Acute hypoxemia in a parturient with primary ciliary dyskinesia following the administration of intravenous oxytocin: a case report

Purpose

We present the case of a parturient diagnosed with primary ciliary dyskinesia with secondary bronchiectasis who developed significant hypoxemia following administration of intravenous oxytocin during Cesarean delivery under spinal anesthesia. This case suggests that oxytocin can affect pulmonary vascular tone and interfere with the protective effects of hypoxic vasoconstriction.

Clinical features

A 35-yr-old primigravida at 37 weeks gestation presented for a scheduled Cesarean delivery due to breech positioning and fetal abnormalities. The patient had a diagnosis of primary ciliary dyskinesia and had undergone a right middle lobectomy seven years earlier for resultant bronchiectasis. Pulmonary function testing in the month prior to delivery showed a 4% decline in her baseline FEV₁ to 1.06 L (32% of predicted value) but she was functionally well. The patient initially had an uneventful spinal anesthetic and maintained an oxygen saturation of 97% on room air in the supine position until delivery of her baby. An intravenous infusion of oxytocin for uterine contraction was started following removal of the placenta. The patient then became acutely hypoxemic with a drop in room air saturation to 84% but with no other accompanying hemodynamic instability. Maternal oxygen saturation did not improve with the addition of supplemental oxygen, and the patient had a significant arterial-alveolar oxygen gradient suggesting an intrapulmonary shunt. No supporting clinical, radiologic, or laboratory evidence of a thrombotic, air, or amniotic fluid embolism or mucous plug was detected. The patient remained hypoxemic during the postoperative period with gradual improvement back to baseline saturation in approximately 48 hr.

Conclusion

The vasodilatory effects of intravenous oxytocin on the pulmonary vasculature may worsen shunting and interfere with hypoxic pulmonary vasoconstriction, producing clinically significant hypoxemia in patients with comorbid lung disease. Oxytocin should be used with caution in patients with compromised lung function.     

Safety and Efficacy of Non-Cemented Femoral Fixation in Patients 75 Years of Age and Older

The aim of this study was to assess peri-operative complications, safety and efficacy of non-cemented femoral fixation in total hip arthroplasty (THA) as compared to cemented femoral fixation in the elderly population. Fifty-two matched pair analysis of patients with 75 years of age and older (104 patients), who underwent primary THA from June 1997 to December 2004, was performed based on age, sex, BMI, and Charnley classification. Mean age was 81 years (75–101) and the average follow up was 3.1 ± 2.9 years (1.2–6.4). There was no difference in peri-operative cardiopulmonary complications, pulmonary failures, deep venous thrombosis, pulmonary embolus, length of stay, or discharge deposition between the two groups. Non-cemented fixation is safe and effective in patients older than 75 years of age.     

Extracorporeal membrane oxygenation in burn and smoke inhalation injury

A systematic review and meta-analysis was conducted to assess the level of evidence for the use of extracorporeal membrane oxygenation (ECMO) in hypoxemic respiratory failure resulting from burn and smoke inhalation injury. We searched any article published before March 01, 2012. Available studies published in any language were included. Five authors rated each article and assessed the methodological quality of studies using the recommendation of the Oxford Centre for Evidence Based Medicine (OCEBM). Our search yielded 66 total citations but only 29 met the inclusion criteria of burn and/or smoke inhalation injury. There are no available systematic reviews/meta-analyses published that met our inclusion criteria. Only a small number of clinical trials, all with a limited number of patients, were available. The overall data suggests that there is no improvement in survival for burn patients suffering acute hypoxemic respiratory failure, with the use of ECMO. ECMO run times of less than 200 h correlate with higher survival compared to 200 h or more. Scald burns show a tendency of higher survival than flame burns.     

Can Bronchoscopic Airway Anatomy Be an Indicator of Autism?

Bronchoscopic evaluations revealed that some children have double branching of bronchi (designated “doublets”) in the lower lungs airways, rather than normal, single branching. Retrospective analyses revealed only one commonality in them: all subjects with doublets also had autism or autism spectrum disorder (ASD). That is, 49 subjects exhibited the presence of initial normal anatomy in upper airway followed by doublets in the lower airway. In contrast, the normal branching pattern was noted in all the remaining 410 subjects who did not have a diagnosis of autism/ASD. We propose that the presence of doublets might be an objective, reliable, and valid biologic marker of autism/ASD.     

Morphology and performance relationship studies on biodegradable ternary blends of poly(3-hydroxybutyrate-co-3-hydroxyvalerate), polylactic acid,and polypropylene carbonate

A biodegradable ternary blend fabricated from polylactic acid (PLA), poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV) and polypropylene carbonate (PPC) with a good balance of stiffness and toughness via optimizing the composition ratio and morphological structure is, to the best of the authors'' knowledge, reported here for the first time. The optimal blend formulation is comprised of 20% PLA, 40% PHBV, and 40% PPC, which possesses a tensile strength measuring 44 MPa and an elongation at break measuring at 215%. Thermal performance analysis revealed an HDT value of 72 °C. The Harkins equation predicts that the three immiscible polymers formed a complete wetting morphology, which was confirmed by scanning electrical microscopy. As the PPC content of the ternary blends is increased, the material undergoes morphological transition from droplet to co-continuous structure, resulting in significant improvement of elongation at break (approximately 40 times higher than that of the PLA–PHBV binary blend). Excellent stiffness and over 200% elongation at break make these sustainable ternary blends feasible for use in packaging as substitutes for certain non-biodegradable petroleum-based single use plastics.

Morphological arrangement leads to biodegradable stiffness–toughness–HDT balanced ternary blends.     

Gender and Racial Disparity among Addiction Psychiatry Fellows in the United States

Psychiatric Quarterly - The United States (US) has a culturally diverse population. However, the percentage of underrepresented minorities (URMs) and women in healthcare does not fully reflect...     

Understanding the cognitive impact on children who are treated for medulloblastoma

OBJECTIVE: Risk-adapted treatment approaches employed within contemporary medulloblastoma treatment protocols aim to reduce the neurotoxicity directed at the central nervous system. Despite these important steps to reduce radiation dose exposure, an overwhelming majority of medulloblastoma survivors continue to experience academic failure and significant learning delays. METHODS: A review of the current literature is presented. RESULTS: Deficits in intellectual function, academic achievement, memory, attention, and processing speed are reported. Finally, intervention programs, including pharmacotherapy and experimental cognitive intervention studies, are discussed. A review of neuroimaging studies shows changes in brain tissue following chemotherapy and radiation treatment. CONCLUSIONS: Declining IQ and academic struggles may be predated by difficulties with attention, memory, and processing speed. More clinical trials directed at treating and preventing neurocognitive late effects through cognitive rehabilitation are needed.