Is intraoperative endoscopy safe in a child with Kasai procedure?

We report a case of venous air embolism which occurred during intraoperative endoscopy in a five-year-old boy who had undergone Kasai procedure in his infancy. The child had a cardiac arrest during the procedure from which he could not be resuscitated. The awareness about this complication would allow rapid diagnosis, which is vital to provide specific treatment and prevent fatal outcome.

Occult acetabular fracture in an elderly runner.

STUDY DESIGN: Resident's case problem. BACKGROUND: A 79-year-old African American male runner sustained a left hip injury while jogging on a running track. Initial radiographs did not show any bony injuries and the patient was diagnosed with hip tendonitis. The patient was initially treated conservatively with medications and referred to a local physical therapy clinic for thermal modalities and therapeutic exercises. The patient failed to show any improvement despite a period of conservative treatment. The author examined the patient 6 months postinjury at a university physical therapy department. DIAGNOSIS: The author suspected the presence of a possible fracture and the patient was referred to an orthopaedic surgeon. Subsequent radiographic imaging studies including a CT scan revealed a supra-acetabular fracture. The patient underwent a total hip arthroplasty approximately 1 year after the initial injury and has since recovered well. DISCUSSION: It is not uncommon for runners or joggers to develop hip or pelvic pain, but there has been no prior report in the literature of the occurrence of an acetabular hip fracture while jogging. This resident's case problem illustrates the challenges of arriving at an accurate diagnosis in the presence of a rare fracture and the need for careful follow-up, especially among elderly individuals with cognitive deficits.

Effects of NMDA receptor inhibition by phencyclidine on the neuronal differentiation of PC12 cells.

Phencyclidine (PCP) is a non-competitive N-methyl-d-aspartate (NMDA) receptor antagonist and exposing the developing brain to PCP has been shown to cause deficits in neurobehavioral functions. In the present study we tested the effects of PCP, as an NMDA receptor inhibitor, on the neuronal differentiation and biogenic amines levels including norepinephrine (NE), epinephrine, dopamine, 3,4-dihydroxyphenylacetic acid (DOPAC), homovanillic acid (HVA), serotonin (5-HT), and 5-hydroxyindole-3-acetic acid (5-HIAA) in the rat pheochromocytoma (PC12) cells. After PC12 cells were differentiated with nerve growth factor (NGF) in the presence of PCP, NMDA binding kinetics, biogenic amines analysis and NMDA receptor protein expression assay were conducted. The results showed that NMDA receptor binding activities were significantly increased after differentiated with NGF in PC12 cells. B(max) values were increased in differentiated cells by four-folds, whereas K(d) values were not changed. All of biogenic amines were significantly increased in differentiated cells. On the other hand, PCP at 50 and 100 microM inhibited neuronal differentiation in a dose-dependent manner in NGF-stimulated PC12 cells without affecting cell viability. PCP treatment during differentiation significantly reduced NMDA binding activity and biogenic amine levels. Western blotting analysis revealed that NMDA receptor protein expression was significantly higher in NGF-differentiated cells and PCP treatment decreased the expression of NMDA receptor proteins. These results indicate that NMDA receptor functions and monoaminergic nervous systems are significantly stimulated during NGF-induced differentiation. PCP suppresses neuronal outgrowth and hampers neuronal functions possibly by inhibiting NMDA receptor functions and biogenic amine production, implying the suppressive effects of PCP exposure on neuronal developments.