First measured intrathoracic blood volume in icu patients indicates the appropriateness of circulatory volume management

Hemodynamic monitoring in Intensive Care Unit (ICU) settings is usually introduced when a patient becomes hemodynamically unstable. We analyzed how empirically guided volume management relates to first measured intrathoracic blood volume (ITBV), at the moment of the beginning of Puls Contour Cardiac Output (PiCCO) hemodynamic monitoring. Data and measurements from 37 ICU patients, divided into four groups according to diagnosis of primary condition, were retrospectively studied. The first group consisted of polytrauma patients, second group of patients with pancreatitis and/or peritonitis, third group were postoperative patients, and fourth group were patients with various medical diagnosis: sepsis, acute respiratory distress syndrome (ARDS), acute lung failure (ALF), and acute heart failure (AHF). PiCCO monitor was introduced when the signs of hemodynamic instability were observed. First measured ITBV was recorded and analyzed according to deviation from reference values. First measured ITBV was in reference range in 14 (37.8%) patients. Volume overloading was observed in 16 (43.2%) and hypovolemia in 7 (18.9%) patients. The observed inappropriate blood volume in patients of all studied groups suggests that there is the need for defining indications and earlier application of hemodynamic monitoring, as well as reassessment of usual empirically guided infusion therapy in ICU setting

First measured intrathoracic blood volume in icu patients indicates the appropriateness of circulatory volume management

Hemodynamic monitoring in Intensive Care Unit (ICU) settings is usually introduced when a patient becomes hemodynamically unstable. We analyzed how empirically guided volume management relates to first measured intrathoracic blood volume (ITBV), at the moment of the beginning of Puls Contour Cardiac Output (PiCCO) hemodynamic monitoring. Data and measurements from 37 ICU patients, divided into four groups according to diagnosis of primary condition, were retrospectively studied. The first group consisted of polytrauma patients, second group of patients with pancreatitis and/or peritonitis, third group were postoperative patients, and fourth group were patients with various medical diagnosis: sepsis, acute respiratory distress syndrome (ARDS), acute lung failure (ALF), and acute heart failure (AHF). PiCCO monitor was introduced when the signs of hemodynamic instability were observed. First measured ITBV was recorded and analyzed according to deviation from reference values. First measured ITBV was in reference range in 14 (37.8%) patients. Volume overloading was observed in 16 (43.2%) and hypovolemia in 7 (18.9%) patients. The observed inappropriate blood volume in patients of all studied groups suggests that there is the need for defining indications and earlier application of hemodynamic monitoring, as well as reassessment of usual empirically guided infusion therapy in ICU setting

Raširenost bovericina u hrvatskom kukuruzu

The occurrence of beauvericin has been investigated in corn kernel (Zea mays L.) samples collected in 1996 (105 samples) and 1997 (104 samples) from 14 corn-producing counties of Croatia. Corn sample extracts were cleaned up by silica gel minicolumns and analyzed for beauvericin by high performance liquid chromatography with UV diode array detector. Higher incidence of positive samples was found in the 1996 crop as compared to the 1997 crop. In particular, 18 samples (17.4 %) of the 1996 crop were found contaminated with a mean beauvericin content of 393 ng/g and the highest level at 1864 ng/g. Only 1 out of 104 samples collected in the 1997 crop was contaminated with 696 ng/g of the toxin.n Beauvericin co-occurred with fumonisins B1 and B2 and with ochratoxin A in 17 and 4 samples, respectively. The results of mycological analysis of corn samples for beauvericin producing Fusarium species were in agreement with results of chemical analysis. In particular, higher incidence of Fusarium verticillioides (Sacc.) Nirenberg (known as Fusarium moniliforme Sheldon) (3.7 %) and Fusarium subglutinans (Wollenweber & Reinking) Nelson, Toussoun & Marasas (5.3 %) was found in 1996 with respect to 1997 (1.9 % of F. verticillioides and 0.4 % of F. subglutinans). This is the first report on the occurrence of beauvericin in Croatia.Učestalost bovericina analizirana je u uzorcima kukuruza skupljenim tijekom 1996. (105 uzoraka) i 1997. godine (104 uzorka) iz 14 županija Republike Hrvatske. Ekstrakt uzoraka kukuruza pročišćen je na silicij-gelskim minikolonama i analiziran na bovericin s tekućinskim kromatografom velike učinkovitosti (HPLC) s UV-diodnim detektorom. Učestalija pojava pozitivnih uzoraka nađena je godine 1996. u usporedbi s 1997. godinom. Godine 1996. nađeno je 18 uzoraka (17,4 %) kontaminiranih bovericinom sa srednjom vrijednošću pozitivnih uzoraka od 393 ng/g, odnosno s najvećom količinom od 1864 ng/g. Samo 1 od 104 skupljena uzorka godine 1997. bio je onečišćen s 696 ng/g toksina. Bovericin je nađen zajedno s fumonizinom B1 i B2 u 17 uzoraka, a s okratoksinom A samo u 4 uzorka. Mikološkom analizom utvrđene Fusarium vrste slažu se s kemijskim analizama na mikotoksine. Veća pojava Fusarium verticillioides (Sacc.) Nirenberg (poznat i kao Fusarium moniliforme Sheldon) (3,7 %) i F. subglutinans (Wollenweber & Reinking) Nelson, Toussoun & Marasas (5,3 %) nađena je godine 1996. u usporedbi s 1997. godinom kada je ustanovljeno (1,9 %) F. verticillioides i (0,4 %) F. subglutinans. Ovo je prvo izvješće o prisutnosti bovericina u Republici Hrvatskoj

