Coagulation and renal effects of voluven versus haes-steril in major orthopedic surgery

Hydroxyelhyl starch [HES] solutions are effective plasma volume expanders. Impairment of coagulation and renal junction occur with large HES volumes infused perioperatively. Therefore, a lower substituted novel HES [Voluven] was developed to minimize hemostatic interactions. The aim of the study is to evaluate the benefit of voluven to reduce hemostatic interactions and preserve renal junction while preserving its efficacy in restoring plasma volume in comparison to HAES-steril [pentastarch]. After approval of our local institutional university ethical committee, and a written consent was obtained from each one. Fifty consecutive adult patients, ASA I and II, scheduled for elective major orthopedic surgery at Assiut University Hospital were included in the study. The patients were allocated into two equal groups [each of 25 patients] according to the type of the study solution used as plasma volume replacement. Group-A: received [Voluven]. Group-B: received HAES-steril. Hemodynamic parameters: central venous pressure [CVP], mean arterial blood pressure [MABP], and heart rate [HR] were recorded before anesthesia induction [baseline], one hour after induction of anesthesia, at the end of surgery, 5 h after surgery and 24 h after surgery. Coagulation profile: Screening tests: prothrombin time [PT], prothrombin concentration [PC], International Normalized Ratio [INR]], partial thromboplastin time [aPTT] and serum fibrinogen level. Specific tests of haemostasis: factor VIII concentration and von Willebrand factor [vWF], Renal function tests: blood urea nitrogen and serum creatinine. Measurements time: sample were collected one day before surgery ['baseline], at 5 h and 24h after surgery. Amount of given colloids [ml], blood loss [ml] and packed RBCs [ml,] were recorded in all patients in two groups. All patients in the two groups were subjected to the some anesthetic management. Data was statistically analyzed using SPSS program version 16, a p value < 0.05 was considered statistically significant. There were significant differences with time as regard PT, PC, and INR in both groups and there was significant difference between the two groups, more increase in PT, INR and more decrease in PC in Haesteril group than in Voluven group. Voluven produced less inhibitory effect on coagulation factor VIII and Von Willibrand factor concentration and consequently, aPTT in comparison with HA ES-steril. Blood loss and transfusion requirements were less with Voluven group than with HAES-steril group. BUN and serum creatinine significantly changed over time in both groups but still within normal range in Voluven groups, but in Haesteril group there were significantly changed over time, mildly elevated above normal range and there was significant difference between the two groups with more increase in Haestril group. Compared with HAES-steril, Voluven are more likely to produce less coagulation abnormalities and less renal impairment in patients undergoing major orthopedic surgery manifested by less blood loss and less erythrocytes transfusion

Central actions of glucocorticoids in the control of body fluid homeostasis: review

The involvement of the hypothalamic-pituitary-adrenal axis in the control of body fluid homeostasis has been extensively investigated in the past few years. In the present study, we reviewed the recent results obtained using different approaches to investigate the effects of glucocorticoids on the mechanisms of oxytocin and vasopressin synthesis and secretion in response to acute and chronic plasma volume and osmolality changes. The data presented here suggest that glucocorticoids are not only involved in the mechanisms underlying the fast release but also in the transcriptional events that lead to decreased synthesis and secretion of these neuropeptides, particularly oxytocin, under diverse experimental conditions of altered fluid volume and tonicity. The endocannabinoid system, through its effects on glutamatergic neurotransmission within the hypothalamus and the nuclear factor κB-mediated transcriptional activity, seems to be also involved in the specific mechanisms by which glucocorticoids exert their central effects on neurohypophyseal hormone synthesis and secretion.

