scholarly journals Diagnosis of Traumatic Ankle Arthrotomies Using Saline Load Tests, Methylene Blue, and Radiopaque Tracer: A Cadaveric Study

2020 ◽  
Vol 5 (1) ◽  
pp. 247301142090561
Author(s):  
Paul R. Allegra ◽  
Rafael A. Sanchez ◽  
Samuel Huntley ◽  
Loren Latta ◽  
Sohil S. Desai ◽  
...  
Keyword(s):  
Methylene Blue ◽  
Normal Saline ◽  
Clinical Relevance ◽  
Challenge Test ◽  
Volume Of Fluid ◽  
Positive Test ◽  
Needle Placement ◽  
Iodinated Contrast ◽  
Load Tests ◽  
Contrast Solution

Background: The objective of this study was to define the volume (mLs) needed for a positive saline load challenge test in anterolateral (AL), anteromedial (AM), posterolateral (PL), or posteromedial (PM) ankle arthrotomy wounds using normal saline (NS) and methylene blue (MB). Another objective was to evaluate the use of fluoroscopy and iodinated contrast in the diagnosis of ankle arthrotomies. Methods: Four cadaveric ankle specimens underwent standardized arthrotomy creation in either the AL, AM, PL, or PM portion of each specimen. An 18-gauge needle was used to inject fluid into each ankle, and the volumes needed for positive fluid challenges were recorded. All 4 ankles were tested 10 times (n = 40) with NS and 10 times using MB (n = 40). A fifth cadaveric ankle was injected with radiopaque contrast solution, and an arthrotomy was simulated and imaged with fluoroscopy.Statistical analyses compared the volumes of NS and MB needed for a positive test. In addition, the 25th, 50th, 75th, 90th, and 95th percentiles of volumes needed for a positive test was calculated. Results: The volume of fluid necessary to detect 25%, 50%, 75%, 90%, and 95% of ankle arthrotomies from any site was 2.0 mL, 4.5 mL, 9.0 mL, 10 mL, and 10 mL, respectively. Anterior arthrotomies required less fluid (2.1 mL ± 0.5) than posterior arthrotomies (9.0 mL ± 1.2) for a positive test ( P < .0001). There was no difference between the amount of NS (5.5 mL ± 3.6) vs MB (5.6 mL ± 3.7) needed for a positive challenge test ( P = .739). Conclusion: Ninety-five percent of ankle arthrotomies could be diagnosed with 10 mL of injected fluid; there was no difference between the volume of NS vs MB needed. Fluoroscopy assisted with needle placement and can be combined with radiopaque contrast solution to diagnose ankle arthrotomies. Clinical Relevance: The findings of this study may improve sensitivity and efficiency in the diagnosis of traumatic ankle arthrotomies, for which there is currently a paucity of literature.

Pre-Surgical Methylene-Blue “targeting” of Small Intrapulmonary Nodules In Patients with Haematological Malignancies: Preliminary Experience.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4551-4551
Author(s):  
M. Mansour Ceesay ◽  
Ouni Jaffer ◽  
Phillip FC Lung ◽  
Michael T Marrinan ◽  
Ranjit Deshpande ◽  
...  
Keyword(s):  
Methylene Blue ◽  
Platelet Count ◽  
Chronic Gvhd ◽  
Pulmonary Nodules ◽  
Target Lesion ◽  
Mycobacterium Fortuitum ◽  
Haematological Malignancies ◽  
Surgical Biopsy ◽  
Iodinated Contrast ◽  
Pleural Surface

