Hyaluronidase shortens levobupivacaine lumbosacral epidural anaesthesia in dogs.

OBJECTIVES: The aim of this study was to evaluate the effects of hyaluronidase added to levobupivacaine in lumbosacral epidural blockade in dogs. METHODS: Six adult mixed breed dogs (two males and four females) weighing 7 to 14 kg (10.5 ±1.5 kg) and aged two to five years were used. Each dog received both treatments in random order: levobupivacaine alone (LBA; n=6) or levobupivacaine plus hyaluronidase (LBH; n=6) administered in the lumbosacral epidural space. Systemic effects, spread and duration of anaesthesia and motor block were determined before treatment and at predetermined intervals. RESULTS: The duration of local anaesthesia was 90 ±10 minutes (P=0.001) for LBH treatment and 150 ±15 minutes for LBA treatment. In the LBH treatment, anaesthesia reached the T12 to T13 dermatome and in the LBA treatment it reached the T11 to T12 dermatome in all animals in 5 and 15 minutes, respectively. Complete motor blockade was 75 ±12 minutes (P=0.01) and 120 ±15 minutes for LBH and LBA treatments, respectively. CLINICAL SIGNIFICANCE: Hyaluronidase added to levobupivacaine significantly shortens the duration of epidural anaesthesia with the same dermatome spread into the epidural space in dogs.

Lignocaine versus bupivacaine for flank anaesthesia using multiport catheters via a caudal epidural approach in cattle.

OBJECTIVE: To determine the anaesthetic and systemic effects of dorsolumbar epidural anaesthesia using non-stylet multiport catheters via the caudal approach to administer hypertonic 5% lignocaine (HL) or hypertonic 0.5% bupivacaine (HB) to the flank in standing cattle. MATERIALS AND METHODS: Six healthy adult cattle weighing 310-455 kg received 0.2 mg/kg HL or 0.025 mg/kg of HB; control animals received 0.9% saline solution. All drugs were injected into the dorsolumbar epidural space via a caudal approach through a non-stylet multiport catheter. Each animal received each treatment at random. Evaluations of anaesthesia, ataxia, heart rate, arterial pressures, respiratory rate and rectal temperature were obtained at 0 (basal), 5, 10, 15, 30, 45, 60, 75, and 90 min after epidural injection and then at 30-min intervals until loss of anaesthesia. All animals received a standard noxious stimulus and a 4-point scale was used to score the response. A second scale was used to score ataxia. RESULTS: The duration of anaesthesia in the upper and lower flanks in cattle was 68 +/- 12 and 110 +/- 15 min (mean +/- SD) after dorsolumbar epidural HL or HB, respectively. Both hypertonic local anaesthetics produced a mild ataxia. The systemic changes were within acceptable limits in these clinically healthy cattle. CONCLUSION: In standing cattle the dorsolumbar epidural injection of hypertonic lignocaine provided faster onset of anaesthesia and fewer cardiovascular effects, but had a shorter duration of anaesthesia than hypertonic bupivacaine.

Opinion of hepatic transplant waiting list patients regarding split liver transplantation.

BACKGROUND: Split liver transplantation (SLT) increases organ supply for hepatic transplantation. Long-term patient survival and complication rates seem to be equivalent between orthotopic liver transplantation (OLT) and SLT. There are controversies among transplant physicians due to an ethical dilemma between benefiting individual needs or those of society. Barshes and Goss (Am J Transplant 5:2047, 2005) demonstrated that the majority of adult liver transplant candidates are favorable to SLT. The aim of our study was to evaluate the opinions of patients at a Brazilian university hospital regarding SLT. MATERIALS AND METHODS: A questionnaire with 14 questions was applied to 50 patients included in a hepatic transplant waiting list regarding SLT. RESULTS: The overall attitudes of 66% of the participants were classified as utilitarian, 31% were classified as self-preserving, and 3% were undecided. Ninety-one percent of patients would be willing to share even if their expected survival after SLT was shorter than that with OLT. For 77% of patients, children must have priority over adults. However, 83% were unaware of the donors for pediatric transplantations. CONCLUSIONS: SLT is a consistent solution for organ demand despite controversies among transplant physicians. The present study demonstrated that most patients were favorable to SLT. In conclusion, attitudes toward graft sharing are not barriers to SLT.

