Skin donations after suicide by acute poisoning.

The demand for skin tissue allografts to treat burns and other types of injuries increases each year to the extent that categories of donors formerly deemed "unsuitable", such as victims of suicide by polytrauma or poisoning, are now considered. Patients who died by ingestion of/exposure to toxic substances can be accepted as tissue donors after assessment of graft safety to rule out any risks of transferring toxic substances to the recipient. A cadaveric skin donation was obtained from a 57-year-old woman who died from intoxication after ingesting colchicine tablets (0.2 mg/kg). To determine the safety of cadaveric skin allografts, high-performance liquid chromatography-mass spectrometry (LC-MS/MS) was used to identify and quantify colchicine in procured skin. Results revealed that colchicine concentrations were lower than the instrument limit of detection (LOD) of 0.5 ng/mg both in epidermis and dermis. Cell viability assessed through the MTT ([3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide]) test was within standard limits. Thanks to accurate tests performed, which are routinely applied also in clinical diagnostics and forensic toxicology, it was possible to ascertain the safety and suitability of skin tissue for donation.

Analysis of performance, bone characteristics, and expression of genes involved in the balance of ionic concentrations in broilers subjected to dietary electrolyte balance levels.

1. Sodium bicarbonate (NaHCO3), potassium carbonate (K2CO3), and ammonium chloride (NH4Cl) are commonly used to correct dietary electrolyte balance (DEB) in birds. However, there are many gaps in the knowledge of their effects when used simultaneously. This study investigated the effect of DEB levels on performance, femur bone characteristics and the expression of genes related to the balance of ionic concentrations in broilers at 21 days of age.2. Male Cobb broiler chickens (n = 245), aged 1-21 d, were divided into groups based on a completely randomised design with five DEB levels (110 mEq/kg, 175 mEq/kg, 240 mEq/kg, 305 mEq/kg, and 370 mEq/kg).3. The performance characteristics measured included body weight (BW), body weight gain (BWG), feed intake (FI), feed conversion (FCR) and body weight birds slaughtered (BWS).4. The bone variables assessed in the femur were weight (WE), relative bone weight (RBWE), length (L), width (WI), maximum load supported (MLS), bone-breaking resistance (BR), and Seedor index (SI). In addition, the expression of CHP1, SLC9A1, and SLC24A3 in the livers, intestines and kidneys of birds was evaluated.5. The DEB level of 370 mEq/kg, at Na+ content of 0.48%, resulted in the highest averages for L, MLS, and BR of the femur. This DEB level increased the expression of SLC9A1 in the liver and SLC24A3 in the intestine. A 240 mEq/kg DEB level decreased the expression of CHP1 in the liver, while supplementation with 110 mEq/kg increased the expression of SLC24A3 in the kidney.6. In conclusion, 370 mEq/kg DEB improved FCR and increased the mean bone characteristics of the femur (L, MLS, and BR) and the expression of SLC9A1 and SLC24A3 in the liver and intestine, respectively. These findings should be considered in future assessments of the effects of DEB levels on broilers.

[Long-term survival metastatic ovarian cancer elderly patient]. / Paziente anziana con carcinoma ovarico metastatico lungo-sopravvivente.

Ovarian cancer is the sixth diagnosed cancer among women worldwide, it has a high mortality and in most cases it's diagnosed in advanced stage (stage III-IV). Combination platinum-paclitaxel chemotherapy administered every 3 weeks is considered the gold standard for first-line treatment of patients with advanced ovarian cancer. Elderly patients with ovarian cancer represents a subgroup with poor prognosis because they are often treated less radically for comorbidities and age. In the present article, we report a case of a 85 year old woman who was diagnosed with stage IV ovarian carcinoma for the presence of peritoneal carcinomatosis ab initio, not radically debulked and then treated with weekly schedule platinum-based and paclitaxel. Despite not being able to complete the chemotherapy, the patient achieved excellent results and represents a case of long survival.

Two-stage phase II study of imatinib mesylate in subjects with refractory or relapsing neuroblastoma.

