Biopharmaceutics: Changes in Gastric Mucosal Permeability Induced by Haemorrhagic Shock in the Anaesthetized Rat: Modulation by Acid

Gastric mucosal damage induced by haemorrhagic shock in the anaesthetized rat has been evaluated by studying changes in capillary-to-lumen clearance of fluorescein isothiocyanate (FITC)-labelled dextran. Haemorrhagic shock (20 min ischaemia + 20 min reperfusion) induced a significant increase in blood-to-lumen permeability to FITC-dextran of different molecular weight (10 000, 40 000 and 70 000) without modifying the macroscopic integrity of the gastric mucosa. The increase in vascular permeability was dependent on the time of administration of the tracer and was correlated with an elevation of the protein content of the gastric lumen. Intravenous administration of the secretagogue pentagastrin (20 or 50 μg kg^?1 h^?1) did not significantly modify the vascular permeability to dextran in control animals or in animals subjected to haemorrhagic shock. When the intraluminal pH was reduced by intragastric administration of acidic saline solution, only pH 1, which itself induced the appearance of macroscopic mucosal lesions, significantly increased vascular permeability to dextran, both in control animals and in animals subjected to haemorrhagic shock. These findings suggest that stress induced by haemorrhagic shock increases vascular gastric permeability to dextran, by an acid-independent mechanism, without affecting the macroscopic integrity of the gastric mucosa.     

Analysis of Rabbit Vascular Responses to DBI,an Ingol Derivative Isolated from Euphorbia canariensis

We have analysed the effects of 7,12-O-diacetyl-8-O-benzoil-2,3-diepiingol (DBI), an ingol derivative isolated from E. canariensis, on isometric tension developed by isolated rabbit basilar and carotid arteries. Concentration-response curves to DBI (10^?8 - 3 × 10^?5 m) were obtained cumulatively in both arteries at resting tension and active tone (KC1, 50 mm). At resting tension, DBI induced a concentration-dependent contraction, which was not inhibited in Ca²⁺-free medium. H7 (1-(5-isoquinoline sulphonyl)-2-methylpiperazine dichloride) (10^?4 m) inhibited the DBI-induced contraction both in basilar and in carotid arteries. Calmidazolium (10^?4 m) inhibited the maximum contraction of the carotid artery to DBI, and completely abolished the response in the basilar artery. In pre-contracted basilar arteries DBI induced a concentration-dependent relaxation that was not modified by incubation with N^G-nitro-l-arginine (l-NOARG; 10^?5 m) or indomethacin (10^?5 m). In the carotid artery with active tone DBI induced further contractions, which were not significantly modified by l-NOARG (10^?5 m) and were potentiated by indomethacin (10^?5 m). These results suggest that DBI contracts rabbit basilar and carotid arteries by a mechanism that is independent of extracellular Ca²⁺ and involves the participation both of protein kinase C and of calmodulin. DBI relaxes basilar but not carotid arteries by a mechanism independent of the liberation of nitric oxide and prostacyclin. In the carotid artery prostacyclin but not nitric oxide partially counteracts the contractile action of DBI.     

Regional differences in hospital use by adults in Spain

The purpose of this paper was to study regional differencesin the use of in-patient hospital services by adults in Spainand to explore how several factors are related to hospital utilization.We studied a sample of 20,741 individuals representative ofthe non-institutionalized Spanish population older than 15 yearsold interviewed in the Spanish health interview survey, carriedout in 1993. A logistic regression model was used to obtainthe odds ratios of using the in-patient hospital services forsocioeconomic status, health care need, health services resourcescharacteristics and for the 17 autonomous communities into whichSpain is divided. Aragon, Baleares and Navarra showed a highpercentage of people using hospital services while in Madridand Asturias a low percentage was found. Indicators of needfor health care were the most important predictive factors ofhospital utilization and neither socioeconomic status nor healthcare system characteristics were associated with the use ofhospital services. Although only 5 autonomous communities showeda high or low percentage of people using hospital services,the unexplained variance needs further research in order toidentify unnecessary reasons for utilization and accessibilityproblems.     

Out-patient antihypertensive drug utilization and stroke mortality: An ecological study

Directly age-standardized rates of out-patient utilization ofantihypertensive drugs (antihypertensives, diuretics and beta-blockers)and stroke mortality in men and women (40–79 years ofage) were compared over 4 years (1987–1990) in a midwestern(Värmland) and a southern (Skäne) province of Swedenand in their 49 (16 + 33) municipalities. In both genders, thestroke mortality and utilization rates of the 3 antihypertensivedrug groups, both combined and separate, were higher in Värmlandand there were positive correlations between these rates whenall 49 municipalities were compared. On the other hand, foreach province and each drug group there were municipalitieswith every possible combination of stroke mortality and antihypertensivedrug utilization rates. In addition, antihypertensive drug utilizationrates were similar in men and women even though the stroke mortalityrates were much lower among the latter. The findings cast doubton the effectiveness of antihypertensive drug treatment in commonpractice.     

Anaesthetic management of the surgical separation of a pair of thoracopagus-cardiopagus twins

We describe the anaesthetic management of the surgical separation of a pair of thoracopagus-cardiopagus twins with a common right atrium and a myocardial tissue bridge containing vascular channels between their ventricles. One of them died during the procedure, the surviving twin is now two years old. The survival of one twin for two years without significant sequelae, after the surgical separation of twins with shared right atrium and fused ventricles, has not previously been reported. Careful preoperative assessment is essential to anticipate potential serious problems during the procedure.     

The Role of Various Cereals in Coeliac Disease

It is well established that the consumption of wheat glutenwill produce the characteristic mucosal lesion of coeliac diseasein subjects who are predisposed to it. The role of other cerealsin the pathogenesis of this disease is less certain. In thepresent study, four different cereals (rye, barley, maize andrice) have been tested by feeding them to volunteer coeliacsubjects who had shown good mucosal recovery on a gluten freediet and assessing the effect by serial jejunal biopsy. Thebiopsy specimens obtained before and after challenge were comparedin terms of histology and disaccharidase activity. The resultsindicate that rye and barley are harmful but that maize andrice are harmless.