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Introduction: Systemic hypotension is frequently and immediately seen after spinal anaesthesia. Historically Ringer lactate is used to substitute the acute relative volume loss after spinal anesthesia, although it remains in intravenous circulation for a short period. The preloading with 5% albumin and gelatine have become popular and effective as they remain intravascular for a longer duration providing sustained normotension. The aim of this study was to assess the efficacy of equal volume of Ringer lactate and Haemaccel as a preloading fluid for the prevention of hypotension after spinal anaesthesia in patients undergoing Lower Segment Cesarean Section. Methods : This was a prospective comparative study in which Patients were randomly allocated in to Group A and group. Group A patients were preloaded with Ringer lactate 10ml/kg body weight and Group B were preloaded with Haemaccel 10 ml/kg body weight within a period of 5-10 minutes before spinal anaesthesia. After giving the block, blood pressure (systolic, diastolic and mean) were recorded every 2.5 minutes for initial 20 minutes and every 5 minutes during the rest of the period of surgery. Onset of hypotension along with other parameters were recorded and analysed using SPSS ver. 13. Results: All together 100 patients were enrolled in the study, 50 in Group A (Ringer lactate) and 50 in Group B (Haemaccel). The episodses of hypotension was higher in patients who received Ringer lactate as preloading fluid than who received haemaccel as preloading fluid (42% versus 24%). Conclusion: Preloading with Haemaccel gives better hemodynamic stability and lesser incidence of hypotension than that of Ringer lactate. DOI: http://dx.doi.org/10.3126/mjsbh.v10i1.6405 Medical Journal of Shree Birendra Hospital Jan-June 2011 10(1) 1-5

Studies have suggested that shockwave lithotripsy (SWL) stone fragmentation rates can be affected by characteristics of the fluid media surrounding the stone, although evidence to implicate the impact of urine specific gravity (SG) is limited and inconclusive. Our aim is to further explore the impact fluid media and SGs have on stone fragmentation using a variable focus lithotripter.Artificial stones were presoaked for 24 hours in urine and then shocked in various fluid media including artificial urine (SG 1.010 control, 1.020, and 1.07), human pooled urine (HPU), degassed HPU, Pentastarch, 100% and 30% contrast, degassed 30% contrast, 100% ethanol, deionized water (dH(2)O), degassed dH(2)O, 5% glucose, Ringer lactate, 0.9% saline, glycerol, whole blood, and lubricating gel. After soaking, SWL using the Modulith SLX-F2 electromagnetic lithotripter was performed. Fragments were dried and sieved using a 4-mm diameter opening grid. Fragments4 mm were weighed and fragmentation coefficients (FCs) calculated (pre-SWL weight - post-SWL weight)/(pre-SWL weight) × 100. Fifteen stones were shocked for each fluid group.Fluid type, viscosity, and degassing all significantly impacted stone fragmentation. While the solutions' SG, per se, did not appear to affect stone fragmentation, the use of degassed 30% contrast significantly improved stone destruction over the SG 1.010 artificial urine control (95.3% vs 71.4, P0.01). Furthermore, degassing improved comminution rates by increasing the number of completely fragmented stones (FC = 100%). Using degassed 30% contrast, 12/15 stones were completely fragmented, compared with only 2/15 in the control group (P = 0.007). Among the whole blood, glycerol, and lubricating gel groups, only 1/15, 0/15, and 1/15 stones reached 100% FC respectively in the narrow focus, possibly because of the detrimental impact of increased viscosity.Different fluid media can significantly affect FC in vitro. Among the various fluids tested, degassed 30% contrast significantly increased the FC and total number of completely fragmented stones.

Human skin allografts can be preserved by different methods. In our clinical practice, human skin allografts are harvested on multi-organ and tissue donors, transferred at +4°C in Ringer Lactate, cryopreserved with 15% Glycerol and held in the vapor phase of a liquid nitrogen freezer until delivery to the burn center. The aim of this experimental study was to evaluate the impact of transport medium and cryoprotectant on the viability of human skin allografts. For this purpose, we compared skin samples harvested from 19 multi-organ and tissue donors with two different transport media and two different cryoprotectants. Viability was assessed by the MTT assay after harvesting at laboratory reception, during storage (at +4°C) at day 2 and day 7, and after cryopreservation and thawing. Histopathological analysis was performed for each MTT assay. Results indicate that, when stored at +4°C, skin retains more viability with RPMI, whereas Glycerol and DMSO are equivalent cryoprotectants regardless of the transport medium. In conclusion, our protocol could be improved by the utilization of RPMI as transport medium.

BACKGROUND: Hypothermic perfusion (HP) of the liver is applied during total vascular exclusion (TVE) to reduce ischemic injury during liver resection. No studies have been performed comparing different perfusion solutions for HP. The aim of this experimental study was to compare Ringer-lactate solution (RL) with Celsior solution (Cs) for HP in a pig model of 60-min TVE. METHOD: Twenty pigs underwent 60-min TVE of the liver. Groups were TVE without HP (no-HP, n = 9), TVE with HP using RL (n = 6), and TVE with HP using Cs (n = 5). Blood and liver tissue samples were taken before TVE and during 24-h reperfusion. RESULTS: In the no-HP group, plasma aspartate aminotransferase values were significantly increased during reperfusion (p

Background: Different fluid regimens are often adopted for elderly patients, but it is not known whether they handle infused fluids differently during the induction of anesthesia than young patients. Methods: Mean arterial pressure (MAP), plasma dilution (based on hemoglobin) and volume kinetics were assessed during an intravenous (i.v.) infusion of 1000 ml of lactated Ringer’s solution over exactly 60 min in 29 patients given general anesthesia with propofol (15 65 years old) and in 16 patients receiving lumbar epidural anesthesia with titrated doses of ropivacaine (7 patients 65 years old). Results: General anesthesia caused a greater decrease in MAP than epidural anesthesia (mean 15% vs. 9%; P

Total gut irrigation (TGI) is a safe method of bowel preparation in children. Many solutions are used but none is ideal. This study has been done to compare household common salt solution prepared by dissolving 10 g of pure NaCl salt (Active Reagent Quality) in 1 l of tap water, polyethylene glycol with electrolytes (PEG) and ringers lactate for TGI in children. We prospectively evaluated the three solutions in terms of efficacy, safety, rapidity, tolerability and cost effectiveness in patients undergoing a variety of colorectal procedures. Patients (126) were randomly assigned into one of the three groups; Group I, household common salt solution, 40; Group II, Peglec, 55; Group III, Ringer lactate, 31. TGI with PEG is the most rapid method of bowel preparation but is least tolerable. Household common salt solution is inexpensive and most tolerable of the three preparations. All three are similar in safety and effectiveness in bowel preparation. Household common salt solution is effective, safe, cost effective and the most tolerable method of bowel preparation.

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.

