Effects of dietary protein-to-energy ratio on rate of growth, protein deposition and tissue composition of pure Iberian boars prior to extensive production.

Thirty entire male Iberian (IB) pigs of 12 kg initial BW were used to study the effects of dietary protein-to-energy ratio on performance, body protein accretion, and tissue composition. Two nutritional regimes were supplied at 3 stages of growth (Phase I, from 12 to 30 kg BW; Phase II, from 30 to 45 kg BW; and Phase III, from 45 to 100 kg BW): the first regime (RefP/E) was formulated to provide optimum protein-to-energy ratios for castrated IB pigs at several stages of growth from 10 to 100 kg BW; the second (IncP/E), for which an overall increase of 2.5 g digestible protein/MJ ME was provided, would allow an increased potential for lean tissue growth presumably well above that expected for the entire male of an obese pig breed. The pigs were surgically castrated at 45 kg BW and slaughtered at about 100 kg BW. In Phases I and II, in which feed was provided ad libitum, no significant differences between dietary treatments in ADG (580 ± 10 and 740 ± 11 g, on average, respectively), G:F (0.475 ± 0.004 and 0.362 ± 0.005, on average, respectively), and gain:ME intake ratio (37.8 ± 0.4 and 26.1 ± 0.4 g/MJ, on average, respectively) were found ( > 0.05). After surgical castration, for the entire fattening period (Phase III), ADFI was fixed and highly restricted. A lower gain:ME intake ratio (14.0 vs. 15.1 g/MJ; < 0.01) was obtained when the diet with the highest digestible protein:ME ratio was offered (IncP/E). With this regime, body protein accretion significantly improved in the IB boar growing from 12 to 45 kg BW, irrespective of the stage of growth, although the amount of protein accreted was notably enhanced at the later stage (75 vs. 85 g/d in Phase I [ < 0.05] and 110.5 vs. 151 g/d in Phase II [ < 0.001]). However, the efficiency of utilization of dietary N remained unchanged irrespective of the diet fed ( > 0.05). In contrast, in the fattening stage, similar daily rates of N retention ( > 0.05) were found, in spite of the observed differences in digestible N intake ( < 0.001). We concluded that the protein (lysine) requirements of the IB boar growing from 12 to 30 kg BW and from 30 to 45 kg BW are met with the supply of 11.5 and 10.2 g digestible protein of ideal AA pattern/MJ ME (0.80 and 0.71 g digestible lysine/MJ ME), respectively. As surgical castration is programmed to be abandoned in European Union by 1 January 2018, this information will be important for the efficient production of the immunologically castrated IB pig, at the earlier stages of growth.

Utilization of milk fatty acids by the suckling Iberian piglets.

A total of 16 pure-bred Iberian (IB) sows, all of them suckling six piglets, were used, eight of them in each of the two consecutive trials (1 and 2). Daily milk yield and composition were determined weekly over a 34-day lactation period. Within each litter, one piglet at birth and four piglets on day 35 of life were slaughtered. Milk intake per piglet tended to be greater in trial 2 (832 v. 893 g/day; P=0.066), but piglets grew at 168±3.3 g/day, irrespective of the trial. In the IB sow milk, the linoleic (LA) : linolenic (LNA) acid ratio averaged 14.6 and 15.2 in trial 1 and trial 2, respectively. A fivefold increase in piglet body fat content was observed over lactation (P<0.001). Most of this fat (81.4%) was present in the carcass. After 34 days of lactation, whole-body relative content of palmitic, palmitoleic, stearic and oleic acids were very close to those in the milk consumed, suggesting direct deposition. Daily deposition of LA derivatives and of LNA and its derivatives was found to be extremely low (<0.02 g, on average). Moreover, some of the arachidonic acid (ARA) in tissues of the IB piglet at birth disappeared throughout the lactating period. An overall fractional deposition for total fatty acids (FA) was 0.409. Fractional oxidation (disappearance) rates were 0.939 and 0.926 for n-6 and n-3 polyunsaturated FA. The overall rate of disappearance for the major non-essential FA (myristic, palmitic, palmitoleic, stearic and oleic acids), estimated as 1-the overall fractional deposition rate, was 0.546. It is concluded that the high degree of FA unsaturation, high oxidation rate of LA and LNA, and poor synthesis of ARA from LA and of docosahexaenoic acid from LNA found in the suckling piglet might increase the energy cost of whole-body fat accretion, a contributor to the observed low efficiency of use of milk energy for growth.