Raširenost bovericina u hrvatskom kukuruzu

The occurrence of beauvericin has been investigated in corn kernel (Zea mays L.) samples collected in 1996 (105 samples) and 1997 (104 samples) from 14 corn-producing counties of Croatia. Corn sample extracts were cleaned up by silica gel minicolumns and analyzed for beauvericin by high performance liquid chromatography with UV diode array detector. Higher incidence of positive samples was found in the 1996 crop as compared to the 1997 crop. In particular, 18 samples (17.4 %) of the 1996 crop were found contaminated with a mean beauvericin content of 393 ng/g and the highest level at 1864 ng/g. Only 1 out of 104 samples collected in the 1997 crop was contaminated with 696 ng/g of the toxin.n Beauvericin co-occurred with fumonisins B1 and B2 and with ochratoxin A in 17 and 4 samples, respectively. The results of mycological analysis of corn samples for beauvericin producing Fusarium species were in agreement with results of chemical analysis. In particular, higher incidence of Fusarium verticillioides (Sacc.) Nirenberg (known as Fusarium moniliforme Sheldon) (3.7 %) and Fusarium subglutinans (Wollenweber & Reinking) Nelson, Toussoun & Marasas (5.3 %) was found in 1996 with respect to 1997 (1.9 % of F. verticillioides and 0.4 % of F. subglutinans). This is the first report on the occurrence of beauvericin in Croatia.Učestalost bovericina analizirana je u uzorcima kukuruza skupljenim tijekom 1996. (105 uzoraka) i 1997. godine (104 uzorka) iz 14 županija Republike Hrvatske. Ekstrakt uzoraka kukuruza pročišćen je na silicij-gelskim minikolonama i analiziran na bovericin s tekućinskim kromatografom velike učinkovitosti (HPLC) s UV-diodnim detektorom. Učestalija pojava pozitivnih uzoraka nađena je godine 1996. u usporedbi s 1997. godinom. Godine 1996. nađeno je 18 uzoraka (17,4 %) kontaminiranih bovericinom sa srednjom vrijednošću pozitivnih uzoraka od 393 ng/g, odnosno s najvećom količinom od 1864 ng/g. Samo 1 od 104 skupljena uzorka godine 1997. bio je onečišćen s 696 ng/g toksina. Bovericin je nađen zajedno s fumonizinom B1 i B2 u 17 uzoraka, a s okratoksinom A samo u 4 uzorka. Mikološkom analizom utvrđene Fusarium vrste slažu se s kemijskim analizama na mikotoksine. Veća pojava Fusarium verticillioides (Sacc.) Nirenberg (poznat i kao Fusarium moniliforme Sheldon) (3,7 %) i F. subglutinans (Wollenweber & Reinking) Nelson, Toussoun & Marasas (5,3 %) nađena je godine 1996. u usporedbi s 1997. godinom kada je ustanovljeno (1,9 %) F. verticillioides i (0,4 %) F. subglutinans. Ovo je prvo izvješće o prisutnosti bovericina u Republici Hrvatskoj

Volatile metabolites associated with one aflatoxigenic and one nontoxigenic Aspergillus flavus strain grown on two different substrates