The interest of sex determination in embryos has an economical and research implication. This method is directly related to the embryo transfer method, which nowadays is considered to be an industry, in both equine and bovine. The purpose of this work was to evaluate the applicability of equine embryo sexing using the polymerase chain reaction (PCR) and to decide if this method is affordable for Romania and yields good results. Five equine embryos have been obtained by natural breeding using transcervical uterine lavage with Ringer Lactate on 6.5 or 7 days. The DNA extraction was performed by using proteinase K and the DNA was quantified by spectrophotometry. Three sets of primers have been used. The double nested PCR was performed, followed by electrophoresis of the amplified samples. From the five embryos obtained, three samples presented a single 445 bp DNA band and no SRY band and they were considered to be females. In two cases, the 445 bp was accompanied by the SRY-1 217 bp and SRY-2 121 bp band, thus being considered to come from male embryos. The embryo biopsy was done in 2 embryos and one biopsied embryo was transferred to a recipient mare. The transfer of the biopsied embryo did not succeed. PCR is suitable for sexing preimplantation equine embryos, but still in order to perform this type of activity at a commercial level, the infrastructure and the development of Equine Reproduction centres it’s mandatory.

A anestesia epidural é uma técnica segura quando realizada de forma correta. No entanto, não é isenta de complicações, sendo uma das mais comuns a hipotensão arterial, que pode ser intensificada pelo decúbito dorsal devido à compressão da veia cava caudal. Neste estudo objetivou-se determinar a incidência e intensidade da hipotensão arterial após anestesia epidural com lidocaína e morfina, bem como identificar se a mudança para decúbito dorsal tem efeito potencializador da hipotensão. Também foi comparada a eficácia do tratamento da hipotensão utilizando-se Ringer com lactato, hidroxietilamido 130/04 a 6% ou efedrina. Foram usados 45 cães submetidos a ovariohisterectomia, orquiectomia ou nodulectomia. Os animais foram premedicados com acepromazina (0,03 mg/kg) e petidina (3 mg/kg, IM), induzidos com midazolam (0,1 mg/kg) e propofol a efeito, ambos IV e mantidos em anestesia inalatória com isoflurano, no plano II do estágio III do esquema de Guedel e, após 15 minutos de estabilização, os cães receberam anestesia epidural com morfina a 1% (0,1 mg/kg) e lidocaína a 2% sem vasoconstritor para um volume final de 1 mL/4,5 kg. Foram avaliadas a frequência (FC) e ritmo cardíacos (ECG), pressão arterial sistólica (PAS), frequência respiratória (f), saturação periférica da oxihemoglobina (SPO2), pressão parcial de CO2 no final da expiração (ETCO2) e a temperatura corpórea (TC). Em estudo piloto, foram usados 12 animais para verificar a ocorrência de hipotensão e ajustar o protocolo experimental (GC, n = 12). Os animais que apresentaram hipotensão foram tratados com Ringer lactato (GRL, n = 10), 20 mL/kg, administrados em 15 minutos; hidroxietilamido 130/04 a 6% (GHA, n = 11), 7 mL/kg, administrados em 15 minutos; ou efedrina (GEF, n = 12), 0,07 mg/kg, IV, administrada em bolus. Após 15 minutos da anestesia epidural ou de realizado o tratamento, os pacientes foram posicionados em decúbito dorsal e a PAS foi aferida por mais 15 minutos. Em caso de hipotensão os animais foram tratados de acordo com o grupo ao qual pertenciam. Considerou-se hipotensão quando a PAS < 80 mmHg ou diminuiu > 20% do valor basal. A incidência global de hipotensão induzida pela anestesia epidural foi de 31,11% (14/45) e pelo decúbito de 28,88% (13/45). Dos animais que ficaram hipotensos após a anestesia epidural (GRL 4/10, GHA 4/11 e GEF 6/12) nenhum respondeu ao tratamento no GRL, três responderam no GHA e seis responderam no GEF (6/12). Concluiu-se que a hipotensão após anestesia epidural em cães é frequente, pode ser potencializada pela mudança de posição para decúbito dorsal e que o hidroxietilamido 130/04 a 6% e a efedrina foram o mais eficazes no tratamento dessa complicação. Epidural anesthesia is a safe technique when performed correctly. However, complications like hypotension are common and can be intensified by dorsal recumbence since the caudal vena cava is compressed. This study intended to determine the incidence and intensity of arterial hypotension after epidural anesthesia with lidocaine and morphine, as well as identify whether the change to dorsal recumbence may potentiate the hypotensive effect of epidural anesthesia. The efficacy of the treatment with Ringer lactate, 6% hydroxyethyl starch 130/04 or ephedrine was also compared. Forty-five dogs undergoing ovariohysterectomy, orchiectomy or lumpectomy were included in the study. The animals were premedicated with acepromazine (0.03 mg/kg) and pethidine (3 mg/kg, IM) and the anesthesia was induced with midazolam (0.1 mg/kg) and propofol, IV. Superficial plane of anesthesia was maintained with isoflurane and after 15 minutes the dogs received epidural anesthesia with 1% morphine (0.1 mg/kg) and 2% lidocaine without vasoconstrictor to a final volume of 1 mL/4.5 kg. Heart rate (FC), systolic blood pressure (PAS), respiratory rate (f), peripheral oxyhemoglobin saturation (SPO2), end-tidal CO2 (ETCO2), and body temperature (CT) were evaluated. In a pilot study, 12 animals were used to verify the occurrence of hypotension and to adjust the experimental protocol (CG, n = 12). The animals with hypotension were treated with Ringer lactate (GRL, n = 10), 20 mL/kg, administered in 15 minutes; hydroxyethyl starch 130/04 6% (GHA, n = 11), 7 mL/kg, administered in 15 minutes; or ephedrine (GEF n = 12), 0.07 mg/kg, administered as a IV bolus. After 15 minutes of epidural anesthesia, patients were positioned in dorsal recumbence and the PAS was measured during 15 minutes. It was considered hypotension when SBP < 80 mmHg or decreased > 20% from basal value (baseline). The overall incidence of hypotension induced by epidural anesthesia was 31.11% (14/45) and by the dorsal recumbence was 28.88% (13/45). None of the animals that were hypotensive after epidural anesthesia (4/10 in GRL, 4/11 in GHA and 6/12 in GEF) responded to the treatment in GRL, three responded in the GHA, and six responded in the GEF (6/12). It was concluded that hypotension after epidural anesthesia in dogs is frequent, and can be enhanced by changing the position to dorsal recumbence, Hydroxyethyl starch 130/04 and ephedrine were more effective in the treatment of this complication. Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq

This paper is the part of feasibility study of non invasive blood glucose monitoring using electrical bioimpedance spectroscopy. The objective of reported experiment is to estimate the change in dielectric properties of ringer lactate solution with respect to D-glucose and to optimize the frequency spectrum for glucose monitoring. The dielectric properties of the ringer lactate solution have been measured with respect to the D-glucose. The experiment shows that there is a significant change in dielectric properties of the ringer lactate solution (equivalent to physiological fluid) with respect to D-glucose (equivalent to blood glucose).