Effects of intermittent suckling on body composition of Iberian piglets weaned at 35 days of age.

Piglet body composition at weaning could be a determinant for pig's viability and may be influenced by factors such as the nutritional management followed during suckling. An experiment was conducted to study whether intermittent suckling (IS) affects body composition at weaning and nutrient and energy retention during a 34-day lactation period in Iberian piglets. Litters were subjected to conventional suckling (CS) or IS (n=10 litters of six piglets per treatment) in two trials. All piglets had ad libitum access to creep feed from day 15 onwards. In IS, piglets were progressively separated from the sow for 6, 8 and 10 h daily during the last week of lactation, whereas in CS piglets had continuous access to their dams. Creep feed intake in litters and BW development of individual piglets were measured throughout the 34-day lactation. Within each litter, both at birth and at weaning (day 35), one piglet was used to assess nutrient retention and body composition by the comparative slaughter approach. During days 29 to 35 of the experiment, daily creep feed intake was greater in IS piglets (IS 124, CS 67 g/piglet, P=0.040), and average daily gain differed significantly between groups (IS 190, CS 150 g/day, P=0.010). BW at weaning was higher in the IS than in the CS piglets (IS 8.19, CS 7.48 kg, P=0.011). Empty-body fat and energy content at weaning were higher in the IS compared with CS litters, as well as fat content in the carcass (P=0.04). The IS treatment did not affect empty-body protein deposition, but significantly increased daily retention of fat, energy, ash and calcium, compared with CS litters (P<0.05). Thus, IS in Iberian piglets seems to enhance feed intake, growth rate and retention of some body components, which may contribute to a higher body fat content at weaning and facilitate the weaning process.

Response analysis of the Iberian pig growing from birth to 150 kg body weight to changes in protein and energy supply.

A total of 251 growing-finishing Iberian (IB) pigs, 32 of which were suckling piglets, were used in 5 separate sets of trials. The comparative slaughter procedure was used to determine nutrient and energy retention at several stages of growth from birth to 150 kg BW. A factorial arrangement was used within each set of trials, involving several concentrations of ideal protein in the diets as 1 factor and 2 or 3 levels of feed intake as the other. The main objective of these studies was to derive the optimal protein-to-energy ratio in the diet to allow for the expression of maximum protein deposition rates. The effect of feed restriction on growth performance, protein deposition, and fat deposition was also assessed. According to allometric equations, empty BW (EBW) was related to whole body components or total chemical constituents of empty body mass (P < 0.001). For pigs receiving solid feed, highly statistically significant multiple regression equations were constructed, which derived nutrient (g/kg) or energy (MJ/kg) composition as a function of EBW, dietary protein-to-energy ratio, and level of feeding (P < 0.001). In pigs offered adequate protein-to-energy diets, ADG at each stage of production was predicted as a function of the average BW and feeding level (P < 0.001). It was observed that the estimates of ME required for maintenance and net efficiency of utilization of ME for growth change were within rather narrow ranges throughout the growth stages studied. Preferred values (413 kJ/kg BW(0.75) × d(-1) and 0.593 for ME(m) and k(g), respectively) were obtained by regressing total energy retention (kJ/kg BW(0.75) × d(-1)) against ME intake (kJ/kg BW(0.75) × d(-1)). A multiple-regression approach revealed that in the IB pig, ME costs for protein deposition and fat deposition reach 60 and 62 kJ/g, which is considerably greater than in conventional or lean pig genotypes. In the IB pig, the maximum daily rate of protein deposition (PD(max), g) seemed to follow a linear-plateau shape with a breaking point at 32.5 kg BW, beyond which PD(max) remained at an average rate of 75 g × d(-1). The marginal efficiency of body protein deposition was estimated at each growth stage. In pigs fed on optimal or suboptimal protein-to-energy diets, the relationship between PD and ME intake declined, following a curvilinear pattern with increasing BW; thus, implying relative increases in lipid gain as BW increased.

