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Albumin administration may improve organ function in hypoalbuminemic critically ill patients. It results in a less positive fluid balance and a better tolerance to enteral feeding.

Cerebral blood flow has been reported to increase during dynamic exercise, but whether this occurs in proportion to the intensity remains unsettled. We measured middle cerebral artery blood flow velocity (vm) by transcranial Doppler ultrasound in 14 healthy young adults, at rest and during dynamic exercise performed on a cycle ergometer at a intensity progressively increasing, by 50 W every 4 min until exhaustion. Arterial blood pressure, heart rate, end-tidal, partial pressure of carbon dioxide (PETCO2), oxygen uptake (VO2) and carbon dioxide output were determined at exercise intensity. Mean vM increased from 53 (SEM 2) cm.s-1 at rest to a maximum of 75 (SEM 4) cm.s-1 at 57% of the maximal attained VO2 (VO2max), and thereafter progressively decreased to 59 (SEM 4) cm.s-1 at VO2max. The respiratory exchange ratio (R) was 0.97 (SEM 0.01) at 57% of VO2max and 1.10 (SEM 0.01) at VO2max. The PETCO2 increased from 5.9 (SEM 0.2) kPa at rest to 7.4 (SEM 0.2) kPa at 57% of VO2max, and thereafter decreased to 5.9 (SEM 0.2) kPa at VO2max. Mean arterial pressure increased from 98 (SEM 1) mmHg (13.1 kPa) at rest to 116 (SEM 1) mmHg (15.5 kPa) at 90% of VO2max, and decreased slightly to 108 (SEM 1) mmHg (14.4 kPa) at VO2max. In all the subjects, the maximal value of vm was recorded at the highest attained exercise intensity below the anaerobic threshold (defined by R greater than 1). We concluded that cerebral blood flow as evaluated by middle cerebral artery flow velocity increased during dynamic exercise as a function of exercise intensity below the anaerobic threshold.(ABSTRACT TRUNCATED AT 250 WORDS)

An ETV is an efficient procedure for controlling hydrocephalus associated with posterior fossa tumor. The authors confirm that a routine postoperative ETV is indicated for treating persistent hydrocephalus. For preventing it, however, they recommend early posterior fossa surgery whenever possible. The low rate of persistent hydrocephalus does not justify adopting routine preoperative ETVs.

Disseminated aspergillosis is an uncommon but frequently fatal disease in critically ill populations. With studies suggesting that the incidence of this disease is increasing, and with relatively few epidemiological data available in this population, we evaluated cases of disseminated aspergillosis identified at autopsy over a one-year period on a 31-bed mixed medico-surgical intensive care unit (ICU) of an academic university hospital. In 1999, there were 489 deaths out of 2984 ICU admissions, and 222 autopsies were performed. Post-mortem examination demonstrated disseminated aspergillosis involving non-contiguous organs in 6 (2.7%) autopsies and, of these, five patients (2.3% of total) had had chronic obstructive pulmonary disease (COPD) and had been treated with corticosteroids and mechanical ventilation for pulmonary infection. One patient also had granulocytopenia. In each patient, sputum and bronchoalveolar lavage (BAL) cultures had been positive for Aspergillus fumigatus after ICU admission but this was considered as colonization and the patients were given fluconazole for suspected candidal infection. In conclusion, COPD patients treated with corticosteroids and presenting with pulmonary infection should be considered at risk for disseminated aspergillosis. The rapidly fatal outcome after ICU admission suggests that colonization with Aspergillus can occur before ICU admission.

After a short ICU stay (<10 days), autopsy revealed discrepancies primarily related to the cause of death associated with diseases whose diagnosis can be difficult. Following more prolonged ICU stays (>10 days), autopsy was more likely to reveal coexisting diseases unrelated to death.

. No effect of creatine supplementation on human myofibrillar and sarcoplasmic protein synthesis after resistance exercise. Am J Physiol Endocrinol Metab 285: E1089-E1094, 2003. First published June 24, 2003 10.1152/ajpendo.00195.2003.-Muscle hypertrophy during resistance training is reportedly increased by creatine supplementation. Having previously failed to find an anabolic effect on muscle protein turnover at rest, either fed or fasted, we have now examined the possibility of a stimulatory effect of creatine in conjunction with acute resistance exercise. Seven healthy men (body mass index, 23 Ϯ 2 kg/m 2 , 21 Ϯ 1 yr, means Ϯ SE) performed 20 ϫ 10 repetitions of leg extension-flexion at 75% one-repetition maximum in one leg, on two occasions, 4 wk apart, before and after ingesting 21 g/day creatine for 5 days. The subjects ate ϳ21 g maltodextrin ϩ 6 g protein/h for 3 h postexercise. We measured incorporation of [1-13 C]leucine into quadriceps muscle proteins in the rested and exercised legs. Leg protein breakdown (as dilution of [ 2 H5]phenylalanine) was also assessed in the exercised and rested leg postexercise. Creatine supplementation increased muscle total creatine by ϳ21% (P Ͻ 0.01). Exercise increased the synthetic rates of myofibrillar and sarcoplasmic proteins by two-to threefold (P Ͻ 0.05), and leg phenylalanine balance became more positive, but creatine was without any anabolic effect. skeletal muscle; protein turnover THE USE OF CREATINE SUPPLEMENTATION as an ergogenic aid has increased markedly, especially among athletes requiring high power outputs during so-called explosive events. In investigating the possible mechanisms for the claimed improvements in performance, many workers have reported that creatine supplementation is accompanied by a significant increase in lean body mass (1,2,4,9,14). There is evidence that the increase in muscle mass does not simply represent an increase in total body water but is mainly intracellular, suggesting that the body cell dry mass has increased (10). Also, there are a number of reports showing increases in muscle fiber area as a result of consuming creatine while training using resistance exercise (29, 30) or during treatment of patients with muscle atrophy (13, 28).The mechanism of the creatine-associated effect on muscle mass is unknown. If it is the result of a direct effect of creatine, it should stimulate muscle protein synthesis or decrease muscle protein breakdown. Increased creatine availability has been reported in studies of animal skeletal and cardiac muscle in vitro to stimulate protein synthesis (15,16,33), although other investigators (11) were unable to confirm this.In starting to investigate the possible effects on human muscle, we began by studying the effect of creatine supplementation on human muscle protein turnover at rest in the fasted and fed conditions (20). In that study, we measured myofibrillar protein synthesis and leg protein breakdown in healthy young men before and after 5 days of dietary creatine supplementation sufficient to r...