Scott Kopec

The effects of Tween-80 on the integrity of solutions of capsaicin: useful information for performing tussigenic challenges

BackgroundBecause variable results of capsaicin challenges may be due to the incomplete solubility of capsaicin, we sought to determine if the use of Tween-80 in solutions of capsaicin improves actual concentrations of freshly prepared and stored solutions.MethodsCapsaicin solutions ranging from 0.5–128 μM were mixed with and without Tween-80. Samples of various concentrations were then stored under 4 environmental conditions: 4°C, protected from light; room temperature, protected from light; room temperature, exposed to light; -20°C. All samples were analyzed initially, and at 2 and 4 months.ResultsWhile freshly prepared solutions with Tween-80 had consistently higher concentrations than those prepared without Tween-80 (83% vs. 69%), Tween-80 does not facilitate complete solubility. For solutions stored at 4°C and protected from light, there was a significant decrease after 2 months in low concentration solutions of both the Tween-80 and non-Tween-80 solutions. Both Tween-80 and non-Tween-80 containing solutions significantly decreased in concentration after 2 months when stored at room temperature and protected from light, room temperature and exposed to light, and -20°C. Concentrations of solutions made of 4 μM or higher are stable when stored at 4°C and protected from light for 4 months.ConclusionWhile the inherent difficulty of forcing capsaicin into solution cannot be eliminated, it can be improved with Tween-80. However, the addition of Tween-80 does not prevent the breakdown of stored capsaicin solutions. We recommend preparing and storing capsaicin solutions according to the methods and results of this study.

Intensive Care of Pulmonary Complications Following Liver Transplantation

Chronic liver disease has been associated with pulmonary dysfunction both before and after liver transplantation. Post-liver transplantation pulmonary complications can affect both morbidity and mortality often necessitating intensive care during the immediate postoperative period. The major pulmonary complications include pneumonia, pleural effusions, pulmonary edema, and atelectasis. Poor clinical outcomes have been known to be associated with age, severity of liver dysfunction, and preexisting lung disease as well as perioperative events related to fluid balance, particularly transfusion and fluid volumes. Delineating each and every one of these pulmonary complications and their associated risk factors becomes paramount in guiding specific therapeutic strategies.

PS01.14: Diagnostic Yield in Patients Undergoing Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration: A Single Center Experience: Topic: Pulmonology

Background: Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration (EBUS-TBNA) is an established diagnostic tool in the evaluation of lung cancer with a variable diagnostic yield, ranging from 62 % 93 %. Although the procedure can be performed under moderate sedation (MS) or general anesthesia (GA) , the impact of sedation type on the diagnostic yield has yielded variable results with some authors reporting a higher yield with deep sedation, whereas others note no difference between MS and GA. We present findings of a retrospective study that looked at the diagnostic yield using an artificial airway under GA compared to conscious sedation through a natural airway in patients undergoing EBUS-TBNA. Methods: Demographic information on age, sex, race and co-morbidities were used to compute an age adjusted Charlson Co-morbidity index for each of 88 patients. Pathology reports were reviewed and an EBUS-TBNA was determined to be diagnostic if any of the sampled lymph nodes yielded a diagnosis. Assessment of the impact of using an artificial airway under GA on diagnostic yield was determined using multivariate logistic regression. Continuous variables are presented as means (± SD) and categorical variables are reported as counts and percentages. For all tests, two-sided P values < 0.05 were considered statistically significant. Results: Patients in the GA group were older (65 years versus 57.6, p1⁄4 0.005), had a higher age-adjusted Charlson comorbidity index, (3.7 versus 1.9, p < 0.001) and a higher ASA classification (3 versus 2 p1⁄4 0.004). Average lymph node size was smaller in the artificial airway group (16.2 mm versus 20.7mm, p1⁄4 0.01). Despite these differences, the diagnostic yield was the same (61.4 % in each group). In multivariate analyses, female sex and lymph node size were the only predictors of a diagnostic EBUS-TBNA. OR 3.3, 95 % CI, 1.23 e 9.1 for female gender, (p1⁄4 0.02) and 1.1, 95 % CI, 1.00 e 1.18 for lymph node size (p1⁄4 0.04). Diagnoses made were: adenocarcinoma of the lung 42.6 %, Sarcoidosis 16.7 %, Small cell lung cancer 14.8 %, Squamous cell carcinoma 11.1 %. Conclusion: EBUS-TBNA performed under general anesthesia through an artificial airway was not associated with an increased diagnostic yield, and therefore conscious sedation should be considered where appropriate, with general anesthesia reserved for those patients who are older, and with a higher perioperative risk. More research assessing the determinants of a positive diagnosis including physician pretest likelihood and PET/ CT avidity are needed to improve diagnostic outcomes.

A 46-Year-Old Woman With Dyspnea From an Inhalational Exposure, Triggering Thyroid Storm and Subsequent Multi-Organ System Failure

Background: Thyroid storm is a rare, life-threatening condition which arises in patients with thyrotoxicosis, with an annual incidence of 2 patients per 1,000,000 and a mortality rate of 11%. Case: We present the case of a 46-year-old-female with a medical history of controlled mild intermittent asthma, who presented with a severe asthma exacerbation, that triggered thyroid storm after exposure to polyurethane fumes. Conclusion: This patient represents, to the best of our knowledge, the first patient in whom the stress related to a severe asthma attack triggered the development of thyroid storm. She also is the first patient with no indication of cardiac dysfunction who developed fatal cardiac arrest after initiation of b-blockade for treatment of thyroid storm.

Massive overdose of Cardizem CD

Long-acting diltiazem preparations are currently frequently prescribed, and the potential for serious morbidity and mortality with an overdose can be significant. We present a case of Cardizem CD overdose in which a 22-year-old patient ingested 18.0 g, in an apparent suicide attempt. She presented within 5 hours of ingestion with a blood pressure of 80/30 mm Hg and a pulse of 80 beats/minute. Interventions included intravenous fluids, activated charcoal, atropine, calcium, dopamine, norepinephrine, glucagon, bowel irrigation with polyethylene glycol, and placement of a temporary transvenous pacemaker. Diltiazem levels were obtained, and an elimination half-life was calculated. Unique side effects of this overdose are discussed, and a treatment approach is suggested. Early and aggressive treatment is essential, and preparation for anticipated side effects should be initiated as soon as possible.