Utilization of milk amino acids by the suckling Iberian piglet.

Sixteen pure-bred Iberian (IB) sows were used in two trials to determine the efficiency of utilization of milk protein and amino acid (AA) for growth in suckling piglets. It was hypothesized that there may be one or more strongly limiting essential AA (EAA) responsible for the slow rate of growth of the IB piglet. This AA will show the highest fractional retention. Daily milk yield and composition were determined weekly over a 34-day lactation period. Within each litter, one piglet at birth and four piglets on d 35 of life were slaughtered. The protein content of the IB sow milk was similar to that reported for conventional breeds. However, branched-chain AA, Thr, Pro, Asp and Ala were in concentrations somewhat below the range of literature values and Arg and Met, substantially above it. Milk intake per piglet tended to be greater in Trial 2 (832 vs. 893 g/day respectively; p = 0.066). However, the IB piglets grew at 168 ± 3.3 g/day, irrespective of the trial. The whole-body protein of piglets at weaning and the protein deposited in their body during the lactating period showed very close AA pattern. Among EAA, His and Arg show the highest fractional retentions (g AA retained/g AA ingested) in whole-body tissues (1.019 ± 0.025 and 0.913 ± 0.017 respectively) and also the highest body to milk ratios (1.50 and 1.41 respectively). Gly and Ala presented, among non essential AA, the highest efficiencies of utilization for tissue deposition (1.803 ± 0.057 and 1.375 ± 0.026 respectively) and body to milk ratios (2.75 and 2.12 respectively). These results suggest that the low efficiency of utilization of milk protein and the low rate of gain of the IB suckling piglet can be explained by a marked shortage in His supply, in addition to the suboptimal milk provision of Arg, Gly and Ala.

Novel sonic hedgehog mutation in a couple with variable expression of holoprosencephaly.

Holoprosencephaly (HPE) is the most common developmental defect of the forebrain and midface in humans. sporadic and inherited mutations in the human sonic hedgehog (SHH) gene cause 37% of familial HPE. A couple was referred to our unit with a family history of two spontaneous first trimester miscarriages and a daughter with HPE who presented early neonatal death. The father had a repaired median cleft lip, absence of central incisors, facial medial hypoplasia, and cleft palate. Intelligence and a brain CT scan were normal. Direct paternal sequencing analysis showed a novel nonsense mutation (W127X). Facial characteristics are considered as HPE microforms, and the pedigree suggested autosomal dominant inheritance with a variable expression of the phenotype. This study reinforces the importance of an exhaustive evaluation of couples with a history of miscarriages and neonatal deaths with structural defects.

Production and composition of Iberian sow's milk and use of milk nutrients by the suckling Iberian piglet.

Sixteen purebred Iberian (IB) sows were used in two consecutive trials to determine the efficiency of conversion of sow's milk into piglet body weight (BW) gain and the relationship between milk protein and body protein retention and between milk energy yield and body energy retention in the nursing IB piglet. In each trial, four sows were selected in order to evaluate their milk production, litter growth and nutrient balance measurements, together with four additional sows for milk sampling. Litter size was equalized to six piglets. Daily milk yield (MY) was determined weekly by the weigh-suckle-weigh technique over a 34-day lactation period. Piglets were weighed individually at birth and then weekly from day 5 of lactation. Milk samples were collected on days 5, 12, 19, 26 and 34 post partum. The comparative slaughter procedure was used to determine piglet nutrient and energy retention. One piglet from each litter was slaughtered at birth and four on the morning of day 35. Total MY was on average 5.175 ± 0.157 kg/day. The average chemical composition (g/kg) of the milk was 179 ± 4 dry matter, 53.4 ± 1.0 CP, 58.5 ± 3.8 fat, 10.4 ± 0.3 ash and 56.9 ± 2.3 lactose. Milk gross energy (GE) was 4.626 ± 0.145 MJ/kg. Milk intake per piglet tended to increase in trial 2 (832 v. 893 g/day; P = 0.066). Piglet BW gain contained (g/kg) 172.1 ± 1.3 protein, 151.5 ± 3.5 fat, 41.4 ± 0.6 ash and 635 ± 3 water and 10.127 ± 0.126 MJ GE/kg. Throughout the 34-day nursing period, the piglets grew at an average rate of 168 ± 3 g/day. The ratio of daily piglet BW gain to daily MY was 0.195 ± 0.002 g/g and the gain per MJ milk GE intake was 41.9 ± 0.5 g/MJ. The overall efficiency of protein accretion (g CP gain/g CP milk intake) was low and declined in trial 2 (0.619 v. 0.571; P = 0.016). Nutrient and energy deposition between birth and weaning were 27.4 ± 0.5 g/day protein, 24.2 ± 0.8 g/day fat and 1615 ± 40 kJ/day energy. Piglet energy requirements for maintenance were 404 kJ metabolizable energy (ME)/kg BW0.75. ME was used for growth with a net efficiency of 0.584. These results suggest that poor efficiency in the use of sow's milk nutrients rather than a shortage in milk nutrient supply might explain the low growth rate of the suckling IB piglet.

