Background: Fluid therapy guided by cardiac output measurements is of particular importance for adequate cerebral perfusion and oxygenation in neurosurgical patients. We examined the usefulness of a noninvasive electrical velocimetry (EV) device based on the thoracic bioimpedance method for perioperative hemodynamic monitoring in patients after aneurysmal subarachnoid hemorrhage. Patients and Methods: In total, 18 patients who underwent surgical clipping or endovascular coiling for ruptured aneurysms were examined prospectively. Simultaneous cardiac index (CI) measurements obtained with EV (CIEV) and reference transpulmonary thermodilution (CITPTD) were compared. A total of 223 pairs of data were collected. Results: A significant correlation was found between CIEV and CITPTD (r=0.86; P
https://ift.tt/2MTM48A
Σάββατο 23 Ιουνίου 2018
Relationship between mold exposure, specific IgE sensitization and clinical asthma: a case-control study
Source:Annals of Allergy, Asthma & Immunology
Author(s): Muriel Vincent, Francis Corazza, Camille Chasseur, Sandrine Bladt, Marta Romano, Kris Huygen, Olivier Denis, Olivier Michel
https://ift.tt/2tym1uK
Risk Factors for Multiple Epinephrine Doses in Food-Triggered Anaphylaxis in Children
Publication date: Available online 23 June 2018
Source:Annals of Allergy, Asthma & Immunology
Author(s): Angela Tsuang, Nikhil R. Menon, Natasha Bahri, Lawrence S. Geyman, Anna Nowak-Węgrzyn
BackgroundFood-related anaphylactic reactions may require treatment with more than one dose of epinephrine. Current guidelines advise patients at risk of anaphylaxis to carry two epinephrine autoinjectors.ObjectiveThe objective of this study was to determine risk factors of multiple dose epinephrine treatment in pediatric food-related anaphylaxis.MethodsParents of children with physician-confirmed diagnosis of food allergy were administered a standardized questionnaire at the time of their clinic visit. These patients were then followed-up prospectively by phone.ResultsSix hundred forty-two subjects had allergic reactions. Twentysix percent of patients reported at least one reaction treated with epinephrine for a total of 221 reactions. Among reactions treated with epinephrine, twenty-four reactions (11%) received two or more doses of epinephrine. The most common triggers were milk (30%) and peanut (18%). Milk-triggered allergic reactions (odds ratio (OR) 3.2, 95% confidence interval (CI) 1.2-8.4) and treatment with oxygen (OR 5.0, 95% CI 2.0- 12.4) were significant risk factors for requiring multiple doses of epinephrine to treat an allergic reaction.ConclusionThis study demonstrates that treatment of anaphylaxis may require more than one epinephrine injection. Reactions triggered by milk or requiring treatment with oxygen are at higher risk for needing more than one dose of epinephrine. Families of food-allergic children should be counseled on the importance of carrying two epinephrine auto-injectors.
https://ift.tt/2lyRSHP
LSECs express functional NOD1 receptors: A role for NOD1 in LSEC maturation-induced T cell immunity in vitro
Source:Molecular Immunology, Volume 101
Author(s): Shunmei Huang, Jun Wu, Xiaoyan Gao, Shi Zou, Liwen Chen, Xilang Yang, Chan Sun, Yanqin Du, Bin Zhu, Jia Li, Xuecheng Yang, Xuemei Feng, Chunchen Wu, Chunwei Shi, Baoju Wang, Yinping Lu, Jia Liu, Xin Zheng, Feili Gong, Mengji Lu, Dongliang Yang
Liver sinusoidal endothelial cells (LSECs) are organ resident APCs capable of antigen presentation and subsequent tolerization of T cells under physiological conditions. In this study, we investigated whether LSEC pretreatment with NOD-like receptor (NLR) agonists can switch the cells from a tolerogenic to an immunogenic state and promote the development of T cell immunity. LSECs constitutively express NOD1, NOD2 and RIPK2. Stimulation of LSECs with DAP induced the activation of NF-κB and MAP kinases and upregulated the expression of chemokines (CXCL2/9, CCL2/7/8) and cytokines (IFN-γ, TNF-α and IL-2). Pretreatment of LSECs with DAP induced significantly increased IFN-γ and IL-2-production by HBV-stimulated CD8+ T cells primed by DAP-treated LSECs. Consistently, a significant reduction in the HBV DNA and HBsAg level occurred in mice receiving T cells primed by DAP-treated LSECs. MDP stimulation had no impact on LSECs or HBV-stimulated CD8+ T cells primed with MDP-treated LSECs except for the upregulation of PD-L1. DAP stimulation in vitro could promote LSEC maturation and activate HBV-specific T cell responses. These results are of particular relevance for the regulation of the local innate immune response against HBV infections.
https://ift.tt/2MQ5YkB
The structural basis for filovirus neutralization by monoclonal antibodies
Liam B King | Brandyn R West | Sharon L Schendel | Erica Ollmann Saphire
https://ift.tt/2KfK4ZH
Cracked Tooth Syndrome in Irradiated Head and Neck Cancer Patients
Publication date: Available online 23 June 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Natalia Rangel Palmier, Cristhian Camilo Madrid, Mariana de Pauli Paglioni, César Rivera, Beatriz Nascimento F. Lebre Martins, Anna Luíza Damaceno Araújo, João Victor Salvajoli, Marcio Ajudarte Lopes, Ana Carolina Prado Ribeiro, Thaís Bianca Brandão, Alan Roger Santos-Silva
ObjectivesThe aim of this study was to assess the presence of enamel craze lines (ECL), part of the spectrum of the so called cracked tooth syndrome, in the surface of teeth irradiated in vivo.Material and MethodsForty teeth extracted from head and neck cancer patients were paired matched and equally divided into 4 groups: non-carious irradiated (G1); non-carious control (G2); radiation-related caries (RRC) (G3), and carious control (G4). Samples were examined for ECL detection with a fiber-optic transillumination device, photographed and ECL mean size, number, and patterns of topographic distribution in tooth crown were determined. Groups were compared accordingly: G1 vs. G2; G3 vs. G4.Results538 ECL were analyzed from which 30.1% were found in non-carious irradiated teeth, 19.3% in non-carious control, 27.6% in RRC and 23% in carious control. Non-carious irradiated teeth presented higher quantities of ECL than non-carious control (p<0.05). Higher incidences of ECL were identified in specific enamel topographies of anterior G1 and G3 samples (p<0.05). There was no correlation between ECL size/numbers and radiation isodoses delivery to teeth.ConclusionIncreased incidence of ECL may indicate weakened enamel structure in irradiated teeth, which might play a role in the onset and progression of RRC.
