Production of extracellular enzymes by Microsporum canis and their role in its virulence.

Microsporum canis is the most prevalent dermatophyte of domestic animals. Several enzymes produced by dermatophytes, particularly keratinases, are considered to play a role in the virulence of this fungus. To investigate the possible relationship between the clinical status of M. canis infection and enzymatic activity of isolates, we studied the relationship between keratinase, elastase, lipase and DNase levels produced in vitro by different isolates and virulence as expressed in a guinea pig model. Samples isolated from symptomatic dogs and cats showed a statistically significantly (P < 0.05) higher keratinase activity than samples isolated from asymptomatic animals. Experimental infection of guinea pigs showed that a strain with high in vitro keratinase activity induced acute infection, which resolved clinically and mycologically faster than the infection induced by a strain with low keratinase activity. This suggested a strong correlation between high keratinase activity and the development of symptoms. The same correlation was not observed for other enzymes tested.

Lipid status after combined pancreas-kidney transplantation and kidney transplantation alone in type I diabetes mellitus.

This study was designed to compare changes in lipid status following organ transplantation between type I diabetes mellitus (DM-I) patients receiving combined pancreas-kidney transplantation (PKT) with those receiving kidney transplantation alone (KTA). A retrospective chart review was used to identify pre- and posttransplantation fasting total cholesterol (TC) and triglycerides (TG) in three groups: DM-I patients receiving KTA (DM:KTA; n = 14), DM-I patients receiving PKT (DM:PKT; n = 20), and kidney transplant recipients without DM (NDM; n = 16). The groups were matched for age, gender, weight, duration of dialysis, smoking history, and duration of diabetes mellitus. Linear regression was used to analyze differences in lipid trends over time (up to 24 months posttransplantation) and the effects of prednisone dose, cyclosporine dose, and serum creatinine. Preoperative TC was significantly lower in the DM:KTA group (P < 0.05) compared with DM:PKT or NDM. There were no significant differences in preoperative TG between the three groups. TC and TG decreased over time only in DM:PKT (P = 0.0112, P = 0.0278, respectively). TC increased and TG was unchanged over time in DM:KTA (P = 0.0003, P = 0.1103, respectively). Neither TC nor TG changed over time in NDM. Trends of TC and TG for DM:PKT were significantly different from DM:KTA (P < 0.01 for both). Trend of TC for NDM was also significantly different from DM:PKT (P = 0.0061). Prednisone dose was significantly related to TC in DM:KTA and NDM (P < 0.01) while cyclosporine dose was significantly related to TC for DM:KTA only (P = 0.0013) in the presence of time. None of the variables tested (prednisone dose, cyclosporine dose, and serum creatinine) significantly affected TG in the presence of time. In summary, TC and TG decreased over time only in DM:PKT. In contrast, TC increased while TG was unchanged in DM:KTA over the same interval (0-24 months). If these trends continue, the beneficial change in lipids in the DM:PKT group may translate into a net improvement in atherosclerosis-mediated events for diabetic patients with chronic renal failure who receive PKT compared with those who do not.

A prospective, randomized, controlled comparison of retrobulbar and general anesthesia for strabismus surgery.

A prospective, randomized controlled study (n = 95) was conducted to compare the morbidity and length of hospital stay associated with retrobulbar neuromuscular blockade (LA) with that associated with general anesthesia (GA) for monocular strabismus surgery in adult patients. A scoring system was developed to assess postoperative nausea and vomiting, pain, level of consciousness, oral intake, and activity while in the hospital and for the first 3 postoperative days. There was no significant difference in the postoperative nausea and vomiting associated with the two anesthetic techniques. Although patients receiving LA experienced less immediate postoperative discomfort (P < .01) and had greater levels of activity (P < .0001) while in the hospital, the discomfort and activity levels of the two groups were similar at home. The LA group was discharged from the hospital sooner (mean, 135 minutes vs 250 minutes; P < .001), allowing more efficient use of hospital resources. Both techniques provided excellent anesthesia for monocular strabismus surgery.

Enflurane-induced grand mal seizures during otic microsurgery.

Abnormal electroencephalographic seizure-like activity and myoclonic movements have been recognized during enflurane anesthesia. This is most commonly seen in the presence of respiratory alkalosis and high concentrations of enflurane. Immediate and delayed postoperative generalized tonic-clonic convulsions have also been reported after enflurane anesthesia. Experimental studies have shown that auditory stimuli could facilitate seizure activity during deep enflurane anesthesia. Here we report a case of intraoperative generalized tonic-clonic convulsion during low concentrations of enflurane without evidence of hyperventilation and the presence of auditory stimulation.

Anesthetic considerations for the oral surgery patient with hemophilia.

Hemophiliac patients undergoing oral surgical procedures can be a challenge for both dental and medical personnel involved in their care and treatment. Anesthetic management of hemophiliac patients may be safely attained by various pain control techniques including local anesthesia. Possible complications resulting from administration of anesthesia must be kept in mind at all times. Preparation, caution, and gentleness are necessities for administration of safe and effective anesthesia to the hemophiliac patient.

Case report: increased myocardial irritability with halothane and aminophylline.

Increased cardiac sensitivity to epinephrine during halothane anesthesia has been well documented; however, there are few reports of increased cardiac irritability due to interaction between halothane anesthesia and aminophylline. The following case report is suggestive of such an interaction resulting in ventricular tachycardia.