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Introduction: A wide range of acid base fluctuations are seen during Cardiopulmonary bypass (CPB) and the development of metabolic acidosis is well recognized. We conducted a study tocompare the metabolic effects of Ringer lactate and Plasmalyte-A as CPB prime in causing bypass associated acidosis in valve replacement surgeries. Methods: We performed a prospective, randomized controlled study on a total of 80 adult patients undergoing CPB for valvular heart surgeries. The patients were randomized into two groups: Group I (Ringer Lactate) and Group II (Plasmalyte-A). Arterial blood samples were taken before initiating CPB, 30 minutes after starting CPB, then every half hourly till termination of CPB and after half an hour stay in the ICU post operatively to analyze primarily H+ ions, bicarbonates, lactate and strong ion difference. Results and Discussion: The results were analyzed in a quantitative manner. In Ringer Lactate group, during CPB, there was reduction in pH from 7.428 ± 0.029 at T1 to 7.335 ± 0.06 (P < 0.01) and 7.358 ± 0.06 (P < 0.01) at T2 and T3 respectively. Mean bicarbonates decreased in Ringer Lactate group during CPB from 24.28 ± 1.65 mEq/L at T1 to 20.98 ± 2.97 mEq/L at T2 (P < 0.01). In Plasmalyte-A group, mean pH, bicarbonate, strong ion difference (SID) were comparable at all time intervals (P > 0.05). In Ringer Lactate group, maximum surge in mean blood lactate levels was seen from 0.85 ± 0.35 mmol/l at T1 to 4.29 ± 1.78 mmol/L (P < 0.01) and 4.17 ± 1.28 mmol/L (P < 0.01) at T2 and T3, respectively. Such surge was not seen in Plasmalyte-A group. The mean SID decreased during the CPB in Ringer Lactate group from 41.102 mEq/L at T1 to 35.66 mEq/L (P = 0.033) at T2 implying metabolic acidosis. Numbered patients having hypotension and arrhythmias were also higher in Ringer Lactate group again indicating higher acidosis. Conclusion: The different composition of Plasmalyte-A and Ringer Lactate have different metabolic implications for patients undergoing cardiac surgery. Patients who received Plasmalyte-A as cardiopulmonary bypass prime developed less metabolic acidosis. Hence we conclude that Plasmalyte-A is the preferred cardiopulmonary bypass prime in adult patients undergoing valve replacement surgeries.

Background Noncultured epidermal cell suspension (NCES) transplantation is a commonly used surgical treatment for resistant stable vitiligo. The combination of platelet-rich plasma (PRP) with different therapeutic modalities for vitiligo yielded higher repigmentation response, probably due to platelet-derived growth factors. Aim To evaluate the efficacy of PRP-suspended NCES compared to NCES suspended in Ringer's lactate (RL) solution in the treatment of stable vitiligo. Patients and methods A prospective comparative study was conducted on 40 patients with stable vitiligo. They were divided into two equal groups: group A (treated with RL-suspended NCES) and group B (treated with PRP-suspended NCES). All patients were followed-up for 6 months for assessment of their therapeutic response regarding clinical outcomes and immunohistochemical expression of HMB-45 in lesional skin. Results Patients treated with PRP-suspended NCES showed a significantly higher repigmentation response compared to those treated with RL-suspended NCES at 1, 3, and 6 months after treatment (p = 0.015, 0.023, 0.029, respectively). The expression of HMB-45 significantly increased in both groups after therapy, but without a significant difference between the two groups. Conclusion The repigmentation response of NCES can be enhanced by suspending the melanocytes in autologous PRP.

Background Infants and neonates are at particular risk of hypoglycemia when suffering from sepsis, asphyxia and hypothermia. A prospective study showed that up to 20% of preterm infants who were ready for discharge were still at risk of hypoglycemia when a feed was delayed. In contrast, surgery and critical illness may cause hyperglycemia. Objectives The aim of this study is to Assessment of glucose containing solutions 2.5 % as a maintenance fluid management intra operative in infants undergoing hernia repair as regard hyperglycemia and hypoglycemia. Patients and Methods The study was conducted on 100 randomly chosen patients aged from 28 days to 1 year, American Society of Anesthesiologists (ASA) class I scheduled for elective open inguinal hernia repair in Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 50 patients each: Ringer lactate Group: patients received ringer lactate as maintenance fluid therapy according to body weight, glucose containing solution: patients received glucose containing solution 2.5% as maintenance fluid therapy according to body weight. Results The results of the study revealed that 12% of patients receiving glucose containing solution 2.5 % had simple hyperglycemia with no hypoglycemic patients recorded while the other group with ringer lactate 2% of patients had simple hyperglycemia and 4% of patients had hypoglycemia . Conclusion The usage of glucose containing solution 2.5% remained controversial, in this study we compared glucose 2.5 % in normal saline 0,9 % to ringer lactate and the results didn’t put a final decision to the usage of glucose containing solutions as The results of the study revealed that 12% of patients receiving glucose containing solution 2.5 % had simple hyperglycemia with no hypoglycemic patients recorded while the other group with ringer lactate 2% of patients had simple hyperglycemia and 4% of patients had hypoglycemia.

