New ways to ventilate newborns in acute respiratory failure

Out treatment options for acute neonatal failure have expanded greatly in the last 20 to 30 years. This article reviews patient-triggered ventilation, high frequency ventilation, negative extrathoracic pressure ventilation, nitric oxide therapy, liquid ventilation, extracorporeal membrane oxygenation, and advances in pulmonary function monitoring. The authors present background theories, describe equipment, review clinical strategies, and the results of recent trials.     

Use of capillary electrophoresis in the characterization of sulfonated metallophthalocyanines: a comparative evaluation of purification procedures following synthesis by the condensation method

Capillary electrophoresis has been presented as a resourceful technique for monitoring the purity of synthetic metallophthalocyanines and evaluating comparatively purification procedures. In this study, the tetrasulfonated cobalt(II) phthalocyanine was synthesized by the condensation method and submitted to several purification procedures such as continuous Soxhlet extraction with ethanol and dioxane, percolation through a gel-filled chromatographic column, and salting-out precipitation in acid medium followed by washing with alkaline solution. The efficiency of each procedure, or combined procedures, was then evaluated by capillary electrophoresis in citrate buffer solution under constant voltage conditions and direct UV-VIS detection at 630 nm and 260 nm. The inorganic anion and cation composition of the purified fractions was also investigated by indirect UV analysis in chromate/cetyltrimethylammonium bromide (CTAB) and imidazole/hydroxyisobutyric acid (HIBA) electrolyte systems, at 254 nm and 214 nm, respectively. The electropherograms obtained at 630 nm showed a high-intensity peak surrounded by satellite peaks of small intensity with migration time of approximately 5-6 min. This profile is indicative of the formation of positional isomers under the synthesis conditions. The electropherograms obtained at 260 nm were useful to monitor contaminants, such as reaction by-products or unreacted starting materials. The salting-out precipitation of the crude product led to a good-quality product with 80% purity (elemental analysis based on nitrogen content), which is comparable to the purity of commercially available tetrasulfonated derivatives. Both UV and infrared (IR) spectra of the purified product resemble that of standards. The capillary electrophoresis ion analysis of the treated product revealed the presence of sodium carbonate as the major contaminant. The combined treatment of salting-out precipitation followed by percolation in a Sephadex column (Pharmacia, S?o Paulo, Brazil) was successful for the removal of carbonate ion. However, the percolation procedure seemed to cause minor demetallation of the macrocycle ring, as confirmed by the presence of free cobalt(II) in the electropherogram of the column eluted fraction.     

Early and late airway complications after lung transplantation: incidence and management

BACKGROUND: Airway anastomosis complications continue to be a source of morbidity for lung transplant recipients. METHODS: This study analyzes incidence, treatment, and follow-up of airway anastomotic complications occurring in 127 consecutive lung transplant airway anastomoses (77 single lung and 25 bilateral sequential lung). Complications were categorized as stenosis (11), granulation tissue (8), infection (7), bronchomalacia (5), or dehiscence (3). Follow-up after treatment ranged from 6 months to 4 years. RESULTS: Nineteen airway anastomosis complications (15.0%) occurred in 18 patients. Telescoping the airway anastomosis reduced the complication rate to 12 of 97 (12.4%), compared with 7 of 30 (23.3%) for omental wrapping, (p = 0.15). Complications developed in 13 of 77 single-lung airway anastomoses (16.9%) versus 6 of 50 bilateral sequential lung recipients (12.0%). Treatment consisted of stenting (9 airway anastomoses), bronchodilation (8), laser debridement (4), rigid bronchoscopic debridement (2), operative revision (2), and growth factor application (2). There was no difference in actuarial survival between patients with or without airway anastomosis complications (p = 1.0). CONCLUSIONS: Airway anastomosis complications can be successfully managed in the immediate or late postoperative period with good outcome up to 4 years after intervention.     

Problem of biliourolithiasis-does it exist?

