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Base Excess (base + excess)
Selected AbstractsEight Hours of Hypotensive versus Normotensive Resuscitation in a Porcine Model of Controlled Hemorrhagic ShockACADEMIC EMERGENCY MEDICINE, Issue 9 2008David E. Skarda MD Abstract Objectives:, The aim of this study was to compare hypotensive and normotensive resuscitation in a porcine model of hemorrhagic shock. Methods:, This was a prospective, comparative, randomized survival study of controlled hemorrhagic shock using 28 male Yorkshire-Landrace pigs (15 to 25 kg). In 24 splenectomized pigs, the authors induced hemorrhagic shock to a systolic blood pressure (sBP) of 48 to 58 mm Hg (,35% bleed). Pigs were randomized to undergo normotensive resuscitation (sBP of 90 mm Hg, n = 7), mild hypotensive resuscitation (sBP of 80 mm Hg, n = 7), severe hypotensive resuscitation (sBP of 65 mm Hg, n = 6), or no resuscitation (n = 4). The authors also included a sham group of animals that were instrumented and splenectomized, but that did not undergo hemorrhagic shock (n = 4). After the initial 8 hours of randomized pressure-targeted resuscitation, all animals were resuscitated to a sBP of 90 mm Hg for 16 hours. Results:, Animals that underwent severe hypotensive resuscitation were less likely to survive, compared with animals that underwent normotensive resuscitation. Mean arterial pressure (MAP) decreased with hemorrhage and increased appropriately with pressure-targeted resuscitation. Base excess (BE) and tissue oxygen saturation (StO2) decreased in all animals that underwent hemorrhagic shock. This decrease persisted only in animals that were pressure target resuscitated to a sBP of 65 mm Hg. Conclusions:, In this model of controlled hemorrhagic shock, initial severe hypotensive pressure-targeted resuscitation for 8 hours was associated with an increased mortality rate and led to a persistent base deficit (BD) and to decreased StO2, suggesting persistent metabolic stress and tissue hypoxia. However, mild hypotensive resuscitation did not lead to a persistent BD or to decreased StO2, suggesting less metabolic stress and less tissue hypoxia. [source] Attenuated endothelin-1 mRNA expression with endothelin-1 receptor blockade during hypoxaemia and reoxygenation in newborn pigletsACTA PAEDIATRICA, Issue 6 2000S Medbø We investigated the cause of decreased plasma endothelin-1 (ET-1) during hypoxaemia and reoxygenation in newborn piglets subjected to simultaneous blocking of the ET-1 receptors. Changes in plasma ET-1 and prepro-ET-1 mRNA expression in the main pulmonary artery and the left lower lobe in the lung were studied in 1-2-d-old piglets. Ten minutes prior to hypoxaemia, the hypoxaemia group (n = 10) was given saline, two groups (both n = 9) were given 1 and 5 mg/kg i.v. SB 217242 (an ET-1 receptor antagonist). Two groups served as normoxic controls, with and without SB 217242 5 mg/kg i.v. Hypoxaemia was induced by ventilating with 8% O2 until base excess was 20mmol/l or mean arterial blood pressure was < 20mmHg. Reoxygenation was performed for 2h with room air. During hypoxaemia, plasma ET-1 decreased in the hypoxaemia group, remained unchanged in the 1-mg group and increased in the 5-mg group. At the end of reoxygenation, plasma ET-1 was above baseline in the 1-mg and 5-mg groups. In the pulmonary artery, the hypoxaemia group showed 2- to 5-fold higher prepro-ET-1 mRNA expression compared to all the other groups (p < 0.05). There were trends for higher prepro-ET-1 mRNA expression in pulmonary tissue in the hypoxaemia group compared to the two receptor-blocking groups (p < 0.07). Conclusions: We conclude that hypoxaemia and reoxygenation increase prepro-ET-1 mRNA expression in the pulmonary artery in newborn piglets. These observations suggest that the half-life of ET-1 is decreased during hypoxaemia and reoxygenation in newborn piglets. [source] Topiramate-induced metabolic acidosis: report of two casesDEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 10 2001Chun-hung Ko MRCP FHKAM Medical Officer Two children who presented with symptomatic metabolic acidosis after being put on topiramate (TPM) are reported. The first patient was an 11-year-old male with refractory complex partial epilepsy who was put on TPM for 13 months. He developed hyperventilation 1 week after increasing the dose to 300mg/day. Arterial blood gas revealed hyperchloraemic metabolic acidosis with partial respiratory compensation: pH 7.36, PCO2 27.2 mmHg, bicarbonate 14.9 mEq/L, base excess -8.9 mmol/L. Hyperventilation