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Biomedical subjects

S J Allen

Publications and source records attributed to S J Allen.

At least 91 records · Page 5Linked to original sources

Regulation of chronic relapsing experimental allergic encephalomyelitis by endogenous and exogenous glucocorticoids.

Expression, development and resolution of the acute form of experimental allergic encephalomyelitis (EAE), typically induced in the highly susceptible Lewis rat, are closely regulated by endogenous corticosteroids. Administration of synthetic glucocorticoids also efficiently controls the manifestation of disease. The pivotal role played by the corticosteroids in modifying the induction and progression of EAE is further emphasised by a reversal of corticoid-mediated effects through adrenalectomy or treatment with the steroid receptor antagonist RU486 (mifepristone). Chronic relapsing EAE (CREAE) is characterised by acute symptoms, periods of remission and re-emergence of disease. The mechanisms governing the development of CREAE are unclear, but may require the regulatory influence of endogenous glucocorticoids. The current study has monitored circulating corticosteroids throughout the course of CREAE in the Biozzi ABH mouse and found that major fluctuations in systemic levels coincide with the relapsing-remitting phases of the disease. Furthermore, increasing circulating adrenocorticoids through administration of the steroidal compound dexamethasone markedly suppresses the occurrence of acute signs. The importance of the glucocorticoids in controlling CREAE is again highlighted by the intensification of symptoms and reduction in the survival rate of inoculated mice receiving RU486 prior to and during the acute phase of disease. The data reinforce the amelioratory actions of exogenous and naturally occurring glucocorticoids in the pathogenesis of EAE and extend earlier observations in the monophasic disease by demonstrating corticosteroid-dependent effects in a relapsing-remitting mouse model.

Animals↗

Flow-proportional administration of nitric oxide with a new delivery system: inspiratory nitric oxide concentration fluctuation during different flow conditions.

OBJECTIVE: To evaluate the accuracy of a flow-proportional delivery system and the pattern of inspiratory nitric oxide (NO) concentration during different flow conditions. DESIGN: Laboratory study in a lung model. SETTING: University experimental laboratory. SUBJECT: With a new delivery system, NO was administered proportional to the inspiratory flow into the inspiratory circuit to deliver a NO concentration of 10 and 30 ppm to a test lung during different ventilatory modes (volume-controlled ventilation [VCV], pressure-controlled ventilation [PCV], and airway pressure release ventilation [APRV]) with a fraction of inspired oxygen (FIO2) of 1.0. INTERVENTIONS: During VCV and PCV, the flow pattern was varied to achieve tidal volumes of 300, 600, and 900 mL, respectively, with inspiratory to expiratory time ratios of 1:3, 1:2, and 1:1. APRV was studied at a minute volume of 6, 12, and 18 L. Nitric oxides (NOx [NO+NO2]) and nitric dioxide (NO2) were monitored by chemiluminescence and electrochemical analysis. As the NO/N2 gas mixture is the only nitrogen source during ventilation with an FIO2 analyzer. RESULTS: During all flow conditions, NOx concentration was stable but slightly higher than expected. Measured and expected mean concentrations differed <9% (mean, <4%). Inspiratory NOx concentration fluctuation derived from N2 concentration was significantly higher than expected at higher flow rates, but this difference was not detected by chemiluminescence or electrochemical analysis. The NO2 production was not affected by the flow rate and was always < or =0.2 ppm (NO, 10 ppm) and < or =1.9 ppm (NO, 30 ppm). CONCLUSION: The tested NO delivery module administered stable mean inspiratory NO concentrations. Although inspiratory NO concentration fluctuates depending on the inspiratory flow rate, this delivery device allows stable NO administration without requiring adjustments when ventilator settings are changed.

Equipment Design↗

Cardiac surgical conditions induced by beta-blockade: effect on myocardial fluid balance.

