Transporting neonates with hypoxic-ischemic encephalopathy utilizing active hypothermia

OBJECTIVE

The objective of this report was to evaluate a servo-controlled active hypothermia device used during the transport of neonates with HIE.

STUDY DESIGN

Retrospective review of all cases of therapeutic hypothermia, both passive and active, using a servo-controlled device in a single regional referral neonatal intensive care unit from 2009-2013 RESULTS: An ambulance (43%), fixed wing aircraft (25%), or helicopter (32%) transported 28 neonates with active hypothermia. The servo-controlled device captured core temperatures in all 28 neonates, resulting in 2,985 minutes of data. All neonates attained a core temperature between 33-34 °C by 33 minutes of the transport. Once the neonates attained a core temperature, the average temperature for the remainder of the transport was 33 ± 0.2 °C. The neonates maintained the core temperature regardless of the type of transport vehicle.

CONCLUSION

Servo-controlled hypothermia enables rapid attainment of targeted temperatures and maintains the temperature throughout the transport process in both ground and air transport.

Synthesis of 5-substituted pyrrolo[1,2-b]pyridazines with antioxidant properties

5-Substituted pyrrolo[1,2-b]pyridazines have been prepared by cyclisation of pyridazine with diphenylcyclopropenone followed by further functionalisations in the pyrrolo[1,2-b]pyridazine 5-position. Several compound exhibit profound inhibition of lipid peroxidation in vitro. Lipid peroxidation of boiled rat liver microsomes was induced by ascorbic acid/FeSO4 and the peroxidation was determined by measuring the thiobarbituric acid reactive material.

[Smoking cessation in patients with severe irreversible chronic obstructive pulmonary disease, "smoker's lung"]

A one year prospectively recorded material of 80 patients with severe chronic obstructive pulmonary disease (COPD) (FEV-1 < 40% predicted), only one never smoker and 26 ex-smokers, were included in the study. The 53 smokers were offered a smoking cessation program. Fifty-three of the total were alive after one year, including 16 of the ex-smokers. Twenty-one (57%) of the 37 surviving smokers had quit smoking (carbon monooxide in expired air < 10 ppm), whereas 16 (43%) still were smoking. FEV-1 increased by median 100 ml among both the quitters (p < 0.01), and the ex-smokers (p < 0.02), whereas FEV-1 declined by 50 ml (p > 0.05) among those who continued to smoke. There were more deaths among the sustainers than among the quitters (p < 0.05). Taking into consideration the many sources of bias in this small, uncontrolled study it seems as if smoking cessation prevents loss of lung function and perhaps even death among patients with advanced degree of smoker's lung.

The lipoxygenase inhibitor nafazatrom inhibits stimulated prolactin secretion in cultured rat lactotrophs (GH4C1 cells)

Arachidonic acid metabolites are involved in the regulation of prolactin (PRL) secretion from rat lactotrophs (GH4C1 cells). Phospholipase A2 (PLA2) stimulated PRL secretion, while the PLA2 inhibitor quinacrine reduced both thyrotropin-releasing hormone (TRH) and vasoactive intestinal peptide (VIP) stimulated PRL release. Hormonally stimulated PRL release was further increased in the presence of the cyclo-oxygenase inhibitor indomethacin. Nafazatrom, a lipoxygenase inhibitor, reduced stimulated PRL secretion regardless of the mechanism of stimulation [hormonally (VIP and TRH) or by increasing intracellular Ca2+ concentration by KCl or Bay-K and cAMP by forskolin]. None of the inhibitors used in this study had any effect either on the basal PRL secretion or on the production of cAMP. Lipoxygenase products seem to be involved in the regulation of PRL secretion, probably by affecting a late step in the signal transduction.

Ofloxacin compared with ciprofloxacin in the treatment of complicated lower urinary tract infections

In a double-blind, double-dummy study 61 patients with structural or functional abnormalities of the urinary tract and verified infection were treated for 7 days with ofloxacin 100 mg bd or ciprofloxacin 250 mg bd by mouth. Of 62 isolated strains none was resistant to ofloxacin or ciprofloxacin in vitro. Nineteen patients (63%) in both groups were free from infection ten days after therapy. Clinical resolution of symptoms occurred in 83% in the ofloxacin group and 68% in the ciprofloxacin group. Adverse reactions were reported in four patients (6.5%), two with skin rash, one with gastrointestinal disturbance and one with influenza-like symptoms. This study demonstrates that ofloxacin and ciprofloxacin are effective in the treatment of complicated lower urinary tract infection.

Clinical evaluation of ofloxacin versus ciprofloxacin in complicated urinary tract infections

Ofloxacin was administered to 18 patients and ciprofloxacin to 17 patients suffering from acute or chronic complicated urinary tract infections. Patients received doses of 100 mg ofloxacin, b.i.d., or 250 mg ciprofloxacin, b.i.d., for seven days. The clinical and bacteriological response were evaluated after 17 days. Resolution of symptoms were found in approximately 60% of cases for both treatments and bacteriological eradication was 66% for ofloxacin and 50% for ciprofloxacin. Side-effects such as itching and rash were reported in three cases. The results indicate that ofloxacin and ciprofloxacin are safe and effective agents in the treatment of complicated urinary tract infections.

