Nosocomial transmission of hepatitis C virus (HCV) subtype 1b involving 11 haemodialysis patients occurred in a haemodialysis unit in Japan in March 2000. Sequencing of the HCV-E1 region (411-bp) and phylogenetic-tree analysis showed near identity between HCV isolates derived from these patients and a haemodialysis patient who was known to be HCV-positive. The mode of transmission could not be conclusively established, but retrospective analysis suggested that the sharing of contaminated multidose vials of heparin-saline solutions, which were prepared in the Haemodialysis Center using accidentally contaminated instruments such as needles, may have been responsible for the outbreak. To prevent transmission of HCV in a haemodialysis unit, it may be important to observe strictly standard precautions and to prepare all medications in the Pharmacy. After these measures were taken, no new seroconversions and no new nosocomial transmissions of HCV have been observed in our haemodialysis unit.
Background and objectives: Palpation has been shown to be rather inaccurate at identifying lumbar interspinous spaces in neuraxial anesthesia. The aim of this study is to assess the accuracy of the determination of the lumbar interspinous spaces by anesthesiologist's palpation using post-operative X-rays in obstetric patients. Methods: We reviewed the anesthetic record and the post-operative abdominal X-rays of the cesarean sections. We indwelled the epidural catheter for post-operative one-shot analgesia. We included combined spinal and epidural anesthesia cases and compared the interspinous level which the anesthesiologist recorded and the epidural catheter insertion level confi rmed by abdominal X-ray for each case. We also evaluated the factors (age, body weight, height, Body Mass Index, gestational age, and the type of surgery [planned / emergency]) leading to misidentifi cation of interspinous level. Results: Nine hundred and sixty seven cesarean sections were performed and a total of 835 cases were evaluated. The levels of the puncture documented by the anesthesiologists were in agreement with the actual catheter insertion levels in 563 (67%) cases. When the anesthesiologists aimed at L2-3 level, we found the catheter insertion at L1-2 in 5 cases (4.9%), none of which had any post-operative neurological defi cits. No variables evaluated were signifi cantly associated with misidentifi cation of interspinous level by the anesthesiologists. Conclusions: There was a discrepancy between the anesthesiologists' estimation by palpation and the actual catheter insertion level shown in X-rays. It seems to be safer to choose the interspinous level L3-4 or lower in spinal anesthesia.
There was a discrepancy between the anesthesiologists' estimation by palpation and the actual catheter insertion level shown in X-rays. It seems to be safer to choose the interspinous level L3-4 or lower in spinal anesthesia.
There are two types of amniotic fluid embolism (AFE) :cardiopulmonary collapse and atonic bleeding with disseminated intravascular coagulation. We experienced a case with amniotic fluid embolism (atonic bleeding with DIC type). A 42-y.o. parturient underwent cesarean section due to progressive PIH. We chose CSEA for cesarean section. Unexpected atonic bleeding occurred, which we diagnosed as AFE and treated with massive blood transfusion. Hysterectomy was not necessary. On the second day after operation the patient developed pulmonary edema and was admitted to the ICU. We should be aware of the potential for cytokine storms after early successful treatment of AFE.
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