Clinical management of latex-allergic children

Latex allergy in children with myelodysplasia and urological anomalies is well recognized. We anesthetized 162 children with latex allergy who underwent 267 anesthetics according to a latex-safe protocol. Medication for allergy prophylaxis was not administered. Our patients were 11.6 +/- 5.8 yr old (range 1-31 yr). Primary diagnoses were myelodysplasia, extrophy of the bladder, and cloacal extrophy. These children had many allergies to medications and foods as well as environmental sensitivities. One patient of 162 (1 procedure of 267) had an allergic reaction after injection of an epidural catheter with bupivacaine and fentanyl. No other patient manifested allergy signs or symptoms. Latex-allergic children can be safely anesthetized using a latex-safe protocol without allergy chemoprophylaxis. These patients require avoidance of latex products or the use of latex products that have been thoroughly washed. IMPLICATIONS: This audit of the medical histories and treatment of 162 children with latex allergy who underwent 267 anesthetics indicates that latex-allergic children can be safely anesthetized if exposure to latex in the medical environment is avoided, and that administration of prophylactic medications to decrease the allergic response is unnecessary.     

Response of lactating dairy cows to various densities of sorghum grain

To examine the effects of various densities of sorghum grain resulting in graded levels of ruminally degradable starch on lactational performance, 32 lactating Holstein cows (90 d in milk [DIM]) were assigned to four treatments for 58 d. Diets contained 37% alfalfa hay, 3% cottonseed hulls, 10% whole cottonseed, 6% soybean meal, 5% of a molasses-mineral-vitamin supplement, and 39% sorghum grain. Treatments were dry-rolled sorghum (DRS) at 643 g/L or stream-flaked sorghum (SF) at 437, 360, and 283 g/L. Dry matter intake was highest for DRS followed by SF360, with the linear (P < .01) and cubic (P < .05) effects significant. The linear decrease in milk (P < .05) and 3.5% fat corrected milk (FCM, P < .025) with decreased density of sorghum was because of large decreases on SF283. Steam-flaking increased total tract digestibilities of DM, OM, CP, starch, and ADF when compared with dry-rolling. Efficiency of conversion of feed DM to FCM and feed CP to milk protein were greater for sorghum flaked at 437 and 360 g/L than for DRS or the 283 g/L flake. The 283 g/L flake decreased DMI, milk yield, and milk fat percentage. Addition of buffer (1% NaHCO3) tended to ameliorate the decrease in DMI. These data show greater efficiency of feed utilization and conversion of feed CP to milk protein in cows fed sorghum grain flaked at 437 and 360 g/L compared with those fed dry-rolled sorghum or that flaked at 283 g/L.     

Thrombotic thrombocytopenic purpura in 13 Dutch centres: treatment and longterm follow-up

OBJECTIVE: Analysis of the incidence, treatment modalities and disease course of thrombotic thrombocytopenic purpura (TTP) in the Netherlands. DESIGN: Retrospective follow-up study. SETTING: 13 centres in the Netherlands. METHODS: Regarding all patients admitted between 1-1-1979 and 1-1-1992 to one of 13 Dutch haematological centres, in whom the diagnosis of TTP was made for the first time, information was gathered from the medical records and from the patients own physicians on patient characteristics at presentation and the occurrence of relapse or death. The follow-up period tended on 1-4-1995. RESULTS: A total of 65 patients with newly diagnosed TTP were identified: 0.34 per 1,000,000 persons a year (95% confidence interval (95%-CI): 0.26-0.45), increasing to 0.83 in the last year of the study. Forty-six (95%) patients were treated with fresh frozen plasma: 18 (28%) by plasma infusion and 44 (68%) by plasma exchange; 48 (74%) (additionally) received corticosteroids. All 52 patients (80%) who survived the first four weeks after admission reached complete remission. Twelve patients with relapsing TTP underwent splenectomy in remission. The 5-year survival rate was 77% (95% CI: 66-87) and the 5-year relapse-free survival rate 38% (95% CI: 25-52). Cardiac symptoms, severe thrombocytopenia and a high serum LDH were risk factors for acute mortality, but no risk factors for relapse or late-occurring death could be identified. CONCLUSION: TTP is a rare disease which is increasingly being recognized. Plasma exchange and corticosteroids are the most frequently used therapies. The disease has a high mortality rate in the acute phase of the disease.     

Corneal blood staining following autologous blood injection for hypotony maculopathy

We experienced the case of left atrial myxoma originating from posterior leaflet mitral valve. Mitral valve repair was performed in that case, because of the presence mitral leaflet defect due to removal of the myxoma. Transesophageal echocardiography was a useful tool for perioperative evaluation of the mitral valve and precise localization of the origin of the myxoma.     

