Anesthesia management in a patient with Churg-Strauss syndrome in the ambulatory setting: A case report

Eosinophilic granulomatosis with polyangiitis (EGPA), also known as Churg-Strauss syndrome, is a rare type of vasculitis with multisystemic involvement. Very few authors have described the anaesthesia technique in these patients. We present the first report on ambulatory surgery in a patient with EGPA. This case dispels concerns about the safety of day surgery and reports successful regional anaesthesia management in a patient with EGPA.

A new perspective in understanding rainfall from satellites over a complex topographic region of India

Present study focuses on rainfall over Western Ghats (WG), a complex topographic region (elevation > 500 m) of India to evaluate and to better understand the satellite behavior in contrast with a flat region (FR) (elevation < 500 m) of central India from 1998 to 2016 using the combinatory data sets of TMPA and IMERG (satellite rainfall estimation). The categorical Intra Seasonal Oscillations (ISO) of Indian summer monsoon (ISM) namely, Madden Julian Oscillation (MJO) and Quasi Bi-Weekly Oscillation (QBWO) are tested in satellite and India Meteorological Department (IMD) gridded rainfall data sets to find out the satellite performance. As the accurate estimation of rainfall from satellites over higher elevation zones is challenging, here we propose a new perspective to select the rainfall products of satellite for better comparison with ground measurements. Considering the satellite’s best capability in detecting the cold clouds resulting from deep convection and its coupling with higher-level circulation, we show that the rainfall from satellites yield fruitful comparison with ground measurements when moist static stability, tropical easterly jet is above the climatological values.

Affinity partitioning of plasmid DNA with a zinc finger protein

The affinity isolation of pre-purified plasmid DNA (pDNA) from model buffer solutions using native and poly(ethylene glycol) (PEG) derivatized zinc finger-GST (Glutathione-S-Transferase) fusion protein was examined in PEG-dextran (DEX) aqueous two-phase systems (ATPSs). In the absence of pDNA, partitioning of unbound PEGylated fusion protein into the PEG-rich phase was confirmed with 97.5% of the PEGylated fusion protein being detected in the PEG phase of a PEG 600-DEX 40 ATPS. This represents a 1322-fold increase in the protein partition coefficient in comparison to the non-PEGylated protein (Kc = 0.013). In the presence of pDNA containing a specific oligonucleotide recognition sequence, the zinc finger moiety of the PEGylated fusion protein bound to the plasmid and steered the complex to the PEG-rich phase. An increase in the proportion of pDNA that partitioned to the PEG-rich phase was observed as the concentration of PEGylated fusion protein was increased. Partitioning of the bound complex occurred to such an extent that no DNA was detected by the picogreen assay in the dextran phase. It was also possible to partition pDNA using a non-PEGylated (native) zinc finger-GST fusion protein in a PEG 1000-DEX 500 ATPS. In this case the native ligand accumulated mainly in the PEG phase. These results indicate good prospects for the design of new plasmid DNA purification methods using fusion proteins as affinity ligands.

Pseudotumoural hemicerebellitis: imaging findings in two cases

Pseudotumoural hemicerebellitis is exceedingly rare. It may closely resemble a tumour either clinically or on imaging, and a high index of suspicion is required to avoid unnecessary surgical procedures. MRI is the most useful diagnostic tool, and reveals a swollen cerebellar hemisphere, hyperintense in T(2) weighted images. A pattern of predominantly pial contrast enhancement, absence of a well-defined mass and regression of the abnormalities in follow up examinations help to rule out malignancy. We report two cases of pseudotumoural cerebellitis (an 11-year-old girl and a 9-year-old boy) studied with CT and MRI.

