A comparative evaluation of inhaled halothane, isoflurane, and sevoflurane during acute normovolemic hemodilution in dogs

The hemodynamic response to acute normovolemic hemodilution (ANH) can be affected by the anesthetics used. We randomized 18 mongrel dogs to undergo ANH with 3 different inhaled anesthetics: halothane, isoflurane, or sevoflurane. Hemodynamics, oxygen transport, and gastric pH were measured before blood withdrawal, at the end of hemodilution, and 30 and 60 min after the end of hemodilution. The baseline measurements of all hemodynamic variables were similar among groups, with the exception of heart rate, which was more rapid in the sevoflurane group. Thirty minutes after hemodilution, the cardiac index increased 88%, 86%, and 157% in the halothane, isoflurane, and sevoflurane groups, respectively, whereas arterial-venous oxygen differences and oxygen consumption were larger in the halothane group compared with the isoflurane and sevoflurane groups. Gastric pH obtained by tonometry did not change and was not different among groups. Because the hemodynamic response to ANH was not blunted, all three anesthetics may be safely used for the maintenance of anesthesia.     

Characteristics of penetrating abdominal firearm injuries in children.

Penetrating injuries of the abdomen which occur primarily from gunshots and stabbing become increasingly prevalent in children. Our purpose is to assess the presentation, management and outcome of children with penetrating abdominal firearm injuries (PAFI) and to evaluate the value of Injury Severity Score (ISS) for predicting injury severity and eventual morbidity and mortality in children with PAFI. Between 1985 and 1997, 69 children < or = 15 years of age with PAFI were hospitalized at our institution. Their hospital records were reviewed retrospectively. Of the 69 children with PAFI, 53 were boys and 16 were girls. The mean age was 9.6. The causes of PAFI were explosives (44%), gunshot (39%) and shotgun injuries (17%). The most common organ injured was the small bowel followed by colon and liver respectively. Postoperative complications were seen in 12 children. The mean value of ISS was 16.8; 41 children had an ISS value of > or = 16. The value of ISS was significantly higher in children with complication than in those without complication. The children with ISS value > or = 16 were hospitalized significantly longer than those with < or = 15 of ISS. Particularly shotgun injuries were commonly associated with severe morbidity. ISS can be useful for predicting the severity of injury and the occurrence of morbidity.     

An unexpected association in a patient with heart failure presenting a surgical challenge

Bicuspid aortic valve (BAV) is the most common form of congenital heart disease and frequently leads to premature valvular dysfunction. BAV is associated with aortic wall abnormalities and a high prevalence of ascending aorta dilatation and coarctation of the aorta (CoA). Consequently, in patients with BAV a careful assessment of the valve, and also of the aortic root and the ascending aorta, should be performed. The most feared complication is aortic dissection, however, the actual incidence of this complication is low. We report the case of a 58-year-old man who presented with New York Heart Association class III heart failure. The work-up revealed BAV with severe stenosis and severe compromise of left ventricle systolic function. In addition, CoA in the isthmus region, and type B dissection of the aorta were diagnosed.     

Urbanization,migration, and indigenous health in Peru

Introduction

We compare demographic, socioeconomic, and anthropometric characteristics and blood pressure (BP), between rural and urban Peruvian indigenous women. These are preliminary results from a project on urbanization, migration, and health.

Methods

Data were collected cross-sectionally (2019) and compared between a rural (n = 92) and an urban (n = 93) community.

Results

Height: μ = 148.3 ± 5.0 cm (range = 137–162), weight: μ = 62.0 ± 11.5 (range = 37.5–108.7), median waist circumference = 89.0 (IQR = 15.8, range = 64.0–126.0), BMI = 28.3 (IQR = 6.2, range = 16.7–40.0), with no significant rural–urban differences. Systolic but not diastolic BP was significantly higher in urban versus rural women (median = 110, IQR = 18, range = 80–170 vs. median = 120, IQR = 10, range = 90–170, p = .002 and median = 70, IQR = 17, range = 50–100 vs. median = 70, IQR = 10, range = 60–100, p = .354), respectively.

Conclusions

Despite major lifestyle differences, there were no anthropometric differences between rural and urban women. Higher systolic BP in urban women may reflect social/economic stressors rather than dietary factors.