Inferior alveolar nerve injury with laryngeal mask airway: a case report

<p>Abstract</p> <p>Introduction</p> <p>The incidence of damage to the individual cranial nerves and their branches associated with laryngeal mask airway use is low; there have been case reports of damage to the lingual nerve, hypoglossal nerve and recurrent laryngeal nerve. To the best of our knowledge we present the first reported case of inferior alveolar nerve injury associated with laryngeal mask airway use.</p> <p>Case presentation</p> <p>A 35-year-old Caucasian man presented to our facility for elective anterior cruciate ligament repair. He had no background history of any significant medical problems. He opted for general anesthesia over a regional technique. He was induced with fentanyl and propofol and a size 4 laryngeal mask airway was inserted without any problems. His head was in a neutral position during the surgery. After surgery in the recovery room, he complained of numbness in his lower lip. He also developed extensive scabbing of the lower lip on the second day after surgery. The numbness and scabbing started improving after a week, with complete recovery after two weeks.</p> <p>Conclusion</p> <p>We report the first case of vascular occlusion and injury to the inferior alveolar nerve, causing scabbing and numbness of the lower lip, resulting from laryngeal mask airway use. This is an original case report mostly of interest for anesthetists who use the laryngeal mask airway in day-to-day practice. Excessive inflation of the laryngeal mask airway cuff could have led to this complication. Despite the low incidence of cranial nerve injury associated with the use of the laryngeal mask airway, vigilant adherence to evidence-based medicine techniques and recommendations from the manufacturer's instructions can prevent such complications.</p

Comparison of the i-gel with the cuffed tracheal tube during pressure-controlled ventilation

Background. The i-gel (Intersurgical Ltd) is a novel device that differs from other supraglottic airway devices in that it has a softer and a non-inflatable cuff. Our study was designed to assess whether the i-gel is suitable to provide pressure-controlled ventilation (PCV) during anaesthesia by measuring the gas leaks and comparing these values with that of the tracheal tube. Methods. Twenty-five patients, ASA I–II, were recruited to the study. Patients received a standard anaesthetic technique followed by an initial placement of the i-gel. The lungs were then ventilated at three different pressures (15, 20, 25 cm H2O) using PCV. The difference between the inspired and expired tidal volumes was used to calculate the leak volume. The leak fraction was defined as the leak volume divided by the inspired tidal volume. Following these observations, the i-gel was removed and replaced with the conventional tracheal tube and the recordings repeated. Results. There was no significant difference between the leak fractions of the i-gel and the tracheal tube at 15 and 20 cm H2O PCV. At 25 cm H2O, the median difference in leak fraction was 0.02 (P¼0.014) and the median difference in leak volume was 26.5 ml (P¼0.006). There was no evidence of gastric insufflations with any of the pressures used during PCV. Conclusions. We suggest that the i-gel can be used as a reasonable alternative to tracheal tube during PCV with moderate airway pressures. Br J Anaesth 2009; 102: 264–8 Keywords: equipment, airway; ventilation, mechanical Accepted for publication: November 4, 200

Neutralizing Antibody-Resistant Hepatitis C Virus Cell-to-Cell Transmission

Hepatitis C virus (HCV) can initiate infection by cell-free particle and cell-cell contact-dependent transmission. In this study we use a novel infectious coculture system to examine these alternative modes of infection. Cell-to-cell transmission is relatively resistant to anti-HCV glycoprotein monoclonal anti- bodies and polyclonal immunoglobulin isolated from infected individuals, providing an effective strategy for escaping host humoral immune responses. Chimeric viruses expressing the structural proteins rep- resenting the seven major HCV genotypes demonstrate neutralizing antibody-resistant cell-to-cell trans- mission. HCV entry is a multistep process involving numerous receptors. In this study we demonstrate that, in contrast to earlier reports, CD81 and the tight-junction components claudin-1 and occludin are all essential for both cell-free and cell-to-cell viral transmission. However, scavenger receptor BI (SR-BI) has a more prominent role in cell-to-cell transmission of the virus, with SR-BI-specific antibodies and small-molecule inhibitors showing preferential inhibition of this infection route. These observations highlight the importance of targeting host cell receptors, in particular SR-BI, to control viral infection and spread in the liver

Multiple effects of silymarin on the hepatitis C virus lifecycle

Silymarin, an extract from milk thistle (Silybum marianum), and its purified flavonolignans have been recently shown to inhibit hepatitis C virus (HCV) infection, both in vitro and in vivo. In the current study, we further characterized silymarin's antiviral actions. Silymarin had antiviral effects against hepatitis C virus cell culture (HCVcc) infection that included inhibition of virus entry, RNA and protein expression, and infectious virus production. Silymarin did not block HCVcc binding to cells but inhibited the entry of several viral pseudoparticles (pp), and fusion of HCVpp with liposomes. Silymarin but not silibinin inhibited genotype 2a NS5B RNA-dependent RNA polymerase (RdRp) activity at concentrations 5 to 10 times higher than required for anti-HCVcc effects. Furthermore, silymarin had inefficient activity on the genotype 1b BK and four 1b RDRPs derived from HCV-infected patients. Moreover, silymarin did not inhibit HCV replication in five independent genotype 1a, 1b, and 2a replicon cell lines that did not produce infectious virus. Silymarin inhibited microsomal triglyceride transfer protein activity, apolipoprotein B secretion, and infectious virion production into culture supernatants. Silymarin also blocked cell-to-cell spread of virus. CONCLUSION: Although inhibition of in vitro NS5B polymerase activity is demonstrable, the mechanisms of silymarin's antiviral action appear to include blocking of virus entry and transmission, possibly by targeting the host cell

Six Months of Multi-Wavelength Follow-up of the Tidal Disruption Candidate ASASSN-14li and Implied TDE Rates from ASAS-SN

We present ground-based and Swift photometric and spectroscopic observations of the candidate tidal disruption event (TDE) ASASSN-14li, found at the center of PGC 043234 ($d\simeq90$ Mpc) by the All-Sky Automated Survey for SuperNovae (ASAS-SN). The source had a peak bolometric luminosity of $L\simeq10^{44}$ ergs s$^{-1}$ and a total integrated energy of $E\simeq7\times10^{50}$ ergs radiated over the $\sim6$ months of observations presented. The UV/optical emission of the source is well-fit by a blackbody with roughly constant temperature of $T\sim35,000$ K, while the luminosity declines by roughly a factor of 16 over this time. The optical/UV luminosity decline is broadly consistent with an exponential decline, $L\propto e^{-t/t_0}$, with $t_0\simeq60$ days. ASASSN-14li also exhibits soft X-ray emission comparable in luminosity to the optical and UV emission but declining at a slower rate, and the X-ray emission now dominates. Spectra of the source show broad Balmer and helium lines in emission as well as strong blue continuum emission at all epochs. We use the discoveries of ASASSN-14li and ASASSN-14ae to estimate the TDE rate implied by ASAS-SN, finding an average rate of $r \simeq 4.1 \times 10^{-5}~{\rm yr}^{-1}$ per galaxy with a 90% confidence interval of $(2.2 - 17.0) \times 10^{-5}~{\rm yr}^{-1}$ per galaxy. ASAS-SN found roughly 1 TDE for every 70 Type Ia supernovae in 2014, a rate that is much higher than that of other surveys.Comment: 21 pages, 9 figures, 6 tables. Photometric data presented in this submission are included as ancillary files. Manuscript updated to reflect changes made in the published version. For a brief video explaining this paper, see https://youtu.be/CTbr-d7cWZ