Long-chain versus medium-chain lipids in acute pancreatitis complicated by acute respiratory distress syndrome: effects on pulmonary hemodynamics and gas exchange

BACKGROUND AND AIMS: In order to assess the effects of fat emulsions in patients with acute pancreatitis and acute respiratory distress syndrome (ARDS) before the pancreatic injury was complicated by infection, pulmonary hemodynamics and gas exchange were investigated during the administration of long-(LCTs) or medium-chain triacylglycerols (MCTs). METHODS: This prospective trial included nine patients with acute pancreatitis and ARDS; each patient was used as his/her own control. In all cases, the needle aspiration culture of the pancreas was negative. Fat emulsion provided 50% of the energy expenditure. The patients were infused, in random order, with pure LCTs and a 1:1 mixture of LCTs/MCTs on days 1 and 2, over an 8 h period. RESULTS: LCT infusion increased the mean pulmonary artery pressure (MPAP) from 28+/-5 to 35+/-3 mmHg, pulmonary venous admixture (Qva/Qt) from 26+/-5% to 36+/-5% and decreased arterial PO2(PaO2)/fractional inspired oxygen (FIO2) from 210+/-20 to 170+/-20 (P<0.05). The infusion of LCT/MCT 1:1 emulsions increased oxygen consumption (VO2) from 340+/-10 to 398+/-15 ml/min, cardiac output (CO) from 8.8+/-0.2 to 9.5+/-0.5 L/min and CO2 production (VCO2) from 247+/-12 to 282+/-14 mL/min (P<0.05). CONCLUSION: LCT/MCT 1:1 mixtures are recommended in cases of acute pancreatitis and ARDS, even though infusion over a short period increases the metabolic demand.     

Linoleic and arachidonic acid in perinatal asphyxia and prematurity.

OBJECTIVES: Long-chain polyunsaturated fatty acids (LC-PUFA) are important for fetal and infant growth and development. The effects of prematurity and perinatal asphyxia on the levels of linoleic acid (LA) and arachidonic acid (AA) in plasma and red blood cell (RBC) membranes were investigated. METHODS: Fifty-five neonates were studied: 18 full term neonates with perinatal asphyxia (group A), nine preterm neonates (group B), and 28 healthy term neonates (group C). Non-esterified and total levels of LA and AA in plasma and RBC membranes were estimated using gas chromatography within the first day of life. Malondialdehyde (MDA) levels were measured using the thiobarbituric acid (TBA) reactivity method. RESULTS: Compared to group C, statistically significant lower levels of plasma free and total AA and free LA were observed in group A, whereas statistically significant higher levels of RBC total LA and AA were observed in RBC membranes of group B. A negative correlation between MDA and LC-PUFA levels was found. CONCLUSION: Perinatal asphyxia is associated with a reduction in LC-PUFA levels, most likely as a result of increased oxidative stress. Premature infants soon after birth have higher LC-PUFA levels than term neonates, probably reflecting the overall metabolic activity and/or intrauterine transport of LC-PUFA.     

Haemodynamic changes in ischaemic vs. anhepatic pig experimental model of acute liver failure

BACKGROUND AND OBJECTIVE: The removal of the non-functioning liver in cases of fulminant liver failure has been advocated by some authors as a means of improving haemodynamic instability and acid-base disturbances associated with acute liver failure. METHODS: The aim of the present experimental study was to investigate whether maintaining a non-functioning liver is preferable over removing it in terms of haemodynamic variables, after acute hepatic failure has been surgically induced. Twenty Landrace pigs were used in the study. All of them underwent portocaval anastomosis and ligation of the hepatic artery. After an 18-h period and with biochemical indices of fulminant hepatic failure clearly demonstrated, the animals were randomly assigned to one of two groups: in 10 pigs (Group A) the ischaemic liver was left in situ and no further surgical intervention was undertaken. The other 10 (Group B) underwent total hepatectomy. Haemodynamic monitoring was the same in both groups. No inotropes were administered throughout the whole period of observation. RESULTS: Haemodynamic deterioration was observed in the hepatectomized pigs (Group B) whereas the group with the ischaemic liver in situ (Group A) remained stable in terms of the haemodynamic variables evaluated until the end of the experiment. (Cardiac index in Group A 7.59 +/- 1.25 L min(-1) m(-2) vs. 2.92 +/- 0.68 L min(-1) m(-2) in Group B, P < 0.05.) CONCLUSIONS: The concept of salvage hepatectomy in cases of acute liver failure should be redefined since there seems to be some experimental evidence that it may not be as beneficial as originally thought.     

Sepsis favors high-on-clopidogrel platelet reactivity

High-on-treatment platelet reactivity (HPR) is associated with ischemic events in patients on antiplatelet therapy with a history of cardiovascular disease. On the other hand, recent data have associated sepsis with adverse cardiovascular events in patients admitted with bacteremia or respiratory infection. We aimed to assess P2Y₁₂-mediated platelet reactivity (PR) during sepsis and recovery in patients under clopidogrel. This was a prospective observational study. Incoming patients presenting with signs/symptoms of sepsis already on a maintenance dose of clopidogrel of 75 mg qd for cardiovascular events were included in this study. Patients were assessed for their PR on presentation and following septic syndrome, using the VerifyNow point-of-care P2Y₁₂ assay. Patients were excluded in the presence of evidence of noncompliance to antiplatelet regimen or in need of discontinuation during this study. Twenty-two septic patients on clopidogrel were included in this study (Supplemental Figure S1). Clopidogrel was administered for previous stroke, coronary, and peripheral artery disease in 27.3, 40.9, and 31.8% of patients, respectively. The main site of infection was respiratory tract followed by urinary tract, while the same amounts of gram-negative and -positive pathogens were isolated. HPR was noted in 77% and 29% of patients during sepsis and recovery, respectively, presenting a significant decrease in P2Y₁₂ reaction units values during follow-up [240.7 ± 58.3 versus 179.5 ± 58.4, 95% CI (–102.7, –39.76), p = 0.0002]. Five patients died of infection, while no adverse cardiovascular events were noted in our study. Our study shows that sepsis may favor HPR, which is reversed when recovery occurs. This finding may underlie the adverse cardiovascular events in patients admitted with sepsis, possibly requiring alteration of antiplatelet regimen during the inflammation period.     

Treatment-induced changes of lymphocyte subsets in patients with adenoid cystic carcinoma of the head and neck

European Archives of Oto-Rhino-Laryngology - Adenoid cystic carcinoma (ACC) of the head and neck is a rare and highly malignant tumor, characterized by perineural growth and early distant...     

Traumatologie der Nase

HNO - Isolierte Nasenfrakturen sind die häufigsten Verletzungen des zentralen Mittelgesichts. Die Frakturtypen können in Abhängigkeit von der Gewalteinwirkung und -ausrichtung...