Adding Bupivacaine to High-potassium Cardioplegia Improves Function and Reduces Cellular Damage of Rat Isolated Hearts after Prolonged, Cold Storage

Background: Bupivacaine retards myocardial acidosis during ischemia. The authors measured function of rat isolated hearts after prolonged storage to determine whether bupivacaine improves cardiac protection compared with standard cardioplegia alone.

Methods: After measuring cardiac function on a Langendorff apparatus, hearts were perfused with cardioplegia alone (controls), cardioplegia containing 500 [mu]m bupivacaine, or cardioplegia containing 2 mm lidocaine; were stored at 4[degrees]C for 12 h; and were then reperfused. Heart rate and left ventricular developed pressures were measured for 60 min. Maximum positive rate of change in ventricular pressure, oxygen consumption, and lactate dehydrogenase release were also measured.

Results: All bupivacaine-treated, four of five lidocaine-treated, and no control hearts beat throughout the 60-min recovery period. Mean values of heart rate, left ventricular developed pressure, maximum positive rate of change in ventricular pressure, rate-pressure product, and efficiency in bupivacaine-treated hearts exceeded those of the control group (P < 0.001 at 60 min for all). Mean values of the lidocaine group were intermediate. Oxygen consumption of the control group exceeded the other groups early in recovery, but not at later times. Lactate dehydrogenase release from the bupivacaine group was less than that from the control group (P < 0.001) but did not differ from baseline.     

Medical removals of the Multiload IUD

In a follow-up evaluation of 3721 Multiload IUD users, the removal rate for medical reasons other than bleeding/pain was only 2.6 per 100 women at three years. Most of these removals were for reasons that appeared to be unrelated to IUD use. The removal rate for pelvic inflammatory disease was 0.3 per 100 woman years. Women were followed up for up to three years after removal of their IUDs. Among women with PID at least 70% of those who desired pregnancy subsequently became pregnant, a rate similar to that of women who had their IUDs electively removed to become pregnant. The study provides further data on the safety of intrauterine contraception.

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Resumen Durante el seguimiento de 3721 usuarias del DIU Multiload, la tasa de remociones por otras razones médicas que sangrado/dolor, fué de 2.6 por 100 mujeres en tres años. La mayoría de estas remociones fueron hechas por razones que parecen no estar relacionadas con el uso del DIU. La tasa de remociones por enfermedad inflamatoria pelviana fué de 0.3 por 100 años-mujer. Las mujeres tuvieron seguimiento hasta tres años después de la remoción de sus DIU. Entre las mujeres con enfermedad inflamatoria pelviana, al menos 70% de las que desearon un embarazo lo consiguieron; una tasa similar a la de mujeres que eligieron la remoción del DIU para quedar embarazadas. El estudio proporciona más información sobre la inocuidad de la anticoncepción intrauterina.

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Résumé Lors d'une évaluation de suivi effectuée sur 3721 utilisatrices de DIU Multiload, le taux de retrait pour des raisons médicales autres que des pertes sanguines/douleurs n'a atteint que 2,6 pour cent des femmes après trois ans. La plupart de ces retraits ont été pratiqués pour des raisons qui ne semblaient pas liées à l'utilisation du DIU. Le taux de retrait pour cause d'inflammation pelvienne s'est élevé à 0,3 pour cent femmes-an. Les femmes ont été suivies pendant des périodes allant jusqu'à trois ans après le retrait du DIU. Parmi les patientes qui avaient contracté une inflammation pelvienne, 70% au moins de celles qui souhaitaient une grossesse sont par la suite devenues enceintes; taux semblable à celui des femmes qui avaient choisi de ne plus porter leur DIU précisément pour avoir un enfant. Cette étude fournit des données supplémentaires sur la sécurité qu'apporte la contraception intrautérine.

     

Contraception for women exposedin utero to diethylstilbestrol

Although the effects ofin utero exposure to diethylstilbestrol (DES) have been extensively documented, there is an absence of information on the suitability of different contraceptives for use by DES-exposed women. This paper briefly describes some of the effects associated with DES exposure. Use of various contraceptive methods by DES-exposed women are considered in light of these effects.

