital subtraction angiography is the gold standard for the diagnosis of cerebral pseudoaneurysms; the diagnostic criteria in the literature include: aneurysms with early morphological changes and distal aneurysms or proximal aneurysms associated with another distal one, in the context of the right symptoms and signs. In the nine patients treated with endovascular techniques, the treatment objective was achieved and rebleeding did not occur. CONCLUSIONS: In cases with clinical suspicion of a pseudoaneurysm, the patient should undergo angiography. This is especially important in patients with inexplicable cerebral hemorrhage and in those with septicemia. CT angiography and MR angiography have good diagnostic accuracy and can replace conventional angiography. However, the treatment of choice is endovascular and treatment should not be delayed unless access to the pseudoaneurysm is impeded, usually due to severe cerebral vasospasm.

Consequences of a low protein diet on the liver and longissimus dorsi transcriptome of Duroc × Iberian crossbred pigs.

Low protein diets supplied during the growing period of pigs can diminish their growth rate and increase the intramuscular fat (IMF) content which affects the sensorial and technological characteristics of the products. In the present study, the effects of a low protein diet supplied during the growing period of Duroc × Iberian crossbred pigs on several phenotypic traits and on liver and longissimus dorsi transcriptome were analysed at the beginning (EARLY) and at the end (LATE) of the growing period. Two experimental groups of 10 crossbred pigs each were fed two isocaloric diets with different protein content: control diet (C) with 16.5% protein and 0.8% lysine and low protein diet (LP) with 11% CP and 0.6% lysine. Animals fed LP diet have a slower growth than those fed C diet, but no effect of LP diet was observed on the IMF content. The transcriptomes of liver and longissimus dorsi were characterised and quantified through RNA-sequencing (RNA-seq). In liver, 134 and 480 differentially expressed annotated genes and new isoforms (DEGs) were detected between C and LP diets for EARLY and LATE animals, respectively. In muscle, 128 and 68 DEGs were detected at EARLY and LATE time-points. Functional interpretation revealed that LP diet may inhibit immune system molecules and processes in both tissues at EARLY stage. In liver, the DEGs mainly affect lipid and cholesterol metabolic processes, while in muscle, the expression changes would be involved in growth, development and meat quality. In conclusion, a low protein diet supplied during the growing period seems to slow down the growth of Duroc × Iberian crossbred pigs, but it also seems to affect multiple biological processes that could compromise the immune system of Duroc × Iberian crossbred pigs. Therefore, these results question the adequacy of this type of regime in Duroc × Iberian pigs that must be studied in greater depth before being implemented.

[Carboxypeptidase-G2 administration after high-dose methotrexate. Treatment and drug interactions]. / Administración de carboxipeptidasa tras altas dosis de metotrexato. Tratamiento e interacciones medicamentosas.

Methotrexate (MTX) is widely used as anticancer agent in various malignancies, including acute lymphoblastic leukaemia, lymphoma and osteosarcoma. High doses of MTX may cause acute renal dysfunction. Nephrotoxicity is prevented by the use of alkalinization and hydration. More recently Carboxypeptidase-G2, a recombinant bacterial enzyme that rapidly hydrolyzes MTX to inactive metabolites, has become available for the treatment of acute nephrotoxicity. On the other hand, glutamine is usually administered in oncology treatments to avoid other side effects. We report a case of an adolescent who was diagnosed with T lymphoblastic lymphoma. He was receiving treatment with glutamine when the third course of methotrexate was administered (5 g/m(2)) and he suffered a deterioration in his renal function. Carboxypeptidase was used but the methotrexate serum concentration reduction was not satisfactory. The technique to assess the amount of enzyme-inactivated methotrexate by quantification of MTX metabolites is not available in our country, therefore, the concentrations of MTX may be overestimated. The literature was reviewed to study the influence of glutamine on delayed methotrexate elimination which may lead to acute toxicity.

Diagnostic yield of lumbosacral magnetic resonance imaging requested by paediatric urology consultations. / Rentabilidad diagnóstica de la resonancia magnética lumbosacra solicitada desde las consultas de urología pediátrica.

