A case of pseudohyperkalemia in a patient presenting with leucocytosis and high potassium level: a Case Report

Pseudohyperkalemia can appear in a variety of settings and should be recognized early. Treatment of pseudohyperkalemia can lead to an inappropriate decrease of actual serum potassium levels which may lead to life threatening conditions. In the case presented, an 81-year-old male presented with massive leucocytosis and an extremely elevated potassium level. This case report emphasizes the importance of recognizing pseudohyperkalemia in a patient with a severely increased potassium and WBC level; such patients may be clinically asymptomatic or may have a normal ECG

Threatened San Clemente Bell\u27s Sparrow nest depredated by island night lizard

We used remote video monitoring systems to document nest predators at San Clemente Bell’s Sparrow (Artemisiospiza belli clementeae) nests and recorded an unexpected depredation by an island night lizard (Xantusia riversiana) on 22 May 2013. This record is the first documented case of a San Clemente Bell’s Sparrow being depredated by any reptile and is also the first documentation of any night lizard species (genus Xantusia) depredating a bird’s nest. Additionally, we found that night lizards are among the smallest lizard species ever observed depredating a bird’s nest. Utilizamos sistemas de monitoreo remoto con vídeo para documentar depredadores de nidos de gorriones en San Clemente Bell (Artemisiospiza belli clementeae) y grabamos una depredación inesperada por un lagartija nocturna de la isla (Xantusia riversiana) el 22 de mayo del 2013. Este registro es el primer caso documentado de un gorrión de San Clemente Bell siendo depredado por un reptil y es también la primera documentación de una lagartija nocturna (género Xantusia) depredando un nido de ave. Además, encontramos que las lagartijas nocturnas se encuentran entre las lagartijas más pequeñas observadas depredando un nido de aves

Anesthetics Impact the Resolution of Inflammation

Local and volatile anesthetics are widely used for surgery. It is not known whether anesthetics impinge on the orchestrated events in spontaneous resolution of acute inflammation. Here we investigated whether a commonly used local anesthetic (lidocaine) and a widely used inhaled anesthetic (isoflurane) impact the active process of resolution of inflammation.Using murine peritonitis induced by zymosan and a systems approach, we report that lidocaine delayed and blocked key events in resolution of inflammation. Lidocaine inhibited both PMN apoptosis and macrophage uptake of apoptotic PMN, events that contributed to impaired PMN removal from exudates and thereby delayed the onset of resolution of acute inflammation and return to homeostasis. Lidocaine did not alter the levels of specific lipid mediators, including pro-inflammatory leukotriene B(4), prostaglandin E(2) and anti-inflammatory lipoxin A(4), in the cell-free peritoneal lavages. Addition of a lipoxin A(4) stable analog, partially rescued lidocaine-delayed resolution of inflammation. To identify protein components underlying lidocaine's actions in resolution, systematic proteomics was carried out using nanospray-liquid chromatography-tandem mass spectrometry. Lidocaine selectively up-regulated pro-inflammatory proteins including S100A8/9 and CRAMP/LL-37, and down-regulated anti-inflammatory and some pro-resolution peptides and proteins including IL-4, IL-13, TGF-â and Galectin-1. In contrast, the volatile anesthetic isoflurane promoted resolution in this system, diminishing the amplitude of PMN infiltration and shortening the resolution interval (Ri) approximately 50%. In addition, isoflurane down-regulated a panel of pro-inflammatory chemokines and cytokines, as well as proteins known to be active in cell migration and chemotaxis (i.e., CRAMP and cofilin-1). The distinct impact of lidocaine and isoflurane on selective molecules may underlie their opposite actions in resolution of inflammation, namely lidocaine delayed the onset of resolution (T(max)), while isoflurane shortened resolution interval (Ri).Taken together, both local and volatile anesthetics impact endogenous resolution program(s), altering specific resolution indices and selective cellular/molecular components in inflammation-resolution. Isoflurane enhances whereas lidocaine impairs timely resolution of acute inflammation

Isotopic study of rainfall and definition of local meteoric water lines: Case of the rainfall stations of the city of Bangui in Central African Republic

The study of the isotopic composition of rainwater discussed in this article allows isotopic characterization of rainfall recorded in the Bangui region over 11 years at two stations. It will highlight the relationships between isotopes, climatic parameters, and temporal variation before defining the local meteoric line, which constitutes the reference point for the region. The results obtained after a follow-up of eleven years without interruption showed two major physical effects, the effect of the rainfall influences more strongly the composition in isotopes, the contents in isotopes vary inversely with the precipitation. For example, heavy rainfall in August and September saw a strong depletion of δ¹⁸O and δ²H contents. These values reach up to -4.96‰ for δ¹⁸O and -28.3‰ for δ²H. Similar, although weaker, effects are observed for July and October precipitation. We also note that the isotope contents at the Bangui University station are lower than those measured at the Bangui Sodeca station located at 386 m altitude on the Lower Ubangi Hill, which is similar to a pseudo-altitude effect. The evolution of stable isotope content in water as a function of meteorological parameters (temperature, rainfall, altitude) has allowed us to determine a local meteorological line for the city of Bangui from two measuring stations defined as follows: δ2H = 7.6 × δ18O + 10.4 (R2 = 0.9909) Université de Bangui, δ2H = 8.4 × δ18O + 12.5 (R2 = 0.9909) Bangui-Sodeca and δ2H = 7.9 × δ18O + 11.3 (R2 = 0.9939) Bangui local meteoric water lines