Background: Adhesive small bowel obstruction (ASBO) is a common cause for admission to surgical wards in developed countries, particularly following colorectal and pelvic surgery. Despite advances in diagnosis and treatment, the operative intervention rate is between 15 and 30%, the recurrence rate is up to 30% following surgery and the mortality is between 2 and 8%. Objective: The aim of current study was to report the time of surgical intervention of patient with adhesive intestinal obstruction. Patients and Methods: This study included a total of 50 patients with clinical diagnosis of adhesive SBO, attending at Surgical Department, Aswan University Hospital. This study was conducted between January 2018 to December 2018. After clinical and radiological diagnosis of adhesive SBO, all patients were promptly hydrated with Ringer lactate solution and their electrolytes and acid base imbalances were corrected. Results: Successful conservative treatment was noted in 28 patients (66%) with discontinuation of nasogastric decompression within an average period of 2 days followed by discharge on fourth day of admission. 22 Patients (44%) underwent surgery, safe conservative management needed the pre- requisite of having ruled out any possibility if strangulation of the bowel as the first step of management. As for hospital stay patients who underwent conservative therapy have less durations of hospital stay (3-6 days) than those who underwent surgical intervention (7-14 days). Conclusion: ABO remains a common clinical problem. Patients presenting with symptoms and signs consistent with ASBO should undergo plain abdominal X-ray. If this confirms the diagnosis, and there is no clinical suspicion of strangulation, a water soluble contrast agent should be administered by Nasogastric tube.

BACKGROUND Pancreatitis is a serious complication of endoscopic retrograde cholangiopancreatography (ERCP), which may lead to death. The purpose of this study was to evaluate the preventive effect of aggressive fluid therapy on the incidence of post-ERCP pancreatitis. METHODS In double-blind controlled condition, 240 patients were selected and divided into two groups. The treatment of the intervention group (n = 120) included a dose of 20 mL/kg of ringer lactate infusion within 90 minutes before ERCP and 3 mL/kg/h during ERCP followed by 3 mL/kg/h up to 8 hours. The treatment of the control group (n = 120) included a dose of 1.5 mL/kg of ringer lactate infusion during ERCP up to 8 hours later. Firstly, the patients were evaluated in terms of excessive fluid and serum amylase and pain level, and then they were re-evaluated 2, 8, and 24 hours after ERCP. RESULTS The mean age of the patients was 51.57 ± 13.5 years. Most of the patients were female (54.5%). Pancreatitis was developed in 26 patients including 5.83% of the patients in the intervention group and 15.83% of the patients in the control group (p = 0.013). Pancreatic pain was seen in 7.5% of the patients in the intervention group and in 27.5% of the control group (p < 0.005). Hyperamylasemia was seen in 20.83% of the patients in the intervention group and in 35% of the control group (p = 0.014). The mean days of hospital admission was 1.308 ± 0.807 in the intervention group and 1.425 ± 0.876 in the control group (p = 0.275). CONCLUSION Aggressive fluid therapy with ringer lactate solution before ERCP can effectively prevent postERCP pancreatitis, pancreatic pain, and hyperamylasemia.

Ringer lactate is the main fluid for resuscitation of acute burns. However it is not a complete fluid alone, as it does not take care of sugar and electrolyte balance adequately. This study has been carried out to compare the use of Ringer lactate (RL) alone and combination of RL with Dextrose Normal Saline (DNS) as fluid replacement therapy in acute burn.To assess the biochemical parameters with the use of DNS as maintenance fluid in combination with Ringer lactate as resuscitation fluid in acute burns resuscitation.A prospective randomized control study has been carried out by enrolling 200 patients into 2 groups, treated in ICU and resuscitated by using Modification of Brooke's formula (2mL/kg/% TBSA for resuscitation plus 2500mL maintenance). Group A received RL for resuscitation and DNS as maintenance in 1st 72h of burns. Group B received RL only for 1st 72h. The effects of this on various blood parameters were studied.Mean value of sodium at 24h was 137.79±3.89 in group A and was 133.2±4.57 (p.0001) in group B. The sodium levels remained in range of 137-138 (p.0001) in group A with only 22% patients showing lower range of sodium levels, whereas, there was a falling trend (p.0001) of sodium levels in group B on subsequent days with 54.00% (p.0001) showing hyponatremia on 1st day which increased to 76% on 3rd day. Mean values of early morning random blood sugar (RBS) levels in group A remained between 165.5±65.51mg/dL-115.82±32.52mg/dL on all 3days but in group B there was a falling trend from 127.49±46.11mg/dL to 102.84±22.92mg/dL by 3rd day. Thus, there was significant difference in levels of sodium and RBS in patients receiving DNS as maintenance fluid in addition to RL in acute phase.RL is not an ideal fluid for maintenance as it is low in sodium (130mEq/L) as well as potassium (4mEq/L) in view of daily electrolyte requirement. There is no glucose content in it to provide calories. Therefore, DNS should be added as daily maintenance fluid with RL as replacement for evaporative losses following burns.