and acidosis resolved after administration of sodium bicarbonate and reduction of the dose of TPM. The second patient was a female who developed increasing irritability at age 16 months and 21 months, each time associated with introduction of TPM and resolved promptly upon withdrawal of the drug. Venous blood gas taken during the second episode revealed pH 7.34, PCO2 37.4 mmHg, bicarbonate 20.4 mEq/L, base excess -4.2 mmol/L. The predominant mechanism of TPM-induced hyperventilation involves inhibition of carbonic anhydrase at the proximal renal tubule, resulting in impaired proximal bicarbonate reabsorption. The occurrence of hyperpnoea or mental status change in any patient who is on TPM should prompt an urgent blood gas sampling, with correction of the acid-base disturbances accordingly. [source] Predictors of anemia in patients on hemodialysisHEMODIALYSIS INTERNATIONAL, Issue 3 2009Willy AASEBØ Abstract Even though the use of erythropoietin and intravenous iron has improved the treatment of anemia in hemodialysis patients, a considerable proportion of these patients still have anemia. The aim of this study was to identify predictors of anemia in a hemodialysis population. In a single-center hemodialysis unit, all patients were studied with blood tests and their medication recorded during a period of 22 months. Correlations with hemoglobin (Hb) were performed with a simple regression or a t test. Variables that reached 5% significance were entered in a multiple regression analysis. Selected variables were presented in quartiles with levels of Hb. Mean Hb was 11.3 g/dL, and 53 patients (40%) had Hb<11.0 g/dL. In the simple regression analysis Hb correlated positively with s-iron, CHr, s-albumin, and doses of sevelamer, and negatively with sedimentation rate (SR), ferritin, base excess, and doses of erythropoietin. In the multiple regression analysis erythrocytes SR was the only variable that remained significant. Elevated SR is the strongest predictor of anemia in hemodialysis patients receiving adequate treatment with erythropoietin and intravenous iron. Patients using high doses of sevelamer had higher Hb levels than patients using low doses. [source] Long-term functional outcomes in patients with various types of orthotopic intestinal neobladderINTERNATIONAL JOURNAL OF UROLOGY, Issue 7 2008Hideaki Miyake Objectives: To evaluate the long-term functional outcomes of various types of orthotopic neobladder (NB). Methods: Eighty-nine patients who underwent orthotopic NB reconstruction after radical cystectomy and were followed for at least 60 months after surgery were included in this retrospective study. The types of NB in this series were: modified Studer type, Hautmann type, Mainz type, Goldwasser type and modified Reddy type in 36, 9, 15, 10 and 19 patients, respectively. Results: Sixty-seven (75.3%) patients could void spontaneously, 15 (16.8%) voided with clean intermittent catheterization (CIC) assistance and seven (7.9%) with CIC alone. After excluding the seven voiding with CIC alone, daytime and night-time continence was achieved in 63 and 50 of the remaining 82 patients, respectively. In addition, the proportion of daytime continence in the modified Studer group was significantly greater than that in the Mainz group, whereas there was no significant difference in the proportion of night-time continence among these groups. Uroflow examination indicated that despite the lack of significant differences in the maximal flow rates and the voided volumes, the post-void residual in the modified Reddy group was significantly smaller than that in the modified Studer group. Blood gas analysis in the 82 patients showed that there were no significant differences in the pH, bicarbonate, chloride and base excess among these groups. Conclusions: Orthotopic NB created with intestinal segments generally has acceptable functional outcomes on long term follow up. These outcomes differ according to the type of NB. To define the optimal procedure for NB reconstruction, it is necessary to understand the long-term functional prospects, on which the subjective success of NB creation is based. [source] The use of desflurane or propofol in combination with remifentanil in myasthenic patients undergoing a video-assisted thoracoscopic-extended thymectomyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2009P. GRITTI Background: Although several studies of the use of desflurane in anesthesia have revealed many desirable qualities, there are no data on the use and effects especially on the neuromuscular