Performance of the SD Bioline TB Ag MPT64 Rapid test for quick confirmation of Mycobacterium bovis isolates from animals

Mycobacterium (M.) bovis, a bacterium in the M. tuberculosis complex, is a causative agent of bovine tuberculosis, a contagious disease of animals. Mycobacterial culture is the gold standard for diagnosing bovine tuberculosis, but this technique is laborious and time-consuming. In the present study, performance of the SD Bioline TB Ag MPT4 Rapid test, an immunochromatographic assay, was evaluated using reference bacterial strains and M. bovis field isolates collected from animals. The SD MPT64 Rapid test produced positive results for 95.5% (63/66) of the M. bovis isolates from cattle and 97.9% (46/47) of the isolates from deer. Additionally, the test had a sensitivity of 96.5% (95% CI, 91.2-99.0), specificity of 100% (95% CI, 96.7-100.0), positive predictive value of 100% (95% CI, 96.7-100.0), and negative predictive value of 92.9% (95% CI, 82.7-98.0) for M. bovis isolates. In conclusion, the SD MPT64 Rapid test is simple to use and may be useful for quickly confirming the presence of M. bovis in animals.

Effect of 6% Hydroxyethyl Starch 130/0.4 as a Priming Solution on Coagulation and Inflammation Following Complex Heart Surgery

PURPOSE: Prolonged duration of cardiopulmonary bypass aggravates the degree of inflammation and coagulopathy. We investigated the influence of 6% hydroxyethyl starch (HES) 130/0.4 on coagulation and inflammation compared with albumin when used for both cardiopulmonary bypass priming and perioperative fluid therapy in patients undergoing complex valvular heart surgery. MATERIALS AND METHODS: Fifty four patients were randomly allocated into albumin-HES, albumin-nonHES, and HES-HES groups. The cardiopulmonary bypass circuit was primed with 5% albumin in the albumin-HES and albumin-nonHES group, and with HES in the HES-HES group. As perioperative fluid, only plasmalyte was used in the albumin-nonHES group whereas HES was used up to 20 mL/kg in the albumin-HES and albumin-HES group. Serial assessments of coagulation profiles using the rotational thromboelastometry and inflammatory markers (tissue necrosis factor-alpha, interleukin-6, and interleukin-8) were performed. RESULTS: Patients' characteristics and the duration of cardiopulmonary bypass (albumin-HES; 137+/-34 min, HES-HES; 136+/-47 min, albumin-nonHES; 132+/-39 min) were all similar among the groups. Postoperative coagulation profiles demonstrated sporadic increases in clot formation time and coagulation time, without any differences in the actual amount of perioperative bleeding and transfusion requirements among the groups. Also, inflammatory markers showed significant activation after cardiopulmonary bypass without any differences among the groups. CONCLUSION: Even in the presence of prolonged duration of cardiopulmonary bypass, HES seemed to yield similar influence on the ensuing coagulopathy and inflammatory response when used for priming and perioperative fluid therapy following complex valvular heart surgery compared with conventional fluid regimen including albumin and plasmalyte.

Sedation for Pediatric Patients Undergoing MRI

Magnetic resonance imaging (MRI) requires the patients to remain completely immobile because it is very sensitive to motion artifacts. Therefore, for pediatric patients, deep sedation is required for successful MRI. Since pediatric patients are vulnerable to the complications of sedation, the most important goal is safety. For safe and successful sedation, assigning well trained anesthesiologists or non-anesthesiologist healthcare professionals for the procedure and suitable equipment, monitoring, and medications are necessary.

Inadvertent Placement of Epidural Catheter in the Extra-epidural Space: Two case reports / 대한마취과학회지

Although epidural block is a well-established anesthetic method, we often experience a failed epidural block. The success rate of epidural block is dependent on the accurate identification of the epidural space and successful location of the catheter within the epidural space. Rarely, it is missed to identify the epidural space with a loss of resistance method due to a variable anatomy of the epidural structure. Occasionally, an epidural catheter may pass into the extra-epidural space. We report 2 cases of misplacement of an epidural catheter in the extra-epidural space. These cases highlights the need for careful identification of the epidural space during epidural puncture and confirming the location for successful placement of the catheter within the epidural space by using a test block with a test dose of the local anesthetic drug after epidural catheterization.