BACKGROUND: Cure rate for subjects with refractory or relapsing metastatic neuroblastoma is <5%. In the search for a novel therapy, continuous daily oral administration of imatinib mesylate was evaluated. PATIENTS AND METHODS: Twenty-four subjects were enrolled in a two-stage study. Imatinib was administered for the first 4 weeks (cycle) at 170 mg/sqm b.i.d. If no major toxicity occurred, the dose was escalated to 300 mg/sqm b.i.d. for a maximum of 12 cycles. Clinical response and toxicity were evaluated according to international criteria. Pharmacokinetics (PK) profiles and tyrosine hydroxylase (TH) mRNA expression were also determined in a subset of subjects. RESULTS: Five (21%) complete responses, with one subject still alive at 68 months, and 2 (8%) partial responses lasting up to 29 months were obtained. No grade 4 toxicity was observed. At steady-state, PK exposure (69.7 µg h/ml) was similar to that of adults receiving 1000 mg/die. Responses appear to correlate with the absence or presence of metastasis in the bone marrow (BM) alone, with low TH expression levels at study entry and low imatinib exposure. CONCLUSIONS: Imatinib mesylate was well-tolerated and effective in the subset of subjects with low BM infiltration as only site of metastasis. Study identifier EudraCT: 2005-005778-63.

Morphology and biometric of the vesicular and bulbourethralglands in castrated and non-castratedSanta Inesbreed sheep

Introduction: The purpose of this paper is to determine the topography, biometry and light microscopyimage of the vesicular and bulbourethral glands in order to analyze morphologic features of the accessorysexual glands in castrated and non-castrated animals.Materials and Methods:The morphology of theaccessory sexual glands was investigated in 14 adult Santa Inesbreed sheep, weighing 32 kg, on average.Six of them were castrated, and eight, non-castrated. For macroscopic study, the description of these twoglands was carried out, as well as dissection and biometry study. Moreover, weight, length, height andwidth measurements were evaluated. For histological analysis, the vesicular and bulbourethral glands weresampled.Results:The topography of the reproductive glands was similar to bovine species. However, lowermacroscopic measurements (p < 0,05) in the glands of the castrated sheep were evidenced when comparedwith the non-castrated ones. Characteristics such as shape of the glands, composition of the layer mucosa,the lamina propria, muscular, the excretory ducts and the adventitia were determined.Conclusion:Sheepcastration promoted changes in the biometric measures of the glands, which were lower in castrated animals.The morphological and biometric characteristics of the vesicular and bulbourethral glands in sheep weredetermined.

Emprego da microscopia eletrônica na avaliação pós-vacinal de epitélio traqueal de patos (Anas platyrhynchos) imunizados contra a doença de Newcastle / The use of scanning electron microscopy in post-vaccinal evaluation of tracheal epithelium in ducks (Anas platyrhynchos) imunized against Newcastle disease

Avaliou-se o emprego da microscopia eletrônica de varredura no estudo da reação respiratória pós-vacinal em epitélio traqueal de patos (Anas platyrhynchos) imunizados contra a doença de Newcastle. Foram utilizadas 48 aves, distribuídas em quatro grupos: T1 - grupo de aves-controle (não vacinadas), T2 - grupo de aves vacinadas com a estirpe Ulster 2C, T3 - grupo de aves vacinadas com a estirpe B1 e T4 - grupo de aves vacinadas com a estirpe LaSota. Independente do grupo experimental, as aves não apresentaram sinais clínicos detectáveis de reação respiratória pós-vacinal. Ao microscópio eletrônico de varredura, observou-se que os animais vacinados com as estirpes B1 e LaSota desenvolveram descamação epitelial da traqueia, enquanto os vacinados com a estirpe Ulster 2C não, mostrando um epitélio traqueal íntegro, semelhante ao do grupo-controle. Os patos vacinados com a estirpe B1 mostraram evidências de regeneração epitelial da traqueia decorridos 21 dias pós-vacinação, o que não ocorreu com os vacinados com a amostra LaSota.

Scanning electron microscopy was used in the study of the post-vaccinal respiratory reaction of the tracheal epithelium of ducks (Anas platyrhynchos) immunized against Newcastle disease. Forty-eight ducks were distributed into four groups: T1 - control birds (non-vaccinated); T2 - birds vaccinated with Ulster 2C strain; t3 - birds vaccinated with B1 strain; and t4 - birds vaccinated with LaSota strain. Regardless the experimental group, birds did not show detectable clinical signs of post-vaccinal respiratory reaction. Scanning electron microscopy showed that birds vaccinated with B1 and LaSota strains developed epithelial sloughing of the trachea, whereas those vaccinated with Ulster 2C strain did not develop this change, showing intact tracheal epithelium, similar to the control group. However, the birds vaccinated with B1 strain showed evidences of regeneration of tracheal epithelium 21 days post-vaccination, which did not happen with the ducks vaccinated with LaSota strain.

