Evidence for phosphorylation-dependent, dynamic, regulation of mGlu5 and Homer2 in expression of cocaine aversion in mice

Cocaine-induced changes in the expression of the glutamate-related scaffolding protein Homer2 influence this drug's psychostimulant and rewarding properties. In response to neuronal activity, Homer2 is phosphorylated on S117/S216 by calcium-calmodulin kinase IIα (CaMKIIα), which induces a rapid dissociation of mGlu5-Homer2 scaffolds. Herein, we examined the requirement for Homer2 phosphorylation in cocaine-induced changes in mGlu5-Homer2 coupling, to include behavioral sensitivity to cocaine. For this, mice with alanine point mutations at (S117/216)-Homer2 (Homer2^AA/AA ) were generated and we determined their affective, cognitive and sensorimotor phenotypes, as well as cocaine-induced changes in conditioned reward and motor hyperactivity. The Homer2^AA/AA mutation prevented activity-dependent phosphorylation of S216 Homer2 in cortical neurons, but Homer2^AA/AA mice did not differ from wild-type controls with respect to Morris maze performance, acoustic startle, spontaneous or cocaine-induced locomotion. Homer2^AA/AA mice exhibited signs of hypo-anxiety similar to the phenotype of transgenic mice with a deficit in signal-regulated mGluR5 phosphorylation (Grm5^AA/AA ). However, opposite of Grm5^AA/AA mice, Homer2^AA/AA mice were less sensitive to the aversive properties of high-dose cocaine under both place- and taste-conditioning procedures. Acute injection with cocaine caused dissociation of mGluR5 and Homer2 in striatal lysates from WT, but not Homer2^AA/AA mice, suggesting a molecular basis for the deficit in cocaine aversion. These findings indicate that CaMKIIα-dependent phosphorylation of Homer2 gates the negative motivational valence of high-dose cocaine via regulation of mGlu5 binding, furthering an important role for dynamic changes in mGlu5-Homer interactions in addiction vulnerability.Significance statementGlobally, psychostimulant use has again risen to reach epidemic proportions, particularly in the United States. Yet, we continue to face a knowledge gap regarding the biological bases of psychostimulant addiction vulnerability to inform disease prognosis and treatment-based recovery. Herein, we show that the psychomotor stimulant cocaine induces the uncoupling of the mGlu5 glutamate receptor from its scaffolding protein Homer2 in brain. Using a transgenic mouse model with deficits cocaine-induced uncoupling of mGlu5-Homer2, we demonstrate an important role for Homer2 scaffolding of mGlu5 in regulating cocaine's aversive properties, without influencing cocaine reward. Findings suggest that environmental factors, to include cocaine exposure, that affect mGlu5-Homer2 scaffolding dynamics may contribute to an individual's subjective response to cocaine to influence addiction vulnerability.

Liver transplant with controlled donors after circulatory death with normothermic regional perfusion and brain dead donors: A multicenter cohort study of transfusion, one-year graft survival and mortality

BACKGROUND

Controlled donation after circulatory death (cDCD) has expanded the donor pool for liver transplantation (LT). However, transfusion requirements and perioperative outcomes should be elucidated. The aim of this multicenter study was to assess red blood cell (RBC) transfusions, one-year graft and patient survival after LT after cDCD with normothermic regional perfusion (NRP) compared with donors after brain death (DBD).

METHODS

591 LT carried out in ten centers during 2019 were reviewed. Thromboelastometry was used to manage coagulation and blood product transfusion in all centers. Normothermic regional perfusion was the standard technique for organ recovery.

RESULTS

447 patients received DBD and 144 cDCD with NRP. Baseline MCF Extem was lower in the cDCD group There were no differences in the percentage of patients (63% vs. 61% p = 0.69), nor in the number of RBC units transfused (4.7 (0.2) vs 5.5 (0.4) in DBD vs cDCD, p = 0.11. Twenty-six patients (6%) died during admission for LT in the DBD group compared with 3 patients (2%) in the cDCD group (p = 0.15). To overcome the bias due to a worse coagulation profile in cDCD recipients, matched samples were compared. No differences in baseline laboratory data, or in intraoperative use of RBC or one-year outcome data were observed between DBD and cDCD recipients.

CONCLUSIONS

cDCD with NRP is not associated with increased RBC transfusion. No differences in graft and patient survival between cDCD and DBD were found. Donors after controlled circulatory death with NRP can increasingly be utilized with safety, improving the imbalance between organ donors and the ever-growing demand.

Clinical profile of patients with peripheral artery disease treated with high-pressure intermittent pneumatic compression in st. lukes medical center-quezon city: a 6-year retrospective cohort study

Background

High-pressure intermittent pneumatic compression (HPIPC) has been proposed as an alternative intervention to supervised exercise to improve intermittent claudication in patients with peripheral artery disease (PAD). This intervention has already been introduced in the Philippines. However, no local data have been published regarding the clinical profile of patients with PAD treated with HPIPC. This study aims to determine the clinical profile of patients with PAD treated with HPIPC in our Medical Center from March 2015 to March 2021.

Purpose

Knowledge about the clinical profile of patients with PAD treated with HPIPC in SLMC-QC will provide local data that can lead to better planning of the next generation of PAD care in our institution or even in the Philippines. This study can therefore serve as a baseline for further studies to identify clinical outcomes using HPIPC.

Methods

A total of eighty-three (N=83) adult patients aged ≥19 years with confirmed diagnosis of PAD and symptoms of intermittent claudication who received at least 12 sessions of HPIPC in the Department of Vascular Medicine from March 2015 to March 2021 were included in this retrospective cohort study. The primary outcome was identification of the clinical profile of the study population that included age, sex, smoking history and co-morbidities such as hypertension, diabetes mellitus (DM), dyslipidemia, coronary artery disease (CAD) and chronic kidney disease (CKD). The secondary outcome was description of the clinical outcomes of the study population after a minimum of 12 sessions of HPIPC. Descriptive statistics were generated for all variables. Continuous variables were presented as mean (standard deviation, SD)'. Nominal and ordinal data were reported as frequencies and percentages. All data were analyzed using Statistical Package for the Social Sciences (SPSS) v27 software. The flow diagram of the study is shown in Figure 1.

