MHAUS Newsletter, June 2007
In this issue:

Who should receive the genetic test for MH?

At present, there are two clinical laboratories in the U.S., PreventionGenetics, L.L.C. www.preventiongenetics.com and the Center for Medical Genetics, University of Pittsburgh Medical Center path.upmc.edu/divisions/mdx/diagnostics.html, that offer clinical genetic testing for MH diagnosis. To date, well over 100 genetic tests for MH have been conducted. But who should be tested?

 All patients who have had a positive muscle contracture test, as well as all families with a clear history of MH, should receive the DNA test. “It is very helpful to consider the individual’s personal history when estimating what their chance is that the RYR1 exam will be of benefit to their family,” says Dr. Barbara Brandom, of the Children’s Hospital and the University of Pittsburgh Medical Center. “Genetic testing should not be done without obtaining the patient’s history prior to testing and counseling the patient based on that, and counseling the patient after the test results are known to be sure that there is no misunderstanding.” 

MHAUS has developed a program to assist those who are advised to undergo genetic testing but do not have the financial resources. Sensitivity of the test, the ability to truly detect those who are at risk for MH, is only about 30%. Still, MHAUS believes that a genetic test is the most desirable test for diagnosis.

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Data supports finding that 20% of acute MH cases experience recrudescence

The North American Malignant Hyperthermia Registry NAMHR) staff was pleased to be acknowledged by Drs. Burkman, Posner and Domino, the authors of “Analysis of the clinical variables associated with recrudescence after malignant hyperthermia reactions.” The analysis of data from the NAMHR was published in the May 2007 issue of “Anesthesiology.” 

The major finding of Dr. Burkman, et al, was that 20% of acute MH cases experienced recrudescence. Half of these episodes occurred more than nine hours after the initial signs of MH. This complication of MH was more common in muscular people, those with many signs of MH including temperature elevation and when the time interval from induction of anesthesia to the appearance of MH was > 2.5 hours. 

“Anesthesiology” also published an editorial by a noted European MH expert, Dr. P. Hopkins, “Recrudescence of MH,” that commented on Burkman's study. Dr. Hopkins concluded that "Burkman, et al. have provided clinically useful data to strengthen the evidence base for patient treatment after an MH reaction" and that "credit must be given to the NAMHR for their dedication to systematic collection of clinical data, which on this scale is unique." 

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MHAUS promotes awareness of MH across the country

“The traffic at the booth was very high,” says Fay Kellogg, Fulfillment Administrator, who attended the Association of PeriOperative Registered Nurses (AORN). “As always, everyone was interested in our literature, the OR poster, the manuals, and the In-service kit.”

The MH Procedural Manual is MHAUS’ most popular educational tool and is available in three versions to accommodate hospital, ambulatory and office surgery settings. “The MH Procedural Manual is an essential tool for training staff to respond to an MH crisis in a timely and efficient manner,” says Jo Nichols, Membership Coordinator, who attended the 26th National Conference of the American Society of PeriAnesthesia Nurses (ASPAN) and reported a constant flow of visitors to the MHAUS booth.

MHAUS staff has also attended the Federation for Ambulatory Surgery Centers (FASA) and the American Association of Ambulatory Surgery Centers (AAASC) in recent months and plans to attend the American Association of Nurse Anesthetists (AANA), the American Society for Healthcare Risk Management (ASHRM) and the American Society of Anesthesiologists (ASA) meetings in coming months.

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MH Addressed at International Trauma Care Society 20th Scientific Program

For the first time in several years, the topic of MH was addressed at the International Trauma Care Society (ITACCS) 20th Scientific Program in Las Vegas, Nevada, from May 14-16, 2007. Approximately 150 anesthesiologists, surgeons, emergency room physicians, ICU physicians and nurses from North America, South America, Europe, India, Japan and other places around the world were in attendance. 

Dr. Brandom presented "Update on Malignant Hyperthermia: Considerations for Trauma Care." Trauma patients are at risk for MH because they often need to have emergency surgery. But subtle signs of MH may not be identified quickly because tachycardia and fever and muscle injury are common complications in trauma patients. 

Temperature monitoring is very important for all trauma patients. Occasionally a trauma patient may develop fulminate MH and benefit from treatment with dantrolene. In such cases the diagnosis of MH should be confirmed with muscle contracture testing or genetic testing, for the benefit of the family.

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MH Mini-Conference scheduled for September 8, 2007

The MH Patient Mini-Conference is set for Saturday, September 8, 2007, at St. Mary’s Hospital in Madison, Wisconsin. The conference runs from 9:00 am to 3:00 pm and will provide updates by medical professionals on current MH research and testing, which includes the latest on molecular genetic testing, as well as address any questions or concerns posed by those attending.

Scheduled speakers include Cynthia Wong, MD, of Northwestern University Feinberg School of Medicine in Chicago, IL, and John Skoog, MD, of Mercy Hospital Medical Center in Des Moines, IA.  Jennifer L. Geurts, a genetic counselor from St. Lukes Medical Center in Milwaukee, WI, has also been enlisted as a guest speaker.

The registration fee is $25.00 per attendee, which should include an expected $5.00 per day parking fee. For further information about the conference and registration, visit the MHAUS website at www.mhaus.org.

 
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MHAUS offers two writing awards

The Malignant Hyperthermia Association of the United States (MHAUS) is pleased to announce the availability of an award in the amount $1500 to the author of a manuscript related to MH.

The Daniel Massik Fund at The Foundation for Jewish Philanthropies in Buffalo, NY was established by Mr. Massik in memory of his son who died from MH. This Award will provide a stipend of $1500 to an anesthesia resident/fellow or an anesthesiologist who is within five years of ending his/her training to attend the annual meeting of the American Society of Anesthesiologists Meeting or, in special circumstances, another meeting of similar merit.

The Award will be given to the primary author of the best manuscript concerning, malignant hyperthermia. The format may be a case report, literature review or original study.

  • The document should address a significant issue related to the problem of malignant hyperthermia.
  • Those participating must currently be a resident fellow in anesthesiology or an anesthesiologist who is within five years of ending his/her training.The paper must be a minimum of 3 double-spaced typed pages and a maximum of 10 pages. Author’s CV should be included.
  • The paper must not be in any stage of publication.
  • Deadline for receipt of the manuscript in the MHAUS office is August 1, 2007

The award will be presented at the MHAUS Recognition Reception at the Annual Meeting of the American Society of Anesthesiologists in San Francisco in October 2007.

The winner will be notified by August 31, 2007 to allow for coordination of travel plans.

For further information regarding the application process for this award, please contact the Malignant Hyperthermia Association of the United States (MHAUS), attention Gloria Artist, either via regular mail at P. O. Box 1069, Sherburne, NY 13460, via fax at 607-674-7910 or email at gloria@mhaus.org.

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