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Khan, Saad,Min, Samuel,Willard, Garrett,Lo, Iris,D'Souza, Rachael,Park, Aaron The Korean Dental Society of Anesthsiology 2020 Journal of Dental Anesthesia and Pain Medicine Vol.20 No.1
Homozygous familial hypercholesterolemia (HoFH) is a rare inherited disorder that presents as abnormally elevated levels of low-density lipoprotein cholesterol and premature heart disease, requiring frequent intervention through lipid apheresis for management. The risk of perioperative cardiac events is higher in patients with HoFH because of its pathophysiological manifestations in the vascular system. Careful cardiac precautions and anesthetic assessments are necessary to ensure patient safety. In the following case report, we discuss the clinical course and anesthetic considerations for a 14-year-old girl with HoFH undergoing sedation for dental extractions and mandibular molar uprighting in an outpatient oral surgery clinic. Considerations included the use of heparin in the patient's weekly plasma lipid apheresis treatment. In order to reduce the risks of peri- and postoperative bleeding and perioperative cardiac events, the operation was scheduled for 4 days after apheresis. This allowed for adequate heparin clearance, while also reducing the likelihood of possible cardiac events. A literature review revealed no results for the outpatient management of patients with HoFH undergoing sedation for noncardiac procedures. Our reported case serves as a clinical example for physicians to be utilized in the future.
Schrader, Kevin K.,Blevins, Willard T. The Microbiological Society of Korea 1999 The journal of microbiology Vol.37 No.3
The effects of bicarbonate concentration, atmospheric carbon dioxide level, and reduced atmospheric oxygen on biomass and geosmin production and geosmin/biomass (G/B) values for Streptomyces halstedii, a producer of the off-flavor compound geosmin, were determined. In addition, a study was performed to determined possible synergistic relationships between a cyanobacterium, Oscillatoria tenuis UTEX #1566, and S. halstedii in the enhancement of actinomycete growth and/or geosmin production. These studies took into consideration those conditions that can occur during cyanobacterial bloom die-offs. Increasing bicarbonate concentration caused slight decreases in geosmin production and G/B for S. halstedii. Increasing atmospheric oxygen promoted geosmin production and G/B while lower oxygen levels resulted in a decrease in geosmin production and G/B by S. halstedii. Biomass production by S. halstedii was adversely affected by reduced oxygen levels while changes in bicarbonate concentration and atmospheric carbon dioxdie levels had little effect on biomass production. Sonicated cells of O. tenuis UTEX #1566 promoted biomass production by S. halstedii, and O. tenuis culture (cells and extracellular metabolites) and culture supernatnat (extracellular metabolites) each promoted geosmin and G/B yields for S. halstedii. In certain aquatic systems, environmental conditions resulting from cyanobacterial blooms and subsequent bloom die-offs could favor actinomycete growth and off-flavor compound by certain actinomycetes.