First Report of Foliar Infection of Cabbage by Phytophthora drechsleri in Argentina.

Cabbage (Brassica oleracea var. capitata L.) is a popular crop grown along the northeast horticultural belt of Buenos Aires Province, Argentina. In the summer of 2010, fields in this region remained flooded for long periods due to frequent and intense precipitation (560 mm from January to March). Commercial cabbage crops in the cities of Luján and General Rodríguez developed patches of diseased plants that were stunted and wilted. Affected plants had necrotic areas in the crowns and roots. Symptoms expanded to the upper stems, leaving vascular tissues exposed. During April 2010, samples from 2 fields were brought to the laboratory where the stems were washed thoroughly and disinfected with a 1% bleach solution for 2 minutes. Small pieces (5 mm in diameter) were removed from the lesion edge, plated on V8 agar (V8A) plates, and incubated at 24°C in the dark for 5 days. Four isolates were transferred to V8A using hyphal tips. Morphological studies were performed on the V8A cultures as well as plates flooded with tap water. Sporangia were obpyriform, nonpapillate, persistent, and variable in size, averaging 44 × 28 µm. Each isolate belonged to the A1 mating type when paired with P. capsici tester isolates, CBS 370.72 and CBS 111.334 (Fungal Biodiversity Centre, CBS, Utrecht, the Netherlands). The isolates produced amphigynous antheridia, and chlamydospores were present but scarce. Maximum temperatures for growth (37°C) were also performed. Edited sequences of the internal transcribed spacer (ITS) region of the rDNA (GenBank Accession Nos. JQ653300, JQ653301, JQ653302, and JQ653303) were compared with Phytophthora sequences available in GenBank using the BLASTN search utility (1) and aligned to the data set of Cooke et al. (2). Sequences of the four isolates (strains 2: R-cai-cuello-col-3, 3: R-cai-cuello-col-18, 4: R-AN-col-1A and 5: R-AN-col-1B) matched 100% with GenBank sequences of P. drechsleri (100% coverage, 100% identity and no gaps). Based on these results, the four Argentinian cabbage isolates were identified as P. drechsleri (3). Pathogenicity tests were completed using three detached heads of mature cabbage plants (B. oleracea var. capitata) for each isolate. A 5-mm colonized mycelial plug of the appropriate isolate was placed on the main vein of the outermost leaves. For the control treatments, three heads were inoculated with non-colonized V8A plugs. The inoculated and control heads of cabbage were incubated in plastic boxes wrapped in black nylon bags at 24°C for 4 days. Broccoli (B. oleracea var. italica) and cauliflower (B. oleracea var. botrytis) were also tested following the same procedure. All heads of cabbage, broccoli, and cauliflower developed necrotic lesions 2 to 4 cm in diameter and a dark grey color. Control heads of each plant remained green. P. dreschleri was consistently reisolated as described above from the inoculated heads, but not from the control heads. To our knowledge, this is the first report of cabbage as a host for P. dreschleri in Argentina. Frezzi (4) reported this species as a pathogen of Chrysanthemum cinerariefolium, Celosia plumosa, Schinus molle, and Solanum lycopersicum in Argentina in 1950. References: (1) S. S. Altschul et al. Nucleic Acids Res. 25:3389, 1997. (2) D. E. L. Cooke et al. Fungal Gen. Biol. 30:17, 2000. (3) D. C. Erwin and O. K. Ribeiro. Phytophthora Diseases Worldwide. The American Phytopathological Society Press, St. Paul, MN, 1996. (4) M. J. Frezzi. Rev. Invest. Agric. Buenos Aires 4:49, 1950.

[Heart transplant]. / Trasplante cardíaco.

