Recommendations for the evaluation and management of the anticipated and non-anticipated difficult airway of the Societat Catalana d'Anestesiologia, Reanimació i Terapèutica del Dolor, based on the adaptation of clinical practice guidelines and expert consensus

The Airway Division of the Catalan Society of Anaesthesiology, Intensive Care and Pain Management (SCARTD) presents its latest guidelines for the evaluation and management of the difficult airway. This update includes the technical advances and changes observed in clinical practice since publication of the first edition of the guidelines in 2008. The recommendations were defined by a consensus of experts from the 19 participating hospitals, and were adapted from 5 recently published international guidelines following an in-depth analysis and systematic comparison of their recommendations. The final document was sent to the members of SCARTD for evaluation, and was reviewed by 11 independent experts. The recommendations, therefore, are supported by the latest scientific evidence and endorsed by professionals in the field. This edition develops the definition of the difficult airway, including all airway management techniques, and places emphasis on evaluating and classifying the airway into 3 categories according to the anticipated degree of difficulty and additional safety considerations in order to plan the management strategy. Pre-management planning, in terms of preparing patients and resources and optimising communication and interaction between all professionals involved, plays a pivotal role in all the scenarios addressed. The guidelines reflect the increased presence of video laryngoscopes and second-generation devices in our setting, and promotes their routine use in intubation and their prompt use in cases of unanticipated difficult airway. They also address the increased use of ultrasound imaging as an aid to evaluation and decision-making. New scenarios have also been included, such as the risk of bronchoaspiration and difficult extubation Finally, the document outlines the training and continuing professional development programmes required to guarantee effective and safe implementation of the guidelines.

Palm oil and cardiovascular disease: a randomized trial of the effects of hybrid palm oil supplementation on human plasma lipid patterns

This study examines, for the first time, the effect of hybrid Elaeis oleifera × E. guineensis palm oil supplementation on human plasma lipids related to CVD risk factors. One hundred sixty eligible participants were randomized and assigned to one of the two treatments: 25 mL hybrid palm oil (HPO group) or 25 mL extra virgin olive oil (EVOO group) daily for 3 months. Fasting venous samples were obtained at baseline and after 1, 2 and 3 months for measurement of plasma lipids (TC, LDL-C, HDL-C and TAGs). Changes in body mass index and waist circumference were also assessed. Although there was an overall reduction in TC (7.4%, p < 0.001) and in LDL-C (15.6%, p < 0.001), no significant differences were found between the treatment groups in a repeated measures analysis of variance for TC (p = 0.0525), LDL-C (p = 0.2356), HDL-C (p = 0.8293) or TAGs (p = 0.3749). Furthermore, HPO consumption had similar effects on plasma lipids to EVOO, thus providing additional support for the concept that hybrid Elaeis oleifera × E. guineensis palm oil can be seen as a "tropical equivalent of olive oil".

Repellent Effect and Metabolite Volatile Profile of the Essential Oil of Achillea millefolium Against Aegorhinus nodipennis (Hope) (Coleoptera: Curculionidae)

Aegorhinus nodipennis (Hope) (Coleoptera: Curculionidae) is an important native pest in fruit crops that is mainly found in European hazelnut fields in the south of Chile. We investigated the behavioral response of A. nodipennis to volatile compounds released from the essential oil of Achillea millefolium and its main constituent using olfactometric bioassays. Gas chromatographic and mass spectral analysis of the A. millefolium essential oil revealed the presence of 11 compounds. Monoterpene β-thujone (96.2%) was the main component of the oil. Other compounds identified were α-thujone, 1,8-cineole, p-cymene, and 4-terpineol, all with percentages below 1%. Both A. millefolium essential oil and thujone exhibited a repellent activity against this insect at the higher doses tested (285.7 ng/cm(2)), demonstrating their potential as repellents for this species.

Metacarpophalangeal and interphalangeal joint arthrodesis: a comparative study between tension band and compression screw fixation

A retrospective, comparative cohort study was performed of metacarpophalangeal or proximal interphalangeal joint arthrodesis with either tension band (n = 28) or compression (Acutrak Mini) screw (n = 29) methods. We compared rate of union, healing time, complications, and re-operation rate. Union was achieved in 26/28 (92.8%) of the tension band group (9.4 weeks) and 24/28 (85.7%) of the compression screw group (9.8 weeks). Only 28 patients in the screw group were assessed for union as one patient in the screw group sustained a fracture at the time of insertion and was converted to tension band fixation. The complication rate was 8/28 (28.6%) in the tension band group and 8/29 (27.6%) in the compression screw group. Re-operation rate was 9/28 (32.1%) in the tension band group and 1/29 (3.6%) in the compression screw group. Our findings indicate that bone healing, healing time, and complications are similar in both groups. The tension band technique had a significantly higher re-operation rate (hardware removal), but was the technique for salvage following failure of the screw technique.

