Macromolecular absorption in small-for-gestational-age infants

Using human alpha-lactalbumin as a marker protein, macromolecular absorption was studied in 40 preterm infants, appropriate for gestational age (AGA), in 12 AGA term infants and in 18 preterm infants, small for gestational age (SGA). The absorption of alpha-lactalbumin was measured as concentration in serum after a human milk feed and expressed as micrograms alpha-lactalbumin/l serum/l human milk/kg body weight on day 7, 14, 21 and 42 after delivery. The serum concentration of alpha-lactalbumin was correlated negatively with maturity and postnatal age. In the SGA infants, the concentration of alpha-lactalbumin was significantly higher than in the AGA infants of similar gestational age. The data show that intrauterine growth retardation causes a delayed postnatal decrease in macromolecular absorption. This may indicate delayed intestinal maturation.     

Endothelial dysfunction after exposure to cobalt chloride enhanced vascular contractility

Brief exposure to cobalt chloride augmented vascular contractility. We hypothesized that endothelial dysfunction plays a role in the augmentation of aortic contractility, after brief exposure to cobalt chloride. Rat aortic ring preparations were mounted in organ baths, exposed to cobalt chloride (0.3-300μmol/L) for 30min, and then subjected to contractile agents or relaxants 1 and 5h after the end of exposure. Presence of cobalt chloride did not affect the contractile response to phenylephrine. Brief exposure to cobalt chloride, however, even at 5h after the end of exposure, not only augmented contractile responses to KCl or phenylephrine but also attenuated the relaxant response to acetylcholine. The mechanical denudation of endothelium or inhibition of endothelial nitric oxide synthase with 100μmol/L N(ω)-nitro-l-arginine methyl ester abolished the augmentation of contractile responses. Pre-treatment with 150units/mL of superoxide dismutase also abrogated the augmented contractile responses. Brief exposure to cobalt chloride did not affect the contractile response to phorbol dibutyrate in the presence or absence of calcium, or the expression of HSP70. In conclusion, endothelial dysfunction plays an important role in the augmentation of aortic contractility, after brief exposure to cobalt chloride.     

Intravenous acetaminophen reduced the use of opioids compared with oral administration after coronary artery bypass grafting

OBJECTIVE: The purpose of this study was to evaluate if intravenous acetaminophen compared to oral administration reduced the consumption of opioids and their side effects without an increase in pain during the stay in the intensive care unit (ICU). DESIGN: Prospective, randomized study. SETTING: An ICU in a university hospital. PARTICIPANTS: Eighty patients with written informed consent undergoing coronary artery bypass grafting with cardiopulmonary bypass. Anesthesia was based on propofol and fentanyl combined with sevoflurane. INTERVENTIONS: Patients were randomized to 2 groups: acetaminophen, 1 g every sixth hour during the postoperative period, either as tablets or intravenously after extubation. MEASUREMENTS AND MAIN RESULTS: The amount of opioids administered during the study period was measured starting with acetaminophen administration during the stay in the ICU until 9 o'clock the following morning. Incidence of postoperative nausea and vomiting (PONV) was noted. Pain was evaluated with a visual analog scale (VAS) from 0 to 10. Three patients, 2 in the oral and 1 in the intravenous group, were excluded because of incomplete data. The intravenous group received less opioids than the orally treated group, 17.4 +/- 7.9 mg compared with 22.1 +/- 8.6 mg (p = 0.016). PONV incidence and VAS scores did not differ. During the first hours after extubation, 50 of 77 patients reported VAS scores >3 with no difference between groups. CONCLUSIONS: Intravenous acetaminophen had a limited opioid-sparing effect when compared with oral administration after coronary artery bypass graft surgery. The opioid-sparing effect was not accompanied by any reduction in the incidence of PONV. The clinical significance of the opioid-sparing effect could therefore be questioned.     

Operating room nitrous oxide trace concentrations: a clinical study in ambulatory surgery

Purpose:

This blinded study evaluates the N₂O concentration variations in an ambulatory surgery centre using a small, simple on-line trace gas concentration monitor (GasFinder™ [Medair AB, Delsbo, Sweden]).

Scope:

Thirty-seven day surgical sessions using standardised anaesthesia with propofol/fentanyl induction and sevoflurane/N₂O with larynx mask. Five of 37 time-weighted averages (TWA) were greater than 25 ppm but less than 100. Peak registered concentrations reached 2000 ppm. Eleven sessions showed peak values higher than 100 ppm (range 13-1693).

Conclusions:

This simple, on-line N₂O monitor is a useful tool for detecting deviations from strict gas hygiene.     

Bacterial vaginosis--a microbiological and immunological enigma

The development of bacterial vaginosis (BV) among women of childbearing age and the resulting quantitative and qualitative shift from normally occurring lactobacilli in the vagina to a mixture of mainly anaerobic bacteria is a microbiological and immunological enigma that so far has precluded the formulation of a unifying generally accepted theory on the aetiology and clinical course of BV. This critical review highlights some of the more important aspects of BV research that could help in formulating new basic ideas respecting the biology of BV, not least the importance of the interleukin mediators of local inflammatory responses and the bacterial shift from the normally occurring lactobacilli species: L. crispatus, L. gasseri, L. jensenii, and L. iners to a mixed flora dominated by anaerobic bacteria.     

Segmented volumes of cerebrum and cerebellum in first episode schizophrenia with auditory hallucinations

The volumes of cerebral and cerebellar regions were measured in first episode schizophrenic patients with (n = 17) and without (n = 8) auditory hallucinations. Magnetic resonance images of cerebral and cerebellar regions were segmented into gray and white fractions using an algorithm for semiautomated fuzzy tissue segmentation. They were defined by using the semiautomated Talairach atlas-based parcellation method. Patients with auditory hallucinations showed larger temporal white matter, frontal gray matter, and temporal gray matter volumes than patients without auditory hallucinations. These findings suggest that auditory hallucinations in schizophrenic patients may be associated with neuropathological abnormalities in frontal and temporal brain regions.