Decrease in bispectral index prior to cardiovascular collapse during Caesarean sections

We report a case of significant reduction in bispectral index (BIS) associated with suspected amniotic fluid embolism (AFE) that occurred prior to change in haemodynamic variables. The patient was a 29‐year‐old nulliparous, who was admitted for Caesarean section under general anaesthesia in the 33rd week of pregnancy. After the baby was born, the BIS value suddenly decreased to 0, with suppression ratio of 100. One minute later, saturation decreased abruptly to 85%, end‐tidal carbon dioxide (EtCO₂) decreased to 5 mmHg, peak inspiratory pressure increased to 35 cm H₂O, and non‐invasive blood pressure (BP) failed to obtain a reading. After administration of vasoactive drugs, the systolic BP was maintained at 100 mmHg or higher, the BIS value rose to 10–20, and the EtCO₂ increased to 24–33 mmHg. In this case, the BIS monitoring may provide an earlier warning of impending cardiovascular collapse in the case of AFE.     

Upper gastrointestinal bleeding in children with haemophilia: a clinical significance of Helicobacter pylori infection

Summary. For patients with haemophilia, gastrointestinal (GI) bleeding is a life‐threatening complication and can be caused by the Helicobacter pylori infection. Among children with haemophilia who had visited with GI bleeding, the prevalence of H. pylori infection and the recurrence rate after H. pylori eradication was investigated. Seven children with haemophilia A with hematemesis (age: 5.3–17.0 years) were evaluated for the causes of GI bleeding and the detection of H. pylori. Gastroendoscopy was done to find the bleeding focus and for further evaluation including rapid urease test and mucosal biopsy. Four patients had dyspepsia and abdominal pain for several weeks or months prior to hematemesis. Three patients did not show any symptoms of bleeding. From gastroendoscopy, four patients were diagnosed as duodenal ulcer, one as H. pylori associated chronic gastritis and one as haemorrhagic gastritis. One patient showing a normal finding was diagnosed with adenoid haemorrhage after nasopharyngoscopy. Helicobacter pylori infection was found in four of six patients with GI bleeding (3, duodenal ulcer; 1, H. pylori associated chronic gastritis). The patients with H. pylori infection had an eradication treatment of triple therapy and no recurrence happened. In children with haemophilia, H. pylori should also be considered as an important cause of GI bleeding. The recurrence of the infection and GI bleeding can be prevented with eradication of H. pylori. Screening test for H. pylori would be needed in children with haemophilia in endemic area.     

Femoral Vasodilation to Cromakalim is Blocked by U37883A,a Non-sulphonylurea that Selectively Inhibits KATP Channels

The purpose of the present study was to determine the effects of U37883A, a non-sulphonylurea inhibitor of K_ATP channels, in the femoral vascular bed of the anaesthetized dog. Administration of U37883A, 4-morpholinecarboxamidine-N-1-adamentyl-N-cyclohexyl hydrochloride (2·5 mg kg^?1, i.v.), significantly inhibited the femoral vasodilator response to intra-femoral arterial injection of cromakalim, an activator of K_ATP channels. In contrast, U37883A had no effect on the femoral vasodilator responses to nitroglycerin, isoprenaline, 5-HT, or 5-carboxamidotryptamine, suggesting this agent is a novel and selective inhibitor of hindlimb vasodilation induced by K_ATP-channel activation. Since U37883A did not significantly alter baseline femoral blood flow and femoral vascular resistance, the present data suggest that K_ATP channels do not contribute, in large measure, to regulating the canine femoral vascular bed under resting conditions in-vivo.     

Adrenomedullin is Inactivated in the Lungs of Neonatal Piglets

Adrenomedullin, a novel 52 amino acid peptide normally present in adult human plasma, has been shown to induce systemic hypotension in the adult rat, pig and cat, and in the new-born piglet. Little is known about the site(s) of adrenomedullin inactivation in adults or neonates. Groups of five 0–2-day old and 2-week old anaesthetized piglets were prepared to enable continuous monitoring of cardiac output, mean systemic arterial pressure, mean pulmonary artery pressure, mean systemic vascular resistance and mean pulmonary vascular resistance. In both age groups, injections of human adreno-medullin_1–52 into the left atrium produced significant (P < 0.05) reductions in mean systemic arterial pressure and mean pulmonary artery pressure. Although injections of similar doses of human adrenomedullin_1–52 into the right atrium produced significant (P < 0.05) decreases in mean pulmonary artery pressure, there were no appreciable alterations in mean systemic arterial pressure in either age group. These results suggest that the systemic vasodilator properties of human adrenomedullin_1–52 are reduced upon first pass through the pulmonary circulation in 2-week old piglets, a phenomenon that is present at birth.     