Fungal volatiles: an environmentally friendly tool to control pathogenic microorganisms in plants

Fungi are an extraordinary and immensely diverse group of microorganisms that colonize many habitats even competing with other microorganisms. Fungi have received recognition for interesting metabolic activities that have an enormous variety of biotechnological applications. Previously, volatile organic compounds produced by fungi (FVOCs) have been demonstrated to have a great capacity for use as antagonist products against plant pathogens. However, in recent years, FVOCs have been received attention as potential alternatives to the use of traditional pesticides and, therefore, as important eco-friendly biotechnological tools to control plant pathogens. Therefore, highlighting the current state of knowledge of these fascinating FVOCs, the actual detection techniques and the bioactivity against plant pathogens is essential to the discovery of new products that can be used as biopesticides.

Morphology and Distribution of Sensilla on the Antennae of Hylamorpha elegans Burmeister (Coleoptera: Scarabaeidae)

Considering that sensilla constitute important functional elements of sensory systems in insects, the aim of this study was to determine the type and distribution of sensilla in the antennae of Hylamorpha elegans Burmeister examined by scanning electron microscopy. Hylamorpha elegans antennae are lamellate and consist of the scape, pedicel, and flagellum. The antennal club of this beetle consists of three terminal plates: proximal, middle, and distal lamellae. Four types of sensilla were observed in the lamellae from both sexes: sensilla trichoidea, chaetica, coeloconica, and placodea. Antennal length was larger in males than in females, and significant sexual variation in the number of sensilla placodea and sensilla coeloconica was observed.

Morphometric Variation on the Cypress Aphid Cinara cupressi (Buckton) (Hemiptera: Aphididae) Associated to Urban Trees

Cinara cupressi (Buckton) is an important aphid pest of the Cupressaceae family, originally reported in Chile in 2003. Since then, it has spread over 4,000 km, contributing to conservation issues, mostly associated with native and urban trees of the Cupressaceae. In the present work, the morphometric variation of C. cupressi was examined to determine if the species present in Chile corresponds to a specific entity, and to identify variations among specimens from different localities in the study area. Colonies were collected from urban trees from northern, central, and southern Chile. Morphometric data for 14 characters in aphids from 63 localities in all the distribution ranges were measured and analyzed by multivariate analysis. Results showed that the species present in Chile corresponds to C. cupressi like a single specific entity, showing no morphological variation across the regions sampled. Our data will be discussed within the context of correct taxonomic identification for the implementation of effective biological control strategies.

Carbendazim dissipation in the biomixture of on-farm biopurification systems and its effect on microbial communities

The impact of repeated carbendazim (CARB) applications on the extent of CARB dissipation, the microbial diversity, the community level physiological profile (CLPP), and the enzymatic activity within the biomixture of an on-farm biopurification system was evaluated. After three successive CARB applications, the CARB dissipation efficiency was high; the efficiency of dissipation was 87%, 94% and 96% after each application, respectively. Although microbial enzymatic activity was affected significantly by CARB application, it could recover after each CARB pulse. Likewise, the numbers of cultivable bacteria, fungi and actinomycetes (as measured in CFUs) were slightly affected by the addition of CARB, but the inhibitory effect of the pesticide application was temporary. Denaturing gradient gel electrophoresis (DGGE) and Biolog Ecoplate assays demonstrated that the microbial populations remained relatively stable over time when compared to the control. The results obtained herein therefore demonstrate the high dissipation capacity of this biomixture and highlight the microbiological robustness of this biological system.

[Transformation of myelodysplastic syndrome to acute lymphoblastic leukemia: 2 new cases]

Myelodysplastic syndromes (MDS) are clonal disorders of hematopoietic stem cells, with a variable risk of transformation to acute myeloid leukemia. Progression into acute lymphoblastic leukemia (ALL) is an extremely rare event, with very few cases published in children. In this report, we describe two cases of myelodysplastic syndromes that progressed to ALL. Moreover, we review previously reported cases of MDS transformation to acute lymphoblastic leukemia in the pediatric population whose prognosis seems to be similar to that for adults.

