There is no cephalocaudal gradient of computed tomography densities or lung behavior in supine patients with acute respiratory distress syndrome.

BACKGROUND: There is debate whether pressure transmission within the lungs and alveolar collapse follow a hydrostatic pattern or the compression exerted by the weight of the heart and the diaphragm causes collapse localized in the areas adjacent to these structures. The second hypothesis proposes the existence of a cephalocaudal gradient in alveolar collapse. We aimed to define whether or not lung density and collapse follow a 'liquid-like' pattern with homogeneous isogravitational layers along the cephalocaudal axis in acute respiratory distress syndrome lungs. METHODS: Acute respiratory distress syndrome patients were submitted to full lung computed tomography scans at positive end-expiratory pressure (PEEP) zero (before) and 25 cmH2 O after a maximum-recruitment maneuver. PEEP was then decreased by 2 cmH2 O every 4 min, and a semi-complete scan performed at the end of each PEEP step. RESULTS: Lung densities were homogeneous within each lung layer. Lung density increased along the ventrodorsal axis toward the dorsal region (ß = 0.49, P < 0.001), while there was no increase, but rather a slight decrease, toward the diaphragm along the cephalocaudal axis and toward the heart. Higher PEEP attenuated density gradients. At PEEP 18 cmH2 O, dependent lung regions started to collapse massively, while best compliance was only reached at a lower PEEP. CONCLUSIONS: We could not detect cephalocaudal gradients in lung densities or in alveolar collapse. Likely, external pressures applied on the lung by the chest wall, organs, and effusions are transmitted throughout the lung in a hydrostatic pattern with homogeneous consequences at each isogravitational layer. A single cross-sectional image of the lung could fully represent the heterogeneous mechanical properties of dependent and non-dependent lung regions.

Effect of flow rate and temperature on transmembrane blood pressure drop in an extracorporeal artificial lung.

INTRODUCTION: Transmembrane pressure drop reflects the resistance of an artificial lung system to blood transit. Decreased resistance (low transmembrane pressure drop) enhances blood flow through the oxygenator, thereby, enhancing gas exchange efficiency. This study is part of a previous one where we observed the behaviour and the modulation of blood pressure drop during the passage of blood through artificial lung membranes. METHODS: Before and after the induction of multi-organ dysfunction, the animals were instrumented and analysed for venous-venous extracorporeal membrane oxygenation, using a pre-defined sequence of blood flows. RESULTS: Blood flow and revolutions per minute (RPM) of the centrifugal pump varied in a linear fashion. At a blood flow of 5.5 L/min, pre- and post-pump blood pressures reached -120 and 450 mmHg, respectively. Transmembrane pressures showed a significant spread, particularly at blood flows above 2 L/min; over the entire range of blood flow rates, there was a positive association of pressure drop with blood flow (0.005 mmHg/mL/minute of blood flow) and a negative association of pressure drop with temperature (-4.828 mmHg/(°Celsius). These associations were similar when blood flows of below and above 2000 mL/minute were examined. CONCLUSIONS: During its passage through the extracorporeal system, blood is exposed to pressure variations from -120 to 450 mmHg. At high blood flows (above 2 L/min), the drop in transmembrane pressure becomes unpredictable and highly variable. Over the entire range of blood flows investigated (0-5500 mL/min), the drop in transmembrane pressure was positively associated with blood flow and negatively associated with body temperature.

Entomofauna associada ao cultivo de Pleurotus sajor-caju (Fr) Singer (Agaricales: Agaricaceae) no município do Capão do Leão, RS, Brasil / Insects associated with the Pleurotus sajor-caju (Fr) Singer (Agaricales: Agaricaceae) crop in the county of Capão do Leão, RS, Brazil

O objetivo deste trabalho foi conhecer a diversidade de artrópodes associada ao cultivo de Pleurotus sajor-caju em palha de arroz pasteurizada em ambiente semicontrolado, localizado no sul do Rio Grande do Sul. A captura dos espécimes foi realizada no período de abril a maio de 2007, durante a fase de frutificação da cultura, compreendendo 45 dias. Foram realizadas nove coletas com intervalos de 5 dias, utilizando armadilhas INTRAL AL 012 (12 volts). Capturou-se um total de 3.129 indivíduos divididos em cinco ordens com predominância de Diptera (2.874), Hymenoptera (152), Ortoptera (69), Colembola (59) e Coleoptera (38). A ordem Diptera foi a que apresentou o maior número de famílias, sendo Mycetophilidae (2.530), Sciaridae (264), Cecidomyiidae (10), Phoridae (46), Muscidae (4), Calliphoridae (1) e Culicidae (19).

