Catheter-induced anaphylaxis and determination of the causative catheter in a patient undergoing neuroendovascular surgery: a case report.

BACKGROUND: Anaphylaxis caused by a catheter itself used for endovascular surgery is rare, and a method for detection of a causative catheter has not been established. We report a case of catheter-induced anaphylaxis in which the causative catheter was successfully detected. CASE PRESENTATION: A 47-year-old male underwent neuroendovascular surgery. During surgery, blood pressure suddenly dropped and the level of tryptase indicated the occurrence of anaphylaxis. There were 24 candidate agents for the cause of anaphylaxis including 8 catheters. We performed the basophil activation test by directly mixing the catheter with blood. One catheter coated with a hyaluronic acid product showed a positive reaction, and we confirmed the result by a modified skin test using an elution solution of the catheter. Later, we successfully completed the neuroendovascular surgery without the catheter. CONCLUSIONS: The methods used in this case can be useful for the detection of the causative agent in catheter-induced anaphylaxis.

Successful Management of a Patient with Intraoperative Bleeding of More than 80,000 mL and Usefulness of QTc Monitoring for Calcium Correction.

Intraoperative massive bleeding is associated with high rates of mortality and anesthetic management of massive bleeding is challenging because it is necessary to achieve volume resuscitation and electrolyte correction simultaneously during massive transfusion. We report a case of life-threatening bleeding of more than 80,000 mL during liver transplantation in which real-time QTc monitoring was useful for an extremely large amount of calcium administration for treatment of hypocalcemia. A 47-year-old female with a giant liver due to polycystic liver disease was scheduled to undergo liver transplantation. During surgery, life-threatening massive bleeding occurred. The maximum rate of blood loss was approximately 15,000 mL/hr and the total amount of estimated blood loss was 81,600 mL. It was extremely difficult to maintain blood pressure and a risk of cardiac arrest continued due to hypotension. In addition, even though administration of insulin and calcium was performed, electrolyte disturbances of hyperkalemia and hypocalcemia with prolongation of QTc interval occurred. At that time, we visually noticed that the QT interval was shortened in response to bolus calcium administration, and we used the change of real-time QTc interval as a supportive indicator for calcium correction. This monitoring allowed for us to administer calcium at an unusually high rate, by which progression of hypocalcemia was prevented. Levels of hemoglobin and coagulation factors were preserved both by restriction of crystalloid infusion and by a massive transfusion protocol. The patient was extubated without pulmonary edema or cardiac overload and was finally discharged without any sequelae. Intensive and cooperative management for massive transfusion and electrolyte correction using QTc monitoring was considered to be a key for successful management.

Late-onset Hereditary ATTR Amyloidosis with a Novel p.P63S (P43S) Transthyretin Variant.

The patient was an 82-year-old Japanese man with no family history suggestive of amyloidosis. He developed bilateral leg edema and shortness of breath and was referred to our hospital. An electrocardiogram showed atrial fibrillation with right bundle branch block. Echocardiography showed concentric LV hypertrophy. An endomyocardial biopsy showed severe ATTR amyloid deposits. A genetic analysis of the transthyretin (TTR) gene revealed a heterozygous c.187C>T missense variant resulting in p.P63S (P43S). In silico analyses predicted that this variant only modestly altered the structure and function of the TTR protein. The p.P63S variant might be associated with an elderly-onset cardiac-dominant ATTRv phenotype.

Significance of left atrial overload by electrocardiogram in the assessment of left ventricular diastolic dysfunction.

BACKGROUND: Although assessment of left ventricular (LV) diastolic function (DF) using echocardiography is important, it is not always feasible in the clinical practice. On the other hand, left atrial (LA) overload shown by electrocardiogram (ECG) indicates LA pressure rise and LA dilatation. The purpose of this study is to examine whether LA overload by ECG can be used as an aid for evaluation of LVDF. METHODS: There were 117 subjects who underwent echocardiography and ECG on the same day. The duration of P-wave (P-duration) in lead II, the amplitude and duration of P-wave negative phase in lead V1 were measured by ECG, and terminal force (PTFV1) was calculated. We analyzed the relationships between LVDF grades and LA overload signs. RESULTS: P-duration showed a good correlation with LA volume index (LAVi) (r = 0.673, P < 0.0001) and PTFV1 showed reasonable correlations with both LAVi and average E/e' (both, r = 0.575, P < 0.0001). Both P-duration and PTFV1 showed significant differences among the LVDF classes (P < 0.0001). Among the ECG indices, P-duration [Formula: see text] 110 ms was the most powerful to judge the presence of LV diastolic dysfunction with 86% of sensitivity and specificity. CONCLUSIONS: P-duration ≥ 110 ms is useful to suggest the presence of LV diastolic dysfunction. Conventional ECG criteria (P-duration ≥ 120 ms and PTFV1 [Formula: see text] 0.04 mm·s) are highly specific and suggest the presence of LV diastolic dysfunction with LA pressure rise. Echocardiography and ECG should be used in a complementary way when LVDF grades are indeterminate.

Higher education in gerontology: A comparison of master's programs in Japan, Taiwan, and Turkey.

As of 2015, there is only one master's program of gerontology acknowledged by each of the following countries: Japan, Taiwan, and Turkey. All three programs have fewer than 15 years of history. These three countries differ in society types based on the proportion of older adults, rate of population aging, and population size. However, in terms of gerontological education, they seem to share great commonalities. Common challenges are a lack of awareness of the field of gerontology, insufficient numbers of gerontology programs and faculty members to produce trained gerontologists within society, and the inadequacy of opportunities for trained gerontologists to play an active role in various fields. This study intends not only to compare the differences and similarities among three countries and programs, but also to elucidate characteristics of a unique gerontology program in each country and identify challenges and possibilities from the perspective of gerontological educators.

[Postintubation Tracheal Stenosis in a Lightly Sedated Patient under a 10-day-long Mechanical Ventilation].

We report a case of severe laryngeal edema devel- oped after the trachea intubation for 10 days. A 78- year-old woman presented with pulmonary edema due to fluid administration for acute pancreatitis. Endotra- cheal intubation and mechanical ventilation therapy were required for 10 days. The cuff pressures and endotracheal tube positions were routinely checked. A light level of sedation was maintained during mechani- cal ventilation. Ten days later, her trachea was extu- bated. One hour after extubation, she was observed to have inspiratory stridor and she complained of respira- tory distress. Fiberoptic examination revealed laryngeal edema and ulceration of the tracheal mucosa, consis- tent with the lesion where the endotracheal tube cuff had been attached. To maintain the airway, re-intuba- tion and elective tracheostomy were performed. Light sedation during mechanical ventilation may predispose the patient to tracheal injury.