Botulinum toxin (BT) is injected intramuscularily and may produce injection site pain (ISP). We wanted to explore whether the pH value of the reconstituted BT drug contributes to ISP and, if so, what strategies can be applied to reduce it. In part 1 of the study, pH values of different reconstitution solutions and of major BT drugs reconstituted with different reconstitution solutions were assessed. In part 2, the effects of reconstitution with normal saline (NS) and Ringer acetate (RA) were compared intraindividually and in a double blind fashion in 34 patients with blepharospasm. pH values of reconstitution solutions were 5.52 ± 0.02 for NS, 6.98 for RA, 6.31 for Ringer lactate, 6.56 for electrolyte and 5.31 for bacteriostatic solution. pH values for NS-reconstitution were 6.09 ± 0.20 for Botox(®), 5.95 ± 0.24 for Dysport(®) and 5.81 ± 0.18 for Xeomin(®). pH values for RA-reconstitution were 6.95 ± 0.03 for Botox(®), 7.01 ± 0.02 for Dysport(®) and 6.87 ± 0.06 for Xeomin(®). By using RA instead of NS the pH could be increased by 0.86 for Botox(®), by 1.06 for Dysport(®) and by 1.06 for Xeomin(®). 47 % of the patients experienced less ISP when Botox(®)-RA was given rather than Botox(®)-NS, 76 % when Xeomin(®)-RA was given rather than Xeomin(®)-NS. None of the patients reported a difference in efficacy between NS- and RA-reconstitution. Despite previous reports, reconstituted BT type A drugs show acidic pH values. Normalising these pH values by use of RA instead of NS reduces ISP considerably without sacrificing clincial efficacy.

Double filling (DF) with perfluorohexyloctane (F6H8) and silicone oil (SIL) has been recently proposed and tested clinically as a means to improve the tamponade properties of single components. This in vitro study investigated (1) the kinetics of the mixing process of F6H8 with SIL (1,000 mPa s) and (2) the contact and emulsification behaviour of DF as compared with pure liquids, with the aim of assessing the tamponade efficiency and its evolution with time.(1) The velocity of the mixing process for F6H8+SIL was estimated by monitoring the position of the interphase in a rectangular cell kept at constant temperature. (2) The surface contact and the tendency to emulsification of DF and of SIL and F6H8 were visually examined by using a Perspex eye model.(1) The mixing process for F6H8+SIL is slow. In the absence of stirring, equilibrium is reached no earlier than 1 month at 37 degrees C. (2) F6H8 was found to show close contact with the eye model and dispersion into droplets; SIL showed poor contact with the cell surface and no dispersion; DF exhibited poor contact with the superior cell surface and little evidence of dispersion.F6H8 dissolves slowly in SIL and equilibrium is only reached after 1 month. The final ratio of the DF phases differs from the initial ratio. An initial F6H8/SIL ratio of 70%:30% vol results in 25% vol of pure F6H8 (density, 1.33 g/cm(3)) and 75% vol of a solution containing F6H8, viz. 60% vol F6H8 in SIL (density 1.17 g/cm(3)). Because of its density and contact properties, the investigated DF has a tamponade effectiveness better than that of SIL on the inferior retina. Compared with using F6H8 alone, DF reduces emulsification.

The solution of choice for wash-out of non–heart-beating donor (NHBD) livers is histidine tryptophan ketoglutarate (HTK). This solution has a lower viscosity, due to absence of a colloid, and is less expensive as compared to the University of Wisconsin (UW) solution. A new preservation solution for machine perfusion was developed, named Polysol. In order to apply Polysol clinically in NHBD organ retrieval, the efficacy as a wash-out solution was investigated. Methods After a warm ischemic time of 30 minutes, the rat liver was washed out via the portal vein with 50 mL of either ringer lactate (RL), HTK or Polysol. After wash-out and harvesting, the liver was reperfused with Krebs-Henseleit buffer. Samples were taken to assess hepatocellular injury and liver function. Results Liver damage parameters were elevated in the RL group as compared to the HTK and Polysol groups. Liver/rat weight ratios were significantly lower after wash-out with Polysol. Overall, no differences were seen in ammonia clearance and bile production. In conclusion, wash-out of the NHBD liver with Polysol results in equal to improved reperfusion results as compared to HTK. Polysol is feasible as a wash-out solution in combination with machine perfusion using Polysol.

Objectif : Verifier les effets du remplissage intravasculaire sur la reaction inflammatoire pendant une intervention chirurgicale majeure. Methode : Trente-six patients devant subir une intervention abdominale reglee ont ete repartis au hasard et ont recu soit de l'hydroxyethylamidon a 6 % (poids moleculaire moyen de 130 000 Dalton, degre de substitution de 0,4 ; n = 18, groupe HEA), soit une solution de Ringer-lactate (groupe RL ; n = 18) comme remplissage intravasculaire. Les liquides ont ete administres avant l'operation et, pendant 48 h a l'unite des soins intensifs. Le remplissage vasculaire dependait de parametres physiologiques. Les concentrations seriques d'interleukine (IL-6, IL-8 et IL-10 et molecules d'adhesion solubles (sELAM-I et sICAM-I) ont ete mesurees apres l'induction de l'anesthesie, quatre heures apres la fin de l'operation, de meme que 24 h et 48 h apres l'operation. Resultats : Les donnees biometriques et perioperatoires, l'hemodynamique et l'oxygenation ont ete similaires chez les patients des deux groupes. Une moyenne de 4470 ± 340 mL de HEA 130/0,4 par patient ont ete administres dans le groupe HEA et de 14310 ± 750 mL de RL par patient du groupe RL pendant l'experimentation. La liberation de cytokines pro-inflammatoires IL-6 et IL-8 a ete significativement plus faible dans le groupe HEA [(valeurs maximales) 47,8 ± 12,1 pg.dL -1 de IL-6 et 35,8 ± 11,2 pg.mL -1 de IL-8 (groupe HEA) vs 61,2 ± 11,2 pg.dL -1 de IL-6 et 57,9 ± 9, 7 pg.mL -1 de IL-8 (groupe RL); P < 0,05]. Les concentrations seriques de sICAM-I ont ete significativement plus elevees dans le groupe RL [(valeurs maximales) 1007 ± 152 ng.mL -1 (groupe RL) vs 687 ± 122 ng.mL -1 (groupe HEA); P < 0,05)]. Les valeurs de sELAM- I ont ete similaires dans les deux groupes. Conclusion: Le remplissage vasculaire avec de l'HEA 130/0,4, compare a la therapie liquidienne a base de solutes cristalloides, peut reduire la reaction inflammatoire chez des patients qui subissent une operation majeure. Nous pensons que cette situation releve d'une microcirculation meilleure accompagnee d'une activation endotheliale reduite et d'une lesion endotheliale moindre.

To assess the usefulness of Ringer-lactate solution with 0.9% dextrose, fluid therapy during surgery in paediatric patients was reviewed. From the literature, the need for intravenous (i.v.) infusion and water could be established. The need for sodium was also evident and use of normonatraemic i.v. solutions should be recommended to avoid hyponatraemia. Little data were found about the value of the other electrolytes. Dextrose requirements have been the subject of debate for the last two decades. The choice of dextrose concentration is a compromise between avoiding hypoglycaemia and hyperglycaemia. Four clinical trials assessing the use of Ringer-lactate solution with 0.9 or 1% dextrose in paediatric patients suggest that it is appropriate for routine infusion in paediatric patients during the perioperative period. However, fluid therapy during surgery has rarely been studied, probably because it is inexpensive, rarely leads to problems and is used in very different clinical settings. Development of consensus clinical guidelines on the use of electrolyte infusions in paediatric surgery would be helpful.