Treatment options are limited for acute pancreatitis (AP). Early aggressive fluid resuscitation (AFR) has been widely considered beneficial because of theoretical improvement in end-organ perfusion, including the pancreas and gut, with pancreatic necrosis and bacterial translocation as consequences of ischemia. There is scarce direct evidence for its association to improved outcomes. Furthermore, it has been described that AFR may be associated with poor outcomes in severe AP. WATERFALL is an investigator-initiated international multicenter open-label randomized controlled trial comparing AFR vs. moderate fluid resuscitation (MFR) in AP. The main outcome variable will be the incidence of moderate to severe AP (a clinically relevant outcome that has been validated). Aggressive fluid resuscitation will consist in lactated Ringer solution (LR) 20-mL/kg bolus (administered over 2 h) followed by LR 3 mL/kg per hour. Patients randomized to MFR will receive an LR bolus 10 mL/kg in case of hypovolemia or no bolus in patients with normal volemia, followed by LR 1.5 mL/kg per hour. The patients will be assessed at 3 (±1), 12 (±4), 24 (±4), 48 (±4), and 72 (±4) h from recruitment, and fluid resuscitation will be adjusted to the patient's clinical and analytical status according to a protocol. Based on a prospective multicenter study, the incidence of moderate to severe AP is 35%. Sample sizes of 372 patients per group (overall 744) achieve 80% power to detect a difference in the incidence of moderate to severe AP of 10%, at a significance level (α) of 0.05 using a two-sided z-test, assuming a 10% dropout rate. These results assume that three sequential tests are made using the O'Brien–Fleming spending function to determine the test boundaries.

Background Sepsis, a syndrome of physiologic, pathologic, and biochemical abnormalities induced by infection, is a major public health concern. Sepsis should be defined as life-threatening organ dysfunction caused by a dys-regulated host response to infection. For clinical operationalization, organ dysfunction can be represented by an increase in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score of 2 points or more, which is associated with an in-hospital mortality greater than 10%. Objective To compare between ringer lactate and voluven in resuscitation of patient with sever sepsis in intensive care unit. Patients and Methods It is a prospective analytical study to compare ringer lactate versus voluven in resuscitation in sever sepsis. The required sample size has been estimated to be 30 patients for each group. A total number of 60 patients were treated for severe sepsis in our ICU during the study period. 30 patients assigned to ringer lactate and 30 patients assigned to HES 130/0.42, there was 40% of patients known to have HTN and 66.7% know to have DM. Results In comparison between the studied groups regarding the ABG data in first day, we found a PH improvement in Voluven group more than Ringer lactate group by P-value 0.020. Pao2 was worsened in Voluven group than Ringer lactate group by p-value 0.022. The laboratory data showed no specific significance between the two groups and C-Reactive protein results were not in the two study groups. Conclusion There’s no significant difference in Patients with severe sepsis assigned to fluid resuscitation with Voluven compared to those receiving Ringer’s lactate in SOFA score results as well as mortality index.

Background: Sepsis is the second leading cause of death in intensive care unit and one of the top 10 cause of deaths worldwide. In sepsis, an inflammation response occurs that leads to the tissue destruction. According to the Survival Sepsis Campaign in 2012, early management in septic patients with 30 ml/kg of crystalloid fluids will have better outcomes. Objective: This study aimed to determine the optimal crystalloid fluid in the resuscitation of septic patients. Method: This double-blinded study was held from March 2017- May 2017 in Haji Adam Malik General Hospital. A total of 40 patients who passed the inclusion and exclusion criteria were assessed for interleukin-6 changes before and after treatment with ringer acetate malate and ringer lactate. Results and Discussion: From 40 Patients who passed the criteria, we compared the administration of Ringer's acetate and Ringer's lactate malate in septic patients. The mean systolic and diastolic blood pressure were increased in both study groups (p Conclusion: Ringer's acetate malate in EGDT of septic patients is superior in decreasing interleukin-6 Compared with Ringer lactate.