Results

The mean (SD)' age of the study population was 75 (14)' years. Approximately 76% of them were aged ≥65 years. Overall, there were more males (57%) than females (43%) in the study. Majority of the study population were never-smokers (70%), had hypertension (89%), DM (81%), dyslipidemia (78%) and abnormal ankle-brachial index (ABI, 80%). The mean (SD)' ABI of the study population was 0.92 (0.5)'. 92% had hemodynamically significant stenosis in the distal arterial segments of the lower extremities while 62% had hemodynamically significant stenosis in the proximal arterial segments of the lower extremities (Table 1).

Conclusion

Age ≥65 years, male sex, never-smoker, hypertension, DM and dyslipidemia defined the clinical profile of patients with PAD treated with HPIPC in SLMC-QC from March 2015 to March 2021. Appropriate management of these risk factors can lead to better PAD care in the institution. Further studies are recommended to determine the efficacy of HPIPC in the treatment of PAD.

Funding Acknowledgement

Type of funding sources: None. Figure 1. Flow diagram of the studyTable 1. Results of the study

Rotation thromboelastometry velocity curve predicts blood loss during liver transplantation

BACKGROUND

Patients undergoing liver transplantation (LT) have a high risk of bleeding. The goal of this study was to assess whether the first derivative of the velocity waveform (V-curve) generated by whole blood rotation thromboelastometry (ROTEM^®) can predict blood loss during LT.

METHODS

Preoperative V-curve parameters were retrospectively evaluated in 198 patients. Patients were divided into quartiles based on blood loss: low (LBL) in the first quartile and high (HBL) in the higher quartiles. A subgroup analysis was performed with patients stratified according to cirrhosis aetiology. A logistic regression model and receiver operator characteristics (ROC) curve were used to test the capacity of the V-curve, to discriminate between LBL and HBL.

RESULTS

In the HBL group, the V-curve showed a lower maximum velocity of clot generation (MaxVel), a lower area under maximum velocity curve (AUC), and a higher time-to-maximum velocity (t-MaxVel) than in the LBL group. t-MaxVel was the only parameter showing a capacity to discriminate between the two groups, with a ROC area of 0.69 (95% CI; 0.62-0.74). The ROC area was 0.78 (95% CI; 0.75-0.83) for the 148 patients with cirrhosis, 0.73 (0.60-0.82) for patients with viral hepatitis and 0.83 (0.78-0.96) for patients with alcoholic hepatitis, the group that showed the best discriminative capacity. Moderate but significant correlations were found between all parameters of V-curve and BL.

CONCLUSIONS

Pre-transplant V-curve obtained from ROTEM is a promising tool for predicting BL risk during LT, particularly in patients with cirrhosis.

Olive oil quality classification and measurement of its organoleptic attributes by untargeted GC-MS and multivariate statistical-based approach

The capabilities of dynamic headspace entrainment followed by thermal desorption in combination with gas chromatography (GC) coupled to single quadrupole mass spectrometry (MS) have been tested for the determination of volatile components of olive oil. This technique has shown a great potential for olive oil quality classification by using an untargeted approach. The data processing strategy consisted of three different steps: component detection from GC-MS data using novel data treatment software PARADISe, a multivariate analysis using EZ-Info, and the creation of the statistical models. The great number of compounds determined enabled not only the development of a quality classification method as a complementary tool to the official established method "PANEL TEST" but also a correlation between these compounds and different types of defect. Classification method was finally validated using blind samples. An accuracy of 85% in oil classification was obtained, with 100% of extra virgin samples correctly classified.

Optimization of the lens sizing for the second eye based on the vault obtained in the first eye in bilateral myopic collamer phakic intraocular lens surgery

PURPOSE

To assess vault and the decision-making process involved in selecting the size of the lens for the fellow eye in a series of patients who received bilateral phakic collamer intraocular lens (pIOL) implants with central hole for correction of myopia.

METHODS

The study sample included all patients who underwent bilateral insertion of a different size pIOL from a pool of 269 patients who underwent sequential bilateral insertion of a pIOL from March 2012 to May 2015 in our institution. Procedures were separated in time to assess the value of the vault and select the pIOL size in second eyes. Vault was analysed objectively using optical coherence tomography.

RESULTS

The decision to change the size of the pIOL in the fellow eye was taken in 25 patients. A smaller pIOL was implanted in the second eye in 9 patients, whereas a lens that was 1 size larger was necessary in 16 patients. Implantation of a larger lens led to a mean increase in vault of 251 ± 180 microns; implantation of a smaller size lens led to a mean decrease in vault of 542 ± 187 microns. In 5 patients, the pIOL implanted in first eye was rotated vertically to reduce lens vault. No lenses had to be explanted.

CONCLUSIONS

Vault in fellow eyes can be improved in patients receiving bilateral myopic pIOL implants by modifying the pIOL size based on the vault value obtained in the first eyes.

Analysis of polychlorinated dibenzo-p-dioxins and dibenzofurans in stack gas emissions by gas chromatography-atmospheric pressure chemical ionization-triple-quadrupole mass spectrometry

A gas chromatography coupled to triple-quadrupole mass spectrometry (GC-(QqQ)MS/MS) including a soft-ionization through an atmospheric pressure chemical ionization (APCI) source based method was compared with the high resolution mass spectrometry (HRMS) standard reference method EN1948, for the analysis of polychlorinated dibenzo-p-dioxins and furans (PCDD/Fs) in stack gas emissions. The stack emission samples were collected, both, by manual method sampling (from 6 to 8h) and by long-term sampling systems (sampling time of several weeks). This work presents the first comparison of GC-(QqQ)MS/MS with APCI source with the European Standard EN1948 technique for stack gas emissions. Sample concentrations ranged from 0.5 to 596pg I-TEQ/Nm³. Comparative results in all investigated samples showed relative errors that were within ±15%. These results make GC-(QqQ)MS/MS with APCI suitable for the quantitative analysis of dioxins in the studied samples and create a real alternative tool to the reference sector GC-HRMS instruments.

Intraoperative Management of High-Risk Liver Transplant Recipients: Concerns and Challenges

Liver transplantation (LT) offers patients with liver disease a real chance for long-term survival. In the past decade, successful survival after LT along with the Model for End-Stage Liver Disease-based allocation policy have increased willingness to accept patients with a higher risk profile and marginal organs and to prioritize the sickest patients on the waiting list. Therefore, the anesthesiologist now deals with very challenging patients. In the present review, we aimed to highlight key aspects of intraoperative LT management in high-risk patients and to place these aspects in the perspective of their impact on perioperative outcomes. Conservative standardized perioperative strategies mandate a switch toward accurate and tailored perioperative anesthetic care to maintain the steady improvement in recipient survival rates after LT. In our opinion, continuous assessment of fluid status and cardiac performance, strategies promoting graft decongestion, rational hemostatic management, and the identification of LT recipients with potential risk of vascular complications should constitute the cornerstone of intraoperative management.