Abstract Abstract 4551 The diagnosis of intrapulmonary nodules in patients with haematological malignancies is problematic as such lesions are often small and impalpable and “non-targeted” surgical biopsy is difficult. The aim was to evaluate the utility of image-guided “targeting” of small pulmonary nodules with methylene-blue before video-assisted thoracoscopic (VATS) biopsy. Eleven patients (8M:3F) with median (range) age of 48 (27-62) years with haematological malignancies (lymphoma, n=6, AML/MDS, n=3, ALL, n=1,Castleman's disease, n=1) were referred for VATS biopsy. Equal volume of iodinated contrast) was injected in the vicinity of the target lesion and along a track (including the pleural surface and the overlying chest wall), using a 20G needle. The platelet count, diameter of targeted nodules, “perpendicular” distance from the pleural surface and complications were recorded. Patients were transferred to surgery from the CT suite. The median (range) platelet count was 256×109/L (54-453). The mean (range) diameter of targeted nodules was 12.5(5-22) mm and these were at a mean distance of 14.3±8.3mm from the pleural surface. Complications included small pneumothoracis in 4/11 (36%) patients and pain in 1/11 (9%). A definitive histopathological/microbiological diagnosis was achieved in 10/11 (91%) patients and included: organising pneumonia (n=4), respiratory bronchiolitis (n=2), Kaposi's sarcoma (n=1), mycobacterium fortuitum infection (n=1) and chronic GVHD (n=1). There were no cases of angioinvasive aspergillosis. This preliminary data suggest that pre-biopsy methylene-blue targeting of intrapulmonary lesions is a safe and promising technique for the diagnosis of indeterminate lung nodules in patients with haematological malignancy. Disclosures: Mufti: Celgene: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding, Speakers Bureau.

Disorders of Neuromuscular Transmission

2008 ◽  
Author(s):  
Agnes Wong
Keyword(s):  
Side Effects ◽  
Myasthenia Gravis ◽  
Acetylcholine Receptor ◽  
Nerve Stimulation ◽  
Normal Saline ◽  
Positive Test ◽  
Receptor Antibody ◽  
Acetylcholine Receptor Antibody ◽  
Butterfly Needle ◽  
Tuberculin Syringe

Myasthenia gravis is the most common disorder affecting the neuromuscular junction (incidence: 5 per 100,000). Ocular involvement accounts for initial complaints in 75% of patients. Of patients presenting with ocular myasthenia, 50–80% eventually develop generalized myasthenia, usually within two years of onset. Myasthenia gravis is an autoimmune disease caused by the presence of antibodies against acetylcholine receptors, which leads to decreased number of available receptors (usually less than one-third that of normal). It is associated with other autoimmune diseases, including thymoma, dysthyroidism, sarcoidosis, pernicious anemia, aplastic anemia, and collagen vascular diseases (e.g., rheumatoid arthritis, lupus, ankylosing spondylitis, ulcerative colitis, Sjögren’s syndrome). ■ Side effects: cholinergic (e.g., bradycardia, angina, bronchospasm) ■ Steps for performing Tensilon test: 1. Prepare 10 mg/mL Tensilon in a tuberculin syringe, 0.6 mg atropine in a tuberculin syringe, and 10 mL normal saline. 2. Establish intravenous access using butterfly needle; flush with 1 mL normal saline. 3. Inject 0.2 mL Tensilon, flush with 1 ml normal saline, and wait 1 min for possible side effects. 4. Inject 0.6 mL Tensilon, flush with 1 mL normal saline, then attach atropine syringe. 5. Wait 3 min; improvement of ptosis or diplopia constitutes a positive test. Improvement of ptosis after application of ice for 2 min on the ptotic eyelid constitutes a positive test. The ice test is especially useful for very young, elderly, or ill patients. Improvement of ptosis or ocular alignment after 30–45 min of sleep constitutes a positive test. ■ Repetitive nerve stimulation with supramaximal stimuli delivered at 2–3 Hz: Rapid decrement of the amplitude of compound muscle action potentials (CMAPs) ≥10–15% confirms the diagnosis in 95% of cases. ■ Single-fiber electromyography (EMG; e.g., frontalis muscle) is highly sensitive (88–99% sensitivity). A positive test consists of increased jitter (increased latency between nerve stimulation and action potential of muscle fibers) and increased blockage (response failure). Acetylcholine receptor antibody is not detectable in about 15% of patients. Muscle-specific kinase is detected in 20% patients who have no acetylcholine receptor antibody and is usually detected in patients with generalized myasthenia gravis.