Objective: Evaluation of the effect of Ringer Lactate, as the resuscitative burn fluid according to Parkland Formula, on restoring the levels of body electrolytes and proteins. Design: A retrospective cohort study. Setting: The National Burns Unit, Mafraq Hospital, Abu Dhabi, United Arab Emirates (UAE). Patients: One hundred and fifteen patients admitted with fresh burns between 1st of January 2011 and 31st of December 2013, who met inclusion and exclusion criteria. Methods: Team collected demographic and clinical data for each patient using a standard form. Patients received Ringer Lactate solely as the resuscitative burn fluid according to Parkland Formula. Baseline (pre-) and third-day (post-) variables included levels of sodium, potassium, chloride, proteins, and albumin. Researchers then performed paired comparisons of serum electrolytes and protein levels. Results: Mean values showed maintenance of the potassium and chloride levels within the normal range after administering the Ringer Lactate, significant decline in sodium, and a marked hypoproteinaemia and hypoalbuminaemia post-resuscitation. Conclusions: Ringer Lactate used as the mere resuscitative post burn fluid is suboptimal. Sodium supplementation may be required to correct hyponatremia. Colloids, preferably intravenous albumin should be added, as advised by the original Parkland Formula.

Context: There is no consensus regarding the concentration of dextrose supplementation to be used in pediatric patients intraoperatively. Aims: The primary objective was to assess the effect of using Ringer lactate (RL) with 1% versus 2% dextrose as maintenance fluid in infants on intraoperative blood glucose levels. The secondary objectives included assessment of incidence of hyperglycemia and hypoglycemia in both groups. Settings and Design: This was a prospective randomized study conducted in a tertiary care teaching institute. Subjects and Methods: Forty infants undergoing cheiloplasty or palatoplasty were included. All patients fasted 6 h for solids and formula feeds, 4 h for breast milk, and 2 h for clear fluids and received general anesthesia as per standardized protocol. Patients belonging to Group 1 received RL with 1% dextrose supplementation, whereas Group 2 received RL with 2% dextrose added to it as an intraoperative maintenance fluid. Random blood sugar (RBS) was checked preoperatively and then at 60 min and 120 min after induction. Hypoglycemia was defined as RBS 150 mg/dL. Statistical Analysis Used: Independent sample ttest and Pearson's Chisquare test were used for statistical analysis. Results: Preoperative RBS was comparable in both groups. RBS at 60 and 120 min was significantly higher in Group 2 compared to Group 1. There was no incidence of hypoglycemia in both groups, and the incidence of hyperglycemia was similar in both groups. Conclusion: Use of RL with 2% dextrose as intraoperative maintenance fluid in infants resulted in significant increase in blood sugar levels as compared to addition of 1% dextrose although the incidence of hyperglycemia remained comparable in both groups.

Background and Aims: Dextrose is commonly added to the intraoperative maintenance fluids of pediatric patients. The primary objective was to evaluate the effect of addition of 1% dextrose to Ringer's lactate (RL) on blood glucose levels in infants undergoing facial cleft surgeries. Material and Methods: This prospective, randomized, single blinded study was conducted in forty infants undergoing either cheiloplasty or palatoplasty. Random blood sugar (RBS) was assessed using a glucometer after induction of anaesthesia, and at 1 and 2 hours later. Group R received RL and Group D received RL with 1% dextrose as intraoperative maintenance fluid. Hypoglycemia was defined as RBS 150 mg/dL. Results: Baseline RBS levels and those at 60 min and 120 min post-induction were comparable in both groups. The increase in blood sugar levels from baseline to 60 min and to 120 min in each group was significant. Incidence of hyperglycemia was comparable in both groups. There were no episodes of hypoglycemia, intraoperatively. Conclusion: Use of Ringer lactate alone or with addition of 1% dextrose resulted in comparable intraoperative blood sugar levels when used as maintenance fluid in infants undergoing facial cleft surgeries.

Background: Stress-induced neuroendocrine and metabolic changes lead to intraoperative hyperglycemia which is related to surgery and the type of intravenous fluids used. Aims: The primary objective was to assess the incidence of hyperglycemia with use of lactate versus acetate-based intravenous fluids in nondiabetics undergoing major surgeries. Incidence of lactatemia and metabolic acidosis were also assessed. Settings and Design: Prospective parallel group observational study conducted in a tertiary care institute. Subjects and Methods: A total of 208 nondiabetic patients undergoing major head and neck free flap or abdominal surgeries were included in the study. Group A received Ringer lactate, and Group B received Ringer acetate as intraoperative maintenance fluid. Intraoperative blood sugar, pH, and lactate levels were monitored. Statistical Tests Used: Chi-square test and independent “t” test were used for analysis. Results: Intraoperative hyperglycemia was more frequent in Group A than B (17.3 vs. 18.4%). Group B patients undergoing gastrointestinal (GI) surgeries showed higher blood glucose at 2, 4, 6, and 8 h when compared to flap surgeries. In Group A, significantly higher blood sugar values were noted at 2 and 8 h in those undergoing GI surgeries. Group B patients undergoing GI surgeries had significantly higher lactate levels at 6 and 8 h. Group B patients had significant acidosis when surgeries lasted >6 h. Conclusion: Nondiabetic patients undergoing major abdominal surgeries who received acetate-based fluids had relatively higher intraoperative blood sugar levels as compared to those receiving lactated solutions, but the incidence of hyperglycemia was comparable. When the duration of surgery exceeded 6 h, acetate-based solutions resulted in significantly higher lactate levels with progressive metabolic acidosis.