The objective of this research was to know the diversity of arthropods associated to the Pleurotus sajor-caju crop in rice straw pasteurized in a semicontrolled environment, located in the south of the state of Rio Grande do Sul, Brazil. The capture of specimens was carried out in the period of April through May 2007, during the phase of fruit bodies of the crop, lasting 45 days. Nine collections with intervals of 5 days were carried out, using INTRAL AL 012 (12 volt) traps. A total of 3129 individuals divided into five orders with predominance of Diptera (2874), Hymenoptera (152), Ortoptera (69), Colembola (59) and Coleoptera (38) was captured. The Diptera order was the one that presented the biggest number of families, being Mycetophilidae (2530), Sciaridae (264), Cecidomyiidae (10), Phoridae (46), Muscidae (4), Calliphoridae (1) and Culicidae (19).

Situação epidemiológica da brucelose bovina no Estado de Sergipe / Epidemiological situation of bovine brucellosis in the State of Sergipe, Brazil

Realizou-se um estudo para caracterizar a situação epidemiológica da brucelose bovina no Estado de Sergipe. O Estado foi estratificado em dois circuitos produtores. Em cada circuito produtor foram amostradas aleatoriamente cerca de 300 propriedades e, dentro dessas foi escolhido de forma aleatória um número pré-estabelecido de animais, dos quais foi obtida uma amostra de sangue. No total foram amostrados 4.757 animais, provenientes de 590 propriedades. Em cada propriedade amostrada foi aplicado um questionário epidemiológico para verificar o tipo de exploração da propriedade e as práticas zootécnicas e sanitárias que poderiam estar associadas ao risco de infecção pela doença. O protocolo de testes utilizado foi o da triagem com o teste do antígeno acidificado tamponado e a confirmação dos positivos com o teste do 2-mercaptoetanol. O rebanho foi considerado positivo, se pelo menos um animal foi reagente às duas provas sorológicas. A prevalência de focos e a de animais foram: 12,6 por cento [9,2-16,0 por cento] e 3,4 por cento [2,3-4,4 por cento], respectivamente. As prevalências de focos e de animais infectados para os circuitos pecuários foram: circuito 1, 11,1 por cento [7,9-15,0 por cento] e 2,6 por cento [1,6-3,5 por cento]; circuito 2, 12,9 por cento [9,1-17,6 por cento] e 6,2 por cento [3,0-9,5 por cento]. Os fatores de risco (odds ratio, OR) associados à condição de foco foram: assistência veterinária (OR= 2,89 [1,15-7,23]), tamanho do rebanho ≥30 fêmeas adultas (OR= 1,88 [1,07-3,28]) e uso de inseminação artificial (OR= 1,92 [0,84-4,38]).

A study to characterize the epidemiological situation of bovine brucellosis in the State of Sergipe was carried out. The State was divided in two regions. Around three hundred herds were randomly sampled in each region and a pre-established number of animals were sampled in each of these herds. A total of 4,757 serum samples from 590 herds were collected. In each herd, it was applied an epidemiological questionnaire focused on herd traits as well as husbandry and sanitary practices that could be associated with the risk of infection. The serum samples were screened by the Rose-Bengal Test (RBT) and positive sera were re-tested by the 2-mercaptoethanol test (2-ME). The herd was considered positive if at least one animal was positive on both RBT and 2-ME tests. The prevalences of infected herds and animals in the State were, respectively: 12.6 percent [9.2-16.0 percent] and 3.4 percent [2.3-4.4 percent]. The prevalences of infected herds and animals in the regions were, respectively: region 1, 11.1 percent [7.9-15.0 percent] and 2.6 percent [1.6-3.5 percent]; and region 2, 12.9 percent [9.1-17.6 percent] and 6.2 percent [3.0-9.5 percent]. The risk factors associated with the presence of the infection were: veterinary assistance (OR= 2.89 [1.15-7.23]), herd size ≥30 adult females (OR= 1.88 [1.07-3.28]), and use of artificial insemination (OR=1.92 [0.84-4.38]).

The lung in sepsis: guilty or innocent?