Quality classification of Spanish olive oils by untargeted gas chromatography coupled to hybrid quadrupole-time of flight mass spectrometry with atmospheric pressure chemical ionization and metabolomics-based statistical approach

The novel atmospheric pressure chemical ionization (APCI) source has been used in combination with gas chromatography (GC) coupled to hybrid quadrupole time-of-flight (QTOF) mass spectrometry (MS) for determination of volatile components of olive oil, enhancing its potential for classification of olive oil samples according to their quality using a metabolomics-based approach. The full-spectrum acquisition has allowed the detection of volatile organic compounds (VOCs) in olive oil samples, including Extra Virgin, Virgin and Lampante qualities. A dynamic headspace extraction with cartridge solvent elution was applied. The metabolomics strategy consisted of three different steps: a full mass spectral alignment of GC-MS data using MzMine 2.0, a multivariate analysis using Ez-Info and the creation of the statistical model with combinations of responses for molecular fragments. The model was finally validated using blind samples, obtaining an accuracy in oil classification of 70%, taking the official established method, "PANEL TEST", as reference.

Impact of Preemptive Fibrinogen Concentrate on Transfusion Requirements in Liver Transplantation: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial

We hypothesized that preemptive fibrinogen administration to obtain an initial plasma level of 2.9 g/L would reduce transfusion requirements in liver transplantation. A randomized, multicenter, hemoglobin-stratified, double-blind, fibrinogen-versus-saline-controlled trial was conducted. The primary end point was the percentage of patients requiring red blood cells. We evaluated 51 patients allocated to fibrinogen and 48 allocated to saline; the primary end point was assessed using data for 92 patients because the electronic record forms were offline for three patients in the fibrinogen group and four in the saline group. We injected a median of 3.54 g fibrinogen preemptively in the fibrinogen group. Nine patients in the saline group (20.9%) required fibrinogen at graft reperfusion (compared with one patient [2.1%] in the fibrinogen group; p = 0.005). Blood was transfused to 52.9% (95% confidence interval [CI] 42.5-63.3%) in the fibrinogen group and 42.74% (95% CI 28.3-57.2%) in the saline group (p = 0.217). Relative risk for blood transfusion was 0.80 (95% CI 0.57-1.13). Thrombotic events occurred in one patient (2.1%) and five patients (11.4%) in the fibrinogen and saline groups, respectively. Seven patients (14.6%) in the fibrinogen group and nine (20.3%) in the saline group required reoperation. Preemptive administration of fibrinogen concentrate did not influence transfusion requirements.

[The cryoprecipitate: that old unknown]

Cryoprecipitate is a plasma derivative rich in fibrinogen and other procoagulant factors. It has been successfully used for decades in the treatment of the coagulopathy of trauma patients, cardiovascular surgery, liver failure and disseminated intravascular coagulation. Although cryoprecipitate is routinely used in many western countries, most of the Spanish regional blood banks stopped its production in the late 1990's. Moreover, in recent years there is a movement to replace cryoprecipitate with manufactured fibrinogen concentrate. As a consequence, many of the younger anaesthesiologists did not have any direct experience with cryoprecipitate. This article aims to describe the characteristics of cryoprecipitate since it is a different product from manufactured fibrinogen concentrate, with its own specific indications that deserve to be further studied in clinical trials.

[Fibreoptic clinical training in anaesthesia. Course design and results based on a self-assessment survey]

BACKGROUND AND OBJECTIVE

Fibreoptic intubation is the technique of choice for resolving complications related to a difficult airway. Our aim was to determine whether a clinical-practice-based, individualized course provides sufficient training and confidence to allow anaesthetists to routinely practice fibreoptic intubation.

METHODS

Our hospital developed a clinical-practice-based, individualized course on fibreoptic intubation in general anaesthesia that provided practice in sedated spontaneously breathing patients and insertion through supraglottic devices. From 2005 to 2009, we e-mailed participants for response to an anonymous online self-assessment survey. We asked participants about the training outcomes and their overall degree of satisfaction.

RESULTS

Seventy-seven participants were sent the questionnaire six months after the course and 61% responded. All respondents considered themselves skilled in handling the bronchoscope at the end of the course and 97% used it in their routine practice in patients with difficult airways.

CONCLUSIONS

These results suggest a high success rate can be expected from individually tailored fibreoptic intubation courses that supplement theory and mannequin experience with clinical practice.

Kinetics of the biodegradation of green table olive wastewaters by aerobic and anaerobic treatments

The biodegradation of the organic pollutant matter present in green table olive wastewater (GTOW) is studied in batch reactors by an aerobic biodegradation and by an anaerobic digestion. In the aerobic biodegradation, the evolution of the substrate (in terms of chemical and biochemical oxygen demand), biomass, and total polyphenolic compounds present in the wastewater are followed during the process, and a kinetic study is performed using Contois' model, which when applied to the experimental results provides the kinetic parameter of this model, resulting in a modified Contois' equation (q=3.3S/(0.31S(0)X+X), gCOD/gVSS d(-1)). Other kinetic parameters were determined: the cellular yield coefficient (YX/S=5.7x10(-2) gVSS/gCOD) and the kinetic constant of cellular death phase (kd=0.16 d(-1)). Similarly, in the anaerobic digestion, the evolution of the substrate digested and the methane produced are followed, and the kinetic study is conducted using a modified Monod model combined with the Levenspiel model, due to the presence of inhibition effects. This model leads to the determination of the kinetic parameters: kinetic constant when no inhibitory substance is present (kM0=8.4x10(-2) h(-1)), critical substrate concentration of inhibition (TP*=0.34 g/L) and inhibitory parameter (n=2.25).

Comparison of two quantitative GC-MS methods for analysis of tomato aroma based on purge-and-trap and on solid-phase microextraction

Two analytical procedures, one based on purge-and-trap and the other on solid phase microextraction, both followed by GC-MS measurement using an ion-trap mass spectrometer in the electron impact mode, have been developed for determination and quantitation of up to 39 aroma compounds in fresh tomatoes. The method based on purge-and-trap for isolation of the volatile compounds uses Tenax as adsorbent and a hexane-diethyl ether mixture as solvent for elution. The method was validated for linearity, precision (better than 20% for most compounds), and limit of detection, which was approximately 1 ng g(-1). This method enabled identification of up to 30 compounds in real samples. Use of SPME was considered as an alternative, to simplify sample treatment while maintaining the information level for the samples (e.g. the number of compounds detected) and quality of quantitation. A procedure based on SPME using a Carboxen/polydimethylsiloxane fibre was developed and validated for determination of 29 aroma compounds; precision was better than 20% and limits of detection ranged from 4 to 30 ng g(-1).

