Role of the L-citrulline/L-arginine cycle in iNANC nerve-mediated nitric oxide production and airway smooth muscle relaxation in allergic asthma.

Nitric oxide synthase (NOS) converts L-arginine into nitric oxide (NO) and L-citrulline. In NO-producing cells, L-citrulline can be recycled to L-arginine in a two-step reaction involving argininosuccinate synthase (ASS) and -lyase (ASL). In guinea pig trachea, L-arginine is a limiting factor in neuronal nNOS-mediated airway smooth muscle relaxation upon inhibitory nonadrenergic noncholinergic (iNANC) nerve stimulation.

Arginase strongly impairs neuronal nitric oxide-mediated airway smooth muscle relaxation in allergic asthma.

Background: Using guinea pig tracheal preparations, we have recently shown that endogenous arginase activity attenuates inhibitory nonadrenergic noncholinergic (iNANC) nerve-mediated airway smooth muscle relaxation by reducing nitric oxide (NO) production--due to competition with neuronal NO-synthase (nNOS) for the common substrate, L-arginine. Furthermore, in a guinea pig model of allergic asthma, airway arginase activity is markedly increased after the early asthmatic reaction (EAR), leading to deficiency of agonist-induced, epithelium-derived NO and subsequent airway hyperreactivity. In this study, we investigated whether increased arginase activity after the EAR affects iNANC nerve-derived NO production and airway smooth muscle relaxation.

Thrombosis and hemorrhage in heparin-induced thrombocytopenia in seriously ill patients.

Objective: Heparin-induced thrombocytopenia (HIT) is the most common form of drug-induced immune-mediated thrombocytopenia. HIT may be aggravated by life-threatening arterial and venous thrombosis and, to a lesser extent, hemorrhagic complications. We investigated the incidence of thromboembolic and hemorrhagic complications in critically ill patients with the multiple organ dysfunction syndrome and HIT.

No benefit of intraoperative whole blood sequestration and autotransfusion during coronary artery bypass grafting: results of a randomized clinical trial.

Objectives: In a randomized clinical trial of patients undergoing elective coronary artery bypass grafting, we evaluated the effect of intraoperative whole blood sequestration and autotransfusion on postoperative blood loss and the use of allogeneic blood products.

Methods: Male patients were included if it was possible to obtain at least 500 mL of autologous blood. For patients in group H (heparin autotransfusion, 50 patients; mean age 59 +/- 8 years), an average of 670 +/- 160 mL heparinized blood was drawn before bypass and reinfused after the period of the extracorporeal circulation.

S100 protein content of umbilical cord blood in healthy newborns in relation to mode of delivery.

Background: Early detection and quantification of brain damage in neonatal asphyxia is important. In adults, S100 protein in blood is associated with damage to the central nervous system.

Objective: To determine whether S100 protein can be detected in arterial and venous cord blood of healthy newborns and to relate S100 protein concentrations in cord blood to mode of delivery.

Catheter replacement in continuous arteriovenous hemodiafiltration: the balance between infectious and mechanical complications.

Objective: To assess the optimal moment of central vascular catheter replacement balancing infectious and mechanical complications in continuous renal replacement therapies in critically ill patients with acute renal failure.

Methods: Prospective sequential trial with historical controls to compare liberal catheter replacement when clinically indicated with routine catheter replacement every 5 days in consecutive patients treated by continuous arteriovenous hemodiafiltration in a level I secondary referral intensive care unit of a university-affiliated teaching hospital. Intention-to-treat analysis.

Transcranial Doppler monitoring during carotid endarterectomy helps to identify patients at risk of postoperative hyperperfusion.

Objectives: to investigate whether transcranial Doppler (TCD) monitoring can identify patients at risk of hyperperfusion, and whether active postoperative treatment of selected patients decreases the risk of intracerebral haemorrhage (ICH).

Design: a case cohort study of 688 patients undergoing carotid endarterectomy (CEA) with intraoperative TCD monitoring.

Methods: sixty-two patients (9%) fulfilled the TCD criteria for hyperperfusion, i.

Ruptured abdominal aortic aneurysms: factors influencing postoperative mortality and long-term survival.

Objective: To update mortality rates and long-term survival of patients admitted to the hospital with ruptured abdominal aortic aneurysm (AAA) and to study prognostic factors associated with mortality.

Design: Retrospective follow-up.

Materials: 309 patients (274 men, 35 women, average age 71) admitted to the hospital between January 1980 and January 1994 who were surgically treated for ruptured AAA were studied.

Cardio-pulmonary-bypass time has important independent influence on mortality and morbidity.

Objective: To determine the influence of cardio-pulmonary-bypass-time on hospital mortality and ICU-morbidity in isolated CABG surgery.

Methods: Between 1985 and 1994 perioperative data of 8578 consecutive CABG operations were prospectively collected. Seven variables: gender, redo vs.

Delirium and cognitive disorders after cardiac operations: relationship to pre- and intraoperative quantitative electroencephalogram.

We examined the incidence of delirium and cognitive disorders after cardiac operations and the related risk factors. The value of pre- and intraoperative QEEG was determined. Using the Mini-Mental State Examination and the Saskatoon Delirium Checklist, 321 patients were tested during the immediate postoperative period.

Selective decontamination of the digestive tract: effect of cessation of routine application at an ICU.