PurposeTo determine a way to prevent the formation of adhesions and delay the time of suture adjustment in the course of adjustable strabismus surgery, an animal study was performed to assess and compare the effects of mitomycin C (Mit-C) and viscoelastic material Viscoat (sodium hyaluronate 3% and chondroitin sulphate 4%, Alcon, Fort Worth, TX).MethodsRight eyes of 47 rabbits were divided into three groups. After recession of the superior rectus muscle (SRM), Mit-C was administered beneath and over the SRM in Group M (16 eyes), Viscoat was administered beneath and over SRM in Group V (16 eyes), and ringer lactate was administered in Group C (15 eyes). SRM then recessed 5 mm with adjustable strabismus surgery technique. Animals in each group were subdivided into 1 and 2, where 1 = adjustment 1 week postoperatively and 2 = adjustment 3 weeks postoperatively. Delayed adjustment was performed in M1group (6 eyes), V1group (6 eyes), and C1group (7 eyes) after 1 week; in M2group (6 eyes), V2 group (6 eyes), and C2group (6 eyes) after 3 weeks. Histopathologic examinations were performed for the remaining 10 eyes without suture adjustment at the end of first and third weeks after adjustable strabismus surgery. The possible length and the necessary force to adjust and the degree of adhesions were recorded.ResultsWhen length and strength of the adjustment, adhesions between muscle and sclera, and adhesions between muscle and conjunctiva were taken into consideration, there was no statistically significant difference among M, V, and C groups at postoperative weeks 1 and 3. The force needed for adjustment in M1group was statistically lower than M2group.ConclusionsThe intraoperative use of Mit-C (0.4 mg/mL) may decrease adhesion formation in the early postoperative period, especially in the first week. The intraoperative use of Viscoat was not effective in reducing postoperative adhesions and delaying adjustment.

Objectives: Euro-Collins and University of Wisconsin are preferred solutions in cadaveric renal transplantation. There are no guidelines regarding the perfusion fluids in live donor renal transplantation. We studied whether Euro-Collins was better than Ringer lactate in terms of protecting allograft function. Materials and Methods: A double-blind permuted randomized trial comparing Euro-Collins and Ringer lactate was performed on 100 patients undergoing live related donor renal transplantation. Outcome variable was serum creatinine. Results: Age, sex, donor nephrectomy and ischemia times, kidney temperature, time of first appearance of urine was not significantly different in both the groups. Fall in serum creatinine was significantly more in Euro-Collins than Ringer lactate in the first postoperative week ( P -< 0.05). The time to reach nadir creatinine was 4.97 days in Euro-Collins and 7.75 days in the Ringer lactate group ( P -0.088). Serum creatinine was significantly lower in the Euro-Collins group till six months, thereafter it equalized with Ringer lactate. When individual parameters were analyzed for time to nadir creatinine, only the cold ischemia time of > 80 min was found to be significant ( P -0.024). Twelve kidneys in Euro-Collins and 17 in the Ringer lactate group had cold ischemia times of ≥80 min and time to nadir creatinine was 4.33 ±3.74 and 12.76± 12.68 days ( P -0.035). Conclusions: Renal function normalized rapidly when Euro-Collins was used. Cold ischemia time of ≥ 80 min was the most important factor affecting the graft function and perfusing with Euro-Collins could protect the allograft.

To assess the effects of intravenous hydration on the duration of active labor in nulliparous women also allowed unrestricted oral consumption of fluids.In a randomized clinical trial 120 nulliparous women with uncomplicated singleton pregnancies at term were randomly assigned to drink fluids at will and receive either no intravenous hydration (group 1) or a Ringer lactate solution at rates of 60 mL, 120 mL, or 240 mL per hour (groups 2-4) throughout active labor.There were differences in duration for the active phase of the first stage of labor (252.3 ± 40.9 min in group 1 vs 206.7±38.3 min in group 4; P0.001) and for the second stage (64.3 ± 13.9 in group 1 vs 49.8 ± 11.4 min in group 4; P=0.01), but not for the third stage. The percentage of participants who needed labor augmentation with oxytocin was less when intravenous hydration was provided (53.3% in group 1 vs 20.0% in group 4; P=0.02).Intravenous hydration significantly decreased the duration of active labor and reduced the frequency of both prolonged labor and oxytocin administration in nulliparous women. htpp://www.irct.ir registration number: IRCT201105256575N2.