Aflatoxigenic and non-toxigenic Aspergillus flavus strains were grown on corn and on peanut substrates. Microbial volatile organic compounds (MVOCS) were collected by trapping headspace volatiles using thermal desorption tubes (TDT) packed with Tenax® TA and Carbotrap™ B. Samples were collected at various fungal growth stages. Trapped compounds were thermally desorbed from the adsorbent tubes, separated by gas chromatography, and identified by mass spectrometry. The fungal stage did not have many differences in the MVOCs but the concentrations of some volatiles changed over time depending on the substrate. Volatiles that were associated with both the aflatoxigenic A. flavus strain and the nontoxigenic strain on both substrates included: ethanol, 1-propanol, butanal, 2-methyl-1-propanol, 3-methylfuran, ethyl acetate, 1-butanol, 3-methylbutanal, 3-methyl-1-butanol, propanoic acid-2-methyl-ethyl-ester, 2-methyl-1-butanol, 1-pentanol, 2-pentanol, 3-methyl-3-buten-1-ol, benzaldehyde, 3-octanone, 2-ethyl-1-hexanol and octane. Volatiles that were associated only with the aflatoxigenic A. flavus strain included: dimethyl disulfide and nonanal. Volatiles that were associated only with the nontoxigenic A. fl avus strain included: hexanal, 1-hexanol, 1-octene-3-ol, 1-octen-3-one and 2-pentyl furan

Mangled Extremity – Case Report, Literature Review and Borderline Cases Guidelines Proposal

Treatment of a mangled lower extremity represents a major challenge. The decision whether to amputate or attempt reconstruction is currently based upon surgical evaluation. The aim of this paper is to propose a new approach to surgical evaluation based on scoring systems, local clinical status of the patient as well as comorbidities, mechanism of trauma and hospital resources. Available literature regarding this topic was evaluated and a case of patient with mangled extremity is presented. Based on current literature guidelines and evidence-based medicine, management for borderline cases is proposed to aid clinical decision making in these situations. We describe a 44-year old male patient who presented with mangled lower left leg. Despite a borderline Mangled Extremity Severity Score (MESS), due to the overall health status of the patient and local clinical status with preserved plantar sensitivity and satisfactory capillary perfusion, reconstruction was attempted. After 6 months of treatment, all wounds healed completely with no pain, and satisfactory motor and sensory function was achieved. In conclusion, the treatment of mangled extremity treatment should be based on evidence based literature along with a clinical evaluation of every individual patient. Scores are helpful, but should not be taken as the sole indication for amputation

Hernia of Morgagni – Case Report

Morgagni’s hernia is result of penetration of the abdominal contents into the chest through an anterior retrocostoxiphoid defect in the anterior midline of the diaphragm. It can be manifested with symptoms since birth as a bloated feeling, nausea and belching after meals. We present a patient with symptomatic herniation of the torqued antral part of stomach and loops of the transverse colon. In our case, chest and abdominal radiography after oral intake of contrast are used to diagnose this condition. Herniation was reduced surgically by a transabdominal approach. At the control examination one year after surgery in our patient all symptoms have disappeared, and was given 15 kg of body weight

Diversity and movement of indoor Alternaria alternata across the mainland USA

Alternaria spp. from sect. Alternaria are frequently associated with hypersensitivity pneumonitis, asthma and allergic fungal rhinitis and sinusitis. Since Alternaria is omnipresent in the outdoor environment, it is thought that the indoor spore concentration is mainly influenced by the outdoor spore concentration. However, few studies have investigated indoor Alternaria isolates, or attempted a phylogeographic or population genetic approach to investigate their movement. Therefore, the aim of the current study was to investigate the molecular diversity of indoor Alternaria isolates in the USA, and to test for recombination, using these approaches. Alternaria isolates collected throughout the USA were identified using ITS, gapdh and endoPG gene sequencing. This was followed by genotyping and population genetic inference of isolates belonging to Alternaria sect. Alternaria together with 37 reference isolates, using five microsatellite markers. Phylogenetic analyses revealed that species of Alternaria sect. Alternaria represented 98% (153 isolates) of the indoor isolates collected throughout the USA, of which 137 isolates could be assigned to A. alternata, 15 to the A. arborescens species complex and a single isolate to A. burnsii. The remaining 2% (3 isolates) represented sect. Infectoriae (single isolate) and sect. Pseudoulocladium (2 isolates). Population assignment analyses of the 137 A. alternata isolates suggested that subpopulations did not exist within the sample. The A. alternata isolates were thus divided into four artificial subpopulations to represent four quadrants of the USA. Forty-four isolates representing the south-western quadrant displayed the highest level of uniqueness based on private alleles, while the highest level of gene flow was detected between the south-eastern (32 isolates) and south-western quadrants. Genotypic diversity was high for all quadrants, and a test for linkage disequilibrium suggested that A. alternata has a cryptic sexual cycle. These statistics could be correlated with environmental factors, suggesting that indoor A. alternata isolates, although extremely diverse, have a continental distribution and high levels of gene flow over the continent.Dutch Ministry of Education, Culture and Science through an endowment of the FES programme ‘‘Making the tree of life work’’.http://www.elsevier.com/locate/yfgbihb201