Nutrient and energy retention in weaned Iberian piglets fed diets with different protein concentrations.

Fifty-eight purebred castrated male Iberian (IB) piglets (initial BW 9.9 ± 0.1 kg) were used in an experiment to determine the effect of dietary protein content (PC) and feeding level (FL) on the rates of BW gain, whole body protein deposition (PD), and energy utilization between 10 and 25 kg of BW using the serial slaughter method. Treatments followed a 4 × 2 factorial arrangement with 4 PC (201, 176, 149, and 123 g of CP/kg of DM) and 2 FL (0.95 and 0.70 × ad libitum) and 6 or 7 piglets per combination of treatments. All diets were formulated to have an optimal AA pattern. Six piglets were slaughtered at the start of the trial to estimate initial body composition. The experimental pigs were individually housed in an environmentally controlled room (27 ± 2°C) until they reached 25 kg of BW, when they were slaughtered and analyzed for body composition. Positive linear effects of dietary PC on ADG, G:F, and gain:ME intake were observed (P < 0.001). Piglets fed at the highest FL showed greater ADG, G:F, and gain:ME intake (P < 0.001). An average increase was estimated to be 38.0 g of gain/MJ of ME intake. Protein deposition increased linearly from 35.6 to 50.9 g/d with increasing dietary PC (P < 0.001). A daily increase was estimated to be 0.35 g of PD/g of CP intake. Although the maximal genetic potential for PD of the IB piglet was not attained, a maximal value of 59.9 g/d for whole-body PD was achieved when the diet provided 201 g of CP/kg of DM and was fed at 0.95 × ad libitum. Piglets on the highest FL deposited on average 39% more body protein (P < 0.001) than restricted piglets. An average value of 4.39 g increase in PD/MJ of ME intake was obtained for diets containing 201 and 176 g of CP/kg of DM. Maintenance energy requirements and net efficiency of utilization of ME for growth, calculated by linear regression of ME intake on body retained energy, were 427 kJ/kg of BW(0.75)·d(-1) and 0.552, respectively. The corresponding partial efficiencies of utilization of ME for protein and fat deposition were 0.378 and 0.672, respectively, considerably less than the accepted values for conventional pig breeds. Practical diets of the young IB piglet should contain at least 201 g of ideal CP/kg of DM.

Prenatal diagnosis of trisomy 21 without the Down syndrome phenotype.

OBJECTIVE: To report a patient with the prenatal diagnosis of trisomy 21 without the clinical Down syndrome (DS) phenotype secondary to the absence of the Down syndrome chromosomal region (DSCR) in a derivative chromosome 21. CASE REPORT AND METHODS: A newborn patient with prenatal diagnosis of duodenal atresia. Cytogenetic studies revealed a regular trisomy 21. At birth, she did not present the clinical features of DS. FISH analysis was performed in the patient with the LSI spectrum probe for the DSCR and in the mother with FISH multicolor analysis using painting probes for chromosomes 20 and 21. RESULTS: FISH analysis in the patient showed two hybridization signals suggesting that the third chromosome 21 did not have the DSCR region explaining the absence of the DS phenotype. FISH multicolor analysis in the mother showed three hybridization signals for chromosomes 20 and 21, concluding a maternal karyotype, 46,XX,t(20;21)(p11.2;q22.1). CONCLUSIONS: The patient was found to have a derivative chromosome 21 secondary to a nondisjunction error in meiosis II without the DS critical region and the phenotype was mostly secondary to the combination of the two partial trisomies.

