Effectiveness of uterine tamponade devices for refractory postpartum haemorrhage after vaginal birth: a systematic review

Objectives

To evaluate uterine tamponade devices’ effectiveness for atonic refractory postpartum haemorrhage (PPH) after vaginal birth and the effect of including them in institutional protocols.

Search strategy

PubMed, EMBASE, CINAHL, LILACS, POPLINE, from inception to January 2021.

Study selection

Randomised and non‐randomised comparative studies.

Outcomes

Composite outcome including surgical interventions (artery ligations, compressive sutures or hysterectomy) or maternal death, and hysterectomy.

Results

All included studies were at high risk of bias. The certainty of the evidence was rated as very low to low. One randomised study measured the effect of the condom‐catheter balloon compared with standard care and found unclear results for the composite outcome (relative risk [RR] 2.33, 95% CI 0.76–7.14) and hysterectomy (RR 4.14, 95% CI 0.48–35.93). Three comparative studies assessed the effect of including uterine balloon tamponade in institutional protocols. A stepped wedge cluster randomised controlled trial suggested an increase in the composite outcome (RR 4.08, 95% CI 1.07–15.58) and unclear results for hysterectomy (RR 4.38, 95% CI 0.47–41.09) with the use of the condom‐catheter or surgical glove balloon. One non‐randomised study showed unclear effects on the composite outcome (RR 0.33, 95% CI 0.11–1.03) and hysterectomy (RR 0.49, 95% CI 0.04–5.38) after the inclusion of the Bakri balloon. The second non‐randomised study found unclear effects on the composite outcome (RR 0.95, 95% CI 0.32–2.81) and hysterectomy (RR 1.84, 95% CI 0.44–7.69) after the inclusion of Ebb or Bakri balloon.

Conclusions

The effect of uterine tamponade devices for the management of atonic refractory PPH after vaginal delivery is unclear, as is the role of the type of device and the setting.

Tweetable abstract

Unclear effects of uterine tamponade devices and their inclusion in institutional protocols for atonic refractory PPH after vaginal delivery.

Unclear effects of uterine tamponade devices and their inclusion in institutional protocols for atonic refractory PPH after vaginal delivery.

Network characterization of the Entangled Model for sustainability indicators. Analysis of the network properties for scenarios

Policy-makers require strategies to select a set of sustainability indicators that are useful for monitoring sustainability. For this reason, we have developed a model where sustainability indicators compete for the attention of society. This model has shown to have steady situations where a set of sustainability indicators are stable. To understand the role of the network configuration, in this paper we analyze the network properties of the Entangled Sustainability model. We have used the degree distribution, the clustering coefficient, and the interaction strength distribution as main measures. We also analyze the network properties for scenarios compared against randomly generated scenarios. We found that the stable situations show different characteristics from the unstable transitions present in the model. We also found that the complex emergent feature of sustainability shown in the model is an attribute of the scenarios, however, the randomly generated scenarios do not present the same network properties.

[Risk factors and clinical evolution of carbapenemase-producing Klebsiella pneumoniae infections in a university hospital in Spain. Case-control study]

OBJECTIVE

Carbapenemase-producing Enterobacterias is a global health hazard due to their ease of transmission, difficulty of treatment, and their personal and economic impact. We analyze the factors associated with an increased risk of infection by Klebsiella pneumoniae carbapenemase-producing bacteria (KPC) and factors related to poor prognosis.

METHODS

We designed a case-control study. KPC isolates were taken during an outbreak in a hospital in Madrid. A logistic regression was performed with the main variables.

RESULTS

Sixteen cases of clinically documented infections were isolated. Overall mortality rates in the cases group was 25%. The most frequent location was blood (37.5%) followed by urine (25%). All but one were OXA-48. Regarding factors related to an increased risk of developing infection, only previous exposure to antibiotics presented statistical significance difference OR 13 (2.40-70.46). With respect to the overall mortality, the presence of pneumonia OR 25 (1.93-323.55) or the use of invasive mechanical ventilation was associated with greater risk 15 OR 33 (1.92-122.8) For attributable mortality only invasive ventilation had a significant association OR 18 (1.48-218.95).