Laparoscopic bilateral cortical-sparing adrenalectomy for pheochromocytoma

© 2016, Springer Science+Business Media New York. Introduction: Since laparoscopic adrenalectomy for pheochromocytoma was reported in 1992, the laparoscopic technique has largely replaced the open approach [4]. Numerous studies have demonstrated that the laparoscopic approach is associated with decreased blood loss, shorter hospitalization, faster recovery, and lower cost [1]. Conversion rates are reported at less than 5.5 %, yet concern still exists that intraoperative hypertensive crisis may be more severe with laparoscopy due to increased intraabdominal pressure [3]. Bilateral pheochromocytomas are common in patients with multiple endocrine neoplasia type 2 (MEN 2) or von Hippel-Lindau (VHL) disease. Total adrenalectomy commits the patient to lifelong steroid hormone replacement and the risk of Addisonian crisis after bilateral adrenalectomy [5]; [8]. The risk of malignant pheochromocytomas in patients with or without MEN 2 or VHL is low. The current literature supports cortical-sparing adrenalectomy in patients with bilateral pheochromocytomas [2, 7, 10]. This video presents a patient with bilateral pheochromocytomas who underwent bilateral laparoscopic cortical-sparing adrenalectomies. Methods: A 40-year-old female presented to her primary care physician with a history of a hypertensive crisis that required an emergent cesarean section. Her workup revealed elevated urinary metanephrines, and a CT scan showed a left adrenal lesion measuring 3.9 cm and a right adrenal lesion measuring 2.7 cm. After undergoing alpha blockade, she was consented for bilateral partial adrenalectomies. A left partial adrenalectomy was performed first using four ports. The ports were then closed and the patient was repositioned in a left lateral decubitus position for a subsequent right partial adrenalectomy. Results: The patient had an uncomplicated hospital course and was discharged home on postoperative day 4. She returned for follow-up at 2 weeks and 1 month and had returned to her normal activities. Testing for MEN and von Hippel-Lindau was both negative. Her electrolyte and cortisol levels normalized, and she was weaned off her postoperative steroids by week five. At 1-year follow-up, she remains off steroids and no longer requires anti-hypertensive medications. Conclusion: Laparoscopic adrenalectomy is the gold standard for removal of benign lesions of the adrenal gland. Bilateral pheochromocytomas are more common in the presence of hereditary conditions such as MEN and von Hippel-Lindau and should be ruled out [8, 10]. The risk of Addisonian crisis and lifelong steroid replacement should prompt cortical preservation with bilateral disease [9]. Laparoscopic bilateral partial adrenalectomies should be considered in patients with bilateral pheochromocytomas [6]. Finally, all patients undergoing pheochromocytoma excision require lifelong follow-up to monitor for recurrence

Laparoscopic Puestow: lateral pancreaticojejunostomy.

© 2016, Springer Science+Business Media New York. Introduction: Chronic pancreatitis is a painful inflammatory disease that leads to progressive and irreversible destruction of pancreatic parenchyma [1]. A lateral pancreaticojejunostomy, also known as the Puestow procedure, is performed for symptomatic chronic pancreatitis associated with a dilated pancreatic duct secondary to calcifications or strictures [4]. An open approach is used traditionally due to the complexity of the case, and there have only been a handful of laparoscopic case reports [2]. This video depicts a laparoscopic lateral pancreaticojejunostomy for chronic pancreatitis. Methods: A 45-year-old gentleman with a 20-year history of chronic alcohol abuse presented with diffuse abdominal pain. His pain was worse postprandially and associated with loose stools. A computed tomography scan revealed multiple calcified deposits within the body and tail of the pancreas, and a dilated pancreatic duct measuring 1.4 cm with a proximal obstructing calcified stone. A 5-port foregut technique was used, and a 15-cm pancreatic ductotomy was performed with an ultrasonic scalpel. Calcified stones were cleared from the duct, and a roux-en-y pancreaticojejunostomy was performed using a hand-sewn technique. Results: The patient had a relatively uncomplicated hospital course with return of bowel function on postoperative day 4. His patient-controlled analgesic device was discontinued on post operative day 3. He was ambulating, tolerating a regular diet and discharged home on postoperative day 5. At 12- and 26-month follow-up, he remains off narcotics, but still requires 1–2 tabs of pancreatic enzyme replacement per meal. Most importantly, he has not had any alcohol for over 2 years. Conclusion: The two primary goals in treating chronic pancreatitis include long-term pain relief and improvements in quality of life [3]. For patients with chronic pancreatitis and a dilated pancreatic duct, a laparoscopic lateral pancreaticojejunostomy may be an effective approach to decrease pain and improve quality of life