Crisis management during anaesthesia: water intoxication

© 2005 BMJ Publishing Group Ltd.Background: Irrigation of closed body spaces may lead to substantial perioperative fluid and electrolyte shifts. A syndrome occurring during transurethral resection of prostate (TURP), and a similar syndrome described in women undergoing transcervical endometrial ablation (TCEA) are both characterised by a spectrum of symptoms which may range from asymptomatic hyponatraemia to convulsions, coma, and death. Such potentially serious consequences require prompt recognition and appropriate management of this "water intoxication" syndrome. Objectives: To examine the role of a previously described core algorithm "COVER ABCD–A SWIFT CHECK", supplemented by a specific sub-algorithm for water intoxication, in the management of this syndrome occurring in association with anaesthesia. Methods: The potential performance of this structured approach for each of the relevant incidents among the first 4000 reported to the Australian Incident Monitoring Study (AIMS) was compared with the actual management as reported by the anaesthetists involved. Results: From the first 4000 incidents reported to AIMS, 10 reports of water intoxication were identified, two from endometrial ablations under general anaesthesia and eight from male urological procedures under spinal anaesthesia. The "core" crisis management algorithm detected a problem in seven cases; however, it was deficient in dealing with neurological presentations. Diagnosis of the cause of the incident would have required a specific water intoxication sub-algorithm in eight cases and a hypotension algorithm in a further two cases. Corrective strategies also required a specific sub-algorithm in eight cases, while the hypotension and cardiac arrest sub-algorithms were required in conjunction with the water intoxication sub-algorithm in the remaining two.M T Kluger, S M Szekely, R J Singleton, S C Help

The polymorphic nature of the human dopamine D4 receptor gene: A comparative analysis of known variants and a novel 27 bp deletion in the promoter region

BACKGROUND: The human dopamine D4 receptor (DRD4) is a candidate gene of great interest in molecular studies of human personality and psychiatric disorders. This gene is unique in having an exceptionally high amount of polymorphic sites both in the coding and in the promoter region. RESULTS: We report the identification of a new 27 bp deletion starting 524 bp upstream of the initiation codon (27 bp del) of the dopamine D4 receptor (DRD4) gene, in the close vicinity of the -521C>T SNP. The presence of the 27 bp deletion leads to the misgenotyping of the -616C>G SNP by the Sau96 I RFLP method, thus the genotype determination of the mutation is of additional importance. The frequency of this novel sequence variation is considerably low (allele frequency is = 0.16%), as no homozygotes, and only 3 heterozygote carriers were found in a healthy, unrelated Caucasian sample (N = 955). CONCLUSION: Remarkably, the deleted region contains consensus sequences of binding sites for several known transcription factors, suggesting that the different alleles may affect the transcriptional regulation of the gene. A comparison of methods and results for the allelic variations of the DRD4 gene in various ethnic groups is also discussed, which has a high impact in psychiatric genetic studies

Scanning Electron Microscope Observations of Growth and Ochratoxin - A Production of Aspergillus alutaceus Variety alutaceus (Formerly A. ochraceus) on Gamma-Irradiated Barley

Scanning electron microscope examination, colony counting and biochemical studies were conducted to describe the effect of gammairradiation on growth and ochratoxin A production by Aspergillus alutaceus. Irradiation at a dose of 1.0 or 2.0 kGy reduced the level of mold growth greatly relative to unirradiated controls. Growth in the irradiated samples after 7 to 12 day incubation was mainly in cracks in the hull, and less mycelium was seen on the grain surface. In unirradiated controls, mycelial growth was heavy and, although conidial heads were most abundant in cracks in the hull, they were seen over the whole surface. Vhen the barley was inoculated before irradiation, the number of colony forming units (cfu) at 5 days after 1.0 or 2.0 kGy irradiation was lower than in the unirradiated controls; however, the number increased over the control by 30 days. A dose of 4.0 kGy eliminated viable fungi. Ochratoxin A production decreased from the control level of 17.6 μg/g with increased dose and was below the detection limit above 4.0 kGy. Vhen barley was inoculated after irradiation the spore count and the ochratoxin A level were higher than the unirradiated control after 27 days. We conclude that the difference in growth and ochratoxin A production on irradiated and unirradiated barley is due to the effect of irradiation on the natural competitive microflora on the grain surface and the reduction of inoculum size of the A. alutaceus by radiation

