Cardiac arrest during sulprostone administration – a case report

Sulprostone, a synthetic prostaglandin analogue with potent uterotonic action, has been shown to have a low complication rate in a large series. We present a case of cardiac arrest in a parturient after Caesarean section during continuous infusion of intravenous sulprostone administered for atonic post‐partum haemorrhage. She had cardiopulmonary resuscitation for 25 min before spontaneous circulation returned. The sequence of events, the results of investigations carried out during the intensive care unit stay, and the presence of multiple cardiovascular risk factors, suggest that sulprostone caused coronary spasm, bradycardia, and subsequent asystole, similar to other cases described in the literature.     

Intra‐operative monitoring – many alarms with minor impact

Alarms are key components of peri‐operative monitoring devices, but a high false‐alarm rate may lead to desensitisation and neglect. The objective of this study was to quantify the number of alarms and assess the value of these alarms during moderate‐risk surgery. For this purpose, we analysed documentation of anaesthesia workstations during 38 surgical procedures. Alarms were classified on technical validity and clinical relevance. The median (IQR [range]) alarm density per procedure was 20.8 (14.5–34.2 [3.7–85.6]) alarms.h^?1 (1 alarm every 2.9 min) and increased during induction and emergence of anaesthesia, with up to one alarm per 0.99 min during these periods (p < 0.001). Sixty‐four per cent of all alarms were clinically irrelevant, whereas 5% of all alarms required immediate intervention. The positive predictive value of an alarm during induction and emergence was 20% (95% CI 16–24%) and 11% (95% CI 8–14%), respectively. This study shows that peri‐operative alarms are frequently irrelevant, with a low predictive value for an emerging event requiring clinical intervention.     

Testicular resistive index determined by Doppler ultrasonography in men with spinal cord injury – a case series

In this case series, the testicular resistive index was determined in men with spinal cord injury. In ten men participating in our fertility programme, the peak systolic and end‐diastolic velocity of centripetal testicular arteries was measured in triplicates by Doppler ultrasonography to calculate the testicular resistive index. Furthermore, the right and left testicular volume was determined by ultrasonography, blood samples were obtained for hormonal evaluation, and sperm analysis was performed according to the WHO guidelines. The median testicular resistive index measured 0.69 and was significantly (P < 0.001) greater than the reported cut‐off value of 0.6. The spermiograms were characterised by normal sperm count but decreased sperm motility and plasma membrane integrity. The median right and left testicular volume was significantly (P < 0.01) smaller compared to the volumes measured in able‐bodied adult males without scrotal pathology and measured 8.4 ml and 7.2 ml respectively. There was a significant (P = 0.005) correlation (r_s = 0.81) between testicular resistive index and sperm concentration. However, no correlations were observed between testicular resistive index and other variables. The testicular resistive index in men with spinal cord injury was significantly greater than 0.6. Measuring the testicular resistive index may represent a useful additional parameter in the assessment of infertility in spinal cord‐injured men.     

Detection of Schmallenberg virus in different Culicoides spp. by real‐time RT‐PCR

To identify possible vectors of Schmallenberg virus (SBV), we tested pools containing heads of biting midges (Culicoides) that were caught during the summer and early autumn of 2011 at several places in Belgium by real‐time RT‐PCR. Pools of heads originating from following species: C. obsoletus complex, C. dewulfi and C. chiopterus were found positive, strongly indicating that these species are relevant vectors for SBV.     