Niveles plasmáticos de mieloperoxidasa y proteína C reactiva en conejos machos en Nueva Zelanda expuestos a una dieta hiperlipidémica / Plasma concentration of myeloperoxidase and C reactive protein in male New Zealand rabbits, exposed to a hyperlipidemic diet

La Mieloperoxidasa (MPO) y la Proteína C Reactiva (PCR) han sido implicados en la fisiopatología de la aterosclerosis. El objetivo del presente estudio fue determinar las concentraciones plasmáticas de MPO y PCR y su relación con la formación de ateromas en conejos. Se estudiaron 23 conejos machos Nueva Zelanda: Grupo 1: conejarina y verdura; Grupo 2: Huevo y conejarina. El periodo experimental duró 13 semanas. Se determinó perfil lipídico por métodos enzimáticos, MPO por ELISA y PCR por turbidimetría en 0 13va semana. Se realizó estudio histológico de aorta. Los resultados revelaron que la PCR se elevó en el grupo 2 al final del estudio (p<0,05). No se observó diferencias en MPO en el grupo 2 en el estudio. En cuanto a los ateromas se evidenciaron lesiones tipo I y II en los conejos del grupo 2. En conclusión, se encontró que la PCR y no la MPO son marcadores de aterosclerosis según nuestras condiciones experimentales.

Myeloperoxidase (MPO) and C-reactive protein (CRP) have been implicated in atherosclerosis. The objective of the present study was to determine plasma concentration MPO and CRP and its relationship of formation of aortic lesions in rabbits. 23 male New Zealand rabbits were study: Group 1: “conejarina” (commercial rabbit food) and vegetables; Group 2: egg and conejarina. The experiment lasted 13 weeks. Lipid profile was done by enzymatic methods, MPO by ELISA, and PCR by turbidimetry in weeks 0 and 13. Histological study of rabbits’ aorta was done. Results revealed that in group 2 CRP increased at final study (p <0.05). No differences were observed in MPO values in the experiment. Regarding atheroma, group 2 presented type I and II lesions. In conclusion only CRP is marker of atherosclerosis according to our experimental conditions.

Disminución del volumen plasmático y cambios en hormonas vasoactivas en embarazadas de bajo peso / Reduced plasma volume and changes in vasoactive hormones in underweight pregnant women

Background: Pregnant women with low weight/height (wt/ht) have lower plasma volume and reduced birth weight than women with normal wt/ht. Aim: To explore the hormonal mechanisms involved in these alterations. Patients and methods: Plasma volume, and several hormones related to plasma volume regulation were determined in 24 near term pregnant women with low wt/ht and in 30 with normal wt/ht. Results: Newborns's weight, height and ponderal index were reduced in the low wt/ht group. Plasma volume (3042 ñ 101 vs 3631 ñ 101 ml, p< 0.001); plasma renin activity (7.5 ñ 0.9 vs 11.1 ñ 0.9 ng/ml/h, p< 0.01) and aldosterone (428 ñ 47 vs 710 ñ 58 pg/ml, p< 0.001) were significantly reduced in the low wt/ht group. Similar reductions were observed in serum estradiol and progesterone levels. Urinary kallikrein activity (354 ñ 112 vs 824 ñ 134 nmoles/24 h, p< 0.05), 6-keto-prostaglandin F1a (561 ñ 90 vs 1121 ñ 165 ng/24 h, p< 0.05) and thromboxane B2 (110 ñ 29 vs 280 ñ 29 ng/24 h, p< 0.05) were also reduced in low wt/ht women. Conclusions: We postulate that the reduced levels of vasoactive hormones observed in pregnant women with low wt/ht may interfere with plasma volume expansion and, in turn, cause low birth weight

El tabaco daña la salud. Alerta para los tejidos periodontales! / Tobacco damages the health. An alert for periodontal tissues!

En este trabajo de revisión bibliográfica se encontró que diversos autores coinciden acerca del daño que las sustancias tóxicas del tabaco, provocan a los tejidos periodontales. Conocer la influencia de la nicotina sobre dichos tejidos, servirá de motivación para trabajar en prevención, mejorar el diagnóstico, conocer la limitación del tratamiento y orientar el pronóstico de la enfermedad periodontal del fumador

Estudio de pacientes con litiasis urinaria calcica / Study of patients with calcified urinary lithiasis