The mortality rate of severe sepsis is still high (20 to 65%) despite the advances in critical care. The most important determinant of the prognosis in this condition is the occurrence of multiple organ dysfunction syndrome (MODS). The lung is the most frequently identified organ to fail in sepsis and is also the most frequent primary site of infection. The development of acute respiratory distress syndrome (ARDS) is common in those cases. The current understanding of the pathogenesis of ARDS suggests that the degree of inflammatory response and its sustained leukocyte activation may determine the clinical evolution of ARDS. The way that mechanical ventilation is delivered is responsible for the start and/or the perpetuation of a pro-inflammatory cascade activation that, due to the loss of the alveolar compartmentalization in ARDS, can reach the bloodstream and induce MODS. On the other hand, during sepsis, the alveolar compartmentalization is lost, allowing the passage of cytokines, released to the bloodstream by any other organ, to the pulmonary endothelium. These cytokines, especially IL-1, TNF-alpha and IL-8, have important roles in the lung dysfunction. Experimental and clinical studies have been demonstrated that ventilation strategies using low tidal volumes and limitation of airway pressures can block cytokines and reduce mortality of patients with respiratory failure. The studies are still insufficient to determine the role of pharmacological therapies in those patients.

Effect of intraperitoneally administered hydrolyzed whey protein on blood pressure and renal sodium handling in awake spontaneously hypertensive rats

The present study evaluated the acute effect of the intraperitoneal (ip) administration of a whey protein hydrolysate (WPH) on systolic arterial blood pressure (SBP) and renal sodium handling by conscious spontaneously hypertensive rats (SHR). The ip administration of WPH in a volume of 1 ml dose-dependently lowered the SBP in SHR 2 h after administration at doses of 0.5 g/kg (0.15 M NaCl: 188.5 ± 9.3 mmHg vs WPH: 176.6 ± 4.9 mmHg, N = 8, P = 0.001) and 1.0 g/kg (0.15 M NaCl: 188.5 ± 9.3 mmHg vs WPH: 163.8 ± 5.9 mmHg, N = 8, P = 0.0018). Creatinine clearance decreased significantly (P = 0.0084) in the WPH-treated group (326 ± 67 æL min-1 100 g body weight-1) compared to 0.15 M NaCl-treated (890 ± 26 æL min-1 100 g body weight-1) and captopril-treated (903 ± 72 æL min-1 100 g body weight-1) rats. The ip administration of 1.0 g WPH/kg also decreased fractional sodium excretion to 0.021 ± 0.019 percent compared to 0.126 ± 0.041 and 0.66 ± 0.015 percent in 0.15 M NaCl and captopril-treated rats, respectively (P = 0.033). Similarly, the fractional potassium excretion in WPH-treated rats (0.25 ± 0.05 percent) was significantly lower (P = 0.0063) than in control (0.91 ± 0.15 percent) and captopril-treated rats (1.24 ± 0.30 percent), respectively. The present study shows a decreased SBP in SHR after the administration of WPH associated with a rise in tubule sodium reabsorption despite an angiotensin I-converting enzyme (ACE)-inhibiting in vitro activity (IC50 = 0.68 mg/mL). The present findings suggest a pathway involving ACE inhibition but measurements of plasma ACE activity and angiotensin II levels are needed to support this suggestion.

Effect of intraperitoneally administered hydrolyzed whey protein on blood pressure and renal sodium handling in awake spontaneously hypertensive rats.

The present study evaluated the acute effect of the intraperitoneal (ip) administration of a whey protein hydrolysate (WPH) on systolic arterial blood pressure (SBP) and renal sodium handling by conscious spontaneously hypertensive rats (SHR). The ip administration of WPH in a volume of 1 ml dose-dependently lowered the SBP in SHR 2 h after administration at doses of 0.5 g/kg (0.15 M NaCl: 188.5 +/- 9.3 mmHg vs WPH: 176.6 +/- 4.9 mmHg, N = 8, P = 0.001) and 1.0 g/kg (0.15 M NaCl: 188.5 +/- 9.3 mmHg vs WPH: 163.8 +/- 5.9 mmHg, N = 8, P = 0.0018). Creatinine clearance decreased significantly (P = 0.0084) in the WPH-treated group (326 +/- 67 microL min-1 100 g body weight-1) compared to 0.15 M NaCl-treated (890 +/- 26 microL min-1 100 g body weight-1) and captopril-treated (903 +/- 72 microL min-1 100 g body weight-1) rats. The ip administration of 1.0 g WPH/kg also decreased fractional sodium excretion to 0.021 +/- 0.019% compared to 0.126 +/- 0.041 and 0.66 +/- 0.015% in 0.15 M NaCl and captopril-treated rats, respectively (P = 0.033). Similarly, the fractional potassium excretion in WPH-treated rats (0.25 +/- 0.05%) was significantly lower (P = 0.0063) than in control (0.91 +/- 0.15%) and captopril-treated rats (1.24 +/- 0.30%), respectively. The present study shows a decreased SBP in SHR after the administration of WPH associated with a rise in tubule sodium reabsorption despite an angiotensin I-converting enzyme (ACE)-inhibiting in vitro activity (IC50 = 0.68 mg/mL). The present findings suggest a pathway involving ACE inhibition but measurements of plasma ACE activity and angiotensin II levels are needed to support this suggestion.

