Fluid resuscitation in live Escherichia coli shock in puppies

The infusion of live E. coli in the puppy produces a severe and usually lethal model of pediatric septic shock with characteristic reduction in cardiac output and blood pressure. Hemodynamic abnormalities are partially reversed with fluid resuscitation alone, and large volumes, supplemented with albumin well within tolerated fluid loads, produce the most pronounced corrections of these derrangements. Certain metabolic changes appear to be unique to the young animal and their correction is less successful regardless of resuscitation regimen. These findings suggest that the initial fluid management of the bacteremic pediatric patient should include Ringer's lactate and 5% albumin at approximately 105% of patient's blood volume. Further resuscitation fluid, as well as the role of steroids and antibiotics, remain work currently being carried out in our laboratory.     

Partial liquid ventilation protects lung during resuscitation from shock

Preliminary animal experience with partial liquid ventilation (PLV) suggests that this therapy may diminish neutrophil invasion and capillary leak during acute lung injury. We sought to confirm these findings in a model of shock-induced lung injury. Sixty anesthetized rats were studied. After hemorrhage to an arterial pressure of 25 mmHg for 45 min, animals were resuscitated with blood and saline and treated with gas ventilation alone or with 5 ml/kg of intratracheally administered perflubron. Myeloperoxidase activity was used to measure lung neutrophil content. A permeability index (the bronchoalveolar-to-blood ratio of 125I-labeled albumin activity) quantified alveolar leak. Injury caused an increase in myeloperoxidase that was reversed by PLV (injury = 0.837 +/- 0.452, PLV = 0.257 +/- 0.165; P < 0.01). Capillary permeability also increased with hemorrhage, with a strong trend toward improvement in the PLV group (permeability indexes: injury = 0.094 +/- 0.102, PLV = 0.045 +/- 0.045; 95% confidence interval for injury--PLV: -0.024, 0.1219). We conclude that PLV is associated with a decrease in pulmonary neutrophil accumulation and a trend toward decreased capillary leak after hemorrhagic shock.     

An argument against the reorganization of APA.

Article discussing the reorganization of the American Psychological Association. The proposed reorganization is essentially a way of allowing conflicting interests to live side by side each other without resolving them. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Dopexamine improves liver oxygenation during crystalloid resuscitation from experimental hemorrhagic shock

OBJECTIVE: To evaluate the effects of dopexamine administration on hemodynamic variables and tissue oxygen tensions during crystalloid resuscitation from hemorrhagic shock. DESIGN: Randomized, control trial. SETTING: An animal laboratory at a university center. SUBJECTS: Twelve piglets, mean weight 22 kg. INTERVENTIONS: The animals were anesthetized and bled to a state of hemorrhagic shock and resuscitated, using a crystalloid solution infused at a rate of approximately 2.6 mL/min/kg (total amount 208 mL/kg). Cardiac output and mean arterial pressure (MAP were measured as indicators of volume filling during the 20- to 30-min resuscitation period and during the follow-up period until 80 mins from the start of resuscitation. Dopexamine was administered by infusion at 6 micrograms/kg-min from the start of volume replacement (dopexamine group, n = 6). The rest of the animals (control group, n = 6) were given volume replacement only. MEASUREMENTS AND MAIN RESULTS: Systemic oxygen transport variables were calculated. Tissue oxygen tensions were continuously recorded from the liver, conjunctival layer, and via subcutaneous and transcutaneous electrodes in the abdominal region. MAP decreased from 119 +/- 2 (SEM) to 44 +/- 2 mm Hg and cardiac output decreased by 77% during the shock period. During resuscitation, cardiac output was restored in both groups. MAP increased close to the baseline during the early resuscitation period and decreased slowly during follow-up. Oxygen delivery remained at 46% of baseline, whereas systemic oxygen consumption was restored during resuscitation in both groups. Liver tissue oxygen tension increased well above baseline during resuscitation in the dopexamine group, and liver tissue oxygen tension was significantly higher than in the control group. After 60 mins of resuscitation, the liver oxygen tension decreased to control group values. None of the other tissue oxygen tensions showed any differences between groups. CONCLUSIONS: Dopexamine administration during crystalloid resuscitation from hemorrhagic shock was well tolerated and resulted in significant and specific, although transient, improvement in liver oxygenation.     

Psychoanalytic Psychology: An argument for change in editorial policy.