CONCLUSIONS

Exposure to previous antibiotics is an independent risk factor for developing KPC infection, adjusted for all other clinical and demographic variables. Risk factors such as the presence of pneumonia or the use of invasive mechanical ventilation were associated with a worse prognosis in terms of overall and attributable mortality.

Relationship between dental occlusion and functional dependence in elderly Caucasians

OBJECTIVE

To determine whether a relationship exists between the number of functional masticatory units (FMUs) and the level of functional dependence of elderly.

SUBJECTS AND METHODS

The study group comprised 502 elderly Caucasians living in nursing homes in north-west Spain and Portugal. The number of FMUs was counted on direct visual inspection. The degree of dependence was assessed using the Barthel index. The results were validated in a group of 156 elderly. Statistical analysis of the results was performed using a generalised linear model (GLM), a logistic GLM, a ROC-GLM curve and a confusion matrix.

RESULTS

The number of FMUs significantly affected the Barthel index score (explained deviance = 27.5%). The number of FMUs was significantly associated with a lower probability of dependence, both for women (explained deviance = 31%) and for men (explained deviance = 33%). The model based on FMUs showed a good discriminatory capacity for dependence (AUC = 0.84 in women and 0.82 in men). The predictive capacity of the dependence model based on FMUs was very high (sensitivity = 0.9 in women and 0.8 in men).

CONCLUSIONS

In institutionalised elderly Caucasians, the number of FMUs is significantly associated with the Barthel index score and could be a predictive factor for dependence.

Reversible oxidation of vicinal-thiols motif in sarcoplasmic reticulum calcium regulatory proteins is involved in muscle fatigue mechanism

The mechanism underlying fatigue in skeletal muscle (SM) related to the redox-potential hypothesis, ranges from a direct effect of oxygen reactive species, to a number of other free radical intermediates targeting specific amino acids in the Ca(2+)-regulatory proteins of the sarcoplasmic reticulum (SR). In the present study, we investigate the selective oxidation/reduction of the protein motif Cys-(Xn=2-6)-Cys, known as a vicinal thiol group (VTG), present in the SR Ca(2+)-ATPase (SERCA) and in the Ca(2+)-channel ryanodine receptor (RyR) which are modified during muscle fatigue in SM. Selective oxidation of VTG with phenyl arsine oxide (PAO) increases fatigue in rat isolated SM and fatigue is prevented when muscle is previously incubated with a VTG selective reducing agent, 2,3-dimercaptopropanol (British anti-Lewisite (BAL)). In isolated SR membranes, PAO [<0.1mM] modifies SERCA conformation and inhibits ATPase activity but does not affect Ca(2+)-release. However, PAO at [>0.1mM] inhibits SERCA and RyR activities in a reversible manner by selectively reducing them. Interestingly, as observed by differential scanning calorimetry, the conformation of SERCA from fatigued muscle changed in a similar manner as when SERCA VTG where oxidized. The addition of BAL to fatigued muscle restored the structural conformation and activity of SERCA with full recovery of muscle force production after fatigue. We conclude that VTG reversible oxidation of SR Ca(2+) regulatory proteins are involved in muscle contraction/relaxation and are a molecular mechanism to be considered for muscle fatigue.

An Entangled Model for Sustainability Indicators

Nowadays the challenge for humanity is to find pathways towards sustainable development. Decision makers require a set of sustainability indicators to know if the sustainability strategies are following those pathways. There are more than one hundred sustainability indicators but they differ on their relative importance according to the size of the locality and change on time. The resources needed to follow these sustainability indicators are scarce and in some instances finite, especially in smaller regions. Therefore strategies to select set of these indicators are useful for decision makers responsible for monitoring sustainability. In this paper we propose a model for the identification and selection of a set of sustainability indicators that adequately represents human systems. In developing this model, we applied evolutionary dynamics in a space where sustainability indicators are fundamental entities interconnected by an interaction matrix. we used a fixed interaction that simulates the current context for the city of Cuernavaca, México as an example. We were able to identify and define relevant sets indicators for the system by using the Pareto principle. In this case we identified a set of sixteen sustainability indicators with more than 80% of the total strength. This set presents resilience to perturbations. For the Tangled Nature framework we provided a manner of treating different contexts (i.e., cities, counties, states, regions, countries, continents or the whole planet), dealing with small dimensions. This model provides decision makers with a valuable tool to select sustainability indicators set for towns, cities, regions, countries, continents or the entire planet according to a coevolutionary framework. The social legitimacy can arise from the fact that each individual indicator must be selected from those that are most important for the subject community.

