Case of anesthesia for laparoscopic cholecystectomy in a patient with a history of frequent anaphylaxis

Idiopathic anaphylaxis is a rare disease that induces anaphylactic shock without extrinsic incentive. We had a patient with such frequent episodes undergoing laparoscopic cholecystectomy. Steroid was administered both at preoperative and intraoperative periods. Epidural anesthesia and general anesthesia by inhalation anesthesia, which are low risk for anaphylaxis, were used to reduce perioperative stress and restricted usage of drugs even in postoperative period. Consequently, we can safety manage anesthesia without episode of anaphylactic shock. To prepare for anaphylaxis we prepared usual therapeutic drugs for shock and measured serum tryptase, which has longer half-life than that of histamine.     

Anesthetic management of a patient with mid-ventricular obstructive hypertrophic cardiomyopathy treated with dual-chamber pacing

A 64-year-old man complicated with mid-ventricular obstructive hypertrophic cardiomyopathy (MVO) was scheduled for resection of rectum cancer under general anesthesia with epidural block. Because of unexpected circulatory collapse at the induction of anesthesia, the operation was canceled. Therefore three weeks later, we inserted a temporary dual-chamber (DDD) pacing device before induction of general anesthesia, and we could maintain stable hemodynamics during general anesthesia. In the patients with MVO, blood outflow from the left ventricle to the aorta is decreased by the abnormal blood flow produced by hypertrophy of the mid left ventricle when inotropic stimulation is applied. Even in an asymptomatic patient with MVO, the hemodynamic catastrophe could occur during the operative period. In patients with hypertrophic obstructive cardiomyopathy (HOCM), DDD pacing appears to be effective to reduce the pressure gradient between the left ventricle and the aorta. Similarly, in our case, DDD pacing was effective to maintain the hemodynamic state during general anesthesia in a patient with MVO.     

Synptons of outpatients as data for syndromic surveillance

OBJECTIVE: To review complaints (such as fever, respiratory symptoms, diarrhea, vomiting, and rashes) in the medical records of outpatients as potential sources of data for syndromic surveillance, and to examine the possibility of practical application from a statistical view point. MATERIALS AND METHODS: Using data obtained from a certain internal and pediatric clinic, we count the number of patients each day who suffered from one of the above five symptoms from January 1st, 2003 to June 30th, 2005. In order to detect outbreaks prospectively after January 1st, 2005, we at first estimate the baseline using the data from January 1st, 2003 to the day before any given day. We then predict the number of patients there ought to be in any given day and judge whether or not an outbreak has occurred. So as to evaluate the system, we check the sensitivity and specificity in its ability to detect outbreaks other than those seen in previous patterns. RESULTS: The total number of cases in which each of the above symptoms occurred were respectively: 11,896 cases of fever, 16,273 cases of respiratory symptoms, 3,672 cases of diarrhea, 3,485 cases of vomiting, and 542 cases of rash. We found prolonged outbreaks of fever and respiratory symptoms in February and March and shorter outbreaks of vomiting and diarrhea in January. The sensitivity and specificity of this system' s ability to detect outbreaks was very high and thus we can confirm that it showed satisfactory performance. DISCUSSION: We found large-scale outbreaks of influenza late in the 2004/2005 season, and small outbreaks of GI that seemed to be particularly related to the Noro virus. In both cases, these outbreaks seemed to be natural phenomena, not artificial, human induced phenomena such as outbreaks caused by bioterrorism attacks. However, since this system was able to detect these outbreaks, we would also be able to use it to detect an outbreak caused by a bioterrorism attack if the size of the outbreak was similar to these cases. CONCLUSION: In order to use this system to detect outbreaks in the community on a smaller level we would have to increase the number of medical institutions cooperating in this study. Moreover, we would need to find a way to handle the different electronic medical record systems and different writing styles used by different medical institutions in order to move toward the practical use of Syndromic Surveillance.     

