Labor Analgesia in a Patient with Severe Dystrophic Calcinosis Cutis.

INTRODUCTION: Calcinosis cutis is a condition characterized by pathologic calcium deposition into superficial dermal skin layers. It is often associated with an autoimmune disease. However, it may also occur after minor localized trauma and infection. DESCRIPTION OF PROBLEM: We report a case of lumbar epidural placement of labor analgesia in a parturient with severe dystrophic calcinosis cutis without apparent complications. CLINICAL SOLUTION: We recommend fastidious optimization of epidural placement conditions for all patients who may be at high risk for neuraxial anesthesia, including consideration of ultrasound use, use of an experienced anesthesia provider for neuraxial placement, and placement in early labor. Additionally, judicious discussion of risks, benefits, and alternatives when obtaining informed consent is critical, ideally with the patient identified for a comprehensive visit in a preoperative obstetric anesthesia clinic before delivery.

Qualitative Assessment of Perioperative Lactation Patient Education: "I Think It's Something Women Navigate on Their Own".

Background: Patients who are lactating at the time of a procedure requiring anesthesia benefit from specific education and care coordination to support continued lactation and avoid complications. Before design and implementation of a comprehensive care pathway for this patient population at our institution, we sought to elicit the patient perspective. Methods: We conducted semistructured qualitative interviews with eight patients by phone regarding their experience as a lactating patient presenting for a procedure with anesthesia care at our institution. These were analyzed for predominant themes regarding their experiences. Results: The patients we interviewed reported receiving conflicting information and feeling a sense of uncertainty. Some patients experienced preventable health effects such as mastitis, and prior experience with breastfeeding was protective. The interviewed patients endorsed a desire for structured support and improved education resources. Discussion: This qualitative study of lactating patients undergoing anesthesia and surgery demonstrates a need for coordinated perioperative lactation care. A structured pathway for this patient population with access to updated care guidelines and patient education would be welcomed.

Divergent aging characteristics in CBA/J and CBA/CaJ mouse cochleae.

Two inbred mouse strains, CBA/J and CBA/CaJ, have been used nearly interchangeably as 'good hearing' standards for research in hearing and deafness. We recently reported, however, that these two strains diverge after 1 year of age, such that CBA/CaJ mice show more rapid elevation of compound action potential (CAP) thresholds at high frequencies (Ohlemiller, Brain Res. 1277: 70-83, 2009). One contributor is progressive decline in endocochlear potential (EP) that appears only in CBA/CaJ. Here, we explore the cellular bases of threshold and EP disparities in old CBA/J and CBA/CaJ mice. Among the major findings, both strains exhibit a characteristic age (∼18 months in CBA/J and 24 months in CBA/CaJ) when females overtake males in sensitivity decline. Strain differences in progression of hearing loss are not due to greater hair cell loss in CBA/CaJ, but instead appear to reflect greater neuronal loss, plus more pronounced changes in the lateral wall, leading to EP decline. While both male and female CBA/CaJ show these pathologies, they are more pronounced in females. A novel feature that differed sharply by strain was moderate loss of outer sulcus cells (or 'root' cells) in spiral ligament of the upper basal turn in old CBA/CaJ mice, giving rise to deep indentations and void spaces in the ligament. We conclude that CBA/CaJ mice differ both quantitatively and qualitatively from CBA/J in age-related cochlear pathology, and model different types of presbycusis.