Comparison of Maintenance and Emergence of Anesthesia in Total Intravenous Anesthesia with Propofol and Remifentanil for Thyroidectomy and Mastectomy / 대한마취과학회지

BACKGROUND: This study investigated the effect of type of surgery on consumption of propofol and remifentanil and recovery index. METHODS: Fifty female patients (ASA physical status 1, 2) scheduled for thyroidectomy (Group I) or mastectomy (Group II) received total intravenous anesthesia (TIVA) with propofol and remifentanil. The anesthesia was maintained with target-controlled infusion (TCI) of propofol and remifentanil under bispectral index (BIS) monitoring. The effect site concentration of propofol was controlled for maintaining BIS values within the range of 45-50. The effect site concentration of remifentanil was controlled for maintaining blood pressure and heart rate within 20% of baseline values. Blood pressure, heart rate, BIS, effect site concentration of propofol and remifentanil were measured before induction, during induction, at the beginning of operation, at the end of operation, and during recovery. The time from discontinuation of propofol to eye opening and regaining of orientation, total amount of propofol and remifentanil used, and the amount of drug per body weight kilogram per hour were investigated. RESULTS: There were no significant differences between Group I and II on the amount of remifentanil used. Although the amount of propofol consumed per body weight kilogram per hour was larger in Group II, there were no significant differences of recovery index between Group I and II. CONCLUSIONS: There were no significant differences in the amount of propofol and remifentanil consumed and recovery index in thyroidectomy and mastectomy under TIVA. The larger amount of propofol consumed per body weight per hour in Group II was thought as a result of shorter operation time than Group I.

External Jugular Vein: Another Landmark for Right Internal Jugular Vein Cannulation Using Ultrasound Imaging / 대한마취과학회지

BACKGROUND: Measuring the distance between internal jugular vein (IJV) and external jugular vein (EJV) on ultrasound image can give the information of the whereabouts of the IJV. We compared the success rate between carotid artery (CA)-guided and EJV-guided cannulation based on the information gathered from ultrasound. METHODS: We studied 152 patients requiring central venous cannulation during anesthesia. Ultrasound images were obtained with 7.5 MHz probe on the right neck at 0 degree, 30 degrees, and maximum rotation of the head in flat and 15 degrees Trendelenberg (T) position. The horizontal diameter of the RIJV and % overlap of the CA with the RIJV at each position, and the horizontal distance of RIJV-REJV at 30 degrees were measured on ultrasound images. In EJV group, the distance of RIJV-REJV was drawn along the cricoid level and the point of IJV was marked as the needle insertion site. Cannulation was performed with palpation of the CA in CA group and performed at the marked point in EJV group without palpation of CA. RESULTS: Overall RIJV diameter was increased in T-position compared to flat position. Following head rotation, RIJV diameter was decreased and % overlap of CA was increased (P < 0.05). In 26.8% of patients at 30 degrees in T position, CA overlapped 26-50% of RIJV. The success rate of cannulation at the first trial was 97.4% in CA group and 96.1% in REJV group. CONCLUSIONS: With the IJV identified on ultrasound image, the distance between the IJV and the EJV can be used as another landmark for RIJV cannulation provided the EJV is visualized with the naked eye.

Anesthetic Management of a Patient with Noonan Syndrome: A case report / 대한마취과학회지

Noonan syndrome is featured by short stature, mental retardation, facial dysmorphia, webbed neck, and heart defects. The phenotype has some similarities with Turner syndrome, but the karyotype is normal and males can be affected. We used Bonfils fiberscope for intubation because we suspected the difficult airway. We report the experience of anesthetic management for osteotomy of calcaneonavicular coalition in a patient with Noonan syndrome.