Apoptosis and rejection in rat intestinal transplantation: correlation with FK506 doses and donor specific bone marrow infusions.

BACKGROUND: Our purpose was to investigate the occurrence and the evolution of apoptosis of enterocytes during acute and chronic rejection in an experimental model of allogeneic heterotopic small bowel transplantation (SBTx). METHODS: Forty-five rats were divided in 10 experimental groups according to the dose of FK506 administration and donor bone marrow infusions (DBMI). Groups 1 and 2 did not received BMI. Groups 3 and 4 received 150x106 cells at day 0, groups 5 and 6 received 75x106 cells at days 0-4, groups 7 and 8 received 75x106 cells at days 4 and 10, and groups 9 and 10 received 30x106 cells at days 4, 10, 15, 20, and 25. Animals of groups 1, 3, 5, 7, and 9 were immunosuppressed with 0.5 mg/kg FK 506, although the remaining groups with 1 mg/kg FK 506, from day 0 to 4 after transplant. Fragment end labeling of DNA was used to detect apoptosis. RESULTS: The number of apoptotic cells detected was highest at day 15 (184+/-154) and then progressively decreased thereafter (day 30=159+/-197; day 45=80+/-167; day 60=0). The number of apoptotic enterocytes was found increased during mild (151+/-108) and moderate (281+/-161) allograft rejection, although a low apoptotic rate was observed in cases without rejection (59+/-13) and during severe (53+/-131) and chronic rejection (46+/-136). Furthermore the number of labeled cells was found inversely correlated with fibrosis (P<0.0001). There was no correlation between apoptosis and the presence or absence of DBMI; however, at day 15 rats receiving 1 mg/day of FK 506 had a significantly lower number of apoptotic cells detected (127+/-103 vs. 233+/-174; P<0.02). CONCLUSIONS: In this study the number of apoptotic cells correlated positively with mild and moderate rejection episodes. In case of severe and chronic rejection a low apoptotic rate was found due probably to extensive necrosis and fibrosis of the mucosa. These data suggest an important role of apoptosis in acute and chronic intestinal rejection in a rat model of intestinal transplantation. Determination of apoptosis in allografts might represent an early sign of small bowel rejection and a useful marker in defining the degree of rejection and its outcome/prognosis.

Intestinal transplantation for short gut syndrome attributable to necrotizing enterocolitis.

BACKGROUND: Necrotizing enterocolitis (NEC) is a life-threatening condition of the neonatal age, which frequently requires surgical intervention. After extensive bowel resection, a small proportion of these patients may develop chronic short gut syndrome (SGS) and require chronic total parenteral nutrition (TPN) use. Intestinal transplantation has been performed in these patients as a life-saving option. This study reviews our experience with intestinal transplantation for SGS attributable to NEC emphasizing the mode of presentation, natural history, timing, and outcome. METHODS: A retrospective chart review was performed for all pediatric patients who underwent small bowel transplantation for NEC at the University of Miami between August 1994 and March 1999. RESULTS: Eleven transplants were performed for 10 patients with NEC (8 male and 2 female; median age: 1.75 years [range: 10 months to 10. 1 years]). Procedures performed were isolated intestinal transplants (n = 2), combined liver-intestinal transplants (n = 6), and multivisceral transplants (n = 3). All patients were born prematurely with median birth weight of 1.640 kg (range: 810 g to 2. 730 kg). They developed NEC in the first few days of life and subsequently underwent an average of 5 surgeries per patient before transplant. Transplant was indicated for liver failure in 8 patients and recurrent central line sepsis in 2 others. At present, 6 patients are alive with an overall 1-year and 3-year actuarial survival of 60% and a median follow-up of 29 months (range: 9-46 months). Six children have been weaned off TPN after a median time of 71 days (range: 19-131) from transplantation. All survivors are at home with functional grafts. CONCLUSION: Intestinal transplantation provided a reasonable outcome in patients with NEC-associated SGS who had already developed life-threatening complications related to TPN. Intestinal transplantation replaced the diseased intestine and liver, enfranchised patients from TPN, and conferred improved quality of life. These patients should be actively considered for intestinal transplantation and referred to a transplant center as soon as possible.