Signaling and biological effects of glucagon-like peptide 1 on the differentiation of mesenchymal stem cells from human bone marrow

Glucagon-like peptide 1 (GLP-1) functions as an incretin hormone with antidiabetogenic properties. However, the role of GLP-1 in human bone marrow-derived mesenchymal stem cells (hMSCs), if any, remains unknown. The effects of GLP-1 on hMSCs were tested with regard to cell proliferation, cytoprotection, and cell differentiation into adipocytes. The signaling pathways involved in these processes were also analyzed. Cells were characterized with biochemical and morphological approaches before and after being induced to differentiate into adipocytes. PCNA protein levels were used as a proliferation index, whereas cell apoptosis was studied by deprivation of fetal bovine serum. Isolated hMSCs expressed stem cell markers as well as mRNA and GLP-1 receptor protein. GLP-1 increased the proliferation of hMSCs, which decreased when they were induced to differentiate into adipocytes. This process produced biochemical and morphological changes in cells expressing PPARgamma, C/EBPbeta, AP2, and LPL in a time-dependent pattern. Notably, GLP-1 significantly reduced the expression of PPARgamma, C/EBPbeta, and LPL. These effects were exerted at least through the MEK and PKC signaling pathways. In addition, GLP-1 significantly reduced cell apoptosis. Our data indicate that, in hMSCs, GLP-1 promotes cellular proliferation and cytoprotection and prevents cell differentiation into adipocytes. These latter findings underscore the potential therapeutic role of GLP-1 in preventing the adipocyte hyperplasia associated with obesity and, additionally, could bolster the maintenance of hMSC stores by promoting the proliferation and cytoprotection of undifferentiated hMSC.

Glucokinase and glucokinase regulatory proteins are functionally coexpressed before birth in the rat brain

Our previous description of functional glucokinase (GK) isoforms and their interactions with glucokinase regulatory protein (GKRP) in adult rat and human brains suggested that both participate in glucose sensing in the central nervous system. To determine whether both proteins are coexpressed and active before birth or during early post-natal life, we characterised these molecules in the brains of foetal and post-natal pup rats. We found GK and GKRP mRNAs that were similar to those previously reported in the adult rat brain. Likewise, GK and GKRP gene expression gave rise to proteins of 52 and 69 kDa, respectively. Immunohistochemistry experiments showed the colocalisation of both GK and GKRP proteins in the same brain cells of 21-day-old rat foetuses. Furthermore, coprecipitation of GK and GKRP in the presence of fructose 6-phosphate suggests interactions between both proteins. The presence of GK phosphorylating activity was detected in different brain areas of 21-day-old foetuses with a contribution to the total glucose-phosphorylating activity of between 17.2 +/- 1.7% and 12.4 +/- 3.7%, with the hypothalamus being the region of maximum activity. The hypothalamic GK activity in 21-day-old foetuses has a high apparent K(m) for glucose and no product inhibition by glucose 6-phosphate. Our findings indicate that both proteins may be functionally active before birth and that they can act within a glucose sensor system involved in controlling food intake.

Effects of monensin and yeast supplementation on blood acid-base balance in finishing feedlot steers fed a high-grain, high-protein diet

The aim of this study was to evaluate the effects of two dietary supplements (monensin and a live yeast culture) on acid-base balance in steers maintained in a commercial feedlot system, considering effects over the finishing productive cycle. Steers (no. =42) were allotted randomly to one of the three study groups: (1) control group (no supplementation, C), (2) monensin supplementation (MON), and (3) live Saccharomyces cerevisiae strain 47 supplementation (SACC). Venous blood samples were collected for the measurement of acid-base parameters and l-lactate. Production parameters were also used as a complementary tool for understanding the internal changes associated with supplementation. During the finishing period, MON steers tended to gain more efficiently than C and SACC steers. In the C group, the finishing-period diet caused a progressive decline in blood bases, in line with the high-grain diet consumption. In contrast, supplemented animals did not show this trend, although lower HCO3− and base excess values were registered in SACC steers than in MON, indicating that ionophore supplementation is less effective for reducing blood base consumption than yeast supplementation. In our study, the lack of the expected response to yeast supplementation may be attributable to the high crude protein content of the ration, a common feature of commercial feedlot industries.