Plasma magnesium in patients submitted to cardiac surgery and its influence on perioperative morbidity

BACKGROUND

To determine the changes in magnesaemia in cardiac surgical patients submitted to cardiopulmonary bypass (CPB) and their influence on perioperative morbidity.

METHODS

SETTING

the cardiovascular surgery department of a university hospital.

PATIENTS

60 patients of both sexes, mean age 60+/-12 yrs, operated on consecutively for myocardial revascularization or valve replacement.

INTERVENTIONS

plasma Mg2+ levels were measured preoperatively, during CPB, postCPB and throughout the first 24 hrs after operation. Preoperative plasma Mg2+ levels of these patients were compared with those of 15 non-cardiac surgical patients and 11 healthy volunteers.

RESULTS

Mean values of Mg2+ similar in the three populations although in the group of cardiac patients the number of hypomagnesaemic patients was significantly higher (16 patients=26.6%). In these 16 patients, preoperative hypomagnesaemia had a statistically significant relationship with the preoperative treatment with beta-blockers and previous history of arrhythmias (p<0.05). A progressive statistically significant decrease of Mg2+ was observed throughout the surgery that remained low at 24 hours postoperatively (p<0.05). Normomagnesemic patients needed significantly more shocks and electrical energy to obtain heart defibrillation after CPB. The incidence of both postoperative arrhythmias and postoperative low cardiac index (<2.5 L.m2) was statistically significantly more frequent in hypomagnesaemic patients (p<0.05).

CONCLUSIONS

Preoperative hypomagnesaemia was more frequent in this small sample of cardiac surgical patients than in non-cardiac surgical patients and was related to preoperative treatment with b-blockers. Hypomagne-saemia caused by CPB persisted 24 hrs after operation and was associated with higher incidence of both postoperative arrhythmias and low cardiac index.

[Outcome of patients who underwent surgical repair of aneurysm after subarachnoid hemorrhage]

BACKGROUND

Follow-up study of patients with surgical repair of aneurysmal subarachnoidal hemorrhage (SAH), looking for clinical outcome predictors.

PATIENTS AND METHODS

Sixty two patients consecutively admitted to a teaching hospital, from January 1992 to December 1995 were included in the study. We studied preoperative, intraoperative and postoperative features looking for their relationship with the outcome. The ultimate outcome was evaluated by means of Glasgow Outcome Scale on discharge and 6 months later.

RESULTS

Smoking (p = 0.0001) and arterial hypertension (AHT) (p = 0.0186) were more frequent in these patients than in general population, but without relationship to the outcome as with the age of the clinical status on admission. The greatest statistical relationship was found between the level of consciousness on postoperative awakening (measured by the Hunt and Hess scale), and the outcome (p = 2.53 x 10(-8). From our results we made an algorithm that correctly assigned 92% of studied patients to their outcome.

CONCLUSIONS

All patients admitted on with aneurysm SAH deserve intensive care treatment besides their clinical grade. The level of consciousness on postoperative awakening was a good outcome predictor.

[Hemangioma of the spermatic cord. Presentation of a case with review of the literature]

OBJECTIVE

To describe a rare variety of spermatic cord tumor, with special reference to the differential diagnosis. The literature is briefly reviewed.

METHODS

The clinical and pathological features of a tumor located in the right inguino-scrotal region of a 27-year-old male patient are described.

RESULTS

The preoperative evaluation disclosed an irregular mass in the right hemiscrotum that was unconnected to the testis. The patient underwent orchidectomy and resection of the tumor. Pathological analysis of the surgical specimen revealed a hemangioma of the spermatic cord.

CONCLUSIONS

Hemangioma of the spermatic cord is a very uncommon tumor, it is a slow growing, indolent, benign scrotal lesion that must be distinguished from other paratesticular masses or tumors with similar clinical features. Ultrasound and other diagnostic imaging techniques are not useful in making the preoperative differential diagnosis.

