Anaesthetic and perioperative management of paediatric organ recipients in nontransplant surgery

The number and success rate of paediatric organ transplantation continue to improve yearly, and the number of transplanted children presenting for either elective or emergency nontransplant surgery is expected to increase accordingly. The general considerations related to any transplant recipient are the physiological and pharmacological problems of allograft denervation, the side effects of immunosuppression, the risk of infection, and the potential for rejection. Preoperative assessment of transplant recipients undergoing non-transplant surgery should focus on graft function, the risk of infection, and function of other organs. Local, regional, or general anaesthesia can be safely delivered to transplant recipients. Specific anaesthetic considerations related to the type of transplantation, have an impact directly on anaesthetic and perioperative management. Since anaesthetists and surgeons in hospitals who are not involved in transplantations, may be required to manage paediatric transplant recipients, the reviews of the existing experience in this field will be valuable tools in their hands.     

Inhibition of adrenal cortical steroid formation by procaine is mediated by reduction of the cAMP-induced 3-hydroxy-3-methylglutaryl-coenzyme A reductase messenger ribonucleic acid levels

Elevated glucocorticoid levels are associated with many diseases, including age-related depression, hypertension, Alzheimer's disease, and acquired immunodeficiency syndrome. Cortisol-lowering agents could provide useful complementary therapy for these disorders. We examined the effect of procaine and procaine in a pharmaceutical formulation on adrenal cortical steroid formation. Procaine inhibited dibutyryl cyclic AMP (dbcAMP)-induced corticosteroid synthesis by murine Y1 and human H295R adrenal cells in a dose-dependent manner without affecting basal steroid formation. Treatment of rats with the procaine-based formulation reduced circulating corticosterone levels. This steroidogenesis-inhibiting activity of procaine was not observed in Leydig cells, suggesting that the effect was specific to adrenocortical cells. In search of the mechanism underlying this inhibitory effect on cAMP-induced corticosteroidogenesis, procaine was found to affect neither the cAMP-dependent protein kinase activity nor key proteins involved in cholesterol transport into mitochondria, cytochrome P450 side chain cleavage enzyme expression, and enzymatic activities associated with cholesterol metabolism to final steroid products. However, procaine reduced in a dose-dependent manner the 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMG-CoA) activity and the dbcAMP-induced HMG-CoA reductase mRNA levels by affecting mRNA stability. These data suggest that the inhibitory effect of procaine on cAMP-induced corticosteroid formation is due to the reduced synthesis of cholesterol. This modulatory effect of procaine on HMG-CoA reductase mRNA expression was also seen in dbcAMP-stimulated Hepa1-6 mouse liver hepatoma cells. Taken together, these results suggest that procaine may provide a pharmacological means for the control of hormone-induced HMG-CoA reductase mRNA expression and hypercortisolemia.     

Known and potential molecules associated with altered B cell development leading to predominantly antibody deficiencies

Predominantly antibody deficiencies (PADs) encompass a heterogeneous group of disorders characterized by low immunoglobulin serum levels in the presence or absence of peripheral B cells. Clinical presentation of affected patients may include recurrent respiratory and gastrointestinal infections, invasive infections, autoimmune manifestations, allergic reactions, lymphoproliferation, and increased susceptibility to malignant transformation. In the last decades, several genetic alterations affecting B-cell development/maturation have been identified as causative of several forms of PADs, adding important information on the genetic background of PADs, which in turn should lead to a better understanding of these disorders and precise clinical management of affected patients. This review aimed to present a comprehensive overview of the known and potentially involved molecules in the etiology of PADs to elucidate the pathogenesis of these disorders and eventually offer a better prognosis for affected patients.     

Determination of urinary thymidine glycol using affinity chromatography, HPLC and post-column reaction detection: a biomarker of oxidative DNA damage upon kidney transplantation

Reactive oxygen species are generated during ischaemia-reperfusion of tissue. Oxidation of thymidine by hydroxyl radicals (HO) leads to the formation of 5,6-dihydroxy-5,6-dihydrothymidine (thymidine glycol). Thymidine glycol is excreted in urine and can be used as biomarker of oxidative DNA damage. Time dependent changes in urinary excretion rates of thymidine glycol were determined in six patients after kidney transplantation and in six healthy controls. A new analytical method was developed involving affinity chromatography and subsequent reverse-phase high-performance liquid chromatography (RP-HPLC) with a post-column chemical reaction detector and endpoint fluorescence detection. The detection limit of this fluorimetric assay was 1.6 ng thymidine glycol per ml urine, which corresponds to about half of the physiological excretion level in healthy control persons. After kidney transplantation the urinary excretion rate of thymidine glycol increased gradually reaching a maximum around 48 h. The excretion rate remained elevated until the end of the observation period of 10 days. Severe proteinuria with an excretion rate of up to 7.2 g of total protein per mmol creatinine was also observed immediately after transplantation and declined within the first 24 h of allograft function (0.35 ± 0.26 g/mmol creatinine). The protein excretion pattern, based on separation of urinary proteins on sodium dodecyl sulphate-polyacrylamide gel electrophorosis (SDS-PAGE), as well as excretion of individual biomarker proteins, indicated nonselective glomerular and tubular damage. The increased excretion of thymidine glycol after kidney transplantation may be explained by ischaemia-reperfusion induced oxidative DNA damage of the transplanted kidney. Received: 19 May 1999 / Accepted: 4 August 1999     

Axillary artery and brachial plexus injury after anterior shoulder dislocation: report of a case and review of the literature

The shoulder is the most commonly dislocated major joint of the body, but associated injury to the axillary artery and the brachial plexus has only been reported sporadically in the literature. This review presents the case of an elderly man with a recurrent dislocation, transection of the axillary artery and an associated severe brachial plexus injury. It also presents the pathognomonic triad of anterior shoulder dislocation, absent peripheral pulse and expanding axillary haematoma to raise the index of suspicion for identifying this limb-threatening injury, which demands immediate arteriography and surgical exploration. This kind of rare injury can be easily missed without a simple clinical examination.     

Anterior chamber volume measurements with Visante optical coherence tomography and Pentacam: repeatability and level of agreement

Background:  The purpose of this study is to examine the repeatability of Pentacam-derived anterior chamber volume measurements, and assess the level of agreement of anterior chamber volume measurements obtained with the Visante and the Pentacam imaging devices.
Methods:  Anterior chamber volume was calculated with the Pentacam device and the Visante using the Wang formula. Results were analysed by means of the Wilcoxon signed rank test, Bland-Altman analysis, Cronbach's alpha test and intraclass correlation coefficient. P -values <0.01 were considered statistically significant.
Results:  One randomly selected eye from each of 20 persons was analysed. Spherical equivalent ranged between −2.50 and +1.50 D, and their age ranged from 25 to 79 years (mean ± SD: 54.4 ± 19.2 years). Mean anterior chamber volume measured with Pentacam was 171.1 ± 39.6 µL (minimum: 103.0 µL, maximum: 236.0 µL), and mean anterior chamber volume measured by Visante was 171.4 ± 42.4 µL (minimum: 96.4 µL, maximum: 245.5 µL). There was no statistically significant difference between Pentacam and Visante measurements of the anterior chamber volume ( P  = 0.691, Wilcoxon signed rank test). Cronbach's alpha and intraclass correlation coefficient for Pentacam were 0.998 and 0.991, respectively.
Conclusions:  Anterior chamber volume measurements obtained with the Visante using the Wang formula were in good agreement with the corresponding ones obtained with Pentacam. This recently described method is easy to perform and might contribute to both clinical and research settings.