Comparative oxidative stability of α‐tocopherol blended and diffused UHMWPEs at 3 years of real‐time aging

Vitamin E (α‐tocopherol) is a free‐radical stabilizing antioxidant used to maintain oxidative stability in radiation cross‐linked ultra‐high molecular weight polyethylene (UHMWPE) used in total joint replacements. We investigated the oxidative resistance of vitamin E‐stabilized UHMWPE in (i) postirradiation vitamin E‐diffused UHMWPE, (ii) vitamin E blended and irradiated UHMWPE, and (iii) unstabilized, irradiated UHMWPE after accelerated aging and real‐time aging in an aqueous environment at 40°C for 36 months. Unstabilized samples exhibited substantial oxidation throughout the surface and bulk with both types of aging. While vitamin E‐stabilized, radiation cross‐linked UHMWPEs were all superior to unstabilized samples, irradiated blends showed surface oxidation and subsurface oxidation potential beginning at ten months in real‐time aging. In contrast, postirradiation vitamin E‐diffused UHMWPEs showed no detectable oxidation and no increase in oxidation potential despite elution of some vitamin E. We also showed that current thermal accelerated aging methods were unable to differentiate among the oxidative stability of vitamin E‐stabilized, radiation cross‐linked UHMWPEs prepared by different processes. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 29:773–780, 2011     

Some questions raised by histologic study of RTOG protocols 75–06 and 77–06 as illustrated by selected samples

Histologic study of about 700 biopsy specimens from patients with prostate cancers collected by the Radiation Therapy Oncology Group (RTOG) reemphasized the difficulty in accurately predicting biologic behavior of the carcinoma in individual cases. Some well-differentiated carcinomas metastasized to regional lymph nodes. Histologic proof of lymph node metastases may be difficult to detect. Some duct carcinomas do not readily fit a Gleason pattern. A variety of histologic grades may be seen either in a single sample or after the passage of time in the same case. Some prostatic epithelial proliferations may closely simulate carcinomas by routine light microscopy, but are biologically benign. Some of these prostate lesions have histologic similarities to breast lesions.     

Development of a real‐time loop‐mediated isothermal amplification assay for detection of Burkholderia mallei

Burkholderia mallei is the aetiological agent of glanders, a highly contagious and re‐emerging zoonotic disease. Early diagnosis of glanders is critically important to ensure timely treatment with appropriate antibiotics in humans, and to prevent spread of infection in animals. Molecular detection of B. mallei has always been troublesome because of its genetic similarity with Burkholderia pseudomallei, the causative agent of melioidosis. In present investigation, a set of six B. mallei ‐specific primers were designed and a simple, rapid, specific and sensitive real‐time loop‐mediated isothermal amplification (LAMP ) assay was developed for detection of B. mallei . The LAMP assay could detect as low as 1 pg of B. mallei genomic DNA and 5.5 × 10³ CFU/ml of B. mallei in spiked human blood. The assay was highly specific for B. mallei as it did not cross‐react with other bacterial strains used in the study. The established LAMP assay is field adaptable and can be a better and viable alternative to PCR ‐based techniques for detection of B. mallei in glanders endemic areas with resource‐limited settings.     

Intra‐operative cardiac arrests during liver transplantation – a retrospective review of the first 15 yr in Asian population

Although many report intra‐operative cardiac arrests (ICAs) in liver transplantation (LT), the incidence, major causes, and outcome remain unclear. We aimed to investigate retrospectively, the incidence, nature, and outcome of ICA in Asian population and to identify risk factors for ICA. Consecutive 1071 LTs in an institution during 1996–2011 (adult 920, pediatric 151/living donor liver transplantation, LDLT 841, deceased donor liver transplantation, DDLT 230) were reviewed. ICA occurred in 14 adult LTs (1.5%), but none in pediatrics. ICA occurred 1.0% and 3.3% in LDLT and DDLT, respectively. Stages of ICA incidence were three at pre‐anhepatic, one at anhepatic, and 10 at neohepatic stage. Post‐reperfusion syndrome (PRS) with hyperkalemia and bleeding were the major causes of ICA. While LDLT showed miscellaneous causes for ICA at various stages, DDLT incurred ICAs at neohepatic stage only. Interestingly, we did not find pulmonary thromboembolism (PTE) to incur ICA. Risk factor analysis showed no association of pre‐operative patient condition, donor types, and intra‐operative parameters. In this review, the incidence of ICA was low in Asian population with LDLT predominance, and while PTE was not the cause of ICA, the neohepatic stage with PRS and bleeding was the most vulnerable period to anticipate ICA.