List-mode likelihood: EM algorithm and image quality estimation demonstrated on 2-D PET

Using a theory of list-mode maximum-likelihood (ML) source reconstruction presented recently by Barrett et al., this paper formulates a corresponding expectation-maximization (EM) algorithm, as well as a method for estimating noise properties at the ML estimate. List-mode ML is of interest in cases where the dimensionality of the measurement space impedes a binning of the measurement data. It can be advantageous in cases where a better forward model can be obtained by including more measurement coordinates provided by a given detector. Different figures of merit for the detector performance can be computed from the Fisher information matrix (FIM). This paper uses the observed FIM, which requires a single data set, thus, avoiding costly ensemble statistics. The proposed techniques are demonstrated for an idealized two-dimensional (2-D) positron emission tomography (PET) [2-D PET] detector. We compute from simulation data the improved image quality obtained by including the time of flight of the coincident quanta.

Non-linear Feature Extraction by Redundancy Reduction in an Unsupervised Stochastic Neural Network

Unsupervised feature extraction by a stochastic neural network can be defined as a minimization of the redundancy between the elements of the output layer, given complete information transfer from input to output. Redundancy minimization can be achieved by minimization of the mutual information between the units of the output layer. Complete information transfer is enforced by maximizing the mutual information of the input and output. With these two conditions we define a novel learning algorithm for stochastic recurrent networks. The minimum of redundancy corresponds to the extraction of statistically independent features, leading to a factorial representation of the environment. The resulting learning rule includes Hebbian and anti-Hebbian learning terms. These two terms are weighted by the amount of information transmitted in the learning synapse minus the grade of redundant information in the corresponding output neuron, giving thus, an information-theoretic interpretation of the proportionality constant of Hebb's biological rule. Simulations demonstrate the performance of this method. When a retina is simulated, the learning algorithm forms decorrelated receptive fields. This represents the first experiment that extends the results of the linear principle component analysis to the nonlinear case by a direct implementation of Barlow's principle of redundancy reduction for unsupervised features extraction by receptive fields formation in a retina model. Copyright 1997 Elsevier Science Ltd.

Social deprivation stress induces adaptative changes of opioid mechanisms in the rat tail artery

Brief (7-14 days) social deprivation stress has been found to increase blood pressure in Wistar rats, an effect dependent on activation of opioid function. The role of central opioids in this and other responses to stress has been repeatedly determined, but the possible involvement of modifications of peripheral opioid mechanisms is poorly understood. To further increase this knowledge, we have examined the opioid sensitivity of tail arteries taken from social deprived Wistar rats by studying the effect of beta-endorphin and DADLE "in vitro". Both opioids inhibited the electrically-induced constriction of the preparations in a dose-dependent manner, but these actions were significantly attenuated after 7-14 days of social deprivation. When the rats were isolated for 30-35 days, the hypertensive response was still present but the arteries from group-housed and isolated animals no longer showed differential sensitivity to opioids. This difference with respect to 7-14 days of isolation could be related to age-dependent changes of opioid function, which were observed among group-housed animals. The results suggest that social deprivation stress induces an adaptation of the tail arteries to the opioid effects on contractility. It is suggested that this endogenous adaptation could be contributing to the hypertensive response observed after social deprivation.

Proteolytic activity of lactobacilli in a model goats' milk curd system

Mesophyllic lactobacilli cultures propagated in MRS broth were inoculated in goats' milk curd slurries and incubated at 30 degrees C for 10 d. The micro-organisms tested were Lactobacillus casei subsp. casei IFPL 731 and IFPL 99, and Lactobacillus plantarum IFPL 3. Whole cells, cell-free extracts and cell lysates were evaluated for acceleration of proteolysis in the curd slurries. Conversion of water-soluble nitrogen to non-protein nitrogen and amino acid nitrogen, reverse phase-HPLC peak areas and ratio of hydrophobic to hydrophilic peptides, were all affected by the type of inoculum used as well as the strain under study. The results suggest that the accelerated-ripening model system developed, containing cell lysates, may be suitable as a good and rapid indicator of the contribution of the strains to proteolysis during cheese ripening.

mu- and delta-opioid receptor-mediated contractile effects on rat aortic vascular smooth muscle