Antimitochondrial antibodies in patients with chronic hepatitis C virus infection: description of 18 cases and review of the literature

To describe the clinical and immunologic patterns of disease expression of patients with chronic hepatitis C virus (HCV) infection and positive antimitochondrial antibodies (AMA). We investigated the presence of AMA in 237 consecutive HCV patients with extrahepatic manifestations from an International Registry. AMA were detected by indirect immunofluorescence in triple rat tissue (liver, stomach and kidney), aceton-fixed criosections and FITC-conjugated rabbit anti-human immunoglobulins. We found positive AMA in 18 (8%) out of 237 HCV patients. All patients were female with a mean age at protocol inclusion of 65.8 years (ranging from 37 to 87 years). Twelve (67%) patients fulfilled classification criteria for systemic autoimmune diseases (SAD), including Sjögren's syndrome (n = 7), systemic sclerosis (n = 3) and systemic lupus erythematosus (n = 2). Fourteen (78%) of the HCV-AMA patients presented at least one of the highly suggestive characteristics of primary biliary cirrhosis (PBC): 9 (50%) had a specific M2 pattern, 6 (33%) had more than twice normal levels of alkaline phosphatase, 5 (28%) had raised IgM levels and 4 (22%) a histological pattern compatible with PBC. Five (28%) patients developed neoplasia after detection of AMA. Seven (39%) patients died, due to neoplasia (n = 4), cirrhotic complications (n = 2) and hepatopulmonary syndrome (n = 1). We describe a subset of HCV patients with positive AMA who presented a broad spectrum of clinical features, including liver, autoimmune and neoplasic manifestations. Two-thirds of these patients presented an associated SAD, mainly Sjögren's syndrome or systemic sclerosis, together with a high frequency of multiple autoantibodies and an increased prevalence of cirrhosis and neoplasia.

Antimitochondrial antibodies in patients with chronic hepatitis C virus infection: description of 18 cases and review of the literature

To describe the clinical and immunologic patterns of disease expression of patients with chronic hepatitis C virus (HCV) infection and positive antimitochondrial antibodies (AMA). We investigated the presence of AMA in 237 consecutive HCV patients with extrahepatic manifestations from an International Registry. AMA were detected by indirect immunofluorescence in triple rat tissue (liver, stomach and kidney), aceton-fixed criosections and FITC-conjugated rabbit anti-human immunoglobulins. We found positive AMA in 18 (8%) out of 237 HCV patients. All patients were female with a mean age at protocol inclusion of 65.8 years (ranging from 37 to 87 years). Twelve (67%) patients fulfilled classification criteria for systemic autoimmune diseases (SAD), including Sjögren's syndrome (n = 7), systemic sclerosis (n = 3) and systemic lupus erythematosus (n = 2). Fourteen (78%) of the HCV-AMA patients presented at least one of the highly suggestive characteristics of primary biliary cirrhosis (PBC): 9 (50%) had a specific M2 pattern, 6 (33%) had more than twice normal levels of alkaline phosphatase, 5 (28%) had raised IgM levels and 4 (22%) a histological pattern compatible with PBC. Five (28%) patients developed neoplasia after detection of AMA. Seven (39%) patients died, due to neoplasia (n = 4), cirrhotic complications (n = 2) and hepatopulmonary syndrome (n = 1). We describe a subset of HCV patients with positive AMA who presented a broad spectrum of clinical features, including liver, autoimmune and neoplasic manifestations. Two-thirds of these patients presented an associated SAD, mainly Sjögren's syndrome or systemic sclerosis, together with a high frequency of multiple autoantibodies and an increased prevalence of cirrhosis and neoplasia.