BACKGROUND: Both crystalloid and blood cardioplegia result in cardiac dysfunction associated with myocardial edema. This edema is partially due to the lack of myocardial contraction during cardioplegia, which stops myocardial lymph flow. As an alternative, acceptable surgical conditions have been created in patients undergoing coronary artery bypass operations with esmolol-induced minimal myocardial contraction. We hypothesized that minimal myocardial contraction during circulatory support using either standard cardiopulmonary bypass (CPB) or a biventricular assist device would prevent myocardial edema by maintaining cardiac lymphatic function and thus prevent cardiac dysfunction. METHODS: We placed 6 dogs on CPB and 6 dogs on a biventricular assist device and serially measured myocardial lymph flow rate and myocardial water content in both groups and preload recruitable stroke work only in the CPB dogs. In all dogs we minimized heart rate with esmolol for 1 hour during total circulatory support. RESULTS: Although myocardial lymph flow remained at baseline level during CPB and increased during biventricular assistance, myocardial water accumulation still occurred during circulatory support. However, as edema resolved rapidly after separation from circulatory support, myocardial water content was only slightly increased after CPB and biventricular assistance, and preload recruitable stroke work was normal. CONCLUSIONS: Our data suggest that minimal myocardial contraction during both CPB and biventricular assistance supports myocardial lymphatic function, resulting in minimal myocardial edema formation associated with normal left ventricular performance after circulatory support. The concept of minimal myocardial contraction may be a useful alternative for myocardial protection, especially in high-risk patients with compromised left ventricular function.

Adrenergic beta-Antagonists↗

Management of the presumed susceptible varicella (chickenpox)-exposed gravida: a cost-effectiveness/cost-benefit analysis.

OBJECTIVE: To compare the cost-effectiveness and cost-benefit of different strategies for managing the presumed susceptible varicella (chickenpox)-exposed gravida. METHODS: Three strategies were evaluated: 1) a do-nothing or observation strategy; 2) a testing strategy, in which immune status was assessed and varicella-zoster immune globulin was administered to those who tested nonimmune; and 3) a universal-administration strategy, in which varicella-zoster immune globulin was given to all exposed, presumed susceptible gravidas. Because precise data are unavailable about varicella mortality and hospitalization rates in pregnancy, a range of potential rates was evaluated, from one to greater than 20 times healthy nonpregnant adult rates. The potential efficacy of varicella-zoster immune globulin varied from 1 to 99%. A strategy was defined as cost-effective if it cost less than $50,000 per life-year gained. RESULTS: If the mortality rate from varicella infection in pregnancy was increased fivefold over the nonpregnant healthy adult rate (ie, from 31/100,000 to 155/100,000 cases), efficacy would have to be at least 49% for the immune-testing strategy to be cost-effective. If pregnancy only doubled the varicella mortality rate, then even with perfect efficacy, the immune-testing strategy would not be cost-effective. Under most assumptions, the universal-administration strategy was cost-ineffective when compared with the immune-testing strategy. Similar results were obtained in the parallel cost-benefit analysis, which considered hospitalization costs and rates. The analysis was sensitive to the varicella transmission rate and the discount rate. CONCLUSION: From a cost-effectiveness/cost-benefit standpoint, management based on immune testing is preferable to universal varicella-zoster immune globulin administration when caring for the varicella-exposed gravida with a negative or indeterminate infection history.

Adult↗

Hypercalcitoninemia and inappropriate calciuria in the acute trauma patient.

PURPOSE: This study was undertaken to determine the role of calcium-regulatory hormones (calcitonin [CT], parathyroid hormone [PTH], and vitamin D analogs) during the first 48 hours after acute trauma. METHODS: Eleven acutely traumatized patients admitted to the shock-trauma intensive care unit (STICU) in a tertiary care teaching hospital were enrolled. Eleven same-day elective surgery patients served as the control group. Levels of ionized calcium (Ca2+), total calcium, magnesium, phosphate, CT, PTH, vitamin D analogs, electrolyte supplementation, and renal electrolyte loss were recorded during the first 48 hours after admission to the STICU. Control-group measurements consisted of Ca2+ and CT. RESULTS: At admission, 91% of the patients had ionized hypocalcemia (1.04 +/- 0.10 mmol/L). Ca2+ levels increased significantly over time (1.13 +/- 0.08 at 24 hours; 1.16 +/- 0.07 at 48 hours) but remained below the control-group value (1.28 +/- 0.05; P < .05) despite supplementation. Ninety-one percent of the patients had increased CT values at admission, 91% at 24 hours, and 78% at 48 hours. Median CT values in the trauma patients were higher throughout the study than in the control group (P < .05). Urinary calcium loss in the trauma patients was within the normal range. PTH and vitamin D analog values were within the normal range throughout the study. Multiple regression analysis did not show any significant correlation between electrolytes and hormone or protein concentrations. CONCLUSIONS: Acute trauma patients have ionized hypocalcemia associated with inappropriate urinary calcium loss, increased CT levels, and normal PTH and vitamin D analog values. We believe the degree of calciuria we observed was inappropriate in the context of ionized hypocalcemia. The cause of these increased CT levels is unclear. Our results suggest that Ca(2+)-regulatory mechanisms may be disrupted in the acute trauma patient.

