scholarly journals Intraoperative anaphylaxis due to aprotinin after local application of fibrin sealant diagnosed by skin tests and basophil activation tests: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Masaki Orihara ◽  
Tomonori Takazawa ◽  
Tatsuo Horiuchi ◽  
Shinya Sakamoto ◽  
Mutsumi Uchiyama ◽  
...  
Keyword(s):  
Fibrin Sealant ◽  
Clinical Symptoms ◽  
Lung Resection ◽  
Vital Signs ◽  
High Serum ◽  
Basophil Activation ◽  
Local Application ◽  
Skin Tests ◽  
Absorbable Suture ◽  
Main Component

Abstract Background There are few cases of anaphylaxis after local application of fibrin sealant diagnosed by skin tests. Case presentation A 49-year-old woman underwent partial lung resection under general anesthesia. Anesthesia was induced uneventfully. Shortly after applying absorbable suture reinforcement felt that contained fibrin sealant, her systolic blood pressure fell to approximately 70 mmHg, along with facial flushing. Anaphylaxis was diagnosed based on the clinical symptoms and high serum tryptase levels. Three months after the event, skin tests were performed with all agents and were positive only for fibrin sealant vial no. 2, whose main component is aprotinin. Subsequently, basophil activation tests using fibrin sealant vial no. 2 and pure aprotinin demonstrated that the causative agent was likely aprotinin. Conclusions We diagnosed aprotinin-induced anaphylaxis using skin tests and basophil activation tests. The occurrence of anaphylaxis should be considered when changes in vital signs are observed after the use of fibrin sealant.

scholarly journals Ketone bodies – causes and effects of their increased presence in cows' body fluids: A review

2021 ◽  
pp. 1492-1503
Author(s):  
Piotr Guliński
Keyword(s):  
Dairy Cows ◽  
High Performance ◽  
Clinical Symptoms ◽  
Ketone Bodies ◽  
Good Condition ◽  
Body Fluids ◽  
Protein Ratio ◽  
Loss Of Appetite ◽  
Point Body ◽  
Main Component

Ketosis is the most common metabolic disease in high-performance dairy cows during the first 6-8 weeks of lactation. Its main symptoms include an excessive amount of so-called ketone bodies in a cow's body fluids. Ketone bodies consist of β-hydroxybutyric acid (βHBA), acetoacetic acid, and acetone. βHBA is the main component with its share of the total volume of ketone bodies in the blood of about 70%. Clinical symptoms of ketosis in cows include loss of appetite, preference for forage to concentrated feed, and acetone odor in their mouth and urine. Those symptoms are accompanied by a production drop, an increase of concurrent illness (mastitis, metritis, and displaced abomasum), and poor reproductive performance. One of the ketosis characteristic effects is an increase in the level of fat in milk (>5%), while protein levels decrease (<2.9%). In the case of subclinical ketosis (SCK), the fat–protein ratio in milk is increased to above 1.4:1. The current consensus for SCK is to consider a cutoff point of βHBA to be at least 1.2 mmol/L in blood plasma. Ketosis prevention is based on keeping perinatal cows in good condition, that is, with around 3.5 points in the five-point body condition scoring, carefully balancing food doses during the first 2 months of lactation with the correct energy–protein ratio. Glucose precursor products should be administered orally, in particular to at-risk herds. Ketosis occurs in 7-14% on average of the total number of cows in a herd. In general, data on the prevalence of SCK vary considerably, depending on their source. Moreover, the problem is mostly observed in poorly-fed animals with high milk production potential. The objectives of this review are to reveal the current situation of ketosis prevalence, the possibility of diagnosis, consequences in dairy cows and to provide some recommendations for ketosis treatment and prevention.

scholarly journals Recommendations from the Italian intersociety consensus on Perioperative Anesthesa Care in Thoracic surgery (PACTS) part 2: intraoperative and postoperative care

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Federico Piccioni ◽  
◽  
Andrea Droghetti ◽  
Alessandro Bertani ◽  
Cecilia Coccia ◽  
...  
Keyword(s):  
Thoracic Surgery ◽  
Postoperative Care ◽  
Task Force ◽  
Lung Resection ◽  
Vital Signs ◽  
Blood Gases ◽  
The United States ◽  
Anesthetic Care ◽  
Intraoperative Care ◽  
Intraoperative Management