Hepatic dysfunction after cardiac surgery in children

OBJECTIVE: The objective of this study was to analyze the incidence and significance of hepatic dysfunction after cardiac surgery in children. DESIGN: Prospective, observational study. SETTING: Pediatric intensive care unit of a university hospital. PATIENTS: The study consisted of 232 children ranging in age from newborn to 17 years with no history of liver disease. MEASUREMENTS AND MAIN RESULTS: Aspartate aminotransferase (AST), alanine aminotransferase (ALT), gammaglutamyltranspeptidase (GGT), alkaline phosphatase, total and conjugated bilirubin, blood glucose, urea, creatinine, and coagulation studies were determined at admission, at 24 and 48 hrs, and at 7 days. Hepatic dysfunction was taken as an ALT of > 100 IU/L or a moderate or high hepatic score. The statistical study included bivariate analysis and multivariate logistic regression to study the risk factors for hepatic dysfunction. Twenty-one patients (9%) showed an ALT > 100 IU/L, and 29.3% had a moderate or high hepatic score. A relationship was found between hepatic dysfunction and the type of cardiopathy (D-transposition of the great arteries and coarctation of the aorta), shock, the administration of dopamine or epinephrine, renal insufficiency, the presence of pulmonary changes (pulmonary edema, atelectasis, pulmonary hypertension, hypoxemia), hematologic disturbances (prothrombin time, kaolin-cephalin time, fibrinogen, and platelets), and the need for a greater number of transfusions of packed cells, plasma, and platelets. Compared with 7.6% of the rest of the patients (p <.001), 38% of patients with an ALT > 100 IU/L died. The hepatic score of those patients who died was 4.2 (2.3)-higher than that of the survivors at 1.5 (1.8), (p <.001). Shock and renal insufficiency were the factors most significantly related to the development of hepatic dysfunction. CONCLUSIONS: Hepatic dysfunction is an uncommon complication in children after cardiac surgery. This complication is related mainly to hemodynamic disturbances and renal insufficiency and is an indicator of poor prognosis.

Discrimination of line orientation in humans and monkeys

Orientation discrimination, the capacity to recognize an orientation difference between two lines presented at different times, probably involves cortical processes such as stimuli encoding, holding them in memory, comparing them, and then deciding. To correlate discrimination with neural activity in combined psychophysical and electrophysiological experiments, precise knowledge of the strategies followed in the completion of the behavioral task is necessary. To address this issue, we measured human and nonhuman primates' capacities to discriminate the orientation of lines in a fixed and in a continuous variable task. Subjects have to indicate whether a line (test) was oriented to one side or to the other of a previously presented line (reference). When the orientation of the reference line did not change across trials (fixed discrimination task), subjects can complete the task either by categorizing the test line, thus ignoring the reference, or by discriminating between them. This ambiguity was avoided when the reference stimulus was changed randomly from trial to trial (continuous discrimination task), forcing humans and monkeys to discriminate by paying continuous attention to the reference and test stimuli. Both humans and monkeys discriminated accurately with stimulus duration as short as 150 ms. Effective interstimulus intervals were of 2.5 s for monkeys but much longer (>6 s) in humans. These results indicated that the fixed and continuous discrimination tasks are different, and accordingly humans and monkeys do use different behavioral strategies to complete each task. Because both tasks might involve different neural processes, these findings have important implications for studying the neural mechanisms underlying visual discrimination.

Functional glucokinase isoforms are expressed in rat brain

Recently, the description of glucokinase mRNA in certain neuroendocrine cells has opened new ways to characterize this enzyme in the rat brain. In this study, we found glucokinase mRNA and a similar RNA splicing pattern of the glucokinase gene product in rat hypothalamus and pancreatic islets; the mRNA that codes for B1 isoform was the most abundant, with minor amounts of those coding for the B2, P1, P2, P1/B2, and P2/B2 isoforms. Glucokinase gene expression in rat brain gave rise to a protein of 52 kDa with a high apparent Km for glucose and no product inhibition by glucose 6-phosphate, with a contribution to the total glucose phosphorylating activity of between 40 and 14%; the hypothalamus and cerebral cortex were the regions of maximal activity. Low and high Km hexokinases were characterized by several criteria. Also, using RT-PCR analysis we found a glucokinase regulatory protein mRNA similar to that previously reported in liver. These findings indicate that the glucokinase present in rat brain should facilitate the adaptation of this organ to fluctuations in blood glucose concentrations, and the expression of glucokinase and GLUT-2 in the same hypothalamic neurons suggests a role in glucose sensing.