Association of influenza outbreak in each nursery school and community in a ward in Tokyo,Japan

In nursery schools, influenza outbreaks have occurred every year. However, influenza characteristics of its diffusion among nursery schools, within each nursery school, and among classes of different ages in nursery schools remains unclear. This paper presents an examination of these matters using the Nursery School Absenteeism Surveillance System (NSASSy). All nursery schools in ward A in Tokyo introduced to the NSASSy in 2015. The study period was November 2015 through March 2016. The data of influenza patients were extracted from NSASSy. We examined four definitions of ‘starting date of community outbreak’ (SDCO) of influenza: 1) the first recorded day of influenza patients (SDCO1), 2) the last day of influenza patients recorded for two consecutive days (SDCO2), 3) three consecutive days (SDCO3), and 4) four consecutive days (SDCO4). We evaluated those four definitions by duration of the initial case at each nursery school from SDCO and evaluated the proportion of nursery schools at which the initial case occurred before SDCO. The average durations of initial cases at respective nursery schools from SDCO1–4 were 40.3, 26.3, 23.1 and 13.3 days. The respective proportions of nursery schools at which the initial case occurred before SDCO1–4 were 3.1%, 6.4%, 9.4% and 40.6%. Results demonstrate that SDCO3 is an appropriate definition of SDCO. Robustness checks for other areas, seasons, and population size constitute the next challenge for research in this area.     

Intrathecally administered ropivacaine is less neurotoxic than procaine, bupivacaine, and levobupivacaine in a rat spinal model

Purpose

The aim of this study was to compare the neurotoxicity of intrathecal procaine, bupivacaine, levobupivacaine, and ropivacaine in an animal model.

Methods

The study comprised two experiments. In the concentration experiment, rats (n?=?78) were administered 0.12???L·g^?1 body weight (BW) of 2% or 20% procaine, 0.5% or 5% bupivacaine, 0.5% or 5% levobupivacaine, or 0.5% or 5% ropivacaine. Based on the findings, the doses were increased by volume in the subsequent volume experiment using 0.12, 0.24, or 0.48???L·g^?1 BW of 6% procaine, 6% levobupivacaine, or 6% ropivacaine (n?=?79). Walking behaviour and sensory threshold were analyzed, and a histological examination of the spinal cord, posterior and anterior roots, and cauda equina was performed.

Results

The concentration experiment showed abnormalities only in the 5% bupivacaine group, and these abnormal findings were in the posterior root (PR) and posterior column (PC). The volume experiment revealed that procaine 0.24???L·g^?1 was neurotoxic, mainly affecting the PR. At 0.48???L·g^?1, severe injury was observed in the PR and PC in all six procaine rats and four of six levobupivacaine rats, while milder injury was limited to the PR in one of six ropivacaine rats, which differed significantly from the former two groups (P?=?0.006 and P?=?0.014, respectively). Electron microscopy showed axonal degeneration.

Conclusion

All four local anesthetics seemed to cause identical neurotoxic lesions commencing in the PR and extending to the PC by axonal degeneration. Bupivacaine appeared to be the most neurotoxic of the four drugs, and the neurotoxicity at higher doses increased by volume with procaine?>?levobupivacaine?>?ropivacaine.     

Exposure to nanoparticle-rich diesel exhaust may cause liver damage

Diesel exhaust (DE) is one of the air pollutants in the world, and exposure to DE is an environmental health concern. Most studies amongst the limited number of studies on hepatotoxicity have focused on genotoxicity or mutagenicity. However, DE exposure may cause liver damage because one prospective study suggests that DE exposure is associated with increased mortality due to arteriosclerosis and cirrhosis of the liver. Peroxisome proliferator-activated receptor (PPAR) α plays a role in the regulation of lipid homeostasis and inflammation and thereby may be involved in the progression of atherosclerosis. We investigated whether nanoparticle-rich diesel exhaust (NR-DE) affects the liver and how PPARα is involved in the NR-DE induced effects. We report these results briefly in this minireview. Our results suggest NR-DE-induced hepatic inflammation and dyslipidemia. PPARα may be involved in the development of these disorders.     

Acoustic speed and attenuation coefficient in sheep aorta measured at 5-9 MHz

B-mode ultrasound (US) images from blood vessels in vivo differ significantly from vascular flow phantom images. Phantoms with acoustic properties more closely matched to those of in vivo arteries may give better images. A method was developed for measuring the speed and attenuation coefficient of US over the range 5 to 9 MHz in samples of sheep aorta using a pulse-echo technique. The times-of-flight method was used with envelope functions to identify the reference points. The method was tested with samples of tissue-mimicking material of known acoustic properties. The tissue samples were stored in Krebs physiologic buffer solution and measured over a range of temperatures. At 37 degrees C, the acoustic speed and attenuation coefficient as a function of frequency in MHz were 1600 +/- 50 ms(-1) and 1.5 +/- 4f(0.94 +/- 1.3) dB cm(-1), respectively.