Abstract Introduction Anesthetic care in patients undergoing thoracic surgery presents specific challenges that require a multidisciplinary approach to management. There remains a need for standardized, evidence-based, continuously updated guidelines for perioperative care in these patients. Methods A multidisciplinary expert group, the Perioperative Anesthesia in Thoracic Surgery (PACTS) group, was established to develop recommendations for anesthesia practice in patients undergoing elective lung resection for lung cancer. The project addressed three key areas: preoperative patient assessment and preparation, intraoperative management (surgical and anesthesiologic care), and postoperative care and discharge. A series of clinical questions was developed, and literature searches were performed to inform discussions around these areas, leading to the development of 69 recommendations. The quality of evidence and strength of recommendations were graded using the United States Preventive Services Task Force criteria. Results Recommendations for intraoperative care focus on airway management, and monitoring of vital signs, hemodynamics, blood gases, neuromuscular blockade, and depth of anesthesia. Recommendations for postoperative care focus on the provision of multimodal analgesia, intensive care unit (ICU) care, and specific measures such as chest drainage, mobilization, noninvasive ventilation, and atrial fibrillation prophylaxis. Conclusions These recommendations should help clinicians to improve intraoperative and postoperative management, and thereby achieve better postoperative outcomes in thoracic surgery patients. Further refinement of the recommendations can be anticipated as the literature continues to evolve.

IgE-mediated allergy to pristinamycin: the value of skin tests and basophil activation tests

Allergy ◽  
2009 ◽  
Vol 64 (11) ◽  
pp. 1694-1694 ◽  
Author(s):  
B. Bensaid ◽  
A. Rozieres ◽  
F. Berard ◽  
J. Bienvenu ◽  
J. F. Nicolas
Keyword(s):  
Basophil Activation ◽  
Skin Tests ◽  
Ige Mediated

scholarly journals What about the others: differential diagnosis of COVID-19 in a German emergency department

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
David Fistera ◽  
Annalena Härtl ◽  
Dirk Pabst ◽  
Randi Manegold ◽  
Carola Holzner ◽  
...  
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Clinical Symptoms ◽  
Respiratory Infections ◽  
Health Care Systems ◽  
Clinical Signs ◽  
Vital Signs ◽  
Main Diagnosis ◽  
Clinical Trial Registry ◽  
Airway Infections

Abstract Background The ongoing COVID-19 pandemic remains a major challenge for worldwide health care systems and in particular emergency medicine. An early and safe triage in the emergency department (ED) is especially crucial for proper therapy. Clinical symptoms of COVID-19 comprise those of many common diseases; thus, differential diagnosis remains challenging. Method We performed a retrospective study of 314 ED patients presenting with conceivable COVID-19 symptoms during the first wave in Germany. All were tested for COVID-19 with SARS-Cov-2-nasopharyngeal swabs. Forty-seven patients were positive. We analyzed the 267 COVID-19 negative patients for their main diagnosis and compared COVID-19 patients with COVID-19 negative respiratory infections for differences in laboratory parameters, symptoms, and vital signs. Results Among the 267 COVID-19 negative patients, 42.7% had respiratory, 14.2% had other infectious, and 11.2% had cardiovascular diseases. Further, 9.0% and 6.7% had oncological and gastroenterological diagnoses, respectively. Compared to COVID-19 negative airway infections, COVID-19 patients showed less dyspnea (OR 0.440; p = 0.024) but more dysgeusia (OR 7.631; p = 0.005). Their hospital stay was significantly longer (9.0 vs. 5.6 days; p = 0.014), and their mortality significantly higher (OR 3.979; p = 0.014). Conclusion For many common ED diagnoses, COVID-19 should be considered a differential diagnosis. COVID-19 cannot be distinguished from COVID-19 negative respiratory infections by clinical signs, symptoms, or laboratory results. When hospitalization is necessary, the clinical course of COVID-19 airway infections seems to be more severe compared to other respiratory infections. Trial registration: German Clinical Trial Registry DRKS, DRKS-ID of the study: DRKS00021675 date of registration: May 8th, 2020, retrospectively registered.

scholarly journals Management of cardiac tamponade due to contrast nephropathy: A case report

2019 ◽  
pp. 11-14
Author(s):  
Nihat M Hokenek ◽  
Mehmet O Erdogan ◽  
Davut Tekyol ◽  
Hakan Hançer ◽  
Ergul A Kozan ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Pericardial Effusion ◽  
Cardiac Tamponade ◽  
Urine Output ◽  
Clinical Symptoms ◽  
Vital Signs ◽  
Contrast Nephropathy ◽  
Volume Load ◽  
Load Increase

Pericardial effusion secondary to contrast nephropathy is a very rare clinical condition. Patients have a volume load increase secondary to acute renal failure. In such a case, the progression of pericardial effusion with tamponade may follow a very rapid course contrary to what is believed. In this case, a 78-year-old male patient with diabetes mellitus and hypertension was admitted to the emergency department with complaints of decreased urine output, nausea, and vomiting. The patient was diagnosed with acute renal failure secondary to contrast nephropathy. Pericardial effusion amount was found to be 2 cm by thorax tomography. As the patient who had no urine output when his vital signs were stable became unstable during dialysis preparation and manifested clinical symptoms of cardiac tamponade, immediate pericardiocentesis was performed. Following that, he became stable and was transferred to the intensive care unit. In current guidelines regarding indications for pericardiocentesis, it is stated that drainage should be performed when the amount of effusion is more than 2 cm in the absence of tamponade, suspected bacterial infection or neoplastic etiology. However, in contrast to the standard approach to patients with acute renal failure, our suggestion is that the indications for pericardiocentesis may be broader in the presence of pericardial effusion.

