Superficial venous thrombophlebitis caused by rocuronium

Pain is one of the major disadvantages of rocuronium, which is used during induction of anesthesia. Even at subparalyzing doses, 50–100% of patients complain of intense pain. Sudden flexion and withdrawal movement in the wrist or arm have been reported following rocuronium use in many papers. No information about risk factors leading to this withdrawal movement or pain on injection is available and whether this reaction leads to erythema or to venous sequelae (i.e. thrombosis and thrombophlebitis) has not been systematically investigated. However, in both of our cases, visible reactions occurred and both patients were diagnosed with venous superficial thrombophlebitis. Therefore, we believe that rocuronium-related pain may, in part, be because of direct venous injury.     

Effect of 180 Days of Water Storage on the Transverse Strength of Acetal Resin Denture Base Material

Purpose: Acetal resin has been used as an alternative denture base and clasp material since 1986. The manufacturers claim that acetal resin has superior physical properties when compared to conventional denture base acrylic resins. Limited information is available about transverse strengths of acetal resin. The purpose of this investigation was to compare transverse strengths of pink and white acetal resins to transverse strengths of conventional heat‐polymerized polymethylmethacrylate (PMMA) resin in increasing durations of water storage. Materials and Methods: A transverse strength test was performed in accordance with International Standards Organization (ISO) specification No 1567. Twenty 65 × 10 × 2.5 mm³ specimens of each resin were prepared; five specimens of each resin group were subjected to three‐point bending test after 50 hours, 30 days, 60 days, and 180 days of water storage in distilled water at 37°C. Experimental groups’ transverse strengths were compared by three‐way ANOVA and Duncan's multiple range tests. Results: Transverse strength of PMMA denture base material was found to be in accordance with the requirements of ISO specification No 1567. Transverse strengths of white and pink acetal resin could not be calculated in this study, as white and pink acetal resin specimens did not break at the maximum applied force in the three‐point bending test. Flexural strength of acetal resin was found to be within the ISO specification limits. As the water storage time increased, the deflection values of PMMA showed no significant difference (p > 0.05). Both the white and pink acetal resin showed significant increase in deflection as the water storage time was increased from 50 hours to 180 days (p < 0.05). Conclusion: The results of this study indicated that transverse strength values of PMMA were within the ISO specification limit. Water storage time (50 hours, 30, 60, and 180 days) had no statistically significant effect on the transverse strength and deflection of PMMA. Acetal resin suffered from permanent deformation, but did not break in the three‐point bending test. Acetal resin showed significant increase in deflection as the water storage time was increased from 50 hours to 180 days. All materials tested demonstrated deflection values in compliance with ISO specification No 1567.     

Bovine mesenteric venous graft as an alternative conduit in patients with cyanotic heart disease with e-polytetrafluoroethylene graft failure caused by thrombophilic factor positivity after modified Blalock-Taussig shunt

Modified Blalock-Taussig shunt (MBTS) is a palliative operation for cyanotic congenital heart disease (CCHD) in patients for whom total correction is not appropriate. Many synthetic or biologic grafts have been proposed as alternative shunt materials. The use of a bovine mesenteric venous graft (BMVG) as a systemic-to-pulmonary artery shunt conduit without the administration of antiaggregant and anticoagulant has been proposed as a treatment for neonates with CCHD, but few reports address the importance of thrombophilic risk factors in MBTS and bovine venous graft as a shunt material. We used BMVG as a shunt material without any antiaggregant or antiplatelet regimen in 13 patients with CCHD, all of whom were candidates for MBTS and had thrombophilic risk factors assessed in our initial study. Early shunt failure occurred in the first 3 patients and was attributed to less surgical experience with this graft. No complications were attributable to graft material or surgery itself. In all cases functioning MBTSs were observed on follow-up. Our study results show that thrombophilic factors should be evaluated before the MBTS procedure. BMVG could be the choice of graft for use without the administration of antiaggregant and anticoagulants in patients with thrombophilic risk factors.     

Epileptic nystagmus in a patient with nonconvulsive status epilepticus.

Epileptic nystagmus (EN) is a rare form of rhythmic eye oscillations occurring during seizure activity. Not only convulsive states, but also nonconvulsive status may represent with EN and this phenomenon may be the only motor manifestation of seizure activity. Epileptic activation of a cortical saccade region may be distinguished from activation of a cortical pursuit region clinically as activation of pursuit regions results in nystagmus slow phases that bring the eyes across the midline. Horizontal EN results most commonly from seizure activity involving the occipital cortex. In this report, horizontal EN in a patient with nonconvulsive status epilepticus (NCSE) is described with clinical, radiological and electrophysiological findings that occur probably due to posterior leukoencephalopathy syndrome.     

Fluid resuscitation of acute hemorrhage in uninephrectomized rabbits--effects on the early function of the remnant kidney

The aim of this study was to determine the effects of fluid resuscitation of acute hemorrhage on the early function and histopathology of the remnant kidney in uninephrectomized rabbits. Thirty-nine adult rabbits were studied in four groups. Group 1 (n = 8) included healthy controls; Group 2 (n = 10) healthy, bled animals; Group 3 (n = 10) uninephrectomized, non-bled animals; and Group 4 (n = 11) uninephrectomized, bled animals. In the hemorrhage groups, 8 mL kg(-1) of blood was drawn, and replaced with lactated Ringer's solution three times the volume of shed blood. Urine and blood samples were collected after 120-minutes of observation. None of the animals experienced hypotension during the study period. Serum and urinary electrolytes were similar between the Groups (p > 0.05). Urine output was lower in Groups 3 and 4 than in Group 1 (p = 0.001, both). Urinary microalbumin, NAG, fractional sodium excretion and creatinine clearance were similar in all four Groups. Light microscopic evaluation revealed only slight enlargement of the proximal tubule lumen in the renal medulla of the rabbits that were both uninephrectomized and bled. We observed no deleterious effects of well resuscitated hemorrhage on early function and histopathology of the remnant kidney in uninephrectomized rabbits.     

Poly (ADP-ribose) polymerase as a potential target for the treatment of acute renal injury caused by lipopolysaccharide

Recent studies have clearly reported that there is a relationship between endotoxemia and acute renal injury. The aim of this study was to investigate whether treatment with the new potent PARP inhibitor PJ34 could prevent the acute renal injury induced by lipopolysaccharide (LPS). Endotoxemia was induced by LPS injection (10 mg/kg, i.v.). LPS increased blood urea nitrogen (BUN) levels from 22 +/- 0.54 mg/dL to 45.7 +/- 5.79 mg/dL (p < 0.05). The plasma creatinine levels were 0.38 +/- 0.02 mg/dL and 0.47 +/- 0.03 mg/dL for the control and LPS groups, respectively. In addition, urinary excretion of N-acetyl-beta-D-glucosaminidase (NAG, a marker of renal tubular damage) was increased after LPS injection. By light microscopy, structural renal damage was observed in the LPS-treated group. However, PJ34 treatment (10 mg/kg, i.p.) attenuated LPS-induced renal injury, as indicated by plasma BUN and creatinine levels, urinary NAG excretion, and renal histology. These results indicated that the overactivation of the PARP pathway may have a role in LPS-induced renal impairment. Hence, pharmacological inhibition of this pathway might be an effective intervention to prevent endotoxin-induced acute renal injury.