A live attenuated Salmonella typhimurium vaccine candidate, LVR01, was constructed by introducing a null deletion into the aroC gene of the parental canine S. typhimurium isolate, P228067. LVR01 was used to orally deliver to the canine immune system a fatty acid binding protein (FABP) from Echinococcus granulosus (EgDf1), as a fusion protein with fragment C (TetC) of tetanus toxin. Immunization studies demonstrated that live LVR01 is well tolerated by orally vaccinated dogs. There was no detectable shedding of the vaccine strain in the faeces 2 days after immunization. Humoral antibody responses were observed against Salmonella, TetC and EgDf1. Cellular responses were consistently detected against Salmonella and TetC. A cellular response against EgDf1 was also seen in a proportion of the LVR01 vaccinated dogs. We propose S. typhimurium LVR01 as a carrier for recombinant antigens and a vector for the construction of multivalent oral vaccines for dogs.

Administration, Oral↗

PubMed2000

Predictors of left atrial spontaneous echo contrast and thrombi in patients with mitral stenosis and atrial fibrillation.

The purpose of this study was to investigate the independent factors associated with the presence of left atrial (LA) spontaneous echo contrast (SEC) and thromboembolic events in patients with mitral stenosis (MS) in chronic atrial fibrillation (AF). Factors independently associated with LASEC, thrombi, and embolic events have been mainly investigated in patients with nonvalvular AF or inhomogeneous populations with rheumatic heart disease. Transesophageal and transthoracic echo studies were performed in 129 patients with MS in chronic AF. Previous embolic events were documented in 45 patients, 20 of them within 6 months, and 65 patients were receiving long-term anticoagulation. The intensity of LASEC and mitral regurgitation, the presence of thrombi and active LA appendage flow (peak velocities > or = 20 cm/s), and LA volume as well as other conventional echo-Doppler determinations were investigated in every patient. The prevalences of significant LASEC (degrees 3+ and 4+), thrombus, active LA appendage flow, and significant mitral regurgitation (>2+) were: 52% (67 patients), 29.5% (38 patients), 32% (41 patients), and 36% (47 patients), respectively. Multivariate analysis showed that decreasing mitral regurgitation severity, absence of active LA appendage flow, and mitral valve area were the independent correlates of LASEC (odds ratio [OR] 3.7, 5.4, and 0.17, respectively; all p <0.02). Active LA appendage flow and anticoagulant therapy were associated negatively, whereas the severity of LASEC was associated positively with the finding of LA thrombus (OR 9.6, 3.9, and 1.6, respectively; all p <0.05). The intensity of LASEC and previous anticoagulant therapy (OR 1.74 and 4.5, respectively; p <0.005) were the independent covariates of thrombi and/or recent embolic events. In conclusion, the severity of mitral regurgitation and lack of active LA appendage flow were, respectively, the strongest independent correlates of significant LASEC and thrombus in patients with MS in chronic AF. LASEC remains the cardiac factor most strongly associated with thrombus and/or recent embolic events in these patients.

Atrial Appendage↗

PubMed2000

Frequency of left ventricular free-wall rupture in patients with acute myocardial infarction treated with primary angioplasty.

A total of 590 patients with myocardial infarction treated with primary angioplasty were studied, to assess the incidence and related factors of free-wall rupture in patients with acute myocardial infarction when treated with primary angioplasty. The incidence of free-wall rupture was 2.2% (13 patients); this incidence was higher in patients >65 years old, women, nonsmokers, as well as in those with anterior location and an initial TIMI grade 0 flow, but it was similar in patients with a successful or unsuccessful angiographic result.

Angioplasty, Balloon, Coronary↗

PubMed2000

Vitreous humor carbohydrate-deficient transferrin concentrations in the postmortem diagnosis of alcoholism.