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.

During the period from January 1992 up to the end of July 2001, theBurns Unit in King Khalid'C'Hospital treated 1735 cases of burns. The burns caseswere of varying causes, age groups, degree, depth and extent. The formula used inlTeating these burns patients was a modification of Parkland fonnula. The fluid usedwas Ringer lactate solution. This fluid was administered for the first 3 days post burnuntil the general condilion of the palient was sfabilized. Early oral intake wasencouraged in aU patients and was started as early as the second or the third day. Colloidswere given by the end of the third or even the fourth day and according to the individualpatients' needs. The results of this treatment regime significantly avoided renalcomplications and ensured patient rehydration.

Institutional Review Board (IRB) approval of this research could not be verified during an investigation by the Landesarztekammer Rheinland-Pfalz (the State Medical Association of Rheinland-Pfalz in Germany). As a result, this article has been retracted, in accordance with the Journal's regulations, at the request of the Directors and Board of the British Journal of Anaesthesia. Lack of IRB approval means that the research was unethical, and that IRB approval for the research was misrepresented in the published article. It does not mean that the research results per se are fraudulent. For further information please see Retraction.

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.

Background: Arterial hypotension following spinal anesthesia still remains the leading cause for maternal mortality and morbidity. Active management of hypotension and more so its prevention of its ads more safety value to spinal anesthesia, which is widely practiced worldwide. Preloading of patients with either crystalloid or colloid prevents the severity of hypotension. Objectives of the study was to compare the preloading efficacy of Ringers lactate solution (20 ml/kg) and 6% hydroxyl ethyl starch at 10 ml/kg in prevention of hypotension following spinal anesthesia in elective caesarean section.Methods: 100 ASA grade I and grade II subjects for elective caesarean section were studied in two groups. Group A (Ringer lactate group) 50 subjects and Group B (hydroxyl ethyl starch group) 50 subjects. Each group was preloaded over a period of 20 minutes before spinal anesthesia with either ringer lactate solution (Group A) at 20 ml/kg or 6% hydroxyl ethyl starch group at 10 ml/kg body weight. Main outcome measures were mean systolic blood pressure, mean diastolic blood pressure, mean arterial blood pressure and mean heart rate.Results: Demographic characteristics of both groups were comparable. Incidence of hypotension was significantly more in ringer lactate group. There was no significant difference of heart rate in both the groups. No allergic reaction was noted to hydroxyl ethyl starch. Vasopressor requirement was also low in hydroxyl ethyl starch group compared to ringer lactate group.Conclusions: Preloading subjects with 6% hydroxyl ethyl starch is beneficial than preloading with ringer lactate solution as it produces better hemodynamic stability to subjects.

Apesar dos avanços na sua abordagem terapêutica, a hemorragia severa continua a ser a principal causa de morbilidade e mortalidade em animais vítimas de trauma ou sujeitos a intervenção cirúrgica. O aparecimento de lesões decorrentes, ou da morte consequente, deve-se ao deficit de volume de fluidos intravasculares e subsequente desenvolvimento do estado hipovolémico. Em termos fisiológicos, a consequência mais devastadora desta condição é a diminuição, absoluta ou relativa, da pré-carga cardíaca, resultando num baixo débito cardíaco, perfusão tecidular inadequada e diminuição do aporte de oxigénio aos tecidos, o qual compromete, inequivocamente, a função celular. O controlo da hipovolémia passa pela resolução da hemorragia e pela correção do deficit de volume intravascular causado e envolve, obrigatoriamente, o recurso à administração de fluidos intravenosos. A escolha do tipo de fluido mais adequado para a terapia intravenosa, em cada ocorrência, é uma tarefa que exige reflexão e ponderação. A seleção dos fluidos apropriados é da responsabilidade do médico veterinário, sendo, no entanto, fundamental que o enfermeiro veterinário detenha conhecimentos básicos sobre as diferenças entre os fluidos disponíveis para a fluidoterapia. O objetivo deste projeto é determinar qual o tipo de fluido mais adequado para ajudar a preservar a integridade e funcionalidade hepática, em situações de hipoperfusão, e assim ajudar a padronizar a sua escolha no momento da decisão pela fluidoterapia. Para atingir este objetivo recorreu-se ao modelo suíno, a fim de recrear a situação de hipoperfusão e posteriormente avaliar os efeitos de dois fluidos diferentes administrados na reposição volémica, o lactato de Ringer e hidroxietilamido 130/0,4. Os animais foram sujeitos a uma hemorragia controlada, após a qual foi reposta a volémia com os respetivos fluidos. Após esta reposição volémica os animais foram eutanaziados e foram obtidas amostras de vários órgãos, incluindo fígado, objeto do presente estudo, alvo de diversas técnicas histopatológicas, nomeadamente o estudo histopatológico de rotina, através de hematoxilina e eosina, e diversos métodos para deteção de eventos apoptóticos, incluindo citocromo c, TUNEL e M30.Após a avaliação exaustiva dos resultados obtidos através das técnicas realizadas, foi possível concluir que o lactato de Ringer confere uma maior proteção contra a lesão de reperfusão, quando comparado com o hidroxietilamido 130/0,4. ABSTRACT: Severe hemorrhage remains the major cause of morbidity and mortality in trauma victims or surgical intervened animals, despite of all the advances in the therapeutic approach. The resulting injuries, or even death, are due to the deficit in intravascular volume and subsequent development of hypovolemic fluid state. In physiological terms, the most devastating consequence of this condition is the absolute or relative decreasing of cardiac preload, resulting in low cardiac output, poor tissue perfusion and decreased oxygen delivery to the tissues, compromising cell function (Hughes, 2006; Pachtinger & Drobatz, 2008; Groeneveld, 2013). Managing hypovolemia involves the resolution of the active hemorrhage and the correction of intravascular volume deficit, through the administration of intravenous fluids. The choice of the most appropriate fluid is a task that requires thinking and reflection. The selection of appropriate fluids is a veterinarian responsibility however, it is essential that the veterinary nurse holds basic knowledge about the differences between the available fluids (Pachtinger & Drobatz, 2008). The objective of this project is to determine the most appropriate type of fluid to preserve the integrity and functionality of hepatic tissue in situations of hypoperfusion and to help to standardize their choice at the time of the decision. Situations of hypoperfusion were created, using the porcine model. Animals were subjected to a controlled bleeding and, after that, the blood volume was replenished with Ringer's lactate or hydroxyethylstarch 130/0,4. Animals were then euthanized and histological sections were taken from liver. Various histopathological techniques, namely hematoxylin & eosin, and several methods of apoptotic events detection, such as, cytochrome c, TUNEL and M30, were executed. After an exhaustive review of all results obtained from these techniques we conclude that the Ringer lactate solution is the one that gives greater protection against reperfusion injuries.