The actions of opioid receptor agonists and antagonists were studied in isolated rat aortic strips. Morphine (10(-7)-10(-6) M) had no contractile effect on resting strips but when added during the relaxation of the contractions induced by 10(-9) M noradrenaline, it induced a contractile response which was blocked by naloxone. The selective mu-opioid receptor agonist, [D-Ala2,N-Me-Phe4,Gly5-ol]enkephalin (DAMGO, 10(-7)-10(-6) M), induced an increase in basal tension which remained after removal of endothelium or in Ca(2+)-free solution, but was inhibited by beta-flunaltrexamine. beta-Flunaltrexamine also inhibited the contractile response induced by DAMGO added during the relaxation of the contractions induced by noradrenaline. The delta-opioid receptor agonist, [D-Pen2,D-Pen5]enkephalin, had no effect on resting tension but potentiated the contractions induced by noradrenaline; these effects were abolished by naltrindol. The selective kappa-opioid receptor agonist, bremazocine, had no effect on resting tension and did not modify the amplitude of the contractions induced by noradrenaline. These results suggest that, at low concentrations, agonists of mu- and delta-opioid receptors may act as modulators of noradrenaline-induced responses, whereas at higher concentrations, mu-opioid receptor stimulation may have a direct contractile effect in isolated rat aorta.

Further evidence for a peripheral sympathicolytic action of the antihypertensive cicletanine in rats

The site and mechanism of action of the antihypertensive agent cicletanine have been studied. In the pithed rat model, intravenous (i.v.) cicletanine was able to reduce the elevated blood pressure induced by continuous infusion of the alpha 1-adrenergic agonist, methoxamine, in a dose-related manner. In strip preparation of the aorta from deoxycorticosterone (DOCA)-salt-treated rats, cicletanine was found to prevent the contraction induced by 1 microM noradrenaline. When subeffective doses of phentolamine (0.25 mg/kg p.o.) plus cicletanine (3 mg/kg p.o.) were given together, a clear-cut antihypertensive effect was observed in DOCA-salt rats. Moreover, subchronic administration of cicletanine (30 mg/kg p.o.), during the one month period of DOCA-salt administration to produce high blood pressure readings, was able to prevent cardiac noradrenaline depletion. These data suggest that the antihypertensive effect of cicletanine, which is clinically well tolerated, may be due to a multifactorial mechanism of its action, through which it might alter a number of physiological mediators while exercising a slight potency on each of them.

Stability of an oral midazolam solution for premedication in paediatric patients

The objectives of this study were to assess the stability of a 1 mg/ml oral midazolam solution elaborated by our Hospital Pharmacy Service, and to confirm its clinical effect in presurgical paediatric patients. The solution's stability was tested by determining its pH and its UV-visible absorption spectrum at room temperature for up to 60 days. A high performance liquid chromatography method was used to confirm it. There was no significant change in pH value of either the test or a control solution. No loss of midazolam could be detected during the test. The Anaesthesiology Service assessed the sedation quality (very good, good, bad) and the venous puncture response, 20 minutes after the administration of 0.3 mg/kg of an oral midazolam solution. Twenty children were examined (age: 4-7 years). In addition, the haemodynamic and ventilatory functions were evaluated.

Vascular alterations in rats with high blood pressure induced by social deprivation stress

While an activation of the opioid system has been found to play a role only in the triggering of the high blood pressure induced by brief (7-14 days) social deprivation stress in Wistar rats, factors responsible for the maintenance of the hypertension after long-term (30-35 days) isolation remained to be elucidated. To this aim, the effects of social deprivation stress on the functional and morphological features of blood vessels were studied. The tail artery, as a muscular vessel, and the aorta, as a large elastic vessel were used in these experiments. In ex vivo experiments, aorta and tail artery strips from rats isolated for 30-35 days were found to be hyperreactive to noradrenaline.

Preproenkephalin RNA increases in the hypothalamus of rats stressed by social deprivation

1. Pharmacological evidence indicates that stress induced by brief (14 to 20-day) social deprivation in the rat is associated with an activation of the central preproenkephalin (ENK) opioid system. This study examines the neurochemical evidence that substantiates such an activation. 2. Using a specific ENK complementary DNA probe, ENK RNA levels were measured by dot blot and Northern blot analyses in different brain areas of socially deprived rats. Immunoreactivity to met-enkephalin-derived peptides was also evaluated by radioimmunoassay in the same brain regions. 3. Brief social deprivation increased the levels of ENK RNA and enkephalin immunoreactivity in whole hypothalamus. 4. Our data suggest that this type of stress appears to be associated to an induction of ENK gene transcription in hypothalamus.

[Subcapsular hematoma after ESWL]

Contribution of 2 cases of post-ESWL subcapsular haematoma in patients with HBP. One of them underwent surgical drainage. In the second case a more conservative attitude was followed. Review of related literature.