https://ift.tt/2ltC4WT
Which plate results in better stability after segmental mandibular resection and fibula free flap reconstruction?: Biomechanical analysis
Publication date: Available online 23 June 2018
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): Si-Myung Park, Jung-Woo Lee, Gunwoo Noh
ObjectiveThis study investigated the biomechanical stability of two plate systems, mini-plates and reconstruction plates, in reconstruction with fibular free flaps.Study DesignThe reconstruction models were constructed using two types of plates in representative segmental mandibular defect cases (C, L, LC1, LC2), respectively. Each model conducted a masticatory simulation approximating three clenching tasks using the muscle forces adjusted to the mandible structure used in this study. In addition, to evaluate the sensitivity of two plate systems for masticatory load changes, a sensitivity analysis was also performed by using finite element analysis.ResultsThe risks of plate fracture and screw loosening measured by stress concentrations were higher in the cases using mini-plates than those using reconstruction plates. Moreover, the mini-plate was more sensitive to varied loads than the reconstruction plate, and has less flexibility to absorb external forces. Mini-plates also caused high strain values, indicating hypertrophy risk in bone around the screw holes.ConclusionsThe use of a reconstruction plate should result in more stable surgical outcomes in most cases, but we note that the risk of atrophy may increase with the use of reconstruction plates, due to the lack of bone stimulation.
https://ift.tt/2tvvTFB
Relationship between mold exposure, specific IgE sensitization and clinical asthma: a case-control study
Mold sensitizations have been repeatedly reported for their association with exacerbations of asthma symptoms and disease severity. In 1999, Neukirch et al. showed that sensitization to A. alternata was associated with severe asthma.1 These findings were later confirmed in the European Community Respiratory Health survey which showed that the frequency of sensitization to A. alternata and/or C. herbarum was significantly associated with asthma severity.2 Previous studies also suggested a link between sensitization to A.
https://ift.tt/2MQx3o1
Risk Factors for Multiple Epinephrine Doses in Food-Triggered Anaphylaxis in Children
Food-related anaphylactic reactions may require treatment with more than one dose of epinephrine. Current guidelines advise patients at risk of anaphylaxis to carry two epinephrine autoinjectors.
https://ift.tt/2yE5OtK
Giant congenital melanocytic nevus in a Cameroonian child: a case report
Giant congenital melanocytic nevus is a very rare condition characterized by a large skin lesion and an increased risk of complications like neurocutaneous melanosis and malignant transformation. Reports of gi...
https://ift.tt/2tndf3d
Orofacial cleft management by short-term surgical missions in South America: literature review
There is a growing demand for surgical care in South America, particularly for patients with congenital orofacial clefts (OFCs). Short-term surgical missions (STSMs) have emerged as a means to deliver surgical expertise and alleviate this demand. The aim of this study was to review the quantity and quality of peer-reviewed reports on OFC repairs performed by STSMs in South America. A literature search was conducted using the PubMed, Embase, Web of Science, and SciELO databases. The search was limited to articles published in English and Spanish.
https://ift.tt/2yEkWHu
Effects of residual speech and auditory deprivation on speech perception of adult cochlear implant recipients
Possible predictive factors of cochlear implant (CI) outcomes have been extensively reported in literature for different user groups such as prelingual pediatric or postlingual adult users. However, there remains unexplained outcome variability among adult CI users; therefore, research concerning these patients continues and many different variables have been reported. This study aimed at evaluating the relationship between preoperative speech reception capacity, residual hearing, duration of deafness, age of implantation, and postoperative monosyllabic word recognition scores (WRSs) in postlingual CI users.
https://ift.tt/2lwha9L
Efficacy of corticosteroids versus placebo in impacted third molar surgery: systematic review and meta-analysis of randomized controlled trials
Publication date: Available online 23 June 2018
Source:International Journal of Oral and Maxillofacial Surgery
Author(s): R. de A.C. Almeida, C.A.A. Lemos, S.L.D. de Moraes, E.P. Pellizzer, B.C. Vasconcelos
The aim of this systematic review was to identify randomized, placebo-controlled clinical trials investigating the effectiveness of corticosteroids in the control of pain, oedema, and trismus following third molar surgery, and to analyse the effects of the type of drug administered and the time and route of drug administration on the outcomes of interest. Searches were performed in the PubMed, Scopus, and Cochrane Library databases. This review was structured according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The search identified 1223 studies. After assessing eligibility based on the inclusion and exclusion criteria, 17 studies were selected for the qualitative analysis (a total of 730 patients aged 15–45 years). Ten studies were included in the meta-analysis, which was performed using Review Manager software. The corticosteroids were effective in controlling pain (P=0.002; mean difference −17.38, 95% confidence interval −24.81 to −9.95) and trismus (P<0.00001; mean difference 6.10, 95% confidence interval 3.42 to 8.77). With the exception of the submucosal route, the route of administration did not appear to affect the outcomes. The administration of a corticosteroid in the preoperative phase was superior to its use in the postoperative phase for the control of trismus.
https://ift.tt/2lvp1nK
Reply
Source:Journal of Allergy and Clinical Immunology
Author(s): Matthew C. Altman, James E. Gern
https://ift.tt/2lwDQqu
Can natural killer cells represent an early life immune response in development of allergic asthma? More precise data analysis should be considered
Source:Journal of Allergy and Clinical Immunology
Author(s): Dan Yang, Chuntao Liu
https://ift.tt/2tyn2To
Effects of epidural anesthesia on postoperative nausea and vomiting in laparoscopic gynecological surgery: a randomized controlled trial
Abstract
Purpose
Patients undergoing laparoscopic gynecological surgery are susceptible to postoperative nausea and vomiting (PONV). We hypothesized that a combination of epidural and general anesthesia to minimize intraoperative opioid administration would reduce the incidence of PONV following laparoscopic gynecological surgery.
Methods
Women undergoing elective laparoscopic gynecological surgery were randomly assigned to receive general anesthesia alone (group G, n = 45) or general anesthesia with epidural anesthesia (group GE, n = 45). Patients in group G received fentanyl and remifentanil for intraoperative analgesia, and those in group GE received single-shot ropivacaine at the time of induction of anesthesia. The primary outcome was the incidence of PONV within 24 h of surgery. Secondary outcomes included the use of rescue metoclopramide within 24 h of surgery and the time to first incidence of PONV and first use of rescue metoclopramide.
Results
The incidence of PONV within 24 h of surgery was 60.0% in group G and 44.4% in group GE [relative risk (RR): 0.53, 95% confidence interval (CI): 0.23–1.23, p = 0.14]. There were no intergroup differences in the use of rescue metoclopramide (40.0% in group G, 24.4% in group GE, RR: 0.49, 95% CI 0.20–1.20, p = 0.11) and the time to first incidence of PONV and first use of rescue metoclopramide (p = 0.20 and 0.12, respectively).
Conclusion
Minimizing intraoperative opioid administration by combining epidural and general anesthesia did not reduce the 24-h incidence of PONV or rescue metoclopramide use after laparoscopic gynecological surgery.
https://ift.tt/2Iis38b
Virtual reality head-mounted display for endoscopically-assisted implant surgery
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A. Matsuo, H. Hamada, H. Oba, K. Shibata
https://ift.tt/2KeYn0B
Turn on ESIPT based chemosensor for histidine: Application in urine analysis and live cell imaging
Publication date: 1 October 2018
Source:Inorganica Chimica Acta, Volume 482
Author(s): Chandrima Das, Bholanath Pakhira, Arnold L. Rheingold, Shyamal Kumar Chattopadhyay
A vitamin B6 cofactor containing excited-state intramolecular proton transfer (ESIPT) based fluorescent sensor [Cu(LH2)Cl2]·2H2O [LH2 is pyridoxal-semicarbazide Schiff base] is used as a selective "naked-eye" fluorescent sensor of l-histidine at pH 7.4 in aqueous media via the ligand displacement approach. Uv-Vis spectrophotometry and cyclic voltammetry can also be used to detect l-histidine by the Cu(II)-complex. The DFT calculation also supports the sensing phenomena. The fluorescence imaging studies indicated that the Cu(II)-complex can be applied to visualize the intracellular histidine in living cells. Our chemosensor can also be used for quantitative determination of histidine in urine. It acts as a helpful tool for physiological and pathological estimation of histidine. It also shows high efficiency in 'dip-stick' method.
