Amniotic fluid embolism induces uterine anaphylaxis and atony following cervical laceration.

Amniotic fluid embolism (AFE) is a rare, high-risk obstetric complication primarily found in the lungs and potentially related to anaphylaxis. Tryptase release from the mast cell reflects anaphylaxis. Case report and findings: A female, aged over 40 years, presented with uterine atony and lethal hemorrhage after induced vaginal labor. Cervical laceration was accompanied by severe hemorrhage. Stromal edema and myometrial swelling were consistent with uterine atony. Alcian blue staining and zinc coproporphyrin immunostaining disclosed AFE, which was more prominent in the uterus than in the lungs. Tryptase immunostaining was diffuse and prominent around the activated mast cells (halos) in the uterus, including the cervix. Similar distribution of findings on the AFE markers, tryptase halos, complement receptor C5aR, and atony in the uterus suggested the causality of AFE to anaphylaxis, complement activation and atony. It is probable that disseminated intravascular coagulation (DIC), induced by AFE, uterine atony and cervical laceration, caused the lethal hemorrhage. It is likely that AFE, in association with cervical laceration, induces uterine anaphylaxis, complement activation, atony, DIC and lethal hemorrhage.

Relationships between the amount of saliva and medications in elderly individuals.

OBJECTIVE: To investigate medications that are related to volume of saliva in the elderly. BACKGROUND DATA: In the elderly, many cases of mouth dryness may represent side effects of medication. MATERIALS AND METHODS: The volume of unstimulated saliva was measured for 30 s (cotton roll test), and with stimulation for 3 min (gum test) in 368 subjects 79-80 years old (177 men, 191 women). Medications were investigated using subject's medication notebooks. RESULTS: Mean volumes of unstimulated and stimulated saliva were 0.14±0.13 and 4.30±2.54 ml respectively. Significant differences were seen between gender and mean volume of saliva. The volume of unstimulated saliva was 0.16±0.15 ml for men and 0.11±0.10 ml for women. The volume of stimulated saliva was 4.99±2.67 ml for men and 3.67±2.25 ml for women. The percentage of subjects taking medication was 64.7% (238/368). Mean number of medications was 2.08±2.26, with no significant difference with gender (2.01±2.37 for men, 2.16±2.16 for women). In a stepwise multiple regression analysis with volume of saliva as the objective variable and number of drugs by category as explanatory variables, significant explanatory variables in addition to gender and number of medications were blood-coagulating agents, Ca antagonists and peptic ulcer drugs for volume of unstimulated saliva, and diabetes medications and peptic ulcer drugs for volume of stimulated saliva. CONCLUSION: These findings suggest that differences exist between gender in volume of saliva for elderly individuals, and that the volume of saliva is affected by the number and type of medications.

Sensory and motor responses of normal young adults during swallowing of foods with different properties and volumes.

We examined the influence of rheological/textural properties and volumes of test foods on the sensory and motor aspects of swallowing in healthy young adults. Three test foods differing in thickening agent concentration (0.0, 1.5, and 3.0%) were prepared and delivered in different volumes (approximately 3, approximately 5, and approximately 7 ml) to subjects seated on a chair. Viscosity analyses of the 1.5 and 3.0% test foods revealed that they behaved as non-Newtonian fluids and were thixotropic. The 1.5% test food differed from the 3.0% test food in its textural properties (hardness, cohesiveness, and adhesiveness). As determined by a linear model equation method, the thickening agent concentration affected the scores of all six sensory evaluation questions that were answered by the subjects, which suggests that the concentration affected the food properties being evaluated. Consistent with previous reports, thickening agent concentration and test food volume also affected some durational parameters of laryngeal (recorded by a piezoelectric sensor) and suprahyoid muscle (recorded on an electromyogram) motor activity. However, thickening agent concentration and test food volume did not affect the single amplitude parameter of the electromyogram that was measured. The thixotropic property of foods can affect the motor aspect of oropharyngeal swallowing as well as the sensory aspect.