Adult↗

Omental transposition in chronic spinal cord injury.

The results of omental transposition in chronic spinal cord injury have been reported in 160 patients operated upon in the United States, Great Britain, China, Japan, India and Mexico, with detailed outcomes reported in few studies. Recovery of function to a greater degree than expected by natural history has been reported. In this series, 15 patients with chronic traumatic spinal cord injury (> 1.5 years from injury) underwent transposition of pedicled omentum to the area of the spinal cord injury. Of the first series of four patients who were operated upon in 1988, one died, one was lost to follow-up and two were followed with sequential neurological examinations and Magnetic Resonance Imaging (MRI) scans preoperatively, at 1 year post injury and 4 1/2 years post injury. Another 11 patients were operated in 1992 and underwent detailed neurological and neurophysiological examinations and had MRI scans preoperatively and every 4 months for at least 1 year after surgery. All patients completed a detailed self-report form. Of the total of 13 operated patients in both series followed for 1-4 1/2 years, six reported some enhanced function at 1 year and five of these felt the changes justified surgery primarily because of improved truncal control and decreased spasticity. MRI scans showed enlargement of the spinal cord as compared to preoperative scans in seven patients. Increased T2 signal intensity of the spinal cord was found by 1 year after surgery in eight of 13 operated patients. Neurophysiological examinations of 11 patients in the second series agreed with self-reports of increases or decreases in spasticity (r = 0.65, P < 0.03). Somatosensory evoked potentials and motor evoked potentials at 4 month intervals up to 1 year in these patients showed no change after surgery. Neurological testing, using the American Spinal Injury Association (ASIA) and International Medical Society of Paraplegia (IMSOP) international scoring standards, failed to show any significant changes when the 1-year post operative examination was compared to the first preoperative examination except for decreased sensory function after surgery which approached statistical significance. When the 11 patients in the second series were compared to eight non-operated matched patients, followed for a similar length of time, no significant differences were found. Complications encountered in the operated patients from both series included one postoperative death from a pulmonary embolus, one postoperative pneumonia, three chronic subcutaneous cerebrospinal fluid (CSF) fistulae requiring wound revision, and one patient who developed biceps and wrist extensor weakness bilaterally requiring graft removal. We conclude that the omental graft remains viable over time and this operation can induce anatomical changes in the spinal cord as judged by MRI. Some patients reported subjective improvement but this was not supported by objective testing. We, therefore, find no justification for further clinical trials of this procedure in patients who have complete or sensory incomplete lesions. Further testing in motor incomplete patients would seem appropriate only with compelling supportive data.

Adolescent↗

Severe malaria in children in Papua New Guinea.

The clinical features of severe falciparum malaria and risk factors for mortality were studied in 489 children admitted with malaria to Madang Hospital, Papua New Guinea. The most common severe manifestations of malaria were severe anaemia (22%) and coma (16%). Children with severe anaemia were younger than those with coma (median age 2.2 vs. 3.7 years) and had been ill for longer before admission (median 7 vs. 4 days, respectively). Although the clinical features of coma in Madang children with malaria resembled closely those reported in African children, mortality was lower (8% vs. 17-25%, respectively). Overall, 17 (3.5%) children died, most within 12 h of admission. A high level of plasma lactate (> or = 5 mmol/l) was common (20%) and was the major predictor of death in multiple regression analysis. Raised plasma creatinine and decreased plasma bicarbonate were also independent predictors of mortality. Coma was not predictive of death, although a high proportion of children with profound coma died. Investigation of the causes of acidosis in children with malaria is a high research priority. In view of the short time interval between admission and death in many children, emphasis must be placed on the prevention or early recognition and treatment of acidosis in the district health clinic as well as the central hospital.