[Childhood cerebral tumors: morbidity and follow-up into adulthood]. / Tumeurs cérébrales de l'enfant: morbidité et suivi à l'âge adulte.

This chapter presents guidelines for the follow-up of children with brain tumors, whether benign or malignant, in their transition to adulthood. The consequences of their disease and its treatment overlap greatly. The complications and long-term follow-up are detailed based on the specialists involved.

Risk factors for hepatic veno-occlusive disease: a retrospective unicentric study in 116 children autografted after a high-dose BU-thiotepa regimen.

At our Institute, during the last decade, the incidence of hepatic veno-occlusive disease (HVOD) appears to be on the increase among pediatric patients treated with BU-thiotepa (BU-TTP)-conditioning regimen. We thus performed a retrospective analysis to identify the risk factors for HVOD, which could explain such a change. In total, 116 patients treated at Institut Gustave Roussy, between May 1998 and December 2005 were eligible for this study having received BU-TTP as their first high-dose chemotherapy regimen, followed by autologous hematopoietic SCT (AHSCT). According to McDonald's clinical criteria, HVOD was diagnosed in 31% of these children. Demographic, clinical, biological and therapeutic parameters were evaluated in uni- and multivariate analyses that showed a significant correlation between previous carboplatin therapy and risk of developing post transplant HVOD (P=0.028). Comparable results were found for etoposide (P=0.048). In addition, a correlation between HVOD and risk of post transplant death was linked to its association with other types of organ failure (P=0.029). This study demonstrates that previous VPCARBO administration in conventional chemotherapy significantly increases the risk of HVOD among brain tumor patients later consolidated with BU-TTP followed by AHSCT.

Effect of natural early menopause on bone mineral density.

OBJECTIVES: Early menopause (EM) is included among the risk factors for osteoporosis. Several studies have shown that women with early menopause have lower bone mineral density (BMD) than those with normal expected age of menopause. The aim of our cross-sectional study was to investigate the effects of time of menopause on vertebral bone mass in healthy postmenopausal women and to evaluate if early menopause is a risk factor for lower vertebral BMD. METHOD: We studied 782 who had never received drugs acting on bone mass. The study population was divided into three groups: women with early, normal (NM), and late (LM) menopause. Our study population was further categorized in 5-year age segments between 45 and >75. RESULTS: The three groups examined did not differ for age, age at menarche, body mass index (BMI), and vertebral BMD, while there were significant differences in age at menopause and years since menopause. Our study showed that women with EM presented significantly lower vertebral BMD than NM and LM in 50-54 age segments. Beyond 55 years, EM, NM, and LM women had no differences in lumbar BMD values. CONCLUSIONS: In conclusion, controversial data demonstrated that the absolute amount of bone loss is greater after early menopause than after normal or late menopause, even if a slight effect of early menopause on bone mass cannot be excluded.

Dimorfismo sexual da traquéia e siringe de periquito (Touist sp. ) / Sexual dimorphism of the parakeet (Touist sp. ) trachea and syrinx

Investigaram-se as diferenças morfológicas da siringe do periquito Touist sp, cinco machos e cinco fêmeas. A traquéia e a siringe foram dissecadas com o auxílio de uma lupa estereoscópia e avaliaram-se o número de anéis, o comprimento da traquéia e da siringe e o comprimento e espessura do músculo traqueolateral. A traquéia do macho apresentou maior número de anéis e maior comprimento que a das fêmeas. O músculo traqueolateral dos machos é mais vigoroso e origina-se no 43º anel traqueal enquanto o das fêmeas origina-se no 30º anel traqueal e se insere no primeiro anel bronquial. A siringe do piriquito é constituída por anéis craniais, cinco nos machos e três nas fêmeas, anéis intermediários, com formato semelhante a uma bolha sulcada ventralmente, anéis caudais, quatro em ambos os sexos, e pessulo. O dimorfismo sexual está presente na morfometria da musculatura e das cartilagens, o que reflete no canto mais vigoroso dos machos

