Malignant Hyperthermia in Bariatric Surgery: A Case Study With Clinical, Pathophysiological, Biochemical and Biophysical Correlations.

Malignant hyperthermia (MH) is an acute pharmacogenetic disorder, which while uncommon is potentially fatal. MH is a calcium channelopathy of skeletal muscle in which a constant increase of intracytoplasmic Ca2+ concentration occurs causing a change in cellular metabolism. A hypermetabolic state develops when susceptible patients are exposed to halogenated volatile inhalational anesthetic agents and depolarizing muscle relaxants and/or extreme physical activity in hot environments. MH presents variable clinical expression. During an episode of MH, the patient may present clinical signs and laboratory findings including masseter muscle spasm, tachycardia, rise in end-tidal CO2 (EtCO2), tachypnea, hyperthermia, cyanosis, metabolic acidosis, rhabdomyolysis, hyperkalemia, myoglobinuria, hyperlactacidemia, and acute renal failure. The aim of this case report is to describe an episode of MH associated with the use of halogenated anesthetic during bariatric surgery. A 29-year-old Brazilian man was admitted to the hospital to undergo a bariatric surgery. The patient's relevant medical history included morbid obesity grade III, allergy to sulfa-based drugs and severe obstructive sleep apnea. Preoperative evaluations with cardiopulmonary exercise testing, echocardiogram and electrocardiogram showed no anatomical and functional changes of the patient's heart. Surgical procedures lasted for 4 h, without complications, but the evolution of the patient's condition indicated oliguria and acute breathing insufficiency. Five hours after the patient was placed under mechanical ventilation in the intensive care unit, he started to present clinical signs of hypermetabolic state, with tremors, excessive sweating, and rapid body temperature increases. In the postoperative period, the patient had hyperglycemia, hypocalcemia, hypernatremia, hyperkalemia, changes in creatine phosphokinase (CPK), aspartate transaminase (AST), alanine aminotransferase (ALT), urea and creatine concentrations, and metabolic and respiratory acidosis. Urinalysis showed traces of proteinuria, presence of ketones, leukocytes, red blood cells, and urobilinogen. In our case report, MH crisis was diagnosed late; the dantrolene was not administrated because it was not available and the patient died. This detailed case report of MH episode triggered by isoflurane anesthetic during bariatric surgery allowed us to describe the severity and lethality of this hypermetabolic syndrome. Dantrolene should be mandatory in all operating rooms. Knowledge of the symptoms, an early diagnosis and an adequate treatment can prevent the death of patients in MH crisis.

Liberação de componentes do extrato de Casearia sylvestris Swartz empregando membranas de látex natural como suporte / Analysis of Casearia sylvestris Swartz extract release from natural rubber latex membranes

A membrana de látex natural (NRL - Natural Rubber Latex), manipulada a partir do látex extraído da seringueira Hevea brasiliensis, tem apresentado grande potencial de aplicação no campo da biomedicina e dos biomateriais. Graças a sua biocompatibilidade e baixa taxa de rejeição, ela tem sido utilizada para próteses e enxertos, atuando como estimulante da angiogênese, adesão celular e barreira física a agentes infecciosos. Além dessas aplicações, as membranas são utilizadas como matriz de sistemas de liberação para avaliar o comportamento da liberação de fármacos e extratos de origem vegetal que apresentam propriedades medicinais. O sistema extrato-membrana tem como objeto de estudo uma nova abordagem dessas substâncias no tratamento de feridas visando à cicatrização e regeneração do tecido envolvido. Casearia sylvestris, conhecida popularmente como guaçatonga, pertence à família Salicaceae, conhecida na medicina popular pelos seus efeitos antiulcerogênicos, cicatrizantes, antiofídicos, anti-inflamatórios e antissépticos, propriedades já comprovadas por estudos. Trabalhos recentes demonstraram que a liberação controlada de fármacos e extratos utilizando membranas de látex natural é uma alternativa interessante e promissora para aplicações biomédicas. Assim, o objetivo deste projeto foi estudar a liberação do extrato de Casearia sylvestris incorporado à membrana de látex em soluções com diferentes valores de pH, com o propósito de estudar seu comportamento e sua liberação de forma controlada. A taxa de liberação do extrato do sistema extrato-membrana foi monitorada e analisada utilizando-se o método de espectroscopia ótica (UV). O pH básico age desestabilizando a membrana indicando que o polímero possui a habilidade de proteger o extrato de ser liberado em valores de pH ácidos, direcionando sua aplicação para o sítio de melhor absorção. Além disso, a liberação segue uma função bi-exponencial...