Foram realizadas 114 coletas de embriões em éguas mestiças das raças Bretã e Campolina, distribuídas ao acaso em dois tratamentos: T1 - fluxo interrompido, método tradicional que utiliza filtro de embrião (n=56) e T2 - fluxo direto, sem interrupção do fluxo e sem utilização do filtro (n=58). O meio utilizado nas lavagens foi o Ringer lactato. Não houve diferenças entre tratamentos em relação à taxa de recuperação de embriões (58,9 e 44,8%), à qualidade dos embriões (3,56 e 3,53), à taxa de recuperação do meio de coleta (98,1% e 98,1%) e à taxa de gestação (52,9 e 81,8%), respectivamente, para T1 e T2. Observaram-se diferenças entre tratamentos quanto ao tempo de duração da coleta (10,3 e 7,4 minutos) e ao intervalo de tempo da coleta à inovulação (39,5 e 65,7 minutos). One hundred and fourteen embryo collections were performed in donor mares of crossbred Breton and Campolina breeds randomly allotted to two treatments: T1 - interrupted flushing (n=56), embryo flushing system whereby an embryo filter was inserted in the recovery line, and T2 - direct flushing (n=58), without flushing interruption. The flushing medium was the Ringer lactate. No differences between T1 and T2 were observed for the embryo recovery rate (58.9% and 44.8%), for the quality of the embryos (3.56 and 3.53), for the recovery medium from the uterus (1962.10ml, 98.1% and 1962.39ml, 98.1%) and for the pregnancy rate of the transferred embryo (52.9% and 81.8%). Also, no differences between T1 and T2 for length of collection (10.3 and 7.4 minutes), and for interval from the collection to transference (39.5 and 65.7 minutes) were observed.

To compare the preloading effect of 500 ml hydroxyethylstarch (HES) 10% with 1 L Lactated Ringer's solution (LR).In 40 healthy women undergoing elective Cesarean section HES, 500 ml (n = 20), or LR, IL (n = 20), was administered during 10 min before spinal anesthesia. The incidence of hypotension, (systolic blood pressure80% of baseline and100 mm Hg), and the amount of ephedrine used to treat it were compared. Also, the incidence of nausea and/or vomiting were recorded. Neonatal outcome was assessed using Apgar scores and umbilical venous and arterial blood gases.The incidence of hypotension was higher in the LR than in HES group (80% vs 40%). Mean minimum systolic blood pressure was lower in the LR than in the HES group (86.1 +/- 12.7 mm Hg vs 99.6 +/- 9.7 mm Hg P0.05). Systolic blood pressure90 mmHg occurred in two of 20 patients (10%) who received HES vs 11 of 20 patients (55%) who received LR (P0.05). More doses of ephedrine were required to treat hypotension in the LRthan in the HES group (35.3 +/- 18.4 mg vs 10.6 +/- 8.6 mg; P0.05). The incidence of nausea and/or vomiting was lower in the HES than in the crystalloid group. Neonatal outcome was good and similar in both groups.Preloading patients undergoing elective Cesarean section with 500 ml HES 10%, decreases the incidence and severity of spinal-induced hypotension more than preloading with 1 L of LR solution.

Die Verpflichtung zur Kostenreduktion gilt auch fur die Flussigkeitstherapie. Folgende Prinzipien sollen hierbei helfen. 1: Ein Preisvergleich lohnt sich immer. Dieses gilt insbesondere fur Kristalloide, da Unterschiede zwischen Praparaten nicht zu erwarten sind. Bei Kolloiden sind noch Faktoren wie das Risiko anaphylaktoider/anaphylaktischer Reaktionen oder Virussicherheit zu berucksichtigen. 2: Je groser die Produkteinheit, desto billiger der Milliliter. Limitiert wird diese Anwendung von den lokalen Gegebenheiten. 3: 0,9%ige Kochsalzlosung ist billiger als Ringer-Laktatlosung. Hierbei mussen lediglich die jeweiligen Kontraindikationen beachtet werden. 4: Kristalloide Losungen sind billiger als kolloidale Losungen. Bei der Preiskalkulation sind Wirkdauer und spezifische Nebenwirkungen miteinzubeziehen. 5: Kostenreduktion durch Differentialindikation kunstlicher Kolloide. Neben dem Preisvergleich sind u.a. das Risiko anaphylaktoider/anaphylaktischer Reaktionen, intravasale Verweildauer, Dosislimitierung oder die mogliche Hamostasebeeinflussung zu beachten. 6: So wenig Humanalbumin wie notig. Da Humanalbumin das teuerste Kolloid darstellt und eine routinemasig Anwendung nicht indiziert ist, sollte der Einsatz restriktiv erfolgen.

We studied the effects of various infusion containers materials on the fluid volumes, different infusion fluids and fluid concentrations of nartograstim (NT), a recombinant human granulocyte colony stimulating factor, on the adsorption of NT to containers, after adding NT preparations (Neu-up® for injection 100) into infusion fluids. The NT concentrations in the infusion fluids after adding NT to containers were determined by a high-performance liquid chromatographic method or bioassay. When 1000 ng of NT was added to 500 ml physiological saline in glass containers (final concentration: 200 ng/ml), the residual rates in the fluids was to 89.5% immediately after addition, and thereafter decreased 73.3% at 6 hr and 59.1% at 24 hr. Similarly, when NT was added to the same solution in polypropylene containers, the residual rates was 74.2% immediately after adding, and 37.5% at 6 hr, and 27.8% at 24 hr. The results in the ethylenvinyl acetate and polyethylene containers were also similar to those in the polypropylene containers. No influence of the volumes (100 and 250 ml) or the kinds of fluids (physiological saline, 5% glucose solution and ringer lactate solution) on the residual rates of NT in fluids was observed. As the fluid concentrations of NT were higher, the residual rates were found to be larger within the range of 100-1200 ng/ml. These decreases in the NT concentrations in the infusion fluids could be prevented almost completely by adding commercially available total-vitamin injections containing polysorbate surfactants.

Background: In 2012, serotype of Dengue Virus had changed from Den-2 and Den-3 to Den-1. In 5–10 years ago, serotype of Den-1 case showed a mild clinical manifestation; but now as a primary case it can also show severe clinical manifestation. One of indicator is an increasing liver enzyme, AST and ALT, with level more than 100–200 U/L. Aim: To getting a better solutions for this problem. Method: Obsevasional Study had been done in medical faculty of Airlangga University (Dr. Soetomo and Soerya hospital) Surabaya on Mei–August 2012. There were 10 cases of dengue virus infection were studied, 5 cases got Ringer Acetate solution (Group A) and 5 cases got Ringer Lactate solution (Group B). The diagnosis was based on criteria WHO 2009. Result: Five cases of Dengue Virus Infection had showed a liver damage soon after using Ringer Lactate solution; AST and ALT were increasing more than 100–200 U/L; but the other 5 cases showed better condition. It might be due to use Ringer Acetate that did not have effect for inducing liver damage. By managing carefully, all of the cases had shown full recovery and healthy condition when being discharged. Conclusion: Using Ringer Acetate as fluid therapy in Dengue Virus Infection is better to prevent liver damage than using Ringer Lactate.