function of desflurane on myasthenia gravis (MG) patients. The purpose of this study was to evaluate the use of either desflurane or propofol, both combined with remifentanil, in patients with MG undergoing a video-assisted thoracoscopic-extended thymectomy (VATET). Methods: Thirty-six MG patients who underwent VATET were enrolled. Nineteen patients were anesthetized with remifentanil and propofol infused with a target-controlled infusion plasma model, and 17 patients with desflurane and remifentanil. No muscle relaxant was used. The intubating conditions, hemodynamic and respiratory changes, neuromuscular transmission and post-operative complications were evaluated. Results: Neuromuscular transmission was significantly decreased in the desflurane group (6.7%, from 3% to 9% during anesthesia P=<0.05). The intubating conditions were good in all 36 patients and 35 patients were successfully extubated in the operating room. The time-to-awakening, post-operatory pH and base excess were significantly different in the two groups, with a decreasing mean arterial pressure in the group administered with desflurane. No patients required reintubation due to myasthenic or cholinergic crisis, or respiratory failure. No other significant differences between the two groups studied were observed. Conclusion: Our experience indicates that anesthesia with desflurane plus remifentanil in patients with MG could determine a reversible muscle relaxation effect, but with no clinical implication, allowing a faster recovery with no difference in extubation time and post-operative complications in the two groups. [source] Effect of Labour and Delivery on Plasma Hepatic Enzymes in the NewbornJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 1 2000Dr. Max Mongelli Abstract Objective: To study the relationship between cord blood hepatic enzymes and obstetric and neonatal outcome in a Chinese population. Materials and Methods: The study group consisted of 288 low-risk Chinese women with singleton term pregnancies. The following enzymes were assayed in cord blood: lactate dehydrogenase (LDH), glutamyl transferase (GGT), aspartate aminotransferase (AST) and alanine transferase (ALT). These were correlated to maternal and neonatal characteristics. Results: A strong correlation was noted between cord blood AST and LDH (R = 0.582, p < 0.01), which was absent amongst those infants delivered by elective cesarean section. LDH, AST and ALT were negatively correlated with cord arterial pH and base excess (BE). GGT was inversely related only to gestational age (R = - 0.18, p < 0.01). Both LDH and AST were weakly correlated with the duration of the first and second stages of labour. LDH was most closely linked to arterial pH, whereas AST was related to both arterial BE and duration of the second stage. Conclusions: The reference values are comparable to those published for Caucasian populations. There are moderate elevations in LDH and AST associated with the onset of labour and changes in acid-base status. [source] A case-based review of a simplified quantitative approach to acid-base analysisJOURNAL OF VETERINARY EMERGENCY AND CRITICAL CARE, Issue 5 2008DACVECC, Kate Hopper BVSc Abstract Objective , To present a simplified quantitative approach to acid-base analysis and to demonstrate its clinical utility. Data Sources , Original research articles and textbooks. Data Synthesis , A simplified quantitative approach to acid-base analysis is presented, which is derived from the Fencl-Stewart approach and calculates the magnitude of the effect on the standardized base excess (SBE) of 5 separate variables: (1) a free water effect (marked by sodium concentration), (2) an effect marked by the chloride concentration, (3) an albumin effect, (4) a lactate effect, and (5) a phosphate effect. Six clinical cases with acid-base abnormalities are presented in which the quantitative approach provides information that is not apparent from the traditional approach. Conclusion , This simplified quantitative approach provides a comprehensive evaluation of complex acid-base disorders, identifies individual processes and their relative influence on SBE, and aids in the development of an appropriate therapeutic plan. [source] Varying clinical presentations at onset of type 1 diabetes mellitus in children , epidemiological evidence for different subtypes of the disease?PEDIATRIC DIABETES, Issue 4 2001Andreas Neu Abstract: Objective:, On the basis of 2121 case observations between 1987 and 1997, we describe the clinical and laboratory characteristics