Pulmonary effects of bupivacaine, ropivacaine, and levobupivacaine in parturients undergoing spinal anaesthesia for elective caesarean delivery: a randomised controlled study.

BACKGROUND: Spinal anaesthesia is the method of choice for elective caesarean delivery, but has been reported to worsen dynamic pulmonary function when using bupivacaine. Similar investigations are lacking for ropivacaine and levobupivacaine. We have therefore compared the pulmonary effects of intrathecal bupivacaine, ropivacaine and levobupivacaine used for caesarean delivery. METHODS: Forced vital capacity, forced expiratory volume in the first second, and peak expiratory flow rate were measured in 48 parturients before and after onset of spinal anaesthesia using either 0.5% bupivacaine 10 mg, 1% ropivacaine 20 mg, or 0.5% levobupivacaine 10 mg. Apgar scores and umbilical arterial pH were recorded. RESULTS: The final level of sensory blockade was not different between groups. Forced vital capacity was significantly decreased with bupivacaine (3.6+/-0.5 L to 3.5+/-0.4 L, P<0.05) and ropivacaine (3.2+/-0.4 L to 3.1+/-0.5 L, P<0.05), but not with levobupivacaine (3.6+/-0.5 L to 3.4+/-0.6 L). Forced expiratory volume during the first second was not decreased in any group. Peak expiratory flow rate was significantly decreased with ropivacaine (5.5+/-1.5 L/s to 5.0+/-1.1 L/s, P<0.05) and levobupivacaine (from 6.0+/-1.1 L/s to 5.2+/-0.9 L/s, P<0.01). Neonatal vital parameters did not differ between the three groups. CONCLUSIONS: Decreases in maternal pulmonary function tests were similar following spinal anaesthesia with bupivacaine, ropivacaine, or levobupivacaine for caesarean delivery. The clinical maternal and neonatal effects of these alterations appeared negligible.

The I-Ab-restricted alloresponse of D10.G4.1 T cells is based on the recognition of an endogenous peptide.

The alloreactivity of T cells is thought to be based on the cross-reactive recognition of allogeneic major histocompatibility complex (MHC) molecules which have bound peptides derived from self antigens or, in the case of cultured T cells, from serum components. While studying the processing requirements of conalbumin (CA) that is recognized by D10.G4.1 T cells in combination with I-Ak molecules we also analysed the cross-reactive stimulation of clone D10.G4.1 T cells by allogeneic, I-Ab expressing stimulator cells which is shown here to be CD4 dependent. In order to distinguish between an endogenous or exogenous origin of a peptide that is presumably co-recognized with I-Ab different types of stimulatory/antigen-presenting cells (APC) were treated with drugs that are known to influence the processing and/or presentation of antigens. It was found that the alloreactive response of D10.G4.1 cells was abolished if the APC were treated with brefeldin A or inhibitors of protein biosynthesis. Under the same conditions neither the CA-specific response of D10.G4.1 cells nor the activation of control T cells by ovalbumin (OVA) or insulin was affected. On the other hand, the use of lysosomotropic agents or inhibitors of glycoprotein trimming had no influence on the ability of the APC to induce the alloresponse of D10.G4.1 cells, whilst the presentation of CA and other protein antigens by the APC was prevented. In addition, treatment of APC with pronase to remove surface MHC molecules or acidic buffer to remove peptides from the binding groove of MHC class II molecules at the surface of APC strongly diminished their ability to induce an alloresponse. However, this capacity was restored by incubating the APC for 2 hr in serum-free medium. These data indicate that the alloreactive response of D10.G4.1 cells is based on the recognition of newly synthesized endogenous peptide(s) in combination with I-Ab.

Primary surgical treatment of Chagas' megaesophagus: results of 450 cases

Quatrocentos e cinqüenta pacientes com Megaesôfago devido a doença de Chagas foram submetidos a tratamento cirúrgico num período de 23 anos. Haviam 275 homens (61.1%) e 175 mulheres (38.9%) e a idade média foi de 44.5 anos. A maioria dos pacientes tinha a doença em estágio avançado (67.1%). Cento e oitenta e cinco foram submetidos a miotomia simples pelo tórax. Noventa e dois por cento destes tiveram bons resultados, 15 continuaram sintomáticos e um óbito (0.54%). Cento e cinco foram operados pelo abdômen, nos quais se associou uma gastrofundopexia frouxa e piloroplastia. Noventa e cinco por cento destes tiveram bons resultados, capazes de se alimentarem normalmente, sem refluxo e näo houve óbito. Cento e oito foram submetidos a uma cardioplastia anterior nos casos de doença mais avançada com 96% de bons resultados, dois maus e duas mortes. Quarenta pacientes submeteram-se a uma esofagectomia parcial e anastomose esôfagogástrica intra torácica com 75% de bons resultados, mortalidade de 7,5% e 17,5% de insucessos. Doze pessoas tiveram uma interposiçäo jejunal com maus resultados em dois (29%), um óbito (14%) e 57% de bons resultados. Dois foram operados através de tubo gástrico invertido como uma operaçäo de última escolha e três tiveram um desvio com o estômago em casos de megaesôfago associado a carcinoma