Malignant hyperthermia in a 41-year-old woman

Malignant hyperthermia is one of the most devastating crises encountered in anaesthesia and it frequently occurs unexpectedly. Although malignant hyperthermia develops in young individuals (mean age approximately 22 years), older people can also be affected. The case of a 41-year-old woman with a history of several previously uneventful general anaesthetics is described. She developed the complete symptomatology of malignant hyperthermia triggered by halothane anaesthesia, with tachycardia, cardiac arrhythmia, cyanosis, combined respiratory and metabolic acidosis and hyperpyrexia. Because treatment with dantrolene and hyperventilation with 100% O2 was started immediately, the symptoms of malignant hyperthermia were stopped within a short time. It should always be remembered, that the life threatening crises which can be caused by malignant hyperthermia can occur at any age and even after several uneventful anaesthetics.     

Regression of melanoma nodules in a patient treated with ranitidine

Human malignant melanoma may regress spontaneously or with immunotherapy, such as Calmette-Guerin bacillus, interferon alfa, interleukin-2, and interleukin-2 plus lymphokine-activated killer cells. Histamine type 2 receptor antagonists can modulate immune function by inhibiting suppressor T-cell induction and activity, and melanoma regressions have been reported after the use of cimetidine with coumarin or interferon alfa. This article describes the complete regression of melanoma nodules in a patient treated with ranitidine hydrochloride, another histamine type 2-receptor antagonist. Ranitidine and cimetidine should be considered to be possibly active immunotherapeutic agents in the design and evaluation of clinical trials.     

Incidence of bladder cancer in a cohort of workers exposed to 4-chloro-o-toluidine while synthesising chlordimeform.

Between 1982 and 1990 seven cases of bladder cancer were detected in a group of 49 workers who were synthesising chlordimeform from 4-chloro-o-toluidine. Latency periods ranged from 15 to 23 years. The incidence of bladder tumours in this group was significantly higher than that of the cancer registers of the former GDR, Saarland, and Denmark by factors of 89.7, 53.8, and 35.0 respectively. This provides further evidence that monocyclic aromatic amines such as 4-chloro-o-toluidine may be carcinogenic in humans.     

Antenatal Screening for HPA-la by Flow Cytometry

Summary: regnant women who attended antenatal clinics at King George V Hospital, the Birth Centre or were referred by obstetricians from February to July. 1996 were screened for the platelet antigen HPA-la by flow cytometry. Forty out of 2300 (1.7%) were found to be negative for this antigen . Of the 28 women followed throughout their pregnancy, none developed antibody to HPA-la. Platelet counts performed on samples from 17 babies born to 17 of these mothers were all normal. This study proves the simplicity and rapidity of flow cytometry for platelet antigen screening. The results were comparable with the Solid Phase Red Cell Adherence (SPRCA) method and with PCR. The lack of a plentiful supply of specific antibody and the rarity of fetomaternai alloimmune thrombocytopenia (FMAIT) argue against the introduction of routine screening for maternal HPA-la status at the present time.     

Ausfallhonorar wegen Nichterscheinens zu einem Exklusiv-Termin

Abstrakt 1. Nimmt ein Patient einen ihm von seinem (Zahn-)Arzt einger?umten Exklusiv-Termin nicht wahr, obwohl er auf dessen Eigenschaft ausdrücklich hingewiesen wurde, so hat er dem (Zahn-)Arzt den Behandlungsausfall abzüglich eines angemessenen Eigenanteils des (Zahn-)Arztes zu ersetzen. 2. Die Ersatzpflicht tritt auch dann ein, wenn der Patient den Termin nicht in der in dem Behandlungsvertrag vorgesehenen Frist absagt. Eine hierfür seitens des (Zahn-)Arztes bestimmte Frist von zwei Tagen vor Behandlungsbeginn stellt sich für den Patienten grunds?tzlich auch nicht als unangemessene Benachteiligung i.S. des § 307 BGB dar. 3. Ein Anspruch des Arztes entf?llt auch bei nur mündlicher Vereinbarung nicht unter dem Gesichtspunkt des § 4 Abs. 5b BMV-Z, denn diese Vorschrift ist teleologisch dahin zu reduzieren, dass nur zahn?rztliche Honoraransprüche aus erfolgten Behandlungen schriftlich vereinbart werden müssen. Soweit es jedoch um einen vertraglichen Anspruch wegen einer Leistungsst?rung geht, vermag das Schriftformerfordernis des § 4 Abs. 5b BMV-Z grunds?tzlich nicht einzugreifen. (Leits?tze des Bearbeiters)     

Allergenic structures in cockroach hypersensitivity

The tissues from which cockroach allergens were derived were identified by use of serum IgE of five patients with allergic rhinitis and bronchial asthma as a result of hypersensitivity to German cockroach. RAST and skin test results demonstrated four of five patients to be positive to cockroach only, and one patient was tested positive to house dust mite as well. Allergen-specific IgE binding to German cockroach was investigated by cryostat sections by means of immunofluorescent test. In all patients with cockroach hypersensitivity, we found IgE bound to the gastrointestinal epithelium and contents of the intestinal tract. In four cases, IgE was also bound to the Malpighian vessels (equivalent in function to kidneys). In three cases, IgE was also bound to the ovarian cells. All cases revealed cytoplasmic staining.