Application of solid-phase microextraction for the determination of pyrethroid residues in vegetable samples by GC-MS

A solid-phase microextraction (SPME) method has been developed for the determination of 7 pyrethroid insecticides (bifenthrin, lambda-cyhalothrin, permethrin, cyfluthrin, cypermethrin, fenvalerate, and tau-fluvalinate) in water, vegetable (tomato), and fruit (strawberry) samples, based on direct immersion mode and subsequent desorption into the injection port of a GC/MS. The SPME procedure showed linear behavior in the range tested (0.5-50 microg L(-1) in water and 0.01-0.1 mg kg(-1) in tomato) with r(2) values ranging between 0.97 and 0.99. For water samples limits of detection ranged between 0.1 and 2 microg L(-1 )with relative standard deviations lower than 20%. Detection limits for tomato samples were between 0.003 and 0.025 mg kg(-1) with relative standard deviations around 25%. Finally, the SPME procedure has been applied to vegetable (tomato) and fruit (strawberry) samples obtained from an experimental plot treated with lambda-cyhalothrin, and in both cases the analyte was detected and quantified using a calibration curve prepared using blank matrix. SPME has been shown to be a simple extraction technique which has a number of advantages such as solvent-free extraction, simplicity, and compatibility with chromatographic analytical systems. Difficulties with the correct quantification in a complex matrix are also discussed.

Role of dopamine in renal dysfunction during laparoscopic surgery

BACKGROUND

Sympathetic vascular insult and hemodynamic changes represent the most reliable explanation of renal impairment resulting from acute intraabdominal pressure. We evaluated the effects of low-dose dopamine administration during a long-lasting surgical laparoscopic procedure.

METHODS

For this study 40, patients submitted to a colorectal laparoscopic procedure with 15 mmHg of intraabdominal pressure were randomly allocated to two groups: 20 receiving 2 mg/kg/min of dopamine and 20 receiving the same perfusion of saline. Hemodynamic parameters, renal function, urinary output, and creatinine clearance, were studied.

RESULTS

The hemodynamic parameters were similar in both groups. The urinary output decreased during the intraoperative period only the saline group (p = 0.4). Then 2 h postoperatively, it increased in both groups, and no statistically significant differences were found between the groups. The creatinine clearance decreased in both groups during the intraoperative time, but it was worse in the saline group (-28 +/- 120 vs -194 +/- 106; p = 0.022). During the postoperative period, both groups showed improvement, but in control group the values remained lower than at baseline (p = 0.04), and significantly lower than in the dopamine group (230 +/- 337 vs 100 +/- 192; p = 0.012).

CONCLUSIONS

An intrabdominal pressure of 15 mmHg induces a time-limited renal dysfunction, and low doses of dopamine could prevent this undesirable effect.

Headspace solid-phase microextraction in combination with gas chromatography and tandem mass spectrometry for the determination of organochlorine and organophosphorus pesticides in whole numan blood

A method for the determination of several organochlorine and organophosphorus pesticides in human whole blood samples was developed. The combination of solid-phase microextraction in headspace mode with gas chromatography with tandem mass spectrometry allowed the determination of 11 selected pesticides at ppb levels, minimizing the sample treatment. Quantitation was carried out by means of calibration curves prepared in blood using labelled surrogate/internal standards. The method showed good linearity between 1 and 50 ng ml(-1) (0.5-25 ng ml(-1) for HCB) using second-order calibration curves. Precision was found to be better than 20% at the three concentration levels assayed in the range of ng ml(-1). The detection limits obtained were in the range 0.02-0.7 ng ml(-1), except for p,p'-DDT (3 ng ml(-1)). The developed procedure was applied to blood and serum samples obtained from agricultural workers. HCB. beta-HCH and p,p'-DDE were most frequently detected in the samples analyzed.

Interferon alpha2b gene delivery using adenoviral vector causes inhibition of tumor growth in xenograft models from a variety of cancers

A recombinant adenovirus expressing human interferon alpha2b driven by the cytomegalovirus promoter, IACB, was shown to produce and secrete biologically active protein in vitro and in vivo. Intravenous administration of IACB in Buffalo rats resulted in circulating levels of biologically active human interferon at 70,000 international units/mL for up to 15 days. Distribution of interferon protein after IACB administration was different from that seen with the subcutaneous delivery of interferon protein. Higher levels of interferon protein were observed in liver and spleen after IACB delivery compared to protein delivery. The antitumor efficacy of IACB, as measured by suppression of tumor growth, was tested in athymic nude mice bearing established human tumor xenografts from different types of human cancer. Subcutaneous tumors most responsive to the intratumoral administration of IACB ranked as U87MG (glioblastoma) and K562 (chronic myelogenous leukemia), followed by Hep 3B (hepatocellular carcinoma) and LN229 cells (glioblastoma). Intravenous administration of IACB in animals bearing U87MG or Hep 3B xenografts was also effective in suppressing tumor growth, although to a lesser extent than the intratumoral administration. IACB was also tested in a metastatic model in beige/SCID mice generated with H69 (small cell lung carcinoma) cells and was found to prolong survival in tumor-bearing animals. This suggested that interferon gene delivery can be effective in suppressing tumor growth in a wide variety of cells.

MR imaging of bone lesions of the ankle and foot

MR imaging is frequently used to evaluate patients with ankle and foot pain, with or without a relationship to trauma or other known clinical outcomes. Abnormal signal intensity of the bone marrow is the common denominator of all entities described in this article, including bone contusion, fractures, osteonecrosis, transient osteoporosis, and reflex sympathetic dystrophy. Specific MR imaging features in association with the available clinical and radiographic findings can be helpful not only to supply an accurate diagnosis but also to provide valuable information for staging and proper management of the condition.