OBJECTIVES: In the historical series, the diagnostic yield of lumbosacral magnetic resonance imaging to rule out occult spinal dysraphism (or occult myelodysplasia), requested by paediatric urology, ranged from 2% to 15%. The aim of this study was to define our cost-effectiveness in children with urinary symptoms and to define endpoints that increase the possibility of finding occult spinal dysraphism. PATIENTS AND METHODS: A screening was conducted on patients with urinary dysfunction for whom an magnetic resonance imaging was requested by the paediatric urology clinic, for persistent symptoms after treatment, voiding dysfunction or other clinical or urodynamic findings. We analysed clinical (UTI, daytime leaks, enuresis, voiding dysfunction, urgency, renal ultrasonography, lumbosacral radiography, history of acute urine retention, skin stigma and myalgia) and urodynamic endpoints (hyperactivity or areflexia, voiding dysfunction, interrupted pattern, accommodation value and maximum flow). A univariate analysis was conducted with SPSS 20.0. RESULTS: We analysed 21 patients during the period 2011-2015. The median age was 6 years (3-10). Three patients (14.3%) had occult spinal dysraphism: one spinal lipoma, one filum lipomatosus and one caudal regression syndrome with channel stenosis. The endpoints with statistically significant differences were the myalgias and the history of acute urine retention (66.7% vs. 5.6%, P=.04; OR= 34; 95%CI: 1.5-781 for both endpoints). CONCLUSIONS: The diagnostic yield of magnetic resonance imaging requested for children with urinary dysfunctions without skin stigma or neuro-orthopaedic abnormalities is low, although nonnegligible. In this group, the patients with a history of acute urine retention and muscle pain (pain, «cramps¼) can experience a greater diagnostic yield or positive predictive value.

Preliminary characterization of dexamethasone-loaded cross-linked hyaluronic acid films for topical ocular therapy.

The aim of this work was to design and characterize cross-linked hyaluronic acid (HA)-itaconic acid (IT) films loaded with dexamethasone sodium phosphate salt (DEX) for topical therapy of inflammatory ocular surface diseases. Films were chemically cross-linked with polyethylene glycol diglycidyl ether (PEGDE), then physical and mechanical characterization by stress-strain, X-ray diffraction, X-ray fluorescence spectrometry and swelling assays was conducted. A sequential in vitro therapeutic efficacy model was designed to assess changes in interleukin (IL)-6 production in an inflamed human corneal epithelial (HCE) cell line after film exposure. Changes in cell proliferation after film exposure were assessed using the alamarBlue(®) proliferation assay. Experimental findings showed desirable mechanical properties and in vitro efficacy to reduce cell inflammation. A moderately decreased proliferation rate was induced in HCE cells by DEX-loaded films, compared to commercial DEX eye drops. These results suggest that DEX and HA have opposite effects. The sequential in vitro therapeutic efficacy model arises as an efficient tool to study drug release from delivery systems by indirect measurement of a biological response.

High performance liquid chromatography methods for studying protein binding of aluminium in human serum in the absence and in the presence of desferrioxamine.

Ion-exchange high performance liquid chromatography of serum proteins was combined with aluminium determination by electrothermal-atomisation-atomic-absorption spectroscopy and fluorimetry for studying the distribution of aluminium in human serum in the absence and in the presence of desferrioxamine. Aluminium was eluted as a single peak in the same fraction as transferrin. However, following the addition of desferrioxamine most of the aluminium was liberated from transferrin and become attached to the chelator.

Omentum flap versus pectoralis major flap in the treatment of mediastinitis.