Graphical abstract
https://ift.tt/2K2pzQS
Glossary
Publication date: 2018
Source:Key Heterocycle Cores for Designing Multitargeting Molecules
https://ift.tt/2InrOc0
Validation of a drooling questionnaire in Indian children with cerebral palsy
Source:International Journal of Pediatric Otorhinolaryngology, Volume 112
Author(s): Anjana Job, P. Naina, Kamran Asif Syed, Maya Thomas, Mary John, Ajoy Mathew Varghese
BackgroundDrooling of saliva is a common problem in children with cerebral palsy. In addition to causing impairment in articulation, drooling also affects socialization, interpersonal relationships and integration into society for these children. There are various methods to assess drooling which measure directly the amount of saliva drooled. However the most convenient and popular method is the use of questionnaires which are mostly western based and need slight modification for the Indian scenario Aim-Validation of a modified questionnaire for the assessment of drooling in children with cerebral palsy.MethodThe modified questionnaire was administered to parents of children with cerebral palsy willing to participate in the study. The drooling score was compared with objective tests, namely cotton pad test and drooling quotient. Internal consistency was assessed using the Cronbach's alpha, test retest reliability by Intraclass Correlation and sensitivity analysis by the Receiver operating characteristic curve.ResultsThe modified questionnaire was found to be easy to administer. The Cronbach's alpha coefficient was between 0.867 and 0.879 which implies a high degree on internal consistency. The intraclass correlation and the test retest reliability was found to be statistically significant with a p value < 0.001 which show that the questionnaire was highly reliable for repeat administration as well as administration by different investigators. The ROC Area was found to be 0.94 with a standard error of 0.02 with a 95% confidence interval of 0.88–0.99, which suggests that the score has great specificity, closer agreement between specificity and sensitivity and excellent precision.ConclusionOur modified questionnaire was easy to administer, highly reliable and valid with high internal consistency. A score of 24 on the questionnaire was found to be the most sensitive and specific point to discriminate between the mild and severe droolers in children with cerebral palsy.
https://ift.tt/2KioGmz
Expression of surfactant Protein-A in the Haemophilus influenzae-induced otitis media in a rat model
Source:International Journal of Pediatric Otorhinolaryngology, Volume 112
Author(s): Gun Hee Yu, Hee-Bok Kim, Seo Hyun Ko, Youn Woo Kim, Yun-Sung Lim, Seok-Won Park, Chang Gun Cho, Joo Hyun Park
The objective of this study was to investigate the expression and the role of surfactant protein A (SP-A) in the middle ear (ME) mucosa in response to bacterial infection in a rat model. Otitis media (OM) was induced by surgical inoculation of non-typeable Haemophilus influenza (NTHi) into the ME cavity of Sprague-Dawley rats. The rats were divided into an NTHi-induced OM group and a phosphate-buffered saline-injected control group. The NTHi-induced OM and control groups were subdivided into sets of 6 rats, one for each of the 6 time points (0, 1, 2, 4, 7, and 14 days post-inoculation), at which point the rats were euthanized after inoculation. The concentrations of SP-A in the ME effusion were determined by an enzyme-linked immunosorbent assay (ELISA). Tissue expression of SP-A, interleukin-1β (IL-1β), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) in infected ME mucosa was assessed by immunohistochemical staining. For mRNA expression quantification, RNA was extracted from the ME mucosa and SP-A expression was monitored and compared between the control and OM groups using quantitative polymerase chain reaction (PCR). Expression of IL-1β, IL-6, and TNF-α in the ME mucosa was also evaluated. SP-A expression was evaluated in the effusion of pediatric OM patients (70 ears) who received ventilation-tube insertion by ELISA. SP-A was detected in normal rat ME mucosa before bacterial inoculation. SP-A expression was up-regulated in the NTHi-induced OM group (p = 0.046). Immunohistochemical staining revealed increased SP-A expression on post-inoculation day 1, 2, and 4 in the OM group. Expression of proinflammatory cytokines (IL-1β, IL-6, and TNF-α) in the ME also increased significantly on post-inoculation day 1, 2, and 4 in the OM group. It correlated with changes in SP-A expression. Expression of SP-A was also identified in the ME effusion of humans. SP-A exists in the ME of the rat and was up-regulated in the ME of NTHi-induced OM. Expression of IL-1β, IL-6, and TNF-α was increased in the ME of the bacteria-induced OM in the rat model. The results suggest that SP-A may play a significant role in the early phase of OM induction and subsequent recovery from it.
https://ift.tt/2MjCqe9
Macrocephaly, epilepsy and intracranial cysts: an image to remember
Description
An 11-year-old, developmentally normal girl presented with recurrent seizures for the past 2 years. She was also noted to have progressively increasing head size since early infancy. She was born to non-consanguineous parents from the Aggarwal community in India and had a 7-year-old younger sister with similar problems. There was no associated history of vision impairment, tone abnormalities, cognitive or behavioural problems, extrapyramidal movements or gait changes. Examination showed head circumference of 58 cm (>3 z-scores), a single café-au-lait macule and normal bilateral fundi. The rest of the systemic examination was unremarkable. Parental head circumference was normal. She was evaluated for familial macrocephaly with epilepsy. MRI brain showed diffuse involvement of the subcortical and periventricular white matter with sparing of corpus callosum and formation of subcortical cysts (figure 1A–D). Electroencephalogram showed intermittent spike-slow waves from left temporal and right centroparietal areas and bilateral frontal intermittent rhythmic delta activity. Targeted...
https://ift.tt/2KiS3VK
Pyrexia of unknown origin: inferior vena cava agenesis
A 26-year-old woman presented with a 5-day history of fever after returning from Bali. She denied sexual contact abroad. On examination, there was suprapubic tenderness and a widespread maculopapular rash. Malaria serology was negative and blood tests were normal except for an elevated C reactive protein. Treatment was initially with ceftriaxone, metronidazole and doxycycline, but her symptoms failed to improve. A CT pelvis suggested a possible tubo-ovarian abscess, a suspected inferior vena cava (IVC) anomaly and left internal iliac/femoral venous thrombosis. A gynaecology review demonstrated left tubo-ovarian tenderness and fullness. An MRI suggested pelvic inflammatory disease and thrombophlebitis affecting the pelvic veins; deep vein thrombosis (DVT) treatment was commenced. Further family history revealed thrombosis throughout multiple generations. Further imaging analysis demonstrated agenesis of the IVC with compensatory dilation of pelvic collaterals and an acute DVT of the deep pelvic venous system. The patient was discharged with direct oral anticoagulant therapy.