In an Editorial Note (Psychoanalytic Psychology, 1989) the Editorial Board of Psychoanalytic Psychology invites comment on its proposal for an occasional section devoted to reports of psychoanalytic psychotherapy. This modification in editorial policy is welcome though it seems a very small advance in the direction of much needed change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The argument for constructivism.

Comments on D. C. Geary's (see record 1995-16916-001) assumption that there is a cerebral primacy in the development of knowledge and the suggestion that there is acontinuum between basic skeletal processes developed by humans as a result of evolutionary processes. Criticizes Geary's point that educational models in which children are offered freedom in the way they learn secondary cognitive abilities (e.g., constructivism), may not be the best possible technique, especially in area of mathematics education . The author acknowledges that culturally enforced "drilling" methods suggested by Geary may, in fact, be more detrimental. The Vygotskian notion of the evolution of knowledge, social constructivism, works far better than "drilling." Education in secondary cognitive abilities must incorporate ways for children to understand motivations and discovering the meaning of mathematics in their own lives through solving of problems, hence, what is known as social constructivism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Diaspirin cross-linked hemoglobin resuscitation improves cerebral perfusion after head injury and shock

BACKGROUND: Shock associated with traumatic brain injury (TBI) doubles the mortality of TBI alone by inducing a secondary ischemic injury. Rapid correction of cerebral perfusion pressure (CPP) is thought to be essential to improving outcome. Diaspirin cross-linked hemoglobin (DCLHb) has been shown to improve cerebral blood flow, increase mean arterial pressure (MAP), and reduce lesion size in models of occlusive cerebral ischemia but has not been evaluated in a model of TBI combined with hemorrhagic shock. METHODS: We studied the effects of DCLHb resuscitation in a porcine model of cryogenic TBI and hemorrhagic shock (MAP = 50 mmHg). After combined insults, animals were randomized to receive a bolus of 4 mliters/kg of either lactated Ringer's solution (n = 5) or DCLHb (n = 6). Lactated Ringer's solution was then infused in both groups to maintain MAP at baseline. Shed blood was returned 1 hour after the initiation of resuscitation (R1). Animals were studied for 24 hours. RESULTS: DCLHb infusion resulted in a significantly greater MAP at R1 and R24 (95 +/- 4 vs. 82 +/- 2 and 99 +/- 3 vs. 85 +/- 3 mm Hg, respectively) and a significantly greater CPP at R1 and R24 (83 +/- 10 vs. 68 +/- 5 and 89 +/- 6 vs. 71 +/- 11 mm Hg, respectively). Intracranial pressure was lower in the DCLHb group, but this difference was not significant. There was no significant difference between the groups in cerebral oxygen delivery. DCLHb animals required less fluid to maintain MAP (12,094 +/- 552 vs. 15,542 +/- 1094 mliters, p < 0.05). CONCLUSION: These data suggest that DCLHb is beneficial in the early resuscitation of head injury and shock and that further investigation is warranted. Key Words: Diaspirin cross-linked hemoglobin, Head injury, Shock, Cerebral perfusion pressure.     

Pentoxifylline prevention of altered hepatocyte calcium regulation during hemorrhagic shock/resuscitation

The role of immune complexes (Icx) in B-cell memory formation and affinity maturation allow for their potential use as vaccines. Recently, a new immune complex vaccine has been developed that is currently under field trials conducted in commercial poultry. This immune complex vaccine is developed by mixing live intermediate plus infectious bursal disease virus (IBDV) with hyperimmune IBDV chicken serum (IBDV-Icx vaccine). Here we have investigated the infectivity of this vaccine as well as the native IBDV (uncomplexed) vaccine in terms of differences in target organs, in target cells and speed of virus replication. At various days after inoculation on day 18 of incubation (in ovo) with either one dose of virus alone or the IBDV-Icx vaccine, the replication of IBDV and the frequency of B cells and other leucocyte populations were examined in the bursa of Fabricius, spleen, and thymus using immunocytochemistry. With both vaccines, IBDV was detected associated with B cells, macrophages and follicular dendritic cells (FDC) in bursa and spleen, although complexing IBDV with specific antibodies caused a delay in virus detection of about 5 days. Most remarkable was the low level of depletion of bursal and splenic B cells in IBDV-Icx vaccinated chickens. Furthermore, in ovo inoculation with the IBDV-Icx vaccine induced more germinal centres in the spleen and larger amounts of IBDV were localized on both splenic and bursal FDC. From these results we hypothesize that the working mechanism of the IBDV-Icx vaccine is related to its specific cellular interaction with FDC in spleen and bursa.     