Anemia↗

Lactobacillus GG and acute diarrhoea in young children in the tropics.

A prospective, placebo controlled, triple blind clinical trial was undertaken in Thailand to determine the effect of Lactobacillus GG on recovery from acute diarrhoea in children. Thirty-nine children (mean age = 8 months) were enrolled and following rehydration received either oral Lactobacillus GG (n = 20) as a freeze-dried preparation or placebo (n = 19) twice daily for 2 days. The clinical characteristics of the study groups were similar. There was no significant difference overall in clinical response detected between the study groups. When only those with acute non-bloody diarrhoea (n = 26) were considered, the mean duration of diarrhoea was significantly shorter in the lactobacillus group (1.9 days) than in the placebo group (3.3 days) (P < 0.055). Stool frequency was less on the second day in the lactobacillus group (P < 0.05). The results suggest that Lactobacillus GG accelerates recovery from acute watery diarrhoea in young children in a tropical setting.

Acute Disease↗

Comparative kinetic analyses of interaction of inhibitors with Rauscher murine leukemia virus and human immunodeficiency virus reverse transcriptases.

The inhibitory effects of several nucleoside triphosphate analogs on Rauscher murine leukemia virus (RMuLV) and human immunodeficiency virus (HIV) type 1 reverse transcriptases (RTs) were studied. With RNA as the template, the apparent K(m) and apparent K(i) values of HIV RT toward its substrates and inhibitors are 12 to 500 times lower than the corresponding values for RMuLV RT. However, the k(i)/k(m) ratios (inhibition efficiencies) for HIV and RMuLV RTs'are similar for AZTTP (zidovudine triphosphate), d4TTP [3'-deoxythymidine-2'-ene-(3'-deoxy-2',3'-didehydrothymidine) triphosphate], PMEADP [9-(2-phosphonylmethoxyethyl)adenine diphosphate], FIAUTP [1-(2-fluoro-2-deoxy-beta-D-arabinofuranosyl)-5-iodouracil triphosphate], and HPMPCDP [(S)-1-(3-hydroxy-2-phosphylmethoxypropyl) cytosine diphosphate]. With DNA as the template, the K(m) values are similar for HIV and RMuLV RTs. However, the K(i)/K(m) values of HIV and RMuLV RTs are significantly different for ddCTP, ddATP, and 3TCTP (2',3'-dideoxy-3'-thiacytidine). The RTs of RMuLV and HIV are sufficiently different from one another that the kinetic inhibition constants for a particular antiviral compounds should be determined to indicate whether anti-RMuLV activity is likely to be predictive for the anti-HIV activity of the compound. This information, in conjunction with species-specific drug metabolism differences and tissue culture antiviral activity, is important in determining the suitability of a particular animal model.

Adenine↗

Regulation of microvascular filtration in the myocardium by interstitial fluid pressure.

We hypothesized that myocardial microvascular filtration rate (Jv) could be manipulated by varying end-diastolic myocardial interstitial hydrostatic (P(int)) pressure. Dogs under general anesthesia were instrumented with intramyocardial capsules to measure P(int) and with prenodal myocardial lymphatic trunk cannulas and superior vena caval balloon-tipped catheters to manipulate myocardial lymph flow. Because, for a given surface area, the lymph-to-plasma protein concentration ration (CL/CP) varies inversely with JV, CL/CP was utilized as an index of changes in JV. When lymphatic outflow pressure (P0) was elevated to abolish lymph flow and force myocardial interstitial fluid volume to expand, P(int) rose significantly from 15.0 +/- 0.8 to 27.6 +/- 1.0 mmHg and CL/CP increased significantly from 0.75 +/- 0.04 to 0.85 +/- 0.04, indicating a decrease in JV. When P0 was lowered and lymph flow resumed, P(int) and CL/CP decreased significantly to 15.3 +/- 0.9 mmHg and 0.75 +/- 0.04, respectively, indicating an increase in JV. We conclude that myocardial microvascular filtration rate may be modulated by changes in P(int) resulting from alterations in myocardial interstitial fluid volume secondary to variations in lymph flow from the heart.