Effects of small bowel exclusion on intestinal myoelectrical activity pattern: comparison between innervated and denervated (transplanted) Thiry-Vella loops in rats.

Small bowel transplantation (SBT) leads to several changes in normal intestinal physiology with special reference to lymphatic disruption and graft denervation. Intestinal myoelectrical activity (MA) has been studied in different conditions, but little is known about MA in excluded bowel segments without the influence of nutrients. We performed this study to evaluate the effects of bowel exclusion on MA pattern. Fifteen Wistar rats were divided into two groups: five were used as donors and five as recipients for SBT; the remaining five underwent isolation of a jejunal segment as Thiry-Vella loop (TVL). On the 20th postoperative day, four bipolar electrodes were implanted in the small bowel of each rat: proximally and distally on the transplanted and the native intestine (SBT group); proximally and distally on the TVL and across the jejunal anastomosis (TVL group). On the 30th postoperative day, MA was recorded for 30 min after a 12 h fast. MA pattern was not altered by the exclusion of innervated jejunal segments (TVLs) with maintenance of high amplitude and migrating myoelectric complex (MMC) occurrence independent of MA in the continuity bowel. The characteristic regular spiking activity was not observed in transplanted grafts and MA analysis showed slow waves containing superimposed irregular spiking activity.

Metabolic and ultrastructural effects of cyclosporin A on pancreatic islets.

We investigated the effect of different doses of cyclosporin A (CyA) on glucose and insulin levels, as well as its residual effects on pancreatic islets ultrastructure after discontinuation of the drug. We studied four groups of Wistar rats. One control- (n = 5) and three experimental groups, n = 10 each, were treated with different doses of CyA i.m. for 14 days: group I, 5 mg/Kg; group II, 15 mg/Kg; and group III, 25 mg/Kg. Five animals of each group were sacrificed after 14 days, and the remaining five after 21 days to assess residual CyA effects. On the day of sacrifice, the rats underwent maltose absorption test, and glucose and insulin levels were measured. Pancreatic biopsies were obtained on day 21 to evaluate islets ultrastructure by electron microscopy. As a result, statistically significant, dose dependent (P < 0.05) increases in glucose and insulin levels were observed in CyA-treated groups. Groups II and III showed insulin levels significantly higher after fasting (P < 0.05) on day 14 comparing to the controls, while in groups I and II values returned to normal after CyA discontinuation. Group III showed persistently increased insulin levels on day 21. Pancreatic ultrastructural changes were observed only in group III. We can conclude that CyA effects on glucose and insulin levels were temporary and reversible at low doses. Ultrastructural changes in the pancreatic islets may occur with high doses of CyA.

[Perspectives of basic health unit functions: report from an experience]. / Perspectiva de ampliação das funções da unidade básica de saúde: relato de experiência.

The authors report an experience of primary health care emphasizing aspects of Health Promotion within the Epidemiologic Model: "The field of force and the Paradigm of well-being". This experience combines physical exercises, leisure, excursions and a course about individual and environmental health to 255 adults (35 to 80 years old) in a square near the Basic Health Unit. The authors mention the necessity of a new arrangement of health services activities comprehending a wide conception of health.