[The carpal tunnel syndrome in the oil toxic syndrome]. / El síndrome del túnel del carpo en el síndrome del aceite tóxico.

BACKGROUND: The toxic oil syndrome (TOS) is an autoimmune disease caused by the ingestion of aniline-denatured rapeseed oil. The carpal tunnel syndrome (CTS) is an entrapment neuropathy due to the median nerve entrapment, which is associated with both occupational activities and autoimmune diseases. The objective of this work was to know the frequency and characteristics of CTS in TOS patients. PATIENTS AND METHODS: Between December 1977 and July 2000, 744 TOS patients were evaluated. The inclusion criteria were: the clinical records for patients diagnosed between May 1981 and November 1997; and for patients diagnosed between December 1997 and July 2000, symptoms with the classical or likely pattern according to the Katz's hand diagram and one of the following findings: a) abnormal electromyogram, and b) hypalgesia in the median nerve territory and positive Tinel and/or Phalen signs. RESULTS: A total of 70 patients (63 women, 90%) were diagnosed; 48 of them had been diagnosed before 1997 and 22 subsequently. The mean age of patients was 47.6 (20-78) years. In 36 patients (51.4%), a bilateral CTS was present. Fifty-six patients (81.4%) had a diagnostic EMG, and 31 (44.2%) were obese, 13 (18.6%) diabetic, and 4 (6%) had hypothyroidism. Most of these cases (48; 68.6%) were housewives. CONCLUSIONS: TOS patients have a high frequency of CTS; therefore, this condition must be suspected in patients with associated obesity and diabetes mellitus.

[Pustulosis of Sneddon Wilkinson disease and multiple myeloma]. / Pustulosis de Sneddon Wilkinson y mieloma múltiple.

A case of subcorneal pustular dermatosis is described, this disease is not very common. Its origin remains unknown, there are some data that indicate an immunological basis because of its associations to hematological disorders and others autoimmune diseases. The diagnosis is based on clinic suspects and the histopathological analysis. The differentiation among other dermatosis like pustular psoriasis, due to its therapeutic implication and evolution. This patient developed an IgA-K myeloma after nine years of evolution, a very common finding in this disease. It has not definitive treatment, being corticosteroids and sulfonamides more effective. The prognosis depends on the appearance of complications and associated processes.

PCR-PRINS-FISH analysis of structurally abnormal sex chromosomes in eight patients with Turner phenotype.

According to cytogenetic analysis, about 50% of Turner individuals are 45,X. The remaining cases have a structurally abnormal X chromosome or are mosaics with a second cell line containing a normal or abnormal sex chromosome. In these mosaics, approximately 20% have a sex marker chromosome whose identity cannot usually be determined by classical cytogenetic methods, requiring the use of molecular techniques. Polymerase chain reaction (PCR), primed in situ labeling (PRINS), and fluorescence in situ hybridization (FISH) analyses were performed in 8 patients with Turner syndrome and 45,X mosaic karyotypes to determine the origin and structure of the marker chromosome in the second cell line. Our data showed that markers were Y-derived in 2 patients and X-derived in the remaining 6 patients. We were also able to determine the breakpoints in the two Y chromosomes. The use of cytogenetic and molecular techniques allowed us to establish unequivocally the origin, X or Y, of the marker chromosomes in the 8 patients with Turner phenotype. This study illustrates the power of resolution and utility of combined cytogenetic and molecular approaches in some clinical cases.

Use of plasma exchange and heparin during cardiopulmonary bypass for a patient with heparin induced thrombocytopenia: a case report.