scholarly journals Macroscopic and pathological assessment of methylene blue and normal saline on postoperative adhesion formation in a rat cecum model

2012 ◽  
Vol 10 (9) ◽  
pp. 537-541 ◽  
Author(s):  
Farzad Panahi ◽  
Seyed Homayoon Sadraie ◽  
Hadi Khoshmohabat ◽  
Elias Shahram ◽  
Gholamreza Kaka ◽  
...  
Keyword(s):  
Methylene Blue ◽  
Normal Saline ◽  
Adhesion Formation ◽  
Postoperative Adhesion ◽  
Rat Cecum ◽  
Pathological Assessment

scholarly journals The comparative power of alcohol, ether, and chloroform as measured by their action upon isolated muscle

1909 ◽  
Vol 81 (551) ◽  
pp. 545-558 ◽  
Keyword(s):  
Normal Saline ◽  
Tap Water ◽  
Volume Of Fluid ◽  
Secondary Coil ◽  
Sartorius Muscle ◽  
Run Off ◽  
In Series ◽  
Set Up ◽  
Fine Copper ◽  
Careful Comparison

The object of the following communication is twofold: (1) to present the results of a careful comparison of the physiological effectiveness of certain narcotics, and (2) to illustrate the degree of accuracy of which such comparisons are susceptible by the systematic use of the sartorius muscle of the frog as an indicator. Method .—The two sartorius muscles of a frog are dissected out and the portions of bone to which they are attached are ligatured with fine copper wires serving as conductors. The muscles are set up in the two vessels V, V and connected with two myographic levers that record their movements on two smoked plates L, R. The connections with the secondary coil of an inductorium (Berne model) are as given in the diagram, so that both muscles are traversed in series by the same current in the same direction. The muscles are directly excited once every 10 seconds by maximal break induction shocks. Each observation consists of three parts: a first part consisting of the normal responses of the muscle immersed in normal saline (0·6 per 100 NaCl in tap water); a second part consisting of the responses while the muscle is immersed in an experimental solution; a third part consisting of the responses while the muscle is replaced in normal saline. The solutions are changed by being run off through a tap and run in from a pipette, care being taken that the volume of fluid is always the same. The induction currents are kept going automatically throughout an experiment, excepting during the short periods required for changing the solution. The apparatus used for this purpose consists of: (1) a Berne coil fed by a 2-volt accumulator; (2) a Brodie clock with interruptions set at six per minute; and (3) a relay key, i. e. that shown by G. R. Mines at the July, 1908, meeting of the Physiological Society.

Lack of Significant Bronchial Reactivity to Inhaled Normal Saline in Subjects with a Positive Methacholine Challenge Test

1995 ◽  
Vol 32 (1) ◽  
pp. 63-67
Author(s):  
Riyad Basir ◽  
Stuart G. Lehrman ◽  
Lawrence J. De Lorenzo ◽  
Rosemary Kalenderian ◽  
George P. Maguire
Keyword(s):  
Normal Saline ◽  
Challenge Test ◽  
Bronchial Reactivity ◽  
Methacholine Challenge ◽  
Methacholine Challenge Test

Clinical Relevance of Shrimp Sensitization in Patients with Allergic Rhinitis: Anti-Der p 10 IgE as Predictor

2021 ◽  
pp. 1-9
Author(s):  
Susana Diez ◽  
Leonardo Puerta ◽  
Dalgys Martínez ◽  
María Muñoz ◽  
Karen Hernández ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Clinical Relevance ◽  
Challenge Test ◽  
Cross Sectional Study ◽  
Cross Reactivity ◽  
Tropical Region ◽  
Cross Sectional ◽  
Negative Results ◽  
Oral Challenge Test ◽  
Significant Difference