Animals↗

Myocardial fluid balance in acute hypertension.

OBJECTIVES: We hypothesized that (1) acute arterial hypertension increases myocardial microvascular fluid filtration and (2) the combination of acute arterial hypertension and coronary sinus pressure elevation may increase myocardial microvascular filtration sufficiently to estimate the osmotic reflection coefficient of the myocardial exchange vessels. METHODS: In nine mechanically ventilated dogs we cannulated the prenodal major cardiac lymph trunk. With the use of central venous phenylephrine infusion, mean arterial pressure (MAP) was raised progressively to 120, 160, and 180 mm Hg. In five dogs we additionally raised coronary sinus pressure (CSP) to 20 and 40 mm Hg. At each manipulation of MAP and/or CSP, we measured indexes of myocardial lymphatic function and lymph-to-plasma concentration ratios for total protein (CL(TP)/CP(TP) and albumin (CL(alb)/CP(alb)). RESULTS: Myocardial lymph flow rate (QL; microL/min) increased exponentially (QL = 10.9.e0.014.(MAP) and myocardial lymph driving pressure (PL; mm Hg) increased linearly (PL = 2.30 + 0.20 + 0.20 . MAP) following increases, whereas CL(TP)/CP(TP) and CL(alb)/CP(alb) decreases from 0.67 +/- 0.07 (SD) to 0.56 +/- 0.10 and from 0.91 +/- 0.05 to 0.75 +/- 0.11, respectively. Adding CSP elevation increased QL up to 12 times control associated with further CL(TP)/C(TP) and CL(alb)/CP(alb) decreases to 0.49 +/- 0.05 and 0.59 +/- 0.02, respectively. CONCLUSIONS: We conclude that hypertensive arterial pressures are, at least in part, transmitted to the myocardial microvascular exchange vessels in the intact animal leading to increased microvascular fluid filtration. However, the combination of acute arterial hypertension and coronary sinus pressure elevation is not sufficient to produce filtration independence required for myocardial osmotic reflection coefficient determination.

Animals↗

Normothermic continuous antegrade blood cardioplegia does not prevent myocardial edema and cardiac dysfunction.

BACKGROUND: Normothermic continuous blood cardioplegia (BC) has been proposed to completely protect the myocardium during cardiac surgery. However, previous work from our laboratory suggests that BC could cause myocardial edema that produces cardiac dysfunction. The purpose of this present study was to evaluate the impact of BC on myocardial fluid balance and left ventricular function. METHODS AND RESULTS: In 11 dogs, myocardial water content (MWC) was determined by microgravimetry. Myocardial lymph flow rate was measured after cannulation of the major prenodal cardiac lymphatic. Preload recruitable stroke work (PRSW) was calculated by sonomicrometry and micromanometry. The dogs were placed on normothermic cardiopulmonary bypass (CPB), and BC was delivered at either 80 to 90 mm Hg (BChigh; n = 6) or 40 to 50 mm Hg (BClow; n = 5) for 1 hour. Coronary sinus lactate and oxygen saturation monitoring demonstrated ischemia avoidance. BC was associated with substantial myocardial lymph flow rate decrease (P < .05) and myocardial edema development in both groups. MWC increased from 76.0 +/- 1.9% to 79.2 +/- 1.7% (P < .05) after 10 minutes of BChigh and from 75.9 +/- 0.6% to 78.9 +/- 1.4% (P < .05) after 30 minutes of BClow. PRSW decreased to 63 +/- 19% (BChigh) and 69 +/- 15% of control (BClow) at 30 minutes after CPB (P < .05). Myocardial lymph flow rate increases of threefold to fourfold that of control (P < .05) resulted in significant myocardial edema reduction associated with PRSW improvement to 71 +/- 17% (BChigh) and to 78 +/- 11% (BClow) at 2 hours after CPB. CONCLUSIONS: We conclude that BC is associated with compromised cardiac function despite ischemia avoidance. This cardiac dysfunction is due to myocardial edema caused by the combination of increased myocardial microvascular fluid filtration and decreased myocardial lymph flow rate during BC.