Eighty-stx children suffering from cholera, aged 2 - 12 years, admitted to the Dr. Sutomo Hospital, Surabaya, were treated intravenously with Ringer Lactate as initial rehydration. Concomitantly young coconut water was given orally ad libitum until complete rehydration was achieved.

Post-traumatic osteitis (PTO) still constitutes a medical and surgical problem. Although different treatment regimes have been tested, controversial results have been obtained. Taurolin-gel® 4% and Taurolin®-collagen are broad spectrum synthetic antibacterial agents used for the local treatment of PTO. This study was designed to evaluate Taurolin under standardised conditions using an animal model for experimentally induced PTO In 21 rabbits a PTO was induced in the left femur and they were assigned into three groups. Four weeks after this operation the second operation followed: in group A (n=5) the intramedullairy rod was removed and the marrow cavity flushed with Ringer lactate solution. In groups B and C (n=16) Taurolin®-gel 4% or Taurolin®-collagen was installed into the marrow cavity after the same debridement. The disease was monitored by hematologic, roentgenografic and bacteriological parameters. After 4 weeks all animals showed signs of an osteitis. At obduction the marrow flush and bone cultures of group A all consisted S. aureus. In group B three out of eight and in group C two out of eight cultures showed bacterial grows. Treatment of an animal PTO is more difficult than the human disease for thorough debridement is difficult. Even though we achieved a succespercentage of 69%. This is a number which is also described in clinical studies. Further investigations with Taurolin® are necessary to develop an optimal treatment regime and to determine to what extent it can be integrated in everyday clinical practise.

Cholera evolves in an endemo-epidemic mode in developing countries. In Cameroon, because of the weakness of our health system, mainly of the epidemiologic surveillance and inadequate timely response, many localities in our country are faced with intermittent cholera epidemics. This study was aimed at analyzing the epidemiological aspects of cholera in the Tcholliré Health District (North Region-Cameroon) in 2011. We therefore applied a retrospective cross-sectional study using data on cholera cases registered within the 27th and the 40th epidemiological weeks in the Tcholliré Health District in 2011. All patients infected with cholera were included. The demographic, clinical and therapeutic variables, as well as the origin and the evolution of cases were drawn from the cholera data base of the Tcholliré Health District. Data analysis was done using SPSS and Excel software. Between the 27th and 40th epidemiological weeks, 334 cases of cholera were notified in the Tcholliré Health District. The sex ratio was 1.27 (187M/147W), the men were most infected (56%). The mean age was 28±17 years, youths aged 16 to 34 were the age group that were most affected with 42.20%. The number of cases varied significantly based on the sex ratio and the health area (p = 0.012). The rate of relapse was 0.61 % and the mortality rate was 1.2%. All the patients had watery stools and vomiting. In addition, all patients were treated primarily with intravenous normal saline at 0.9% or Ringer Lactate and ORS for oral therapy. The antibiotic used was Doxycycline 100 mg. Cholera remains a diarrheal disease that threatens all regions in Cameroon. It comes about as a result of a deficiency in individual and collective hygienic practices, and a passive epidemiologic monitoring. Nevertheless, the institution of a monitoring system and also effective combat methods will significantly reduce the recurrence of cholera epidemics.

Sir, Add sugar to water it turns into acid! Add salt to water to drink it also turns into acid! This may not be happening at home but this is what happens daily in a hospital. Five percent dextrose has a pH of 4.2 and normal saline has a pH of 5.5 when the molecules used in them are neutral. Lebowitz et al. pointed out the same concern a nearly half a century ago in their study to calculate titerable acidity of commonly used intravenous fluids.[1] The literature is silent about the cause of this, however, it reflects in clinical outcomes, as this acid we infuse is associated with increased incidence thrombophlebitis with decreasing pH of the infuscate. On analyzing it can be seen that dextrose based fluids are most associated with venous thrombophlebitis followed by normal saline and least by ringer lactate which is in coherence with te concept of decreasing pH-increasing thrombophlebitis. Gaudry and Duffy in their comments on pH of intravenous fluids attributed the probable cause of this acidity to their method of sterilization by heat.[2] The exact mechanism is yet not commented upon by any available literature. It is unlikely for the constituents of fluids to cause this acidosis as normal saline and hypertonic saline both have same pH of 5.5. So if Sodium chloride (a neutral salt) were to be linked to acidosis it would have caused hypertonic saline to be more acidic. This acidity may not be of concern when smaller volumes of fluids are used but in case of major infusions they may actually be significant but unless we know what causes it, we can’t treat it. The pH of 4.2 of dextrose compared to a patient in severe acidosis with a pH of 7.1 has a Hydrogen ion concentration greater by 1,000 times. The only thing that the label of these fluids carries is a quote that says “buffered in hydrochloric acid” so in operative or critical care settings this infusion becomes questionable in acidotic patients. On the one end, all the modern fluids tend to add bicarbonate precursors in the form of lactate, malate, gluconate and acetate but on the other hand we just infuse hydrogen ions in concentrations more than 1,000 times the normal blood. A recent letter to editor by Viktor Rosival in Indian journal of critical care itself talks about clinical ineffectiveness of these bicarbonate buffers in the presence of acidosis.[3] With this letter, we wish to draw attention towards the dilemma of using acidic infusions while worrying about acidosis. Furthermore, in terms of acidosis where large infusions are needed it may be more physiological to use “balanced” fluids like Plamalyte with a pH of 7.4.