Resume Objectif Le contenu hydrique cerebral etant plutot determine par des gradients osmotiquesque par des pressions hydrostatiques ou oncotiques, le but de cette etude a ete de comparer l'effet de differents solutes de remplissage sur l'osmolalite plasmatique. Type d'etude Etude comparative randomisee. Patients Trente patients de classe physique ASA 1 et 2, programmes pour une chirurgie non hemorragique, ont ete randomises en trois groupes, recevant respectivement 2 000 mL de Ringer lactate (RL) (n = 10), 750 mL d'hydroxyethylamidon a 6 % (HEA) (n = 10), ou 2 000 mL de NaCl 0,9 % (NaCl) (n = 10). Methodes L'osmolalite plasmatique, la natremie, la glycemie et la protidemie ont ete mesurees avant l'induction anesthesique (T1), apres la perfusion de la moitie du solute (T2) et a la fin de la perfusion (T3). Resultats Les trois groupes ont ete identiques pour l'âge, le poids, l'osmolalite, la natremie, la glycemie et la protidemie a T1. Dans le groupe RL (T1: 299 ± 5 mOsm·kg−1), l'osmolalite a T2 (295 ± 4 mOsm·kg−1) et T3 (292 ± 5 mOsm·kg−1) a ete significativement plus basse par rapport a celles des groupes HEA(T1: 300 ± 6, T2: 301 ± 6, T3:304± 13 mOsm·kg−1) et NaCI (T1: 298 ± 6, T2: 299 ± 5, T3: 298 ± 5 mOsm·kg−1) ; P Conclusion Au cours d'un remplissage vasculaire avec du NaCl 0,9 % ou de l'HEA 6 %, l'osmolalite plasmatique est restee stable, alors qu'elle est diminuee apres Ringer lactate. Pour cette raison, le NaCl 0,9 % et HEA 6 % peuvent etre recommandes pour des patients ayant une alteration de la barriere hematoencephalique, plutot que le Ringer lactate.

Introducción: El objetivo del presente estudio es analizar el efecto de soluciones cristaloides simples (solución salina y solución de Ringer Lactato) y una solución de preservación de órganos compleja (solución Celsior) sobre la la pared intestinal de ratones mediante el empleo de microscopía electrónica de barrido tras su preservación hipotérmica. Material y Métodos: Los segmentos intestinales de íleon procedentes de ratones CD1 fueron perfundidos por vía vascular e intraluminal con soluciones cristaloides simples como el suero salino (grupo 2) o solución de Ringer-Lactato (grupo 3), y con soluciones complejas como la solución Celsior (grupo 4). Los segmentos fueron almacenados durante 14 horas a 4º C con la misma solución empleada para su perfusión. Las diferentes muestras fueron procesadas utilizando protocolos convencionales para microscopia electrónica de barrido. Resultados: Nuestros resultados muestran que el grupo 2 se caracterizó por presentar un patrón vellositario y microvellositario compatible con el grupo control (grupo 1). El grupo 3 mostró lesiones focales caracterizadas por pérdidas epiteliales a nivel del vértice vellositario y exposición del eje conjuntivo-vascular de la vellosidad. Finalmente, el grupo 4 presentó un patrón vellositario desestructurado con hendiduras subepiteliales extensas, así como destrucción de células enterocíticas hasta la base. Discusión: El estudio demuestra que las soluciones cristaloides simples administradas por vía vascular e intraluminal mantienen la integridad morfológica de la mucosa intestinal tras su preservación hipotérmica. La microscopia electrónica de barrido constituye una metodología óptima en la valoración topográfica del daño tisular inducido por diferentes protocolos de preservación., Introduction: The aim of this study is to analyze the effect of simple crystalloid solutions (saline and Ringer lactate solution) and an organ preservation solution (Celsior) on murine intestinal ileal mucosa by scanning electron microscopy after hypothermic preservation. Material and Methods: The intestinal segments of ileum from CD1 mice were intravascularly and intraluminally flushed with 3 different preservation solutions. The used solutions were the simple crystalloid solution normal saline -group 2- and Lactated Ringer (LR) -group 3-. As organ preservation solution, the solution Celsior -group 4- was used. The segments were stored for 14 hours at 4 ° C with the same solution used for perfusion. The samples were processed using standard protocols for scanning electron microscopy. Results: Our results show that group 2 was characterized by villous and microvilli pattern similar to the control group (group 1). The group 3 showed focal lesions characterized by missing epithelium at the apex level and the exposure of the connective-vascular axis of the villi. Finally, group 4 presented a disrupted villous pattern with extensive subepithelial clefts as well as complete denuded villi. Discussion: This study shows that simple crystalloid solutions administered via vascular and intraluminal maintain morphological integrity of the intestinal mucosa after hypothermic preservation. In addition, scanning electron microscopy is an optimal methodology to evaluate the topographical tissue damage induced by various preservation protocols.

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.

The stability of ifosfamide in Ringer lactate buffer solution either alone or mixed with mesna at 37 degrees C for a 7-day period was analyzed by HPLC. This study was performed to investigate the feasibility of continuous infusion of ifosfamide by a multiday pump in order to reduce the toxicity and to increase the production of active alkylating metabolites of the parent drug. The total decay of ifosfamide activity did not exceed 3.2% at day 7. We conclude that ifosfamide can be safely delivered in a 7-day infusion with no significant loss of activity.

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.

Background: Hypotension after spinal anaesthesia is preventable by adequate pre-loading with colloids or crystalloids. Women posted for emergency caesarean section are more vulnerable for hypotension as they are not preloaded adequately due to time constraints. The idea of the study is to maintain haemodynamics by administering preload solution without any delay. Here 6% Hydoxyethyl starch (HES) is compared with Ringer lactate (RL) as a preloading solution. Materials and Methods: 50 pregnant women posted for emergency caesarean section were randomly allocated into 2 groups – Group H of 25 women received 500 ml of 6% HES and Group R of 25 women received 500 ml of RL intravenously as preload prior to spinal anaesthesia. The requirement of ephedrine to counter hypotension and the changes in the haemodynamic parameters were noted. Statistical analysis was done using Student’s ‘t’ test, Fisher’s test and Chi square test, and p

En este estudio se presentan los resultados obtenidos al comparar las propiedades de resistencia a la corrosión de dos aleaciones austeníticas Fermanal Mn - 22,6, Al- 6,30, C- 0,68, Cr- 3,10, Fe- 67,33 (F1) y Mn- 30,0, Al- 8,5, C-1, Cr -3,20, Mo- 1,10, Fe- 56,20 (F2) frente a las del acero AISI 316 LVM con el propósito de determinar la viabilidad de dichas aleaciones como reemplazos óseos. Las propiedades electroquímicas se evaluaron mediante medidas de potencial, curvas de polarización Tafel y resistencia a la polarización lineal (LPR), con ringer lactato como fluido biológico simulado. Para la pruebas tribológicas se utilizó un tribómetro pin on disk y se determinó la morfología de la huella de desgaste. Los resultados mostraron que la adición de molibdeno en la aleación F2 mejora sustancialmente la resistencia a la corrosión, el comportamiento electroquímico es similar al AISI 316 LVM, por lo cual, las aleaciones Fermanal, son materiales apropiados para aplicaciones biomédicas. This study present the results obtained by comparing the corrosive properties of two Fermanal austenitic alloys Mn -22.6, Al- 6.30, C- 0.68, Cr- 3.10, Fe- 67.33 (F1) and Mn- 30, Al- 8.5, C-1, Cr -3.20, Mo- 1.10, Fe- 56.20 (F2) with the AISI316LVM steel with the purpose of determine the viability of this alloys as bony substitutions. The electrochemical properties were evaluated trough potential measures, Tafel curves polarization and lineal polarization resistance (LPR) with ringer lactate as simulated biological fluid. For the tribological test a pin on disk tribometer was used to determinate wear mark morphology. The results showed that the molybdenum addition in the F2 alloy improves substancially the corrosion resistance, the electrochemistry behavior is similar to AISI 316 LVM, therefore, the Fermanal alloys is appropriate materials for biomedical applications.