Flush resuscitation for group A streptococcus toxic shock: a possible role for continuous renal replacement therapy and plasmapheresis

Concentrations of citalopram in medicolegal samples from 92 autopsies and 27 living persons are described. In autopsy cases in which citalopram alone was the cause of death, concentrations ranged from 2.0 to 6.2 mg/kg whole blood. In autopsy cases in which citalopram together with other substances was considered to be the cause of death, the concentrations of citalopram ranged from 0.6 to 5.2 mg/kg whole blood. In autopsy cases toxic concentrations ranged from 0.4 to 0.9 mg/kg whole blood and therapeutic concentrations from 0.03 to 0.6 mg/kg whole blood. In samples from living persons the concentrations of citalopram in whole blood were 0.02 to 0.3 mg/kg.     

Multifocal ventricular tachycardia after resuscitation by direct current counter shock in a dog

Cardiac arrest occurred in a male Labrador Retriever dog weighing 27.8 kg during induction to anesthesia. Immediately after the failure of resuscitation by the external cardiac compression, thoracotomy was performed and open chest direct current (DC) counter shocks were applied with routine emergency medications. Then the dog recovered consciousness. Although cardiac rhythm just after resuscitation was sinus tachycardia with paroxysmal supraventricular tachycardia, multifocal ventricular arrhythmia occurred 2 hr after resuscitation. This arrhythmia might be the result from reversible cardiac lesions due to DC counter shock.     

Pulmonary capillary pressure and tissue perfusion: clinical implications during resuscitation from shock

During shock resuscitation, a combination of fluids, vasopressors, vasodilators, and inotropes is administered in order to achieve a cardiac output or overall oxygen delivery as per guidelines of individual clinicians. The measurement of ventricular end-diastolic pressure allows a clinician to describe a therapeutic goal of optimum cardiac output response to changes in end-diastolic pressure. This concept has formed the backbone of resuscitative strategies in many forms of shock. Ventricular end-diastolic pressure is indirectly measured as the pulmonary artery occlusion pressure (PAOP) in critically ill patients with the use of a pulmonary artery catheter. Cytokines and other mediators may injure the pulmonary capillary endothelium which will affect the rate of leakage in the pulmonary capillaries. This may have important clinical implications in the therapy of shock in inflammatory states such as sepsis and the adult respiratory distress syndrome. Therefore, the true edema-forming pressure within the pulmonary bed is of considerable importance to the intensivist at the bedside. True pulmonary capillary pressure represents the midpoint of the capillary bed and is the hydrostatic pressure which directly drives the rate of pulmonary interstitial edema formation. During shock resuscitation in disorders in which vascular integrity may be impaired, the ability to measure pulmonary capillary pressure would be of great clinical benefit. It is impossible to directly measure pulmonary capillary hydrostatic pressure in the intact lung and, therefore, only indirect measurements are clinically possible. Numerous studies have demonstrated the lack of consistent relationship between the pulmonary capillary pressure, PAOP, pulmonary artery diastolic pressure, and the severity of acute lung injury. The assumption that PAOP, and thus left atrial pressure, is a good indirect measurement of pulmonary filtration pressure within the capillary bed is erroneous, in particular in the presence of increased resistance within the pulmonary venous bed between the capillaries and the left atrium, as may exist in disorders in which there is cytokine production. It is now clear that a significant gradient between pulmonary capillary pressure and PAOP may be present in inflammatory disorders which are not present in noninflammatory states, and that pulmonary capillary pressure may be measured at the bedside of critically ill patients. Bedside measurement of pulmonary capillary pressure may allow for added precision in our therapeutic goals in resuscitation from inflammatory shock. If further studies confirm the reliability and reproducibility of bedside measurement, pulmonary capillary pressure may become an invaluable part of the hemodynamic profile in the critically ill patient in shock.     

An unusual consequence of stereotactic colloid cyst aspiration: case report

The removal of a colloid cyst of the third ventricle by stereotactic cyst aspiration is frequently performed as an alternative to a transcortical-transventricular or transcallosal operative route. A consequence of a CT-guided stereotactic aspiration, where residual colloid cyst material has been dislodged into the lateral ventricle and likened to an intraventricular mouse, is described.