Changes of lactate levels during cardiopulmonary bypass in patients undergoing cardiac transplantation: possible early marker of morbidity and mortality.

OBJECTIVES: High levels of lactate are associated with tissue hypoperfusion during cardiac surgery resulting in postoperative morbidity and mortality among patients undergoing cardiopulmonary bypass (CBP). Our goal was to evaluate the change in lactate levels during CBP for their possible predictive value for complications after heart transplant surgery. MATERIALS AND METHODS: From January to December 2010 we studied lactate levels in 16 heart transplant patients. Arterial blood samples were collected before, during, and after cardiopulmonary bypass on admission to the intensive care unit (ICU). Lactate levels were measured using the cobas B221 (Roche Diagnostic). The neurological, lung, and kidney complications were associated with mortality within 30 days. RESULTS: One patient displayed lactate levels > 2 mmol/L before bypass while 4 (25%) showed levels > 4 mmol/L during CPB. Lactate values higher than or equal to 4 mmol/L on ICU admission occurred in nine patients (56%). Postoperative mortality was higher among the group with levels above below 4 mmol/L on ICU admission (18.7% vs 6.2%). Neurological complications were observed in 22% of patients with elevated levels as opposed to none of the patients with levels below 4 mmol/L. Pulmonary complications were noted in 22% of patients with high lactate values versus 0% among the other group. CONCLUSION: Hyperlactemia above certain levels occurring during CPB serve as a biomarker to identify early postoperative morbidity and mortality.

Detección de deficiencia de yodo en el sur de España mediante el cribado del hipotiroidismo congénito / Using newborn congenital hypothyroidism screening specimens to detect iodine deficiency in three regions of Spain

Introducción: Se midió hipertirotropinemia neonatal en 3 provincias del sur de España y se analizó la repercusión de una posible deficiencia de yodo en un programa de cribado de hipotiroidismo congénito (CH, congenital hypothyroidism). Material y métodos: El estudio comprende 113.108 recién nacidos que se dividieron en 2 grupos según el momento en que se extrajo la muestra para el cribado. En 78.646 se recogió después de las 48h de vida y en 34.462 se obtuvo en el momento del nacimiento del cordón umbilical (muestras precoces). Los recién nacidos procedían de las provincias de Sevilla, Huelva y Córdoba. La tirotropina (TSH) se midió por fluorimetría a tiempo discriminado. Resultados: El porcentaje de hipertirotropinemia neonatal fue superior en Huelva (5,2%) que en Sevilla (1%) (p<0,001), hecho constatado igualmente en el grupo de muestras precoces (Huelva: 5,3%; Sevilla: 1,9%, y Córdoba: 1,7%: p<0,001). En este último grupo, el 0,3 y el 0,2% de los recién nacidos de Sevilla y Córdoba, respectivamente, presentaron TSH >20mUI/l y 10 recién nacidos tuvieron que localizarse por cada recién nacido con CH. En Huelva hubo que llamar a 17 recién nacidos por caso detectado. Conclusiones: La distribución heterogénea de las concentraciones de TSH en los recién nacidos de las 3 áreas geográficas parece indicar una ingesta de yodo irregular y deficiente. La extracción de muestras precoces más una posible deficiencia de yodo incrementa el número de falsos positivos en el programa de cribado neonatal de CH (AU)

Background: Neonatal hyperthyrotropinemia by measurements of thyrotropin (TSH) concentrations has been assessed in three different areas of Spain. The repercussions of a possible iodine deficiency in a congenital hypothyroidism screening program have also been analysed. Material and Methods: The study comprised 113,108 newborns, which were divided into two groups according to the time of blood sampling. In 78,646 newborns heel blood samples were obtained after 48h whereas in 34,462 newborns, samples were obtained at birth from the umbilical cord (early samples). Newborns came from three areas of the south of Spain, Seville, Huelva and Cordoba. TSH concentrations were measured by time-resolved fluoroimmunoassay. Results: The percentage of hyperthyrotropinemia was greater in Huelva (5.2%) than Seville (1.0%) (p<0.001), similar to that observed in early samples, which was higher in Huelva (5.3%) than in Seville (1.9%) and Cordoba (1.7%) (p<0.001). In the early samples group, 0.3% and 0.2% of the newborns from Seville and Cordoba respectively, had TSH >20mIU/L and 10 infants should have been recalled for a new sample for each case detected. While in Huelva 17 infants (0.9%) were recalled per case detected. Conclusions: The heterogeneous distribution of TSH concentrations in newborns from several geographical areas appears to indicate an irregular and deficient iodine intake. Using early samples and a possible iodine deficiency, increase false positive results in a Neonatal Screening Program of congenital hypothyroidism (AU)

[Possible effect of bromocriptine on the insulin receptor]. / Posible efecto de la bromocriptina sobre el receptor de insulina.

The administration of 0.00011 mg/g weight/day of bromocriptine (CB154) for 7 days to Wistar rats, improved the peripheral glucose uptake without significant changes in plasma insulin level, during the intravenous glucose tolerance test (0.33 g/kg). The mode of the bromocriptine action on binding of 125I insulin to erythrocyte insulin receptors has been evaluated. The total number of sites was greater with bromocriptine (513.1 +/- 124.1 pM/1,CB154 815.6 +/- 107.9 pM/l) (p less than 0.01). The high affinity/low capacity compound of insulin receptor, in CB154 rats (51.8 +/- 16.8 pM/l) was higher than in normal rats (18.3 +/- 8.9 pM/l) (p less than 0.005). Additional studies indicated that CB154 had no effect on the rate of association and dissociation of 125I insulin from rats erythrocyte insulin receptors. The degradation of insulin or the erythrocyte receptor sites do not change, after the treatment with CB154.