Amniotic fluid embolism: A case report of good outcome with timely intensive multidisciplinary team involvement

OBJECTIVE

Amniotic fluid embolism is one of the most serious pregnancy complications. It can cause sudden maternal collapse with high mortality and morbidity. We present a case report regarding the important of prompt decision making and multidisciplinary team work for management of amniotic fluid embolism to yield favorable maternal and neonatal outcome.

CASE REPORT

This is a 35-year-old, gravida 2, para 1, woman underwent labor induction at gestational age of 37 + 6 weeks due to elective induction. She had sudden facial cyanosis and shortness of breath right after artificial rupture of membrane. Prompt decision of urgent cesarean section, aggressive and timely massive blood transfusion and multidisciplinary team work had spared patient from extracorporeal membrane oxygenation placement and prolonged hospitalization. A male infant was born with Apgar score 3' -> 5' with estimate body weight of 2958 gm; he was hospitalized for 10 days and no other complications was found at follow up pediatric outpatient clinic.

CONCLUSION

One of the most dreadful, but rare pregnancy complications is amniotic fluid embolism (AFE). It can cause serious maternal and neonatal morbidity and mortality. Rapid recognition and multidisciplinary team management are essential to maternal and neonatal prognosis.

Acute chorioamnionitis complicated with symmetrical peripheral gangrene

OBJECTIVE

Symmetrical peripheral gangrene (SPG) is an uncommon but important clinical syndrome. We present a case of acute chorioamnionitis complicated with SPG.

CASE REPORT

A 33-year-old female (gravida 5, para 2) was admitted with preterm premature rupture of membranes (PPROM) at 20 weeks and four days of gestation. She received cervical cerclage four days ago. Seven days after the diagnosis of PPROM, she developed fever, tachypnea and tachycardia. Termination of pregnancy was decided for clinical diagnosis of sepsis. After the abortus was born, gangrene change on the nose was noticed. Afterwards, this patient developed acrocyanosis of extremities. SPG developed following sepsis with intravascular disseminated coagulation (DIC). After intensive care, the patient underwent hyperbaric oxygen therapy and fasciectomy of the left forearm.

CONCLUSION

We suggest awareness of SPG associated with acute chorioamnionitis. Early recognition of SPG, multidisciplinary care, and treatment of its underlying conditions are the mainstays of management.

N-glycosylation and residues Asn805 and Asn890 are involved in the functional properties of type VI adenylyl cyclase

In this study, we demonstrate that type VI adenylyl cyclase (ACVI) is glycosylated in vivo. Treating HEK293 cells expressing ACVI with tunicamycin to block the addition of N-linked oligosaccharide or removing the N-linked oligosaccharide by in vitro peptidyl-N-glycosidase F digestion reduced the molecular mass of ACVI. Furthermore, tunicamycin treatment suppressed the forskolin-stimulated activity of ACVI. Mutation of either one or both potential N-glycosylation sites (Asn(805) and Asn(890), located on extracellular loops 5 and 6, respectively) also reduced the molecular mass of ACVI. Therefore, ACVI was glycosylated at both Asn(805) and Asn(890). Confocal analysis indicated that glycosylation was not required for the delivery of ACVI to the cell surface. Although no significant alterations in K(m) values for ATP or sensitivity to divalent cations were detected, the glycosylation-deficient ACVI mutant N805Q/N890Q-ACVI exhibited much lower forskolin-, Mn(2+)-, and Mg(2+)-stimulated cyclase activities than did wild-type ACVI. By contrast, the Galpha(s)-stimulated cyclase activities of wild-type ACVI and N805Q/N890Q-ACVI were indistinguishable. Furthermore, compared with wild-type ACVI, N805Q/N890Q-ACVI was less sensitive to inhibition mediated by dopamine D2 receptors or by protein kinase C. Collectively, glycosylation of ACVI not only affected its catalytic activity in an activator-dependent manner, but also altered its ability to be regulated by a Galpha(i) protein-coupled receptor or by protein kinase C.

Pulmonary valvular stenosis complicated by cerebrovascular accident and congestive heart failure in a young child

Pulmonary valvular stenosis (PS) with intact ventricular septum is a common congenital heart disease. In general, mild PS has a benign clinical course. However, in severe PS and some cases of moderate stenosis, increasing severity of the lesion may occur. The manifestations of either cerebrovascular accident (CVA) or congestive heart failure (CHF) are rarely reported in pediatric patients with PS. In this report, we describe a girl with severe PS complicated by seizures and sudden onset of hemiparesis at 13 months of age who developed CHF when 16 months old. CHF was cured after successful balloon valvuloplasty. She remained well without residual hemiparesis or recurrent seizures during the 1-year follow-up. Early balloon valvuloplasty should be emphasized in patients with severe PS, even if there are no significant clinical symptoms. With prompt balloon valvuloplasty, these complications can be effectively prevented.

Electrode-electrolyte interface impedance: experiments and model

The impedance of the junction between a solid or aqueous electrolyte and a metal electrode at which no charge transfer processes occur (blocking contacts) follows closely the constant phase angle form, Z = A(j omega)-n, over a wide frequency range, where A is a constant, and the frequency exponent n is typically in the range of 0.7 to 0.95. Several models have been proposed in which the magnitude of the frequency exponent n is related by a simple expression to the fractal dimension d of the rough electrode surface. But experiments with aqueous H2SO4 and roughened platinum and silicon electrodes show that there is no simple relationship, if any at all, between n and d when d is determined from the analysis of one dimensional surface profiles. Moreover, n is not a simple function of the average roughness of the electrode. In order to gain some insight into the effect of electrode topography and the interface impedance, a model for the response of the interface to a constant voltage pulse was constructed. This model is based on the idea that, following a pulse, locally concentrated regions of ions accumulate rapidly at the tips of large protrusions on the electrode surface which screens deeper regions of the electrode from the field driven flux of mobile ions. After this rapid charging, ions are able to reach the deeper, screened regions of the electrode by diffusion, and it is this diffusive process that gives rise to the observed t1-n dependence of the charge collected. Computer simulations, similar to the diffusion limited aggregation model, using measured profiles as fixed (non-growing) clusters, gave exponents n in good agreement with experiment.