of diabetes mellitus type 1 at its onset. Our objective is to analyze whether clinical presentation follows a uniform pattern or whether there is evidence for different subtypes. Research design and methods: Thirty-one pediatric hospitals and one diabetes center in Baden-Wuerttemberg (BW), Germany, participated in this study. The hospital records of 2121 children below 15 yr of age were examined retrospectively. Statistical analysis was done after logarithmic transformation into a normal distribution. Results: The average duration of symptoms was found to be 15.2 d (95% CI (Confidence Intervals) = 14.3,16.1) ranging between 2.0 and 180 d (95% central range). The most frequent symptoms were polyuria and polydipsia; 7.2% presented with altered level of consciousness. The mean blood glucose value was 407.9 mg/dL (95% CI = 400.0,416.0), corresponding to 23.3 mmol/L (95% CI = 22.8,23.8). The median pH value was 7.35 (95% CI = 7.34,7.36), and the median base excess was ,5 mmol/L (95% CI =,5 to ,4). The younger patients had a shorter duration of symptoms and suffered most frequently from ketoacidosis. Conclusions: Although the symptoms of diabetes at its onset follow a uniform pattern, the clinical presentation and duration of symptoms indicate that there may be various forms of type 1 diabetes. [source] ORIGINAL ARTICLE: Maternal Blood Serum and Plasma Human Tumor-Associated Antigen RCAS1 During the Course of Uncomplicated Pregnancies: A Prospective StudyAMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 3 2010Ekaterine Tskitishvili Citation Tskitishvili E, Sharentuya N, Tsubouchi H, Kinugasa-Taniguchi Y, Kanagawa T, Shimoya K, Tomimatsu T, Kimura T. Maternal blood serum and plasma human tumor-associated antigen RCAS1 during the course of uncomplicated pregnancies: a prospective study. Am J Reprod Immunol 2010; 64: 218,224 Problem, We aimed to investigate the expression of the tumor-associated RCAS1 protein in maternal blood of uncomplicated pregnancies. Method of study, Maternal blood was obtained from women with uncomplicated pregnancies (N = 43) at 11,13, 20,22, 32,34, 37,38 weeks of gestation, and immediately after delivery. Serum RCAS1 concentration was studied by ELISA, and plasma mRNA was subjected to real-time (RT)-PCR. Results, Serum RCAS1 protein concentration was significantly up-regulated at 11,13 and 20,22 weeks than that at 32,34 weeks and after delivery. RCAS1 mRNA level was significantly increased at 11,13 weeks than that at 37,38 weeks. A significant positive correlation was defined between RCAS1 serum concentration at 11,13 weeks and gestational age at delivery and that between plasma RCAS1 mRNA levels at 37,38 weeks and umbilical cord blood base excess. A significant negative correlation was found between RCAS1 serum concentration at 37,38 weeks and umbilical cord blood pH at delivery. Conclusions, RCAS1 protein might have importance in the development of uncomplicated pregnancies and for the prediction of pregnancy outcome. [source] Original Article: Benefits of introducing universal umbilical cord blood gas and lactate analysis into an obstetric unitAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 4 2010Christopher R.H. WHITE Background:, Current evidence suggests that umbilical arterial pH analysis provides the most sensitive reflection of birth asphyxia. However, there's debate whether umbilical cord blood gas analysis (UC-BGA) should be conducted on some or all deliveries. Aim:, The aim of this study was to evaluate the impact of introducing universal UC-BGA at delivery on perinatal outcome. Methods:, An observational study of all deliveries ,20 weeks' gestation at a tertiary obstetric unit between January 2003 and December 2006. Paired UC-BGA was performed on 97% of deliveries (n = 19,646). Univariate and adjusted analysis assessed inter-year UC-BGA differences and the likelihood of metabolic acidosis and nursery admission. Results:, There was a progressive improvement in umbilical artery pH, pO2, pCO2, base excess and lactate values in univariate and adjusted analyses (P < 0.001). There was a significant reduction in the newborns with an arterial pH <7.10 (OR = 0.71; 95%CI 0.53,0.95) and lactate >6.1 mmol/L (OR = 0.37; 95%CI 0.30,0.46). Utilising population specific 5th and 95th percentiles, there was a reduction in newborns with arterial pH less than 5th percentile (pH 7.12; OR = 0.75; 95%CI 0.59,0.96) and lactate levels greater than 95th percentile (6.7 mmol/L; OR = 0.37; 95%CI 0.29,0.49). There was a reduction in term (OR = 0.65; 95%CI 0.54,0.78), and