Deaths from the effects of alcohol intoxication are encountered routinely in forensic practice. In an important number of cases difficulty may arise in interpreting the significance of results obtained in the autopsy. In clinical practice biochemical markers, particularly serum gamma-glutamyl-transpeptidase (GGT), alanine aminotransferase (ALT), aspartate transaminase (AST), carbohydrate-deficient transferrin (CDT), and erythrocyte mean corpuscular volume are used to diagnose heavy alcohol consumption. CDT is used as a reliable and specific marker. In postmortem diagnosis, because of the difficulty in interpreting blood alcohol levels and relatively non-specific pathological features, biochemical compounds have been studied for use as possible markers. The aim of this study was to evaluate the usefulness of the postmortem determination of CDT in vitreous humor as a confirmation of antemortem alcoholism. CDT levels were studied in 66 male cadavers with a mean age of 55.9 years (S.D. 17.0, range 22-87 years) with a mean postmortem interval of 17.9 h (S.D. 11.4, range 4-72 h). Cases were assigned to two diagnostic groups according to the antemortem diagnosis of alcoholism. Statistically significant differences were found for CDT and ALT concentrations between the two diagnostic groups. The highest vitreous humor levels of CDT and ALT were obtained in the group of cases with a previous diagnosis of alcoholism. Our results suggest that vitreous humor CDT levels are useful in cases where the postmortem diagnosis of alcoholism is hindered by the non-specificity of data.

Adult↗

PubMed2000

Patient-controlled analgesia with ketorolac in pediatric surgery.

Our aim was to quantify the analgesic efficiency of the patient-controlled analgesia technique (PCA), using ketorolac, in children aged 6-14 undergoing a surgical intervention. We carried out a double-blind test with two randomly selected groups: the PCA group comprising patients submitted to intravenous PCA, with "bolus on demand" and the Standard group, with conventional analgesia dispensed with ketorolac I.V. (0.5 mg/kg/6 hours). Evaluation of pain experienced was performed using the Hannallah behavioural scale and quantification of the summing of pain intensity. Analgesic efficiency was determined by the pain intensity difference (PID) score. Evaluation of pain experienced during hour 1 reveals a marked reduction with time for each group; no inter-group differences were found. At hour 6 there were neither intra-group nor inter-group differences. The accumulated pain score revealed a significant reduction in hour 6, with no differences between the two groups. Evaluation of the analgesic effect revealed no differences, either intra-group or intergroup, during the experimental period. The sum of the PIDs revealed significant differences in the standard group between the values for hours 1 and 6. Under the experimental conditions described, both techniques were equally effective for pain treatment, but the efficiency was higher for the PCA group.

Analgesia, Patient-Controlled↗

PubMed2000

Cefminox versus metronidazole plus gentamicin intra-abdominal infections: a prospective randomized controlled clinical trial.

BACKGROUND: The aim of this prospective study was to compare the safety and efficacy of a new cephamycin, cefminox 2 g/12 h, to those of the usual regimen combining metronidazole 500 mg/8 h and gentamicin 80 mg/8 h (M+G). PATIENTS AND METHODS: 160 patients with clinically proven intra-abdominal infection were prospectively included in an open parallel randomized comparative multicenter trial. Antibiotics were started preoperatively and discontinued after clinical and laboratory evidence of resolution of the infection. Serum and peritoneal fluid levels and serum bactericidal activities were also studied. RESULTS: 150 patients were clinically evaluable. There was one failure in the cefminox group and three in the M+G group (not significant, RR: 1.07, 95% CI: 1-1.15). No differences were found in the number of wound infections, length of stay or duration of antibiotic therapy. Adverse effects were reported in 11 cases, all of them mild to moderate. Escherichia coli and Bacteroides fragilis were the most frequently found microorganisms. CONCLUSION: Cefminox is as effective and as safe as M+G in the treatment of intra-abdominal infections.

Abdomen↗

PubMed2000

Long-lasting delayed hyperalgesia after subchronic swim stress.