Enhanced endothelin-mediated coronary vasoconstriction and attenuated basal nitric oxide activity in experimental hypercholesterolemia

Matrix metalloproteinases (MPs) constitute a family of proteolytic enzymes (proteases) that degrade extracellular matrix (ECM) and promote the local or metastatic potential of carcinoma cells, and whose action is restrained by special inhibitors (metalloproteinase inhibitors; MIs). We assessed the role of the MPs stromelysin-3 (STR-3), putative metalloproteinase-1 (PUMP-I), and the gelatinases of molecular weights 72 kDa and 92 kDa, as well as the role of their inhibitors tissue inhibitor of metalloproteinase-1 (TIMP-1) and TIMP-2, as markers of metastatic potential in 25 fresh biopsies of squamous-cell lung carcinomas (SCLCs). We examined levels of messenger ribonucleic acid (mRNA) expression for these MPs and inhibitors through Northern blot analysis in 10 carcinomas of high-to-moderate differentiation without lymph-node involvement, and in 15 infiltrative carcinomas of moderate-to-low differentiation with lymph-node involvement. Five cases with significant epithelial atypia and five samples with normal mucosa were used as controls. Expression of STR-3 and TIMP-2 was also assessed immunohistochemically with the avidin-biotin-complex (ABC) technique. We noticed a progressive increase in the expression levels of MPs, especially of STR-3, and of TIMP-2, from the stage of epithelial atypia to the detection of carcinoma, finding the highest values of these substances among carcinomas of low differentiation with nodal metastases. These findings were also confirmed with immunohistochemical analysis. Our results suggest that there is a significant association of the expression of MPs and MIs with both the local and metastatic potential and the degree of cellular differentiation of SCLC, and that this association is clinically important because of its prognostic and therapeutic implications.     

Functional connectivity in the rodent trigeminal pathway grown in vitro

In explant cocultures of the rat trigeminal pathway, embryonic trigeminal ganglion cells grow their axons into peripheral cutaneous and central nervous system targets (R.S. Erzurumlu, S. Jhaveri, Target influences on the morphology of trigeminal axons, Exp. Neurol, 135 (1995) 1-16; R.S. Erzurumlu, S. Jhaveri, H. Takahashi, R.D.G. McKay, Target-derived influences on axon growth modes in explant cocultures of trigeminal neurons, Proc. Natl. Acad. Sci. USA 90 (1993) 7235-7239). In heterochronic cocultures, composed of embryonic trigeminal ganglion, embryonic whisker pad and postnatal brainstem slice, trigeminal axons develop arbors and terminal boutons in the brainstem trigeminal nuclei. To determine whether these terminal arbors establish functional connections with the brainstem neurons, we examined the electrophysiological properties of brainstem neurons and their responsiveness to trigeminal ganglion stimulation. Intracellular recordings were done in vitro on cells of the trigeminal subnucleus interpolaris (SPI) in trigeminal pathway cocultures (E15 whisker pad, E15 trigeminal ganglion, and postnatal day (PND) 0-2 brainstem slice) or in the SPI of acutely prepared brainstem slices. Electrophysiological properties of SPI cells in both preparations were virtually identical. The voltage responses of SPI neurons to intracellular current injection were highly linear suggesting they lacked a number of voltage-dependent conductances. Depolarizing current injection produced trains of action potentials with a frequency that varied with stimulus intensity. In explant cocultures, electrical activation of the trigeminal ganglion evoked EPSPs, and EPSPs coupled with IPSPs in SPI cells. Bicuculline blockade of IPSP activity resulted in long lasting EPSPs whose duration increased with membrane depolarization. These results show that brainstem trigeminal neurons can retain their functional properties in culture and establish functional connections with primary sensory afferents.     

Antisense-mediated resistance to measles virus infection in HeLa cells

Endogenous expression of antisense RNA in transfected cells has been explored for use in blocking cellular gene expression and for its antiviral potential. Antisense strategies were used with the goal of blocking measles virus (MV) infection. A recombinant expression plasmid was designed to produce antisense oligonucleotides targeted to the 5' end of the MV nucleocapsid protein mRNA. This construct was transfected into HeLa cells. The transfected cell line and a control cell line expressing a random RNA comprising the same nucleotides were infected with MV and assessed for viral resistance by observation of cytopathic effect (CPE); infectious virus was quantified by viral plaque assay. Both cell lines were also infected with a related paramyxovirus, mumps virus, as a specificity control. Both CPE and infectious virus were reduced by approximately 90% in the antisense-expressing line compared with that in control cells or transfectant cells expressing random RNA. There was no evidence of resistance to infection with mumps virus in any cell line.     

Identification of nursing management diagnoses

Theories from nursing and management provide frameworks for enhancing effectiveness of nursing management practice. The concept nursing management diagnosis has been developed by integrating nursing diagnosis and organizational diagnosis as a basis for nurse manager decision-making. Method triangulation was used to identify problems of managing nursing units, to validate those problems for relevancy to practice, to generate nursing management diagnoses, and to validate the diagnoses. Diagnoses were validated according to a definition of nursing management diagnosis provided. Of the 72 nursing management diagnoses identified, 66 were validated at a 70% level of agreement by nurse managers participating in the study.     

Colectomy for sigmoid volvulus

PURPOSE: Volvulus of the sigmoid carries a high mortality. This minimally invasive technique is designed for poor-risk patients. TECHNIQUE: Aided by laparoscopy, the mobile sigmoid is exteriorized through a mini-incision without preliminary dissection. The entire resection and anastomosis is performed on the surface of the abdomen. The options of end colostomy, primary anastomosis with or without fecal diversion, can all be used with this method. RESULTS: No mortality or leakage occurred in four patients. CONCLUSION: This rapid operation does not require advanced laparoscopic skills. Preliminary results should be confirmed by others.