Animals↗

Isolation, sequence and overexpression of the gene encoding NAD-dependent formate dehydrogenase from the methylotrophic yeast Candida methylica.

NAD-dependent formate dehydrogenase (FDH) was isolated from Candida methylica (Cm) grown on 0.5% methanol. Its N-terminal amino acid (aa) sequence was determined, as was that of a commercial FDH from Candida boidinii. Degenerate oligodeoxyribonucleotides were made to the 5' region of the fdh gene from Cm using this information and to the 3' region using C-terminal aa sequence data from the methylotropic yeast, Hansenula polymorpha. An almost complete 1.1-kb fragment was amplified from Cm genomic DNA via the polymerase chain reaction (PCR). This fragment was cloned, sequenced and used to probe a Southern blot, from which a 3.4-kb EcoRI fragment containing the fdh open reading frame (ORF) was isolated. The complete nucleotide sequence of this fdh ORF was determined and corresponds to a protein of 364 aa (40,343 Da). The ORF of fdh was cloned into pKK223-3 using PCR and transformed into Escherichia coli. Enzymatically active FDH was produced to 15% of soluble E. coli protein. The deduced aa sequence of this FDH is compared to the aa sequences of four known FDH, from bacteria, yeast, fungi and plant mitochondria.

Amino Acid Sequence↗

Transesophageal echocardiographic study of venous air embolism following pneumomediastinum in dogs.

BACKGROUND: Continuous venous air emboli have been detected in the inferior vena cava and smaller veins using transesophageal echocardiography in patients with positive pressure ventilation and associated pulmonary barotrauma. The authors hypothesized that gas entered the venous circulation, following dissection of small vessels at several sites in the subcutaneous or retro-peritoneal soft tissues. OBJECTIVE: The present study was designed to determine if a comparable venous gas embolism occurred in anesthetized dogs, after creation of a pneumomediastinum. DESIGN: Using transesophageal echocardiography, we observed 11 anesthetized dogs mechanically ventilated with positive end-expiratory pressure, while mediastinal air was introduced through a catheter at a rate of 0.5 ml/kg/min. RESULTS: A continuous stream of bubbles appeared in the inferior vena cava in 8/11 dogs (73%) after an infusion period of 280 +/- 81 min. A surge of bubbles was commonly observed following abdominal massage and was often associated with a transient decrease of end-tidal carbon dioxide tensions. In two dogs the air infusion rate was reduced to 0.25 mg/kg/min, and bubbles were detected in the inferior vena cava for as long as 16 consecutive hours. CONCLUSION: We conclude that in anesthetized dogs mechanically ventilated with positive end-expiratory pressure, unremitting pneumomediastinum is usually followed by continuous venous air embolism. A mechanism hypothesized for venous gas entry in the clinical condition of positive end-expiratory pressure ventilation with subcutaneous gas is suggested by this model.

Animals↗

A rapid antiviral in situ enzyme-linked immunosorbent assay for feline immunodeficiency virus.

An in situ enzyme-linked immunosorbent assay (ELISA) was developed as a rapid alternative to the focal infectivity assay (FIA) for screening potential anti-retroviral molecules. The assay utilizes 96-well microtiter plates to allow for determination of antiviral effect and cytotoxicity of multiple compounds simultaneously. In contrast to the FIA which requires visual scoring of foci under low-power microscopy, the 96-well ELISA is read spectrophotometrically based on the soluble alkaline phosphatase substrate, p-nitrophenyl phosphate. The IC50 and CC50 values for several antiretroviral compounds were determined using the ELISA and results were confirmed by FIA. In all cases, compounds assayed by the newly described ELISA exhibited IC50 values in agreement with literature values derived from either the FIA or reverse transcriptase assays.

Animals↗

Arterial blood sampling devices influence ionized calcium measurements.

