Effects of Eurocollins solution as aortic flush for the procurement of human pancreas

BACKGROUND: Belzer solution is considered to be the best preservation media used for pancreas transplantation; however, its high cost accounts for approximately 14.5% of all resources allocated by the Brazilian government toward each pancreatic transplant. The objective of the present study was to test a reduction of Belzer solution during pancreas harvest, thereby lowering procedural cost. METHODS: The patients received pancreas-kidney transplantations during the period from January 2003 to August 2004. Patients were divided into two groups. Patients assigned to Group A (n=30) received only Belzer solution (2 L through the aorta artery), whereas patients in Group B (n=16) were perfused first with 1 L of Eurocollins solution followed by 1 L of Belzer solution. The two groups were assessed for differences in the following clinical parameters: the need for insulin replacement or antifungal and anticytomegalovirus treatment, pancreatitis, acute cellular rejection, graft vascular thrombosis, fistulas, intra-abdominal collection, graft loss, deaths, pancreatic ischemia time, and average hospitalization time. RESULTS: No statistically significant differences were observed in any of the parameters analyzed (P<0.05). The use of Eurocollins solution, followed by Belzer solution during pancreas harvesting, did not result in differences in graft survival or functionality, postsurgical complications, or patient survival and hospitalization time, when compared to the use of Belzer solution alone. CONCLUSIONS: Perfusion with 1 L of Eurocollins solution followed by 1 L of Belzer solution during pancreas harvesting seems to be a simple and efficient alternative for reducing the costs of the harvesting process.     

Epidemiology of Escherichia coli O157:H7 outbreaks, United States, 1982-2002

Escherichia coli O157:H7 causes 73,000 illnesses in the United States annually. We reviewed E. coli O157 outbreaks reported to Centers for Disease Control and Prevention (CDC) to better understand the epidemiology of E. coli O157. E. coli O157 outbreaks (>or=2 cases of E. coli O157 infection with a common epidemiologic exposure) reported to CDC from 1982 to 2002 were reviewed. In that period, 49 states reported 350 outbreaks, representing 8,598 cases, 1,493 (17%) hospitalizations, 354 (4%) hemolytic uremic syndrome cases, and 40 (0.5%) deaths. Transmission route for 183 (52%) was foodborne, 74 (21%) unknown, 50 (14%) person-to-person, 31 (9%) waterborne, 11 (3%) animal contact, and 1 (0.3%) laboratory-related. The food vehicle for 75 (41%) foodborne outbreaks was ground beef, and for 38 (21%) outbreaks, produce.     

Bioavailability of two oral formulations of azithromycin 500 mg: a randomized, open-label, two-period crossover comparison in healthy Mexican adult subjects

BACKGROUND: Azithromycin is related to erythromycin but is more active against gram-negative bacteria and less active against streptococci and staphylococci compared with erythromycin. For these reasons, and because of convenience of dosing (QD for 3 days), azithromycin is widely used in Mexico. Although several generic formulations of azithromycin are available in Mexico, information concerning the bioavailability of each formulation in the Mexican population is not available. OBJECTIVE: The aim of this study was to compare the bioavailability and tolerability of 2 oral formulations of azithromycin 500 mg used in Mexico: Macrozit (trademark of Laboratorios Liomont, S.A. de C.V., Mexico City, Mexico; test formulation) and Azitrocin (trademark of Pfizer, S.A. de C.V., Mexico City, Mexico; reference formulation). METHODS: This 2 x 2, crossover, randomized, open-label study was conducted at the Department of Pharmacology and Toxicology, Universidad Autóma de Nuevo Leon, Monterrey, Mexico. Eligible subjects were healthy volunteers of either sex and with the following characteristics: age > or =19 to 25 years, weight 54 to 77 kg, and height 159 to 177 cm. Subjects were randomly assigned to receive Macrozit followed by Azitrocin, or vice versa, with a 3-week washout period between doses. After a 12-hour (overnight) fast, subjects received a single, 500-mg dose of each formulation. For analysis of pharmacokinetic properties, including C(max), AUC(0-t), and AUC(0-infinity), blood samples were drawn at 0.5, 1, 1.5, 2, 2.5, 3, 4, 6, 12, 24, 48, 72, 96, and 120 hours after dosing. The formulations were considered bioequivalent if the logarithm (ln)-transformed ratios of C(max) and AUC were within the predetermined equivalence range of 80% to 125% and if P < or = 0.05 for the 90% CIs. Tolerability was assessed by monitoring and subject interview regarding the potential presence of adverse events (AEs). RESULTS: Twenty-eight subjects were enrolled in the study; 27 completed it (14 men, 13 women; mean age, 21.7 years). Fourteen subjects received the test formulation first. No period or sequence effect was observed. The 90% CIs for the corresponding ratios of C(max), AUC(0-t), and AUC(0-infinity) were 80.67 to 107.21, 91.39 to 107.59, and 90.61 to 106.19 (all, P < 0.05). Similar results were found for data without a logarithmic transformation. No AEs were found throughout the study. CONCLUSIONS: In this small study in healthy Mexican volunteers, a single, 500-mg dose of Macrozit was found to be bioequivalent to that of Azitrocin based on the rate and extent of absorption. Both formulations were well tolerated.     

