Perioperative administration of recombinant activated factor VII in a Glanzmann's thrombasthenia patient with platelet refractoriness: case report

Abstract Glanzmannʼs Trombasthenia (GT) is a genetic disorder, that develops with a tendency toward bleeding and is characterized by the absence or decrease in platelet aggregation. Surgical bleeding may be difficult to control. Platelet transfusion is the main treatment, albeit refractoriness can occur. We describe the case of a patient with GT and platelet refractoriness, who was submitted to radical prostatectomy and dental extraction. The perioperative treatment with apheresis platelet concentrate and activated recombinant factor seven allowed the procedures to be performed uneventfully. We discuss the complexity of the case and the treatment option.

Validation of new analytical methodology for determining fenoterolhydrobromide by HPLC: application in pharmaceutical products

Fenoterol hydrobromide is a B2-adrenergic agonist agent used for asthma and chronic obstructive pulmonary disease treatment. HPLC methodology was developed and validated for quantitative determination of fenoterol hydrobromide. The methodology was achieved by using a reversed-phase C18column, (150 mm ¡Á 3.9 mm i.d., 5 ¦Ìm) Thermo. The mobile phase was consisted of acetonitrile: water(30:70, v/v) with 0,1% triethylamine, pH adjusted to 5.0 with formic acid and flow rate of 1.0 mL.min-1with UV detection at 276 nm. The concentration range was from 0.025 to 0.15 mg.mL-1, and the correlation coefficient of analytical curve was >0.999. The detection limit and the quantifying limit (QL) were 0.003mg.mL-1 and 0.012 mg.mL-1, respectively. Intra- and interday relative standard deviations were ¡Ü2.0%. Themetho dology accuracy showed the percentage mean of 99.53%. The described technique was found to be simple, rapid, precise, accurate and sensitive; the advantages over the others current methodologies arethe low-cost and low-polluting conditions. Owing to its simplicity and reliable results, this methodology is suitable to be used in quality control of pharmaceutical drugs containing fenoterol hydrobromide as active componente.

Mioclonia espinhal após anestesia subaracnoidea com bupivacaína / Spinal myoclonus after subarachnoid anesthesia with bupivacaine

JUSTIFICATIVA E OBJETIVOS: Apresenta-se neste relato de caso uma complicação muito rara após a anestesia espinhal, com o objetivo de oferecer algum subsídio ao manuseio e à conduta terapêutica. RELATO DO CASO: Paciente de 63 anos, negro, ASA I, programado para a ressecção transuretral da próstata (RTU), foi submetido a uma anestesia subaracnoidea com bupivacaína (15 mg) sem adrenalina. A punção não apresentou intercorrências e o paciente foi posicionado para cirurgia. Logo após o posicionamento cirúrgico, o paciente reclamou de dor intensa na região perineal, acompanhada de movimentos involuntários, tipo contrações tônico-clônicas, nos membros inferiores. O paciente recebeu benzodiazepínico para controle das mioclonias, sem resultado. Em seguida, o paciente apresentou agitação importante e, submetido à intubação orotraqueal, foi mantido em ventilação controlada e encaminhado para a Unidade de Cuidados Intensivos. Apesar da realização de todos os exames bioquímicos e de imagem, nenhuma causa aparente foi detectada. Não houve troca de medicação e o mesmo lote de anestésico havia sido usado em outros pacientes naquele dia, sem intercorrências. CONCLUSÕES: Com o afastamento de todas as causas possíveis, foi aceito, por exclusão, o diagnóstico de mioclonia espinhal pós-raquianestesia com bupivacaína.

BACKGROUND AND OBJECTIVES: It is presented in this case report a very rare complication after spinal anesthesia to provide subsidies to the management and therapeutic conduct. CASE REPORT: This is a 63-year old African-Brazilian patient, ASA I, scheduled for transurethral resection of the prostate (TURP). He underwent subarachnoid anesthesia with bupivacaine (15 mg) without adrenaline. Intercurrences were not observed during puncture, and the patient was positioned for surgery. Soon after positioning the patient, he complained of severe pain in the perineum region followed by involuntary tonic-clonic movements of the lower limbs. The patient was treated with a benzodiazepine to control the myoclonus without response. This episode was followed by significant agitation and the patient was intubated. He was maintained in controlled ventilation and transferred to the Intensive Care Unit. Despite all biochemical and imaging tests performed, an apparent cause was not detected. The medication was not changed and the same batch of anesthetic had been used in other patients that same day without intercurrences. CONCLUSIONS: After ruling out all possible causes, the diagnosis of spinal myoclonus after spinal anesthesia with bupivacaine was made by exclusion.

JUSTIFICATIVA Y OBJETIVOS: En este relato de caso, presentamos una complicación muy rara después de la anestesia espinal, con el objetivo de ofrecer algún subsidio para el manejo y la conducta terapéutica. RELATO DEL CASO: Paciente de 63 años, negro, ASA I, programado para la resección transuretral de la próstata (RTU), que fue sometido a una anestesia subaracnoidea con bupivacaína (15 mg), sin adrenalina. La punción no presentó intercurrencias y el paciente fue posicionado para la cirugía. Inmediatamente después del posicionamiento quirúrgico, el paciente se quejó de un intenso dolor en la región perineal, seguido de movimientos involuntarios, como contracciones tónico-clónicas en los miembros inferiores. El paciente recibió benzodiazepínico para el control de las mioclonías, sin resultados. Enseguida, debutó con una agitación importante y fue sometido a la intubación orotraqueal y mantenido bajo ventilación controlada. Posteriormente fue derivado a la Unidad de Cuidados Intensivos. A pesar de la realización de todos los exámenes bioquímicos y de imagen, no se detectó ninguna causa aparente. No hubo cambio de medicación y se usó el mismo lote de anestésico que había sido usado en otros pacientes aquel día, sin intercurrencias. CONCLUSIONES: Al descartar todas las posibles causas, se aceptó, por exclusión, el diagnóstico de la mioclonía espinal postraquianestesia con bupivacaína.

The unusual and potentially fatal growing teratoma syndrome

Objective: Growing teratoma syndrome consists of germ cell tumors that grow following chemotherapy despite complete eradication of the malignant cells and normalization of the tumor markers. They can metastasize to any site, particularly the retroperitoneum, mediastinum and cervical region. Here we report our experience with this rare syndrome and stress the need for early recognition and treatment to avoid the subsequent morbidity and mortality associated with it. Patients and Methods: We reviewed the hospital records of patients suffering from testicular tumors with retroperitoneal metastasis treated at our hospital between January 2002 and December 2006. We included those who underwent radical orchiectomy, followed by chemotherapy and retroperitoneal lymphadenectomy for persistence of post-treatment large tumor, but whose tumor markers had normalized. Results: In this period, fourteen patients underwent retroperitoneal lymphadenectomy for persistence of tumor masses and normalization of tumor markers. Of these, the result of the anatomo-pathological examination was teratoma in six cases. Two of these patients evolved poorly and died from the disease; one because we were unable to fully remove the lesion, with subsequent renal insufficiency from bilateral ureteral obstruction and colonic obstruction with sepsis and the other due to cachexia because of the impossibility of removing the cervical and thoracic masses. Conclusions: Patients suffering from growing teratoma syndrome need to be recognized and treated surgically as soon as possible to avoid the negative consequences of morbidity and death, as occurred in two of our patients.