The effect of a 4.5 mL/h Ringer infusion on the recovery from a unilateral 40-min renal artery occlusion was investigated in Sprague-Dawley rats. The inulin clearance measured in the experimental kidney 24 and 48 h after the insult in control animals that did not receive the Ringer infusion was 0.14 +/- 0.10 (mean +/- SE) and 0.11 +/- 0.05 mL/min, respectively. In animals that received 24 h of Ringer infusion begun at the time of the renal artery occlusion the inulin clearance was 0.81 +/- 0.07 mL/min, a value significantly higher than either of the control groups (p less than .05). If, however, the Ringer infusion was stopped at 24 h and the inulin clearance measured at 48 h, it had decreased significantly (0.27 +/- 0.09 mL/min) and was no longer greater than the control groups. Similarly, if the infusion was continued for 48 h there was no longer a significant difference between the inulin clearance (0.37 +/- 0.11), when compared with 48 h of no infusion (0.11 +/- 0.05). The histology of the different groups corresponded with the functional data. We conclude that 24 h of Ringer infusion leads to functional and histological protection when measured at 24 h; however, if measured at 48 h, protection is no longer evident. These studies suggest that caution should be exercised in extrapolating from the results of protective maneuvers in ischemic acute renal failure investigated by short-term studies.

Summary Purpose The improvement of the ischaemic tolerance of myocutaneous flaps is of clinical importance and hence the subject of numerous investigations. Methods In an attempt to increase the ischaemic tolerance, 20 myocutaneous flaps (rectus abdominis muscle) in pigs were elevated and perfused with various, established solutions prior to the onset of ischaemia. The flaps were elevated, utilizing the superior epigastric vessels as the pedicle. Ten flaps were flushed with the University of Wisconsin solution, five with the Euro-Collins solution and the last five with a Ringer-Lactate solution, prior to the 6 h long, normothermic ischaemia. On the day of operation, the first, third, fifth, seventh and tenth postoperative day clincical examinations and thermography were performed as well as biopsies. Additionally, on the tenth postoperative day, the rate of necrosis was determined morphometrically as the average of three measurements. Results Ten days after surgery, the flaps pretreated with the University of Wisconsin solution displayed a vital surface area of 89%, the Euro-Collins solution 23% and the Ringer-Lactate solution 14%. Histologically, muscle tissue proved to be more susceptible to ischaemia than skin. Conclusion Regarding the rectus abdominis flap in a pig model, the University of Wisconsin solution proved superior in the prevention of ischaemic injury compared with the Euro-Collins solution and Ringer Lactate. In accordance with the literature, muscle tissue proved to be more susceptible to ischaemia than skin in our study.

The aim of the study was to assess of the role of intraoperative cultures taken at the end of major heart surgery (MHS) in the prediction of postoperative mediastinitis (PM) in patients undergoing MHS over a 6-month period in a tertiary university hospital. Just before wound closure, a sample of the sternal border was taken, swabbing back and forth the sternal border and the subcutaneous tissues. A second sample was taken after irrigation of the deep mediastinal structures with 10 mL of Ringer lactate. Swabs were processed semiquantitatively and the mediastinal fluid with a quantitative technique. The observation of one or more colonies per plate was considered a positive culture. Cultures obtained at the end of 229 surgical interventions (227 patients) were positive with the semiquantitative or with the quantitative procedures in 31.0% (95% confidence interval [CI], 25.1-37.4%) and 34.5% (95% CI, 28.4-41.0%) of the times, respectively (P = NS). The number of microorganisms isolated in the wound swab or mediastinal fluid was 91 and 110, respectively. Of the 227 patients, 7 developed an episode of PM (3.1%; 95% CI, 1.2-6.2%) after a median time of 11 days (range, 5-19 days). The microorganisms causing the 7 cases of mediastinitis were not isolated in the intraoperative cultures in any of the cases. The value of intraoperative cultures as a test for prediction of PM depending on the breakpoint chosen were as follows: sensitivity (0%), specificity (66.2-97.3%), and positive (0%) and negative predictive values (96.8-98.0%). We recommend against surveillance cultures taken intraoperatively in patients undergoing MHS.

