11/67. Fechtner's syndrome: considerations of anesthetic management. Implications: Fechtner's syndrome is a rare form of macrothrombocytopenia (potentially associated with other hemostatic deficiencies, e.g., von Willebrand's disease and protein Z deficiency), which can exacerbate the risk of uncontrollable bleeding during surgery. We describe the management of a patient with Fechtner's syndrome involving desmopressin, prednisone, and platelets, which produced safe and effective results during cochlear implant surgery. ( info) |
12/67. Latex allergy--implications for Irish patients and healthcare workers. A 34-year-old lady presented with an exacerbation of her atopic dermatitis. She also gave a history of angioedema during labour. Type I latex hypersensitivity was confirmed by serological and epicutaneous testing. Virtually unrecognised until the 1980s, latex hypersensitivity is now being reported more and more frequently, particularly in spina bifida patients, atopics and healthcare personnel. The importance of this problem for patients and healthcare personnel is discussed. ( info) |
13/67. Latex allergy. An orthopaedic case presentation and considerations in patient care. Latex allergy has become a challenging phenomenon in health care delivery for the last several years given the numerous products containing latex. The number of individuals with latex allergy has grown dramatically since the institution of standard precautions issued by the Centers for disease Control and Prevention (CDC) in 1987 in response to the AIDS epidemic. The allergic reaction to latex ranges from a minor skin rash to anaphylactic shock. Preventing exposure to latex is the key to managing and preventing this allergy. Providing a safe environment for patients with latex allergy is the responsibility of all health care professionals. Identification of patients with such an allergy or those at risk is the initial step toward providing a safe environment. Care givers must have a clear understanding of the routes of exposure, effective prevention modalities, the types of allergic reactions that may be manifested by latex sensitivities, the signs and symptoms of allergic reactions, and the treatment options related to the reactions. An orthopaedic case presentation represents a multidisciplinary team approach that successfully managed a patient undergoing a total knee arthroplasty. ( info) |
14/67. Latex protein: a hidden "food" allergen? Avoidance of latex allergens is the primary method to prevent adverse reactions. Natural rubber latex is found in many different products in both the health care industry and in modern society, and consequently results in unexpected exposures of sensitized individuals. The use of latex gloves by food handlers provides one potential route for inadvertent exposure to latex allergens. In this study we have used two immunological methods to determine whether latex proteins are transferred to foods following contact with latex gloves. Direct transfer of latex protein to cheese was visualized using a modified immunoblot method. Sliced cheese was touched with a gloved finger. A nitrocellulose membrane was applied to lift the potential fingerprints and a rabbit anti-latex antiserum was used to visualize the transfer of any latex finger-prints. After handling lettuce with gloves, transferred protein was recovered by extracting the lettuce and quantified using an inhibition ELISA for latex proteins. Fingerprints of latex protein were readily detectable on cheese after contact with powdered latex gloves, but not with vinyl gloves. Furthermore, powdered latex glove use resulted in measurable amounts of latex protein on lettuce with an exposure-dependent increase in the latex protein levels. lettuce alone or lettuce handled with vinyl gloves was negative for latex protein. The use of latex gloves by food handlers is the source of an indirect food additive in the form of latex proteins. It is recommended that food handlers avoid the use of latex gloves to eliminate inadvertent exposure of latex-sensitive individuals. ( info) |
15/67. Latex allergy: a nursing update. Latex allergy emerged in the 1990's as a significant and challenging public health concern for patients as well as healthcare workers. This article provides a review of this complex health care challenge. Understanding latex allergy production and sources of exposure will provide a background to explore the immunological implications of this exposure risk. Diagnostic and treatment measures are reviewed. The focus of this article is to increase awareness and encourage prevention of this growing health concern. ( info) |
