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M H el Habbal

Publications and source records attributed to M H el Habbal.

9 recordsLinked to original sources
PubMed1997

Cardiopulmonary bypass tubes and prime solutions stimulate neutrophil adhesion molecules.

OBJECTIVE: To evaluate effects of the material of the cardiopulmonary bypass (CPB) tubes (polyvinyl chloride, PVC) and prime solutions on expression of neutrophil adhesion molecule CD11b and L-selectin. METHODS: We carried out a series of experiments using donor blood from 30 healthy adult human volunteers. In all experiments, neutrophil cell surface expressions of CD11b and L-selectin were assayed immediately and serially up to 2 hours, using immune-fluorescence techniques and flow cytometry. Study 1: Effects of PVC were compared with glass and polystyrene (n = 5). Study 2: Blood was mixed with Plasma-lyte (Pl) (prime solution), Hartman solutions, albumin or not altered (control), n = 5. Study 3: The effects of changing pH of the Pl (control, neutralised and acidic solution, n = 5) were examined. Study 4: Haemodilution (undiluted, 1:1, 1:2, and 1:3, vol/vol, prime to blood, n = 5) was carried out using Pl and the subsequent changes in expressions of the adhesion molecules were analysed. Study 5: The combined effect of PVC and Pl was assessed (n = 5). Study 6: We evaluated the effect of increasing plasma water by adding sterile water to whole blood and compared it with control (n = 5). RESULTS: Study 1: PVC, similar to glass, caused more up-regulation of CD11b and down-regulation of L-selectin than polystyrene (238 and 162% vs. 68 increase of CD11b, P < 0.001; 89 and 95% vs. 16% decrease of L-selectin, P < 0.001). Study 2: Pl and Hartman solutions caused more up-regulation of CD11b and down-regulation of L-selectin compared to albumin and control (166 and 188% vs. 26 and 44% increase of CD11b, P < 0.01; 19 and 26% vs. 10 and 6% decrease of L-selectin, P < 0.01, respectively). Study 3: Haemodilution had no effect on these molecules. Study 4: The mean of the difference between the acidic and neutral solution was 208% increase of CD11b and 30% decrease of L-selectin, P < 0.05. Study 5: The combined effect of mixing blood with Pl and exposure to PVC caused marked up-regulation of CD11b (336% increase, P < 0.01) and down-regulation of L-selectin (78% decrease, P < 0.05). Study 6: Water for injection caused marked up-regulation of CD1 1b and down-regulation of L-selectin. CONCLUSIONS: Mixing blood with acidic prime solution and/or exposing it to PVC tubes causes up-regulation of neutrophil adhesion molecule CD11b and down-regulation of L-selectin. Neutralisation of the prime solution reduces the extent of neutrophil activation, whereas haemodilution has no effect. Increasing plasma water is stimulating to the neutrophil. Modulation of prime solutions and the material of CPB tubes may reduce neutrophil activation which may reduce patient morbidity.

Adult↗
PubMed1996

Application of kinetics in intensive care management of children with generalized oedema.

OBJECTIVE: To evaluate the effects of a pulsating air bed on the relief of tissue oedema and duration of intensive care unit (ICU) stay of children post-cardiac surgery. DESIGN: Random allocation. SETTING: Pediatric cardiac ICU. PATIENTS AND PARTICIPANTS: Sixteen patients, aged 3-48 months, who underwent the surgical repair of atrioventricular septal defect. INTERVENTION: The treatment group received continuous postoperative management on a pulsating low air-loss bed. The control group was managed on a standard non-pulsating bed. The end point of the study was that total body water (TBW) returned to preoperative levels. MEASUREMENTS: The TBW was measured by bioelectrical impedance and expressed as a percentage change of body weight as determined prior to treatment. Measurements were made before surgery, upon arrival on the ICU, and serially until TBW returned to preoperative levels. All patients were treated according to the standard ICU protocol, which includes strict fluid and diuretic regimens. Urine output, mean blood pressure and central venous pressure were measured. RESULTS: All patients developed a 2-20% increase in TBW above baseline after open heart surgery. Preoperative measurements and ICU admission values were identical. The maximum increase in TBW was reached 3-6 h after return to the ICU. These values were higher in the control group (p < 0.01). The TBW returned to normal in the treatment group at 24 h after surgery, and at 48-72 h after surgery in the control group (p < 0.001). There was a tendency for higher urine output and central venous pressure in the treated group. The duration of stay in the ICU was significantly less for the treated group (p < 0.05). CONCLUSIONS: Continuous air pulsation by a specialty ICU bed reduced TBW, relieved tissue oedema, and improved hemodynamics in oedematous post-operative paediatric cardiac surgery patients. This reduced morbidity may have cost-effective implications relating to decreased ICU stay and resource consumption. Further studies to evaluate the use of this technology in critically ill children are warranted.

