To determine whether intraoperative fluid management affects urine output in patients undergoing laparoscopic bariatric operations.Design: Randomized controlled trial.Setting: Academic tertiary referral center.Patients: Morbidly obese patients scheduled to undergo laparoscopic bariatric procedures.Interventions: Patients were randomly assigned to receive intraoperatively high (10 mL /kg/h, n = 55) or low (4 mL/kg/h, n= 52) amounts of Ringer lactate solution. Main Outcome Measures:The primary end point was urine output. Secondary end points were postoperative creatinine serum concentration and complication rate.Results: Significantly more fluids were administered intraoperatively to patients in the high-volume group compared with the low-volume group (P Ͻ .001). Regardless of the amount of fluids administered intraoperatively, low urine outputs (median [range], 100 [15-1050] mL in the high-volume group vs 107 [25-500] mL in the lowvolume group; P=.34) were documented and were not significantly different. The mean creatinine serum concentration was within normal range at all times and was not significantly different between the groups (P=.68). The number of patients with complications was nonsignificantly lower in the low-volume group compared with the high-volume group (7 vs 10 patients, respectively; P=.60). Conclusions:In patients undergoing laparoscopic bariatric surgery, intraoperative urine output is low regardless of the use of relatively high-volume fluid therapy.The results suggest that we should reconsider the common practice to administer intraoperative fluids in response to low urine output. Further studies are required to evaluate these data in other surgical patient populations.

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SummaryThe Fontan procedure is performed for patients with a hypoplastic right ventricle, and pregnancies following this palliative surgery are likely to increase. We present a parturient with the Fontan physiology who successfully underwent two consecutive caesarean deliveries; the first under general anaesthesia for emergency surgery and the second under regional anaesthesia for elective surgery. We suggest that pregnancy and delivery do not typically adversely affect maternal cardiac status in these patients. Attention must be paid, however, to fetal loss, prematurity, growth retardation and associated cardiac congenital malformations for which insufficient data exist in the literature in this patient population. The 2000-2002 Report of the Confidential Enquiries into Maternal Deaths [1] highlighted cardiac disease as the second most frequent cause of maternal death, and 20% of these were cases of congenital cardiac disease. We present a parturient with the Fontan physiology who successfully completed two consecutive pregnancies and deliveries. Previous individual case reports of pregnancy following the Fontan procedure discuss anaesthetic guidelines [2,3] or focus on potential complications during labour and delivery [3,4]. To date, only one study has included a large series, of 33 Fontan deliveries, with regard to maternal and fetal outcome [5]. The novelty of our case resides not only in two successive pregnancies 1 year apart for the same woman, but also in two different anaesthetic approaches for two different obstetric situations. We describe the Fontan procedure and its anaesthetic implications along with a presentation of our conclusions regarding management of such cases. Case reportA 25-year-old nulliparous patient presented initially at 12 weeks of gestation in her first pregnancy. She was born with a hypoplastic right ventricle and tricuspid atresia, for which she underwent a Blalock-Taussig shunt at 12 years, a Glenn shunt at 19 years and a superseding Fontan procedure at 22 years. The procedure involved transposition of the pulmonary trunk to the right atrium using a tunnel technique with a Gore-Tex tube graft. Following the Fontan procedure she was well with a normal level of activity (New York Heart Association class I).At initial presentation she had no history of dyspnoea, orthopnoea or arrhythmias. She had clubbing, but no cyanosis. There was no peripheral oedema. Blood pressure was 120 ⁄ 85 mmHg and heart rate regular at 82 beats.min )1 . A loud systolic ejection, pansystolic murmur could be heard over the precordium. Lung fields were clear and arterial oxygen saturation was 95% in room air. Echocardiography demonstrated good superior and inferior vena caval flow to the pulmonary artery, good ventricular function, but moderate to severe mitral regurgitation and severe tricuspid regurgitation. Her body weight was 54 kg. At 24 weeks' gestation she was hospitalised with an abnormal fetal ultrasound showing absent end-diastolic

Background: Sepsis remains the leading cause of death in critically ill patients. One of the primary organs affected by sepsis is the lung, presenting as the Acute Respiratory Distress Syndrome (ARDS). Organ damage in sepsis involves an alteration in gene expression, making gene transfer a potential therapeutic modality. This work examines the feasibility of applying simian virus 40 (SV40) vectors for pulmonary gene therapy.