From the RSNA Refresher Courses. Radiological Society of North America. MR imaging of the ankle and foot

Magnetic resonance (MR) imaging has opened new horizons in the diagnosis and treatment of many musculoskeletal diseases of the ankle and foot. It demonstrates abnormalities in the bones and soft tissues before they become evident at other imaging modalities. The exquisite soft-tissue contrast resolution, noninvasive nature, and multiplanar capabilities of MR imaging make it especially valuable for the detection and assessment of a variety of soft-tissue disorders of the ligaments (eg, sprain), tendons (tendinosis, peritendinosis, tenosynovitis, entrapment, rupture, dislocation), and other soft-tissue structures (eg, anterolateral impingement syndrome, sinus tarsi syndrome, compressive neuropathies [eg, tarsal tunnel syndrome, Morton neuroma], synovial disorders). MR imaging has also been shown to be highly sensitive in the detection and staging of a number of musculoskeletal infections including cellulitis, soft-tissue abscesses, and osteomyelitis. In addition, MR imaging is excellent for the early detection and assessment of a number of osseous abnormalities such as bone contusions, stress and insufficiency fractures, osteochondral fractures, osteonecrosis, and transient bone marrow edema. MR imaging is increasingly being recognized as the modality of choice for assessment of pathologic conditions of the ankle and foot.

Traumatic musculotendinous injuries of the knee: diagnosis with MR imaging

Magnetic resonance (MR) imaging is the imaging modality of choice for evaluation of acute traumatic musculotendinous injuries of the knee. Three discrete categories of acute injuries to the musculotendinous unit can be defined: muscle contusion, myotendinous strain, and tendon avulsion. Among the quadriceps muscles, the rectus femoris is the most susceptible to injury at the myotendinous junction due to its superficial location, predominance of type II fibers, eccentric muscle action, and extension across two joints. Among the muscles of the pes anserinus, the sartorius is the most susceptible to strain injury due to its superficial location and biarticular course. The classic fusiform configuration of the semimembranosus along with a propensity for eccentric actions also make it prone to strain injury. MR imaging findings associated with rupture of the iliotibial tract include discontinuity and edema, which are best noted on coronal images. The same mechanism of injury that tears the arcuate ligament from its fibular insertion can also result in avulsion injury of the biceps femoris. The gastrocnemius muscle is prone to strain injury due to its action across two joints and its superficial location. Injuries of the muscle belly and myotendinous junction of the popliteus are far more common than tendinous injuries.

L-arginine reduces liver and biliary tract damage after liver transplantation from non-heart-beating donor pigs

BACKGROUND

To evaluate whether L-arginine reduces liver and biliary tract damage after transplantation from non heart-beating donor pigs.

METHODS

Twenty-five animals received an allograft from non-heart-beating donors. After 40 min of cardiac arrest, normothermic recirculation was run for 30 min. The animals were randomly treated with L-arginine (400 mg x kg(-1) during normothermic recirculation) or saline (control group). Then, the animals were cooled and their livers were transplanted after 6 hr of cold ischemia. The animals were killed on the 5th day, liver damage was assessed on wedged liver biopsies by a semiquantitative analysis and by morphometric analysis of the necrotic areas, and biliary tract damage by histological examination of the explanted liver.

RESULTS

Seventeen animals survived the study period. The histological parameters assessed (sinusoidal congestion and dilatation, sinusoidal infiltration by polymorphonuclear cells and lymphocytes, endothelitis, dissociation of liver cell plates, and centrilobular necrosis) were significantly worse in the control group. The necrotic area affected 15.9 +/- 14.5% of the liver biopsies in the control group and 3.7 +/- 3.1% in the L-arginine group (P<0.05). Six of eight animal in the control group and only one of eight survivors in the L-arginine group developed ischemic cholangitis (P<0.01). L-Arginine administration was associated with higher portal blood flow (676.9 +/- 149.46 vs. 475.2 +/- 205.6 ml x min x m(-2); P<0.05), higher hepatic hialuronic acid extraction at normothermic recirculation (38.8 +/- 53.7% vs. -4.2 +/- 18.2%; P<0.05) and after reperfusion (28.6 +/- 55.5% vs. -10.9 +/- 15.5%; P<0.05) and lower levels of alpha-glutation-S-transferase at reperfusion (1325 +/- 1098% respect to baseline vs. 6488 +/- 5612%; P<0.02).

CONCLUSIONS

L-Arginine administration during liver procurement from non heart beating donors prevents liver and biliary tract damage.

Morton's neuroma: is it always symptomatic?

OBJECTIVE

We determined the prevalence of clinically silent Morton's neuroma and searched for distinguishing MR imaging features of Morton's neuroma in patients with clinical complaints related to this entity and in patients with clinically silent lesions.

MATERIALS AND METHODS

One radiologist who was unaware of clinical findings retrospectively reviewed 85 consecutive foot MR examinations. MR imaging criteria for Morton's neuroma included a low- to intermediate-signal-intensity soft-tissue mass in the intermetatarsal space. The size, location, and signal intensity of each neuroma and the presence of intermetatarsal bursae were recorded. The patients were subdivided into symptomatic or asymptomatic groups on the basis of the patients' answers on a questionnaire documenting the locations and characteristics of symptoms and discussions with each referring physician about clinical findings. Surgical confirmation was available in eight of 25 symptomatic patients.

RESULTS

The prevalence of Morton's neuroma in patients with no clinical evidence of this condition was 33% (19/57). Twenty-five patients had symptomatic Morton's neuroma, 19 had Morton's neuroma based on MR imaging findings with no clinical manifestations, and 41 did not have Morton's neuroma. Slightly larger lesions were observed in the symptomatic group, although significant overlap was noted between the two groups. The mean transverse diameter of symptomatic neuromas was 5.3 mm (standard deviation, 2.14) compared with 4.1 mm (standard deviation, 1.75) for asymptomatic neuromas; this difference was marginally significant (p = 0.05).

CONCLUSION

The MR imaging diagnosis of Morton's neuroma does not imply symptomatology. Careful correlation between clinical and MR imaging findings is mandatory before Morton's neuroma is considered clinically relevant.

Solid-phase microextraction in pesticide residue analysis

The applications of solid-phase microextraction (SPME) for sample preparation in pesticide residue analysis are reviewed in this paper taking into account the different approaches of this technique coupled mainly to gas chromatography but also to high-performance liquid chromatography. A complete revision of the existing literature has been made considering the different applications divided according to the pesticide families (organochlorine, organophosphorus, triazines, thiocarbamates, substituted uracils, urea derivatives and dinitroanilines among others) and the sample matrices analysed which included environmental samples (water and soil), food samples and biological fluids. Details on the analytical characteristics of the procedures described in the reviewed papers are given, and new trends in the applications of SPME in this field are discussed.