The analysis of 190 case records and 112 clinical cases of the patients with combination of biliary--and urolithiasis (biliourolithiasis-BUL) was carried out. Besides, for proving frequency of combined disease the differential analysis of 2300 case records of urolithiasis and biliary lithiasis separately was carried out as well. It was determined that this combination occurs in 10%. The purposeful, precise definition of complains, anamnesis of the illness, ultrasound and x-ray examination of biliary and urologic system are of paramount importance in timely diagnosis of such combined diseases. Diagnostic and tactic errors committed by surgeons as well as by urologists are often explained by insufficient knowledge of physicians about rather common combination of bilio- and urolithiasis. Among 112 patients 25 were admitted as urgent, the others--according to planned order--with various diagnoses, and their combined pathology was diagnosed at clinic only after purposeful precise examination. Urgent operations on biliary system were carried out in 21 patients. 84 patients underwent elective operations on biliary and urologic system, simultaneous operations of them being carried out in 31 patients. 7 patients due to their severe cardio-vascular disease underwent conservative treatment. Postoperative lethality made up 0.9%. From 190 patients (archives data) 162 have been operated on. Postoperative lethality made up 3.4%. Cost effect of simultaneous combined operations made up 1,168,000 roubles. It is advisable for patients with BUL diseases, taking into account function of the liver and kidney, their organs blood flow, to perform simultaneous of consecutive surgical interventions on biliary as well as on the urologic system which contribute to the well-timed social and professional rehabilitation of the patients.     

Distribution of tritiated dihydromicrocystin in swine

The distribution of tritiated dihydromicrocystin [3H]2H-MCLR was studied in anesthetized specific-pathogen-free pigs. Two doses were administered i.m. and one dose was given via an isolated ileal loop. At 4 hr after i.v. administration of the toxin at 25 micrograms/kg, 64.6% of the total dose (%TD) was located in the liver, with smaller amounts distributed to the kidneys (1.2% TD), lungs (1.75% TD), heart (0.22% TD), ileum (0.13% TD) and spleen (0.04% TD). A similar distribution was found at 4 hr postdosing in pigs given 75 micrograms/kg, although the liver contained a lower fraction of the total dose, at 46.99% TD, and the kidneys had somewhat more, at 2.19% TD, than the low dose. At the high dose, the fractions of the amount given accounted for by the lungs (0.55% TD), heart (0.23% TD), ileum (0.20% TD) and spleen (0.07% TD) were similar to those at the low dose. The livers of the pigs given 75 micrograms/kg via the ileal loop, at 5 hr postdosing, contained 49.5% TD and the ileum had 33.94% TD. Smaller amounts were distributed to kidneys (1.04% TD), lungs (0.65% TD), heart (0.81% TD) and spleen (0.16% TD). The livers of both groups dosed at 75 micrograms/kg contained higher concentrations of toxin, but lower percentages of the total dose, than the livers of pigs dosed at 25 micrograms/kg. Larger increases in serum arginase in the two 75 micrograms/kg groups were associated with histological evidence of more severe liver damage than at the 25 micrograms/kg dose. Analysis of radiolabeled compounds from hepatic tissue using fast atom bombardment mass spectrometry determined that the primary constituent was [3H]2H-MCLR, but two minor radioactive components were also isolated. These findings indicate that [3H]2H-MCLR is rapidly concentrated in the liver of swine, whether given i.v. or via an isolated ileal loop, that at extremely toxic doses uptake is slowed, and that it is as toxicologically active as the parent compound.     

Recent studies on the reproductive biology of the schistosomes and their relevance to speciation in the Digenea

The members of the family Schistosomatidae, dioecious Digenea, are discussed with regard to their distribution, intermediate and definitive host-parasite relationships. The biological species concept is considered together with the difficulties of its application to Schistosoma spp. and the Digenea. The correlation between pairing of adult schistosomes, physical and sexual development and the maintenance of reproductive potential is emphasised. Development of the female reproductive system does not depend upon species-specific pairing. In some combinations, e.g., Schistosoma haematobium/Schistosoma intercalatum and Schistosoma bovis/Schistosoma curassoni, a specific mate choice system apparently does not exist, whereas it does in other combinations, e.g., Schistosoma mansoni/Schistosoma intercalatum. In mixed infections change of mate may occur and when the opportunity arises heterospecific pairs of worms will change partners to conspecific pairs. Interspecific pairing in adult schistosomes will lead to either hybridisation or parthenogenesis. Yet the majority of schistosomes that inhabit the same definitive host maintain their genetic identity: specific mate recognition, site selection within the host and heterologous immunity have been suggested as isolating mechanisms. Experimental intraspecific crosses have enabled evaluation of the degree to which some populations separated and became reproductively isolated through pre-mating isolating mechanisms, indicative of incipient speciation, e.g., the Lower Guinea and Zaire strains of S. intercalatum. The occurrence and significance of parthenogenesis in schistosomes and other species of Digenea are discussed. The consequences of interspecific mating interactions in schistosomes with regard to parasite epidemiology, interspecific competition and genetic heterogeneity are debated. Geographical isolation and host specificity represent important pre-zygotic isolating mechanisms. It is suggested that site selection within the host and heterologous immunity may both reduce interspecific genetic interchange when digenean parasites utilise the same definitive host.