M. tuberculosis Somatic Antigen Specific CD8+T cell Responses in BCG-Vaccinated Subjects / 결핵및호흡기질환

BACKGROUND: The immune responses mediated by CD8+T cells are known to be significant in controlling M. tuberculosis infections. In order to determine the role of cytotoxic CD8+T cells in the protective immune mechanism in latently infected subjects, this study examined whether or not the cytotoxic immune responses of CD8+T cells specific to the M. tuberculosis somatic antigens are induced in BCG vaccinated healthy subjects. METHODS: Cytotoxicity and IFN-gamma elispot assays were used to investigate the activities of CD8+T cells specific for the thyA30-38 peptide epitope in circulating peripheral blood mononuclear cells (PBMC) from BCG-vaccinated HLA-A*0201 and A*0206 subjects. RESULTS: The results indicate the cytotoxic and IFN-gamma immune responses of CD8+T cells specific for thyA30-38 were induced in BCG vaccinated healthy subjects. CONCLUSION: The cytotoxic and IFN-gamma responses by CD8+T cells specific for the M. tuberculosis somatic antigens are induced in BCG-vaccinated subjects, and appear to be involved in the protective immune mechanism in latently infected people against a M. tuberculosis infection.

The Study of MHC class I Restricted CD8+ T Cell Mediated Immune Responses against Mycobacterium tuberculosis Infection: Evidence of M. tuberculosis Specific CD8+ T Cells in TB Patients and PPD+ Healthy Individuals

BACKGROUND: The protective immunity against tuberculosis (TB) involves both CD4+ T cells and CD8+ T cells. In our previous study, we defined four Mycobacterium tuberculosis derived peptide epitopes specific for HLA-A*0201 restricted CD8+ T cells (ThyA30-38, RpoB127-135, 85B15-23, PstA175-83). In this study, we investigated the immune responses induced by these peptide specific CD8+ T cells in latently and chronically infected people with TB. METHODS: We characterized these peptide specific CD8+ T cell population present in PBMC of both TB patients and PPD healthy people using IFN-gammaelispot assay, intracellular staining and HLA-A2 dimer staining. RESULTS: The frequency of peptide specific CD8+ T cell was in the range of 1 to 25 in 1.7x10(5) PBMC based on ex vivo IFN-gamma elispot assay, demonstrating that these peptide specific CD8+ T cell responses are induced in both TB patients and PPD people. Short term cell lines (STCL) specific for these peptides proliferated in vitro and secreted IFN-gamma upon antigenic stimulation in PPD+ donors. Lastly, HLA-A*0201 dimer assays indicated that PstA175-83 specific CD8+ T cell population in PPD+ healthy donors is heterogeneous since approximately 25~33% of PstA175-83 specific CD8+ T cell population in PPD+ healthy donors produced IFN-gamma upon peptide stimulation. CONCLUSION: Our results suggest that MHC class I restricted CD8+ T cell mediated immune responses to M. tuberculosis infection are induced in both TB patients and PPD+ people; however, the CD8+ T cell population is functionally heterogeneous.

Benefits of a ProSeal Laryngeal Mask Airway in a Laparoscopic Cholecystectomy / 대한마취과학회지

BACKGROUND: The ProSeal laryngeal mask airway (PLMA) is a new laryngeal mask device with a larger cuff and a drainage tube. This study was designed to assess the usefulness and the safety of the PLMA in a laparoscopic cholecystectomy. METHODS: Forty patients undergoing a laparoscopic cholecystectomy were randomly allocated to two groups; an endotracheal tube (ETT) group or a PLMA group. Anesthesia was induced with intravenous fentanyl and propofol and maintained with TCI-propofol. Blood pressure, heart rate, peak inspiratory pressure, peripheral O2 saturation (SpO2), end-tidal CO2 tension (PETCO2) and PaCO2 was measured during the operation. The incidence of gastric content regurgitation and gross pulmonary aspiration were evaluated. Postoperatively, SpO2, the visual analogue scale (VAS) of pain, nausea and vomiting (PONV), and sore throat were evaluated at 30 minutes intervals in post-anesthetic care unit (PACU) and at night. RESULTS: There were no significant differences in intraoperative PIP, SpO2, PETCO2, postoperative SpO2, VAS scores, PONV, and sore throat between the two groups. Gross pulmonary aspiration was not found in either group, but minimal gastric regurgitation occurred in 2 cases of the ETT group and 1 case of the PLMA group. CONCLUSIONS: We concluded that there were no differences in patient safety and adequate ventilation for a laparoscopic cholecystectomy between the ETT group and PLMA group. Moreover, there were no increases in blood pressure and heart rate in PLMA group during insertion/intubation.