Natural Rubber Latex (NRL) membrane, made from latex extracted from the rubber tree Hevea brasiliensis, has shown great potential for use in the biomedicine and biomaterials area. Thanks to its biocompatibility and low rejection rate, it has been used for implants and grafts, acting as a stimulant of angiogenesis and cell adhesion and as a barrier against infectious agents. Besides these applications, the membranes are used as model release systems, to assess the release behavior of drugs and plant extracts that exhibit medicinal properties. The extract-membrane system represents a new approach to studying these substances, as aids to wound healing and tissue regeneration. Casearia sylvestris, popularly known as guaçatonga, belongs to the family Salicaceae, known in popular medicine for its anti-ulcerogenic, wound healing, anti-ophidian, antiinflammatory and antiseptic properties, all of which are proven by scientific studies. Recent studies have also shown that the controlled release of drugs and extracts from natural latex membranes is an interesting and promising process for biomedical applications. The objective of this project was thus to study the release of Casearia sylvestris extract incorporated into natural rubber membranes. The main concern was to study and optimize the controlled release of the extract at various pHs. The rate of release was monitored and analyzed by the method of optical spectroscopy (UV). Basic pHacts to destabilize the membrane, indicating that the polymer has the ability to protect the extract from being released at acidic pH values. The controlled release follows a bi-exponential function...

Prevalent cardiac phenotype resulting in heart transplantation in a novel LMNA gene duplication.

Mutations in the lamin A/C gene (LMNA) are known to be involved in several diseases such as Emery-Dreifuss muscular dystrophy, limb-girdle muscular dystrophy type 1B and dilated cardiomyopathies with conduction disease, with considerable phenotype heterogeneity. Here we report on a novel autosomal dominant mutation in LMNA in two direct relatives presenting with different clinical phenotypes, characterized by severe life-threatening limb-girdle muscle involvement and cardiac dysfunction treated with heart transplantation in the proband, and by ventricular tachyarrhythmias with preserved cardiac and skeletal muscle function in her young son. To our knowledge, this is the first report of a duplication in the LMNA gene. The two phenotypes described could reflect different clinical stages of the same disease. We hypothesize that early recognition and initiation of therapeutic manoeuvres in the younger patient may retard the rate of progression of the cardiomyopathy.

Calcium carbonate crystallization in the presence of taurine.

The kinetics of calcite (CaCO(3)) crystallization on calcite seed crystals in the presence of taurine was investigated by the constant composition method. The presence of taurine (4 x 10(- 5)- 4 x 10(-4)M) in the supersaturated solutions lead to calcite crystals with a characteristic discontinuous planes of growth and poor habit, as compared to the hombohedral morphology of the seed crystals. The acceleration effect of taurine on the crystal growth rate was 17-96%. The apparent order of the crystal growth was found to be 2.0+/- 0.2 typical for a surface diffusion-controlled spiral growth processes.

Poly(lactide)-poly(ethylene glycol) micelles as a carrier for griseofulvin.

In this work, the feasibility to develop micelle carriers of griseofulvin based on PLA-PEG copolymers was investigated. With the use of the dialysis method of micelle formation, the micellization behavior of a range of PLA(X)-PEG(5) copolymers was investigated. At copolymer concentrations in the organic solvent 10-20 mg/mL, stable micelles with 100% yield could only be prepared from PLA(X)-PEG(5) copolymers with molar composition in the range 50-70% PEG. The copolymers exhibited sufficiently low CMC to provide stable micelles in vivo. The loading capacity of PLA(4)-PEG(5) micelles with griseofulvin was 6.5 mg of drug/1 g of copolymer. The release of griseofulvin from the PLA-PEG micelles in vitro in phosphate-buffered saline (PBS) was sustained over 30 days. No burst effect was observed. Analysis of the release kinetics suggested that the release was erosion-controlled. The release profile was biphasic. Micelle degradation data in PBS indicated that the second phase of release was induced by copolymer degradation. The PLA-PEG micelles of griseofulvin were stable in simulated gastric and intestinal fluids for a long-enough time for oral application. Overall, the PLA-PEG micelles have suitable properties to be considered as potential oral or topical formulations of griseofulvin, provided that the drug-loading capacity of the micelles is sufficiently improved.

The crystallization of Hydroxyapatite in the presence of sodium alginate.

