Is routine extubation overnight safe in cardiac surgery patients?

Objectives

Expedient extubation after cardiac surgery has been associated with improved outcomes, leading to postoperative extubation frequently during overnight hours. However, recent evidence in a mixed medical-surgical intensive care unit population demonstrated worse outcomes with overnight extubation. This study investigated the impact of overnight extubation in a statewide, multicenter Society of Thoracic Surgeons database.

The significance of individual patient characteristics for loading capacity and deformation of the proximal end of the femur

The influence of such individual characteristics as age, sex, morphological characteristics (CDD angle, length of femoral neck, total and medullary diameter and score on the Singh osteoporosis index) on the loading capacity and deformation of the proximal end of the femur were determined in this experimental study. In all, 341 femora taken from the cadavers of persons who had died at over 60 years of age were tested under alternating load in up to 4000 cycles and, if no instability occurred, also under static load. The loading capacity and deformation were compared. The loading capacity was significantly higher in male femora with (5441 +/- 257 N) than in female femora (4273 +/- 1850 N). The loading capacity also decreased with increasing age and with decreasing CCD angle and Singh index score (higher degree of osteoporosis). Because of the high standard deviation in each group these differences were not significant.     

Stimulation of protein phosphatase activity by insulin and growth factors in 3T3 cells.

Incubation of Swiss mouse 3T3-D1 cells with physiological concentrations of insulin resulted in a rapid and transient activation of protein phosphatase activity as measured by using [32P]phosphorylase a as substrate. Activation reached a maximum level (140% of control value) within 5 min of addition and returned to control levels within 20 min. The effect of insulin was dose-dependent with half-maximal activation occurring at approximately 5 nM insulin. This activity could be completely inhibited by addition of the heat-stable protein inhibitor 2, which suggests the presence of an activated type-1 phosphatase. Similar effects on phosphatase activity were seen when epidermal growth factor and platelet-derived growth factor were tested. These results suggest that some of the intracellular effects caused by insulin and growth factors are mediated through the activation of a protein phosphatase.     

Severe ciguatera poisoning in Madagascar: A case report

In a single outbreak on the East coast of Madagascar, more than 500 people, 98 of whom died, were poisoned by the flesh of a shark, Carcharhinus amboinensis. From clinical symptoms it can be concluded that this poisoning is due to ciguatera toxins. It is the first case of a severe outbreak caused by a shark, and it is the first case with a mortality rate of 20%.     

The effect of adjuvant combined chemo/immunotherapy on immunological parameters and clinical course in patients with breast carcinoma

In 61 breast cancer patients the effect of an combined adjuvant chemo-/immunotherapy with thymopentin (Timunox, Cilag) on different parameters of cell-mediated immunity (Leucocyte Migration Inhibition Test, serum level of tumor necrosis factor alpha, IL 2, Interferon alpha and distribution of lymphocyte subsets in the peripheral blood) and the clinical course of disease was evaluated and compared to patients receiving only chemotherapy. In cancer patients additionally treated with thymopentin an increase of the interferon alpha serum level could be observed, whereas the other parameters examined did not change. In the control group the percentage of T helper cells decreased under chemotherapy (p less than 0.05). Due to the short time of observation of 49 months until now no significant changes concerning the disease free interval and the time of survival between both groups could be found. Possibly the additional administration of thymopentin in breast cancer patients at least leads to a reduction of the immunosuppressive side effects of an adjuvant chemotherapy.     

Animal experiments for the evaluation of laserspectroscopy in the fetus during labor.

Laserspectroscopy with near-infrared light is newly available for clinical application. The equipment consists of a near-infrared data collection unit (NIRDCU) and a personal computer. Emission of laser light at wavelengths of 775, 805, 845 and 904 nm is provided by the four laser diodes of the NIRDCU. By analyzing changes of optical density during laser radiation, information is obtained regarding the intracellular redox state and relative changes of blood volume. During measurement with the system on the fetal scalp during delivery we were able to get a first impression of the method's potential. While the application of the laser sensors is still cumbersome, signals providing information of the relative changes of hemoglobin concentration, relative changes of blood volume and cytochrome aa3 seems achievable. Laserspectrophotometric monitors may become safe, low cost and portable instruments for the non-invasive assessment of the biochemical and biophysical status in the fetus.     

Sterilitätsbehandlung durch homologe intrauterine Insemination

Homologous intrauterine insemination (IUI) both in spontaneous and, preferably, in ovulation induction cycles, is widely recommended as the first choice of assisted conception techniques. However, there is no consensus on the effectiveness of such an approach. Especially in cases of male subfertility divergent views exist with regard to the therapeutic benefit. The literature survey presented is intended to provide information on the pregnancy rates achievable after homologous IUI for male-factor subfertility. For the sake of clarity, this review is limited to prospective, randomized IUI studies conducted since 1984, which clearly indicated that the work focused on male subfertility only as well as on either spontaneous cycles or cycles stimulated with a single regimen (clomiphene citrate or gonadotropins). We conclude from evidence-based data that IUI is justified as a reasonable first-line therapy in moderate male factor cases, especially if gonadotropins are used for mild ovarian stimulation.     

Combined transrectal ultrasonography and urodynamics in the evaluation of detrusor-sphincter dyssynergia

Thirty-one combined transrectal ultrasonographic and urodynamic studies were performed in 24 patients with spinal cord lesions at different levels between C4 and T12. Ultrasonography provided accurate real-time imaging of the bladder neck, prostatic urethra and external sphincter during the bladder filling phase as well as during the voiding phase. Bladder and rectal pressures, sphincter EMG and uroflow were recorded simultaneously. Transrectal ultrasonography contributed significantly to the accuracy of diagnosing detrusor-sphincter dyssynergia. Sphincter contractions were clearly visualised with ultrasonographic video monitoring. This imaging method was especially helpful in sorting out the problems of 3 patients with poor emptying of bladder after endoscopic sphincterotomy. One had a urethral stricture and the other 2 had sphincters that opened adequately but bladders that emptied poorly because of detrusor hypocontractility. Other problems, such as benign prostatic hyperplasia and false passage, were also easily recognised. Transrectal ultrasonography not only provides accurate information but also involves no exposure to radiation and thus precludes the need for costly lead-shielded examination rooms.     

Calmodulin-stimulated cyclic nucleotide phosphodiesterase (PDE1C) is induced in human arterial smooth muscle cells of the synthetic, proliferative phenotype.

The diversity among cyclic nucleotide phosphodiesterases provides multiple mechanisms for regulation of cAMP and cGMP in the cardiovascular system. Here we report that a calmodulin-stimulated phosphodiesterase (PDE1C) is highly expressed in proliferating human arterial smooth muscle cells (SMCs) in primary culture, but not in the quiescent SMCs of intact human aorta. High levels of PDE1C were found in primary cultures of SMCs derived from explants of human newborn and adult aortas, and in SMCs cultured from severe atherosclerotic lesions. PDE1C was the major cAMP hydrolytic activity in these SMCs. PDE expression patterns in primary SMC cultures from monkey and rat aortas were different from those from human cells. In monkey, high expression of PDE1B was found, whereas PDE1C was not detected. In rat SMCs, PDE1A was the only detectable calmodulin-stimulated PDE. These findings suggest that many of the commonly used animal species may not provide good models for studying the roles of PDEs in proliferation of human SMCs. More importantly, the observation that PDE1C is induced only in proliferating SMCs suggests that it may be both an indicator of proliferation and a possible target for treatment of atherosclerosis or restenosis after angioplasty, conditions in which proliferation of arterial SMCs is negatively modulated by cyclic nucleotides.