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Resumen Aunque los efectos de la exposición a dietilestilbestrol (DES) en útero ha sido documentada extensivamente, hay falta de información sobre la conveniencia de diferentes anticonceptivos para uso en mujeres expuestas a DES. Este trabajo describe brevemente algunos de los efectos asociados con la exposición a DES. Se considera el uso de distintos métodos anticonceptivos para mujeres expuestas a DES en vista a esos efectos.

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Résumé Bien que les effets de l'exposition de l'utérus au diéthylstilboestrol (DES) fassent l'objet d'une documentation importante, on manque d'information sur les différents contraceptifs que peuvent utiliser les femmes exposées au DES. Cet article décrit brièvement certains des effets associés à l'exposition au DES et examine, en considération de ces effets, l'utilisation de diverses méthodes de contraception par les femmes qui y sont exposées.

     

Kinetics of insulin-mediated and non-insulin-mediated glucose uptake in humans

The kinetics of insulin-mediated glucose uptake (IMGU) and non-insulin-mediated glucose uptake (NIMGU) in humans have not been well defined. We used the glucose-clamp technique to measure rates of whole-body and leg muscle glucose uptake in six healthy lean men during hyperinsulinemia (approximately 460 pM) to study IMGU and during somatostatin-induced insulinopenia to study NIMGU at four glucose levels (4.5, 9, 12, and 21 mM). To measure leg glucose uptake, the femoral artery and vein were catheterized, and blood flow was measured by thermodilution (leg glucose uptake = arteriovenous glucose difference [A-VG] x blood flow). With this approach, we found that, during hyperinsulinemia, both whole-body and leg glucose uptake increased in a curvilinear fashion at every glucose level, the highest glucose uptake values obtained being 139 +/- 17 mumol.kg-1.min-1 and 3656 +/- 931 mumol.min-1.leg-1, respectively. Leg blood flow increased twofold from 6.0 +/- 1.7 to 11.7 +/- 3.1 dl/min (P less than 0.01) over the range of glucose and was correlated with whole-body glucose uptake (r = 0.55, P less than 0.005). Leg muscle glucose extraction, independent of changes in blood flow, which is reflected by the A-VG, saturated over the range of glucose (1.28 +/- 0.12, 2.22 +/- 0.30, 2.92 +/- 0.42, 3.02 +/- 0.41 mM, NS between last 2 values) with a half-maximal effective glucose concentration (EG50) of 5.3 +/- 0.4 mM.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hyperperfusion of ictal seizure focus demonstrated by MR perfusion imaging.

MR using a susceptibility-weighted sequence and dynamic contrast enhancement with gadolinium demonstrated relative hyperperfusion of the right temporoparietal cortex in a patient in focal status epilepticus. A single-photon emission CT (SPECT) scan also demonstrated hyperperfusion of the right temporoparietal cortex. Perfusion MR, SPECT, and electroencephalogram normalized when the seizures ended.     

Proximal femoral focal deficiency: radiologic analysis of 49 cases

Proximal femoral focal deficiency, an uncommon congenital anomaly, necessitates early radiologic classification for surgical planning and treatment. Objective radiographic criteria, including femoral length index, acetabular depth index, acetabular angle index, and shape of the proximal femur were determined in 49 patients before cartilaginous ossification of the femoral capital epiphysis; final classification was based on follow-up radiographs or findings at arthrography or surgery. These parameters were analyzed to determine the accuracy and contributions of each in classification. Correct classification into one of three groups was possible in 86% of cases with use of three of the parameters: femoral length index, acetabular depth index, and shape of the proximal femur. The acetabular angle was found to contribute insignificantly to classification. Magnetic resonance imaging, used in only one case, depicted the nonossified cartilaginous femoral capital epiphysis, thus obviating the need for invasive diagnostic procedures and facilitating early classification.     