Background: Selective decontamination of the digestive tract (SDD) with non-absorbable antibiotics was extensively used at intensive care units (ICU) in Europe to prevent nosocomial infections in critically ill patients. After three recent meta-analyses in which it was demonstrated that SDD did not influence hospital stay and mortality in these patients several ICU's decided to stop the routine use of SDD.

Objective: To examine the effects of the cessation of SDD on nosocomial infections, mortality and hospital stay at an ICU in post-operative patients.

The relationship between sigmoidal intramucosal pH and intestinal arterial occlusion during aortic reconstructive surgery.

Objectives: To investigate the effects of perioperative occlusion of intestinal arteries on clinical outcome and changes in sigmoidal intramuscular pH (pHi). To determine the value of sigmoidal pHi measurement in predicting ischaemic colitis after aortic reconstructive surgery.

Design: Prospective, non-selective, open study.

[Results of long-term intensive care in 223 patients].

Objective: To determine survival rates of patients treated for more than 30 days in an intensive care unit (ICU).

Design: Retrospective, descriptive.

Setting: Intensive care unit of the St.

[A rare cause of hemiparesis: cerebral hydatidosis].

A 6-year-old Turkish boy was brought to the Netherlands by his immigrant father because of hemiparesis. There were no signs of raised intracranial pressure. Cerebral hydatidosis was diagnosed.

[An infant with short stature and red cheeks (Rothmund-Thomson syndrome)].

An infant with short stature and progressive skin lesions of cheeks and dorsum of the hands is described. Further problems such as recurrent diarrhoea and respiratory infections suggested zinc-deficiency, malabsorption-syndrome, Bloom syndrome and early Lupus Erythematosus respectively. Finally Rothmund-Thomson syndrome was diagnosed.

Pulmonary shunting after cardiopulmonary bypass.

The effect of cardiopulmonary bypass (CPB) on pulmonary function was investigated in 32 adult patients, including 23 patients undergoing coronary artery bypass grafting and nine patients undergoing heart-valve replacement. Clinical indicators for pulmonary insufficiency, such as chest X-ray, gas exchange and lung function tests were measured. Transthoracic electrical impedances were measured, and the mean specific thoracic impedance (RHO) was calculated.

Renal function following open heart surgery: the influence of postoperative artificial ventilation.

In order to detect changes in renal perfusion and function in the postoperative period of open heart surgery, a prospective study of 21 patients following open heart surgery was performed. Cardiac output, renal blood flow, glomerular filtration and renal function parameters were determined during intermittent positive pressure ventilation (IPPV), and during spontaneous ventilation (SV). During IPPV, renal perfusion was found to be substantially decreased.

Haematological characteristics of a new membrane oxygenator: the Cobe CML.

The new Cobe CML membrane oxygenator is more compact than other membrane oxygenators and has a combined venous and cardiotomy suction reservoir. Its size makes it as easy to use as a bubble oxygenator. The studies reported here were designed to show whether the excellent haemocompatibility found with other types of membrane oxygenators had ben compromised by the changes introduced in the Cobe CML oxygenator.

The effect of hemodynamic factors on cardiac performance following open heart surgery.

Sixteen patients who had undergone open heart surgery were studied in order to determine the factors influencing cardiac performance in the postoperative period. Hemodynamic influences during and following cardiopulmonary bypass were found to be more important than the preoperative cardiac function. The flow rate used during cardiopulmonary bypass had a pronounced influence on the post-operative cardiac performance.

Hematological advantage of a membrane oxygenator over a bubble oxygenator in long perfusions.

To determine whether the large volumes of cardiotomy suction which occur during long perfusions can obscure the hematological advantage of the membrane oxygenator (MO) over the bubble oxygenator (BO), we studied 23 patients undergoing a coronary artery bypass grafting operation with an expected perfusion time of 3 hours (MO group, N = 10, SciMed spiral coil; BO group, N = 13, Shiley 100-A). During MO perfusion we found significantly higher platelet numbers, better platelet function (adenosine diphosphate-induced platelet aggregation), and less hemolysis (plasma hemoglobin), than during the BO perfusion. After the MO perfusion we measured significantly shorter bleeding times (Simplate II) and fewer transfusions of blood products.

Serious acute renal failure following open heart surgery.

The influence of 51 preoperative, peroperative and postoperative variables on the development of serious acute renal failure (ARF) following open heart surgery was studied. Although a large number of significant variables was found, a logit-model with only 2 explanatory variables showed an almost perfect fit. With this model the chances of serious ARF up to 90% were estimated.

Controlled cardiotomy suction during clinical bubble oxygenator perfusions.

Cardiotomy suction causes platelet damage and hemolysis due to air aspiration along with blood suction (uncontrolled suction = US). However, prevention of air aspiration (controlled suction = CS) reduces platelet damage and hemolysis and improves postoperative hemostasis, as only attainable in membrane oxygenator (MO) perfusions. We therefore studied 3 groups of patients subjected to extracorporeal circulation: bubble oxygenator (BO) with CS (n = 10), BO with US (n = 8) and MO with US (n = 10).

Assessment of gestational age: a simplified scoring system.

Because of the disadvantages of the Dubowitz score in very ill preterms, an alternative score based on 7 morphological items was designed, and the results are compared to those of the Dubowitz score in 229 newborns. This scoring system proved to be reliable and easy to perform; standard deviation was +/- 10.2 days versus 9.