Total intravenous anesthesia with midazolam, remifentanil, propofol and cistracurium in morbid obesity.

BACKGROUND: According to physical impairments of massive obesity, cardiac, respiratory and gastrointestinal physiology must be considered as much as pharmacokinetic behavior. Anesthetic management of morbidly obese patients has to be carefully planned, in order to minimize the increased risks of aspirative pneumonitis, hemodynamic instability and delay in recovery. The ideal anesthesia should provide a smooth and quick induction, allowing rapid airway control, prominent hemodynamic stability, and rapid emergence from anesthesia. To approach these ideal conditions, a Total Intravenous Anesthesia (TIVA) with midazolam, remifentanil, propofol and cisatracurium was designed and analyzed. METHODS: 10 consenting morbidly obese patients scheduled for elective Laparoscopic Adjustable Gastric Banding participated in the study. TIVA with midazolam, remifentanil, propofol and cisatracurium was used in all cases. Time to loss of consciousness, tracheal intubation, perianesthetic physiological parameters and complications, incidence of awareness with recall, recovery times, postoperative analgesia and costs of drugs were evaluated. RESULTS: The analyzed data showed adequate time and physiological conditions for induction and tracheal intubation, stable maintenance with easy handling of deepness, low incidence of perianesthetic complications, excellent recovery performance and institutional efficiency. CONCLUSIONS: TIVA with midazolam, remifentanil, propofol and cisatracurium was found to be effective, secure, predictable and economic for the anesthetic management of morbidly obese patients.

Effect of two natural light regimes and nutrient addition on the forest herb Begonia decandra (Begoniaceae).

The effect of two natural light-growing conditions (understory versus light gaps) and the interaction with nutrient availability (through fertilization) were studied in the understory herb Begonia decandra, in the Luquillo Experimental Forest in Puerto Rico. Sixteen potted plants obtained from cuttings were randomly chosen and distributed in each of eighth forest environments (four light gaps and four understories), for a total of 128 plants. Fertilizer was applied to half of the plants in each site. After seven months in the two given microenvironments, increased light and fertilization resulted in greater growth and some changes in the biomass allocation patterns. All measured variables responded similarly to reported changes for tree seedlings and saplings from other tropical and subtropical regions. Total growth parameters (height, biomass and leaf area) were very sensitive to increases in the main resource (light). The addition of nutrients was less important in producing changes in the allocation variables (root to shoot ratio, leaf area ratio, and specific leaf mass) under conditions of high light availability. Changes due to nutrient levels were relatively greater on plants grown under under-story conditions. Also, small light differences among sites can cause significant changes in the variables related to total growth. Lastly, plant mortality in the nutrient treatments was found to be independent of mortality in two forest light environments. Some hypotheses about resource acquisition and plant growth are not supported by this data.

On the structural preservation of recombinant human growth hormone in a dried film of a synthetic biodegradable polymer.

In this work we describe the structural investigation of the model protein recombinant human growth hormone (rhGH) under conditions relevant to polymeric sustained-delivery depots, including the dried protein entrapped in a film of poly(DL-lactic-co-glycolic)acid. At each step of the procedure, dehydration of rhGH by lyophilization, suspension in methylene chloride, and drying from that suspension, the structure of rhGH was probed noninvasively using Fourier transform infrared (FTIR) spectroscopy. We found that the structure of rhGH was significantly changed by the dehydration process as indicated by a marked drop in the alpha-helix content and increase in the beta-sheet content. Subsequent suspension of this powder in methylene chloride, drying from that suspension, and drying from a methylene chloride/PLGA solution introduced only minor additional structural changes when using appropriate conditions. This result is likely due to the limited molecular mobility of proteins in nonprotein-dissolving organic solvents. Finally, when rhGH was co-lyophilized with the lyoprotectant trehalose, which preserves the secondary structure, the rhGH entrapped in the PLGA matrix also had a nativelike secondary structure.

Effect of excipients on the stability and structure of lyophilized recombinant human growth hormone.

We have investigated the effect of mannitol, sorbitol, methyl alpha-D-mannopyranoside, lactose, trehalose, and cellobiose on the stability and structure of the pharmaceutical protein recombinant human growth hormone (rhGH) in the lyophilized state. All excipients afforded significant protection of the protein against aggregation, particularly at levels to potentially satisfy water-binding sites on the protein in the dried state (i.e., 131:1 excipient-to-protein molar ratio). At higher excipient-to-protein ratios, X-ray diffraction studies showed that mannitol and sorbitol were prone to crystallization and afforded somewhat less stabilization than at lower ratios where the excipient remained in the amorphous, protein-containing phase. The secondary structure of rhGH was determined using Fourier transform infrared (FTIR) spectroscopy. rhGH exhibited a decrease in alpha-helix and increase in beta-sheet structures upon drying. Addition of excipient stabilized the secondary structure upon lyophilization to a varying extent depending on the formulation. Samples with a significant degree of structural conservation, as indicated by the alpha-helix content, generally exhibited reduced aggregation. In addition, prevention of protein-protein interactions (indicated by reduced beta-sheet formation) also tended to result in lower rates of aggregation. Therefore, in addition to preserving the protein structure, bulk additives that do not crystallize easily and remain amorphous in the solid state can be used to increase protein-protein distance and thus prevent aggregation.

Retratamiento acortado bisemanal por siete meses a pacientes con tuberculosis pulmonar

Fueron analizados 50 casos de pacientes tuberculosos hospitalizados en el hospital Dr. Rodolfo de la Cruz Lora quienes habían sido tratados anteriormente de forma irregular. Se obtuvo una tasa de negativación del 76% de las baciloscopía al cabo de dos meses de tratamiento con esquema de corta duración a base de isoniacida, rifampicina, pirazinamida y estreptomicina. Estos resultados nos autorizan a adoptar sin temor tales esquemas terapéuticos, que se caracterizan por una buena tolerancia

Changing profiles in vasectomy subjects in the past decade.

Two groups of vasectomy patients were reviewed: 376 men operated upon between 1968 and 1971 and 608 between 1974 and 1978. Average age, length of marriage, and number of living children prior to vasectomy were greater in the first group (P less than 0.01). The results are compatible with the idea that couples are planning smaller families and turning increasingly to vasectomy as a reliable permanent birth control method immediately following the completion of their families.