Air↗
PubMed1995

Neutrophil activation in paediatric extracorporeal circuits: effect of circulation and temperature variation.

OBJECTIVE: Upregulation of neutrophil adhesion molecules (CD11b and L-selectin) and release of a modulating cytokine (IL8) have been reported in vivo and in vitro in adult cardiopulmonary bypass. The aim of this study was to determine whether paediatric bypass preparations have similar influences and whether neutrophil-endothelium interactions are required for IL8 release. METHODS: In vitro paediatric cardiopulmonary bypass circuits (n = 15) were constructed (identical to those used clinically), as well as static loops (n = 15) using donor blood. The effects of circulation and temperature (17 degrees C, 25 degrees C, 37 degrees C) on the initiation of acute inflammation were examined. Cellular expressions of neutrophil adhesion molecules CD11b and L-selectin were assayed by immunofluorescence technique, and serum IL8, IL6, TNF-alpha, leucocyte elastase, and terminal complement complex were measured by ELISA. RESULTS: In all experiments, an immediate increase in CD11b expression occurred [median values, in relative fluorescence units: 64.9 (range 45.3-212.9) at rest; 365.2 (205-835.4) at 10 min; P < 0.001], along with a decrease in L-selectin expression [153.5 (115.5-220.7) at rest; 42 (12-134) at 10 min; P < 0.01]. Serum concentrations of the following increased gradually and were higher in circulation than in static loops: IL8 [1500 (500-2500) pg.ml-1 in circuit v 600 (180-1500) pg.ml-1 in loop, P < 0.001]; TNF-alpha P < 0.05]; and terminal complement complex [25.9 (6.8-120) v 4.7 (0-21.6) AU.ml-1, P < 0.01]. Cooling decreased and rewarming increased upregulation of CD11b and downregulation of L-selectin and release of IL8. IL6 was undetectable. CONCLUSIONS: In the absence of endothelium, in vitro paediatric cardiopulmonary bypass causes profound acute inflammatory changes in donor blood with release of IL8. These changes were greater than in adult cardiopulmonary bypass. Temperature variation and circulation modulate the responses.

Adult↗
PubMed1992

Cardiovascular manifestations of Marfan's syndrome in the young.

This study investigated prevalence of life-threatening cardiovascular complications in the first 20 years of life of 186 patients with Marfan's syndrome. This was combined with echocardiographic observations on aortic root diameter. The aortic root diameter was measured in 91 of 186 patients (group A) and compared with that of 150 normal subjects aged 3 weeks to 20 years (group B). Fifteen patients underwent serial measurement of the aortic root diameter. Eight patients had serious cardiovascular sequelae that were related to the aorta (seven) and mitral regurgitation (one). In group A, aortic root diameters were at the upper limits of normal and above. Dilatation of the aortic root occurred in the eight patients before the development of life-threatening complications. Prevalence of serious cardiovascular manifestations of Marfan's syndrome in young persons is low. In children the aortic root diameter should be measured regularly (every 6 to 12 months) in as much as its rapid dilatation is predictive of those at risk of life-threatening sequelae.

Aorta↗
PubMed1989

The aortic root in subaortic stenosis.

This study investigated the size of the aortic root (AoR) and its effect on surgical outcome in patients with fixed subaortic stenosis. The diameter of the AoR was measured in two groups by means of two-dimensional echocardiography. Group A consisted of 138 normal subjects, aged 3 weeks to 20 years (mean 7.5 years). Group B consisted of 28 patients with fixed subaortic stenosis, aged 1.5 to 18 years (mean 9.5 years), 21 of whom had undergone surgical resection of the stenosis. Normal values and growth curves for AoR diameter were obtained from patients in group A. There was marked retardation of growth of the AoR among patients in group B, with seven patients having a small AoR diameter (less than 2 standard deviations). Postoperative gradients had a high correlation with the small size of diameter of the AoR (r = -0.84). In fixed subaortic stenosis the AoR may be small (25%). The presence of a small AoR has a marked effect on the optimal relief of fixed subaortic stenosis. The diameter of the AoR should be measured preoperatively, inasmuch as special surgical techniques may be required.

Adolescent↗