The effects of Ringer lactate, 6% hydroxyethyl starch (HES) (130/0.4) or 4% succinylated gelatin solutions on perioperative coagulability were measured by thromboelastography (TEG). Seventy-five patients (ASA I-III) who were to undergo major orthopedic procedures performed under epidural anesthesia were included in the study. Patients were randomly divided into three groups of 25 each for the administration of maintenance fluids: group RL (Ringer lactate), group HES (6% HES 130/0.4), and group JEL (4% gelofusine solution). Blood samples were obtained during the perioperative period before epidural anesthesia (t1, baseline), at the end of the surgery (t2), and 24 h after the operation (t3). TEG data, reaction time (R), coagulation time (K), angle value (α), and maximum amplitude (MA) were recorded. TEG parameters changed from normal values in all patients. In group RL, R and K times decreased compared to perioperative values while the α angle and MA increased (P < 0.05). In group HES, R and K times increased, however, the α angle and MA decreased (P < 0.05). In group JEL, R time increased (P < 0.05), but K time, α angle and MA did not change significantly. In the present study, RL, 6% HES (130/0.4) and 4% JEL solutions caused changes in the coagulation system of all patients as measured by TEG, but these changes remained within normal limits.

Introduction When characterizing small intestine early lesions in studies concerning intestinal hypoperfusion in pigs, authors faced a significant difficulty when trying to standard the oedema grading to allow an accurate comparison between groups. Therefore, specific alterations were assumed to characterize grade1 (G1), grade2 (G2) and grade3 (G3) oedema. Material and Methods Eighteen Large White pigs underwent total intravenous anaesthesia (TIVA) with propofol and remifentanil. 25 ml/kg of arterial blood were removed from the femoral artery over 20 minutes. Volume was replaced using Ringer Lactate in Gr1 (n=6) and Hydroxyethyl starch 130/0.4 in Gr2 (n=6), 20 minutes after bleeding. Animals of G3 (n=6) were under TIVA without any haemorrhage and volume replacement. One hour after, pigs were euthanized and small intestine samples taken for histopathological examination. Oedema was described and classified in a specific scale: G0-Normal–normal central lacteal G1-Mild–lacteal dilation G2-Moderate-lacteal dilation and/or oedema of lamina propria G3-Marked–lacteal dilation dilation, oedema of lamina propria, and/or presence of submucosal oedema Pictures were made to better characterize the scale used. Results G2 oedema was predominant in duodenum in Gr1 (n=3), while in Gr2 and Gr3 was G1 for the same intestinal segment (n=5, n=4, respectively). G1 was predominant in jejunum in Gr1 (n=4), while G2 and G0 was more observed in Gr2 (n=2, n=2, respectively) and G2 in Gr3 (n=3). G1 was predominant in ileum in both Gr1 (n=5) and Gr2 (n=4), being G0 the grade more often observed in this segment in Gr3 (n=3). Jejunum was the only intestinal segment were G3 oedema was observed, and only in Gr2 (n=1).The higher frequency of G0 oedema for all the intestinal segments was observed in Gr3 (n=8). Conclusion The characterization used for the different grades of oedema improved uniformity when deciding which grade to attribute in each case and may allow standardization of oedema grading in further studies. Portuguese Foundation for Science and Technology under the project COMPETE: FCOMP-01-0124-FEDER-009525 (PTDC/CVT/101999/2008)

This work has compared the surfaces of two different steel samples used as orthopedical implants, classified as ASTM F138 and ISO5832-9, through optical emission spectroscopy, by means of SEM and EDS. The samples (implants) were also submitted to potentiodynamic cyclic polarization in Ringer lactate and NaCl 0.9 M L-1 solutions; ISO5832-9 sample did not show any kind of localized corrosion, but in the case of F138 steel was observed a pit localized corrosion in both solutions. In Ringer lactate solution it was observed a loss of about 63% for nickel and 26% for iron for F138 stell, compared to the initial composition.

Background: The spleen is important for many hematopoietic and immunological functions, namely hemodynamic compensation during hemorrhagic shock, with a crucial role in the compensation of hypovolaemia, on restoring blood volume in situations of acute haemorrhage. Also, the administration of physiological solutions is of great importance for the correction of circulating volume, avoiding the complications of hypovolaemia. Objectives: To evaluate spleen’s histopathological changes in pigs associated with volume replacement using two different physiologic solutions, after acute bleeding. Methods: 31 Large White pigs under general anaesthesia with propofol and remifentanil. A total of 25ml/kg of blood was passively removed during 20 minutes. Intravascular volume was replaced using Ringer Lactate 25 ml/kg (Group 1- thirteen pigs) and HES 130/0.4 20 ml/kg (Group 2- eleven pigs). Spleen samples were processed for routine hystologic evaluation. Congestion, inflammatory infiltrate, ellipsoids enlargement and follicular lymphoid hyperplasia were evaluated in a semi-quantitative score. Results: Follicular lymphoid hyperplasia was exacerbated in group 1 (84.6 %; grade III), when comparing with group 2 (36.4 %; grade III). The remaining lesions did not show differences between group 1 and group 2. Conclusion: Volume replacement with HES 130/0.4 may reduce follicular lymphoid hyperplasia when compared with volume replacement with Ringer Lactate. Portuguese Foundation for Science and Technology under the project COMPETE: FCOMP-01-0124-FEDER-009525 (PTDC/CVT/101999/2008)

Isotonic saline solution is frequently used in nasal and tracheal lavage. In a previous clinical study, it was found that Ringer-Lactate solution, as a nasal lavage, was better for mucociliary clearance function than isotonic saline solution after nasal septal surgery. In this experimental study, the effects of Ringer-Lactate and isotonic saline solutions on mucociliary clearance of healthy rat tracheal epithelium were investigated by measuring the transport of carbon particles. We found that tracheal segments that were irrigated with Ringer-Lactate had better mucociliary transport than those irrigated with isotonic saline (p = 0.035).

OBJECTIVE: The purpose of this study was to determine the stability of oxytocin in lactated Ringer's solution and lactated Ringer's–dextrose 5% solution over a 24-hour period at 25°C and over a 7-day period at 5°C. STUDY DESIGN: Twenty units (2.1 μg equal 1 unit) of oxytocin were injected into 1000 mL of lactated Ringer's solution and lactated Ringer's–dextrose 5% solution. Samples for the analysis were drawn at specified times after storage at 5°C and 25°C. These samples were stored at −70°C for later analysis. Statistical analysis was done with 1-way analysis of variance and Tukey-Kramer multiple comparisons. RESULTS: Twenty units of oxytocin in 1000 mL of lactated Ringer's solution and lactated Ringer's–dextrose 5% solution was found to be stable for 7 days at 5°C and for 24 hours at 25°C. CONCLUSION: Premixed oxytocin solutions in lactated Ringer's solution and lactated Ringer's–dextrose 5% solution are stable in conditions commonly found in dispensing pharmacies and labor and delivery units. This finding could lead to the more efficient use of personnel during the mixing process, could provide solutions that are aseptically prepared, and could be a tool to reduce costs and improve patient care. (Am J Obstet Gynecol 2002;186:496-8.)

