Anaphylaxis ; chemically induced ; diagnosis ; Anti-Infective Agents, Local ; adverse effects ; Chlorhexidine ; adverse effects ; Humans ; Male ; Middle Aged

Benzalkonium chloride (BAC) is commonly used as a bactericidal preservative in nebulizer solutions, and can cause paradoxical onchoconstriction following nebulizing therapy in some asthmatics. We describe a case of anaphylactic shock in a 23-yr-old asthmatic woman following an intradermal skin test with a salbutamol solution containing BAC. Since she complained of cough and dyspnea after inhalation therapy with a nebulizer solution, we conducted an intradermal skin test using the same solution, which contained BAC. About 10 min later, the patient reported dizziness, palpitations, and dyspnea. On examination, tachycardia, tachypnea, and hypotension were found. She was resuscitated with a subcutaneous injection of epinephrine and an infusion of saline. One month later, we conducted a bronchial provocation test with BAC, and she showed a positive response.
Adult ; Anaphylaxis/*chemically induced ; Anti-Asthmatic Agents/administration & dosage ; Anti-Infective Agents, Local/*adverse effects ; Asthma/*drug therapy ; Benzalkonium Compounds/*adverse effects ; Female ; Human ; Nebulizers and Vaporizers ; Support, Non-U.S. Gov't

The aim of this study was to investigate the cytotoxicity of modified nonequilibrium plasma with chlorhexidine digluconate (CHX) on human gingival fibroblasts (HGFs), and to evaluate the biosecurity of modified nonequilibrium plasma with 2% CHX as a new method of root canal treatment. Tissue samples taken from human gingiva were primarily cultured and passaged. Cells from passages 3-7 were used. HGFs were treated by modified nonequilibrium plasma with 2% CHX for 0 min (control group), 30 s, 1 min, 1.5 min, 3 min, 5 min, and 10 min, respectively, and then they were incubated for 0, 24, and 48 h. After that, cell counting kit-8 (CCK-8) assay was applied to analyze the cytotoxicity of modified nonequilibrium plasma with 2% CHX on HGFs. There was no significant difference between the 0 h group treated with the modified nonequilibrium plasma for 1 min and the control group (P>0.05). However, there were significant differences between all the other treated groups and the control group (P<0.05). When treated for 1.5 min or shorter, the cell viability was obviously increased; while treated for 3 min or longer, it was obviously reduced. Moreover, when successively cultured for 0, 24, and 48 h, cell viability was decreased at first and then increased in the 3-min-treated and 5-min-treated groups. The modified nonequilibrium plasma with 2% CHX was of no influence on cell viability in 1.5 min treatment, and it could be safely used on root canal treatment.
Adolescent ; Adult ; Anti-Infective Agents, Local ; adverse effects ; toxicity ; Cell Survival ; drug effects ; Cells, Cultured ; Chlorhexidine ; adverse effects ; analogs & derivatives ; toxicity ; Fibroblasts ; drug effects ; Gingiva ; cytology ; Humans ; Plasma ; chemistry ; Root Canal Therapy ; instrumentation ; methods

BACKGROUNDBlood culture contamination is a significant adverse event. The aim of this project was to evaluate the efficacy of a strict blood collection procedure in reducing the blood culture contamination rate.

METHODSA prospectively controlled study was performed in two different medical areas in Peking Union Medical College Hospital (PUMCH) for 16 months (from May 2006 to September 2007). In test group, a strict blood collection procedure was carried out by trained nurses with the veinpuncture sites were scrupulously disinfected with 2.5% tincture of iodine plus 70% alcohol. In control group, commonly used procedure in PUMCH was performed with 0.45% chlorhexidine acetate plus 0.2% iodine. Blood culture positive results for 4 target organisms (Coagulase-negative staphylococci, Propionibacterium acnes, Corynebacterium species and Bacillus species) were further assessed by physicians from infectious department to determine whether a sample was true positive (pathogen) or false positive (contamination).

RESULTSTotal 9321 blood culture collections were analyzed. The blood culture contamination rate in test group was significantly lower than that in control group (5/3177 (0.16%) vs. 77/6144 (1.25%); χ(2) = 13.382, P < 0.001). The most common contaminant was Coagulase-negative staphylococcus (76.83%). The average cultural time during which contaminated samples became positive was longer than that for true pathogen samples (42.0 hours vs. 13.9 hours, P = 0.041).

CONCLUSIONUsing a strict blood collection procedure can significantly reduce blood culture contamination rate.

