Intake of myo-inositol hexaphosphate and urinary excretion of inositol phosphates in Wistar rats: Gavage vs. oral administration with sugar.

OBJECTIVE: To evaluate the urinary levels of inositol phosphates (InsPs) in rats that received different salts of myo-inositol hexaphosphate (InsP6) by gavage or by oral administration. METHODS: Thirty rats received AIN-76A diet (in which InsPs are undetectable) for 15 days. Then, 12 rats received InsP6 by gavage as a Na salt or a Ca/Mg salt; after 4 days, the Na or Ca/Mg InsP6 was administered with water containing 15 g/L sucrose and urine samples were collected. The other 18 rats received oral InsP6, in which 0.5 g of sugar was combined with InsP6 as a Na salt, a Ca/Mg salt, or a Na salt with CaCO3; daily urine samples were collected. Urine levels of InsPs were determined using a nonspecific method and a specific method (polyacrylamide gel electrophoresis, PAGE), and different InsPs were identified by mass spectroscopy (MS). RESULTS: After 15 days of the InsP6-free diet, the non-specific method detected no urinary InsPs, and MS detected only InsP2. After administration of Na-InsP6 by gavage, the non-specific method indicated more urinary InsPs than the amount of InsP6 determined by PAGE. MS indicated the presence of urinary InsP2, InsP3, InsP4, InsP5, and InsP6 in these rats, with notable variations among animals. Use of the same treatment to administer Ca/Mg-InsP6 led to a lower overall content of urinary InsPs and a lower level of InsP6. Oral administration of InsP6 as a sugar pill led to lower urinary levels of InsPs than administration of InsP6 by gavage, and administration as a Ca/Mg pill or a Ca/Mg pill with CaCO3 led to lower levels than administration as a Na pill. CONCLUSION: Administration of InsP6 to rats leads to the excretion of a mixture of different InsPs. Rats more effectively absorb InsP6 when supplied without dietary components that interfere with its uptake, such as the Ca ion and sugar.

Evaluation of inositol phosphates in urine after topical administration of myo-inositol hexaphosphate to female Wistar rats.

AIMS: Previous studies demonstrated a remarkable increase of urinary InsP6 by topical administration. However, the methodology used for InsP6 analysis was not specific. The aim of this paper is to measure urinary inositol phosphates InsPs using more advanced methodologies and to compare the results with those obtained by the non-specific method. MATERIALS AND METHODS: We fed 12 female rats with a diet without InsP6 for 16days. Then, we administered a topical InsP6 gel at high doses for 7days (50mgInsP6/day) or at low doses for 28days (20mgInsP6/day). We measured urine levels InsPs using a nonspecific method (based on the ability of InsPs to complex Al3+) and levels of InsP6 by a specific method (using polyacrylamide gel electrophoresis). Identification of different InsPs was performed by MS. KEY FINDINGS: At baseline, after dietary deprivation of InsP6, rats only excreted InsP2 in their urine, and there was no detectable InsP6 or other InsPs. Rats given the high dose treatment for 7days had abundant urinary InsP6, but also had other InsPs in their urine; cessation of InsP6 administration led to decreased levels of urinary InsPs. Rats given the low dose treatment for 28days had increasing levels of urinary InsPs over time. The maximum urinary InsP6 was at 21days, after which InsPs excretion decreased. SIGNIFICANCE: We conclude that the skin can absorb InsP6 from a topical gel, and that InsP6 is excreted in the urine, along with other InsPs (InsP5, InsP4, InsP3, and InsP2).

Manejo anestésico en paciente pediátrico con vía aérea difícil afectado de epidermólisis ampollosa distrófica / Anaesthetic management in a paediatric patient with a difficult airway due to epidermolysis bullosa dystrophica

La epidermólisis ampollosa distrófica (EAD) es una patología hereditaria infrecuente, caracterizada por la formación de ampollas ante mínimos traumatismos, que tienden a formar cicatrices distróficas y llevan a secuelas limitantes y amenazantes para la vida. Es frecuente que los pacientes afectados de EAD precisen diferentes intervenciones quirúrgicas a lo largo de su vida. Los principales objetivos del manejo anestésico son la prevención del traumatismo/infección sobre la piel o las mucosas y el establecimiento de una vía aérea segura sin producir ampollas. El posicionamiento del paciente y el material utilizado para la monitorización de signos vitales y para la administración de agentes anestésicos pueden producir nuevas lesiones. Debe lubricarse todo el material y evitar adhesivos y movimientos de fricción sobre la piel. Estos pacientes suelen presentar múltiples comorbilidades y accesos vasculares y vía aérea difíciles. La formación de nuevas ampollas durante la instrumentación de vía aérea puede llevar a una obstrucción aguda de la misma. Presentamos el caso de un paciente con EAD y vía aérea difícil sometido a corrección de sindactilia y exodoncia múltiple (AU)

Dystrophic epidermolysis bullosa (DEB) is a rare inherited disorder characterized by blistering after minimal trauma. These blisters tend to form dystrophic scars, leading to limiting and life-threatening sequelae. The anaesthetic management of patients with DEB is a challenge, even for the most experienced anaesthesiologists, but basic principles can help us prepare the plan of care. The main goals are to prevent trauma/infection of skin/mucous, and to establish a secure airway without causing bullae. Patient positioning and the instruments used to monitor vital signs and administering anaesthetic agents can cause new lesions. It is advisable to lubricate the instruments and to avoid adhesive material and shearing forces on the skin. Besides the implications of the comorbidities, there is a potential difficult intubation and difficult vascular access. Acute airway obstruction can occur due to airway instrumentation. We report the case of a patient diagnosed with EBD difficult airway and undergoing correction of syndactylyl and dental extractions (AU)

[Anaesthetic management in a paediatric patient with a difficult airway due to epidermolysis bullosa dystrophica]. / Manejo anestésico en paciente pediátrico con vía aérea difícil afectado de epidermólisis ampollosa distrófica.