OBJECTIVE: To determine the effect of commercially available arterial blood sampling devices on ionized calcium measurements. DESIGN: Prospective study. SETTING: Neurosurgical and shock-trauma intensive care units (ICU) at a tertiary care teaching hospital. PATIENTS: Fourteen patients admitted to the ICU. Each patient had an indwelling arterial catheter. INTERVENTIONS: Arterial blood sampling. MEASUREMENTS AND MAIN RESULTS: In 14 ICU patients, measurements of arterial blood ionized calcium concentrations were performed, using 12 different commercially available arterial blood sampling devices. Significant underestimation of ionized calcium in blood samples compared with the reference test tube (Vacutainer 45) was seen in seven of the devices. Arterial blood ionized calcium concentrations measured, using one commercially available syringe, were significantly higher compared with the reference test tube. There was no correlation between either the amount or type of heparin in the arterial blood sampling devices and arterial blood ionized calcium measurement. CONCLUSIONS: This study demonstrates that various commercially available arterial blood sampling devices alter arterial blood ionized calcium measurements. These alterations are clinically important because ICU patients may be treated with inappropriate calcium supplementation.

Arteries↗

Lactobacillus GG promotes recovery from acute nonbloody diarrhea in Pakistan.

A prospective, placebo-controlled, triple blind clinical trial was carried out in Pakistan to determine the effect of Lactobacillus GG on the course of acute diarrhea in hospitalized children. Forty children (mean age, 13 months) were enrolled and after rehydration received either oral Lactobacillus GG (n = 21) or placebo (n = 19) twice daily for 2 days, in addition to the usual diet. The clinical course of diarrhea was followed during the treatment period. Features on admission into the study groups were similar and were characterized by severe diarrhea, malnutrition and inappropriate management before presentation. Response was evident on Day 2 when the frequency of both vomiting and diarrhea was less in the Lactobacillus group. In those who had presented with acute nonbloody diarrhea (n = 32), the percentage of children with persistent watery diarrhea at 48 hours was significantly less in the Lactobacillus group: 31% vs. 75% (P < 0.01). No significant difference was observed by 48 hours in those presenting with bloody diarrhea. The relevance of this finding to the management of diarrhea in the tropics is discussed.

Acute Disease↗

Impact of cardiopulmonary bypass and cardioplegic arrest on myocardial lymphatic function.

Cardioplegic arrest (CPA) is associated with interstitial myocardial edema, which has been shown to impair myocardial function. The accumulation of interstitial myocardial edema may be enhanced by impaired myocardial lymph flow. The purpose of this study was to investigate the effects of CPA on myocardial lymphatic function. In nine anesthetized dogs, we cannulated a prenodal cardiac lymphatic and measured myocardial lymph flow rate (QL), myocardial lymph driving pressure (PL), and myocardial lymph hyaluronan (Hya) concentration. We determined left ventricular function using pressure-volume curves derived by sonomicrometry and micromanometry. The dogs were placed on cardiopulmonary bypass (CPB) (28 degrees C) and subjected to 60 min of hypothermic, crystalloid CPA. With the onset of asystole both QL and PL decreased significantly from 70.7 +/- 31.8 (SD) to 3.3 +/- 4.0 microliters/min and from 19.9 +/- 8.0 to 10.4 +/- 1.8 mmHg, respectively (P < 0.01). Following return of sinus rhythm after separation from CPB, QL and PL increased significantly to 135.4 +/- 28.0 microliters/min and 27.3 +/- 7.5 mmHg, respectively (P < 0.01). Post-CPA myocardial edema was demonstrated by gravimetric wet-to-dry weight determination of 3.67 +/- 0.20 (normal 2.90 +/- 0.20, P < 0.001) and was associated with significantly decreased left ventricular function. Myocardial Hya turnover rate was 1.3 +/- 1.0% per day under baseline conditions and increased significantly to 2.7 +/- 0.9% per day post-CPA (P < 0.01). We conclude that organized myocardial contraction is the major determinant of myocardial lymph flow. Myocardial lymph flow impairment during CPA may contribute to post-CPA myocardial edema and left ventricular dysfunction.

Animals↗