Rats subjected to an inescapable subchronic stress, consisting of 10-20 min of forced swimming for 3 days, showed a thermal hyperalgesia and an enhanced nociceptive behavior to the subcutaneous administration of formalin 24 and 48 h, respectively, after the last swim session. Hyperalgesia to thermal and chemical stimulants was still present 8 and 9 days after the last swim session, respectively. Chemical, but not thermal, nociception was negatively correlated with the swim effort or struggle times during the last swim session. The serotonin-selective reuptake inhibitors clomipramine (2.5 mg/kg/day, i.p., started 3 or 7 days before stress) and fluoxetine (0.25 mg/kg/day, i.p., started 7 days before stress), or serotonin precursor tryptophan (3 mg/kg/day, i.p., 24 h before each swim stress) blocked the development of both the thermal and the chemical hyperalgesia and increased swim effort times compared to vehicle-treated rats. These treatments did not affect nociceptive responses in control rats subjected to sham swimming. These findings suggest that repeated stress can produce a long-lasting increase in pain sensitivity to both phasic or tonic noxious stimuli by diminishing central serotonin activity. This model may help elucidate the underlying neural mechanisms that mediate the effects of repeated stress on pain sensitivity and affective states.

Animals↗

PubMed2000

[Myocardial scintigraphy and patency of coronary bypass graft with mammary artery].

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Heart↗

PubMed2000

[Usefulness of the new imaging techniques, second harmonic and contrast in endocardial border visualization. Reliability analysis in segmental contraction assessment].

AIM: This study sought to determine if newer techniques significantly improve endocardial border definition in suboptimal acoustic windows, and the reproducibility of the evaluation of wall motion abnormalities according to the different techniques and degrees of expertise. METHODS: We studied a total of 20 consecutive patients with poor ultrasound window, to assess, if the use of tissue harmonic imaging (2H) or contrast with second harmonic (Levovist ; 4 g i.v.), (2HC) improves endocardial border visualization. In order to analyze inter and intraobserver reliability with the different techniques, four observers with different degrees of expertise were each asked to assess the segmental wall motion score of 31 consecutive echocardiograms. RESULTS: The quality of the image was clearly superior with 2H and 2HC compared with 2D. This difference was larger in apex and lateral endocardial border from 0.9 and 1 to 1.5 and 1.64 (p < 0.001) with 2H. 2HC was found to slightly but significantly improve the endocardial definition in apex compared with 2H (1.64 vs 1.81; p = 0.016). The percentage of segments assessed for interobserver variability significantly improve with 2H and 2HC (2D = 50%, 2H = 75% and 2HC = 95%). Interobserver agreement with the different techniques between the experienced observers did not statistically differ. The less experienced observer presented a significantly lower interobserver reliability than those with experience, and did not improve with 2H and 2HC. CONCLUSIONS: a) Native tissue harmonic imaging and second harmonic imaging with contrast (Levovist ) significantly improves endocardial border visualization; b) the newer imaging techniques significantly improve performance (percentage of evaluated segments) without decreasing reliability, and c) experience in assessing wall motion is the main factor in interobserver agreement.

Echocardiography↗

PubMed2000

Echocardiographic features of left atrial dissection.

AIMS: To study left atrial dissection, a rare complication of mitral valve replacement. METHODS AND RESULTS: From our hospital database of 5497 transoesophageal echocardiograms, we analysed 524 echocardiograms performed on 478 patients with mitral valve prosthesis. We found four patients (0.84%) with left atrial dissection diagnosed by transoesophageal echocardiography that visualized the left atrial dissection: in three patients the diagnosis was confirmed intraoperatively. Three patients had previously had replacements of the mitral valve. Left atrial dissection was a severe complication: one patient died and the two patients successfully operated on had paraprosthetic regurgitation. CONCLUSION: Transoesophageal echocardiography is the first choice for diagnosis of left atrial dissection, a rare complication of mitral valve replacement with an acute/subacute clinical course. Previous mitral valve replacement seems to be the main risk factor to develop left atrial dissection.

Aged↗

PubMed2000

Transpyloric enteral nutrition reduces the complication rate and cost in the critically ill child.