Dystrophic epidermolysis bullosa (DEB) is a rare inherited disorder characterized by blistering after minimal trauma. These blisters tend to form dystrophic scars, leading to limiting and life-threatening sequelae. The anaesthetic management of patients with DEB is a challenge, even for the most experienced anaesthesiologists, but basic principles can help us prepare the plan of care. The main goals are to prevent trauma/infection of skin/mucous, and to establish a secure airway without causing bullae. Patient positioning and the instruments used to monitor vital signs and administering anaesthetic agents can cause new lesions. It is advisable to lubricate the instruments and to avoid adhesive material and shearing forces on the skin. Besides the implications of the comorbidities, there is a potential difficult intubation and difficult vascular access. Acute airway obstruction can occur due to airway instrumentation. We report the case of a patient diagnosed with EBD difficult airway and undergoing correction of syndactylyl and dental extractions.

Aneurisma de arteria femoral superficial: reporte de un caso y revisión de la patología / Superficial femoral artery aneurysm: report of a case and review of the pathology

El aneurisma arteriosclerótico aislado de la arteria femoral superficial es una patología inusual. Presentamos el caso de un paciente de 89 años que acude a nuestro hospital por una masa pulsátil de muslo derecho. Se demostró la presencia de un aneurisma a través del diagnóstico por imágenes y procedimos a su resección quirúrgica. Realizamos una revisión de la literatura de esta patología poco frecuente.

[Effect of ischemic tourniquet pressure on the intensity of postoperative pain]]. / Influencia de la presión del torniquete de isquemia sobre la intensidad del dolor postoperatorio.

OBJECTIVE: To evaluate the influence of tourniquet pressure (TP) on the postoperative pain of patients undergoing total knee arthroplasty (TKA). MATERIAL AND METHODS: This prospective double-blind study enrolled 86 patients scheduled for TKA. The patients were randomized to groups to receive either a high TP (400 mgHg) or a low TP (100 mgHg above systolic pressure). A spinal block was performed in each patient. Intravenous morphine and metamizol were infused through a patient-controlled analgesia device. Postoperative pain was estimated on a visual analog scale (VAS). We also recorded the amount of morphine infused, functional recovery of the limb and the presence of complications. RESULTS: Surgical field conditions were considered good in all but two low PT cases. Postoperative pain was less intense in the low TP group at 6, 12, 24 and 36 hours, and that group required less morphine (11.38 +/- 4.9 mg vs. 15.13 +/- 4.9 mg, p < 0.05). More patients achieved 90 degrees flexion four days after surgery in the low TP group (65%) than in the high TP group (41%) (p < 0.05). CONCLUSIONS: Applying a lower-than-usual TP in orthopedic surgery could be sufficient for reducing postoperative pain while still providing a bloodless surgical field.

Influencia de la presión del torniquete de isquemia sobre la intensidad del dolor postoperatorio / Influence os ischemic torniquet pressure on the intensity of postoperative pain

OBJETIVO: Evaluar la influencia de la presión de torniquete sobre el dolor postoperatorio en pacientes sometidos a cirugía protésica de rodilla. MATERIAL Y MÉTODOS: Se realiza un estudio prospectivo a doble ciego incluyendo a 86 pacientes programados para cirugía protésica de rodilla. Los pacientes se distribuyeron aleatoriamente en dos grupos en función de la presión del torniquete: grupo de alta presión de torniquete (APT), a 400 mmHg, y grupo de baja presión de torniquete (BPT), presión de torniquete igual a la tensión arterial sistólica más 100 mmHg. En todos los pacientes se realizó una anestesia subaracnoidea. Se administró morfina endovenosa en modo PCA y metamizol endovenoso para la analgesia postoperatoria. Se evaluó el dolor postoperatorio con una escala visual analógica (EVA); también se registraron la dosis total de morfina administrada, la recuperación funcional de la extremidad y la presencia de complicaciones. RESULTADOS: Las condiciones quirúrgicas fueron adecuadas en todos los casos excepto en 2 pacientes del grupo BPT. La intensidad del dolor postoperatorio fue menor en el grupo BPT a las 6, 12, 24 y 36 horas, requiriendo este grupo una menor administración de morfina, 11,38ñ5,1 mg (media ñ desviación estándar) frente 15,13ñ4,9 mg en el grupo BPT (p<0,05). El 65 por ciento de pacientes del grupo BPT consiguió un arco de flexión de 90º el cuarto día del postoperatorio, frente al 41 por ciento en el grupo APT (p<0,05). CONCLUSIONES: La aplicación de una presión de torniquete inferior a la habitual en cirugía ortopédica podría ser suficiente para obtener un campo exangüe y una menor intensidad de dolor postoperatorio (AU)