The outcome of mediastinal reconstruction during the past 10 years at the "Instituto Nacional de Cardiología Ignacio Chávez" (INCIC), Mexico City was compared. A total of 7136 patients were submitted to open heart surgery. Eighty-two patients (1.15 percent) developed mediastinitis, and 33 patients (0.46 percent) developed sternal osteomyelitis. Only patients who developed mediastinitis with sternal osteomyelitis were included in the study. Reconstruction was performed either with a major omentum flap (12 patients) or a pectoralis major flap (21 patients). The sepsis-related mortality rate was higher in the pectoralis group (28.6 percent) than in the omentum group (0 percent) (p < 0.05). All of the postoperative deaths of the pectoralis group were caused by septic shock; in the omentum group, there were no such deaths. It is concluded that mediastinal reconstruction using the omentum flap in patients with mediastinitis secondary to open heart surgery is associated with fewer septic complications than using the pectoralis major flap.

[Lung transplantation in rats: a viable experimental model]. / Trasplante pulmonar en ratas. Un modelo viable de estudio experimental.

OBJECTIVES: To incorporate a new fast, safe, and reversible anesthetic procedure into the experimental model of lung transplantation (LT) using a cuff technique originally described by Mizuta. MATERIAL AND METHOD: Eighty-eight Sprague-Dawley rats were used in the experimental model. Thirty left LTs were performed, using 60 rats. The donor heart-lung block was excised by median sternotomy with dissection of the left lung and cuffs (intravenous catheters cut into 3-mm sections) were put in place. The left lung was implanted in the recipient by lateral thoracotomy using the cuffs for anastomoses. The duration of surgery and postoperative complications were recorded. Also noted were signs of ischemia-reperfusion injury, and acute rejection of the transplanted lung. RESULTS: We discarded lungs excised from 8 animals when developing the experimental model. Transplants could not be completed in 10 rats due to technical problems, despite satisfactory excision. Of the rats who received a transplant, 4 died in the first 24 hours and 26 survived to 48 hours. They were then killed and examined. The state of the anastomoses was good and signs of ischemia-reperfusion injury, as well as acute rejection were observed in the parenchyma of the transplanted lung. CONCLUSIONS: LT with cuffs in rats is a valid, reliable, reproducible, and cheap model for studying ischemia-reperfusion injury and rejection in LT. The surgical technique is complex, requiring experienced surgeons and a long learning process. Modification of the technique to more closely resemble the surgical procedure in humans is possible, thus facilitating interpretation and allowing more reliable extrapolation to humans.

[Malnutrition prevalence in institutionalized elderly people in Valencia Community, Spain]. / Prevalencia de malnutrición entre ancianos institucionalizados en la Comunidad Valenciana.

BACKGROUND: The goal of this study was to know the prevalence of malnutrition in an institutionalized elderly population according to age and sex. PATIENTS AND METHOD: We studied 615 institutionalized patients, with a mean age (SD) of 79.33 (9.07) years. Anthropometric parameters included weight, height, knee-heel length, tricipital and subescapular skin folds, arm perimeter and fat mass. Biochemical parameters included: total cholesterol, triglycerides, albumin, prealbumin, transferrin,retinol-binding protein, C3 and lymphocyte count. Malnutrition prevalence was 26.87% (CI 95%, 23.15-30.86), 29.08% (CI 95%, 22.82-35.97) in men and 25.59% (CI 95%, 25.01-30.61) in women. Anthropometric parameters were found to be decreased in all malnourished patients. Significant decreases in albumin and retinol-binding protein concentrations were observed in some age groups of malnourished patients. We also found a decrease in the total cholesterol level in parallel to an age increase in both sexes, regardless of the nutritional status. Triglyceride levels were significantly decreased in both males and females with malnutrition. CONCLUSIONS: We detected a high prevalence of malnutrition, yet lower than reported in other studies with similar age groups.

[Anatomical description of a natural perforation present in the human lumbar pia mater]. / Descripción anatómica de la presencia de perforaciones naturales en la piamadre humana en la médula lumbar.