The morphologic differences of the trachea and syrinx of five male and five female Touist sp. parakeets were studied. Trachea and syrinx were dissected with the aid of a stereoscopic magnifying glass and the number of rings, the length of trachea and syrinx were evaluated, as well as the length and thickness of the tracheolateral muscle. Trachea of male parakeets had larger amount of rings and was lengther than the female. Tracheolateral muscle of the males was more vigorous and arised in the 43rd tracheal ring while in the females it originated in the 30th tracheal and inserted in first bronchi ring. The syrinx was constituted by cranial rings (five in males and three in females), intermediate rings (resembly a bubble furrowed ventrally), caudal rings (four in both sexes) and the pessule. Sexual dimorphism directly influenced on the syrinx, concerning the morfometry of the musculature and cartilages, making males sound more vigorously

Morphometric study of Rynchotus rufescens testis throughout the year.

The research aimed to study the morphologic variation of the testis, seeking to promote the selection and genetic control of those that present appreciable spermatic production throughout the year. Testis morphology of the Rynchotus rufescens partridge was investigated, analyzing the testis weight, the seminiferous tubules diameter, the thickness of the seminiferous epithelium, the amount of meiotic figures and the thickness of the tunica albuginea. Sixty male partridges were used, divided in 12 groups, and one group per month had the testis collected for the histological routine and the sections were stained using the Hematoxilin-Eosin technique. For the histological sections analysis, morphometric measures were taken, with the aid of an Image Analyzer and the resulting data were submitted to analysis of variance and to Tukey's test. Based on the histological modifications of the seminiferous epithelium and the morphometric analysis, the partridge testis morphology could be divided in four successive phases throughout the year. The reproductive phase occurred in the spring, characterized by the complete spermatogenesis process. The regression phase occurred in the summer, with the involution of the seminiferous epithelium. The rest phase took place in the fall, with spermatogonias presence and some spermatocytes beginning the meiosis. The phase of recrudescence occurred in the winter, with the recovery of the seminiferous epithelium and absence of spermatozoa. In conclusion, the characteristics analyzed revealed a variation over the year, with greater production of spermatozoa in the spring and less in the winter.

Morphometric study of Rynchotus rufescens testis throughout the year

The research aimed to study the morphologic variation of the testis, seeking to promote the selection and genetic control of those that present appreciable spermatic production throughout the year. Testis morphology of the Rynchotus rufescens partridge was investigated, analyzing the testis weight, the seminiferous tubules diameter, the thickness of the seminiferous epithelium, the amount of meiotic figures and the thickness of the tunica albuginea. Sixty male partridges were used, divided in 12 groups, and one group per month had the testis collected for the histological routine and the sections were stained using the Hematoxilin-Eosin technique. For the histological sections analysis, morphometric measures were taken, with the aid of an Image Analyzer and the resulting data were submitted to analysis of variance and to Tukey's test. Based on the histological modifications of the seminiferous epithelium and the morphometric analysis, the partridge testis morphology could be divided in four successive phases throughout the year. The reproductive phase occurred in the spring, characterized by the complete spermatogenesis process. The regression phase occurred in the summer, with the involution of the seminiferous epithelium. The rest phase took place in the fall, with spermatogonias presence and some spermatocytes beginning the meiosis. The phase of recrudescence occurred in the winter, with the recovery of the seminiferous epithelium and absence of spermatozoa. In conclusion, the characteristics analyzed revealed a variation over the year, with greater production of spermatozoa in the spring and less in the winter.

O trabalho teve como objetivo estudar a variação morfológica do testículo, visando promover a seleção e o controle genético de exemplares que apresentem produção espermática apreciável ao longo do ano. A morfologia testicular de perdiz Rynchotus rufescens foi avaliada, analisando o peso do testículo, o diâmetro dos túbulos seminíferos, a espessura do epitélio seminífero, o número de figuras de meiose e a espessura da túnica albugínea. Foram utilizados 60 machos de perdizes, divididos em 12 grupos, sendo que um grupo por mês teve os testículos coletados para a rotina histológica e foram corados pela técnica de Hematoxilina-Eosina. Para a análise dos cortes histológicos, foram realizadas medidas morfométricas, com o auxílio de um Analisador de Imagem e os dados encontrados foram submetidos à análise de variância e teste de Tukey. Baseado nas modificações histológicas do epitélio seminífero e na análise morfométrica, a morfologia testicular da perdiz pôde ser dividida em quatro fases sucessivas ao longo do ano. A fase reprodutiva ocorreu na primavera, caracterizando-se pelo completo processo de espermatogênese. A fase de regressão aconteceu no verão, ocorrendo involução do epitélio seminífero. No outono ocorreu a fase de repouso, com a presença de espermatogônias e alguns espermatócitos em início de meiose, já a fase de recrudescência da perdiz aconteceu no inverno, com a recuperação do epitélio seminífero e ausência de espermatozóides. Em conclusão, as características analisadas revelaram uma variação durante o ano, com maior produção de espermatozóides na primavera e menor produção no inverno.