Therapeutic embolization of systemic arterial supply to normal basal segments of the left lower lobe of the lung

Systemic arterialization of normal lung without sequestration is a rare congenital abnormality. The basal segments of the left lower lobe are most frequently involved. The involved lung has no structural abnormalities of the tracheobronchial tree that distinguish this abnormality from bronchopulmonary sequestration. Haemoptysis and exertional dyspnoea are common presenting symptoms. We report the case of a 26-year-old man who presented with recurrent haemoptysis due to systemic arterialization of basal segments of the left lower lobe of the lung, without sequestration. Therapeutic embolization using metallic coils was successfully performed without any complications. There was no further haemoptysis during a 6-month follow up. Therapeutic embolization is a safe and effective method of managing the haemoptysis associated with aberrant systemic arterial supply to the normal lung.     

The Vein Hook Successfully Used for Eradication of Steatocystoma Multiplex

BACKGROUND: Steatocystoma multiplex is characterized by the formation of the numerous cutaneous cysts in the exposed area leaving some cosmetic problems for the patients. Only surgical excision has been effective, and its several variations were done with limited success. Because the patients usually have many cysts, excision of cysts was tedious for the doctors and left scars on the patients. METHOD: Five patients agreeing to participate in this experiments were selected. The vein hook used for ambulatory phlebectomy was employed to eradicate the cysts. The skin was incised approximately 2 to 3 mm in length. Then the mosquito forceps removed the cysts by gently squeezing or hooking the inner or outer cyst wall. By completely removing tissue around the cyst, recurrence was able to be prevented. RESULT: It took approximately 1 minute to excise one cyst completely, it left no hypertrophic scars except for transient postinflammatory hyperpigmentation, and it had no recurrences for 14 to 30 months on five patients. CONCLUSION: The use of this instrument is very simple and time-saving, providing excellent success rate with favorable cosmetic results. It can be a good alternative for eradication of the cysts in steatocystma multiplex. The authors have indicated no significant interest with commercial supporters.     

COMPARISON OF THE EFFECTS OF THE LARYNGEAL MASK AIRWAY AND ENDOTRACHEAL INTUBATION ON VOCAL FUNCTION

We have compared changes in vocal function produced after insertionof a laryngeal mask airway (LMA) with those produced by trachealintubation in 20 patients. Using acoustic waveform analysis,we computed amplitude variability (AV), pitch variability (PV),harmonics-to-noise ratio (HNR) and additive noise level (ANL)before anaesthesia and at 1, 4, and 24 h after tracheal extubation.There were no significant changes in vocal function after extubationexcept for HNR ratio (P = 0.046) at 4 h in the LMA group. Therewere differences in all four variables at 1 h, 4 h, or both,after tracheal extubation compared with baseline in the trachealtube group. In both groups, all variables were the same as baselinevalues 24 h after extubation. We observed significant differencesin AV (4 h), PV and ANL (1, 4 h) values between the two groups.These observations suggest that the LMA causes less vocal changethan tracheal intubation (Br. J. Anaesth. 1993; 71: 648–650)     

GENETIC MATERIAL IS PRESENT IN CADAVERIC DERMIS AND CADAVERIC FASCIA LATA

PURPOSE: We determined whether genetic material is present in the commercially processed cadaveric allografts used in sling surgery. MATERIALS AND METHODS: We evaluated 16 samples from 2 commercial sources of human allograft, including 8 each of freeze-dried gamma irradiated cadaveric fascia lata and acellular cadaveric dermis. Fresh human rectus fascia and sterile saline served as positive and negative controls, respectively. All samples underwent a standard proteinase K/sodium dodecyl sulfate/phenol extraction technique to isolate DNA. Polymerase chain reaction was done to amplify the retrieved DNA material, spectrophotometry to quantify DNA concentration and agarose gel electrophoresis to determine the size of DNA fragments. RESULTS: Of the 16 samples tested from 2 commercial sources of human allograft fascia 14 (87.5%) contained DNA. Mean DNA concentration plus or minus standard error was 258.3 +/- 80.1 and 272.8 +/- 168.8 microg./gm. tissue for cadaveric fascia lata and cadaveric dermis, respectively. Polymerase chain reaction amplified DNA segments of 2,000 bp from 1 of each of the 8 samples of cadaveric fascia lata and cadaveric dermis. CONCLUSIONS: Freeze-dried gamma irradiated cadaveric fascia lata and acellular cadaveric dermis contained intact DNA.