overall (OR = 0.75; 95%CI 0.64,0.87) nursery admissions. These improved perinatal outcomes were independent of intervention rates. Conclusions:, These data suggest that introduction of universal UC-BGA may result in improved perinatal outcomes, which were observed to be independent of obstetric intervention. We suggest that these improvements might be attributed to provision of biochemical data relating to fetal acid-base status at delivery influencing intrapartum care in subsequent cases. [source] Effects of Formaldehyde on Cardiovascular System in In Situ Rat HeartsBASIC AND CLINICAL PHARMACOLOGY & TOXICOLOGY, Issue 4 2009Daisuke Takeshita After 20,30 min. of intravenous infusion of 3.7% formaldehyde solution (FA) at 10 ,l (3.7 mg)/kg/min, normal and hypertrophic hearts showed significant decreases in left ventricle end-systolic pressure (ESP), heart rate and cardiac output per minute, indicating an acute pumping failure. Hypertrophic hearts showed significantly smaller ESP, stroke volumes and cardiac output than those in normal hearts. Systolic pressure,volume area at midrange left ventricular volume (PVAmLVV: a mechanical work capability index) was significantly smaller than that in normal hearts and per cent of mean PVAmLVVversus pre-infusion mean value in hypertrophic hearts was significantly decreased compared to normal hearts 30 min. after FA infusion. The marked decrease in pH, base excess and no changes in PaO2 and PaCO2 suggest metabolic acidosis. The correction of metabolic acidosis with 9% NaHCO3 did not influence on the acute pumping failure, indicating that metabolic acidosis did not cause it. Ultrastructural observations revealed marked dilation of the sarcoplasmic reticulum with intact sarcolemmal membranes and no disintegration of muscle myofibrils. Ryanodine receptors and calcium (Ca2+) pumps (SERCA2A) located in the sarcoplasmic reticulum have major roles in the cytosolic Ca2+ handling. Taken together, acute pumping failure by FA may derive from the impairment of Ca2+ handling in the cardiac excitation,contraction coupling. [source] Determining the Optimal Dose of Intravenous Fat Emulsion for the Treatment of Severe Verapamil Toxicity in a Rodent ModelACADEMIC EMERGENCY MEDICINE, Issue 12 2008Eric Perez MD Abstract Objectives:, Recent animal studies have shown that intravenous fat emulsion (IFE) increases survival and hemodynamics in severe verapamil toxicity. However, the optimal dose of IFE is unknown. The primary objective was to determine the optimal dose of IFE based on survival in severe verapamil toxicity. Secondary objectives were to determine the effects on hemodynamic and metabolic parameters. The hypothesis was that there is a dose-dependent effect of IFE on survival until a maximum dose is reached. Methods:, This was a controlled dose-escalation study. Thirty male rats were anesthetized, ventilated, and instrumented to record mean arterial pressure (MAP) and heart rate (HR). Verapamil toxicity was achieved by a constant infusion of 15 mg/kg/hr. After 5 minutes, a bolus of 20% IFE was given. Animals were divided into six groups based on differing doses of IFE. Arterial base excess (ABE) was measured every 30 minutes. Data were analyzed with analysis of variance. Results:, The mean survival time for each dose of IFE was 0 mL/kg = 34 minutes, 6.2 mL/kg = 58 minutes, 12.4 mL/kg = 63 minutes, 18.6 mL/kg = 143.8 minutes, 24.8 mL/kg = 125.6 minutes, and 37.6 mL/kg = 130 minutes. Post hoc testing determined that the 18.6 mL/kg dose resulted in the greatest survival when compared to other doses. It increased survival 107.2 minutes (p = 0.004), 91.2 minutes (p = 0.001), and 80.8 minutes (p = 0.023) when compared to the lower doses of 0, 6.2, and 12.4 mL/kg, respectively. There was no added benefit to survival for doses greater than 18.6 mL/kg. The secondary outcomes of HR, MAP, and ABE showed the most benefit with 24.8 mL/kg of IFE at both 30 and 60 minutes. Conclusions:, The greatest benefit to survival occurs with 18.6 mL/kg IFE, while the greatest benefit to HR, MAP, and BE occurs at 24.8 mL/kg IFE. The optimal dose for the treatment of severe verapamil toxicity in this murine model was 18.6 mL/kg. [source] Titration of poly(dA-dT) · poly(dA-dT) in solution at variable NaCl concentrationBIOPOLYMERS, Issue 2 2004Marta Airoldi Abstract CD and uv absorption data showed that high molecular weight poly(dA-dT) · poly(dA-dT), at 298 K, undergoes an acid-induced transition from B-double helix to random coil in NaCl solutions of different concentrations, ranging