Langerhans cells in candidal leukoplakia

Using histochemical and immunohistochemical methods, we examined specimens of candidal leukoplakia from the oral mucosa of 5 smokers to determine the morphological relationships between Candida and Langerhans cells (LC) in tissue sections. LC were fairly evenly distributed in control sections, but had a patchy distribution in lesions. Fewer LC were found in lesions than in control tissue, but the difference was not statistically significant. Candidal antigens were not detected on LC by the methods used, but we found ATPase-positive LC among, or at least near, intraepithelial candidal hyphae. However, sections double-reacted with anti-Candida and T6 antibodies to label candidal antigens and LC, respectively, showed a clear zone of epithelium between the T6-positive LC and the candidal hyphae. The difference in distribution of ATPase-positive and T6-positive LC may indicate locations of 2 subtypes of LC, or a change in T6 antigen expression by the LC closest to the candidal hyphae.

Fructose, xylitol and glucose in total parenteral nutrition

A comparison was made between isocaloric amounts of 24% glucose and 24% Triofusin (composed of 120 g fructose, 60 g glucose and 60 g xylitol per liter) during the course of a 6-day, 3-phase crossover study of 15 patients undergoing total parenteral nutrition. The patients received a total of 0.5 g carbohydrate per kg per day. Plasma glucose as significantly higher during glucose infusion (7-22 mmol/l, median: 9 mmol/l,) than during Triofusin infusion (5-16 mmol/l, median: 6 mmol/l). A moderate to severe glucosuria was detected in three patients during infusion of 24% glucose, and this declined considerably during the Triofusin period. The total renal carbohydrate loss during the glucose period was 0-143 g, median: 6 g per day, and during the Triofusin period was 6-68 g, median: 10 g per day. The nitrogen balance and carbamide production rate were the same in the two infusion regimes. Changes in biochemical liver parameters were observed in most of the patients, but these could not be attributed to parenteral nutrition. None of the patients developed symptoms of metabolic acidosis. There was a slightly but significantly higher urinary excretion of oxalate in the Triofusin period (0.1-1.1 mmol per day, median: 0.5 mmol per day) than in the glucose period (0.1-1.0 mmol per day, median: 0.4 mmol per day). Most of the patients exhibited a slightly increased urinary excretion of urate, irrespective of the infusion regimen. Serum urate remained normal. It was concluded that Triofusin infused in the described dosage is a suitable calorie source for parenteral nutrition, but that it does not present a distinct advantage over the use of pure glucose solution. In patients suffering from reduced glucose tolerance, however, Triofusin represents a more easily manageable calorie course.

Respiratory, analgesic and endocrine responses to an enkephalin analogue in normal man

In a controlled study, the effect of a new enkephalin analogue (FW 34-569, Sandoz) on respiratory function (ventilatory response to CO2), pain threshold (hot plate technique), and plasma cortisol, prolactin, growth hormone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) was investigated in six normal subjects. One milligram of enkephalin, but not 0.5 mg, resulted in a significantly decreased ventilatory response to CO2, although mean values were not significantly different from saline control values (0.05 less than P less than 0.1). Neither 0.5 mg nor 1.0 mg enkephalin influenced pain threshold, but doses stimulated growth hormones and prolactin release and inhibited the release of cortisol and LH, while FSH remained unchanged.

Oral findings in glassblowers

Oral changes related to the occupation of glassblowing have been examined in 74 Danish glassblowers, consisting of 44 active glassblowers (Group 1) and 30 past glassblowers (Group 2). In addition, 15 non-glassblowers (Group 3) were examined. All three groups worked in the same department of mouth-blown glassware in Holmegaard's Glassworks. White patches of the buccal mucosa occurred in 23% of active glassblowers, but did not occur among past or non-glassblowers. Histologically, the white lesions revealed morsicatio buccarum-like changes. The lesions are reversible and should be distinguished from leukoplakias. The term "glassblower's white patch" is suggested. Furthermore black discolorations of vermillion border and front teeth occured in 30% and 62%, respectively, of active glassblowers. Tooth fractures, mostly enamel fractures, caused by the blowpipe were found in 43% of active glassblowers and 19% of past glassblowers.

5-Fluorouracil (NSC-19893), DTIC (NSC-45388), BCNU (NSC-409962), and vincristine (NSC-67574) in advanced colorectal carcinoma

Thirty-three patients with advanced colorectal carcinoma were treated with 5-day courses of 5-fluorouracil (10 mg/kg/day, iv, Days 1-5), DTIC (3 mg/kg/day, iv, Days 1 and 2), BCNU (1.5 mg/kg/day, iv, Day 1 only), and vincristine (0.025 mg/kg/day, iv, Day 1 only) at 5-week intervals. One patient achieved CR and six patients achieved PRs. Five of ten patients treated within 8 weeks after detection of advanced cancer had CR or PR (P = 0.02). After most courses toxicity was moderate, although it necessitated a change to another regimen for one patient. One patient refused further cancer chemotherapy and one patient died due to severe bone-marrow toxicity.

Duration of smoking and quantity of tobacco used by patients with gastric cancer

Abstract 221 patients with gastric cancer (g.c), 174 of them current or ex‐smokers, have been questioned about their smoking habits. Data regarding 157 patients (131 men and 26 women) who had smoked more than a total of 20 kg have been analysed. While the women start smoking at different ages, the men start early, at approximately the same age, the majority before 16. The average duration of smoking was 48 years for men and 37 years for women. The average quantity of tobacco used was 378 kg for men and 176 kg for women. Among the women there is a marked dispersion in respect to the duration of smoking as well as the age on admission for g.c. Among the men there was an accumulation of admissions around the age of 64, i.e. after an average of 48 years of smoking. Thus in men there is a definite concurrence between the duration of smoking and the time of admission for g.c. In men over 60 years there is a statistically significant relation between the average total amount of tobacco used and the time of admission for g.c, independent of the patient's age. It is concluded that the use of tobacco may be one of the causes of the higher frequency of g.c. in men than in women.