https://ift.tt/2IjDwEi
Pregnancy and gastric cancer: diagnostic and treatment dilemma
Gastric cancer in pregnancy is an extremely rare entity. The incidence of gastric cancer is more in elderly patients and higher in the male population. Gastric cancer symptoms can be nausea, vomiting and epigastric discomfort which is similar to early pregnancy symptoms. This leads to a misinterpretation and delay in the diagnosis during pregnancy. Gastric cancer in pregnancy is associated with poor prognosis because of its delayed diagnosis at an advance stage. We present our patient here, with this rare clinical diagnosis and with no suspicion in a young healthy woman.
https://ift.tt/2K0Kofz
Delayed leucoencephalopathy after coil embolisation of unruptured cerebral aneurysm
A 56-year-old right-handed woman was successfully treated by coil embolisation for a large unruptured paraclinoid aneurysm of the left internal carotid artery. Though she was discharged on day 3 after the intervention with uneventful clinical course, she was rehospitalised for continuous headache and right upper limb weakness 2 weeks after the treatment. Subsequent progression of cognitive dysfunction and right hemiparesis were observed. Repeated MRI revealed diffuse leucoencephalopathy within the ipsilateral brain hemisphere. Clinical course, serological examination, and radiological findings were consistent with localised hypocomplemental vasculitis caused by delayed hypersensitivity reaction. Immunosuppressive treatments using prednisolone successfully improved her symptoms. After a washout period for immunosuppressant, skin reaction test was performed and revealed polyglycolic-polylactic acid, coating material of the coil, positive for delayed allergic reaction. Given the increased frequency of endovascular treatment for unruptured aneurysms, even such a rare complication should be recognised and treated properly to avoid neurological sequelae.
https://ift.tt/2IngrRm
Pancreatic intraepithelial neoplasia in heterotopic pancreas: incidentally diagnosed on endoscopic mucosal resection of a duodenal polyp
Heterotopic pancreas is the presence of pancreatic tissue outside its normal location. It can develop similar pathological conditions that develop in the normal pancreas, including adenocarcinoma and its precursor lesions. Due to the rarity of the condition, the diagnosis can be challenging, and treatment is not well established. We present a 47-year-old female patient referred for endoscopic resection of a 2 cm polyp in the second part of her duodenum. Complete endoscopic mucosal resection (EMR) was performed, with pathology revealing low-grade pancreatic intraepithelial neoplasia (PanIN) in heterotopic pancreatic tissue. To the best of our knowledge, this is the first case of heterotopic pancreas with low-grade PanIN in the duodenum to be incidentally diagnosed and treated with EMR.
https://ift.tt/2Kfcgfi
Involvement of bilateral posterior limb of internal capsule in hypernatraemic dehydration
Description
A 3-month-old male infant presented with loose stools and vomiting for the past 2 weeks and altered sensorium for the past 5 days. He was being administered inadequately diluted oral rehydration solution. On examination, he had moderate encephalopathy, depressed anterior fontanel and doughy skin. Laboratory investigations showed serum sodium 200 mEq/L, potassium 6.1 mEq/L, chloride 129 mEq/L, urea 136 mg/dL and creatinine 0.7 mg/dL. MRI of the brain showed predominant involvement of bilateral posterior limbs of internal capsule and genu with diffusion restriction (figure 1A–F). The baby improved with administration of free water, supportive care and gradual reduction of serum sodium. There were no seizures, and encephalopathy improved by day 3 of hospitalisation. At 3-month follow-up, he has normal development, absence of seizures or focal motor deficits.
Figure 1
(A–F) MRI brain on day 4 of illness, axial T2 (A and D), diffusion-weighted (B and E, b...
https://ift.tt/2yD0xCC
Spontaneous intracerebral haemorrhage: a rare complication of aortic aneurysm endoleak
We present a rare case of intracerebral haemorrhage secondary to consumptive coagulopathy in relation to ongoing endoleak after thoracic endovascular aneurysm repair (TEVAR). A 68-year-old man underwent elective TEVAR for an 18 cm diameter Crawford type II thoracoabdominal aneurysm. He was subsequently shown to have a type 1b endoleak and a short episode of disseminated intravascularcoagulation (DIC) perioperatively. Two months after the procedure, he experienced a consumptive coagulopathy leading to intracerebral haemorrhage and ultimately his death. Endoleak-related DIC is an underappreciated phenomenon within the medical literature. Currently, management is reliant on general DIC principles and anecdotal experiences of others within the case report literature.
https://ift.tt/2MUn6WC
A migratory shark bone
Fish bone ingestion is a common presentation in ENT. If not managed correctly, it can cause serious complications for the patient and dilemmas for the clinician. A 49-year-old Sri Lankan woman presented to the emergency department following shark bone ingestion with a 'pricking' sensation in her throat. After initial investigation, the bone migrated through to the sternocleidomastoid muscle. After surgical removal of the shark bone she went on to develop a large neck collection, which required surgical drainage. The careful attention to the patient's history and use of imaging facilitated treatment in this case of fish bone ingestion and management of the sequelae.
https://ift.tt/2twIZ5s
Recidiva de carcinoma nasosinusal relacionado con el virus del papiloma humano con características similares al adenoide quístico
Publication date: Available online 22 June 2018
Source:Acta Otorrinolaringológica Española
Author(s): Andrés Felipe Sáenz González, Eduardo Morera Serna, Adriana Marcela Quintero Duarte, Rafael Ramos Asensio
https://ift.tt/2Kk3HA0
The Child with Recurrent Mycobacterial Disease
Abstract
Purpose of Review
Many genetic conditions predispose affected individuals to opportunistic infections. A number of immunodeficiency diseases, including genetic defects termed Mendelian susceptibility to mycobacterial disease (MSMD), permit infection from many different strains of mycobacteria that would otherwise not cause disease. These include tuberculous and nontuberculous mycobacteria, and bacille Calmette-Guérin vaccine (BCG). Patients may present with infections from other organisms that depend on macrophage function for containment. Defects in multiple genes in the IL-12 and NFKB signaling pathways can cause the MSMD phenotype, some of which include IL12RB1, IL12B, IKBKG, ISG15, IFNGR1, IFNGR2, CYBB, TYK2, IRF8, and STAT1.
Recent Findings
Multiple autosomal recessive and dominant, and 2 X-linked recessive gene defects resulting in the MSMD phenotype have been reported, and others await discovery. This review presents the known gene defects and describes clinical findings that result from the mutations.
