A "last ditch" airway.

In a patient whose airway is in jeopardy after unsuccessful attempts at conservative measures to clear it and after failed attempts at intubation, the intravenous tubing connector spike may be considered as an emergency percutaneous tracheostomy device. It is readily available wherever physicians have intravenous solutions at hand. It is inserted through the cricothyroid space with the help of a scalpel blade or other sharp instrument such as a pair of scissors. A severed spike can be as easily carried in a pocket, purse or medical bag as can an intravenous cannula. A number 11 scalpel blade fits neatly between two credit cards. The shape of the spike makes it fortuitously adaptable to intermittent positive pressure ventilation by mouth or standard resuscitation equipment. If the patient is otherwise well enough, it is of sufficient bore to allow spontaneous respiration. I have been fortunate not to have had the opportunity to use this device in an emergency situation as of the time of the submission of this paper.     

A new microvascular "sleeve" anastomosis

A new technique for performing a microvascular end-in-end or "sleeve" anastomosis is described. The new method utilizes two asymmetrically placed, looped sutures that do not enter the active lumen or breach the active intima. It has advantages over previous methods because it consistently saves time and because of the decrease in the number of possible technical complications. In 77 anastomoses performed in white rats by different surgeons, including a few inexperienced students of microsurgery, there was only one failure (24-hr patency). After eight practice anastomoses, the average time taken from vessel division to final clamp release in 30 procedures was 7 min 33 sec, with a standard deviation of 1 min 45 sec. The sleeve anastomosis performed by this method has shown itself to be as reliable as a conventional end-to-end suture method and has the advantages of significant time saving and minimization of intimal trauma. The anastomosis of vessels of differing sizes is facilitated by the conformation of this new method and the technique has clinical potential in the anastomoses of interposition vein grafts and in human intravenous anastomoses.     

A case of "trigger toe"

"Triggering" of the toes, in which local tendon hypertrophy prevents the smooth movement of the tendon, has been described as a problem more theoretical than real and only three cases have been reported. The authors report a case of partial tethering of the flexor hallucis longus tendon just distal to the medial malleolus in a 28-year-old jogger who had painful triggering of the great toe on plantar flexion of the ankle and great toe. Division of the flexor hallucis longus tendon pulley distal and posterior to the medial malleolus cured the patient.