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Intraoperative cardiovascular collapse secondary to latex allergy
INTERNATIONAL
401
ABSTRACTS
Anterior Innominate Osteotomies for Failure or Late Closure of Bladder Extrophy ................... Ischemic Necrosis in Pathogenesis of Spontaneously Ruptured Enterocystoplasty ............... .... Antenatal Diagnosis of Renal Pelvic Dilatation.. Renal Obstructive Dysplasia ........... ......... ............ Testicular Adrenal-Like Tissue in Congenital Adrenal Hyperplasia ..................................... .... Musculoskeletal
407 407 407 407 407
System
Transverse Ligament Rupture and Atlantoaxial Subluxation in Children ................................. ... 408 Failure of Ultrasound to Detect Hemarthrosis in the Investigation of the Irritable Hip ............... 408 Neoplasms
Reduction in Tumor Burden Allowing Partial Nephrectomy Following Preoperative Chemotherapy in Biopsy-Proven Wilms’ Tumor ......... Extended Follow-Up of Bilateral Wilms’ Tumor. Nephrogenic Rests in Wilms’ Tumor Patients With the Drash Syndrome . ........... .................... Postoperative Treatment of Nonmetastatic Visible Residual Neuroblastoma ............... ........... .. N-myc Genomic Content and DNA PIoidy in Stage IV S Neuroblastoma ............................... Results of Surgical Resection of Soft Tissue Sarcomas of the Chest Wall .............................. Contribution of Salvage Surgery to Management of Childhood Osteosarcoma ............................. Presentation of Ki-1 Lymphoma as a Buttock Mass in a Child ........ .......... ........... ......... ........... .
408 408 408 408 409
restitution of regional organ blood flow and resulted in a more uniform circulatory response than the other solutions.-Richard R. Rick&s lntraoperative Cardiovascular Collapse Secondary to Latex Allergy. D.H. Nguyen, M.W Bums, G.G. Shapiro, et al. J Ural
146:571-574, (August), 1991. An apparent allergic reaction has been noted in children undergoing open urological surgery. This condition is characterized by precipitous hypotension, tachycardia, and upper body flushing, and it often causes termination of the procedure. Latex allergy has been identified as the possible inciting event. Contact of latex rubber gloves with intraabdominal structures (handling bowel) appears to be the most dramatic trigger mechanism for this reaction. Ten patients are reported with latex allergy, six of whom have myelomeningocele, who have undergone reconstructive surgery. Severe anaphylactic shock developed intraoperatively in five patients and during a barium enema performed with a latex catheter in one patient. These six patients had previous allergic reactions to latex material, which was not detected preoperatively. In the remaining four patients latex allergy was diagnosed preoperatively. A total of six patients agreed to a skin prick test to liquid latex. Three patients reacted with a wheal size greater than or equal to a histamine control at a dilution of l:l,OOO and three patients at 1:lOO. In contrast, none of the five normal controls reacted to any of the concentrations including full-strength latex. A history of exposure to latex products (balloons, surgical gloves. catheters, condoms, and so forth) with allergic reactions should heighten surgeons awareness of a potentially severe intraoperative reaction. Furthermore, a skin prick test may be used to screen high-risk patients, such as those with myelomeningocele. A protocol involving preoperative corticosteroid and antihistamine therapy is recommended.-GeoRe Holcomb. Jr
409 409 409
GENERAL CONSIDERATIONS Instantaneous Restoration of Regional Organ Blood Flow After Severe Hemorrhage: Effect of Small-Volume Resuscitation With Hypertonic-Hyperoncotic Solutions. U. fieimeier, U.B. Brueckner, J. Schmidt, et al. J Surg Res 49:493-503, (Decem-
ber), 1990. The acute effects of small-volume infusion of hypertonichyperoncotic solutions on central hemodynamics, regional blood flow, and respiratory function following severe hemorrhage were analyzed in anesthetized beagles. A mean arterial pressure of 40 mm Hg was sustained for 45 minutes before replacing 10% of the shed blood volume as an intravenous bolus infusion (over 2 minutes) of either 10% Dextran 60 in 7.2% NaCI, 10% Dextran 60 in 0.9% NaCl, or 7.2% NaCl alone. Within 5 minutes, the mean arterial pressure increased to 56% to 74% of baseline while at the same time the cardiac output reached or even exceeded prehemorrhage values for all three solutions. Regional blood flow in the kidneys, pancreas, and gastric mucosa was completely restored while blood flow in the myocardium, brain, skeletal muscle, adrenal glands, and small intestine and colon increased even above baseline values. Respiratory function was not adversely effected by any of the solutions. Of the three solutions, 10% Dextran 60 in 7.2% saline seemed to be the best because it provided instantaneous
Klippel-Trenaunay Syndrome: The Risks and Benefits of Vascular Interventions. P. Gloviczki, A. W. Stancon, G.B. Stickler, et al.