from 0.005 to 0.600M. Similarly, titration of the polynucleotide with a strong base causes duplex-to-single strands transition. The base- and acid-induced transitions were both reversible by back-titration (with an acid or, respectively, with a base): the apparent pKa were the same in both directions. However, the number of protons per titratable site (adenine N1) required to reach half-denaturation was in great excess over the stoichiometric value; to a much larger extent, the same effect was observed also for the deprotonation of the N3H sites of thymine. Moreover, in the basic denaturation experiments, at low salt concentrations ([NaCl],0.300M) less acid than calculated was needed to back-titrate the base excess to half-denaturation. Both effects could be qualitatively justified on the basis of the counterion condensation theory of polyelectrolytes and considering the energy barrier created by the negatively charged phosphodiester groups to the penetration of the OH, ions inside the double helix and the screening effect of the Na+ ions on such charges, in the deprotonation experiments. © 2004 Wiley Periodicals, Inc. Biopolymers, 2004 [source] The Proinflammatory Cytokine Response following Resuscitation in the Swine Model Depends on the Method of Ventricular Fibrillation InductionACADEMIC EMERGENCY MEDICINE, Issue 10 2008James T. Niemann MD Abstract Objectives:, A systemic inflammatory response has been reported following resuscitation from cardiac arrest. The purpose of this study was to compare the magnitude of the tumor necrosis factor-, (TNF-,) response in two different swine models of ventricular fibrillation (VF) arrest. Methods:, This was a randomized comparative trial conducted with domestic swine (N = 28, mean weight 40 kg, range 34,49 kg) of both genders. Anesthetized and instrumented swine were randomized to electrically induced VF (n = 14) or spontaneous VF induced by occlusion of a coronary artery (n = 14). After 8 minutes of VF, countershocks were given and standard advanced cardiac life support was initiated. Resuscitated animals were observed for 3 hours, and hemodynamics, base excess, and TNF-, concentrations were measured at intervals. Results:, TNF-, concentrations were significantly greater in the ischemic VF group throughout the postresuscitation period. Multivariate modeling demonstrated that the TNF-, level was dependent on the method of VF induction and correlated with ischemia time (untreated VF period plus time to restoration of circulation) and the degree of postresuscitation hypoperfusion as reflected in base excess measurements. Conclusions:, This study demonstrates that TNF-, concentrations increase after resuscitation from cardiac arrest and that the TNF-, response is more profound in animals subjected to ischemic, spontaneous VF. The observed differences may be due to a longer resuscitation time and persistent postresuscitation hypoperfusion in the ischemic VF group. These differences need to be considered in studies evaluating mechanisms of postresuscitation organ dysfunction and defining mortality markers. [source] Delayed umbilical cord clamping at birth has effects on arterial and venous blood gases and lactate concentrationsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2008N Wiberg Objective, To estimate the influence of delayed umbilical cord clamping at birth on arterial and venous umbilical cord blood gases, bicarbonate (), base excess (BE) and lactate in vigorous newborns. Setting, University hospital. Design, Prospective observational. Sample, Vaginally delivered term newborns. Material and methods, Umbilical cord arterial and venous blood was sampled repeatedly every 45 seconds (T0= time zero; T45= 45 seconds, T90= 90 seconds) until the cord pulsations spontaneously ceased in 66 vigorous singletons with cephalic vaginal delivery at 36,42 weeks. Longitudinal comparisons were performed with the Wilcoxon signed-ranks matched pairs test. Mixed effect models were used to describe the shape of the regression curves. Main outcome measures, Longitudinal changes of umbilical cord blood gases and lactate. Results, In arterial cord blood, there were significant decreases of pH (7.24,7.21), (18.9,18.1 mmol/l) and BE (,4.85 to ,6.14 mmol/l), and significant increases of PaCO2 (7.64,8.07 kPa), PO2 (2.30,2.74 kPa) and lactate (5.3,5.9 mmol/l) from T0 to T90, with the most pronounced changes at T0,T45. Similar changes occurred in venous blood pH (7.32,7.31), (19.54,19.33 mmol/l), BE (,4.93 to ,5.19 mmol/l), PaCO2 (5.69,5.81 kPa) and lactate (5.0,5.3 