A heart transplant is at present considered the treatment of choice in cases of terminal cardiac insufficiency refractory to medical or surgical treatment. Due to factors such as the greater life expectancy of the population and the more efficient management of acute coronary syndromes, there is an increasing number of people who suffer from heart failure. It is estimated that the prevalence of the disease in developed countries is around 1%; of this figure, some 10% are in an advanced stage and are thus potential receptors of a heart transplant. The problem is that it is still not possible to offer this therapeutic form to all of the patients that require it. Consequently, it is necessary to optimise the results of the heart transplant through the selection of patients, selection and management of donors, perioperative management and control of the disease due to graft rejection. Since the first transplant carried out in 1967, numerous advances and changes have taken place, which has made it possible to increase survival and quality of life of those who have received a new heart. In this article we review the most relevant aspects of the heart transplant and the challenges that are currently faced.

[Reduction of the need for blood derivatives in liver transplantation using aprotinin]. / Reducción de los requerimientos de hemoderivados en el trasplante hepático con aprotinina.

OBJECTIVES: To evaluate the efficacy of aprotinin in reducing the need for blood products in orthotopic liver transplantation. PATIENTS AND METHODS: Blood product needs and coagulation test results were studied in 42 adults with cirrhosis of the liver who received orthotopic liver transplants. The first 16 liver transplants carried out without aprotinin (control group) were compared with the next 26 consecutive transplant patients who received aprotinin. Each of the first 9 received a loading dose of 2 million units that was followed by the infusion of half a million units per hour until the end of surgery. The next 17 received the same infusion dose at the same rate but no loading dose. RESULTS: Patients who received aprotinin required fewer transfusions of blood products (5.3 units of packed red blood cells as opposed to 13 units; 9 units of fresh frozen plasma versus 14.6 units; 1.7 units of platelets versus 4.2 units; and 3.8 units of cryoprecipitates versus 8.8 units). We observed a marked reduction of fibrinolysis (less increase in D dimers after removal of the liver when aprotinin was used. CONCLUSIONS: Prophylactic use of aprotinin during surgery has a beneficial effect on hemostatic mechanisms, reducing the need for blood products. A reduction in fibrinolysis seems to contribute to this effect.

Cost analysis of neuromuscular blocking agents in the operating room: cisatracurium, atracurium, vecuronium and rocuronium.

Cisatracurium (C), Atracurium (A), Rocuronium (R) and Vecuronium (V) are four neuromuscular blockers (NMB) used in the operating room with similar efficacy, defined as adequate muscle relaxation, but different pharmacokinetics. C and A have organ-independent elimination, A is associated with histamine release and R has a shorter onset time. The objective of this study was to economically compare these four NMB from the hospital point of view in order to facilitate drug selection. A cost analysis was performed. Only direct costs were considered and data were collected through a retrospective chart review. A total of 151 patient charts were randomly selected. Differences between patients receiving one of the four NMB were evaluated by ANOVA or Kruskal-Wallis tests. Then a multiple linear regression analysis was conducted. In the chart review, no significant difference was observed between the four groups of patients in age, weight or surgery duration (p > 0.05). Multiple regression analysis revealed that atracurium was on average PTA 237 (1 Euro = PTA 166) cheaper per surgery than any other NMB after adjusting for other factors (p < 0.01) and there is no significant difference in cost between the other three NMBs (p > 0.1). We recommend the use of rocuronium when a quick onset is needed and the patient does not have hepatic failure, cisatracurium when a haemodynamic instability is possible and atracurium in the remaining cases. If just one NMB can be included in the drug formulary we would select cisatracurium due to its pharmacological advantages over atracurium with a small increment in cost.

The effects of epidural analgesia and conventional anaesthesia on renal excretion of PGE2 during orthopaedic surgery.

The effect of standard anaesthesia (G-I) and epidural analgesia (G-II) on urinary synthesis of PGE2 was compared in two groups of 12 patients each undergoing orthopaedic surgery. This study demonstrates a significant elevation of renal PGE2 in patients undergoing standard anaesthesia during surgery. In marked contrast, with epidural analgesia, the inhibition of renal secretion of PGE2 is apparent. These findings strongly suggest the important role of the sympathetic nervous system in the synthesis of PGE2.

Combination of ondansetron and droperidol in the prophylaxis of postoperative nausea and vomiting.