Effect of four enteral foods on the small bowel of undernourished rats after midgut resection

OBJECTIVE

To describe the effects of new enteral foods on the adaptation of the gut mucosa after massive intestinal resection in rats.

DESIGN

Laboratory experiment.

SETTING

Teaching hospital, Spain.

SUBJECTS

91 male Wistar rats, 69 of which were studied (5 were excluded and 17 died).

INTERVENTIONS

Previously undernourished rats were subjected to either massive bowel resection (n = 30) or laparotomy (n = 26) and fed four enteral hypocaloric diets for 7 days: Alitraq (n = 7 in each group), Impact (n = 8 and 7), Enrich (n = 8 and 6), and Elemental (n = 7 and 6). The remainder were not operated on and fed chow (n = 7) or a diet containing no protein (n = 6). Two diets were high in protein (Alitraq and Impact) and two contained normal amounts (Enrich and Elemental).

MAIN OUTCOME MEASURES

Bowel mucosal thickness and proliferation; disaccharidase activity; intestinal weight and length; body weight; and plasma somatostatin, IGF-1, and peptide YY concentrations.

RESULTS

Enriched diets provided a higher body and intestinal weight, and increased length of jejunal and ileal villous size. Peptide concentrations were modified by resection but not by the diet given. Concentrations of somatostatin and insulin-like growth factor were reduced in all groups with the exception of somatostatin in the two diets high in protein in the sham-operated rats.

CONCLUSIONS

Enriched diets all improve the intestinal adaptive response to massive bowel resection in rats, offering advantages over diets with normal amounts of protein.

Molybdophosphoric Acid Adsorption on Titania from Ethanol-Water Solutions

The equilibrium adsorption at 20 degreesC of molybdophosphoric acid solutions, using ethanol-water as solvent, on titania was studied. The molybdenum adsorption isotherm showed a sigmoidal shape; low values of molybdenum adsorbed were observed for final equilibrium concentrations lower than 50 mg Mo/ml, and for higher concentrations, the adsorbed molybdenum amount almost reached a plateau. From this isotherm it could be concluded that the solute-support interaction was not strong. UV-visible and NMR spectra of the solutions before and after the adsorption on titania showed that the species PMo12O3-<INF POS="STACK">40 was present. This species also was observed by DRS in the wet samples and by NMR, FT-IR, and DRS, in the solid samples dried at room temperature and calcined at 255, 310, 365, and 425 degreesC, showing that the thermal stability of molybdophosphoric acid adsorbed on titania is similar to that of the bulk acid. The impregnating solutions and the impregnated solid changed with the time to a bluish color as a consequence of the formation of heteropoly blues which presented Mo6+ partially reduced to Mo5+. The XRD patterns indicated that the species adsorbed onto the support surface are highly dispersed like a noncrystalline form. Copyright 1998 Academic Press.

Effects of exogenous neurotensin on intestinal postresectional growth in the suckling rat

BACKGROUND

In the suckling rat, massive bowel resection provokes intestinal malabsorption that leads to diminished growth. The object of this report was to test whether neurotensin, intestinal trophic peptide, enhances postresection intestinal adaptation, improving absorption and reducing the adverse effects of resection on growth.

METHODS

Fifty-seven 15-day-old suckling. Wistar rats were divided into four groups: 41 rats were subjected to resection of 90% of their small bowel, while the rest (n = 16) underwent laparotomy. Half of the animals, resected and laparotomized, were treated with neurotensin for 30 days. The body weight was monitored, and samples of bone and intestinal mucosa were obtained at the end of the study period for analysis. Blood was tested to determine iron, ferritin, folic acid, and vitamin B12 levels.

RESULTS

The resected animals lost body weight regardless of neurotensin administration. In the resected animals, femur weight increased significantly when they received neurotensin. Bowel resection provokes significant increases in the intestinal mucosa (crypts and villi), but after neurotensin administration, significant increases were detected only in the jejunum of the resected animals but not in the ileum of laparotomized rats. In the resected animals, significant decreases in iron, ferritin, folic acid, and vitamin B12 levels were observed. The postresection administration of neurotensin only produced a significant rise in the ferritin concentration.

CONCLUSIONS

In the suckling rat, neurotensin enhances the intestinal proliferative phenomenon but does not improve the course of medium-term postresection growth.