Activity of 50 Long-Period Comets Beyond 5.2 AU

Remote investigations of the ancient solar system matter has been traditionally carried out through the observations of long-period (LP) comets that are less affected by solar irradiation than the short-period counterparts orbiting much closer to the Sun. Here we summarize the results of our decade-long survey of the distant activity of LP comets. We found that the most important separation in the dataset is based on the dynamical nature of the objects. Dynamically new comets are characterized by a higher level of activity on average: the most active new comets in our sample can be characterized by afrho values >3--4 higher than that of our most active returning comets. New comets develop more symmetric comae, suggesting a generally isotropic outflow. Contrary to this, the coma of recurrent comets can be less symmetrical, ocassionally exhibiting negative slope parameters, suggesting sudden variations in matter production. The morphological appearance of the observed comets is rather diverse. A surprisingly large fraction of the comets have long, teniouos tails, but the presence of impressive tails does not show a clear correlation with the brightness of the comets.Comment: 21 pages, 4 figures, accepted for publication in A

Genetic associations with childhood brain growth, defined in two longitudinal cohorts

Genome-wide association studies (GWASs) are unraveling the genetics of adult brain neuroanatomy as measured by cross-sectional anatomic magnetic resonance imaging (aMRI). However, the genetic mechanisms that shape childhood brain development are, as yet, largely unexplored. In this study we identify common genetic variants associated with childhood brain development as defined by longitudinal aMRI. Genome-wide single nucleotide polymorphism (SNP) data were determined in two cohorts: one enriched for attention-deficit/hyperactivity disorder (ADHD) (LONG cohort: 458 participants; 119 with ADHD) and the other from a population-based cohort (Generation R: 257 participants). The growth of the brain's major regions (cerebral cortex, white matter, basal ganglia, and cerebellum) and one region of interest (the right lateral prefrontal cortex) were defined on all individuals from two aMRIs, and a GWAS and a pathway analysis were performed. In addition, association between polygenic risk for ADHD and brain growth was determined for the LONG cohort. For white matter growth, GWAS meta-analysis identified a genome-wide significant intergenic SNP (rs12386571, P = 9.09 × 10-9 ), near AKR1B10. This gene is part of the aldo-keto reductase superfamily and shows neural expression. No enrichment of neural pathways was detected and polygenic risk for ADHD was not associated with the brain growth phenotypes in the LONG cohort that was enriched for the diagnosis of ADHD. The study illustrates the use of a novel brain growth phenotype defined in vivo for further study

A prospective seroepidemiological study of human herpesvirus-8 infection and the risk of multiple myeloma

Presence of the Human Herpesvirus 8 (HHV8) genome has been reported in the bone marrow of multiple myeloma (MM) patients. So far, serological studies of HHV8 and MM have been inconsistent but have not included prospective epidemiological studies. We evaluated whether HHV8 infection is associated with increased risk for MM in a prospective population-based study of 39 000 Finnish subjects who donated serum samples in the period 1968–72. Serum samples from 47 subjects who developed MM during a 23-year follow-up and 224 age, area of residence and sex-matched subjects who remained healthy over a similar follow-up period were evaluated for HHV8 antibodies at enrolment, as assayed both with an immunofluorescence assay (IFA) for lytic and latent HHV8 antigens and by Western blot (WB) with three recombinant HHV8 proteins (ORFs 65, 73 and K8.1A). HHV8 seropositivity for at least one HHV8 protein on WB was found in 7% of the Finnish population and was not associated with the risk of developing MM (Relative Risk (RR) = 0.89, Confidence Interval (CI): 0.25–3.25). HHV8 seropositivity for lytic and latent antigens in the IFA was found in 16% and 0.4% of the Finnish population and tended to associate with risk of MM (RR = 2.02, CI: 0.94–4.33 and RR = 10.00, CI: 0.91–110.29, respectively). In conclusion, no statistically significant evidence for an association between HHV8 infection and the risk of future MM was found. © 2001 Cancer Research Campaign http://www.bjcancer.co