Surgery 110:469-479, (September).
1991.
This report documents the clinical experience with 144 patients with Klippel-Trenaunay syndrome (KTS). Hemangiomas and hypertrophy of the soft tissues were present in greater than 90% of patients; varicosities were present in 76%. The majority of patients (71.5%) had single extremity involvement. Leg length discrepancies were documented by roentgenograms, and all patients underwent noninvasive arterial and venous evaluation, contrast venography, and nuclear magnetic resonance imaging. The majority of patients were treated with elastic compression only. Surgical treatment for vascular malformations was variably applied. Operations included amputations, removal of varicose veins, and resection of hemangiomas. One patient underwent a deep venous reconstruction of an atresia of the superficial femoral vein. The article outlines important venographic findings and anatomical variations in this large group of patients with this congenital malformation. In contrast to other studies originating in France, this report stresses a conservative approach for patients with KTS with an excellent discussion on patient management. The report also notes that, despite resection of varicose veins or hemangiomatous tissue, lower extremity hypertrophy is persistent.--Thomas F. Traq. Jr Tension Pneumothorax During Extracorporeal Membrane Oxygenation. J.B. Zwischenberger, R.M. Bowers, and G.J. Pickens. Ann
Thorac Surg 47:868-871. (June), 1989. Tension pneumothorax during extracorporeal membrane oxygenation (ECMO) is a well-recognized complication that can have
401
ABSTRACTS
Anterior Innominate Osteotomies for Failure or Late Closure of Bladder Extrophy ................... Ischemic Necrosis in Pathogenesis of Spontaneously Ruptured Enterocystoplasty ............... .... Antenatal Diagnosis of Renal Pelvic Dilatation.. Renal Obstructive Dysplasia ........... ......... ............ Testicular Adrenal-Like Tissue in Congenital Adrenal Hyperplasia ..................................... .... Musculoskeletal
407 407 407 407 407
System
Transverse Ligament Rupture and Atlantoaxial Subluxation in Children ................................. ... 408 Failure of Ultrasound to Detect Hemarthrosis in the Investigation of the Irritable Hip ............... 408 Neoplasms
Reduction in Tumor Burden Allowing Partial Nephrectomy Following Preoperative Chemotherapy in Biopsy-Proven Wilms’ Tumor ......... Extended Follow-Up of Bilateral Wilms’ Tumor. Nephrogenic Rests in Wilms’ Tumor Patients With the Drash Syndrome . ........... .................... Postoperative Treatment of Nonmetastatic Visible Residual Neuroblastoma ............... ........... .. N-myc Genomic Content and DNA PIoidy in Stage IV S Neuroblastoma ............................... Results of Surgical Resection of Soft Tissue Sarcomas of the Chest Wall .............................. Contribution of Salvage Surgery to Management of Childhood Osteosarcoma ............................. Presentation of Ki-1 Lymphoma as a Buttock Mass in a Child ........ .......... ........... ......... ........... .