mmol/l), although the changes were smaller and most pronounced at T45,T90. No significant changes were observed in venous PO2. Conclusion, Persistent cord pulsations and delayed cord clamping at birth result in significantly different measured values of cord blood acid,base parameters. [source] A pilot study for a randomised controlled trial of waterbirth versus land birthBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2004Joanne Woodward Objectives To assess the feasibility of undertaking an adequately powered multicentre study comparing waterbirth with land birth. To assess whether women are willing to participate in such a trial and whether participation has a negative effect on their birthing experience. Design A randomised controlled trial (RCT) with ,preference arm'. Setting District general hospital with 3600 deliveries annually. Population Women with no pregnancy complications and no anticipated problems for labour/delivery. Methods Women were recruited and randomised between 36 and 40 weeks of gestation. Comparison of randomised and ,preference arm' to assess any impact of randomisation on women's birthing experience. Main outcome measures Data were collected at delivery concerning the labour, the pool water and baby's condition at birth and six weeks of age. The main outcome measures are means and standard deviation of cord O2, CO2, haemoglobin, haematocrit and base excess; medians and ranges of time to first breathe and cord pH; bacterial growth from pool water samples and neonatal swabs; and maternal satisfaction. Results Eighty women participated,60 women were randomised. Twenty women participated in a non-randomised ,preference arm'. The babies randomised to a waterbirth demonstrated a significantly lower umbilical artery pCO2 (P= 0.003); however, it is recognised that this study is underpowered. Women were willing to participate and randomisation did not appear to alter satisfaction. Conclusion This small study has shown that a RCT is feasible and demonstrated outcome measures, which can be successfully collected in an average delivery suite. [source] Deterioration in cord blood gas status during the second stage of labour is more rapid in the second twin than in the first twinBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2004Tak-Yeung Leung Objective To compare in twin pregnancy the rate of deterioration in umbilical blood gas status during the second stage of labour, and to investigate whether the duration of the first twin's delivery has any effect on the blood gas status of the second twin. Design A retrospective study. Setting Department of Obstetrics and Gynaecology in a university teaching hospital. Population Twin pregnancies with both of the twins delivered by normal cephalic vaginal mode, at or beyond 34 weeks of gestation, over a period of seven years. Twins with any maternal or fetal complications including discordant growth, intrauterine growth restriction, intrauterine death, fetal malformations, fetal distress, pre-eclampsia and diabetes were excluded. Methods The first twins' second stage was defined as from the start of maternal pushing to his/her delivery, while the second twins' second stage started after the delivery of the first twin and ended by his/her delivery. The total duration of the second stage was the sum of the above two intervals. The correlations between the first twins' umbilical cord blood gas parameters and the duration of their own second stage, the second twins' umbilical cord blood gas parameters and the duration of their own second stage, as well as that of the total second stage, were studied. Main outcome measures The changes of umbilical arterial pH of each twin with the duration of the corresponding second stage of labour, and the difference among them. Results A total of 51 cases were reviewed. The median gestation at delivery was 37 weeks. The median duration of first twins' second stage was 10 minutes (range 1,75) while that of the second twins' was 10 minutes (range 3,26). The first twins' second stage was inversely correlated with their arterial pH, venous pH and base excess [BE] (P < 0.01). Both the second twins' second stage and the total second stage were inversely correlated with both of their arterial and venous pH and BE (P < 0.01). However, further multiple regression analysis suggested that the correlation of the total second stage with the second twins' cord blood parameters could be solely explained by their own second stage. The rate of reduction in the second twins' arterial pH was 4.95 × 10,3 per