Ação do mononitrato-5 isossorbida sublingual durante cinecoronariografia: comparação com o uso de nitroglicerina sublingual / Sublingual isosorbide-5 mononitrate during coronary arteriography: comparison with sublingual nitroglycerin

OBJETIVO - Avaliar o efeito sublingual do mononitrato-5 de isossobida (MN5IS) e nitroglicerina (NTG) sobre o diâmetro luminal de artérias coronárias epicárdicas, pressão arterial média e efeitos colaterais. MÉTODOS - Cinqüenta pacientes foram submetidos a cateterismo cardíaco e cinecoronariografia, na condição inicial e 5 min após administração sublingual de MN5IS grupo A (GA) ou NTG grupo B (GB). RESULTADOS - O diâmetro coronário de referência aumentou em ambos os grupos, sem significância estatística entre os mesmos. Nos GA e GB foram demosntrados uma diminuição (1,66mmHg) e um aumento (0,79mmHg) na pressão arterial média, respectivamente (p=0,123). Não foram observados efeitos colaterais com o uso destas drogas. CONCLUSÄO - MN5IS sublingual é uma alternativa à administração de NTG durante cinecoronariografia e representa um alternativa terapêutica para o tratamento de doença cardíaca isquêmica.

[Sublingual isosorbide-5 mononitrate during coronary arteriography. Comparison with sublingual nitroglycerin]. / Ação do mononitrato-5 de isossorbida sublingual durante cinecoronariografia. Comparação com o uso de nitroglicerina sublingual.

PURPOSE: To evaluate the effect of sublingual isosorbide-5 mononitrate (ISMN) and nitroglycerin (NTG) on luminal diameter of epicardial coronary arteries, mean arterial pressure and deleterious effects. METHODS: Fifty patients were submitted to cardiac catheterization and coronary arteriography, at baseline, and 5 min after sublingual administration of ISMN, group A (GA) or NTG, group B (GB). RESULTS: Reference vessel diameter increased in both groups, without statistical significance. In GA and GB, a decrease (1.66 mmHg) and an increase (0.79 mmHg) in mean arterial pressure, respectively, were demonstrated (p = 0.123). There were no deleterious effects with the use of these drugs. CONCLUSION: Sublingual ISMN is an alternative to administration of NTG during coronary arteriography, and represents a therapeutic alternative to ischemic heart disease treatment.

Revascularization of the ischaemic hand using in situ veins.

Chronic severe ischaemia of the upper limb is rare, due to the low incidence of arterial disease and to the presence of an adequate pre-existent collateral network. However, sometimes it occasionally occurs, dictating the need for revascularization. Since 1990, the authors have revascularized five upper extremities with severe ischaemic changes, employing the cephalic and/or basilic veins, used in situ. The aetiology of the arterial disease was autoimmune in one case and late sequelae of trauma in the others. Of the in situ venous bypasses performed, three were brachial-radial, and two sequential grafts (one axillary-radial-ulnar and one axillary-brachial-radial-ulnar). One concomitant sympathectomy was performed. All patients had excellent early and late results which leads the authors to recommend such revascularization of the forearm and hand, especially in the presence of severe ischaemia.

Duodenal ulcer and eradication of Helicobacter pylori in a developing country. An 18-month follow-up study.

Forty-eight patients with endoscopically proven duodenal ulcer (DU) and Helicobacter pylori infection detected by 14C-urea breath test (BT) were assigned to 5 days of treatment with furazolidone, metronidazole, and amoxicillin in addition to eventual classical anti-ulcer agents if necessary. Clinical evaluation and BT were repeated at 2, 6, and 18 months after therapy to determine H. pylori eradication or reinfection. Endoscopy was also repeated at 6 and 18 months after treatment to detect DU relapse. In 29 (60%) patients H. pylori had been eradicated at 2 months after therapy, and in 19 (40%) infection persisted. After successful eradication, 6 of 29 (20.7%) were reinfected. All 24 patients who were negative at the 18-month evaluation were asymptomatic, free of anti-ulcer drugs, and with healed ulcers, whereas among the 19 positive patients followed up, 11 (57%) continued to be symptomatic and still using anti-ulcer agents (p less than 0.010), and 10 (53%) showed active ulcers at endoscopy (p less than 0.010). H. pylori eradication is clearly followed by long-term remission of DU. Reinfection may be an additional problem in treating DU patients in developing countries.

