Chest compressions versus ventilation plus chest compressions in a pediatric asphyxial cardiac arrest animal model

Objective

To compare the ventilation achieved with chest compressions (CC) or ventilation plus compressions (VC) in a pediatric animal model of cardiac arrest.

Design

Randomized experimental study.

Setting

Experimental department of a University Hospital.

Methods

Twelve infant pigs with asphyxial cardiac arrest. Sequential 3-min periods of VC and CC were performed for a total duration of 9 min. Tidal volume (TV), end-tidal CO₂ (EtCO₂), mean arterial pressure (MAP), central venous pressure (CVP), mean pulmonary arterial pressure (mPAP), and peripheral, cerebral, and renal saturations were recorded and arterial and venous blood gases were analyzed.

Results

VC achieved a TV similar to the preset parameters on the ventilator, whilst the TV in CC was very low (P < 0.001). EtCO₂ with VC was significantly higher than with CC (14.0 vs. 3.9 mmHg, P < 0.05). Arterial pH was higher with VC than with CC (6.99 vs. 6.90 mmHg, P < 0.05). Arterial PCO₂ was lower with VC than with CC (62.1 vs. 97.0 mmHg, P < 0.05). There were no significant differences in the MAP; CVP; mPAP; peripheral, renal, and cerebral saturations; or lactate concentrations between the two techniques.

Conclusions

VC achieves better ventilation than CC during cardiopulmonary resuscitation and has no negative effect on the hemodynamic situation.     

Arachnoid cyst complicated by intracystic hemorrhage and spontaneous subdural hematoma: magnetic resonance findings

Arachnoid cysts are collections of cerebrospinal fluid within the arachnoid membrane. They are benign lesions and most are congenital. They are usually asymptomatic; however, they can bleed and become symptomatic. Although arachnoid cyst associated to intracystic hemorrhage and spontaneous subdural hematoma is an uncommon complication, it is a well-known indication for emergency neurosurgery. We present the findings in a ten-year-old boy diagnosed with arachnoid cyst complicated by intracystic hemorrhage and spontaneous subdural hematoma diagnosed by magnetic resonance.     

Population structure of <Emphasis Type="Italic">Citrus tristeza virus</Emphasis> from field Argentinean isolates

We studied the genetic variability of three genomic regions (p23, p25 and p27 genes) from 11 field Citrus tristeza virus isolates from the two main citrus growing areas of Argentina, a country where the most efficient vector of the virus, Toxoptera citricida, is present for decades. The pathogenicity of the isolates was determinated by biological indexing, single-strand conformation polymorphism analysis showed that most isolates contained high intra-isolate variability. Divergent sequence variants were detected in some isolates, suggesting re-infections of the field plants. Phylogenetic analysis of the predominant sequence variants of each isolate revealed similar grouping of isolates for genes p25 and p27. The analysis of p23 showed two groups contained the severe isolates. Our results showed a high intra-isolate sequence variability suggesting that re-infections could contribute to the observed variability and that the host can play an important role in the selection of the sequence variants present in these isolates. N. G. Iglesias and S. P. Gago-Zachert contributed equally to this study.     

Magnetoencephalography for research of auditory cortex

CONCLUSION: The results could indicate that, during phylogeny and human ontogeny, the central nervous system has enhanced the speech activity from any other activity even though other frequencies could be relevant for survival. OBJECTIVE: People of all ages can experience alterations of auditory perception that progressively increase with aging. The whole approach to these alterations needs not only peripheral (cochlear) or brainstem studies but also an analysis of the auditory cortex. In fact, auditory evoked fields (AEF) may contribute to the understanding of the neural correlate of sound awareness. SUBJECTS AND METHODS: The M100 response after pure tone stimulation (five frequencies ranging from 500 to 8000 Hz) was analyzed in a group of nine adult subjects with normal hearing, older than 25 years of age and under 40 years old. Average M100 field intensity was calculated for all magnetoencephalography (MEG) channels in a 60 ms window around the M100 waveform. RESULTS: The results indicate a more intense cortical response to main speech frequencies (0.5 to 2 kHz) as compared with other frequencies not involved in human conversation.     

Oropharyngeal kaposiform hemangioendothelioma

The kaposiform hemangioendothelioma is a very infrequent tumor proceeding from the endothelial-derived spindle cells, more often found on the limbs, although peritoneal, retroperitoneal and sacrum locations are also prevailing. Head and neck are exceptional locations. The kaposiform hemangioendothelioma is almost exclusively found in children and early adolescents, and it is highly associated with the Kasabach-Merritt syndrome and lymphangiomatosis. The main treatment is the tumor surgical removal, including wide margins, plus supporting therapy when Kasabach-Merritt syndrome is linked. We report an isolated oropharyngeal kaposiform hemangioendothelioma 9-10-year old male case.     

Analysis of risk factors following pediatric liver transplantation

Abstract Several recipient, donor and operation factors as well as postoperative complications related to patient survival after liver transplantation (LT) in children were studied by univariate and multivariate analyses. In a 13‐year period, 103 patients under 15 years of age underwent 120 LT; the mean age was 63 months and 36% were under 2 years of age. Indications for LT were cholestatic disease in 68 (56%), metabolic diseases in 18 (14%), fulminant hepatic failure in 8 (7.5%), cirrhosis in 7 (5.8%), and retransplants in 17 (14%). Whole liver was transplanted in 79% of cases and partial liver in 21 %. Actuarial survival at 1, 5, and 10 years was 70 %, 61 %, and 57 %, respectively. United Network of Organ Sharing (UNOS) I recipients (RR = 2.7), primary non‐function (PNF) (RR = 13.9), and hepatic artery thombosis (HAT) (RR = 3.8) were independent factors for lower patient survival in multivariate analysis. Thus, in our experience, postoperative mortality as a consequence of the patient's condition before transplantation, or complications such as PNF or HAT, are the major causes of decreased survival in pediatric LT.     

Nandrolone decanoate is a good alternative for the treatment of anemia in elderly male patients on hemodialysis

Objective: To assess the efficiency of nandrolone decanoate (ND) in the control of anemia in elderly male patients on hemodialysis (HD), and to determine its influence on nutritional parameters. Design: A prospective 6-month study with randomization of patients on recombinant human erythropoietin (rHuEPO) therapy into two groups. Group A: rHuEPO was stopped before starting treatment with ND. Group E: rHuEPO was continued. Setting: Renal unit, tertiary-care center. Patients: 14 male patients in Group A and 19 patients, 12 males and 7 females, in Group E. Interventions: In Group A rHuEPO was stopped and ND 200 mg/I.M. weekly was given over six months. Results: The increase in hemoglobin and hematocrit levels was progressive with ND, and significant differences (p < 0.003) were evident after six months (9.6 ± 1.0 vs 11.0 ± 1.4 and 28.9 ± 4.7 vs 33.0 ± 4.7, respectively), which remained unmodified in Group E. Group A showed a significant increase in serum creatinine, total protein, transferrin and anthropometric parameters. These parameters remained stable and even presented a tendency to decrease in Group E. There was a significant rise in the concentration of triglycerides and a significant decrease in both HDL-cholesterol and apolipoprotein A-1 in Group A. However, lipoprotein (a) decreased significantly. No significant changes were detected in Group E. Conclusions: The use of ND would allow us an acceptable treatment of anemia as well as a better nutritional condition in elderly male patients on dialysis.