16/67. Allergic reaction after rubber dam placement. In the last few years allergic reactions to natural rubber latex (NRL) have increased in dental practice affecting both the dental team and patients. Some case reports discuss the potential risks of hypersensitivity to NRL products. An adverse patient reaction after dental rubber dam placement is reported. About 1 min after the isolation of the tooth with a rubber dam the patient presented signs and symptoms of hypersensitivity. oxygen and intravenous hydrocortisone were administered and the patient kept under observation. After 2 h she had stable vital signs and no more allergics symptoms. It is unclear whether components of the NRL dam or the cornstarch powder incorporated with the rubber dam was responsible for the allergic reaction. dentists must be aware of the health problem and be prepared for an adequate management in dental practice. ( info) |
17/67. Is "latex safe" possible? Using a systematic approach in occupational health. 1. Exposure to natural rubber latex, either by contact or by inhalation, can pose an extreme workplace hazard for sensitive health care workers. Latex reduction strategies are necessary to provide a safer work environment for those who are sensitive, and to prevent future sensitization of healthy workers. 2. Developing a latex reduction plan requires a multifaceted approach. An interdisciplinary task force is highly recommended to achieve optimal latex reduction. 3. Educating staff about latex safety for both health care workers and the patient population is important in providing a safer work environment. ( info) |
18/67. Latex allergy: an update for the otolaryngologist. OBJECTIVE: To describe the clinical manifestations of latex allergy in otolaryngology patients. DESIGN: Descriptive case series. SETTING: Tertiary academic otolaryngology practice. patients: otolaryngology patients with documented allergic reactions to latex during surgery and confirmatory laboratory test results for latex allergy. MAIN OUTCOME MEASURES: Clinical description of latex reactions; identification of risk factors for latex allergy. RESULTS: We describe 3 patients, 2 children and 1 young adult, with severe latex allergy manifested by intraoperative cardiorespiratory changes and confirmed by positive latex-specific IgE test results. A 9-year-old boy with a tracheotomy and a history of multiple procedures for laryngeal stenosis developed a rash and unexplained bronchospasm during an open laryngeal procedure. Surgery was aborted, and subsequent surgery was performed uneventfully 4 weeks later using a latex-safe environment. A 13-year-old boy with recurrent respiratory papillomatosis and a ventriculoperitoneal shunt had sudden unexplained arterial oxygen desaturation and a rash during laser endoscopy. He was then treated successfully using latex-safe protocols. A 23-year-old man with a parotid malignancy developed unexplained hypotension and ventilatory difficulties in the operating room during preparation for surgery. He responded to medical treatment for anaphylaxis. CONCLUSION: The otolaryngologist should share in the increased awareness of latex allergy. Our patients who have had multiple surgical procedures or who are exposed to latex on a long-term basis may be at increased risk. Latex allergy should be considered when unexplained cardiorespiratory compromise occurs during surgery. ( info) |
19/67. Anaphylactic shock from a latex allergy in a patient with spinal trauma. Allergy to latex is a condition that affects patients as well as health care workers. It is a spectrum of immunologic disorders that ranges from mild hypersensitivity to life-threatening anaphylaxis. Beginning in the early 1970s, the health care community has become more aware of this entity, leading to many improvements in the understanding, diagnosis and treatment of patients with latex allergy. Many hospitals have developed protocols and procedures for patients with latex sensitivity. However, some physicians remain unaware of the logistics of taking care of patients with this disorder. We present a case of a severe anaphylactic reaction to latex in a trauma patient with a spinal cord injury. The difficulty of treating the acutely injured patient with this disorder is illustrated. A list of equipment that may be included in a latex-free emergency kit is provided. ( info) |
20/67. The effect of polymethyl methacrylate on latex-free surgical gloves. In the current medical environment of increased awareness about latex sensitivity, more patients are presenting with known latex allergy. One such patient presented to us for total knee arthroplasty. During this procedure, we noticed holes in our latex-free surgical gloves when polymethyl methacrylate (PMMA) was being handled. Through subsequent testing of different brands of latex-free surgical gloves with various brands of bone-cement, we found that Allergard latex-free surgical gloves are destroyed by contact with PMMA. Biogel Neotech and Duraprene latex-free gloves show no such destruction. These results indicate that Allergard gloves should not be used in procedures in which bone-cement is employed. Biogel Neotech and Duraprene latex-free gloves are an acceptable alternative. ( info) |