beta-hydroxybutyrate induces acute pulmonary endothelial dysfunction in rabbits

Role of an anti-acetonemic diet in reducing the need for tonsillectomy in children with recurrent tonsillitis

OBJECTIVE

The aim of this study was to investigate the effectiveness of an anti-acetonemic diet in reducing the need for tonsillectomy especially in the first years of life in children with recurrent tonsillitis.

METHODS

From 2002 to 2005 we carried out a prospective randomized study enrolling 1200 children aged 2-10 who were referred to our outpatient services complaining of recurrent tonsillitis. Children were randomly assigned to the case group or to the control group. In case children, clinical signs of persistent ketosis were investigated and a hypolipidic anti-acetonemic diet was prescribed. We compared the mean age of children who underwent tonsillectomy and evaluated the association between an anti-acetonemic diet and avoidance of tonsillectomy.

RESULTS

The association between an anti-acetonemic diet and avoidance of tonsillectomy was statistically significant; the mean age of case children who underwent tonsillectomy resulted significantly higher than that of control children.

CONCLUSION

By prescribing an appropriate dietetic regimen we obtained a significant decrease in the number of tonsillectomies for recurrent tonsillitis and an increase in the mean age of the children treated surgically.

Angiotensin, bradykinin and the endothelium

Angiotensins and kinins are endogenous peptides with diverse biological actions; as such, they represent current and future targets of therapeutic intervention. The field of angiotensin biology has changed significantly over the last 50 years. Our original understanding of the crucial role of angiotensin II in the regulation of vascular tone and electrolyte homeostasis has been expanded to include the discovery of new angiotensins, their important role in cardiovascular inflammation and the development of clinically useful synthesis inhibitors and receptor antagonists. While less applied progress has been achieved in the kinin field, there are continuous discoveries in bradykinin physiology and in the complexity of kinin interactions with other proteins. The present review focuses on mechanisms and interactions of angiotensins and kinins that deal specifically with vascular endothelium.

Pediatric diabetic ketoacidosis and hyperglycemic hyperosmolar state

Diabetic ketoacidosis is an important complication of diabetes in children and is the most frequent diabetes-related cause of death in childhood. The pathophysiology of this condition can be viewed as an exaggeration of the normal physiologic mechanisms responsible for maintaining an adequate fuel supply to the brain and other tissues during periods of fasting and physiologic stress. The optimal therapy has been a subject of controversy, particularly because the most frequent serious complication of diabetic ketoacidosis-cerebral edema-and the relationship of this complication to treatment are incompletely understood. In this article, the author reviews the pathophysiology of diabetic ketoacidosis and its complications and presents an evidence-based approach to the management of this condition.

Pulmonary endothelium in acute lung injury: from basic science to the critically ill

BACKGROUND

Pulmonary endothelium is an active organ possessing numerous physiological, immunological, and metabolic functions. These functions may be altered early in acute lung injury (ALI) and further contribute to the development of acute respiratory distress syndrome (ARDS). Pulmonary endothelium is strategically located to filter the entire blood before it enters the systemic circulation; consequently its integrity is essential for the maintenance of adequate homeostasis in both the pulmonary and systemic circulations. Noxious agents that affect pulmonary endothelium induce alterations in hemodynamics and hemofluidity, promote interactions with circulating blood cells, and lead to increased vascular permeability and pulmonary edema formation.

OBJECTIVE

We highlight pathogenic mechanisms of pulmonary endothelial injury and their clinical implications in ALI/ARDS patients.