Awake nasotracheal fiberoptic intubation and self-positioning followed by anesthesia induction in prone patients: A pilot observational study.

Anesthesia followed by placement in the prone position takes time and may result in complications. This study aimed to evaluate the feasibility of awake nasotracheal fiberoptic intubation and self-positioning followed by anesthesia induction in prone-positioned patients under general anesthesia.Sixty-two patients (ASA physical status I-II) scheduled for awake nasotracheal fiberoptic intubation and prone self-positioning before surgery under general anesthesia were selected. Patient preparation began with detailed preoperative counseling regarding the procedure. Premedication with sedative and antisialagogue was followed by airway anesthesia with topical lidocaine; then, awake nasotracheal fiberoptic intubation was carried out. The patients then positioned themselves comfortably before induction of general anesthesia. The changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), incidence of coughing or gagging, and rate pressure product (RPP) were assessed. Statistical analysis was performed with repeated-measures one-way analysis of variance.Fifty-eight of the 62 patients completed prone self-positioning smoothly. Compared with values before intubation, SBP, DBP, HR, and RPP were slightly increased after intubation, although the difference was not statistically significant (P > 0.05). One patient had moderate coughing and 1 patient had gagging during prone self-positioning, which were tolerable.These findings indicated that awake nasotracheal fiberoptic intubation and self-positioning followed by induction of anesthesia is safe and feasible alternative to routine prone positioning after induction of general anesthesia.

[Etiologic analysis of 487 cases of ophthalmoplegia].

OBJECTIVE: To study the etiology of ophthalmoplegia cases. METHODS: A retrospective case series study. We summarized and analyzed etiological diagnosis of 487 ophthalmoplegia patients from January 2005 to September 2010 in Beijing Tongren Hospital of Capital Medical University and Beijing Tongren Eye Center. Clinical data included the case history, clinical manifestations, and results of examinations of neurology, ophthalmology, endocrinology and iconography. The analysis of variance (ANOVA) and Chi-Square test were used in our study. RESULTS: Nineteen different kinds of causes were identified. In terms of age onset, microvascular ischemic (MVI) patients were the oldest (60.38 +/- 11.16) in all groups. It significantly distinguished from myasthenia gravis (MG) and local non-specific inflammation (F = 24.46, P = 0.000). From the view of ophthalmoplegia characters, bilateral asymmetry ophthalmoplegia was the character of MG. We also found that all MVI patients had lesions in unilateral single ocular movement nerve. Unilateral multiple nerves or muscles lesions were the main feature of local non-specific inflammation. In addition, from the view of concomitant symptoms, local aching was very frequent in local non-specific inflammation (all 60 cases) and MVI (44 cases) patients (Chi2 = 36.346, P = 0.000). The mild pupil changing could be found in about one half patients of the two diseases (Chi2 = 0.026, P = 0.875). CONCLUSIONS: The causes of ophthalmoplegia are very complicate. MG, MVI and local non-specific inflammation are the most frequent causes. In more than half of patients, the lesions are located in neurological system, about one third located in neuromuscular junction and the least in the muscles.

[Preparation and identification of monoclonal antibody against hMOF].

OBJECTIVE: To prepare and identify the monoclonal antibody (mAb) against hMOF. METHODS: BALB/C mice were immunized with protein from the spleen cells isolated and fused with SP2/0 cells. After several rounds of screening and cloning, the hybridoma cell strain secreting anti-hMOF mAb was obtained. Its specificity was evaluated with ELISA and Western blot, and the titer, immunoglobulin subtype and affinity of the mAb were measured. RESULTS: One cell strains of hybridoma were obtained and named as 4C1C8. The anti-hMOF mAb secreted by the hybridoma cell strain was identified as IgG1 subtype. The mAb titers in ascitic fluid were 1 409600, as determined with ELISA with an affinity reaching to 7.65 x 10(6) L/mol. Western blot demonstrated that the antibodies could specifically recognize the immunogen. The cell immunohistochemistry proved that the antibody could recognize the hMOF antigens expressed on the normal cells HL7702. CONCLUSION: The success in anti-hMOF mAb preparation provides the basis for further study of hMOF.

