[Anesthesia for cesarean delivery in a case of myotonia congenita]

We report the case of a 29-year-old woman with congenital myotony who underwent cesarean section under intradural anesthesia with 0.5% hyperbaric bupivacaine plus fentanyl. We describe the behavior of the anesthetic used as well as the implications this condition has for the anesthesiologist.

[Infusion of propofol as anesthetic and antiemetic drug]

OBJECTIVES

To determine the possible antiemetic effect of propofol as the single agent for intravenous anesthesia in children undergoing strabismus surgery, in comparison with other techniques.

PATIENTS AND METHOD

Eighty ASA I and II patients between 3 and 10 years, divided into 4 groups of 20, were studied prospectively. Groups I, II and III were premedicated with dehydrobenzylperidol (90 micrograms/kg) i.m. Group I then received sleep doses of thiopental and N2O. Group II received propofol, sleep doses, and N2O. Groups III and IV received sleep doses of propofol followed by intravenous perfusion (10 mg/kg/h).

RESULTS

Half the patients in group I experienced postoperative vomiting, more than in groups II, III and IV (p < 0.05). The incidence of vomiting in group II was 30%. Groups III and IV experienced less vomiting (5-10%) than did groups I and II (p < 0.05). The incidence of bradycardia during surgery was higher in groups III and IV (p < 0.05); medical treatment was not required.

CONCLUSIONS

Propofol used as the single agent for induction and maintenance of anesthesia offers clear advantages in reducing emesis after strabismus surgery.

Mineral fibers induce apoptosis in Syrian hamster embryo fibroblasts

It is known that asbestos and other mineral fibers induce lung cancer and mesothelioma. However, the primary mechanisms of fiber-induced carcinogenesis still remain to be elucidated. Previous studies, including our own, have shown that asbestos causes specific mitotic disturbances, micronucleus formation and typical changes in chromatin structure resembling those of apoptosis. This effect has been considered as programmed cell death removing damaged or pre-cancerous cells. We investigated the induction of apoptosis by asbestos (amosite, crocidolite, chrysotile) and ceramic fibers. The typical ladder pattern of DNA fragments was identified by means of gel electrophoresis, the intracellular calcium concentration was measured and flow cytometry analyses were carried out to determine the percentage of apoptotic cells. The different fibers showed different potencies for the induction of apoptosis in Syrian hamster embryo (SHE) cells. Depending on the type of fiber applied 3-33% of cells underwent apoptosis. Chrysotile proved to be the most potent inducer of apoptosis compared to the other fibers. In addition, an increase intracellular calcium level was observed in apoptotic SHE cells. Chrysotile induced apoptosis after a considerably longer exposure time (66-72 h) than cisplatin (24 h). In view of these findings we hypothesize that chrysotile induces apoptosis resulting from long-term changes in intracellular regulation pathways.

Comparative analysis of Brucella serotype A and M and Yersinia enterocolitica O:9 polysaccharides for serological diagnosis of brucellosis in cattle, sheep, and goats

Hapten polysaccharides of Brucella smooth M and A serotypes were prepared from Brucella sp. and Yersinia enterocolitica O:9 by previously described hydrolytic (O chain) or nonhydrolytic (native hapten [NH]) procedures. The purified polysaccharides differed only in the presence (O chain) or absence (NH) of lipopolysaccharide core sugars. The polysaccharides were compared by reverse radial immunodiffusion for the diagnosis of brucellosis in cattle (Brucella abortus biotype 1 [A serotype] and Brucella melitensis biotype 3 [AM serotype]), sheep (B. melitensis biotypes 1 [M serotype] and 3), and goats (B. melitensis biotype 1). The reverse radial immunodiffusion test with the NH from B. melitensis 16 M (serotype M) showed the highest sensitivity (89.6 to 97.3%), regardless of the host species and the serotype of the infecting Brucella sp. Y. enterocolitica O:9 NH (A serotype) was useful for diagnosing disease in cattle infected with B. abortus biotype 1, but not in cattle infected with B. melitensis biotype 3, sheep, or goats. The different results obtained with the serotype M and A polysaccharides and the sera from animals infected with M, A, and AM serotypes of Brucella spp. showed that in naturally infected animals, a large proportion of the antibodies are directed to or react with a previously defined common epitope(s) (J. T. Douglas and D. A. Palmer, J. Clin. Microbiol. 26:1353-1356, 1988) different from the A or M epitopes. By using the radial immunodiffusion test with B. melitensis 16M NH, it was possible to differentiate infected from vaccinated cattle, sheep, and goats with a sensitivity and specificity similar to that of the complement fixation test.

[Acute ischemia of lower limb and long-term treatment with epidural bupivacaine]

We report the treatment of an ischemic lower limb (arterial obstruction shown by angiography at popliteal level, proximal to common tibioperoneal artery) with 0.125% and 0.20% epidural bupivacaine, which was continuously administered by pump during 30 days. Simultaneously, 8 mg morphine chloride was administered every 24 hours by epidural route, anticoagulation with heparin was started, and transcutaneous electrical stimulation was used. The favorable outcome, with sufficient peripheral revascularization, permitted to preserve the limb. During therapy no sign of cardiac toxicity attributable to bupivacaine was detected.