Reiter's syndrome caused by Streptococcus viridans in a patient with HLA-B27 antigen.

A 26-year-old male patient with mitral valve prolapse and HLA-B27 antigen received endodontic treatment for dental caries. Two weeks later fever, dysuria, diarrhea, sterile inflammatory arthritis of lower limbs, enthesitis, dactylitis, conjunctivitis, and uveitis consecutively developed. Blood culture performed at the time of active arthritis yielded Streptococcus viridans. He did not have any history of psoriasis, acute infectious diarrhea, chronic inflammatory bowel diseases, or sexually transmitted diseases. Laboratory studies also excluded the possibility of infections by human immunodeficiency virus, hepatitis B or C virus, chlamydia, and streptococci from the upper airway. This report indicates that Streptococcus viridans can be the triggering microorganisms of Reiter's syndrome in some circumstances.

The interaction of the neuromuscular effects between mivacurium and esmolol in rats.

BACKGROUND: To study the neuromuscular interaction between mivacurium and esmolol, we compared the neuromuscular actions of the ED90 dose of mivacurium both in the absence and presence of esmolol infusion. METHODS: Twelve rats were anesthetized with urethane. Train-of-four stimulation was applied every 12 s to the sciatic nerve, and the electromyogram (EMG) response of the anterior tibial muscle was measured. RESULTS: The ED50 and ED90 of mivacurium in rats were 144 +/- 7.3 micrograms/kg and 197 +/- 7.7 micrograms/kg, respectively. The maximal EMG depression produced by ED50 of mivacurium decreased significantly with esmolol treatment from 88.2 +/- 2.7% to 83.1 +/- 2.6% after esmolol infusion (p < 0.05). The onset time for 75% EMG depression was much shorter for control (44 +/- 6.3 s) than that of esmolol treatment (78.2 +/- 2.4 s; p < 0.05). There was no difference between their duration. CONCLUSIONS: The results of this study demonstrated that esmolol does not potentiate the neuromuscular effect of mivacurium but antagonize the maximal neuromuscular block and decrease its onset time in rats.

[Incidence of venous air embolism in parturients during cesarean section with regional anesthesia].

The purpose of the study is to probe the situation of venous air embolism (VAE) and the accompanying complications occurring in Chinese parturients in Taiwan during Cesarean section. Sixty ASA physical status class I-II parturients who were subjected to cesarean section under regional anesthesia were evaluated. The sensor of the Doppler device was placed on the anterior chest to detect the rumbles of air when it came to pass, and simultaneously the signs and symptoms following VAE were observed. Our results demonstrated that the usual or normal Doppler heart sound changed in 38 parturients out of 60 (63.3%), and the alteration occurred very often when the uterus was being incised (81.6%), or sutured (97.4%), and concurred strong correlation with such signs and symptoms such as chest tightness or precordial pain (78.9%), shortness of breath (60.5%), and change of heart rate or blood pressure (86.8%). The method of anesthesia (spinal or epidural block) did not have effect on the occurrence of VAE, but different surgical approaches and different positions in which the patients were posed during operation did apparently bring about VAE of variable degree. Besides, supplying of oxygen could mitigate the symptoms produced by VAE. Consequently, the application of Doppler monitor during Cesarean section can detect VAE earlier and more efficiently and thus provides information timely treatment.