Virginia Apgar (1909-1974): The Mother of Neonatal Resuscitation.

Dr. Virginia Apgar was an American anesthesiologist and researcher who heavily influenced the development of neonatal resuscitation in the immediate postpartum period with her simple five-point scoring system. Today, the APGAR scoring system is used around the world in delivery rooms to guide clinicians in the evaluation of newborns and to distinguish which might need urgent resuscitation.

Urgent Cesarean Section in a Patient on Venovenous Extracorporeal Membrane Oxygenation.

A G7P6 40-year-old female at 20 weeks gestation, with a history of polysubstance use disorder and hepatitis C, presented to the emergency department with severe shortness of breath and hypoxia requiring intubation. After a thorough workup, she was diagnosed with aspiration pneumonitis and was treated with a course of antibiotics. After progressing well, she was soon extubated and transferred to a subacute rehabilitation facility (SAR).

Anaesthetic management of a patient with severe pulmonary hypertension, moderate tricuspid regurgitation and moderate right ventricular dysfunction presenting for a dilation and curettage.

A primigravida woman in her 30s with severe pulmonary hypertension, tricuspid regurgitation and depressed right ventricular function presented for therapeutic termination of pregnancy at 7 weeks gestation after referral and multidisciplinary recommendation. A slowly titrated lumbar epidural was chosen for the primary anaesthetic. Under standard American Society of Anesthesiologists (ASA) monitoring, invasive blood pressure monitoring and continuous transthoracic echocardiography, the patient's right ventricular systolic function was monitored throughout the case using qualitative and quantitative metrics and was notable for a right ventricular systolic pressure of 102.

Anesthetic Management of an Obstetric Patient With Ehlers-Danlos and Wolff-Parkinson-White Syndromes.

A 31-year-old, primigravida, nullipara (G1P0) female with a past medical history of Ehlers-Danlos Syndrome (EDS), newly diagnosed Wolff-Parkinson-White Syndrome (WPW), and fetal breech presentation initially presented at 36+5 weeks gestation for an external cephalic version (ECV). The patient noted significant symptomatology related to her WPW which had worsened over the course of her pregnancy despite being started on oral metoprolol. Despite joint recommendations from the anesthesia and obstetric teams to combine the ECV with a same-day scheduled induction of labor or cesarean section, the patient declined.

Pediatric Traumatic Brain Injury: Impact on the Developing Brain.

Traumatic brain injury (TBI) is a serious public health concern impacting millions of children and adolescents each year. Experiencing a brain injury during key critical periods of brain development can affect the normal formation of brain networks that are responsible for a range of complex neurocognitive outcomes. In addition, there are multiple pre- and postinjury factors that influence the trajectory of recovery and outcomes.

World-Class Innovation, but at What Cost? A Brief Examination of the American Healthcare System.

The American healthcare system, often counted among the world's best, offers expedient access to a highly subspecialized network of physicians who work at the forefront of developing and utilizing novel, cutting-edge procedures, and medications. Patients typically have access to large numbers of qualified physicians in every metropolitan area and thus are afforded the luxury of individual choice in hospital, physician, and experience. Unfortunately, the costs of maintaining such a system are quite profound, and the higher investments do not pay dividends in health outcomes.

Double Lumen Endobronchial Tube Placement for Lung Separation via a Tracheostomy Stoma in a Patient Status-Post Laryngectomy.

A 63-year-old male with a history of chronic obstructive pulmonary disease and squamous cell carcinoma of the larynx status-post laryngectomy and tracheostomy presented for a robotic-assisted right upper lobectomy for neoplasm excision. On physical examination, he was noted to have moderate hypoxia with an SpOof 93% on room air. In order to facilitate potential apneic oxygen insufflation and continuous positive airway pressure in the operative lung, a traditional left-sided 35-French double-lumen endobronchial tube was placed through his tracheostomy, and utilized to facilitate lung separation and to improve surgical manipulation.

Profound Hyperkalemia and Anemia in a Dialysis Patient With a Gastrointestinal Bleed.

An 80-year-old male receiving dialysis three times per week presented to the emergency room with general malaise after missing four consecutive dialysis appointments. During his workup, he was noted to have a potassium of 9.1 mmol/L, hemoglobin of 4.

Severe hypertrophic cardiomyopathy with left ventricular outflow tract obstruction identified with preprocedural point-of-care ultrasound before emergent tracheal repair.

A woman in her 60s was brought to the operating room directly from the trauma bay for emergent intervention to repair a tracheal rupture sustained during a reported fall from standing height. She was intubated and sedated prior to arrival by paramedics for respiratory distress. Her family reported that the patient had dizziness after standing followed by the patient fainting and striking her neck.

Addition of nebulised lidocaine to prevent refractory bronchospasms in a patient receiving serial bronchoscopies.

A patient in his 20s with a history of granulomatosis with polyangiitis required 15 bronchoscopies with dilations in 1 year due to bronchial fibrosis and secretions leading to worsening shortness of breath. During these bronchoscopies, the patient experienced increasingly severe bronchospasms refractory to conventional preventative and treatment methodologies leading to prolonged hypoxia, reintubations and ICU admissions. During his 8th to 15th bronchoscopies, nebulised lidocaine was added to the pretreatment regimen, which eliminated perioperative bronchospasms and allowed for the elimination of all other adjunctive preventative treatments.