The aim of this study was to compare the efficacy and safety of ondansetron plus droperidol with each drug alone or placebo in the prevention of postoperative nausea and vomiting (PONV). One hundred females, aged 18-65 yr, ASA physical status I-II, undergoing general anesthesia for elective abdominal surgery were included in a prospective, double-blind, placebo-controlled, randomized study. A standardized anesthetic technique and postoperative analgesia (ketorolac plus patient-controlled analgesia [PCA] with morphine) were used in all patients. Patients were randomly assigned to receive placebo (Group 1, n = 25), droperidol 2.5 mg with induction of anesthesia and 1.25 mg 12 h later (Group 2, n = 25), ondansetron 4 mg with induction (Group 3, n = 25), and ondansetron plus droperidol at the same doses as Groups 3 and 2, respectively (Group 4, n = 25). A complete response, defined as no PONV in 48 h, occurred in 28% of patients in Group 1, 60% in Group 2 (P < 0.05 vs Group 1), 56% in Group 3 (P < 0.05 vs Group 1), and 92% in Group 4 (P < 0.01 vs Groups 1, 2, and 3). Sedation was significantly greater with droperidol (Groups 2 and 4) for 12 h postoperatively. In conclusion, the combination of ondansetron plus droperidol was more effective than each antiemetic alone or placebo in the prevention of PONV in women undergoing elective abdominal surgery.

Repeated transient neurological symptoms after spinal anaesthesia with hyperbaric 5% lidocaine.

We report a case of repeated delayed pain after cystoscopy under spinal lidocaine anaesthesia, which may be caused by transient radicular irritation. The possible aetiology of the symptoms is discussed.

The effect of labetalol on urinary prostacyclin secretion during surgery.

The effects of labetalol on the secretion of prostacyclin and plasma-renin activity (PRA) were evaluated, relative to a control group in 24 patients undergoing hip osteotomy. They were randomly assigned to two groups (G-I and G-II) with 12 patients each. Patients allocated to both groups received standard anaesthesia (thiopentone, pancuronium, fentanyl and nitrous oxide). Patients belonging to Group II were given labetalol at a dose of 0.8 mg kg-1. The stable metabolite of PGI2, 6-keto-PGF1 alpha was quantified from urine samples by radioimmunoassay (RIA). Cortisol, PRA and aldosterone were determined from blood samples. A significant increase in 6-keto-PGF1 alpha elimination was observed in G-I. Labetalol administration partially but significantly inhibited this increase. We believe that prostacyclin is involved not through the beta 1 but through the alpha 1 receptors in the secretion of renin.

A comparative study with oral nifedipine, intravenous nimodipine, and magnesium sulfate in postoperative analgesia.

UNLABELLED: We tested the ability of two L-type calcium channel blockers (nifedipine and nimodipine) and the N-methyl D-aspartate natural antagonist magnesium to decrease morphine requirements and pain in the postoperative period in 92 patients undergoing elective colorectal surgery. In a randomized, double-blinded study, patients were assigned to one of four groups. The control group received placebo. The nifedipine group received 60 mg of oral nifedipine. The magnesium group received an initial dose of 30 mg/kg followed by 10 mg x kg(-1) x h(-1) of magnesium sulfate over 20 h. The nimodipine group received 30 microg x kg(-1) x h(-1) of nimodipine over 20 h. Postoperative morphine consumption was assessed for 48 h. Pain at rest and pain on movement were assessed up to the fifth day postsurgery. There were no differences among groups in postoperative morphine consumption at 12 and 24 h. The nifedipine group consumed more morphine than the control and nimodipine groups during 24-48 h. Pain at rest scores were higher at 16 and 24 h in the nifedipine group than in the other three groups. Pain on movement scores were lower at 72 h in the nimodipine group than in the control and nifedipine groups. In conclusion, the perioperative application of oral nifedipine, IV nimodipine, or IV magnesium sulfate failed to decrease postoperative morphine requirements after colorectal surgery. IMPLICATIONS: The increase of intracellular calcium plays a key role in spinal transmission of pain and in the establishment of central sensitization. We examined the effects of nifedipine, nimodipine, and magnesium sulfate in postoperative analgesia after colorectal surgery. We found no differences in morphine consumption with the administration of each drug alone.