Intraoperative anaphylaxis to latex

This case report describes intraoperative anaphylaxis occurring in a fourteen-year-old female with spina bifida in which latex surgical gloves were incriminated as the aetiologic agent. The patient was non-atopic but since eight years of age she had developed localized angioedema and urticarial skin reactions on exposure to rubber. She had previously undergone several uneventful surgical procedures. Forty-five minutes following induction of anaesthesia and during laparotomy for elective cholecystectomy she experienced sudden onset of increased airway pressure, oxygen desaturation, tachycardia, profound hypotension and erythema consistent with an anaphylactic reaction. Resuscitation with manual ventilation and oxygen, intravenous fluids and an epinephrine infusion was successful. Subsequent investigations for allergies demonstrated a strongly positive skin prick test and RAST to latex antigen, with negative results to anaesthetic agents, antibiotics and inhalant allergens. During two later operations prophylaxis consisting of diphenhydramine, ranitidine and hydrocortisone appeared to prevent further reactions. Latex should be considered as a cause of life-threatening intraoperative allergic reactions in patients with a history of rubber allergy or frequent exposure to latex products.     

Differential roles of neurokinin 1 and neurokinin 2 receptors in the development and maintenance of heat hyperalgesia induced by acute inflammation

1. Following induction of acute inflammation by intraarticular injection of kaolin and carrageenan into the knee joint in rats, there was a significant decrease in the withdrawal latency to radiant heat applied to the paw (i.e. heat hyperalgesia), an increased joint circumference and increased joint temperature.
2. A neurokinin₁ (NK₁) receptor antagonist (CP-99,994, 10 mM) had no effect on the paw withdrawal latency when it was administered spinally through a microdialysis fibre before the induction of inflammation. Pretreatment with a NK₂ receptor antagonist (SR48968, 1 mM) administered spinally through the microdialysis fibre prevented the heat hyperalgesia from developing in the early stages of the inflammation.
3. Post-treatment through the microdialysis fibre with the NK₁ receptor antagonist (0.0110 mM) was effective in reversing the heat hyperalgesia. In contrast, post-treatment spinally with the NK₂ receptor antagonist (0.011 mM) had no effect on the heat hyperalgesia. The inactive stereoisomers of the NK₁ receptor antagonist, CP100,263, or the NK₂ receptor antagonist, SR48965, administered at the same doses, had no effect on the joint inflammation or the heat hyperalgesia.
4. Pretreatment systemically with the NK₁ receptor antagonist (30 mg kg⁻¹) had no effect on the heat hyperalgesia or pain-related behaviour ratings where 0 is none and 5 is non weight bearing and complete avoidance of limb contact. Pretreatment with a NK₂ receptor antagonist (10 mg kg⁻¹) systemically prevented the heat hyperalgesia and pain-related behaviour ratings from developing in the early stages of the inflammation. The inactive stereoisomers of NK₁ receptor antagonist, CP100,263, or the NK₂ receptor antagonist, SR48965, administered at the same doses, had no effect on the joint inflammation or the heat hyperalgesia.
5. Post-treatment systemically with either the NK₁ (0.130 mg kg⁻¹) or the NK₂ (0.110 mg kg⁻¹) receptor antagonist resulted in a dose-dependent reversal of the heat hyperalgesia. Pain-related behaviour ratings were reduced by post-treatment only with the NK₁ receptor antagonist. The inactive stereoisomers of the NK₁ receptor antagonist, CP100,263, or the NK₂ receptor antagonist, SR48965, administered at the same doses, had no effect on the behavioural responses.
6. Direct pretreatment of the knee joint with either the NK₁ (30 mg) or the NK₂ (10 mg) receptor antagonist prevented the heat hyperalgesia from developing without affecting joint swelling. The inactive stereoisomers of the NK₁ receptor antagonist, CP100,263, or the NK₂ receptor antagonist, SR48965, administered at the same doses, had no effect on the joint inflammation or the heat hyperalgesia.
7. There appears to be a differential role for the spinal tachykinin receptors in the development and maintenance of the heat hyperalgesia associated with acute joint inflammation. The NK₂ receptors appear to be activated early in the development of the heat hyperalgesia and NK₁ receptors are involved in the maintenance of the heat hyperalgesia.
8. Peripherally, both NK₁ and NK₂ receptors are involved in the development of heat hyperalgesia and pain-related behaviour ratings induced by acute inflammation.