<b><i>Introduction:</i></b> Cross-reactivity between shrimp and house dust mite (HDM) proteins has been widely documented. In tropical region, shrimp (5–15%) and mite sensitization (80–95%) is prevalent in allergic patients. However, the clinical relevance of shrimp sensitization in patients with allergic rhinitis (AR) has been poorly studied. The aim of this study was to determine the prevalence and the clinical relevance shrimp IgE sensitization in AR patients sensitized to <i>Dermatophagoides pteronyssinus.</i> <b><i>Methods:</i></b> The study was conducted in Medellin (Colombia). A cross-sectional study in patients with AR sensitized to HDM was performed in 3 steps: (i) assessment of IgE sensitization frequency to shrimp <i>Penaeus azteca</i>, <i>Litopenaeus vannamei,</i> and tropomyosin homologous allergens rDer p 10, rPen a 1, and rLit v 1, (ii) evaluation of the clinical relevance of shrimp sensitization using oral challenge test (OCT) and (iii) identification of possible risk factors for positive-OCT results. Ethical committee approval was obtained. <b><i>Results:</i></b> From 443 patients with AR, 86 (19.4%) were sensitized to shrimp and 23 of them (26.7%) had shrimp allergy diagnosis. Thirty-six of the patients sensitized to shrimp (41.2%) reported not previously consumed this food and eleven of them had a positive-OCT (30.5%). There was not statistically significant difference in total IgE or sIgE (<i>D. pteronyssinus, P. azteca, L. vannamei</i>, rPen a 1, and rLit v 1) between OCT groups (positive vs. negative results). Anti-Der p 10 IgE was associated with risk for a positive-OCT in different multivariable scenarios. <b><i>Discussion/Conclusion:</i></b> Our results suggest that in patients with HDM-associated AR and shrimp IgE sensitization is necessary to evaluate the clinical relevance of shrimp IgE even if the patient has never consumed shrimp because of cross-reactivity. Anti-Der p 10 could be a possible biomarker of clinical relevance to shrimp sensitization and could reduce the need for OCTs.

Use of gadolinium chelate to confirm epidural needle placement in patients with an iodinated contrast reaction

2006 ◽  
Vol 36 (4) ◽  
pp. 301-307 ◽  
Author(s):  
Sanjay K. Shetty ◽  
Erik N. Nelson ◽  
Tara M. Lawrimore ◽  
William E. Palmer
Keyword(s):  
Epidural Needle ◽  
Needle Placement ◽  
Contrast Reaction ◽  
Gadolinium Chelate ◽  
Iodinated Contrast

A SEM and Light Microscope Study of the Epidermal Leaf Structures of the Carnivorous Plant, Sarracenia purpurea, L.

1971 ◽  
Vol 29 ◽  
pp. 358-359
Author(s):  
B. J. Panessa ◽  
J. F. Gennaro
Keyword(s):  
Methylene Blue ◽  
Toluidine Blue ◽  
Outer Surface ◽  
Microscope Study ◽  
Light Microscope ◽  
Carnivorous Plant ◽  
Sarracenia Purpurea ◽  
Inner Surface

Tissue from the hood and sarcophagus regions were fixed in 6% glutaraldehyde in 1 M.cacodylate buffer and washed in buffer. Tissue for SEM was partially dried, attached to aluminium targets with silver conducting paint, carbon-gold coated(100-500Å), and examined in a Kent Cambridge Stereoscan S4. Tissue for the light microscope was post fixed in 1% aqueous OsO4, dehydrated in acetone (4°C), embedded in Epon 812 and sectioned at ½u on a Sorvall MT 2 ultramicrotome. Cross and longitudinal sections were cut and stained with PAS, 0.5% toluidine blue and 1% azure II-methylene blue. Measurements were made from both SEM and Light micrographs.The tissue had two structurally distinct surfaces, an outer surface with small (225-500 µ) pubescent hairs (12/mm2), numerous stoma (77/mm2), and nectar glands(8/mm2); and an inner surface with large (784-1000 µ)stiff hairs(4/mm2), fewer stoma (46/mm2) and larger, more complex glands(16/mm2), presumably of a digestive nature.

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