OBJECTIVE: The pia mater has always been considered more permeable than other meningeal membranes. Natural pia mater perforations found in some animals at-test to this membrane's permeability. Such perforations, however, have never been demonstrated in human tissue. Our objective was to study human pia mater from the dorsal lumbar region, looking for perforations that facilitate the diffusion of substances to the spinal cord following subarachnoid administration. MATERIAL AND METHOD: The specimens were removed from four human cadavers aged 70, 72, 77 and 78 years between 8 and 12 hours after death. The specimens were fixed in a phosphate glutaraldehyde buffer solution, followed by desiccation in acetone and critical point elimination of acetone, treatment with carbon and metallization with gold. RESULTS: The pia mater was composed of a smooth surfaced, thin layer of cells and underlying connective tissue formed mainly of collagen fibers and fundamental amorphous matter. The collagen fibers were oriented in various directions. Throughout the surface of the pia mater, natural circular, elliptical and ovoid perforations were distributed irregularly. Size varied. Most measured over 10 to 15 micrometers in diameter or less than 5 to 8 micrometers. Inside the openings, fibers similar to collagen fibers could be seen at the point where they would normally be found beneath the cell layer. CONCLUSION: The total thickness of the pia mater varies in different zones of the spine, as a result of variations in the thickness of the cell layer and in the underlying extracellular layer. The existence of natural fenestrations in all the analyzed specimens of human dorsal lumbar pia mater accounts for the high permeability of this membrane, which permits substances administered in spinal fluid to reach the spinal cord. These natural fenestrations are areas where the cell surface in absent, with underlying collagen fibers usually visible. The pia mater is generally believed to be composed of a complete cell layer that forms a barrier between the central nervous system and the subarachnoid space; however, the presence of fenestrations would indicate that such a barrier does not exist, the base membrane being placed under the connective fibers, the only intact structure prior to medullary glial cells.

[Does the subdural space exist?]. / Existe el espacio subdural?

A potential space between the dura mater and the arachnoides is thought to exist, occupied by a serous fluid and called the subdural space. Recent studies may change this classical concept, however. The dura-arachnoid complex from the epidural to the arachnoid space is formed by morphologically distinct layers: the dura mater, the subdural compartment and the arachnoid mater, which are made up of different cell types. The dura mater consists of greater and lesser laminae formed mainly of collagen fibers aligned differently. The subdural compartment is formed by a number of so-called "neurothelial cells", which are in close contact with the inner dural layers. These cells are flat and have long interlaced branches. The arachnoides are made of cells grouped in three different layers. The outer layer is the "barrier arachnoid layer". Located just inside the anterior cell plane, this layer is made of less flattened cells that form an epithelial-type tissue, with complex cell-cell junctures surrounded by collagen fibers. The middle layer is the reticular arachnoid, composed of irregularly interlaced cells alternating with collagen fibers and intercellular gaps of varying sizes. The innermost layer, the trabecular arachnoid, is in direct contact with the subarachnoid space. The cells of this layer form strands that contribute to the weblike pattern found in the subarachnoid space. Recently, special techniques for fixing and preparing samples, preserving in situ the anatomical relations between the arachnoides and the dura mater, have allowed us to examine the normal configuration of the subdural space. All samples examined revealed the presence of a cellular plane between the dura mater and the arachnoides, with no evidence of the classically described space. The zone of least resistance in the dura-arachnoid complex was the subdural compartment, which could be torn mainly along intercellular spaces, though cell rupture was also observed, affecting the cytoplasmic membranes of adjacent cells. The subdural space is opened by tearing the subdural compartment between neurothelial cells alongside the collagen fibers of the dura mater. Such a tear can be caused mechanically by injecting air or contrast media, which exert pressure on a laminar structure that tends to separate because it is weaker than neighboring ones.

[Electron microscopic analysis of particles from surgical gloves and their possible introduction into the epidural space during epidural anesthesia]. / Análisis con microscopia electrónica de las partículas procedentes de los guantes quirúrgicos y su posible introducción dentro del espacio epidural durante la anestesia epidural.