BACKGROUND: Studies in adults have shown that transpyloric enteral nutrition (TEN) is useful in certain patients who cannot tolerate oral or gastric feeding. This study was conducted to compare TEN with parenteral nutrition (PN) in critically ill pediatric patients. METHODS: A retrospective descriptive study conducted in the pediatric intensive care unit of a tertiary pediatric referral center. All patients in the pediatric intensive care unit (PICU) receiving PN and/or TEN from January 1993 through December 1996 were included in the study. RESULTS: Two hundred forty patients (14.6% of all patients admitted to the PICU) received PN and/or TEN (168 exclusively PN, 21 exclusively TEN, and 51 a combined regimen). The number of patients receiving PN and duration of PN declined significantly from 1993 (65 patients, 703 days) through 1996 (48 patients, 395 days). This was mirrored by the increase in the number of patients receiving TEN and duration of TEN. The incidence of complications (hyperglycemia, hypertriglyceridemia, and cholestasis) was higher in the PN group. There was no difference in the incidence of hospital-acquired infection or mortality between the two groups. The cost of TEN was lower than that of PN, with an estimated annual saving of $5,422. CONCLUSIONS: Transpyloric enteral nutrition is a suitable method of nutritional support for critically ill pediatric patients. It has fewer complications and a lower cost than PN.

Child↗

PubMed2000

1:1 complex of 4-nitrobenzoic acid and 4-nitropyridine N-oxide

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Journal Article↗

PubMed2000

3,5-diiodo-L-thyronine regulates glucose-6-phosphate dehydrogenase activity in the rat.

Thyroid hormones influence the activity of lipogenic enzymes such as malic enzyme (ME) and glucose-6-phosphate dehydrogenase (G6PD). The effect of T3 on ME is exerted at the transcriptional level, but it is unclear if its effect on G6PD is also nuclear mediated. Furthermore, other iodothyronines that have been shown to possess biological activity (such as diiodothyronines) could contribute to this enzyme's regulation. In this study the effects of 3,5-diiodothyronine (T2) on the aforementioned enzymes were examined and compared with those of T3. Rats made hypothyroid by propylthiouracil and iopanoic acid treatment were used throughout. Enzyme activities were determined spectrophotometrically, and G6PD messenger RNA (mRNA) expression was analyzed by Northern blotting using a human G6PD complementary DNA probe. Injections of T2 to hypothyroid animals significantly enhanced the activity of both enzymes. The effect of T2 on ME was nuclear mediated and mimicked the effect of T3. The effects of T2 and T3 on G6PD differed. Injection of T3 into hypothyroid rats induced an increase in both enzyme activity and G6PD mRNA expression, indicating a nuclear-mediated effect. The effect of T2 on G6PD activity, on the other hand, was not nuclear mediated. The injection of T2 into hypothyroid animals did not change G6PD mRNA expression, and the strong increase in the enzyme's activity (from +70% to +300%) was unaffected by simultaneous injection of protein synthesis inhibitors. As the lowest dose of 1 microg T2/100 g BW affects G6PD activity 3-5 times more than the same dose of T3, these data provide the first evidence that T2 is a factor capable of regulating G6PD activity.

Animals↗

PubMed2000

Release of nortriptyline hydrochloride from oil-water microemulsions.

The release of nortritptyline hydrochloride from oil-in-water (o/w) microemulsions (isopropyl myristate as oil, propylene glycol as cosurfactant, polysorbate 80 as surfactant and phosphate buffer, pH 7.4, as the continuous phase) containing increasing concentrations of polyethylene glycol 400, used to facilitate the diffusion of a drug from the inner oily phase of the microemulsion to the outer aqueous phase of such a dispersion system, was studied by determining the permeability constants of the drug through hydrophilic and lipophilic membranes separating the o/w microemulsions from the receiving aqueous phase (phosphate buffer pH 7.4). The permeability of nortriptyline hydrochloride from microemulsions through the lipophilic membrane increased as the concentration of polyethylene glycol 400 in the disperse system increased. The apparent permeability constant for nortriptyline hydrochloride, from the microemulsion without polyethylene glycol, was 1.36 x 10(-3) cm x h(-1), it increased up to 7.80 x 10(-3) cm x h(-1) in the presence of polyethylene glycol at a concentration of 50% (v/v) of the initial volume of the aqueous phase.

Adrenergic Uptake Inhibitors↗