Severe Intraoperative Bronchospasm Treated with a Vibrating-Mesh Nebulizer

Bronchospasm and status asthmaticus are two of the most dreaded complications that a pediatric anesthesiologist may face. With the occurrence of severe bronchospasm and the inability to ventilate, children are particularly vulnerable to apnea and ensuing hypoxia because of their smaller airway size, smaller lung functional residual capacity, and higher oxygen consumption rates than adults. Nebulized medication delivery in intubated children is also more difficult because of smaller endotracheal tube internal diameters. This case demonstrates the potentially lifesaving use of a vibrating-mesh membrane nebulizer connected to the anesthesia circuit for treating bronchospasm.Key Words: Asthma, Bronchospasm, Nasal intubation, Pediatric dental anesthesia, Vibrating-mesh, nebulizerAsthma is an episodic disease characterized by hyperreactive bronchi, chronic airway inflammation, and airflow obstruction during expiration. Bronchospasm is caused by spasmodic contraction of the bronchial smooth muscle. Status asthmaticus is bronchospasm that does not respond to standard treatments, which include intravenous (IV), inhaled, and subcutaneous (SQ) interventions. It is estimated that 9.6 million children in the USA have been diagnosed with asthma. This represents approximately 13% of the total pediatric population.^1,2 The incidence of asthma is higher in urban areas, in children of low socioeconomic status, and in those with a history of atopy.^3,4 The area in which our institution is located (Bronx, New York) has the highest incidence of asthma in New York State.^3,4 The current report presents a case of bronchospasm in a 3-year-old child that was refractory to all usual treatments. A therapy not previously reported as being used in the operating room, a vibrating-mesh membrane nebulizer (Aeroneb Professional Nebulizer [APN] System, AG-AP6000-US, Aerogen Ltd, Ireland), was used to successfully relieve this episode.     

Anti-M3 muscarinic acetylcholine receptor antibodies in patients with Sjögren’s syndrome

Sjögren’s syndrome (SS) is an autoimmune disease that affects exocrine glands including salivary and lacrimal glands. Recently, autoantibodies against muscarinic acetylcholine receptor M3 (M3R) have been detected in serum from 9 to 100 % of patients with SS in addition to anti-SS-A and anti-SS-B antibodies. These observations suggest the possibility that anti-M3R antibodies could serve as a new diagnostic test in patients with SS. Some anti-M3R antibodies are directly responsible for salivary underproduction in patients with SS. Thus, strategies designed to eliminate such pathogenic antibodies could help cure SS sufferers. In this review, we summarize the current state of knowledge of anti-M3R autoantibodies in patients with SS and the correlation between B cell epitopes and the function of anti-M3R antibodies.     

Intrathoracic splenosis: evaluation by superparamagnetic iron oxide-enhanced magnetic resonance imaging and radionuclide scintigraphy

Splenosis represents the heterotopic autotransplantation of splenic tissue after either splenic trauma or surgery. Intrathoracic splenosis is a rare condition resulting from concomitant rupture of the spleen and the left hemidiaphragm. We report a case of splenosis in a 41-year-old male patient who had experienced severe thoracoabdominal injury including rupture of the spleen and left hemidiaphragm and post-traumatic splenectomy 20 years previously. Abnormal opacities in the cardiac region were noted on a chest radiograph at an annual checkup. Computed tomography (CT) of the chest demonstrated multiple, well-circumscribed pleura-based nodules at the posterior base of the left hemithorax and the left subdiaphragmatic area. On magnetic resonance imaging (MRI), the lesions were hypointense on T1-weighted images and hyperintense on T2-weighted images. After administration of superparamagnetic iron oxide (SPIO), the lesions showed decreased signal intensity but remained slightly hyperintense relative to liver parenchyma on T2-weighted images. ^99mTc-labeled Sn colloid scintigraphy revealed multiple areas of increased activity consistent with the lesions on the CT and MRI scans. In addition to the history of splenic trauma and left hemothorax, SPIO-enhanced MRI and radionuclide scintigraphy, which can demonstrate phagocytic ability in the ectopic splenic tissue, were useful for confirming the diagnosis.     