OBJECTIVE: Many publications have linked surgical glove powder to inflammatory reactions of the peritoneum, pleura, pericardium and meninges. Accidental contamination may also increase the likelihood of complications after spinal and epidural anesthesia. We aimed to analyze the morphological characteristics of microscopic particles adhering to surgical gloves and to analyze how likely such particles are to enter the epidural space during catheterization. MATERIAL AND METHOD: One hundred epidural catheters were studied in two groups (A and B) of 50. Group A catheters contained stylettes and the distal ends were open (Vygon). Group B catheters contained no stylettes and had closed distal ends and three side openings (Becton Dickinson). Continuous epidural anesthesia was simulated with half the catheters in each group (25) by touching the distal end of each line with the gloves and later inserting the catheter through a Tuohy needle. All catheters--those used in the simulation as well as the untouched ones--were then examined under a scanning electron microscope. The particles on the internal and external surfaces of the gloves had previously been identified under a microscope and analyzed by X-ray diffraction. RESULTS: Gloves: external glove surfaces carried particles measuring between 3 and 4 mu; their morphology was consistent with calcium carbonate. On internal surfaces we found larger particles, between 11 and 14 mu in diameter, shaped differently and of smooth appearance. Analysis of the latter showed them to contain traces of magnesium and to have characteristics consistent with organic molecules. The particles of one surface were never observed on the other. Catheters: the non-manipulated catheters in both groups contained no free particles matching those described above, whereas the outside surfaces of the catheters in contact with gloves contained particles consistent with those of external glove surfaces. The number of particles per square millimeter of surface was 2,598 (95% CI 2,200 to 2,900) in group A catheters and 2,340 (95% CI 2,000 to 2,600) in the group B catheters (p = NS). The differences in the number of particles adhering to catheters touched by gloves and those that had not been manipulated were statistically significant (p < 0.001). CONCLUSIONS: Particles adhering to gloves can be drawn into the epidural space during continuous epidural anesthesia. All unnecessary manipulation should therefore be avoided, and the portion of the catheter to be inserted into the epidural space should not be touched in order to prevent possible nonspecific meningeal inflammatory responses.

[Subarachnoid anesthesia for cesarean section in a patient with Ehlers-Danlos syndrome type II]. / Anestesia subaracnoidea para cesárea a una paciente con síndrome de Ehlers-Danlos tipo II.

A 32 year-old woman with full-term pregnancy and a history of Ehlers-Danlos syndrome type II underwent cesarean delivery owing to breech presentation and the presence of oligohydramnios. Anesthesia was provided with a subarachnoid block with 6.5 mg of bupivacaine and 32.5 microg of fentanyl to T4. Depth of anesthesia was adequate and hemodynamic stability was good. The intervention was uneventful and the outcomes were excellent for both mother and fetus. A subarachnoid block with low doses of local anesthetic and fentanyl is an appropriate, safe alternative to general anesthesia for cesarean section in women with Ehlers-Danlos who have normal coagulation tests and no history of bleeding.

[Analysis of the external and internal surface of human dura mater with scanning electron microscopy]. / Análisis de la superficie externa e interna de la duramadre humana mediante microscopia electrónica de barrido.

INTRODUCTION: In recent years several studies have raised questions about the anatomy of the human dura mater. Our objective has therefore been to examine its tridimensional structure with the aid of the scanning electron microscope. METHOD: Samples were taken from 4 human cadavers (70, 72, 77 and 78 years old) between 8 and 12 hours after death. After fixing in glutaraldehyde phosphate buffer, dehydration in acetone and elimination of the acetone at the critical point, treatment with carbon and metallization with gold, the external and internal surfaces were examined. RESULTS: The external, or epidural, surface of the dura mater is made up of thin collagen fibers joined in bands running in different directions. The outer surface and lower layers of the dura contain elastic, interwoven fibers surpassing 2 microns in diameter. The inner surface, which is smooth and glossy, is formed of thin ribbons of arachnoids that are fused and tightly attached to the structure of the dura mater. CONCLUSION: The outer surface of the dura mater consists mainly of collagen fibers which alone or in groups run in different directions: longitudinally, horizontally or obliquely, depending on the are studied. These findings contradict the classical descriptions of the dura mater as having parallel, longitudinally placed collagen fibers in the tangential plane.