Modelo experimental de tumor de Walker

Com o objetivo de padronizar normas técnicas para obtenção de modelo animal com tumor de Walker 256 e de estabelecer o número de células tumorais necessárias para que esse tumor tenha grande porcentagem de pega e longevidade, possibilitando o desenvolvimento de pesquisas em várias áreas da saúde, foi realizado trabalho em duas etapas. Na primeira foram utilizados 120 ratos para treinamento e definição da técnica. Na segunda etapa foram utilizados 84 ratos, sendo estes separados em 7 grupos (G) de 12 animais cada. O tumor, na forma ascítica, foi inoculado no tecido celular subcutâneo do dorso dos ratos com os seguintes números de células: GI, 1 x 10(7); GII, 5 x 10(6); GIII, 2,5 x 10(6); GIV, 1 x 10(6); GV, 5 x 10(5); GVI, 3 x 10(5) e GVII, 2 x 10(5). Foram avaliadas a porcentagem de pega e a longevidade nos grupos. Os animais dos GI, GII, GIII e GIV obtiveram 100% de desenvolvimento tumoral, porém baixa longevidade. Os dos GV e GVI obtiveram desenvolvimento tumoral em frequência maior que 90% e longevidade satisfatória. Os do GVII não apresentaram desenvolvimento tumoral. Concluiu-se que todos os procedimentos devem ser exaustivamente treinados e que o número de células tumorais viáveis para inoculação, em tecido celular subcutâneo de ratos, deve estar na faixa entre 5 x 10(5) e 3 x 10(5).

[Fragile X Syndrome: case report in two brothers]

OBJECTIVE

To alert the pediatricians about the phenotype of the patients with Fragile X Syndrome, because of it's high incidence and the variable degrees of incapacity that may occur.

METHODS

Case report of two brothers with the classical findings of the Fragile X Syndrome (mental retardation, "Dumbo-like" ears, macroorchidism, among others), confirmed by cytogenetic studies.

RESULTS

The diagnosis of the syndrome is based on the presence of a variable number of cells with fragile sites on the X chromosome at Xq 27.3. The DNA analysis revealed Fragile X locus in 14% of the brothers' metaphases and in 1% of the mother's. It was also observed that two cousins on the mother's side had the syndrome, confirmed by genetic studies.

CONCLUSIONS

The recognition of this syndrome by the pediatrician is of extreme importance to an early multidisciplinary approach.

[Aicardi syndrome and choroid plexus papilloma: a rare association. Case report]

The authors report a case of a 5 months old female child with clinical features of Aicardi syndrome: agenesis of the corpus callosum, occular abnormalities ("chorioretinal lacunae" and microphthalmus), infantile spasms, mental retardation, vertebral malformations and thoracic deformity. The pacient was submitted to complementary examinations that confirmed the diagnosis. The neuroradiologic images (MRI) showed besides corpus callosum agenesis a tumor located at the left ventricular atrium (choroid plexus papilloma). This association is a rare occurrence and the present case is the seventh described in literature. Furthermore, we suggest that the choroid plexus pappilloma could be a characteristic tumor of the Aicardi syndrome.

[Familial myasthenia gravis: a case report in identical twins]

To the best of our knowledge this is the seventh case report of monozygotic twins both affected by myasthenia gravis (MG). The monozygotism was proven by sex identity, blood group and HLA determinations ('O' Rh+, A2, A19.2, B40, CW3). One paternal aunt was also affected and the three cases have high titles of anti-acetylcholine receptor antibodies and anti-striated muscle antibodies, which indicate an acquired form of MG. After several myasthenic crises the twins are now doing well with corticosteroid therapy. The paternal aunt has a more benign form of MG, with ocular and limb involvement (grade IIa of Osserman) and was submitted to thymectomy. The authors discuss the use of corticosteroid for the infantile form of MG instead of thymectomy, based on the immaturity of the immune system in the young age. The use of other immunosuppressive drugs is not advisable because of potential hazardous development of neoplasms.

Chagas' megaesophagus: manometric studies before and after Thal's fundic patch operation

The authors present their experience with manometric studies, before and after Thal's fundic patch operation, in patients with Chagas' megaesophagus. The preoperative studies showed in the majority of the patients synchronous, waves of normal duration, that had low peak pressure and were repetitive (vigorous achalasia). The postoperative studies showed disappearance of the vigorous achalasia in over half the patients and increase of the contraction peak pressure in one patient.