     

Modulation of retinal pigment epithelial cell behavior by Agaricus bisporus lectin.

PURPOSE: To determine whether Agaricus bisporus lectin (ABL) binds retinal pigment epithelial cells (RPEs), to conduct a preliminary viability study of RPEs exposed to ABL, and to evaluate the effects of ABL on RPE proliferation and RPE-mediated matrix contraction in vitro. METHODS: Using cultured bovine RPEs, immunohistochemistry was used to study ABL binding. Morphologic and trypan blue exclusion techniques were used for toxicity studies. The effect of ABL on RPE proliferation was investigated by [methyl-3H]-thymidine incorporation. The effect of ABL on RPE-mediated matrix contraction was evaluated with RPE-populated three-dimensional collagen matrices. RESULTS: ABL bound to RPE cells. This binding was inhibited by asialomucin. No change in RPE morphology or trypan blue exclusion compared with controls was observed in RPEs incubated with 5 to 60 microg/ml ABL for 3 days. Twenty-four-hour incubations of RPEs with ABL significantly inhibited RPE proliferation in a dose-dependent way, 40 microg/ml ABL inhibited proliferation by 83% (SE 14, P<0.05). ABL showed a dose-dependent significant inhibition of RPE-mediated collagen matrix contraction over 3 days, with 93% inhibition compared with controls by 40 microg/ml lectin (P<0.05). The inhibitory effect of ABL on proliferation and gel contraction was partly reversible after eliminating ABL from the culture medium. CONCLUSIONS: Bovine RPE cells bind ABL, and preliminary evaluations suggest that levels of ABL that are nontoxic to the cells potently inhibit RPE proliferation and RPE-mediated matrix contraction. ABL deserves further investigation as a potential inhibitor of RPE proliferation and cell-mediated matrix contraction in anomalous reparative processes such as proliferative vitreoretinopathy and as a laboratory tool for RPE behavioral studies.     

Razabrasion: An alternative approach to perioral rhytides

Persistence of perioral rhytides is a frequent source of patient concern following standard rhytidectomy. Dissatisfaction with the limited results and occasional complications that result from mechanical, manual, and chemical abrasive methods of management prompted application of the steel blade dermal shave technique to this problem. Manual oscillation of a sterile commercial razor blade with depth and width controlled by digital pressure eradicates all but the deepest perioral wrinkles. Eleven patients have undergone razabrasion within the past 19 months without complication. Local anesthesia is sufficient. Topographically distant but synchronous facial operations may be performed safely, but undermining of the shaved facial skin should be avoided for 6 months after razabrasion. Later results will be studied to define the longevity of the effect, but we are encouraged that the method offers the most gentle, most rapid, and best controlled (as to level of dermal shave) current method of tangential dermal splitting. The paper describes the technique of razabrasion of perioral rhytides and reports our early results.     

Screening for hypertension

A strategy for the control of hypertension in communities is presented as a staged program. Stage I consists of the evaluation and improvement of hypertension management in health care facilities. State II entails case-finding in health care facilities. Finally, Stage III involves targeted screening in the community. While isolated screening programs have been justly labeled irrational, such a sequential strategy represents a highly rational approach to the community control of hypertension.Dr. Gillum is with the Laboratory of Physiological Hygiene, University of Minnesota School of Public Health, Minneapolis, Minnesota 55455. Dr. Stason is with the Center for the Analysis of Health Practices, Harvard School of Public Health, Boston, Massachusetts 02115. Dr. Weinstein is with the John F. Kennedy School of Government, Harvard University, Cambridge, Massachusetts 02138. This work was supported in part by grant F32HL5018 from the National Institutes of Health. The Hypertension Screening Group of the 1974–75 Harvard School of Public Health Faculty Seminar on the Analysis of Health and Medical Practices provided an ongoing forum for the development of this work.     