Evaluation of ischemic injury during liver procurement from non-heart-beating donors

The aim of this study was to assess liver viability after different periods of cardiac arrest and the predictive value of two markers of ischemia-reperfusion injury.

METHODS

A pig liver transplantation model of non-heart-beating donors was studied. Four donor groups were designed; three groups were submitted to different periods of cardiac arrest (20, 30 and 40 min), and the fourth group served as the control group (without cardiac arrest). In the non-heart-beating donor groups, normothermic recirculation was established 30 min prior to total body cooling. Aminotransferase, alpha-glutathione-S-transferase, and hyaluronic acid determinations as well as liver biopsies, were serially performed.

RESULTS

Although hepatocellular function could be preserved after 40 min of cardiac arrest, histological lesions at 5 days were considered irreversible due to the presence of a necrotic biliary tract. An overall significant relationship was found between the time period of cardiac arrest (20, 30 or 40 min) and the levels of hyaluronic acid (p = 0.004) or alpha-glutathione-S-transferase (p = 0.01) obtained during liver procurement and transplantation.

CONCLUSIONS

The period of cardiac arrest is the determinant factor of liver viability after liver transplantation from non-heart-beating donors. As early markers of endothelial or hepatocellular damage, hyaluronic acid or alpha-glutathione-S-transferase levels may help to evaluate the ischemic injury of a potential donor.

Use of solid-phase microextraction for the quantitative determination of herbicides in soil and water samples

An in-depth study of SPME optimization and application has been made, considering not only aqueous (surface water and groundwater samples) but also the more complex soil samples. Seven herbicides widely used in the area of study have been selected including five triazine herbicides (atrazine, simazine, terbumeton, terbuthylazine, terbutryn), molinate, and bromacil. linearity range was between 0.1 and 10 ng/mL and the repeatability below 10% when applying the optimized SPME procedure to water samples. Reproducibility was found to be lower than 20% at the 1 ng/mL level, and the limits of determination in environmental water samples using GC/MS (SIM mode) were well below 0.1 ng/mL (values ranging from 10 to 60 ng/L). Extraction of selected herbicides from soil was carried out by microwave-assisted solvent extraction using methanol in screw-capped vials, leading to recoveries over 80% in spiked soil samples at the 5-200 ng/g level. SPME application over methanolic soil extracts required a 10-fold dilution with distilled water. The recommended procedure was found to be fully applicable for quantitative determination of selected herbicides in soils containing low organic matter content with coefficients of variation below or around 10% and limits of determination ranging from 1 to 10 ng/g. Both procedures were applied to real-world surface water and soil samples where several pesticides were detected including atrazine, simazine, terbuthylazine, and molinate.

Superior labrum anterior-posterior lesions: diagnosis with MR arthrography of the shoulder

PURPOSE

To determine the accuracy of magnetic resonance (MR) arthrography in the diagnosis of superior labrum anterior-posterior (SLAP) lesions of the shoulder.

MATERIALS AND METHODS

From January 1995 to June 1998, MR arthrography of the shoulder was performed in 159 patients with a history of chronic shoulder pain or instability. Fifty-two patients underwent arthroscopy or open surgery 12 days to 5 months after MR arthrography. Diagnostic criteria for SLAP lesion included marked fraying of the articular aspect of the labrum, biceps anchor avulsion, inferiorly displaced bucket handle fragment, and extension of the tear into the biceps tendon fibers. Surgical findings were correlated with those from MR arthrography.

RESULTS

SLAP injuries were diagnosed at surgery in 19 of the 52 patients (37%). Six of the 19 lesions (32%) were classified as type I, nine (47%) as type II, one (5%) as type III, and three (16%) as type IV. MR arthrography had a sensitivity of 89% (17 of 19 patients), a specificity of 91% (30 of 33 patients), and an accuracy of 90% (47 of 52 patients). The MR arthrographic classification showed correlation with the arthroscopic or surgical classification in 13 of 17 patients (76%) in whom SLAP lesions were diagnosed at MR arthrography.

CONCLUSION

MR arthrography is a useful and accurate technique in the diagnosis of SLAP lesions of the shoulder. MR arthrography provides pertinent preoperative information with regard to the exact location of tears and grade of involvement of the biceps tendon.

Glenohumeral instability: evaluation using MR arthrography of the shoulder

In the setting of glenohumeral instability or when internal derangement of the shoulder joint is suspected, MR arthrography has been demonstrated to be an accurate diagnostic imaging technique. Knowledge of the complex anatomy of the shoulder and its variations is essential in order to maximize diagnostic accuracy.

Detecting anti-SSA and anti-SSB antibodies in routine analysis: a comparison between double immunodiffusion and immunoblotting

The aim of this study was to assess the performance of a commercially available procedure for detecting anti-Sjögren's syndrome A (anti-SSA) and anti-Sjögren's syndrome B (anti-SSB) antibodies by immunoblotting (IB) and compare it with double immunodiffusion (DID). We also studied the clinical significance of these profiles in a series of unselected anti-SSA positive patients. Serum samples from 534 patients that were positive on an immunofluorescent screening test using HEp-2 cells were analysed for anti-SSA and anti-SSB antibodies by DID and IB (Biolab Anablot System II), and the results on anti-SSA antibodies were confirmed by an enzyme-linked immunosorbent assay (ELISA). Fifty-five serum samples were found to be positive for anti-SSA antibodies. Among these, 24 were anti-SSA negative by IB but positive by DID and ELISA ('non-blotter sera'), whereas only three serum samples were anti-SSA negative by DID but positive by IB and ELISA. Of the 18 anti-SSB positive serum samples, eight were negative by DID. All the serum samples that were anti-SSB positive by DID were also positive by IB. Anti-SSB antibodies showed a significant association with eye dryness and leucopenia. Anti-52 kDa SSA antibodies were associated with anti-SSB antibodies but showed no significant association with sicca symptoms, while anti-60 kDa SSA antibodies were associated with lower rates of leucopenia. The 'non-blotter' profile showed no significant association with any clinical parameter. IB is less sensitive than DID for detecting anti-SSA antibodies but more sensitive than DID for detecting anti-SSB antibodies. The determination of anti-SSA immunoblotting profiles in patients positive for anti-SSA antibodies by DID does not significantly improve the clinical usefulness of this test. As expected, anti-SSB antibodies were associated with clinical features of Sjögren's disease. Non-blotting (probably conformational) anti-SSA antibodies did not show any further association with clinical parameters and seem to have no clinical relevance.