[Carboxyhemoglobin levels and risk factors of carbon monoxide poisoning in children;]

BACKGROUND

To determine carboxyhemoglobin levels and to investigate carbon monoxide poisoning risk in children.

PATIENTS AND METHODS

We determine carboxyhemoglobin blood levels by cooximetry in 65 children, between 15 days and 15 years attended in a pediatric emergency section. We analyze carbon monoxide risk factors (type of heating and smokers in the family).

RESULTS

Mean carboxyhemoglobin levels in 59 children without acute intoxication was 0.5 +/- 0.87% (range 0-3.8%). There are no significant differences with respect to age and sex. Children with wood or coal heating (0.88 +/- 1.34%) and gas heating (0.58 +/- 0.97%) have carboxyhemoglobin levels higher than children with electric heating (0.28 +/- 0.4%) but differences were no statistically significant. Four patients have carboxyhemoglobin levels > 2%, two with coal or wood hating and two with gas heating. Children with smokers in the family have carboxyhemoglobin levels higher than the rest of children (0.65 +/- 1.05% versus 0.34 +/- 0.45%) without statistical significance. The four children with carboxyhemoglobin levels > 2% live with smokers. Six children suffered carbon monoxide poisoning with carboxyhemoglobin levels between 20.6 and 36.6%.

CONCLUSIONS

Mean carboxyhemoglobin levels in children are low. There are carbon monoxide poisoning risk factors (wood, coal or gas heating at home, and smokers in the family) in a high percentage of the children, although they did not show statistical significance.

[Response of the intestinal mucosa to different enteral diets in situations of surgical stress and malnutrition]

INTRODUCTION AND OBJECTIVES

malnutrition and surgical stress is a relatively common association. At present, different enteral nutrition formulation are available, which are potentially applicable to different pathological conditions. The use of one diet or another may modify both the nutritional state as the intestinal structure and function. The objective of this study is to evaluate, in a malnutrition and surgical stress model in the rat, the effect of four enteral diets on the ponderal and structural evolution of the intestinal mucosa.

MATERIAL AND METHODS

adult Wistar rats weighing 230 g divided into four groups (n = 8/group), according to the enteral nutrition diet administered (elemental-elemental-028, polymeric with fiber-Enrich, peptidic with glutamine-Alltraq, and rich in arginine, fatty acids, and CO3 impact). All animals were subjected to an acute protein deficit for one week, and surgical stress consisting of the performance of a laparotomy. During another week the animals were fed with one of the four diets on a hypocaloric base of 195 kcal/week/rat, to maximize the effects of each diet, after which the animals were sacrificed. Determinations were made of body and intestinal weight variations, and samples were taken of the jejunum, ileum, and colon tissue. A histomorphometric study was conducted on these samples (crypt length and villosity).

RESULTS

all groups lost weight in a similar manner with respect to the initial weight, with the exception of the animals fed with the polymeric diet with fiber, whose weight loss was even more marked. The intestinal weight was greater in those animals who received an arginine rich diet. In the jejunum and ileum samples the villus length was greatest in the group receiving a glutamine rich diet, with the length being shortest when fed with the elemental diet. The crypt depth showed as similar variation. In the colon, the greatest crypt depth was seen in the animals who received a fiber rich diet.

DISCUSSION AND CONCLUSIONS

diets rich in glutamine and arginine, as well as the elemental diet, are more efficient when it comes to maintaining body weight, although the latter is the one which maintains the small intestine weight the least, without there being a direct relation between these two parameters. The enriched diets are the ones which give the best results when it comes to maintaining body weight and mucosal mass. In the colon, the fiber enriched diet stimulate the growth of colonic mucosa.

Postoperative gangrenous peritonitis after laparoscopic cholecystectomy: a new complication for a new technique

We report a case of anaerobic peritonitis with bowel emphysema, but no hollow organ perforations, following gallbladder removal for acute acalculous cholecystitis using a laparoscopic procedure in a diabetic patient. Management consisted of profuse peritoneal irrigation and zipper laparostomy. After a long postoperative period, the patient recovered without sequelae. The patient suffered typical acute cholecystitis with empyema and a diabetic status; anaerobial flora is frequent in these cases. The patient was operated on by means of a closed technique without contact with either air or oxygen. Moreover, CO2 injection into the peritoneal cavity with this technique, along with gallbladder rupture, created an ideal medium for anaerobial growth. We suggest that acalculous cholecystitis in diabetic patients could represent a contraindication for laparoscopic cholecystectomy; alternatively, open cholecystectomy should at least be considered when gallbladder rupture occurs during laparoscopy.