Avaliou-se ação da solução isotônica poliônica enteral da sene mais fluidoterapia intravenosa e da fluidoterapia intravenosa no tratamento da compactação no cólon maior em eqüinos. Foram utilizados 20 animais divididos em quatro grupos. Os animais dos grupos tratados eram portadores de compactação no cólon maior induzida experimentalmente. O grupo C, controle, não foi tratado, o grupo E8 foi tratado com solução isotônica poliônica enteral (8ml/kg/hora/48horas), o grupo SE recebeu sene (20mg/kg, duas doses de 24/24h) mais ringer lactato intravenoso (10ml/kg/hora/12horas, durante dois dias) e o grupo RL recebeu ringer lactato intravenoso (16ml/kg/hora/12horas, durante dois dias). O tratamento E8 provocou hipernatremia, hipercloremia e hiperglicemia. No grupo SE foi observada maior concentração dos valores de uréia, creatinina, osmolalidade e lactato plasmático. O tratamento RL não resultou em alteração no equilíbrio hidroeletrolítico e foi o mais eficiente para a correção dos valores bioquímicos em eqüinos com compactação do cólon maior, seguido pelo E8. O SE foi o menos eficiente na normalização das variáveis bioquímicas. The effects of isotonic polionic enteral solution, sene plus intravenous (IV) fluid therapy or fluid therapy IV only for the large colon impaction treatment in horses were evaluated. Twenty animals were divided in four groups. Animals of the treated groups had experimentally induced colon impactions. Group C (control) was not treated; group E8 received isotonic polionic enteral solution (8ml/kg/hour/48 hours); group SE received sene (20mg/kg, two doses with 24 hours interval) and ringer lactate IV (10ml/kg/hour/12 hour, during two days), and group RL received ringer lactate IV (16ml/kg/hour/12hour, during two days) only. Animals in the E8 group had hypernatremia, hypercloremia and hyperglycemia. Animals of the SE group had higher concentration of urea, creatinine, osmolality and plasmatic lactate. Ringer lactate IV only, group RL, did not cause alteration in the electrolytic equilibrium. In conclusion, intravenous fluid therapy with Ringer solution alone was the most efficient treatment for biochemical correction in horses with large colon impaction. Fluid therapy was also efficient in minor degree. Sene treatment associated with intravenous fluid therapy had the poorest results among the protocols to normalize biochemical variables.

We cared for a patient with progressive renal impairment who presented with blurred vision, QRS broadening and cardiac failure due to chronic cibenzoline intoxication. Treatment consisted of catecholamines and repetitive infusions of Ringer lactate. Cardiac function and symptoms recovered completely.

Objective To evaluate the effects of Ringer's lactate instillation, Interceed(TC7) (Johnson and Johnson Medical, Inc., New Brunswick, NJ), and Gore-Tex Surgical Membrane (W. L. Gore and Associates, Inc., Flagstaff, AZ) in a rat uterine horn model. Setting Rats were in a conventional laboratory setting. Participants Sprague-Dawley white rats, weighing 225 to 250g. Interventions The left uterine horn was subjected to a standardized lesion by serosal denudation and devascularization. The rats were randomly assigned into control group, Interceed(TC7) group, Gore-Tex group, and Ringer's lactate group. Main Outcome Measuresx Degree of adhesions was evaluated 2 weeks after the initial surgery. Results Adhesion score after Ringer's lactate instillation was significantly lower than those of control, Interceed(TC7), and Gore-Tex groups. Gore-Tex was associated with less adhesion formation than control. No difference was found in the adhesion formation between the Interceed(TC7) group and the control group. Conclusion Confirming our previous observations, Ringer's lactate instillation is effective in decreasing adhesion formation. Gore-Tex reduces adhesion formation, but its efficacy is inferior to those of Ringer's lactate. Contrary to previous reports, Interceed(TC7) is ineffective in our animal model.

We compared the effects of continuous Ringer's lactate infusion and Ringer's lactate instillation on postsurgical adhesion formation in the rat model. The results show that intraperitoneal Ringer's lactate instillation reduces postsurgical adhesions. However, its efficacy is not improved by additional infusion of Ringer's lactate. (J GYNECOL SURG 11:241, 1995)

The first phase of treatment is the stabilization of the vital functions and preparation for evacuation.