Preservation of the proteolytic activity of a bovine spleen lysosomal-enriched extract using various freezing conditions.

The preservation of the proteolytic activity of a bovine spleen lysosomal-enriched (BSLE) extract was investigated. The BSLE extract (pH = 5.8), was subjected to storage under different conditions: refrigeration at 0 degrees C for 60 days; freezing at -20 degrees C -either directly or previously frozen in liquid nitrogen-, -80 degrees C and in liquid nitrogen; freeze-drying and stored at 0 degrees C; and freezing at -20 degrees C or in liquid nitrogen in the presence of glycerol and sorbitol as cryoprotectants. Freezing at low temperatures (-80 degrees C and in liquid nitrogen) was most effective for preserving about 100% of the initial activity of all cathepsins (B, B+L and D), as well as the activity of the extract on myofibrils, for two years. Freezing at -20 degrees C, on the contrary, led to significant (P < 0.01) losses of activity. Freeze-drying was able to preserve cathepsin activity, while it failed to maintain activity on myofibrils. Both cryoprotectants sorbitol and glycerol significantly (P < 0.01) enhanced enzyme preservation, particularly cathepsin D and the activity on myofibrils, even at a freezing temperature of -20 degrees C.

[Ischemic stroke of middle cerebral artery territory after the traumatic epidural hematoma]. / Accidente cerebrovascular isquémico del territorio de la arteria cerebral media tras hematoma epidural traumático.

INTRODUCTION: Epidural haematoma is a complication which may occur after apparently minor head injury. It may lead to the sudden onset, after a variable lucid interval, of transtentorial uncal hernia with consequent risk to life. If drainage is done early, the prognosis is excellent. CLINICAL CASE: We present a case of right parietal epidural haematoma in a 5 year-old-boy following a minor head injury, with no fracture of the skull. After a clear interval of 40 hours his consciousness deteriorated, there was right mydriasis and extension hypertonia of arms and legs. Following surgical removal there was evidence of an extensive cerebrovascular accident in the territory of the middle cerebral artery. CONCLUSIONS: Although they are infrequent, infarcts have been described in relation to epidural haematoma in all cerebral territories, predominantly in the distribution of the posterior cerebral artery. In the territory of the middle cerebral artery this may be due to traction and stenosis or occlusion of the small perforating branches, secondary to the displacement of midline cerebral structures or the space-occupying effect of epidural haematoma. All head injuries, including minor injuries mean a risk of serious hemorrhagic complications, the prognosis of which depends on the rapidity with which they are treated. GUIDELINES: Adapted to each centre are necessary for a common problem, usually without complications, but which may have unpredictably fatal results. Head injury is a dynamic process and therefore requires close clinical observation, which cannot be substituted by any complementary test.

[Survival with no sequelae after near-drowning with very poor signs for prognosis including persistent bilateral non-reactive mydriasis]. / Supervivencia sin secuelas tras casi-ahogamiento con muy malos signos pronósticos, incluida midriasis arreactiva bilateral persistente.

INTRODUCTION: The outcome of cases of near-drowning and initially poor prognostic signs are usually discouraging because of the severity of the consequent encephalopathy in most survivors. However, good recovery has been described, in spite of bad prognostic factors initially. It is difficult to establish the predictors of poor outcome which would enable one to decide when to establish and maintain advanced cardio-pulmonary resuscitation measures (CPR), since each case of near-drowning is different. CLINICAL CASE: A four year old boy survived near-drowning in cold water without sequelas but with initial signs of very poor prognosis, including prolonged immersion time, coma, severe metabolic acidosis, hyperglycemia and persistent bilateral arreactive mydriasis. DISCUSSION: The beneficial effect of hypothermia is well known, and explains (at least partially) survival in cases of apparently irreversible near-drowning. Potential benefits are reduced metabolic demand which prevents the adverse effects of hypoxia and the 'diving reflex' which short-circuits the blood supply to vital organs such as the brain and heart. We consider that the persistently arreactive pupils were not due to hypoxia, but rather to bilateral uncal compression of the third cranial nerves due to cerebral edema secondary to initial hypoxia and water intoxication. CONCLUSION: This observation is yet another argument for the establishment and maintenance of aggressive manoeuvers of CPR and treatment in all children who have nearly-drowned, independently of the apparent seriousness or irreversibility.

[Multicenter prospective study on severe bacterial meningitis in children]. / Estudio prospectivo multicéntrico de la meningitis bacteriana grave pediátrica.

UNLABELLED: We prospectively studied the epidemiologic, clinic signs and outcome of bacterial meningitis in 125 children who were admitted into a PICU (Pediatric Intensive Care Unit) of 11 hospitals of Spain and whose meningitis was diagnosed between May 1994 and April 1995. RESULTS: The median age of the children was 3.55 +/- 3.32 years (range 1 month to 16.5 yrs). Eighty-eight were bacterial meningitis, probably bacterial 30 and aseptic 7. The most frequently isolated organisms were N. meningitidis (52), H. influenza type b (17) and S. pneumoniae (8). Twenty-five percent of N. meningitidis had C serotype. Incidence rate of each germen was depending of age. All patients diagnosed of H. influenza type b meningitis were less than 3 years old. H. influenza type b and meningococcus had similar incidence rate during the first year of life (27% versus 31%). During the first three years of life H. influenza type b produced one third of bacterial meningitis. A mortality rate of 5.6% (seven patients: 3 S. pneumoniae, 1 N. meningitidis, 1 H. influenza type b and 2 unknown germen) was observed. Patients who die had lower Glasgow coma score (p = 0.034) and seizures (p = 0.001) at admission. At discharge of PICU, 9 survivors (7.2%) had sequelae: mental retardation in 7 patients and hearing loss in two. One third of patients needed hemodynamic support and a 15% of them ventilatory support. CONCLUSIONS: Age is an important epidemiological factor in the etiology of pediatric acute meningitis. H. influenza type b and N. meningitidis had similar incidence rate during the first year of life. S. pneumoniae had the highest mortality rate (37.5%). The presence of coma and seizures at admission were associated with mortality.

Somatosensory evoked potential elicited by acupoint's stimulus.

Based on the observation that repeated acupoint stimulation elicits evoked potentials whose latency varies as a result of the stimulus intensity we assessed the evoked potential elicited by stimulus of three acupoints (Hegu, Shenmen and Houxi), comparing the results to the potentials produced by median nerve stimulus and nonacupunctural point. Fourteen healthy individuals were studied, and no modifications related to the Hegu and Shenmen point potentials increased with the amount of stimuli, until it reached a plateau at around 400 stimuli. It did not vary for Houxi and the nonacupunctural point. We conclude that the somesthesic afference from acupunctural points must involve control circuits that are quantitatively different for each point.