408 408 408 408 409
restitution of regional organ blood flow and resulted in a more uniform circulatory response than the other solutions.-Richard R. Rick&s lntraoperative Cardiovascular Collapse Secondary to Latex Allergy. D.H. Nguyen, M.W Bums, G.G. Shapiro, et al. J Ural
146:571-574, (August), 1991. An apparent allergic reaction has been noted in children undergoing open urological surgery. This condition is characterized by precipitous hypotension, tachycardia, and upper body flushing, and it often causes termination of the procedure. Latex allergy has been identified as the possible inciting event. Contact of latex rubber gloves with intraabdominal structures (handling bowel) appears to be the most dramatic trigger mechanism for this reaction. Ten patients are reported with latex allergy, six of whom have myelomeningocele, who have undergone reconstructive surgery. Severe anaphylactic shock developed intraoperatively in five patients and during a barium enema performed with a latex catheter in one patient. These six patients had previous allergic reactions to latex material, which was not detected preoperatively. In the remaining four patients latex allergy was diagnosed preoperatively. A total of six patients agreed to a skin prick test to liquid latex. Three patients reacted with a wheal size greater than or equal to a histamine control at a dilution of l:l,OOO and three patients at 1:lOO. In contrast, none of the five normal controls reacted to any of the concentrations including full-strength latex. A history of exposure to latex products (balloons, surgical gloves. catheters, condoms, and so forth) with allergic reactions should heighten surgeons awareness of a potentially severe intraoperative reaction. Furthermore, a skin prick test may be used to screen high-risk patients, such as those with myelomeningocele. A protocol involving preoperative corticosteroid and antihistamine therapy is recommended.-GeoRe Holcomb. Jr
409 409 409
GENERAL CONSIDERATIONS Instantaneous Restoration of Regional Organ Blood Flow After Severe Hemorrhage: Effect of Small-Volume Resuscitation With Hypertonic-Hyperoncotic Solutions. U. fieimeier, U.B. Brueckner, J. Schmidt, et al. J Surg Res 49:493-503, (Decem-
ber), 1990. The acute effects of small-volume infusion of hypertonichyperoncotic solutions on central hemodynamics, regional blood flow, and respiratory function following severe hemorrhage were analyzed in anesthetized beagles. A mean arterial pressure of 40 mm Hg was sustained for 45 minutes before replacing 10% of the shed blood volume as an intravenous bolus infusion (over 2 minutes) of either 10% Dextran 60 in 7.2% NaCI, 10% Dextran 60 in 0.9% NaCl, or 7.2% NaCl alone. Within 5 minutes, the mean arterial pressure increased to 56% to 74% of baseline while at the same time the cardiac output reached or even exceeded prehemorrhage values for all three solutions. Regional blood flow in the kidneys, pancreas, and gastric mucosa was completely restored while blood flow in the myocardium, brain, skeletal muscle, adrenal glands, and small intestine and colon increased even above baseline values. Respiratory function was not adversely effected by any of the solutions. Of the three solutions, 10% Dextran 60 in 7.2% saline seemed to be the best because it provided instantaneous
Klippel-Trenaunay Syndrome: The Risks and Benefits of Vascular Interventions. P. Gloviczki, A. W. Stancon, G.B. Stickler, et al.
Surgery 110:469-479, (September).
1991.
This report documents the clinical experience with 144 patients with Klippel-Trenaunay syndrome (KTS). Hemangiomas and hypertrophy of the soft tissues were present in greater than 90% of patients; varicosities were present in 76%. The majority of patients (71.5%) had single extremity involvement. Leg length discrepancies were documented by roentgenograms, and all patients underwent noninvasive arterial and venous evaluation, contrast venography, and nuclear magnetic resonance imaging. The majority of patients were treated with elastic compression only. Surgical treatment for vascular malformations was variably applied. Operations included amputations, removal of varicose veins, and resection of hemangiomas. One patient underwent a deep venous reconstruction of an atresia of the superficial femoral vein. The article outlines important venographic findings and anatomical variations in this large group of patients with this congenital malformation. In contrast to other studies originating in France, this report stresses a conservative approach for patients with KTS with an excellent discussion on patient management. The report also notes that, despite resection of varicose veins or hemangiomatous tissue, lower extremity hypertrophy is persistent.--Thomas F. Traq. Jr Tension Pneumothorax During Extracorporeal Membrane Oxygenation. J.B. Zwischenberger, R.M. Bowers, and G.J. Pickens. Ann
Thorac Surg 47:868-871. (June), 1989. Tension pneumothorax during extracorporeal membrane oxygenation (ECMO) is a well-recognized complication that can have