Quality Improvement in Pediatric Head Trauma with PECARN Rules Implementation as Computerized Decision Support.

Background: For the 1.4 million emergency department (ED) visits for traumatic brain injury (TBI) annually in the United States, computed tomography (CT) may be over utilized. The Pediatric Emergency Care Applied Research Network developed 2 prediction rules to identify children at very low risk of clinically important TBI.

The meiotic process and aneuploidy.

Normal females developing at 25 degrees C produce their first population of oocytes at 132 +/- 2 hr post oviposition. Entrance of the oocytes into premeiotic interphase signals initiation of DNA replication which continues for 30 hr. Coincidentally, extensive SCs appear, averaging 50 microns (132 hr), peaking at 75 microns (144 hr), and continuing into early vitellarial stages.

Time of Recombination in the DROSOPHILA MELANOGASTER Oocyte. III. Selection and Characterization of Temperature-Sensitive and -Insensitive, Recombination-Deficient Alleles in Drosophila.

The procedure for the selection of a temperature-sensitive recombination mutant in Drosophila is described. Use of this procedure has led to the recovery of three alleles at a new recombination locus called rec-1, located within the region of chromosome 3 circumscribed by Deficiency (3R)sbd(105). One allele, rec-1(26), is temperature sensitive, and the other two alleles, rec-1(6) and rec-1(16), are temperature insensitive.

Synaptonemal complexes at premeiotic interphase in the mouse spermatocyte.

Male mice were injected intraperitoneally with 125 microCi (1 Ci = 3.7 X 10(10) becquerels) of [3H]thymidine at 1-hr intervals and killed 1 hr after the second injection. Testes were prepared for bright-field and electron microscopic autoradiography.

Time of recombination in the Drosophila melanogaster oocyte. II. Electron microscopic and genetic studies of a temperature-sensitive recombination mutant.

A test has been carried out to determine if the restrictive temperature (31 degrees) acts to reduce recombination in the temperature-sensitive recombination-deficient genotype rec-l26/rec-l16 by reducing or eliminating the synaptonemal complex. Measurements of the length of synaptonemal complexes in heat-treated and untreated stage 1 oocytes, following termination of the temperature-sensitive period, reveal less than a 5% difference, with the greater length present in the treated oocytes. Alterations are not observed in synaptonemal complex distribution within the nucleus or in its fine structure.

Origin of meiotic nondisjunction in Drosophila females.

Meiotic nondisjunction can be induced by external agents, such as heat, radiation, and chemicals, and by internal genotypic alterations, namely, point mutations and chromosomal rearrangements. In many cases, nondisjunction arises from a reduction or elimination of crossing over, leading to the production of homologous univalents which fail to co-orient on the metaphase plate and to disjoin properly. In some organisms, e.

Time of recombination in the Drosophila melanogaster oocyte: evidence from a temperature-sensitive recombination-deficient mutant.

A temperature-sensitive recombination-deficient mutant, rec-126, has been isolated that permits high frequencies of recombination at the permissive temperature (25 degrees) but greatly decreases recombination at the restrictive temperature (31 degrees). The sensitive period for response of female germ cells carrying this mutant to the restrictive temperature has been defined. Sensitivity begins very close to the time the oocyte enters premeiotic interphase and initiates DNA synthesis; it continues for the duration of premeiotic-S; and it terminates with the completion of S.

A Comparison of Heat and Interchromosomal Effects on Recombination and Interference in DROSOPHILA MELANOGASTER.

Heat and interchromosomal effects on recombination have been compared for 23 regions comprising the predominantly euchromatic portions of the five arms of the Drosophila genome. Patterns of response are strikingly similar, with both modifiers causing proximal and distal increases and minimal effects in the middle of the arms. Changes in interference for the same regions in the presence of the two modifiers reveal little similarity, except for the X chromosome.

Synaptonemal complexes during premeiotic DNA synthesis in oocytes of Drosophila melanogaster.

Well-synchronized populations of oocytes obtained by means of the "pupal system" (Grell, 1973a) have been examined to determine the time of appearance of the synaptonemal complex. The complex first appears in the most advanced oocytes between 132 and 138 hr of female development. Between 138 and 156 hr the complex apparently undergoes a fourfold increase in length.

Studies on tolerance. I. The role of the interval between doses on the development of tolerance to morphine.

The effect of varying the interval between doses on the rate of development of tolerance to a series of injections of morphine was studied in two strains of rats. Morphine sulfate injections (15 mg/kg s.c.

Recombination and DNA replication in the Drosophila melanogaster oocyte.

A method is described that permits the recovery of a well-synchronized population of oocytes. Utilizing this pupal system, the heat-responsive period for increasing crossing-over in the Drosophila genome has been defined for the X chromosome and a portion of chromosome 2. The response is initiated close to the time of oocyte formation (premeiotic interphase) and is terminated after approximately 36 hr.