Fat suppression in MR imaging: techniques and pitfalls

Fat suppression is commonly used in magnetic resonance (MR) imaging to suppress the signal from adipose tissue or detect adipose tissue. Fat suppression can be achieved with three methods: fat saturation, inversion-recovery imaging, and opposed-phase imaging. Selection of a fat suppression technique should depend on the purpose of the fat suppression (contrast enhancement vs tissue characterization) and the amount of fat in the tissue being studied. Fat saturation is recommended for suppression of signal from large amounts of fat and reliable acquisition of contrast material-enhanced images. The main drawbacks of this technique are sensitivity to magnetic field nonuniformity, misregistration artifacts, and unreliability when used with low-field-strength magnets. Inversion-recovery imaging allows homogeneous and global fat suppression and can be used with low-field-strength magnets. However, this technique is not specific for fat, and the signal intensity of tissue with a long T1 and tissue with a short T1 may be ambiguous. Opposed-phase imaging is a fast and readily available technique. This method is recommended for demonstration of lesions that contain small amounts of fat. The main drawback of opposed-phase imaging is unreliability in the detection of small tumors embedded in fatty tissue.

Liver conditioning after cardiac arrest: the use of normothermic recirculation in an experimental animal model

The aim of this study was to compare the possible role of normothermic recirculation with the role of liver transplants from non-heart-beating donor pigs after 20 min of cardiac arrest. Three groups were studied, of which two were control groups: group 1, in which the liver was harvested from a heart-beating donor; group 2, in which the liver was harvested after a period of cardiac arrest followed by total body cooling; and group 3, in which the liver was procured as in group 2, but including a period of 30 min of cardiopulmonary bypass and tissue oxygenation at 37 degrees C before total body cooling. Survival at 5 days; endothelial (hyaluronic acid) and hepatocellular damage (AST, ALT, and alpha-GST); adenine nucleotides (energy charge), and histological changes were evaluated. Normothermic recirculation during 30 min showed a significant effect on survival (p = .03), endothelial damage (p < .05), and histological changes after reperfusion (p = .04). Cardiopulmonary bypass significantly increased the energy charge during the normothermic recirculation period (p = .001). Moreover, this study shows that a significant survival (100%) can be achieved with a liver allograft after 20 min of cardiac arrest. Although the liver suffers a major insult in terms of endothelial damage and hepatocellular damage, lesions caused by the ischemic injury are reversible. Histological changes also indicate lesion reversibility, since they almost disappear after 5 days.

Chondrosarcoma of the short tubular bones of the hands and feet

OBJECTIVE

To report 12 cases of chondrosarcoma in a rare location, the short tubular bones of the hands and feet, as well as 12 cases of enchondroma in similar locations, emphasizing the radiologic and histopathologic features.

DESIGN AND PATIENTS

All relevant cases that had both histologic slides and radiographs available were taken from the files of one orthopedic referral hospital and the personal files of one of the authors. A similar number of enchondroma cases was selected at random from the files.

RESULTS AND CONCLUSIONS

One malignancy arose in a background of enchondromatosis, with all the others being solitary lesions. A pathologic diagnosis of malignancy is often difficult in the absence of radiologic signs of malignancy (cortical destruction with or without soft tissue extension). However, three cases were unusual in that the initial radiograph demonstrated a benign appearance. Another group of three malignancies was surprisingly indolent biologically. The treatment of choice is ray resection (or more limited amputation in a lesion of the middle or distal phalanx).

Comparison of simplified methods for pesticide residue analysis. Use of large-volume injection in capillary gas chromatography

The combination of manual and automated extraction procedures using low sample volumes (5-50 ml) with large-volume oncolumn injection (LVI) (200 microliters) in capillary gas chromatography with flame photometric detection (GC-FPD) has allowed the determination of 16 organophosphorus pesticides in clean water samples at the low ng l-1 level with an important simplification in the sample preparation step. A simple and fast offline liquid-liquid microextraction procedure (2-5 ml water/l ml methyl tert.-butyl ether) has been applied to spiked groundwater samples (containing 0.5 ng of each pesticide) with good recoveries (over 80%) and precision (better than 10%), giving detection limits between 5 and 100 ng l-1 using 200 microliters injections in the GC-FPD system. The application of an inline automated liquid-liquid microextraction-LVI-GC procedure (2 ml water/2 ml methyl tert.-butyl ether: injection of 200 microliters in GC-FPD) using the autosampler ASPEC XL led to lower recoveries (> 50%) as a result of the low efficiency for mixing organic and aqueous phases, although with very satisfactory coefficients of variation (lower than 7%) and detection limits between 20 and 200 ng l-1. Manual and automated solid-phase extraction procedures using the well known C18 cartridges and the new Oasis HLB have been applied to groundwater samples (5-50 ml) spiked with 1 ng of each pesticide. Results obtained for both the manual and the automated procedures were satisfactory (recoveries over 80%) and the limits of detection for 50 ml sample volume ranged from 1 to 6 ng l-1.

Hepatic blood flow and oxygen extraction ratio during normothermic recirculation and total body cooling as viability predictors in non-heart-beating donor pigs

BACKGROUND

Our aim was to evaluate the hepatic blood flows and oxygen metabolism of non-heart-beating donor (NHBD) pigs, with the use of cardiopulmonary bypass (CPB) and normothermic recirculation (NR) before total body cooling, and its relationship with recipient survival.

METHODS

Thirty-five pigs were transplanted with an allograft from NHBDs. After warm ischemia (WI) time (20, 30, or 40 min), CPB and NR were run for 30 min. After this period, the animals were cooled to 15 degrees C. In the control group (20 min of WI), the period of NR was excluded. Liver procurement was then performed.

RESULTS

Survival rate was 100% in the 20WI, 70% in the 30WI, and 50% in the 40WI. Control group survival rate was 0%. Hepatic artery blood flow and portal blood flow recovered during NR. Pump blood flow during CPB increased rapidly during NR and was significantly higher in the 20WI. When donors of the livers transplanted in "surviving pigs" (DSP) were compared with donors of the livers transplanted in "nonsurviving pigs" (DNSP), hepatic artery blood flow, portal blood flow, and pump blood flow were higher in the DSP. Hepatic oxygen extraction ratio increased in the three groups with respect to baseline values. Hepatic oxygen extraction ratio was lower in the 20WI than in the other groups and was lower in the DSP than in the DNSP.

CONCLUSIONS

The use of a NR period before total body cooling improves survival of liver transplantation in NHBDs. Portal blood flow and pump blood flow measurements can predict the viability of the grafts.