[14C-urea breath test to diagnose gastric Helicobacter pylori colonization]. / Test respiratoire à l'urée marquée au carbone-14 pour le diagnostic de la colonisation gastrique par Helicobacter pylori.

Helicobacter pylori (H. pylori), ex-Campylobacter pylori, is now considered to be the causative agent of active chronic gastritis in humans and may be diagnosed by histology, gram-stain, culture, urease test or noninvasively by 14C-urea breath test. The aim of this study was to determine the sensitivity, specificity, and reproducibility of the breath test as compared with the microbiological (culture) "gold standard". Forty-one subjects were studied. Gastroscopy was performed in all participants and 2 antral mucosa biopsy specimens were taken for urease test and microbiological (gram-stain and culture) studies. The breath test was performed within one week after the gastroscopy. After fasting overnight, a control breath sample was obtained and a standard meal was offered to delay gastric emptying. Then, the participants drank 5 microCi of 14C-urea in 20 ml of water and breath samples were collected at 10, 15, 30 and 60 min in a hyamine-ethanol solution with a p-H indicator. A repeat test was performed in 9 subjects to assess test reproducibility. Twenty-nine subjects (71 percent) were Hp positive and 12 (29 percent) H. pylori negative. A highly significant difference (p less than 0.0001) was observed in 14CO2 exhalation in colonized and non-colonized subjects in samples collected at all times studied. As compared with culture we found that the breath test was 97 percent sensitive and 100 percent specific. We conclude that 14C-urea breath test is a simple, inexpensive, sensitive, and reliable method to detect H. pylori colonization. It is a useful test to epidemiologic and therapeutic trials.

Abortamento: epidemiologia. / Abortion: epidemiology

Dentre 1012 abortamentos havidos na Maternidade Prof. Monteiro de Moraes, Recife no ano de 1980, 700 foram selecionados para averiguacoes mais detalhadas.Dentre as variaveis cogitadas para estudo, foram destacadas: idade gestacional, tempo decorrido entre o aparecimento dos sintomas e o internamento hospitalar, forma clinica, complicacoes, abortamentos anterioes, sintomatologia, transfusao de sangue, permanencia hospitalar e tipo de tratamento.Ficou evidenciado que mais de 90% das pacientes eram nao pagantes, o abortamento do 3o. mes foi o mais frequente; o abortamento incompleto foi a forma clinica mais assidua, e as complicacoes foram registradas em apenas 2,7% das pacientes. O sintoma mais encontradico foi a hemorragia, embora apenas 6% das pacientes tenham necessitado de transfusao de sangue.A curetagem uterina foi o tratamento empregado em maior numero de vezes

Operacao cesariana em Recife em 1979: incidencia e mortalidade materna. / Cesarean section in Recife during 1979: incidence and maternal death rate

Em 19 maternidades da cidade do Recife (Pernambuco, Brasil), em 1979, houve um total de 12 156 cesarianas (incidencia de 28,1%) e 30 953 partos vaginais. A mortalidade materna na operacao cesariana, foi de 3,3 por 1 000.Nas pacientes indigentes, foram realizadas 2 327 cesarianas (incidencia de 11,2%) e 18 414 partos vaginais. A mortalidade materna na operacao cesariana foi de 9 por 1 000. Nas pacientes do INAMPS, foram realizadas 5621 cesarianas (incidencia de 35,4%) e 10226 partos vaginais. A mortalidade materna na operacao cesariana foi de 3 por 1000. Nas pacientes previdenciarias estaduais e militares, foram realizadas 444 cesarianas (incidencia de 42,6%) e 596 partos vaginais. A mortalidade materna na operacao cesariana foi de 2,2 por 1 000. Nas pacientes de clinica particular, foram realizadas 3 764 cesarianas (incidencia de 67,7%) e 1 717 partos vaginais A mortalidade materna na operacao cesariana foi de 0,5 por 1 000. As causas mais frequentes de mortalidade materna foram: hemorragia, eclampsia, infeccao e embolia amniotica. No global, a mortalidade materna na operacao cesariana foi 6,13 vezes maior do que no parto vaginal