Migraine and stroke: the role of oral contraceptives

The use of oral contraceptives (OCs) confers an increased risk for ischaemic stroke (IS). This risk slightly decreases, but remains significant, if low-dose formulations are used, particularly if other risk factors, such as hypertension or smoking, are associated. Some inherited prothrombotic conditions (e.g., Factor V Leiden, G20210A prothrombin or methylenetetrahydrofolate reductase C677T polymorphism) could also greatly increase the IS risk if present in OC users. Migraine, particularly with aura, is an independent risk factor for IS, and the patient’s IS risk is probably affected by other individual risk factors (e.g., age, genetic predisposition to thrombosis, presence of patent foramen ovale or enhanced platelet aggregation) which seem to be over-represented in migraine patients. IS risk among migraineurs is further increased when OCs are currently used and can become very high if associated with smoking. Consequently, in 2004 the WHO stated in its ‘Medical Eligibility Criteria for Contraceptive Use’ that women suffering from migraine with aura at any age should never use OCs. Moreover, since the exposure to the effects of OCs may greatly increase the IS risk in some migraine subpopulations with specific personal characteristic, testing for these risk factors may allow for more accurate stratification of the population at risk before long-term use of OCs is prescribed.     

Central angiotensin III-induced dipsogenicity in rats and gerbils

Under normal visual stimulation, simultaneous recording from ganglion cells in the retina and from the axons of these cells in the brain revealed activity-dependent differences in the velocity of impulse propagation. In frog ganglion cells, spikes initiated 5-500 ms after a previous impulse showed supernormal increases in conduction velocity of up to 17%; spikes initiated 500-2000 ms after a previous one traveled more slowly than a spike initiated after a long period of rest. Cat ganglion cell impulses showed much smaller supernormality (maximum 3%), but exhibited pronounced slowing due to refractoriness and long-term fatigue associated with their high levels of spontaneous activity.     

Scheimpflug biometry of the anterior segment after implantation of foldable iris-fixated lenses

PURPOSE: To evaluate intraocular dimensions of the anterior segment of myopic phakic eyes after implantation of foldable iris-fixated lenses. METHODS: Seventeen myopic eyes that received a foldable iris-fixated phakic intraocular lens (PIOL) were assessed. Distances between the cornea and the IOL-optic edge and between the IOL optic and the crystalline lens were evaluated using Scheimpflug photography 3 months postoperatively. RESULTS: The average postoperative distance between the central corneal endothelium and the anterior surface of the IOL was 2.01 +/- 0.26 mm. The distance between the corneal endothelium and the peripheral edge of the IOL averaged 1.32 +/- 0.18 mm at the 12 o'clock position and 1.34 +/- 0.21 mm at the 6 o'clock position. The distance between the crystalline lens and the posterior surface of the IOL averaged 0.73 +/- 0.09 mm. CONCLUSIONS: The high quality of the three-dimensional Scheimpflug images allowed measurements of intraocular distances in PIOL implanted eyes. Distances between the foldable iris-fixated IOL and crucial surrounding tissues could be determined 3 months postoperatively.     

Oral contraceptives in women with migraine: balancing risks and benefits

Neurological Sciences - Oral contraceptives (OCs) are a safe and highly effective method of birth control, but can also be associated with some risks, mainly a potential thrombotic risk. OCs may...     

Characterization of rabbit polyclonal sera against recombinant Shiga toxin and its subunits for detection of Stx-producing E. coli

Shiga toxin (Stx) is the principal virulence factor of Shigatoxigenic Escherichia coli (STEC), a food-born pathogen associated disease with uncomplicated diarrhea or the hemolytic-uremic syndrome. In this study, rabbit polyclonal anti recombinant A, B subunits of Shiga toxin and holotoxin antisera were raised and employed for immunological purpose. By immunoblotting, these antisera recognized respective subunit and the holotoxin antiserum recognized both subunits, equally. The raised antisera could also neutralize the cytotoxicity of the shiga toxin on vero cells. The neutralizing ability of the prepared sera was compared for different subunits. The neutralization of toxicity was observed by incubation of raised sera with the rStx or Shiga toxin from wild type strains. The inhibition of cell toxicity was shown by anti-A, anit-B and anti-AB antisera, separately. It was shown that anti-A antibody, more significantly recognized Stx producing strains, comparing to anti-B antibody. These sera from immunized rabbits were also used as specific antibodies in Enzyme-Linked Immunosorbant Assay (ELISA) for detection of Shiga toxin. It was demonstrated that the raised antibodies especially antibody against A subunit could be a useful tool for immunological diagnosis of STEC induced infection.