The clinical utility of provocative radionuclide oesophageal transit in the evaluation of non-cardiac chest pain

We combined edrophonium provocative testing with the technique of radionuclide oesophageal transit (RET) in 30 consecutive patients with non-cardiac chest pain (NCCP) and 12 controls. The oesophageal transit time of aqueous technetium-99m sulfur colloid was determined before and after intravenous infusion of 80 g/kg edrophonium chloride (ED). Patient symptoms during provocative RET (P-RET) were recorded. Thirteen (43%) of the patients had abnormal study results, whereas all control subjects had normal results. Three groups considered abnormal were observed: (a) in two patients (6%), the pain was reproduced and transit pre- and post-ED administration was prolonged (>15 s); (b) in six patients (20%), the pain was reproduced, but transit was normal pre- and post-ED; (c) in five patients (17%), transit pre- and post-ED was prolonged, but no pain was reproduced. In five patients (17%), ED prolonged the transit time > 15 s without pain, but the baseline transit was normal. Transit time was measurable in 23 patients. Mean pre-ED transit time was 10.2 ± 7.4 s (mean ± SD) and post-ED, 12.4 ± 8.0 s (P=0.3). We conclude that ED has no significant effect on transit time, and the pain induced by ED rarely correlates with an abnormal transit; P-RET provides additional information to baseline RET, increasing sensitivity, and may be a useful screening method in the evaluation of patients with NCCP.     

The outcome of behavior therapy for agoraphobia in relation to marital adjustment.

After intensively treating 18 agoraphobic patients with 13 1/2 hours of exposure in vivo, we examined the effects on both patients and their spouses over a period of six months, using questionnaire measures of symptoms and marital adjustment. Those patients whose marriages were rated as unsatisfactory before treatment improved less during treatment, and were significantly more likely to relapse during follow-up, than those patients with satisfactory marriages. The marriages of nine patients appeared to be adversely influenced by their symptomatic improvement, and two distinct types of marital interaction were observed in relation to this. In one pattern, the patients' symptoms appeared to strengthen aspects of largely affectionless "compulsory" marriages; in the other, the patients' symptoms appeared to protect their spouses from recognizing or examining aspects of their own personal and interpersonal problems.     

Contrast sensitivity through hybrid diffractive, Fresnel, and refractive prisms.

BACKGROUND: Fresnel and wedge-shaped refractive prisms are used diagnostically and therapeutically in clinical practice. This article extends the study on the effect of prisms on visual acuity to the effect on contrast sensitivity by membrane Fresnel (F), refractive (R), and newly designed hybrid diffractive (C) prisms (ComPrisms), which combine a wedge-shaped refractive prism with a diffractive element. METHODS: Vistech contrast sensitivity function (CSF) Charts A, B, and C were used to measure the monocular and binocular contrast sensitivity of 21 and 20 subjects, respectively. CSF was measured without prisms (U), through the hybrid diffractive prisms, membrane Fresnel prisms, and acrylic refractive prisms in powers of 20delta, 30delta, and 40delta. RESULTS: Repeated measures analysis of variance calculations resulted in significant main effects in contrast sensitivity across prism types, prism powers, and between monocular and binocular measurements. Results of the Scheffé test for all possible contrast sensitivity comparisons between spatial frequencies are provided. It was found that as prism power increased from 20delta to 40delta, the rate of reduction in area under the CSF curve of ComPrisms became half that of the refractive and Fresnel prisms. CONCLUSIONS: Although all three prism types reduced contrast sensitivity with respect to the unaided condition, the ComPrisms at all powers provided significantly better contrast sensitivity than the refractive or Fresnel prisms of equivalent power. Significant binocular summations in contrast sensitivity were found without prisms and across all prism types and powers.