Summary
If MSMD is suspected, a careful clinical history and examination and basic immunodeficiency screening tests will narrow the differential diagnosis. A specific diagnosis requires more sophisticated laboratory investigation. Genetic testing permits a definitive diagnosis, permitting genetic counseling. Mild cases respond well to appropriate antibiotic therapy, whereas severe disease may require hematopoietic stem cell transplantation.
https://ift.tt/2Kd3E5o
The course of sexual interest and enjoyment in head and neck cancer patients treated with primary (chemo)radiotherapy
Source:Oral Oncology, Volume 83
Author(s): H.C. Melissant, F. Jansen, L.E.R. Schutte, B.I. Lissenberg-Witte, J. Buter, C.R. Leemans, M.A. Sprangers, M.R. Vergeer, E.T.M. Laan, I.M. Verdonck-de Leeuw
IntroductionThe aim of this prospective study was to investigate the course of sexual interest and enjoyment in relation to sociodemographic and clinical factors, health-related quality of life (HRQOL), and symptoms of psychological distress in head and neck cancer (HNC) patients treated with primary (chemo)radiotherapy.MethodsHNC patients (n = 354) completed patient-reported outcome measures (PROMs) on HRQOL (EORTC QLQ-C30 and QLQ-H&N35, including the sexuality subscale covering less sexual interest and enjoyment), and psychological distress (HADS) pretreatment, at 6-week follow-up and at 3-, 6-, 12-, 18-, and 24-month follow-up (i.e., after treatment). Linear mixed models were used to analyze the course of sexuality from pretreatment to 24-month follow-up, and to investigate its relation to sociodemographic and clinical factors, HRQOL, and psychological distress as measured at baseline, and to investigate the course of sexuality from 6- to 24-month follow-up in relation to these factors measured at 6-month follow-up.ResultsBefore start of treatment, 37% of patients reported having less sexuality, which increased to 60% at 6-week follow-up, and returned to baseline level from 12-month follow-up onwards. Older age (p = 0.037) and trouble with social contact (p < 0.001), weight loss (p = 0.013), and constipation (p = 0.041) before treatment were associated with less sexuality over time. Female gender (p = 0.021) and poor social functioning (p < 0.001) at 6-month follow-up were associated with less sexuality from 6- to 24-month follow-up.DiscussionLess sexuality is often reported in HNC patients treated with (chemo)radiotherapy. Using PROMs in clinical practice may help identify patients who might benefit from supportive care targeting sexuality.
https://ift.tt/2twD6Fo
Pattern of and survival following loco-regional and distant recurrence in patients with HPV+ and HPV− oropharyngeal squamous cell carcinoma: A population-based study
Source:Oral Oncology, Volume 83
Author(s): Christian Grønhøj, Kathrine Kronberg Jakobsen, David H. Jensen, Jacob Rasmussen, Elo Andersen, Jeppe Friborg, Christian von Buchwald
ObjectivesThe incidence of human papillomavirus (HPV) positive oropharyngeal squamous cell carcinoma (OPSCC) is increasing. Currently, data is sparse on the pattern and timing of recurrence. This long-term study concerning both HPV- and p16-status aimed to report predictive factors, pattern, timing of loco-regional recurrence (LRR) and distant recurrence (DR), and survival following recurrence in patients diagnosed with OPSCC.Material and methodsWe included patients diagnosed with OPSCC from 2000 to 2014 in Eastern Denmark, who were treated with curative intent. Tumors were defined as HPV-positive when they were both HPV-DNA and p16-positive. Time-to-failure and -death were estimated by the Kaplan-Meier method. Cox proportional hazards models were used to evaluate predictors of failure.ResultsThe cohort consisted of 1244 consecutive patients with OPSCC of which 288 patients (23%) experienced recurrence. Of these patients, the majority (n = 197/1244; 16%) experienced LRR and the remaining (n = 91/1244; 7%) DR. Significantly more HPV-negative patients experienced recurrence (n = 170/486; 35%) compared to HPV-positive patient (n = 112/726; 15%). DR occurred for both groups predominantly to the lung (n = 63/91; 69.2%) followed by the liver and bone. Factors influencing risk of LRR included gender, T-classification, and HPV-status. The same variables influenced risk of DR in addition to the UICC-8 classification, N-classification, pack years of smoking, and performance status. HPV-status was the strongest risk factor for LRR and DR.ConclusionLRR and DR occur significantly less often in HPV-positive patients compared with HPV-negative patients. HPV-status is an independent and strong predictor of recurrence. DR most commonly occurs to the lungs, irrespective of HPV-status.
https://ift.tt/2lrvjF7
Gastro-omental free flap for reconstruction of tongue defects
Source:Oral Oncology, Volume 83
Author(s): Sivakumar Vidhyadharan, Krishnakumar Thankappan, Ramu Janarthanan, Deepak Balasubramanian, Mohit Sharma, Jimmy Mathew, Othiyil Vayoth Sudheer, Subramania Iyer
ObjectivesThe purpose of this paper is to report the technique and outcomes of the use of gastro-omental free flap reconstruction in glossectomy defects.Materials and MethodsThis is a prospective case series of 9 patients of tongue squamous cell carcinoma, who underwent either subtotal or partial glossectomy and reconstruction with gastro–omental free flap. The flap anatomy, surgical technique and the outcomes including the swallowing and speech are presented.ResultsFive patients underwent partial glossectomy and 4 had sub-total glossectomy. The median age was 43 years; and the median follow up was 11.4 months. Laparoscopic harvest was done in 8 patients. There was one flap loss. Seven patients underwent postoperative radiotherapy. Functional evaluation was done in 5 patients who were disease free. Four could tolerate soft diet orally, one patient was on liquid to pureed diet. Speech was intelligible in 4. None of the patients had any complications related to laparotomy or laparoscopy.ConclusionGastro-omental flap provided a secretory mucosal surface and was beneficial in the saliva depleted patients post radiotherapy. The laparoscopic harvest of this flap has minimized donor site morbidity. One patient had a flap loss. Two patients reported superficial ulcerations on the surface, one of them had to undergo surgical debulking to correct it while the other healed with conservative measures. Speech and swallowing outcomes of the reconstructed tongue was good, especially in patients with partial glossectomy. The reconstructed gastric mucosal flaps tolerated the adjuvant radiation well.
https://ift.tt/2yHbsvg
Antibody-dependent cell-mediated cytotoxicity induced by active immunotherapy based on racotumomab in non-small cell lung cancer patients
Abstract
Antitumor strategies based on positive modulation of the immune system currently represent therapeutic options with prominent acceptance for cancer patients' treatment due to its selectivity and higher tolerance compared to chemotherapy. Racotumomab is an anti-idiotype (anti-Id) monoclonal antibody (mAb) directed to NeuGc-containing gangliosides such as NeuGcGM3, a widely reported tumor-specific neoantigen in many human cancers. Racotumomab has been approved in Latin American countries as an active immunotherapy for advanced non-small cell lung cancer (NSCLC) treatment. In this work, we evaluated the induction of Ab-dependent cell-mediated cytotoxicity (ADCC) in NSCLC patients included in a phase III clinical trial, in response to vaccination with racotumomab. The development of anti-NeuGcGM3 antibodies (Abs) in serum samples of immunized patients was first evaluated using the NeuGcGM3-expressing X63 cells, showing that racotumomab vaccination developed antigen-specific Abs that are able to recognize NeuGcGM3 expressed in tumor cell membranes. ADCC response against NeuGcGM3-expressing X63 (target) was observed in racotumomab-treated- but not in control group patients. When target cells were depleted of gangliosides by treatment with a glucosylceramide synthase inhibitor, we observed a significant reduction of the ADCC activity developed by sera from racotumomab-vaccinated patients, suggesting a target-specific response. Our data demonstrate that anti-NeuGcGM3 Abs induced by racotumomab vaccination are able to mediate an antigen-specific ADCC response against tumor cells in NSCLC patients.
https://ift.tt/2K0xzlr
Risques de conjonctivite avec le dupilumab (Dupixent®)
Publication date: Available online 22 June 2018
Source:Annales de Dermatologie et de Vénéréologie
Author(s): J.-L. Schmutz
https://ift.tt/2tnrMfu
The impact of low body mass index on postoperative outcomes in pancreatectomy patients: a retrospective analysis of Japanese administrative data
Abstract
Purpose
To comparatively examine in-hospital mortality among different underweight body mass index (BMI) categories in pancreatic cancer patients after pancreatectomy in Japan.