Platelet-leukocyte interactions in hemodialysis patients: culprit or bystander?

The formation of circulating platelet-leukocyte complexes has been observed in a variety of conditions and may be pathophysiologically significant. Platelet-leukocyte interactions in fact facilitate metabolic cooperation and mutual activation, which may be of relevance in many biological processes including inflammation, atherogenesis and hemostasis. During hemodialysis procedure, the series of reactions that can occur upon blood contact with the foreign membrane surface may involve a variety of changes affecting almost every cellular and plasmatic component of the blood. This article reviews the evidence for abnormal interactions between circulating platelets and leukocytes in uremic patients undergoing maintenance hemodialysis and the pathophysiologic implications which may stem from such interactions.

Wireless capsule endoscopy in the diagnostic of small intestine angiodysplasia in chronic uremic patient.

Gastroenteric bleeding due to angiodysplasia (AD) is a relatively common occurrence in patients with end-stage renal failure. Gastric and colon angiodysplasic lesions can be easily revealed by endoscopic procedures, whereas lesions of the small intestine are more difficult to detect. Imaging modalities used in the diagnostic imaging algorithm for the detection of small-bowel AD, include non-invasive methods like enema-helical computer tomography,(99m)Tc-labelled red blood cell scintigraphy, and angiography, and invasive methods such as intraoperative enteroscopy. We report the cases of 3 hemodialysis patients with recurrent episodes of gastrointestinal bleeding, caused by small-bowel AD diagnosed by means of wireless-capsule endoscopy. In all cases, previous gastroscopy and colonoscopy were unrevealing. Wireless-capsule endoscopy consists in swallowing a capsule endoscope (11 mmx27 mm) which contains a miniature video camera, a light source, batteries, and a radio transmitter. Video images are transmitted by means of radio telemetry to aerials taped to the body that allow images to be captured. Moving images from a period as long as 6 h are stored on a portable recorder. Wireless-capsule endoscopy may prove valuable in the assessment of gastrointestinal bleeding in uremic patients with unrevealing results at gastroscopy and colonoscopy.

[Russell's syndrome: a case of long-term survival and review of the literature]. / Sindrome di Russell: descrizione di un caso clinico a lunga sopravvivenza e revisione della letteratura.

We report the case of a two years old, normally eating child, affected by organic macies and severe dystrophy. After the negative response of blood and laboratory examinations let us exclude a malabsorption syndrome, only the performance of neuro-radiologic exams showed evidence of a subthalamic tumor as the cause of a "Diencephalic syndrome". Diencephalic syndrome or Russell's syndrome is a diencephalic tumor induced disease, which sets in the first time of life. The disease clinical markers are a severe emaciation with appetite preservation and absence or very scarce evidence of any telltale neurological sign. The tumoral histo-pathology most frequently shows a low grade of malignancy astrocytoma, whose eradication is very often difficult because of particular anatomic site. Treatment of choice includes an excisional biopsy with chemotherapy and radiotherapy. We report a clinical case of long-term survival and review of the literature.

Increased platelet phosphatidylserine exposure and caspase activation in chronic uremia.

Platelet activation is associated with exposure of the aminophospholipid phosphatidylserine (PS) to the outer hemi-leaflet of the plasma membrane bilayer, which seems to be involved in the coagulation process. Because platelet activation may occur in patients suffering from chronic uremia, which is frequently associated with a thrombophilic tendency, we studied whether uremic platelets show an increased propensity to expose PS on the outer membrane leaflet and whether this process is linked with important functional and molecular changes. Flow cytometric percentage of annexin V-positive platelets, a measure of PS externalization, was significantly elevated (P < 0.001) in uremic patients when compared to normal controls under both unstimulated and agonist-stimulated conditions. Uremic platelet procoagulant activity, as measured by thrombin generation, was more than twice as high (4.13 +/- 0.3 micro mL(-1)) as that found in normal controls (1.86 +/- 0.2 micro mL(-1)). Two independent assays showed that the enzymatic activity of caspase-3, a protease involved in the loss of membrane PS asymmetry, was significantly greater in the platelets of uremic subjects than in those of healthy controls. PS exposure in agonist-stimulated platelets was markedly reduced by inhibition of caspase-3 activity but was not affected by inhibition of calpain activity. These results support the view that the thrombophilic susceptibility of uremic patients may be partly ascribed to increased PS exposure to the outer membrane leaflet of platelets. This process seems to be causally linked to an increase in caspase-3 activity, particularly during platelet activation.