Patients with documented history of heparin-induced thrombocytopenia (HIT) pose a difficult problem during surgery using cardiopulmonary bypass (CPB). Several alternatives to heparin exist, but these products either are not approved for use in the United States or have more side effects than heparin. We report on a patient with documented heparin-induced antibody and left main coronary artery disease who underwent uneventful coronary artery bypass surgery and recovery by using preoperative plasmaphresis and limited use of porcine intestinal heparin during CPB.

Automated oxyhemoglobin dissociation curve construction to assess sickle cell anemia therapy.

Oxyhemoglobin dissociation curves measure the most important function of red blood cells - the affinity for oxygen and its delivery to the tissues. This function may be deranged in sickle cell anemia and some other hemoglobinopathies. An automated oxyhemoglobin dissociation curve analyzer constructed dissociation curves in 55 patients with hemoglobinopathies and in 24 control subjects while maintaining constant temperature and pH. Sigmoid curves were converted to rectilinear ones using the Hill equation. Oxygen affinity of red cells was assessed by calculation of P50 (the PO2 at which hemoglobin is half saturated). Results revealed separation of oxyhemoglobin dissociation Hill plots according to phenotype but with wide variability. Mean oxygen affinity of fetal hemoglobin was greatest, whereas that of sickle hemoglobin was least. Other hemoglobins were intermediate. A positive correlation between decreased oxygen affinity and carboxyhemoglobin confirmed the decreased oxygen affinity of sickle hemoglobin and decreased oxygen affinity and increased diphosphoglycerate in red cells. Hill plots are less sensitive discriminators of oxygen affinity than traditional sigmoid dissociation curves and offer no particular advantage. Serial studies in a subset of three sickle cell anemia patients treated conservatively suggest automated oxyhemoglobin dissociation curves may be useful in assessment of effectiveness of newer therapies of sickle cell anemia after refinement of the method and studies of larger populations.

[Clinical and analytical findings in patients with toxic oil syndrome. Study of a cohort of 758 patients]. / Hallazgos clínicos y analíticos en pacientes afectados por el síndrome del aceite tóxico. Estudio de una cohorte de 758 pacientes.

OBJECTIVE: To report the symptoms and analytical findings observed in the collective of patients affected with the toxic oil syndrome (TOS) 18 years after the poisoning. METHODS: At the Centro de Investigación sobre el Síndrome del Aceite Tóxico (CISAT) we followed the clinical and analytical course of 758 patients affected with the TOS since December 1997 up to May 1999. Patients were evaluated by means of a previously standardized questionnaire in which a clinical review and a battery of complementary tests (thyroid hormones, spirometry with diffusion test and arterial gasometry) were included. One hundred and sixty-two patients underwent also echocardiogram because of presumptive pulmonary hypertension and/or heart disease. RESULTS: Out of the 758 patients, 516 were females and 242 males (M:F ratio 2:1), with ages ranging from 17 to 84 years (mean age 47 years). One of the most remarkable findings was the increased prevalence of cardiovascular risk factors: arterial hypertension (34%), dyslipemias (44%), overweight (40%), obesity (27%), carbohydrate intolerance (9%) and diabetes mellitus (9.4%). The most common reported symptoms were: cramps (78%), arthralgias (78%), and paresthesias (70%). Only 2.8% of patients reported to be asymptomatic. The analytical results most commonly changed were: changes in lipidic and carbohydrate metabolism (already reported), overt or subclinical hypothyroidism (6.6%) and respiratory changes in patients with no previous pulmonary disease: changes in spirometry (6%), diffusion test (8%) and hypoxemia (18%). Echocardiographic findings suggestive of PHT were obtained in 3.1% of cases. CONCLUSIONS: Although TOS occurred in 1981, this syndrome still has a relevant morbidity in a portion of the spanish population. To remark the high prevalence of cardiovascular risk factors with changes in lipidic and carbohydrate metabolism and subclinical hypothyroidism observed in our series. Further studies are necessary to evaluate the actual dimension of this poisoning.

Impact of heparin bonding on pediatric cardiopulmonary bypass: a prospective randomized study.