The future of intrauterine contraception

In this review paper some guidelines for IUD use are presented that if followed should reduce the incidence of IUD-related complications. Recent IUD developments are discussed including the levonorgestrel-releasing T, a new variation of the Multiload, and IUDs designed for postpartum insertion. Since significant improvements in IUD safety will most likely result from a better understanding of IUD-related side-effects and adverse reactions, the paper includes recommendations for future IUD research that could enhance the safety, effectiveness and acceptability of available IUDs.

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Resumen En esta revisión presentamos una serie de directrices que si se siguiesen reducirían significativamente la incidencia de las complicaciones referidas al uso del DIU. Actualmente se evestionan los recientes descubrimientos en torno al DIU, incluido el Levonorgestrel-T, una nueva variación del Multiload y DIUs indicados para la inserción postparto. Desde que se efectuaron importantes modificaciones en su utilización, hemos observado un incremento de su inocuidad y un descenso de los efectos indeseables, gracias principalmente a una utilización más oportuna. Ademas nos ha permitido comprener mejor los efectos colaterales relacionados con su uso. Incluimos tambien recomendaciones, para futuros trabajos, que pueden cambiar las directrices seguidas hasta ahora, mejorando la seguridad, efectividad y aceptabilidad de los DIUs.

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Résumé Dans cette communication d'ensemble sont présentés des conseils généraux relatifs à l'utilisation des DIU, qui devraient permettre, s'ils sont suivis, de réduire l'incidence des complications que ces dispositifs peuvent entraîner. Y sont examinés de récents progrès réalisés sur les DIU, et notamment sur le modèle T libérant du lévonorgestrel qui est une variante du modèle Multiload et des dispositifs conçus pour leur insertion après l'accouchement. Etant donné que toutes les améliorations importantes qui seront apportées du point de vue de la sécurité des DIU résulteront probablement d'une meilleure compréhension des effets secondaires et des réactions adverses imputables aux DIU, cette communications inclut des recommandations pour les recherches à venir, qui pourraient rehausser la sécurité, l'efficacité et l'acceptabilité des dispositifs actuellement sur le marché.

     

Liver transplantation: MR angiography with surgical validation

Thirty patients (mean age, 45 years) were evaluated with magnetic resonance (MR) angiography before liver transplantation to assess the accuracy of MR angiography. A series of breath-hold, two-dimensional images were acquired and subsequently processed to form three-dimensional projection angiograms. Graphic information on blood flow in the portal vein was acquired by using presaturation bolus tracking. Correlative duplex ultrasound (US) was performed in 28 patients, and surgical or autopsy correlation was available in all cases. MR angiography demonstrated patency of the portal vein in 26 (96%) of 27 patients, made possible the diagnosis of portal venous occlusion in three of three patients, depicted reversed portal flow in one patient, and provided clear delineation of the extent of varices and specific portosystemic collateral vessels. When duplex US was successful, there was full agreement with MR angiographic results in assessing portal vein patency and flow direction. All of the MR findings were corroborated at surgical exploration or autopsy. The authors conclude that MR angiography is very accurate in the portal system and is valuable in preoperative assessment for liver transplantation.     

Brain tissue oxygenation in patients with cerebral occlusive disease and arteriovenous malformations

It is not clear if ventilation with oxygen increases brain tissue oxygen pressure (PO2) during ischaemia. We have measured brain tissue PO2, carbon dioxide pressure (PCO2) and pH during baseline anaesthesia and oxygen ventilation in non-ischaemic control patients (n = 9), patients with cerebral occlusive disease (n = 11) and patients with arteriovenous malformations (AVM, n = 12). The same anaesthetic treatment was given to all groups and anaesthesia was constant during the study. Arterial pressure, brain temperature and arterial blood-gas tensions were similar between groups. Under baseline conditions, brain tissue PO2 was mean 4.2 (SD 1.4) kPa in the controls and was 70% lower in patients with ischaemia and AVM. Patients with occlusive disease also had elevated tissue PCO2 and acidosis. During oxygen ventilation, PO2 increased to 7.5 (2.9) kPa in controls and this was 50% greater than the increase in the ischaemia and AVM patients. The results showed that baseline tissue oxygenation and increases in PO2 during hyperoxia were attenuated in patients with ischaemia or AVM.