minute, and was significantly faster than that of the first twins', which was 1.55 × 10,3 per minute (P < 0.05). Conclusions During normal vaginal delivery, the umbilical cord blood gas status of both the first and the second twins deteriorated with the duration of their corresponding second stages, but the effects are greater in the latter. Furthermore, the duration of the first twins' second stage does not affect the blood gas status of the second twins'. These observations support the postulation of a diminished uteroplacental exchange function after the delivery of the first twin. Close monitoring and expeditious delivery of the second twins are important. [source] Hemodynamic Effects of Intravenous Fat Emulsion in an Animal Model of Severe Verapamil Toxicity Resuscitated with Atropine, Calcium, and SalineACADEMIC EMERGENCY MEDICINE, Issue 2 2007Theodore C. Bania MD Background Intravenous fat emulsion (IFE) decreases cardiotoxicity from several lipid-soluble drugs, including verapamil. Objectives To verify if the addition of IFE to the standard treatment of severe verapamil toxicity would improve hemodynamics and survival. Methods Fourteen dogs were instrumented to measure systolic blood pressure, diastolic blood pressure, mean arterial pressure (MAP), heart rate, cardiac output, central venous pressures, left ventricular pressure changes over time, mixed venous oxygen saturation, pH, and base excess. Verapamil toxicity, defined as a 50% decrease in MAP, was induced with verapamil at 6 mg/kg/hr and maintained for 30 minutes by titrating the verapamil infusion rate. Following verapamil toxicity, the verapamil infusion rate was changed to 2 mg/kg/hr and continued for 90 minutes. All dogs were resuscitated with atropine (0.04 mg/kg intravenously) and calcium chloride (15 mg/kg intravenously every 5 minutes for three doses) and then randomized to receive either IFE (7 mg/kg of 20%) intravenously or equivalent volumes of 0.9% normal saline over 30 minutes. Measurements were recorded for 120 minutes by investigators blinded to the treatment. Data were analyzed using analysis of variance, survival analysis, and log-rank test. Results Before the 30-minute IFE or normal saline infusion, there were no differences in hemodynamic parameters. After IFE or normal saline infusion, the IFE-treated group had higher MAP at 30 minutes (95% confidence interval [CI] = 5.6 to 44.7 mm Hg), 45 minutes (95% CI = 10.8 to 50.0 mm Hg), and 60 minutes (95% CI = 10.2 to 53.1 mm Hg). Kaplan,Meier 120-minute survival rate was 14% (95% CI = 0.5% to 53%) for the saline group as compared with 100% (95% CI = 59% to 100%) for the IFE group (p = 0.01). Conclusions Standard resuscitation and IFE increase MAP and survival in an animal model of severe verapamil toxicity compared with standard resuscitation alone. [source] Non-Typhi Salmonella gastroenteritis in children presenting to the emergency department: characteristics of patients with associated bacteraemiaCLINICAL MICROBIOLOGY AND INFECTION, Issue 8 2005M. Bar-Meir Abstract The records of children with Salmonella gastroenteritis only (n = 97), and those with associated bacteraemia (n = 64), seen in one medical centre during a 12-year period, were analysed retrospectively. Mean patient age was 2.24 ± 2.8 years (range, 0.05,16 years), and 49% were male. Children with bacteraemia presented after a longer duration of symptoms (7.0 ± 6.9 vs. 3.9 ± 4.6 days, p 0.0002), and had higher erythrocyte sedimentation rates (45 ± 22 vs. 33 ± 22 mm/h, p < 0.02) and lactate dehydrogenase values (924 ± 113 vs. 685 ± 165 IU/L, p 0.001). There was a trend in bacteraemic children towards immunosuppression (6.3% vs. 1.0%, p 0.08) and a lower number of siblings (2.9 ± 1.9 vs. 3.8 ± 2.7, p 0.063). Non-bacteraemic children had a more severe clinical appearance, and a higher percentage had a moderate to bad general appearance (51.5 vs. 29.7%, p < 0.01), with dehydration (37.1 vs. 18.8%, p 0.02) and vomiting (58.8 vs. 39.0%, p 0.02). Laboratory dehydration indicators were also markedly worse in non-bacteraemic children, with urine specific gravity of 1020 ± 9.4 vs. 1013 ± 9.0 (p 0.0002), base excess of ,,4.2 ± 3.0 vs. ,,2.5 ± 3.4 mEq/L (p 0.01), and blood urea nitrogen of 10.1 ± 7.0 vs. 7.4 ± 4.5 mg% (p 0.002). Thus, the clinical presentation of bacteraemic children was more gradual, and associated gastroenteritis and dehydration was less pronounced. These findings may contribute in part to the inadvertent discharge of bacteraemic children from the emergency department. [source] | ||||||||||