Chondrocalcinosis of the hyaline cartilage of the knee: MRI manifestations

PURPOSE

To determine the ability of MRI to detect the presence of crystals of calcium pyrophosphate in the articular cartilage of the knee.

DESIGN AND PATIENTS

The MR studies of 12 knees (11 cases) were reviewed retrospectively and correlated with radiographs (12 cases) and the findings at arthroscopy (2 cases) and surgery (1 case). A total of 72 articular surfaces were evaluated. Radiographic, surgical or arthroscopic demonstration of chondrocalcinosis was used as the gold standard. Additionally, two fragments of the knee of a patient who underwent total knee replacement and demonstrated extensive chondrocalcinosis were studied with radiography and MRI using spin-echo T1-, T2- and proton-density-weighted images as well as two- and three-dimensional fat saturation (2D and 3D Fat Sat) gradient recalled echo (GRE) and STIR sequences.

RESULTS

MRI revealed multiple hypointense foci within the articular cartilage in 34 articular surfaces, better shown on 2D and 3D GRE sequences. Radiographs showed 12 articular surfaces with chondrocalcinosis. In three cases with arthroscopic or surgical correlation, MRI demonstrated more diffuse involvement of the articular cartilage than did the radiographs. The 3D Fat Sat GRE sequences were the best for demonstrating articular calcification in vitro. In no case was meniscal calcification identified with MRI. Hyperintense halos around some of the calcifications were seen on the MR images.

CONCLUSION

MRI can depict articular cartilage calcification as hypointense foci using GRE techniques. Differential diagnosis includes loose bodies, post-surgical changes, marginal osteophytes and hemosiderin deposition.

Solid-phase microextraction for quantitative analysis of organophosphorus pesticides in environmental water samples

Solid-phase microextraction (SPME) is a relatively new technique that appears as a convenient and efficient extraction method in contrast with more complex techniques used for pesticide residue analysis based on liquid-liquid and solid-phase extraction. This extraction procedure involves the absorption of analytes into a polymeric film coated onto a fine silica fiber directly dipped in the aqueous sample. An SPME procedure for the determination of 12 organophosphorus pesticides in clean environmental water samples at low ng/ml concentration level has been developed by optimising variables involved in extraction and desorption. The absorption equilibrium has been estimated by mathematical treatment of the process using an expression that describes experimental absorption time profiles. The method was evaluated according to the reproducibility, linearity range and limits of detection using two different fiber coatings: 100 microm polydimethylsiloxane and 85 microm polyacrylate. The limits of detection obtained using nitrogen-phosphorus detection ranged between 0.01 and 0.2 ng/ml with relative standard deviations lower than 15% at the 1 ng/ml level. The method showed good linearity between 0.1 and 10 ng/ml with regression coefficients ranging between 0.97 and 0.999. Determination of organophosphorus pesticides in water samples in concentration below 0.1 ng/ml can be easily carried out with this fast, economic and solvent-free SPME procedure.

Low incorporation of soleus tendon: a potential diagnostic pitfall on MR imaging

We describe a case of thickening and longitudinal increased signal within the Achilles tendon in a patient denying any recent or previous history of Achilles tendon injury. The MR appearance, while simulating tendinosis or rupture, was compatible with incomplete incorporation of the soleus tendon into the gastrocnemius tendon. This constitutes a normal anatomical variant, not previously described in the radiologic literature, and should not be confused with increased signal and thickening due to disease of the Achilles tendon.

Peroneus brevis tendon in normal subjects: MR morphology and its relationship to longitudinal tears

PURPOSE

The most prevalent, yet unproven, theory for the development of longitudinal splits of the peroneus brevis tendon is the compression of the peroneus brevis tendon by the peroneus longus tendon in dorsiflexion. The goal of our study was to provide insight into this pathomechanism by evaluating the shape of the peroneus brevis tendon and its relationship to the adjacent structures in the fibular groove during plantarflexion and dorsiflexion.

METHOD

The MR images of 13 ankles in asymptomatic adult volunteers were performed in full dorsiflexion and plantarflexion. The axial MR images were assessed for the shape of the peroneus brevis tendon and its relationship to the peroneus longus tendon and posterior cortex of the fibula in both plantarflexion and dorsiflexion.

RESULTS

In 12 of the 13 volunteers, the peroneus brevis tendon was located anterior or anteromedial to the peroneus longus tendon in the fibular groove. In those volunteers the peroneus brevis tendon was more flattened and compressed against the fibular groove by the overlying peroneus longus tendon in dorsiflexion than plantarflexion. Fat planes were noted in plantarflexion between the peroneal tendons as well as between the peroneus brevis tendon and the fibular groove. These were obliterated in dorsiflexion.

CONCLUSION

The changes in configuration of the tendon of the peroneus brevis tendon in dorsiflexion compared with plantarflexion provide support to our present understanding of the pathomechanism of longitudinal tears of the peroneus brevis tendon.

Prolonged pneumoperitoneum at 15 mmHg causes lactic acidosis

BACKGROUND

Acute increases in intraabdominal pressure (IAP) induce systemic and regional circulatory changes. Besides, mechanical compression on the capillary beds may decrease oxygen availability to the tissues. The purpose of this clinical study was to analyze the effects of increased IAP on acid-base disturbances and plasma lactate levels during prolonged carbon dioxide pneumoperitoneum.

METHODS

Twenty-eight patients undergoing laparoscopic sigmoidectomy were included in this study. Fourteen of them (group A) had IAP of 15 +/- 1 mmHg while the remaining 14 (group B) had IAP of 10 +/- 1 mmHg. The control group included six patients undergoing conventional sigmoidectomy.

RESULTS

A progressive significant increase in PaCO2 was observed in the laparoscopic groups (p < 0.01). Plasma lactate levels in group A significantly increased 90 min after insufflation (p < 0.05) and reached the highest value 1 h after deflation (9.9 +/- 1 vs 31.9 +/- 2.5 mg/dl, p < 0.005). Simultaneously, arterial pH decreased in all groups; however, at 1 h after surgery, it was significantly lower (p = 0.02) in group A. There was a significant correlation between acid concentration due to lactate and lactate concentration (GA: R2 = 0.717, p = 0.03; GB: R2 = 0.879, p = 0.006 and GC: R2 = 0.853, p = 0.008).

CONCLUSION

High IAP causes lactic acidic accumulation in patients undergoing prolonged laparoscopic procedures.