Central nystagmus and alterations in vestibular tests due to an inadvertent gentamicin administration into spinal space: A CARE case report.

INTRODUCTION: Gentamicin has a well-known potential for damaging the peripheral vestibular organs. However, it is considered to be innocuous to the CNS as it crosses the blood-brain barrier poorly. Here, we describe central neuro-otological abnormalities developed by a patient after deployment of gentamicin into his spinal space. CASE SUMMARY: A 61-year-old male unintentionally received gentamicin during spinal locoregional anesthesia for a urological procedure. During the first 48 hours the patient presented upper extremity dysmetria, dysarthria, and bilateral abducens nerve paralysis from which he recovered completely. He remained asymptomatic from day 3 to 10 after the incident. On day 11 he presented an acute vestibular syndrome. Severe bilateral vestibulopathy was confirmed by means of video head impulse testing. From day 14 onwards, he presented a persistent horizontal left-beating nystagmus, showing no variation or signs of compensation after 14 months, not responding to intensive vestibular rehabilitation or vestibular suppressant drugs. During follow-up, intercurrent gaze-evoked/direction-changing nystagmus has been recorded in various opportunities. DISCUSSION: We interpreted these findings as signs of both severe peripheral bilateral vestibulopathy and cerebellar and/or midbrain late-onset neurotoxicity, which can be explained by the intrinsic neurotoxic capability of high doses of gentamicin in the CNS.

Ribavirin effect on pulmonary function in young infants with respiratory syncytial virus bronchiolitis.

To assess the effect of ribavirin on pulmonary function in infants with respiratory syncytial virus bronchiolitis, we performed a randomized (nonmatched), double blinded, placebo-controlled study of 19 infants with RSV bronchiolitis. Infants with underlying respiratory, cardiac or immunologic disease were excluded. Patients were given ribavirin (10) or placebo (9) via an aerosol generator for 18 hours/day for 3 days. Pulmonary function (dynamic compliance, total lung resistance) was calculated using a pneumotachographic method on Days 1, 2 and 7. Differences between groups on clinical criteria were not found. Approximately one-half of each group showed increased compliance and decreased lung resistance after 24 to 48 hours of therapy. By Day 7 compliance had increased 30% in the placebo group and 210% in the ribavirin-treated infants (P = 0.05). Significant differences in the rate of change of lung resistance were not seen by Day 7. We conclude that previously noted improvements in the early course of respiratory syncytial virus bronchiolitis treated with ribavirin do not appear to be a result of measurable changes in pulmonary function. However, paradoxical increases in airway resistance were not found in patients treated with ribavirin.

Dose-response relationship of inhaled metaproterenol sulfate in preschool children with mild asthma.

The dose-response relationship of single doses of nebulized metaproterenol sulfate 5% inhalant solution was evaluated by placebo-controlled, parallel-group study of 30 children, aged 3 to 6 years old, with stable asthma. Total respiratory resistance, the primary variable used to assess response, was measured by the forced oscillation method for a period of 6 hours from the start of inhalation. When comparisons were made between metaproterenol sulfate and saline, only 0.01 and 0.02 mL/kg showed significant bronchodilation (P less than .05) in percent change from baseline and area under the curve. However, no significant differences were seen between these doses. Moreover, the effect was sustained for 3 hours with both higher doses. Minimal side effects were observed. Metaproterenol sulfate 5% inhalant solution at a dose of 0.01 mL/kg seems to be optimal to elicit significant and sustained bronchodilatory response in preschool children with mild asthma.

Neonatal pulse oximetry: accuracy and reliability.

Pulse oximetry has gained widespread use in neonatal oxygen monitoring. However, because specific morbidity in neonates has been related to abnormal levels of oxygen partial pressure (PaO2), it is essential to demonstrate that pulse oxygen saturation values (SpO2) are highly accurate and reflect with precision the simultaneous PaO2. In this report, data is presented that describe the accuracy of the Ohmeda Biox 3700 pulse oximeter. SpO2 was highly correlated with arterial blood oxygen saturation (r = .99) measured on arterial (catheter) blood using a two-wavelength Radiometer OSM2 Hemoximeter. When compared with PaO2, SpO2 values of 92% +/- 3% (mean +/- range) excluded all of the measured PaO2 values less than 45 mm Hg and greater than 100 mm Hg. SpO2-tcPO2 (transcutaneous PO2) and SpO2-PaO2 (catheter or percutaneous arterial PO2) correlations showed that bronchopulmonary dysplasia, percutaneous arterial sampling, and nipple feeding skewed the tcPO2 but not the PaO2 correlations with SpO2, indicating that SpO2 is not sensitive to peripheral factors that affect tcPO2. SpO2-PaO2 correlation was not affected by gestational age. A high degree of accuracy of SpO2 values and SpO2 prediction of normal appearing PaO2 values are defined by these results.

Fast hemoglobins and red blood cell metabolites in citrate phosphate dextrose adenine stored blood.

Blood was drawn from 10 fasted, healthy volunteers and stored under standard blood bank conditions in citrate-phosphate-dextrose-adenine (CPDA-1). Blood was sampled before storage (Day 0) and on Days 5, 12, 19, 26, and 35. Laboratory testing for glucose, HbAla + b, HbAlc, pyruvic acid, lactic acid, adenosine triphosphate (ATP), 2, 3-diphosphoglycerate (2,3DPG), plasma free hemoglobin (Hb) and pH (blood gases) were performed. In addition, P50 was also serially measured in two of the individuals and in their stored blood. Significant elevations of HbAla + b and HbAlc (fast hemoglobins) were found on Days 12 and 19 of storage (p less than 0.05). These elevations of fast hemoglobins are due to hypoxia, acidosis, and hyperglycemia. Following the initial elevation of the fast hemoglobins (Hbs), there was a decline in their concentration, from Day 12, which could partly be explained by cell death.

Hemobilia producida por Ascaris lumbricoides. / Hemobilia produced by Ascaris lumbricoides

Se presenta el caso de un nino de cinco anos, con sangrado digestivo alto por hemobilia tropical. Se describe la historia clinica, examenes auxiliares y hallazgos operatorios. El diagnostico fue hecho por estudio anatomopatologico