[Effects of neurotensin on the development of suckling rats with intestinal resection]

Massive intestinal resection produces malabsorption which, in the suckling rat, reduces growth. Our aim was to determine whether the proliferative action of neurotensin, can reduce the negative effects on growth induced by bowel resection. Fifteen days old suckling Wistar rats were used. Twenty rats underwent 90% midgut resection and twelve were used as controls. Half the animals were treated with neurotensin (600 micrograms/kg-day) until sacrifice 30 days later. Body and bone weight were measured and mucosal samples obtained. All resected animals lost body weight and bone weight. Neurotensin treatment reduced femur weight loss. After bowel resection, significant trophic effects were observed at mucosal level (crypt and villous size) but only in the jejunum of resected animals neurotensin treatment had a trophic effect. In conclusion, neurotensin favors intestinal adaptation after resection without improving mid-term growth in the suckling rat.

Cloning and sequence analysis of an extremely homogeneous tandemly repeated DNA in the grasshopper Eyprepocnemis plorans

Digestion of total nuclear DNA of the grasshopper Eyprepocnemis plorans with seven different restriction endonucleases (REs), and subsequent agarose gel electrophoresis, has shown the presence of highly repetitive DNA yielding the typical ladder-like banding pattern. The most clear pattern was produced by DraI, the monomer being some 180 bp. This repeat unit was subsequently cloned and sequenced. Bidirectional sequencing of five randomly chosen clones showed exactly the same nucleotides in all 180 positions. The possible explanations for such an extreme homogeneity of this tandem repeat are discussed in the light of current hypotheses on repetitive DNA function and molecular drive mechanisms.

[Cystic neoplasm of the pancreas as a cause of intestinal obstruction]

Cystic neoplasms of the pancreas are unusual varieties of pancreatic tumors. We herein report a new case presenting with atypical features, such as mental and electrolytic disturbances secondary to upper intestinal obstruction. We reviewed the literature, and discuss the differential diagnosis, the histopathological characteristics of prognostic value, and the therapeutic strategy. We conclude that these tumors should be included in the differential diagnosis of the upper intestinal obstructions, and emphasize the need to remove the lesion in all cases because of the difficulties of predicting the benign or malignant behaviour of these tumors before and during the surgical procedure.

Inhibitory effect of opiates on male rat sexual behavior may be mediated by opiate receptors outside the central nervous system

The importance of opiate receptors outside the central nervous system for the inhibitory actions of morphine on male rat sexual behavior was evaluated. Morphine (10 mg/kg) produced an almost complete inhibition of sexual behavior. This inhibition was antagonized by naloxone at a dose of 1 mg/kg but not at a dose of 0.25 mg/kg. The quaternary opioid antagonist methylnaloxone effectively blocked the inhibitory actions of morphine at a dose of 20 mg/kg but not at a dose of 5 mg/kg. Since the affinity of methylnaloxone for opiate receptors is about 5% of that of naloxone, it may be concluded that both antagonists were about equally effective in inhibiting the effects of morphine. Furthermore, the opiate-like drug loperamide was found to inhibit sexual behavior. This drug acts mainly outside the central nervous system. Its effect was blocked by both naloxone and methylnaloxone, suggesting that opiate receptors are involved. It was also shown that methylnaloxone is unable to block the reinforcing effects of morphine in the conditioned place preference procedure. Because the reinforcing effects of opiates seem to be localized to the central nervous system, it may be proposed that methylnaloxone does not antagonize morphine's central effects. Moreover, loperamide had no effect in the place preference procedure, suggesting that this drug does not act at central opioid receptors. Taken together, these data show that peripheral opioid receptors are responsible for at least some of the inhibitory actions of morphine on male sexual behavior. After treatment with morphine + methylnaloxone, ejaculatory mechanisms were facilitated, reflected in a reduced number of preejaculatory intromissions and a shortened ejaculation latency.(ABSTRACT TRUNCATED AT 250 WORDS)