A short cervix in women with preterm labor and intact membranes: a risk factor for microbial invasion of the amniotic cavity

OBJECTIVE: The purpose of this study was to determine whether there was a relationship between sonographic cervical length and the presence of culture-proven microbial invasion of the amniotic cavity in women with preterm labor and intact membranes. STUDY DESIGN: Ultrasonography and amniocentesis were performed in 401 patients admitted with preterm labor (22-35 weeks) and cervical dilatation of < or = 3 cm, as assessed by digital examination. Cervical length was determined by transvaginal ultrasound at admission. Outcome variables were the presence of microbial invasion of the amniotic cavity (defined as a positive amniotic fluid culture) and the occurrence of preterm delivery before 35 weeks. Contingency tables, chi2 test, receiver-operator characteristic (ROC) curves, and logistic regression were used for statistical analysis. RESULTS: The prevalence of microbial invasion of the amniotic cavity was 7% (28/401). Spontaneous preterm delivery (< or = 35 weeks) occurred in 21.4% (82/384) of patients. ROC curve analysis showed a significant relationship between the frequency of microbial invasion of the amniotic cavity and the length of the uterine cervix (area under the curve: 0.77; P < .005). Patients with a cervical length < 15 mm had a higher rate of a positive amniotic fluid culture than patients with a cervical length > or = 15 mm (26.3% [15/57] vs. 3.8% [13/344], respectively; P < .05). Moreover, patients with a short cervix (defined as < 15 mm) were more likely to deliver spontaneously before 35 weeks, 32 weeks, within 7 days, and within 48 hours of admission ( P < .05 for all comparisons). Forty percent of patients (161/401) had a cervical length > or = 30 mm. These patients had a very low risk of microbial invasion of the amniotic cavity (1.9% [3/161]), spontaneous delivery < or = 35 weeks (4.5% [7/154]), < or = 32 weeks (2.6% [2/76]), within 7 days (1.9% [3/154]), and within 48 hours (0% [0/154]) of admission. CONCLUSION: Endovaginal ultrasonographic examination of the uterine cervix in women with preterm labor identifies patients at increased risk for intrauterine infection.     

Evidence of involvement of the nNOS and the kappa-opioid receptor in the same intracellular network of the rat periaqueductal gray that controls morphine tolerance and dependence

Tolerance and dependence are the most important side effects of opioid-mediated pain therapies. However, the mechanisms through which these phenomena are produced still remain unknown. Among the opioid receptors, the kappa-opioid receptor has been the focus of strong research efforts, since it contributes to the reversal of morphine-induced tolerance and dependence. Parallel to this, neuronal nitric oxide synthase has been shown to play a key role in the development of these unwanted effects. Both the kappa-opioid receptor and neuronal nitric oxide synthase are abundantly located in the CNS. One of the areas where these cellular agents are best represented is a key encephalic nucleus in the development of tolerance to the analgesic action of opioid drugs, the periaqueductal gray. In this work, we studied whether morphine-induced tolerance and dependence causes changes (a) in the activity of neuronal nitric oxide synthase and (b) in kappa-opioid receptor expression in the rat periaqueductal gray. Besides, we examined the colocalization of both molecules. Our results point to an involvement of KOR and nNOS in the same intracellular network that controls the development of morphine tolerance and dependence.     

CT and MR imaging findings of malignant cardiac tumors

This article reviews CT and MRI features of malignant cardiac and pericardial tumors, most of which originate from the lung, breast, melanoma, leukemia, or lymphoma through lymphatic, hematogenous, transvenous, and direct pathways. Although echocardiography establishes the diagnosis in most cases, CT and MRI provide additional physical, spatial, and functional information that further aids the evaluation of metastases. For instance, CT provides superior resolution for detecting calcification or fat, while MRI with its direct multiplanar ability more completely characterizes the heart, pericardium, mediastinum, and lungs. MRI also helps elucidate the pathophysiological effects of these tumors on cardiac function through gated cine-loop sequences. Beyond tumor characterization, both modalities can help confirm diagnosis through the addition of contrast, which helps distinguish tumor from myocardium, thrombus, and blood flow artifact. Ultimately, MRI best facilitates surgical planning and posttreatment follow-up in large part because of its unparalleled ability to locate and delimit these tumors.     

Simultaneous pancreas-kidney transplantation: infectious complications and microbiological aspects

OBJECTIVE: The purpose of this study was to describe the clinical and microbiological characteristics of the infectious complications among simultaneous pancreas-kidney transplantations (SPKT). MATERIALS AND METHODS: Among the first 45 SPKT the mean age was 34 years (range, 21 to 49) and the mean duration of follow-up 13 months (range, 2 to 27 months). RESULTS: Twenty-three patients (51%) presented at least one to three episodes (1.7 mean) of infectious complications that needed hospitalization. The etiology of the infections included 71% bacterial (44% gram-negative rods and 27% gram-positive cocci), 16% viral (12% from CMV and 4% from Herpes sp) and 13% fungal (8% by Candida sp and 4% by others fungus). Wound and urinary infections were most frequent, occurring in 22% and 28% of the patients, respectively. All patients who were submitted to vesical drainage developed infections in contrast a rate of only 44% among patients undergoing enteric drainage. CONCLUSION: Infectious complications are the main cause of morbidity and mortality following simultaneous pancreas-kidney transplantation, especially with vesical drainage. The use of enteric drainage combined with administration of broad spectrum prophylactic antibiotics is recommended.