Delayed adverse reaction to sodium ioxaglic acid-meglumine

A patient had a maculopapular rash, fever, hepatic cytolysis, rhabdomyolysis, eosinophilia and raised total IgEs after coronarography with ioxaglic acid-meglumine (Hexabrix). Intradermal test to ioxaglic acid-meglumine was positive 48 hrs later. Histological examination revealed perivascular lymphocytic infiltration, with predominantly CD45Ro+ and CD8+ T cells and apoptotic basal keratinocytes. This case documents a late hypersensitivity reaction to ioxaglic acid-meglumine.     

Adverse reactions to intravenous agents in anaesthesia in France

Summary One hundred severe peranesthetic accidents occuring in hospitals in the eastern part of France were tested between 1975 and 1980 at the Immunological Unit of the University Hospital in Nancy. Tests were carried out a posteriori; mean time: three weeks after the accident (extremes: one week to one year). A second battery of tests was carried out in 35%, and a third one in 8% of the patients.Anaphylaxis was differentiated from anaphylactoid reactions be means of the tests. Responsible drugs were determined by intradermal testing, by the human basophil degranulation test and P.K. tests.Predisposing factors were studied: atopy (IgE dosage), increase of histamine release (intradermal testing with 48/80), abnormal receptivity to histamine (intradermal histamine), spasmophilia (electromyography recordings).The results show that 42 accidents were due to true anaphylaxis (one of them due to IgG); 48% of the reported accidents were due to succinylcholine. Some of the predisposing factors, in the tested population, are found in a higher proportion than in the French population as a whole; atopy, hypersensitivity to histamine, previous drug allergy, spasmophilia.     

Contrast-enhanced ultrasound versus CT and operative findings in evaluation of renal vein aneurysm with AV fistula

We report the case of a 61-year-old patient admitted to our hospital owing to recent nonspecific abdominal pain. Five years earlier he had been treated with a graft owing to thoracic and abdominal aortic aneurysm with dissection. He now showed a left renal vein aneurysm with a diameter of 11x7.5 cm. This case demonstrates that contrast enhanced ultrasound (CEUS), employed in addition to computed tomography angiography, offers a promising new option for diagnosis and preoperative treatment planning in patients with abdominal vascular diseases. The results were compared with operative findings.     

Anaphylaxis due to succinylcholine. Immunoallergological study of thirteen cases

The antigen non-specific release of histamine by synthetic neuromuscular blocking agents is well known, though our review of thirty-two cases reported in the literature of anaphylactoid reactions to succinylcholine, shows that there is insufficient evidence to determine whether the signs are due to anaphylactic or to anaphylactoid reactions. We have examined thirteen cases in whom evidence of anaphylactic sensitization was examined by direct skin tests (in eleven cases) Prausnitz--Küstner tests (in five), rabbit basophil degranulation, Shelley test (in twelve) and human basophil degranulation (in seven). These tests were done on two to four occasions, and the optimal period for the first test ascertained to be 6 to 12 weeks after the episode. All eleven patients examined by direct skin tests showed evidence of anaphylactic sensitivity, and in three of five cases the sensitivity could be transferred by the Prausnitz--Küstner procedure. In one of these P--K tests there was evidence of both IgE and of IgG S-TS antibodies (heat-stable antibody conferring sensitivity for 2 hr). Particular susceptibilities to adverse reactions of this drug appear to be prior drug allergy (in 50% of cases), several previous anaesthetics, and atopy.     

Intramuscular haemangioma of the extensor pollicis brevis muscle with periosteal reaction of the radius: a case report and review of the literature

We report the rare case of a histologically proven mixed-type intramuscular haemangioma, adjacent to the periosteum of the radius, that caused a periosteal reaction. We also carried out a review of the literature relevant to this case. A 28-year-old male professional drummer presented with an 8-month history of pain and swelling of the dorsal aspect of the right radius. Diagnosis was established on the basis of plain radiographs and magnetic resonance imaging, and was confirmed by histology. The lesion was treated solely by resection of the soft-tissue mass. The patient remained asymptomatic 4 years post-operatively, with no radiographic signs of recurrence. From a review of the literature, it is evident that the terminology for haemangiomas causing regional bone changes is unclear. A new classification of the intramuscular haemangiomas is proposed in order to distinguish between lesions that, according to current knowledge, exhibit radiological and clinical areas of overlap.