Anesthetic considerations for cesarean section in the parturient with familial cardiomyopathy

Dilated cardiomyopathy (DCM) is a heart muscle disease characterized by ventricular dilatation and impaired systolic cardiac function. DCM is defined by the presence of: a) fractional myocardial shortening less then 25% (> 2 SD) and/or ejection fraction less than 45% (> 2 SD); and b) left ventricular end diastolic diameter (LVEDD) greater than 117% excluding any known cause of myocardial disease. Familial dilated cardiomyopathy (FDC) accounts for 20-48% of all DCM cases, and is defined by the presence of two or more affected relatives with DCM meeting the above diagnostic criteria or a relative of a DCM patient with unexplained sudden death before the age of 35 years. We herein present the first reported case in the literature of a parturient with FDC undergoing urgent Cesarean section (secondary to worsening cardiac function) and briefly highlight anesthetic considerations for parturients with this heart condition.

Common molecular signature in SOD1 for both sporadic and familial amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) is a devastating motor neuron degenerative disease whose etiology and pathogenesis remain poorly understood. Most cases of ALS ( approximately 90%) are sporadic (SALS), occurring in the absence of genetic associations. Approximately 20% of familial ALS (FALS) cases are due to known mutations in the copper, zinc superoxide dismutase (SOD1) gene. Molecular evidence for a common pathogenesis of SALS and FALS has remained elusive. Here we use covalent chemical modification to reveal an attribute of spinal cord SOD1 common to both SOD1-linked FALS and SALS, but not present in normal or disease-affected tissues from other neurodegenerative diseases, including Alzheimer's, Parkinson's, and Huntington's diseases and spinal muscular atrophy, a non-ALS motor neuron disease. Biotinylation reveals a 32-kDa, covalently cross-linked SOD1-containing protein species produced not only in FALS caused by SOD1 mutation, but also in SALS. These studies use chemical modification as a novel tool for the detection of a disease-associated biomarker. Our results identify a shared molecular event involving a known target gene and suggest a common step in the pathogenesis between SALS and FALS.

Transport behavior of 3,3'-dichlorobenzidine in a freshwater estuary

Like many hydrophobic organic compounds, 3,3'-dichlorobenzidine (DCB) partitions preferentially to (sediment) particles in lake systems. As such, the behavior of DCB in these systems is substantially affected by the movement of sediments. A field investigation of DCB distribution in sediments of Lake Macatawa (Holland, MI, USA) was initiated. The pattern of DCB distribution within the lake was found to display an oscillatory pattern that was consistent with a wind-driven mechanism of sediment transport. Numerical modeling of seiching behavior supported the hypothesized importance of this mechanism of sediment transport and redistribution. The dynamic behavior of sediment-associated DCB within Lake Macatawa seems to be strongly influenced by phenomena that are common to many freshwater estuaries. As such, the behavior of this system is expected to represent a reasonable model of the dynamic behavior of hydrophobic contaminants in other freshwater estuaries.

Congenital longitudinal deficiency of the fibula: follow-up of treatment by Syme amputation

Congenital longitudinal deficiency of the fibula presented two major problems in management: severe shortening of the limb and equinovalgus deformity of the ankle and foot. When the deformity was severe, our attempts at reducing the deformities of the foot and ankle with soft-tissue procedures and our attempts at achieving limb-length equality with various lengthening procedures were unsuccessful. Our best results in these patients were achieved with an early Syme amputation. The pattern of the deformity and the determination of the growth inhibition factor in the involved limb now enable us to make an early estimate of the deformity and plan appropriately. Syme amputation is definitive and allows the patient to have nearly normal function of the limb and a prosthesis of excellent appearance.