Methods
We conducted a large-scale multi-center retrospective cohort study of adult patients with pancreatic cancer who underwent pancreatectomy between April 1, 2010 and March 31, 2016. Patients were classified according to BMI as follows: normal BMI (18.50–24.99 kg/m2), mild thinness (17.00–18.49 kg/m2), moderate thinness (16.00–16.99 kg/m2), and severe thinness (< 16.00 kg/m2). A multivariable logistic regression analysis was performed with in-hospital mortality as the dependent variable and BMI groups as the main independent variable of interest.
Results
We analyzed 6173 patients from 332 hospitals. The results showed that the severe thinness group had a longer postoperative hospital stay (34.4 ± 25.6 days) and higher incidence of postoperative pneumonia (5.5%) than the other groups. The generalized estimating equations accounted for patient demographics, surgical procedure, anesthetic technique, activities of daily living score, and Charlson comorbidity index as covariates. Relative to the normal BMI group, the odds ratios for in-hospital mortality were 0.57 (95% confidence interval: 0.26–1.24; P = 0.16) in the mild thinness group, 1.49 (0.64–3.48; P = 0.36) in the moderate thinness group, and 2.54 (1.05–6.08; P = 0.04) in the severe thinness group.
Conclusion
Severe thinness was significantly associated with a higher risk of mortality, and extremely low BMI should be considered a risk factor in pancreatectomy patients.
https://ift.tt/2tliLU4
Perioperative Management in Hepatic Resections: Comparative Effectiveness of Neuraxial Anesthesia and Disparity of Care Patterns
BACKGROUND: Complication rates after hepatic resection can be affected by management decisions of the hospital care team and/or disparities in care. This is true in many other surgical populations, but little study has been done regarding patients undergoing hepatectomy. METHODS: Data from the claims-based national Premier Perspective database were used for 2006 to 2014. The analytical sample consisted of adults undergoing partial hepatectomy and total hepatic lobectomy with anesthesia care consisting of general anesthesia (GA) only or neuraxial and GA (n = 9442). The key independent variable was type of anesthesia that was categorized as GA versus GA + neuraxial. The outcomes examined were clinical complications and health care resource utilization. Unadjusted bivariate and adjusted multivariate analyses were conducted to examine the effects of the different types of anesthesia on clinical complications and health care resource utilization after controlling for patient- and hospital-level characteristics. RESULTS: Approximately 9% of patients were provided with GA + neuraxial anesthesia during hepatic resection. In multivariate analyses, no association was observed between types of anesthesia and clinical complications and/or health care utilization (eg, admission to intensive care unit). However, patients who received blood transfusions were significantly more likely to have complications and intensive care unit stays. In addition, certain disparities of care, including having surgery in a rural hospital, were associated with poorer outcomes. CONCLUSIONS: Neuraxial anesthesia utilization was not associated with improvement in clinical outcome or cost among patients undergoing hepatic resections when compared to patients receiving GA alone. Future research may focus on prospective data sources with more clinical information on such patients and examine the effects of GA + neuraxial anesthesia on various complications and health care resource utilization. Accepted for publication May 14, 2018. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Jeron Zerillo, MD, Department of Anesthesiology, Mount Sinai School of Medicine, 1 Gustave L Levy Pl, New York, NY 10029. Address e-mail to jeron.zerillo@mountsinai.org. © 2018 International Anesthesia Research Society
https://ift.tt/2ltuYSg
https://ift.tt/2ltuYSg
Variable Ventilation Associated With Recruitment Maneuver Minimizes Tissue Damage and Pulmonary Inflammation in Anesthetized Lung-Healthy Rats
BACKGROUND: Recruitment maneuver and positive end-expiratory pressure (PEEP) can be used to counteract intraoperative anesthesia-induced atelectasis. Variable ventilation can stabilize lung mechanics by avoiding the monotonic tidal volume and protect lung parenchyma as tidal recruitment is encompassed within the tidal volume variability. METHODS: Forty-nine (7 per group) male Wistar rats were anesthetized, paralyzed, and mechanically ventilated. A recruitment maneuver followed by stepwise decremental PEEP titration was performed while continuously estimating respiratory system mechanics using recursive least squares. After a new recruitment, animals were ventilated for 2 hours in volume-control with monotonic (VCV) or variable (VV) tidal volumes. PEEP was adjusted at a level corresponding to the minimum elastance or 2 cm H2O above or below this level. Lungs were harvested for histologic analysis (left lung) and cytokines measurement (right lung). Seven animals were euthanized before the first recruitment as controls. RESULTS: A time-dependent increase in respiratory system elastance was observed and significantly minimized by PEEP (P
https://ift.tt/2ttovKN
https://ift.tt/2ttovKN
High-Fidelity Simulation Nurse Training Reduces Unplanned Interruption of Continuous Renal Replacement Therapy Sessions in Critically Ill Patients: The SimHeR Randomized Controlled Trial
BACKGROUND: Although continuous renal replacement therapy (CRRT) is common, unplanned interruptions (UI) often limit its usefulness. In many units, nurses are responsible for CRRT management. We hypothesized that a nurse training program based on high-fidelity simulation would reduce the rate of interrupted sessions. METHODS: We performed a 2-phase (training and evaluation), randomized, single-center, open study: During the training phase, intensive care unit nurses underwent a 6-hour training program and were randomized to receive (intervention) or not (control) an additional high-fidelity simulation training (6 hours). During the evaluation phase, management of CRRT sessions was randomized to either intervention or control nurses. Sessions were defined as UI if they were interrupted and the interruption was not prescribed in writing more than 3 hours before. RESULTS: Study nurses had experience with hemodialysis, but no experience with CRRT before training. Intervention nurses had higher scores than control nurses on the knowledge tests (grade, median [Q1–Q3], 14 [10.5–15] vs 11 [10–12]/20; P = .044). During a 13-month period, 106 sessions were randomized (n = 53/group) among 50 patients (mean age 70 ± 13 years, mean simplified acute physiology II score 69 [54–96]). Twenty-one sessions were not analyzed (4 were not performed and 17 patients died during sessions). Among the 42 intervention and 43 control sessions analyzed, 25 (59%) and 38 (88%) were labeled as UI (relative risk [95% CI], 0.67 [0.51–0.88]; P = .002). Intervention nurses required help significantly less frequently (0 [0–1] vs 3 [1–4] times/session; P
https://ift.tt/2lxLa5f
https://ift.tt/2lxLa5f
Propofol Attenuates the Myocardial Protection Properties of Desflurane by Modulating Mitochondrial Permeability Transition