[On-line HFR and removal of uremic toxins inducing the loss of phospholipidic asymmetry of the erythrocyte membrane]. / HFR on-line e rimozione di tossine uremiche inducenti la perdita dell'asimmetria fosfolipidica della membrana eritrocitaria.

The phospholipids of the erythrocyte membrane are normally distributed asymmetrically in the double layer with the aminophospholipid phosphatidylserine (PS) present only on the inside of the membrane, since its exposure on the outside has numerous physiopathological consequences. In previous studies we have observed that solutes retained in uremia cause increased exposure of PS on the outer surfaces of the erythrocyte membrane and that this phenomenon may be involved in the uremic physiopathology, reducing erythrocyte survival and encouraging abnormal erythrocyte-endothelium interactions. The capability of the extracorporeal blood clearance treatment in removing the circulating uremic factors, responsible for the increased exposure of PS in red blood cells (RBC), was evaluated in 6 chronic uremic patients treated with haemodialysis (HD) or with on-line HFR in a random cross-over perspective study. The PS removal was evaluated indirectly by measuring the expression of PS in normal RBC incubated with uremic plasma obtained at various moments of the clearance session. The capability of the uremic plasma to expose PS on the RBC of healthy subjects (n-times increase compared to incubation of normal RBC with autologous plasma) was essentially unmodified during HD (3.3 +/- 0.2 pre HD; 3.3 +/- 0.1 after 2 hours; 3.1 +/- 0.2 at the end of the session) but was reduced during HFR (3.1 +/- 0.2 pre HD; 2.3 +/- 0.1 after 2 hours; 1.6 +/- 0.1 at the end of dialysis; p<0.001 at the end of dialysis vs pre and after 2 hours and p<0.001 vs HD at 2 hours and at the end of the session). The reduced capability of the uremic plasma obtained during the HFR session to expose PS in normal RBC, proves removal of the plasmatic uremic factors able to externalize the PS. To assess whether this removal effect is linked to the cartridge containing styrene resin used in the treatment with HFR, samples of ultrafiltrate were taken before and after the cartridge and its capability to express PS on normal RBC was measured. The absolute RBC values expressing PS (%) were (pre-cartridge vs post-cartridge) 8.6 +/- 0.3 vs 3.8 +/- 0.2 after 5 minutes from the start of the session; 3.9 +0.1 vs 1.6 +0.2 halfway through the session; 3.1 +/- 0.1 vs 1.3 +/- 0.66 at the end of the session (p<0.005 pre vs post at all times). Our results show that uremic compounds able to cause increased exposure of PS in RBC can be removed during on-line HFR, mainly thanks to the adsorption properties of the cartridge containing resin. This removal might be of benefit to uremic patients, improving the anaemic condition and reducing abnormal RBC-endothelium interactions which may contribute to endothelial disorder during uremia.

Cell activation and cellular-cellular interactions during hemodialysis: effect of dialyzer membrane.

