Effects of albumin and Ringer's lactate on production of lung cytokines and hydrogen peroxide after resuscitated hemorrhage and endotoxemia in rats

RATIONALE AND HYPOTHESIS: Acute lung injury is a frequent complication of severe sepsis or blood loss and is often associated with an excessive inflammatory response requiring mechanical ventilation. We tested the hypothesis that the types of fluids used during early resuscitation have an important effect on the evolution of lung injury. METHODS: Rats were subjected to either hemorrhage or endotoxemia for 1 hr, followed by resuscitation to a controlled mean blood pressure with Ringer's lactate, 5% albumin, or 25% albumin for 1 hr. After resuscitation, blood cytokine levels were measured. The lung was then excised and ventilated with a tidal volume of 30 mL/kg for 2 hrs. RESULTS: The volume of fluids required was significantly smaller in the albumin-treated groups than in the Ringer's lactate groups. In the hemorrhagic shock model, plasma concentrations of tumor necrosis factor-alpha, interleukin-6, and macrophage inflammatory protein-2 were significantly lower and interleukin-10 was significantly higher in the albumin-treated groups compared with the Ringer's lactate-treated group. The levels of tumor necrosis factor-alpha and macrophage inflammatory protein-2 in bronchoalveolar lavage fluid were lower and interleukin-10 was higher in the albumin-treated groups than in the Ringer's lactate group. The decreased cytokine production was associated with a reduction of hydrogen peroxide formation with albumin resuscitation. The lung wet/dry ratio was lower in the 5% albumin (0.54 +/- 0.01) and 25% albumin (0.55 +/- 0.02) groups than in the Ringer's lactate group (0.62 +/- 0.02; both p <.05). These effects of albumin seen in the hemorrhagic shock model were not observed in the endotoxic shock model. CONCLUSIONS: We conclude that resuscitation with albumin may have utility in reducing ventilator-induced lung injury after hemorrhagic shock, but not after endotoxic shock. These findings suggest that the mechanisms leading to ventilator-induced lung injury after hemorrhage differ from those after endotoxemia.     

The impact of plasma levels of C-reactive protein,lipoprotein (a) and homocysteine on the long-term prognosis after successful coronary stenting: The Global Evaluation of New Events and Restenosis After Stent Implantation Study

OBJECTIVES: The objective of this study was to evaluate the association of high plasma levels of either C-reactive protein (CRP), lipoprotein (a) (Lp[a]) or total homocysteine (tHCY) with the long-term prognosis after successful coronary stenting (CS). BACKGROUND: High plasma levels of either CRP, Lp(a) or tHCY may have an impact in coronary artery disease. However, long-term prospective data after coronary stenting (CS) are limited. METHODS: Four-hundred and eighty-three consecutive patients with either stable or unstable coronary syndromes were followed for up to three years after successful CS. The composite of cardiac death, myocardial infarction or rehospitalization for rest unstable angina, whichever occurred first, was the prespecified primary end point. Moreover, the one-year incidence of clinical recurrence of symptoms, in-stent restenosis (ISR) and progression of atherosclerosis to a significant lesion (PTSL) were additionally evaluated. PTSL was defined as an increase by at least 25% in the luminal diameter stenosis of a known nonsignificant lesion (or=70% luminal diameter stenosis). RESULTS: By the end of the follow-up, high plasma levels of either CRP or Lp(a) but not tHCY were independently associated with the primary end point. In particular, CRP >or=0.68 mg/dl (p < 0.001) or Lp(a) >or=25 mg/dl (p = 0.003) conferred a significantly increased risk. By 1 year, a CRP >or=0.68 mg/dl conferred a significantly increased risk for clinical recurrence of symptoms (p < 0.001) or PTSL (p < 0.001). None of the studied biochemical markers was related to ISR. CONCLUSIONS: High plasma levels of either CRP or Lp(a) but not tHCY may be associated with a higher incidence of late adverse events after successful CS. PTSL in vessels not previously intervened upon may play a significant role in the underlying pathophysiology as opposed to ISR.     

Tibial tubercle osteotomy: A biomechanical comparison of two techniques

Purpose

The purpose of this study was to determine whether a modified step-cut tibial tubercle osteotomy (Maquet–Fulkerson hybrid) might produce comparable or better results than a standard oblique anteromedialization tibial tubercle osteotomy (Fulkerson type) and thus warrant the surgical need for additional cuts.

Employer-Mandated Sleep Apnea Screening and Diagnosis in Commercial Drivers

INTRODUCTION:: Obstructive sleep apnea (OSA) is common among commercial drivers and associated with health/safety risks, leading several trucking firms to mandate OSA screening. METHODS:: A total of 19,371 commercial drivers were screened for OSA with an online questionnaire (Somni-Sage) through employer mandates. Questionnaire and polysomnography results were analyzed retrospectively. RESULTS:: Screening categorized 5908 drivers (30%) as higher risk. To date, employers have sent 2103 higher-risk drivers for polysomnography, demonstrating that 68% of high-risk drivers tested had an apnea-hypopnea index (AHI) greater than 10 and 80% had an AHI of 5 or more. A conservative prevalence estimate for OSA (AHI > 10) was 21% among the drivers studied. CONCLUSIONS:: Online screening followed by polysomnography for high-risk drivers demonstrates as many as 21% of commercial drivers may have OSA. Mandatory screening can have a high yield among commercial drivers.     

Predictors of on-duty coronary events in male firefighters in the United States

Coronary heart disease (CHD) accounts for 39% of "on-duty" deaths in firefighters in the United States. No studies have examined the factors that distinguish fatal from nonfatal work-associated CHD events. Male firefighters experiencing on-duty CHD events were retrospectively investigated to identify cardiovascular risk factors predictive of case fatality; 87 fatalities (death within 24 hours of the event) were compared with 113 survivors who retired with disability pensions for heart disease after on-duty nonfatal events. Cardiovascular risk factors were then examined for associations with case fatality. Predictors of CHD death in multivariate analyses were a previous diagnosis of CHD (or peripheral/cerebrovascular disease) (odds ratio [OR] 4.09, 95% confidence intervals [CI] 1.58 to 10.58), current smoking (OR 3.68, 95% CI 1.61 to 8.45), and hypertension (OR 4.15, 95% CI 1.83 to 9.44). Age < or =45 years, diabetes mellitus, and serum cholesterol level were not significant predictors of case fatality. In conclusion, previous CHD, current smoking, and hypertension are strong predictors of fatality in male firefighters experiencing on-duty CHD events. Accordingly, prevention efforts should include early detection and control of hypertension, smoking cessation/prohibition, and the restriction of most firefighters with significant CHD from strenuous duties.     

Colon perforation during percutaneous renal surgery: a 10-year experience in a single endourology centre

The use of percutaneous renal surgery has been recently revolutionised with novel endourological instruments and techniques. However, the incidence, prevention and management of severe complications such as colon perforation still lack consensus. By presenting our 10-year experience, we would like to highlight the diagnosis and management of the rare complication of colon perforation.