BACKGROUND: Heparin-coated circuits reduce the inflammatory response to cardiopulmonary bypass in adult patients; however, little is known about its effects in the pediatric population. Two studies were performed to assess this technology's impact on inflammation and clinical outcomes. METHODS: In a pilot study, complement and interleukins were measured in 19 patients who had either uncoated cardiopulmonary bypass circuits or heparin-bonded circuits. Subsequently, 23 additional patients were studied in a randomized fashion. Respiratory function and blood product utilization were recorded. RESULTS: In the pilot study, heparin-bonded circuit patients had less complement 3a (p < 0.001) and interleukin-8 (p < 0.05) compared with uncoated cardiopulmonary bypass circuit patients. The randomized study revealed that the heparin-bonded circuit was associated with reduced complement 3a (p = 0.02). Multiple variable analysis revealed that the following postoperative variables were increased with bypass time (p = 0.01) and diminished with heparin-bonded circuits: interleukins (p = 0.01), peak airway pressures (p = 0.05), and prothrombin time (p = 0.03). CONCLUSIONS: Heparin-bonded circuits significantly reduce cytokines and complement during cardiopulmonary bypass and lower interleukin levels postbypass; they were also associated with improved pulmonary and coagulation function. Heparin-bonded circuits ameliorate the systemic inflammatory response in pediatric patients from cardiopulmonary bypass.

Hallazgos clínicos y analíticos en pacientes afectados por el síndrome del aceite tóxico. estudio de una cohorte de 758 pacientes / Clinical and analytical findings in patients affected with the toxic oil syndrome. Study of a cohort of 758 patients

Objetivo. Describir la sintomatología y los hallazgos analíticos que el colectivo de pacientes afectados por el síndrome del aceite tóxico (SAT) presenta 18 años después de haber sufrido la intoxicación. Métodos. En el centro de Investigación sobre el Síndrome del Aceite Tóxico (CISAT) hemos seguido la evolución clínica y analítica de 758 pacientes afectados por el SAT desde diciembre de 1997 hasta mayo de 1999. Los pacientes fueron evaluados mediante un cuestionario previamente estandarizado en el que se incluía una revisión clínica y una batería de exploraciones complementarias, entre las que se incluían hormonas tiroideas, espirometría con prueba de difusión y gasometría arterial. A 162 pacientes se les realizó además ecocardiograma por presentar sospecha de hipertensión pulmonar y/o cardiopatía. Resultados. De los 758 pacientes, 516 eran mujeres y 242 varones (M:V-2:1), con edades comprendidas entre 17 y 84 años (edad media de 47 ñ años). Uno de los hallazgos más llamativos fue la elevada prevalencia de los factores de riesgo cardiovasculares: hipertensión arterial (34 por ciento), dislipidemias (44 por ciento), sobrepeso (40 por ciento), obesidad (27 por ciento), intolerancia hidrocarbonada (9 por ciento) y diabetes mellitus (9,4 por ciento). Los síntomas más frecuentemente referidos fueron: calambres (78 por ciento), artralgias (78 por ciento) y parestesias (70 por ciento). Únicamente referían estar asintomáticos el 2,8 por ciento de los afectados. Los resultados analíticos alterados con más frecuencia fueron: alteraciones del metabolismo lipídico e hidrocarbonado (ya referidos), hipotiroidismo franco o subclínico (6,6 por ciento) y alteraciones respiratorias en pacientes sin patología pulmonar previa conocida: alteraciones en la espirometría (6 por ciento), en la prueba de difusión (8 por ciento) e hipoxemia (18 por ciento). Se obtuvieron datos ecocardiográficos sugestivos de hipertensión pulmonar (HTP) en el 3,1 por ciento de los casos. Conclusiones. A pesar de que el SAT ocurrió en 1981, este síndrome sigue teniendo una importante morbilidad en parte de la población española, destacando la elevada prevalencia de factores de riesgo cardiovascular con alteraciones del metabolismo lipídico e hidrocarbonado e hipotiroidismo subclínico encontrados en nuestra serie. Son necesarios estudios ulteriores para evaluar la dimensión definitiva de esta epidemia (AU)