[Childhood-onset myasthenia gravis: the analysis of influencing factors of therapeutic effect and prognosis].

OBJECTIVE: Though myasthenia gravis (MG) is a typical autoimmune disorder, there was some controversy on the treatment of the childhood-onset MG. By observing the efficacy of different therapies, the authors analyzed the affecting factors of prognosis in childhood-onset MG. METHOD: The retrospective data of 155 patients with childhood-onset MG (age of MG onset was less than 15 years) were collected from Department of Neurology, Beijing Tongren Hospital (January 2000 - February 2010). The patients were non-randomly divided according to their treatment into 3 groups (glucocorticoid, thymectomy and glucocorticoid combined with thymectomy groups). Postintervention status meeting the criteria of Myasthenia Gravis Foundation of America (MGFA) "complete stable remission, CSR", "pharmacologic remission, PR", "minimal manifestations, MM", or "Improved, I" was regarded as desirable response, which was used as primary indicator of observation. The authors assessed the efficacy of three therapies and analyzed the influencing factors of prognosis by using Chi-square test and Logistic regression. RESULT: At 3 months of treatment, glucocorticoid group showed the highest effective rate. At the end of 1 year or 2 years of treatment, glucocorticoid combined with thymectomy group showed the highest effective rate respectively. The generalization rate of MG at 2 years, 10 years and 20 years in childhood-onset ocular MG patients were 4.3%, 10.7%, and 41.5%, respectively. Of patients with generalization of MG, 48.1% occurred within 2 years, 92.6% within 20 years. Univariate analysis showed that in childhood-onset ocular MG patients, variables such as age at onset (> 10 years), LG-MG and with chronic fatigue were significantly associated with general MG conversion. Whereas multivariate analysis showed that patients with age at onset (> 10 years) and chronic muscle fatigue were apt to convert to generalized MG. CONCLUSION: Glucocorticoid appeared to have an effect that leads to early remission of symptoms in childhood-onset MG patients and glucocorticoid combined with thymectomy appeared to have better long-term effect. For those childhood-onset ocular MG patients with longer course of disease, older age of onset, chronic fatigue, or LG-MG, physicians should try to prevent the generalization of MG by immunosuppressive therapies.

[Analysis of characteristics of ocular manifestations of benign intracranial hypertension].

OBJECTIVE: To investigate the ocular manifestation of benign intracranial hypertension (BIH). METHODS: It was a retrospective case series study. Clinical data of BIH patients were investigated retrospectively, including symptom, fundus findings, visual acuity and visual field. RESULTS: It was a retrospective case series study. The majority of 67 patients were female (46 cases, 87%), of which 71.7% were over-weight. While ocular symptoms were reported in 94.0% (63 cases) of cases in whole disease course, 28 cases (41.8%) primarily presented with ocular symptoms, including transient bilateral loss of vision, visual deterioration and diplopia. Papilledema was found in 65 cases (97.0%), of which 54 cases (80.6%) were bilateral. Some patients showed unilateral papilledema (11 cases, 16.4%)and optic atrophy. Abnormal visual acuity was found in 95 eyes (70.9%), of which 35 eyes (26.4%) were below 20/200. Visual field abnormality was found in 89.8% of 49 tested cases. The most common visual field lesion was the enlargement of the blind spot (82 eyes, 83.7%), followed by general constriction in 24 eyes (24.5%), nasal step in 17 eyes (25.4%), central scotoma in 9 eyes (9.2%), Bjerrum scotoma in 22 eyes (22.4%) and arcuate scotoma in 14 eyes (14.3%). CONCLUSION: BIH is not really "benign", especially from the viewpoint of optic nerve function.