Anti-Infective Agents, Local ; pharmacology ; Bacillus ; drug effects ; Blood ; microbiology ; Blood Specimen Collection ; adverse effects ; methods ; Chlorhexidine ; pharmacokinetics ; Corynebacterium ; drug effects ; Disinfection ; methods ; Humans ; Iodine ; pharmacology ; Propionibacterium ; drug effects ; Prospective Studies ; Staphylococcus ; drug effects

Chlorhexidine is widely used as an antiseptic and disinfectant in medical and nonmedical environments. Although the sensitization rate seems to be low, its ubiquitous use raises the possibility of sensitization in many patients and medical care workers. We describe a patient with anaphylaxis during digital rectal examination with chlorhexidine jelly. Urticaria, angioedema, dyspnea, and hypotension developed within a few minutes of the rectal examination. The patient fully recovered after treatment with epinephrine and corticosteroids. Skin tests for chlorhexidine were undertaken 5 weeks later, showing positive prick and intradermal skin tests. Within 30 min of the skin test, the patient complained of febrile sensation, chest tightness, angioedema, and urticaria on the face and trunk. An enzyme allergosorbent test for latex was negative. We present this case to alert clinicians about hypersensitivity to chlorhexidine that could potentially be life-threatening. We suggest that chlorhexidine should be recognized as a causative agent of anaphylaxis during procedural interventions.
Administration, Topical ; Adrenal Cortex Hormones/administration & dosage ; Anaphylaxis/*chemically induced/drug therapy ; Anti-Infective Agents, Local/administration & dosage/*adverse effects ; Chlorhexidine/administration & dosage/*adverse effects ; *Digital Rectal Examination ; Epinephrine/administration & dosage ; Humans ; Male ; Middle Aged ; Sympathomimetics/administration & dosage

OBJECTIVE: We wanted to evaluate the safety and feasibility of ethanol sclerotherapy for treating craniofacial venous malformations (CVMs). MATERIALS AND METHODS: From May 1998 to April 2007, 87 patients (40 men and 47 women; age range, 2-68 years) with CVMs underwent staged ethanol sclerotherapy (range, 1-21 sessions; median number of sessions, 2) by the direct puncture technique. Clinical follow up (range, 0-120 months; mean follow up, 35 months; median follow up, 28 months) was performed for all the patients. Therapeutic outcomes were established by evaluating the clinical outcome of the signs and symptoms in all patients, as well as the degree of devascularization, which was determined on the follow-up imaging, in 71 patients. RESULTS: A total of 305 procedures with the use of ethanol were performed in 87 patients. Follow-up imaging studies were performed for 71 of 87 patients. Twenty-three (32%) of the 71 patients showed excellent outcomes, 37 patients (52%) showed good outcomes and 11 patients (16%) showed poor outcomes. Ethanol sclerotherapy was considered effective for 60 patients. All the minor complications such as bulla (n = 5) healed with only wound dressing and observation. Any major complication such as skin necrosis did not develop. CONCLUSION: Percutaneous ethanol sclerotherapy is an effective, safe treatment for CVMs.
Adolescent ; Adult ; Aged ; Analgesics/administration & dosage ; Anti-Infective Agents, Local/adverse effects/*therapeutic use ; Child ; Child, Preschool ; Craniofacial Abnormalities/*therapy ; Ethanol/adverse effects/*therapeutic use ; Feasibility Studies ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pain/drug therapy/etiology ; Retrospective Studies ; Sclerosing Solutions/adverse effects/therapeutic use ; Sclerotherapy/adverse effects/*methods ; Treatment Outcome ; Vascular Malformations/*therapy ; Young Adult

Adolescent ; Adult ; Aged ; Anesthetics, Local ; adverse effects ; therapeutic use ; Anti-Infective Agents ; adverse effects ; therapeutic use ; Child ; Drug-Related Side Effects and Adverse Reactions ; Drugs, Chinese Herbal ; adverse effects ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Mouth Diseases ; drug therapy ; Time Factors ; Young Adult

Orthognathic surgery is frequently accompanied by intermaxillary fixation. Intermaxillary fixation impedes the maintenance of effective oral hygiene and prolonged fixation can result in periodontal disease. A potential shorter term effect is the generation of oral malodour. It is unclear, however, as to how the production of malodorous compounds in the oral cavity is altered post-surgery. Oral air concentration of sulphur containing compounds, short chain organic acids, ammonia, isoprene and acetone were measured using selected ion flow tube-mass spectrometry in a patient who had undergone orthognathic surgery with subsequent intermaxillary fixation. Total sulphide levels rose approximately 5-fold during fixation with metal ties, with smaller increases recorded for the other compounds measured with the exception of isoprene which remained close to baseline levels. Organic acid levels declined markedly once elastic ties had replaced metal ties, with a lesser reduction being observed in sulphide levels, with both declining further after the commencement of a chlorhexidine-containing mouthwash. These data suggest that bacterial generation of a variety of malodorous compounds increases markedly following intermaxillary fixation. This single case also suggests that the use of elastic ties and effective oral hygiene techniques, including the use of chlorhexidine mouthwash, may help ameliorate such post-surgical effects.
Adult ; Anti-Infective Agents, Local ; therapeutic use ; Breath Tests ; Chlorhexidine ; therapeutic use ; Halitosis ; drug therapy ; etiology ; Humans ; Jaw Fixation Techniques ; adverse effects ; instrumentation ; Male ; Mandibular Advancement ; Metals ; adverse effects ; Mouthwashes ; therapeutic use ; Orthognathic Surgical Procedures ; Spectrometry, Mass, Secondary Ion ; Sulfides ; analysis