Filtration dynamics and natriuretic response to volume expansion in humans

We used differential solute clearances and a theoretical analysis of glomerular ultrafiltration and dextran sieving to characterize the hemodynamic response of nine healthy humans to infusion of isoncotic, 5% albumin in saline or saline vehicle alone. During albumin infusion (10.2 +/- 0.2 ml.kg-1.30 min-1) plasma volume increased by 18%, but oncotic pressure rose by only 0.8 mmHg. Despite the hypervolemia, renal blood flow (RBF) declined by 140 ml/min and glomerular filtration rate (GFR) declined by 16 ml/min during the infusion. RBF increased progressively postinfusion, exceeding baseline by 135 ml/min after 4 h; GFR was restored to baseline. Although oncotic pressure declined by 2 mmHg, a similar transient decline in GFR (-13 ml/min) was associated also with infusion of saline vehicle alone (9.4 +/- 0.3 ml.kg-1.30 min-1), which increased plasma volume by 9%. Sieving coefficients of dextrans (radius 32-42 A) were lowered during and after either infusion, a phenomenon that we compute to reflect a reduction in glomerular pore size. Assuming that the transcapillary hydraulic pressure difference was not lowered, we calculate that there was a simultaneous depression of the ultrafiltration coefficient (Kf) during volume expansion with saline and possibly also to a lesser extent with albumin. The hypofiltration during either infusion delayed the onset of a natriuretic response until the filtered sodium load was restored to baseline in the postinfusion period. We propose that the net effect of changes in intracapillary pressures and Kf during volume expanding infusions is to transiently lower GFR, thereby preventing the human kidney from mounting an immediate natriuretic response to acute hypervolemia.

Inositol 1,4,5-trisphosphate increases myoplasmic [Ca2+] in isolated muscle fibers. Depolarization enhances its effects

Inositol 1,4,5-trisphosphate (InsP3) has been proposed as an intracellular messenger which mobilizes calcium from the sarcoplasmic reticulum, during excitation-contraction coupling in skeletal muscle. We have measured the myoplasmic free calcium concentration ([Ca2+]i) by means of calcium selective microelectrodes in intact fibers isolated from Leptodactylus insularis microinjected with InsP3. In muscle fibers bathed in normal Ringer, the mean resting [Ca2+]i was 0.11 +/- 0.01 microM (M +/- SEM, n = 30). The microinjection of 0.3, 0.5 and 1 microM InsP3 induced transient increments in the [Ca2+]i to 0.35 +/- 0.02 microM (n = 9), to 0.53 +/- 0.03 microM (n = 11) and 0.94 +/- 0.06 microM (n = 10) respectively. Microinjection of 0.3, 0.5 and 1 microM InsP3 in muscle fibers incubated in low Ca2+ solution induced increments in [Ca2+]i similar to those observed in fibers bathed with normal Ringer. The microinjection of 0.3, 0.5 and 1 microM InsP3 in muscle fibers partially depolarized with 10 mM [K+]o induced transient enhancements of the resting [Ca2+]i that were greater than the transients observed in the normally polarized muscle. In partially depolarized fibers microinjected with 0.3, 0.5 and 1 microM InsP3, the [Ca2+]i was changed to 1.45 +/- 0.14 microM (n = 20), to 3.37 +/- 0.34 microM (n = 7) and to 7.43 +/- 0.70 microM (n = 6) respectively. In all partially depolarized fibers these increments in [Ca2+]i were associated with local contraction.(ABSTRACT TRUNCATED AT 250 WORDS)

Atrial natriuretic peptide and response to changing plasma volume in diabetic nephropathy

We evaluated the renal and hormonal responses to volume expansion induced by water immersion in subjects with diabetic nephropathy (n = 12) and in healthy control subjects (n = 9). Immersion induced similar average increments in sodium excretion (+/- 223 vs. 176 mumol/min) and comparable decrements in renovascular resistance (RVR; -15 vs. -16 U). However, whereas the control subjects responded uniformly, the response among diabetic subjects was highly variable, with a subset of patients exhibiting paradoxical antinatriuresis and vasoconstriction. Immersion was associated with marked elevation of atrial natriuretic peptide (ANP) in plasma of diabetic versus control subjects (61 +/- 9 vs. 19 +/- 2 pM, respectively; P less than 0.001). Yet for each picomolar increment in plasma ANP during immersion, the corresponding increases in urinary excretion of cyclic guanosine monophosphate (26 vs. 279 pmol/min) and sodium (9 vs. 47 mumol/min) and the reciprocal lowering of RVR (0.7 vs. 1.9 U) were blunted in the diabetic versus control group. Volume contraction in the postimmersion period was associated with disproportionate antinatriuresis and renal vasoconstriction in the diabetic group, despite a persistent elevation of ANP (29 +/- 2 vs. 16 +/- 2 pM, P less than 0.01). We propose that renal insensitivity to ANP in diabetic nephropathy could contribute to altered vasoreactivity and abnormal excretory responsiveness to changing plasma volume. Blunted natriuresis in response to ANP release and enhanced sodium retention during volume contraction could account for the expanded extracellular fluid volume that has consistently been reported to accompany the development of diabetic nephropathy.

