Coronary artery spasm during anesthetic induction in a patient with bronchial asthma

A 68-year-old man was scheduled for subtotal gastrectomy. He had bronchial asthma, but had no history of ischemic heart disease and showed normal ECG. He stopped taking antiasthmatic drugs after the admission. His operation had been postponed for 10 days for an attack of bronchial asthma. The asthmatic attack was suppressed by infusing aminophilline. Before the operation, general anesthesia combined with epidural anesthesia (mepivacaine; 60 mg) was induced. At the time of the insertion of a stomach tube, bradycardia (48 bpm) and hypotension (48/30 mmHg) with an elevation of ST-segment in ECG were observed. We administrated 10 mg of isosorbide dinitrate followed by continuous intravenous injection (0.5 mg.kg-1.min-1) of dopamine (6 mg.kg-1.min-1). After 20 minutes, increases of both blood pressure (82/49 mmHg) and heart rate (89 bpm) were achieved and ST-segment in ECG was reversed. The operation was postponed again. Although the patient had refused to take coronary angiogram, the episode was explained by coronary artery spasm. Pathogenesis of the spasm was likely to be 1) elevation of endogenous cathecolamine due to asthma, 2) inhibition of cardiac sympathetic system by epidural anesthesia and 3) stimulation of vagal system by the insertion of a stomach tube.     

Functional evidence for involvement of multiple putative tumor suppressor genes on the short arm of chromosome 3 in human oral squamous cell carcinogenesis

The authors present their experience at the Centre for the surgical treatment of morbid obesity at Milano University where since 1974, 603 obese patients underwent surgery: 312 jejuno-ileal bypass (JIB), 70 bilio-intestinal bypass (BIB), 102 horizontal gastroplasties (HGP), 44 silastic ring vertical gastroplasties (SRVGP) and 75 adjustable silastic gastric banding (ASGB). Average follow-up for these procedures is 16, 6, 11, 4 years and 24 months respectively. Weight loss is satisfactory in all cases even though the percentages vary in the different procedures. The most serious complications (severe hepatic failure, oxalic interstitial nephritis, persisting malabsorption) occurred in patients submitted to JIB. The best clinical outcome with the lowest complications rate was obtained with BIB compared to other intestinal bypasses. The most frequent complication observed in patients submitted to gastroplasties was incoercible vomiting while the most severe complications were diffuse peritonitis, secondary to gastric perforation, and peripheric neuropathy. Our experience confirms that surgical treatment of morbid obesity refractory to medical therapy is today a safe and effective treatment. BIB has still a role in super-obese young patients (BMI over 50) refusing dietary restriction lifetime. The gastric procedures, especially laparoscopic ASGB, seem to be the best option. The excellent outcome of bariatric surgery can be obtained only in specialized centers where various specialists work together.     

Identification of important regions in the cytoplasmic juxtamembrane domain of type I receptor that separate signaling pathways of transforming growth factor-beta

Proteins in the transforming growth factor-beta (TGF-beta) superfamily exert their effects by forming heteromeric complexes of their type I and type II serine/threonine kinase receptors. The type I and type II receptors form distinct subgroups in the serine/threonine kinase receptor family based on the sequences of the kinase domains and the presence of a highly conserved region called the GS domain (or type I box) located just N-terminal to the kinase domain in the type I receptors. Recent studies have revealed that upon TGF-beta binding several serine and threonine residues in the GS domain of TGF-beta type I receptor (T beta R-I) are phosphorylated by TGF-beta type II receptor (T beta R-II) and that the phosphorylation of GS domain is essential for TGF-beta signaling. Here we investigated the role of cytoplasmic juxtamembrane region located between the transmembrane domain and the GS domain of T beta R-I by mutational analyses using mutant mink lung epithelial cells, which lack endogenous T beta R-I. Upon transfection, wild-type T beta R-I restored the TGF-beta signals for growth inhibition and production of plasminogen activator inhibitor-1 (PAI-1) and fibronectin. A deletion mutant, T beta R-I/JD1(delta 150-181), which lacks the juxtamembrane region preceding the GS domain, bound TGF-beta in concert with T beta R-II and transduced a signal leading to production of PAI-I but not growth inhibition. Recombinant receptors with mutations that change serine 172 to alanine (S172A) or threonine 176 to valine (T176V) were similar to wild-type T beta R-I in their abilities to bind TGF-beta, formed complexes with T beta R-II, and transduced a signal for PAI-1 and fibronectin. Similar to T beta R-I/JD1 (delta 150-181), however, these missence mutant receptors were impaired to mediate a growth inhibitory signal. These observations indicate that serine 172 and threonine 176 of T beta R-I are dispensable for extracellular matrix protein production but essential to the growth inhibition by TGF-beta.     

Anesthetic management of a multiallergic patient scheduled for cholecystectomy

A 64-year-old woman was scheduled for cholecystectomy. Her past history revealed that serious anaphylactic reactions including generalized flushing and urticaria, severe hypotension and unconsciousness which occurred after eating crab four years ago. Puncture and/or intradermal skin test and subsequent lymphocyte stimulation test to several drugs commonly used in perioperative period were performed prior to anesthesia. Positive reactions to intravenous anesthetics and muscle relaxants, and negative reactions to inhalational and local anesthetics were found. Famotidine and ketotifen fumarate were given to prevent histamine release for four days before operation. After premedication with scopolamine, a catheter was inserted into epidural space at Th9-T10 level and 2% lidocaine 2 ml was administered initially into the epidural space. Anesthesia was induced with inhalation of nitrous oxide and oxygen, and deepened gradually by the increments of sevoflurane. Tracheal intubation was performed smoothly without adjunct muscle relaxant. Anesthesia was maintained with sevoflurane and epidural anesthesia with intermittent lidocaine administration. No adverse responses were noted at the time of iopamidol injection for intraoperative cholangiography. The anesthesia and postoperative course of this patient were uneventful.     

BPF: a novel cluster boundary points detection method for static and streaming data

Data points situated near a cluster boundary are called boundary points and they can represent useful information about the process generating this data. The existing methods of boundary points detection cannot differentiate boundary points from outliers as they are affected by the presence of outliers as well as by the size and density of clusters in the dataset. Also, they require tuning of one or more parameters and prior knowledge of the number of outliers in the dataset for tuning. In this research, a boundary points detection method called BPF is proposed which can effectively differentiate boundary points from outliers and core points. BPF combines the well-known outlier detection method Local Outlier Factor (LOF) with Gravity value to calculate the BPF score. Our proposed algorithm StaticBPF can detect the top-m boundary points in the given dataset. Importantly, StaticBPF requires tuning of only one parameter i.e. the number of nearest neighbors \((k)\) and can employ the same \(k\) used by LOF for outlier detection. This paper also extends BPF for streaming data and proposes StreamBPF. StreamBPF employs a grid structure for improving k-nearest neighbor computation and an incremental method of calculating BPF scores of a subset of data points in a sliding window over data streams. In evaluation, the accuracy of StaticBPF and the runtime efficiency of StreamBPF are evaluated on synthetic and real data where they generally performed better than their competitors.