Background and Goal of Study: Perioperative and intraoperative hypovolemia may cause intestinal hypoperfusion and postoperative complications 1 . The objective of this study is to analyse the ef fect on the small bowel m of HES 130/0.4 and Ringer solutions used for volume replacement after se-vere haemorrhage in pigs. Materials and Methods: Six Large White pigs under TIVA with propofol 15 mg/kg/h and remifentanil 0.3 ug/kg/h; 25 ml/kg of arterial blood was removed during 20 minutes from each pig. Blood volume was replaced at 999 ml/h, 20 minutes after the end of the bleeding as follows: Gr1- three pigs, volume was replaced with 25 ml/kg Ringer; Gr2- three pigs, the volume was replaced with 20 ml/kg HES 130/0.4. Pigs were maintained under the same TIVA for an ad-ditional one hour before euthanasia with 40 mEq of KCl. Small bowel samples were collected and a) semiquantitative parameters oedema, congestion, hy-peraemia, haemorrhage, inflammatory infiltration, cellular degeneration and necrosis, and b) the epithelial detachment were evaluated and classified in a specific scale from 0 to 3 2 , and 0 to 5 3,4 , respectively. The quantitative morpho-logical assessment to mucosal loss (ML) percentage and crypt:interstitium ratio (C:I) was also analysed. Mean arterial pressure (MAP) and heart rate (HR) were analysed. Results and Discussion: Gr1- MAP decreased 60% from baseline (69.3±3.8 mmHg to 27.7±4.2 mmHg); ML percentage was 2.18±0.46% (duodenum), 0.62±1.07% (jejunum) and 0.45±0.77% (ileum); the C:I was 0.5±0.06% (duodenum), 0.49±0.02% (jejunum) and 0.46±0.09% (ileum). Gr2- MAP decreased 71% from baseline (78.7±18.9 mmHg to 22.7±0.1 mmHg); ML percentage was 0.75±1.3% (duodenum), 0.0±0.0% (jejunum) and 0.0±0.0% (ileum); the C:I was 0.73±0.28% (duodenum), 0.48±0.11% (jejunum) and 0.43±0.12% (ileum). C:I ratio did not presented relevant dif ferences among the Groups. There were no significant changes in HR in both groups. Conclusions: Volume replacement with HES 130/0.4 may reduce the ML in the small bowel after severe haemorrhage, when compared to using Ringer Lactate. Duodenum mucosa seems to be more sensitive to hypoperfusion than jejunum and ileum mucosa. Portuguese Foundation for Science and Technology under the project COMPETE: FCOMP-01-0124-FEDER-009525 (PTDC/CVT/101999/2008)

Hintergrund: Werden Blutkonserven vor der Verabreichung nicht erwärmt, so kann es besonders bei hoher Transfusionsgeschwindigkeit zu einem bedrohlichen Abfall der Körperkerntemperatur kommen. In Deutschland werden zur Vermeidung dieser Gefahr vorwiegend Durchflußerwärmer eingesetzt. Material und Methodik: In der vorliegenden Studie verglichen wir den Fenwal BW-5 (Travenol), den Biotest BW 385 und 385L (Biegler) sowie den DW 1220 (American Pharmaseal) bei verschiedenen Durchflußraten von Erythrozytenkonzentrat bzw. Ringer-Lactat-Lösung. Ergebnisse: Bis zu einer Durchflußrate von zirka 30 ml/min wurden mit dem Biotest BW 385L höhere Transfusionstemperaturen als mit den anderen Wärmern erreicht. Im Bereich oberhalb von zirka 60 ml/min konnte eine Transfusionstemperatur von über 30°C nur noch mit dem Fenwal BW-5 erzielt werden, dies allerdings auch nur bis zirka 100 ml/min. Schlußfolgerungen: Für die roiitinemäßige Erwärmung von Transfusionen und In- fusionen ist der Biotest BW 385L am besten geeignet. Bei Massivtransfusionen ist entweder die parallele Verwendung von zwei bis drei Fenwal BW-5 oder aber der Einsatz anderer Erwärmungstechniken zu empfehlen.

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.

This is the essential point of the initial management of ocular chemical splashes, which is here developed and illustrated by new experimental data of the first importance. The following are successively addressed: the mechanisms of diffusion with utilization of a powerful OCT imaging technique, the osmotic effect with measurement of corneal stroma hydration, and finally the effects of irrigation with fluids in various conditions of chemical injury at the epithelial surface. Numerous original graphics illustrate the results of these innovative studies. The main ocular washing products available on the market for decontamination of chemical splashes are compared and some clear conclusions are formulated as to their advantages, efficacy, and adverse effects. Examples of specific decontamination for radicals, peroxides, and hydrofluoric acid conclude the discussion on a practical dimension.

Foi estudado o comportamento eletroquímico a 37°C do aço inoxidável ISO 5832-9, em meios de NaCl 0,9 %, de Ringer Lactato e meio mínimo de Eagle (MEM), por voltametria linear e análises da superfície por microscopia eletrônica de varredura (MEV) e por espectroscopia por dispersão de energia (EDS). Foram feitos ensaios mecânicos e testes de toxicidade. O aço ISO 5832-9 se encontra passivado no potencial de corrosão e não apresenta corrosão por pite nos três meios estudados em toda faixa de potencial investigada, desde o potencial de corrosão até 50 mV acima do potencial de transpassivação. Em meio de MEM, no entanto, as análises por MEV e EDS mostraram que o referido aço, nesse valor mais elevado de potencial, apresentou um comportamento diferente, com perda das inclusões de óxido de manganês. Os potenciais de corrosão, Ecorr (potencial de circuito aberto estacionário) bem como os valores de densidade de corrente de passivação, variaram na seguinte ordem: Ecorr, RL < Ecorr, NaCl < Ecorr, MEM. e jMEM << jRL ≅ jNaCl. No ensaio de citotoxicidade, o aço foi caracterizado como não-tóxico. The electrochemical behavior of ISO 5832-9 stainless steel at 37 oC in 0.9% NaCl, Ringer Lactate and minimum essential medium (MEM) has been studied, using linear voltammetry, and surface analysis by SEM and EDS. Mechanical and toxicity tests were made. ISO 5832-9 is passivated at corrosion potential (Ecorr) and it does not present pitting corrosion on the media studied from Ecorr to 50 mV above the transpassivation potential (Ei). SEM and EDS analysis have shown that the sample previously immersed in MEM presents a different behavior at 50 mV above Ei: the manganese oxide inclusions are absent in the surface. Ecorr values and passivation current density values jpass changed according to the following. Ecorr, RL < Ecorr,NaCl < Ecorr, MEM and jMEM << jRL ≅ jNaCl. The stainless steel was characterized as non toxic in the cytotoxicity assay.