Electrohydraulic and ultrasonic lithotripsy in 100 consecutive cases of primary ureteral stones

We have performed, between May 1985 and December 1988, in situ lithotripsy in 100 consecutive cases of primary ureteral stones, using electrohydraulic lithotripsy in 33 patients and ultrasonic lithotripsy in the remaining 67. After using similar instruments and surgical techniques in both groups, we have comparatively evaluated the complications encountered and the results obtained. With the electrohydraulic lithotripsy we have obtained a complication rate of 42% (operative and postoperative) and favorable results in 72.7% of the patients; using ultrasonic lithotripsy, the complication rate was 10.4%, and favorable results were obtained in 92.5%. We conclude that, at least in our experience, ultrasonic lithotripsy is less invasive and more successful than electrohydraulic lithotripsy in the treatment of primary stone disease.

[Complications of rigid ureteroscopy]

Peri- and post-operative complications higher than 37c (15%) encountered in 250 urethroscopies performed between May 1985 and January 1989 are presented in this paper. These experiences are compared to those from other 20 series (2,599 urethroscopies) representing 14.5% complications. In order to study their pathogeny, the sample was divided into four groups:

CONTROL GROUP

27 patients where normality of urinary tract was demonstrated in 92.6% of all evaluations made at intervals of about 20 months. Technical scope: Two groups chronologically different: 16% complications in urethroscopies performed in 1985 and 7% complications in those performed in 1986. Differences in the techniques applied: classic extraction (14%) vs. urethroscopy (13%) and electrohydraulic lithotrity (42%) vs ultrasonic lithotrity (12%). Finally, a description is made of those cause believed to be responsible for major complications: perforation, avulsion and ureteral stenosis.

The antihypertensive agent cicletanine reverses vascular hyperreactivity to noradrenaline and cardiac hypertrophy in DOCA-salt rats

Cicletanine, when given p.o. either acutely or subchronically, was found to produce a clear-cut antihypertensive effect in the deoxycorticosterone salt experimental rat model. This compound was able to reverse high blood pressure, even at doses deprived of diuretic effect. Subchronic treatment (30 mg/kg, p.o.; 14 days) with cicletanine reduced the enhanced contractile response to noradrenaline in deoxycorticosterone salt rat aortic strips and reversed the cardiac hypertrophy in these animals. The antihypertensive effect after long-term treatment with cicletanine in deoxycorticosterone salt rats appears to be related to an antagonism of the elevated sympathetic drive to the vascular smooth muscle.

[Surgical treatment with prosthesis implantation in 100 patients with erectile sexual dysfunction]

We present our case study of 100 penile prostheses in patients suffering from erectile sexual dysfunction of different etiologies. We carry out a review of the different diagnostic stages and the different surgical approaches for prosthetic implant and their complications.

Studies on the mechanism of action of the antihypertensive agent cicletanine

DOCA-salt rats have been previously shown to respond readily to the antihypertensive agent cicletanine (C). To study the mechanism of action of this drug, DOCA-salt rats were subchronically (14 d) treated with a 30 mg/kg (p.o.) dose of C and, once killed, their thoracic aortas challenged with a concentration (0.1 microM) of the vasocontractile agent noradrenaline (NA). Arteries from rats treated with C responded less to NA than the arteries from rats given placebo for the same time period. In another set of experiments, prior treatment with the inhibitor of prostaglandin synthesis indomethacin (2 x 2.5 mg/kg, s.c.) blunted the acute antihypertensive effect of C (30 mg/kg, p.o.) in this experimental model. These data suggest that C may work through a long-term induced blockade of the sympathetic tone that could be somehow related to a promotion of the formation of the vasodilator prostaglandin prostacyclin.