scholarly journals Continuous monitoring of health data with a wearable device in pediatric patients undergoing chemotherapy for cancer – a feasibility pilot study

2021 ◽  
Author(s):  
Brack Eva ◽  
Koenig Christa ◽  
Roessler Jochen ◽  
Ammann Roland A.
Keyword(s):  
Pilot Study ◽  
Continuous Monitoring ◽  
Pediatric Patients ◽  
Clinical Symptoms ◽  
Vital Signs ◽  
Ethics Committees ◽  
Health Data ◽  
Wearable Device ◽  
Delayed Treatment ◽  
Patient Will

Abstract Pediatric patients with cancer are at high risk for severe infections and delayed treatment increases mortality. Infections can trigger changes of vital signs long before clinical symptoms arise. Continuous recording may detect such changes earlier than discrete measurements. This is the protocol for an investigator-initiated, single-center observational pilot study on the feasibility of continuous monitoring of health data with a wearable device (WD) in pediatric patients undergoing chemotherapy of cancer. A total of 20 patients will be included, including at least 4 patients <6 years. Each patient will wear the WD for 14 days and we expect study duration of three to four months. The protocol had been registered at www.clinicaltrials.com (NCT04134429) and was approved by the local Ethics Committees (Ethikkommission der Universitätskinderkliniken Bern, “Gesuch 1912”, Kantonale Ethikkommission Bern, BASEC-No.: 2019-01919).

Skin testing in allergy

2019 ◽  
Vol 40 (6) ◽  
pp. 366-368
Author(s):  
Gayatri Patel ◽  
Carol Saltoun
Keyword(s):  
Skin Test ◽  
Immunoglobulin E ◽  
Clinical Symptoms ◽  
Skin Testing ◽  
Smooth Muscle Contraction ◽  
Skin Tests ◽  
Test Reaction ◽  
Positive Skin ◽  
Intradermal Testing ◽  
Clinical Sensitivity

Skin tests are used in addition to a directed history and physical examination to exclude or confirm immunoglobulin E (IgE) mediated diseases, such as allergic rhinitis, asthma, and anaphylaxis, to aeroallergens, foods, insect venoms, and certain drugs. There are two types of skin testing used in clinical practice: percutaneous testing (prick or puncture) and intracutaneous testing (intradermal). Prick testing involves introducing a needle into the upper layers of the skin through a drop of allergen extract that has been placed on the skin and gently lifting the epidermis up. Various devices are available for prick testing. Intracutaneous (intradermal) testing involves injecting a small amount of allergen into the dermis. The release of preformed histamine from mast cells causes increased vascular permeability via smooth-muscle contraction and development of a wheal; inflammatory mediators initiate a neural reflex, which causes vasodilatation, which leads to erythema (the flare). Prick testing methods are the initial technique for detecting the presence of IgE. These may correlate better with clinical sensitivity and are more specific but less sensitive than intradermal testing. Sites of skin testing include the back and the volar aspect of the arm. By skin testing on the arm, the patient can witness the emergence and often sense the pruritus of the skin test reaction. Because more patients are sensitized (have IgE antibodies and positive skin test reactions) than have corresponding symptoms, the diagnosis of allergy can be made only by correlating skin testing results with the presence of clinical symptoms.

MILK ALLERGY

PEDIATRICS ◽  
1957 ◽  
Vol 20 (3) ◽  
pp. 393-399
Author(s):  
Kay D. Bachman ◽  
Susan C. Dees
Keyword(s):  
Respiratory Symptoms ◽  
Clinical Symptoms ◽  
Skin Tests ◽  
Cow’S Milk ◽  
Gastrointestinal Disorders ◽  
Milk Allergy ◽  
Cow's Milk ◽  
Bovine Lactalbumin ◽  
Scratch Tests ◽  
Allergic Manifestations

During two consecutive calendar years, a series of 403 babies receiving routine well-baby care were followed and records kept of all symptoms and illness occurring during their first 2 years of life. Gastrointestinal disorders and eczematous rash were the symptoms most frequently encountered which appeared to be due to allergy. Many minor digestive, skin and respiratory symptoms were recorded which did not prove to be allergic manifestations during the 2 years of observations. Colic was present in 52 well babies, of whom 2 were sensitive to milk. The incidence of allergy to cow's milk in this series of infants was 4 in 403 or 1%. Scratch tests were negative in 66 of 72 well babies tested, and no strongly positive reactions were observed. The allergens used were cow's milk, bovine lactalbumin, casein and egg. No correlation could be made between skin tests and clinical symptoms. Three infants showed a few scattered eosinophils in the stool smear, among 156 from whom stool smears were made. These babies had colic but no symptoms suggestive of allergy later.

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