The effect of sodium alginate on the crystal growth of hydroxyapatite (HAP) was investigated at sustained supersaturation by the constant composition technique. Sodium alginate was found to inhibit HAP crystal growth at low concentrations and reduced the crystal growth rates by 42-86% for inhibitor concentrations of 2.1x10(-7)-12.6x10(-7) mol/l. The inhibition effect on the crystal growth rate may be explained possibly through adsorption onto the active growth sites. A detailed kinetics analysis suggested a Langmuir-type adsorption of the alginate on HAP surface and a value of 1.63x10(7) l/mol was obtained for the affinity constant of sodium alginate for the surface of HAP. The apparent order for the crystallization reaction was determined to be approximately 2, thus suggesting a surface diffusion controlled spiral growth mechanism.

Determination of oxamniquine in capsules by HPLC.

A sensitive, accurate, reliable and easy method was developed for the quantification of oxamniquine in capsules using high-performance liquid chromatography (HPLC) with UV detection. This technique provided conditions for the separation of the active ingredient from the dosage form by extraction in methanol. Isocratic reversed phase chromatography was performed using methanol, water, and triethanolamine (60:40:0.099, v/v/w) (System C) or methanol, acetonitrile, water and formic acid (40:30:30:0.083, v/v/w) (System D) as mobile phase, a stainless steel column (125 x 4 mm i.d., 5 microm) filled with LiChrospher 100 RP-18 (Merck), column temperature of 28+/-2 degrees C and detection at 260 nm. The calibration curves were linear over a wide concentration range (1.0-20.0 microg ml(-1) of oxamniquine) to the Systems C and D with good correlation factor (0.9990 and 0.9982, respectively). The average content obtained were 100.1+/-1.5% (System C) and 102.4+/-0.8% (System D). The presence of lactose, starch, magnesium stearate and sodium laurylsulphate did not interfere in the results of the analysis. The above findings showed the proposed method to be both simple and added advantage of allowing for fast analysis.

Combined passive-active immunization against the hepatitis B virus of 132 newborns of chronic carrier mothers: long term results.

One hundred thirty-two newborns of carrier mothers were given combined passive-active immunization against the hepatitis B virus. Doses of hepatitis B immunoglobulin (HBIG) were 0.5 ml, and doses of vaccine (Heptavax B) were 10 micrograms. Schedules used were: HBIG, 0, 3 and 6 months and vaccine 1, 2 and 7 months (Schedule 1); HBIG, 0, 3 and 6 months, vaccine, 7, 8 and 13 months (Schedule 2); HBIG, 0 month and vaccine 1, 2 and 7 months (Schedule 3); HBIG, 0 month and vaccine 0, 1 and 6 months (Schedule 4). The study population consisted of 60 boys and 72 girls. Ethnic origins were the following: Haitian, 42; Cambodian, 33; French Canadian, 22; Vietnamese, 21; others, 14. Thirty-two children were born to hepatitis B e antigen-positive mothers. General outcome was: 121 became anti-hepatitis B surface antigen-positive; 5 became hepatitis B surface antigen-positive; and 6 remained negative for all markers (nonresponders). Sex, ethnic origin and immunization schedule had no influence on the outcome. Of the 32 children born to hepatitis B e antigen-positive mothers, only 4 became hepatitis B surface antigen-positive. In those who became anti-hepatitis B surface antigen-positive, mean serum anti-hepatitis B surface antigen antibody concentrations (log mIU/ml +/- SD) were: 3.47 +/- 1.03 at 8 to 9 months post-Vaccine 1; 2.89 +/- 0.91 at 14 to 17 months; 2.39 +/- 1.0 at 23 to 29 months; and 2.26 +/- 0.92 at 35 to 41 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Prevalence of hepatitis B virus infection in pregnant women in the Montreal area.

From January 1982 to June 1984, 30,315 serum specimens from pregnant women at nine hospitals in the Montreal area were screened for hepatitis B surface antigen (HBsAg). Of the specimens 103, from 98 women, were positive, a prevalence rate of 3.4 per 1000. The ethnic origin of the 98 women and the number who were also positive for e antigen (HBeAg) were as follows: French-Canadian, 29 (3 HBeAg-positive); Asian, 28 (14); Haitian, 32 (0); other, 7 (0); and unknown, 2 (0). The prevalence rates of HBsAg positivity according to ethnic origin at one of the hospitals were 73.9 in Asians, 33.1 in Haitians, 0.9 in French Canadians and 8.0 in women of other extraction. If the prevalence rate found in this study is true for the 95 000 live births that occur yearly in the province of Quebec, there are an estimated 323 infants at risk for hepatitis B virus (HBV) infection each year in the province. Screening programs for detecting HBV carriage in pregnant women should be instituted, since recent studies have shown combined active-passive immunization to be effective in preventing perinatal transmission of HBV infection.