Se presenta el trabajo relacionado con la litiasis rinaria cronica, se han revisado 863 historias clínicas del Servicio de Nefro-urología del hospital "Jaime Mendoza" dependiente de la Caja Nacional de Salud de la ciudad de sucre, Bolivia, entre los años de 1987 a 1991. Habiendose encontrado 64 pacientes portadores de litiasis urinaria calcica, lo que corresponde al 7,4. Como quiera que el manejo de la litiasis urinaria no es satisfactorio en nuestro medio, las medidas profilacticas practicamente no existen o solo se limitan a la restriccion de la leche y aumentar la ingestion de agua. Motivados por esa realidad, hemos adaptado en nuestro Servicio el protocolo de estudio de la litiasis urinaria calcica propuesto por Pak y Coe. Para ello fue necesario previamente establecer como punto de partida los valores normales del protocolo, el mismo se realizo en un grupo de 20 personas de ambos sexos, sin antecedentes de litiasis. Posteriormente hemos aplicado ese mismo protocolo a 20 de nuestros pacientes portadores de litiasis urinaria calcica habiendose encontrado 18 alteraciones. Finalmente se ofrece un cuadro de la ubicacion de la litiasis en los diferentes segmentos del aparato urinario.

Bioequivalence study for diazepam commercial tablets in psychiatric patients

The bioequivalence of three different commercial diazepan tablets (5mg) using the innovator product (Valium, Roche) as a reference was evaluated in eight psychiatric patients, following a multiple-dose regimen (5 mg t.i.d.). Each patient receive the four treatments sequentially according to a Latin square design, with balance for first residual effect. Blood samples were taken once the steady state of the drug had been reached, and the plasma levels were determined using a HPLC method. No statistical differences were found in diazepam steady-state levels after the adminsitration of the four formulations, indicating that they could be aconsidered equivalent

Anemia na gestaçäo / Anemia in pregnancy

Os autores pretendem fazer uma breve revisäo bibliográfica, visando a orientaçäo de médicos e estudantes sobre os aspectos fisiológicos e patológicos da anemia na gestaçäo

Cambios en los niveles plasmáticos de glucosa en pacientes sometidos a cirugía otorrinolaringológica electiva con anestesia general intravenosa total con propofol vs anestesia general inhalatoria con halotano / Changes in plasma levels of glucose in patients scheduled for ONT procedures during propofol anesthesia versus halothame anesthesia

El presente trabajo describe los efectos de la anestesia total intravenosa con propofol versus anestesia general con halotano, en cirugia otorrinolaringológica. Se formaron dos grupos de pacientes con el objeto de evaluar los niveles plasmáticos de glucosa con estas dos técnicas anestésicas. Se encontró un ligero incremento estadísticamente significativo, en los niveles de glucosa en el grupo de pacientes que recibió anestesia total intravenosa con propofol. Tal incremento no mostró repercución clínica. Se discute la importancia de estos hallazgos en la practica diaria de la anestesia

effect of halothane anaesthesia on blood and plasma volumes in bilharzial hepatosplenomegaly

Ten male patients with bilharzial hepatosplenomegaly were the subject of this study. Another ten male patients of nearly the same age and body weight were taken as control. The plasma and blood volumes were estimated before and 30 minutes after 2% halothane anaesthesia without any surgical interference. The plasma volume was determined by Evens blue dye method and the total blood volume was calculated from the haematocrit value. There was no significant difference between the mean blood volumes of the two groups before the administration of halothane. The 2% halothane administration for 30 minutes, significantly increased the mean total blood volumes in both groups, although the difference between the mean percent increases was not significant. The mean haematocit values of both groups did not display any significant change before or following the exposure to halothane. Patients with bilharzial hepatosplenomegaly developed more hypervolaemia during halothane anaesthesia, possibly mainly due to an increase in the plasma volume. The effect of halothane anaesthesia on the blood volume was the subject of conflicting reports. Some authors [Payne and colleagues, 1959, and Grable and associates, 1962] reported an increase in blood volume, while other [Morse and colleagues, 1963] could not detect any change in blood volume following the administration of halothane. Hepatosplenic bilharziasis is a disease associated with changes in haemodynamic pattern [Mousa, 1967] and these changes can be modified by the action of various drugs especially the vasoactive ones. The purpose of this study is to report the effect of halothane anaesthesia on the plasma and blood volumes in hepatosplenic bilharziasis