During hemodialysis (HD), circulating blood cells can be activated and also engage in dynamic interplay. These phenomena may be important factors behind dialysis membrane bio(in)compatibility. In the present prospective cross-over study, we have used flow cytometry to evaluate the influence of different dialysis membranes on the activation of circulating blood cells (leukocytes, platelets) and their dynamic interactions (formation of circulating platelet-leukocyte and platelet-erythrocyte aggregates) during in vivo HD. Each patient (n = 10) was treated with dialyzers containing membranes of cellulose diacetate, polysulfone and ethylenevinylalcohol (EVAL) in a randomized order. Upregulation of adhesion receptor expression (CD15s, CD11b/CD18) occurred mainly with the cellulosic membrane, though an increase in CD11b/CD18 circulating on neutrophils was also found with both synthetic membranes. Circulating activated platelets (P-selectin/CD63-positive platelets) increased during HD sessions with cellulose diacetate and polysulfone. An increased formation of platelet-neutrophil aggregates was found at 15 and 30 min during dialysis with cellulose diacetate and polysulfone but not with EVAL. Platelet-erythrocyte aggregates also increased with cellulose diacetate and at 15 min with polysulfone as well. Generally in concomitance with the increase in platelet-neutrophil coaggregates, there was an increased hydrogen peroxide production by neutrophils. The results of this study indicate that cellular mechanisms can be activated during HD largely depending on the membrane material, EVAL causing less reactivity than the other two membranes. It appears that each dialysis membrane has multiple and different characteristics that may contribute to interactions with blood components. Our results also indicate that derivatizing cellulose (cellulose diacetate) may be a useful way to improve the biocompatibility of the cellulose polymer and that there may be great variability in the biocompatibility profile of synthetic membranes, dialysis with polysulfone being in general associated with a higher degree of cell activation than EVAL membrane.

[Acute pulmonary edema with pseudohypotension]. / Edema polmonare acuto con pseudoipotensione.

A 69-year-old male was admitted to our Coronary Care Unit because of increasing dyspnea in a non-Q wave myocardial infarction complicated by severe heart failure. Physical examination revealed dyspnea, cyanosis, sweat, bilateral crepitations on the whole chest and severe hypotension (blood pressure 80/40 mmHg on the left arm and 90/55 mmHg on the right arm). A coronarographic examination was performed as the patient's clinical status worsened despite an appropriate treatment of the hemodynamic impairment with vasoactive drugs. It showed no hemodynamically significant coronary stenosis and an elevated left ventricular systolic pressure (180/200 mmHg). An obstruction of the vascular district of both arms was diagnosed as the underlying cause of such relevant difference between the left ventricular and humeral blood pressures. A computed tomographic spiral scan of the chest confirmed the presence of a bilateral subclavian artery from the aortic arch and an atheromatous substenosis of the right subclavian artery. The subsequent evaluation of the blood pressure at the lower limbs showed values of systolic blood pressure > 220 mmHg, while the values at upper limbs were persistently < 90 mmHg. In conclusion, careful evaluation of the blood pressure at all four limbs is necessary in all patients with suspected peripheral vascular disease in which a single determination may be misleading.

One percent sodium carboxymethylcellulose prevents experimentally induced abdominal adhesions in horses.

OBJECTIVE: To evaluate the efficacy of 1% sodium carboxymethylcellulose (SCMC) for prevention of experimentally induced abdominal adhesions in horses. STUDY DESIGN: Prospective, controlled, experimental study. ANIMAL POPULATION: Twelve healthy adult horses. METHODS: The effect of 1% SCMC on adhesion formation was evaluated in 12 healthy horses by using an established model of serosal trauma to induce intraabdominal adhesions. After ventral median celiotomy, 2 separate areas of the jejunum were abraded, and three 2-0 chromic gut sutures were placed in each abraded area. Jejunal resection and end-to-end anastomosis was performed at 2 sites distant to the abrasion sites. In treated horses (n = 6), 2 L of 1% SCMC was applied to the intestine before and after intestinal manipulation. In control horses (n = 6), 2 L of saline solution were applied to the intestine before and after surgical manipulation. All horses were euthanatized 10 days after surgery, and the abdominal cavity was evaluated for adhesion formation. The frequency of intraabdominal adhesions between groups was compared with a chi-square test. Statistical significance was set at P <.05. RESULTS: All control horses had intraabdominal adhesions. Fibrous adhesions were associated with both jejunal abrasion sites in 5 control horses. Fibrous adhesions were also associated with 1 or both jejunal anastomotic sites in 5 control horses. Only 1 treated horse developed adhesions at the jejunal abrasion sites, and no adhesions were present at the anastomotic sites in the treated horses. There were significantly fewer adhesions in the SCMC treatment group compared with the control group (P <.05). CONCLUSION: In this experimental model, application of 1% SCMC reduced the frequency of intraabdominal adhesions at areas of serosal abrasion and at jejunal anastomotic sites. CLINICAL RELEVANCE: In horses at an increased risk for developing intraabdominal adhesions after intestinal surgery, the use of 1% SCMC during celiotomy may decrease the frequency of adhesion formation.