Anaphylactoid reaction to maltose 5% solution during spinal anaesthesia.

PURPOSE: A rare case of an anaphylactoid reaction to maltose solution is presented. CLINICAL FEATURES: A 28-yr-old man underwent repair of bilateral inguinal hernia under spinal anaesthesia with dibucaine. At the end of operation, he developed generalized flush and circulatory collapse immediately after receiving Na acetate solution containing maltose, 5%, i.v. The reactions were treated with 32 mg ephedrine and 250 mg methylprednisolone i.v., and rapid infusion of 1,000 ml acetated Ringer's solution. The skin tests provoked positive responses to maltose solutions. CONCLUSION: The clinical features and skin tests suggested that the episode was an anaphylactoid reaction to maltose. Maltose is one of the dissacharides (MW: 342) produced from starch and glycogen. Maltose solutions are used frequently in Japan as a carbohydrate source. Further study is required to confirm whether maltose has an immunological antigen-eliciting activity.

Use of a fusion protein to obtain crystals suitable for X-ray analysis: crystallization of a GST-fused protein containing the DNA-binding domain of DNA replication-related element-binding factor, DREF.

Crystals of glutathione-S-transferase (GST)-fused protein containing the DNA-binding domain of DNA replication-related element-binding factor, DREF, were obtained under crystallization conditions similar to those for GST. Preliminary X-ray crystallographic analysis revealed that crystals of the GST-fused protein belong to space group P6(1)22 or P6(5)22 with unit cell dimensions a = b = 140.4 A, c = 93.5 A and gamma = 120 degrees, having one molecule in the crystallographic asymmetric unit. The crystals diffract to 2.5 A resolution. The cell dimensions are related to those of GST crystals thus far reported. Crystallization of the DNA-binding domain that was cleaved from the fused protein by thrombin was also carried out using several methods under numerous conditions, but efforts to produce well-ordered large crystals were unsuccessful. A possible application of GST-fusion proteins for small target proteins or domains to obtain crystals suitable for X-ray structure determination is proposed.

[Changes in hemodynamics and mixed venous oxygen saturation during intraoperative harvest of autologous platelet-rich plasma].

Intraoperative harvest and transfusion back of platelet-rich plasma (PRP) are an effective procedure to decrease the requirement of blood transfusion. We selected the right atrium as the site for collection and transfusion back of the blood for the harvest of PRP. We studied changes of the hemodynamics and mixed venous oxygen saturation (SvO2 during the intraoperative harvest of autologous PRP in two patients who were undergoing cardiopulmonary bypass (CPB) surgery. The whole blood was collected, processed and the red blood cells were transfused immediately back to the patients using the Plasma Collection System (Haemonetics Model 50). The procedure was accomplished prior to starting CPB. The PRP product was transfused back into the patients at the completion of CPB. The arterial blood pressure, cardiac output, and SvO2 decreased during the collecting phase and immediately returned to the baseline values during the returning phase. No change was observed in the heart rate and arterial oxygen saturation. We conclude that the usage of right atrium as the site for collection and transfusion back of the blood to harvest PRP is effective and useful, and the continuous monitoring of SvO2 is mandatory for detecting the decline of the cardiac output.

Caroli's disease: scintigraphic and radiographic findings.

Caroli's disease is a rare congenital anomaly of the liver. Since new diagnostic techniques for the evaluation of hepatic disease have been introduced, the number of reported cases of Caroli's disease has been gradually increasing. This report describes the case of a 13 year old girl with nausea, vomiting, fever and hepatomegaly. The diagnosis of Caroli's disease was established by ultrasonography and CT scan. The complications and management are discussed. The important points in management are to relieve symptoms and to conduct regular examinations by ultrasonography for the early detection of hepatobiliary carcinoma.