BACKGROUND: Desflurane and propofol are cardioprotective, but relative efficacy is unclear. The aim was to compare myocardial protection of single, simultaneous, and serial administration of desflurane and propofol. METHODS: Sixty New Zealand White rabbits and 65 isolated Sprague Dawley rat hearts randomly received desflurane, propofol, simultaneous desflurane and propofol, or sequential desflurane then propofol. Rabbits were subdivided to receive either ischemia-reperfusion with temporary occlusion of the left anterior descending artery or a time-matched, nonischemic perfusion protocol, whereas rat hearts were perfused in a Langendorff model with global ischemia-reperfusion. End points were hemodynamic, functional recovery, and mitochondrial uptake of 3H-2-deoxy-D-glucose as an indicator of mitochondrial permeability transition. RESULTS: In rabbits, there were minimal increases in preload-recruitable stroke-work with propofol(P
https://ift.tt/2lrW2kT
https://ift.tt/2lrW2kT
Electroencephalographic Arousal Patterns Under Dexmedetomidine Sedation
BACKGROUND: The depth of dexmedetomidine-induced sedation is difficult to assess without arousing the patient. We evaluated frontal electroencephalogram (EEG) as an objective measure of dexmedetomidine-induced sedation. Our aims were to characterize the response patterns of EEG during a wide range of dexmedetomidine-induced sedation and to determine which spectral power best correlated with assessed levels of dexmedetomidine-induced sedation. METHODS: Sedline EEG sensor was positioned on the forehead of 16 volunteers. Frontal EEG data were collected at 250 Hz using the Sedline monitor. A computer-controlled infusion pump was used to infuse dexmedetomidine to four 15-minute target plasma concentrations of 0.3, 0.6, 1.2, and 2.4 ng/mL. Arterial blood samples for dexmedetomidine plasma concentration and sedation (self-reported numerical rating scale) and arousal were measured at baseline and at the end of each infusion step. The EEG signal was used to estimate spectral power in sequential 4-second data segments with 75% overlap for 3 power bands: delta = 0.5–1.5 Hz, alpha = 9–14 Hz, beta = 15–24 Hz. We quantified the relationships among the plasma concentrations of dexmedetomidine, level of sedation, and various EEG parameters. RESULTS: EEG data at the end of the dexmedetomidine infusion steps show progressive loss of high frequencies (beta) and increase in alpha and delta powers, with increasing dexmedetomidine concentrations. Beta prearousal spectral power was best in predicting dexmedetomidine-induced level of sedation (R = −0.60, 95% CI, −0.43 to −0.75). The respective values for delta and alpha powers were R = 0.28 (95% CI, 0.03–0.45) and R = 0.16 (95% CI, −0.09 to 0.38). When the beta power has dropped below −16 dB or the delta power is above 15 dB, the subjects show moderate to deep levels of sedation. When awakening the subject, there is a reduction in power in the delta and alpha bands at the 0.6, 1.2, and 2.4 ng/mL dexmedetomidine target levels (P
https://ift.tt/2yAVwun
https://ift.tt/2yAVwun
Spinal Activation of Tropomyosin Receptor Kinase-B Recovers the Impaired Endogenous Analgesia in Neuropathic Pain Rats
BACKGROUND: Although endogenous analgesia plays an important role in controlling pain states, chronic pain patients exhibit decreased endogenous analgesia compared to healthy individuals. In rats, noxious stimulus–induced analgesia (NSIA), which is an indicator of endogenous analgesia, diminished 6 weeks after spinal nerve ligation (SNL6W). A recent study in rats with deleted noradrenergic fibers demonstrated that the noradrenergic fibers were essential to NSIA. It has also been reported that brain-derived neurotrophic factor increased spinal noradrenergic fibers. Therefore, this study examined the effect of TrkB activation, which is the receptor for brain-derived neurotrophic factor, on impaired NSIA in SNL6W rats. In addition, we also examined the effect of endogenous analgesia on acute incisional pain. METHODS: After 5 daily intraperitoneal injections of 7,8-dihydroxyflavone (7,8-DHF, TrkB agonist, 5 mg/kg), NSIA was examined by measuring the withdrawal threshold increment in the left (contralateral to nerve ligation) hindpaw at 30 minutes after capsaicin injection (250 μg) in the forepaw. K252a (TrkB antagonist, 2 μg) was administrated intrathecally for 5 days. Idazoxan (α2 adrenoceptor antagonist, 30 μg), atropine (muscarinic antagonist, 30 μg), and propranolol (nonselective β adrenoceptor antagonist, 30 μg) were administered intrathecally for 15 minutes before capsaicin injection. Microdialysis and immunohistochemistry were performed to examine the noradrenergic plasticity in the spinal dorsal horn. A hindpaw incision was performed on the left (contralateral to nerve ligation) hindpaw. Data were analyzed by 1-way analyses of variance or 2-way repeated-measures 1-way analysis of variance followed by a Student t test with Bonferroni correction. RESULTS: Five daily intraperitoneal injections of 7,8-DHF restored the attenuated NSIA in SNL6W rats (n = 7, P = .002; estimated treatment effect [95% CI]: 62.9 [27.0–98.7] g), with this effect blocked by 5 daily intrathecal coadministrations of K252a (n = 6, P
https://ift.tt/2luOJc6
https://ift.tt/2luOJc6
Driving Under the Influence of Cannabis: A Framework for Future Policy
Marijuana is the most widely consumed illicit substance in the United States, and an increasing number of states have legalized it for both medicinal and recreational purposes. As it becomes more readily available, there will be a concurrent rise in the number of users and, consequently, the number of motor vehicle operators driving under the influence. This article examines the cognitive and psychomotor effects of cannabis, as well as current policy concerning driving under the influence of drugs. The authors performed a MEDLINE search on the epidemiology of cannabis use, its cognitive and psychomotor effects, and policies regarding driving under the influence of drugs. Twenty-eight epidemiological studies, 16 acute cognitive and psychomotor studies, 8 chronic cognitive and psychomotor studies, and pertinent state and federal laws and policies were reviewed. These search results revealed that marijuana use is associated with significant cognitive and psychomotor effects. In addition, the legalization of marijuana varies from state to state, as do the laws pertaining to driving under the influence of drugs. Marijuana is a commonly found illicit substance in motor vehicle operators driving under the influence of drugs. Current evidence shows that blood levels of tetrahydrocannabinol do not correlate well with the level of impairment. In addition, although acute infrequent use of cannabis typically leads to cognitive and psychomotor impairment, this is not consistently the case for chronic heavy use. To establish the framework for driving under the influence of cannabis policy, we must review the current published evidence and examine existing policy at state and federal levels. Accepted for publication May 10, 2018. Funding: This study was partially funded by the Centers for Rehabilitation Sciences Research, US Department of Defense. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Robert M. Chow, MD, Department of Anesthesiology, Yale School of Medicine, 330 Cedar St, TMP-3, New Haven, CT 06520. Address e-mail to Robert.chow@yale.edu. © 2018 International Anesthesia Research Society
https://ift.tt/2tvg0ig
https://ift.tt/2tvg0ig
Incidence of Venous Air Embolism During Endoscopic Retrograde Cholangiopancreatography
BACKGROUND: Known complications of endoscopic retrograde cholangiopancreatography (ERCP) include pancreatitis, bleeding, duodenal perforation, and venous air embolism (VAE). The aim of this study was to determine the incidence of VAE during ERCP and be able to differentiate high-risk versus low-risk ERCP procedures. METHODS: This is a prospective cohort study consisting of patients who underwent ERCP and were monitored with a precordial Doppler ultrasound (PDU) for VAE. PDU monitoring was digitally recorded and analyzed to confirm the suspected VAE. Demographic and clinical data related to the anesthetic care, endoscopic procedure, and intraoperative hemodynamics were analyzed. RESULTS: A total of 843 ERCP procedures were performed over a 15-month period. The incidence of VAE was 2.4% (20 patients). All VAE's occurred during procedures in which stent placement, sphincterotomy, biopsy, duct dilation, gallstone retrieval, cholangioscopy, or necrosectomy occurred. Ten of 20 (50%) of VAEs were associated with hemodynamic alterations. None occurred if the procedure was only diagnostic or for stent removal. Subanalysis for the type of procedure showed that VAE was statistically more frequent when stents were removed and then replaced or if a cholangioscopy was performed. CONCLUSIONS: The high incidence of VAE highlights the need for practitioners to be aware of this potentially serious event. Use of PDU can aid in the detection of VAE during ERCP and should be considered especially during high-risk therapeutic procedures. Detection may allow appropriate interventions before serious adverse events such as cardiovascular collapse occur. Accepted for publication January 19, 2018. Funding: None. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Ayesha S. Bryant, MSPH, MD, Department of Anesthesiology and Perioperative Medicine, University of Alabama at Birmingham, 625 19th St S, JT 880A, Birmingham, AL 35249. Address e-mail to asbryant@uabmc.edu. © 2018 International Anesthesia Research Society
https://ift.tt/2ltc5yL
https://ift.tt/2ltc5yL
Association Between Intraoperative Oliguria and Acute Kidney Injury After Major Noncardiac Surgery
BACKGROUND: Acute kidney injury (AKI) occurs in 6.1%–22.4% of patients undergoing major noncardiac surgery. Previous studies have shown no association between intraoperative urine output and postoperative acute renal failure. However, these studies used various definitions of acute renal failure. We therefore investigated the association between intraoperative oliguria and postoperative AKI defined by the serum creatinine criteria of the Risk, Injury, Failure, Loss, and End-stage kidney disease (RIFLE) classification. METHODS: In this single-center, retrospective, observational study, we screened 26,984 patients undergoing elective or emergency surgery during the period September 1, 2008 to October 31, 2011 at a university hospital. Exclusion criteria were age
https://ift.tt/2lrQkiV
https://ift.tt/2lrQkiV
Superficial femoral artery transection following penetrating trauma
Abstract
We describe a patient who sustained a penetrating injury to the posterior right lower extremity just above the popliteal region with transection of the superficial femoral artery (SFA) despite minimal evidence of active bleeding. An on-table angiogram identified flow in the SFA followed by the popliteal artery and into the trifurcation of the right lower extremity. Eventually, a second operation revealed transection followed by end-to-end anastomosis of SFA and stabilization of the patient. The findings of this case highlight the need for a high index of suspicion and persistent clinical investigation to identify vascular injuries in the absence of hard signs of vascular trauma.https://ift.tt/2tvcQLn
Unusual complication of bladder prolapse with subsequent diagnosis of urothelial carcinoma leading to a necrotizing soft tissue infection after radical cystectomy
Abstract
There is lack of information in the literature on long-term complications of suprapubic catheters. The most common complications include urinary tract infection, bladder calculi, urine leakage and neoplastic changes. We report a case of an unusual complication of bladder prolapse, with subsequent diagnosis of urothelial carcinoma, leading to a necrotizing soft tissue infection after a radical cystectomy in a patient with long-term catheterization and its management. Due to the rarity of this complication, its management has not been well studied. In this particular case, the logical indication was radical cystectomy due to the presence of bladder necrosis.https://ift.tt/2MNZQcB
Comparative efficacy of intralesional triamcinolone acetonide injection during early and static stage of pathological scarring
Journal of Cosmetic Dermatology, EarlyView.
https://ift.tt/2lrJoSV
Both perforin and FasL are required for optimal CD8 T cell control of autoreactive B cells and autoantibody production in parent-into-F1 lupus mice
Source:Clinical Immunology
Author(s): Kateryna Soloviova, Maksym Puliaiev, Roman Puliaev, Irina Puliaeva, Charles S. Via
To test the relative roles of perforin (pfp) vs. FasL in CTL control of autoreactive B cell expansion, we used the parent-into-F1 model of murine graft-vs.–host disease in which donor CD8 CTL prevent lupus like disease by eliminating activated autoreactive B cells. F1 mice receiving either pfp or FasL defective donor T cells exhibited an intermediate short-term phenotype. Pairing of purified normal CD4 T cells with either pfp or FasL defective CD8 T cell subsets resulted in impaired host B cell elimination and mild lupus like disease that was roughly equivalent in the two experimental groups. Thus, in addition to major roles in tumor and intracellular pathogen control, pfp mediated CD8 CTL killing plays a significant role in controlling autoreactive B cell expansion and lupus downregulation that is comparable to that mediated by FasL killing. Importantly, both pathways are required for optimal elimination of activated autoreactive B cells.
https://ift.tt/2IhoX4c
Soluble ST2 suppresses IL-5 production by human basophilic KU812 cells, induced by epithelial cell-derived IL-33
Publication date: Available online 22 June 2018
Source:Allergology International
Author(s): Koji Matsumoto, Hideaki Kouzaki, Hirotaka Kikuoka, Tomohisa Kato, Ichiro Tojima, Shino Shimizu, Takeshi Shimizu
BackgroundEpithelial cell-derived IL-33 has an important role in the initiation and activation of innate allergic inflammation. IL-33 acts as a cytokine through the ST2 receptor (ST2L) and it stimulates the production of Th2 cytokines. Soluble ST2 (sST2) may regulate Th2 responses by neutralizing the activity of IL-33. Basophils express ST2L and produce IL-5 in response to IL-33. However, the role of the epithelial cell–basophil interaction and sST2 in IL-5 production remains unclear.MethodsCultured human bronchial epithelial (hBE33) cells, that contained the human IL-33 gene (i.e., hBE33 cells) and a human basophilic cell line, KU812 cells, were used to study the epithelial cell–basophil interaction in the production of IL-5 induced by HDM.ResultsAt 15 min after incubation, HDM stimulated the rapid release of IL-33 from cultured hBE33 cells. IL-33 and the supernatant of HDM-treated hBE33 cells stimulated IL-5 production from KU812 cells. Anti-IL-33 antibody and anti-ST2 antibody treatment of KU812 cells suppressed IL-5 production, which had been induced by the supernatant of HDM-treated hBE33 cells. The hBE33 cells secreted sST2 in a time-dependent manner. The production of sST2 by KU812 cells co-cultured with hBE33 cells was significantly increased, compared with KU812 cells cultured with the supernatant of hBE33 cells. Soluble ST2 suppressed IL-5 production by KU812 cells, which was induced by the supernatant of HDM-treated hBE33 cells.ConclusionsEpithelial cell-derived IL-33 promoted IL-5 production by KU812 cells. The subsequently produced sST2 has important roles in regulating Th2 responses.
https://ift.tt/2tuZv5P
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