Comparison of the Cobalt Glidescope® video laryngoscope with conventional laryngoscopy in simulated normal and difficult infant airways*

Aim: To evaluate the new pediatric Glidescope^® (Cobalt GVL^® Stat) by assessing the time taken to tracheal intubation under normal and difficult intubation conditions. We hypothesized that the Glidescope^® would perform as well as conventional laryngoscopy. Background: A new pediatric Glidescope^® became available in October 2008. It combines a disposable, sterile laryngoscope blade and a reusable video baton. It is narrower and longer than the previous version and is available in a greater range of sizes more appropriate to pediatric use. Methods: We performed a randomized study of 32 pediatric anesthetists and intensivists to compare the Cobalt GVL^® Stat with the Miller laryngoscope under simulated normal and difficult airway conditions in a pediatric manikin. Results: We found no difference in time taken to tracheal intubation using the Glidescope^® or Miller laryngoscope under normal (29.3 vs 26.2 s, P = 0.36) or difficult (45.8 and 44.4 s, P = 0.84) conditions. Subjective evaluation of devices for field of view (excellent: 59% vs 53%) and ease of use (excellent: 69% vs 63%) was similar for the Miller laryngoscope and Glidescope^®, respectively. However, only 34% of participants said that they would definitely use the Glidescope^® in an emergency compared with 66% who would be willing to use the Miller laryngoscope. Conclusions: The new Glidescope^® performs as well as the Miller laryngoscope under simulated normal and difficult airway conditions.     

When Water Hurts

Deglutition syncope refers to an uncommon cause of neurally mediated syncope induced by swallowing. We briefly review a case of a 66-year-old man who experienced recurrent syncope episodes during ingestion of beverages, mainly water. Our investigations documented several short asymptomatic episodes of asystole and one prolonged complete atrioventricular block of around 15 seconds associated with the syncopal events, during swallowing. Barium x-ray and manometry evaluations revealed only a nonspecific esophageal dysmotility. An underlying sick-sinus syndrome was found on electrophysiologic study. A DDD pacemaker implantation was performed leading to total disappearance of patient's symptoms.     

Strong association between an HLA-DR antigen and thyroid carcinoma

A group of 20 patients affected with thyroid carcinoma, all from Southern Italy, was typed for HLA-A,-B,-C and -DR antigens. Sixteen of them (80%) typed for DR1, while in the control group (120 unrelated healthy individuals from the same region) only 22 (18.3%) shared the same antigen ( x ²2 = 32.96). The data indicate a highly significant association between the HLA-DR1 gene and the thyroid carcinoma.     

CAPGRAS SYNDROME IN VASCULAR DEMENTIA: RECOGNITION MEMORY AND VISUAL PROCESSING

Face recognition memory and the processing of tachistoscopically presented visual stimuli were investigated in two subjects with Capgras syndrome coexisting with vascular dementia. The subjects were both found to have impairment of face recognition memory as well as impairment of verbal recognition memory. One of the subjects was found to have a reversal of the usual advantage of the right hemisphere for processing perceptual stimuli which were visually similar. The failure to find this reversed pattern in the other subject was attributed to CT scan evidence of an old anterior infarct of his left hemisphere. The neuropsychological basis of Capgras syndrome is discussed in the light of these findings.     

An Audit of Doctor's Management of Patients with Chest Pain in the Accident and Emergency Department

SUMMARY In a series of 604 patients attending an accident and emergencydepartment with chest pain, the decisions made by casualty officersabout admission to the coronary care unit were compared withthe retrospective opinions of experienced clinical assessorswho knew the results of any subsequent investigations. Of the119 patients whom the assessors judged should have been admittedto the coronary care unit, 14 (11. 8 per cent) were judged tohave been discharged in error. Of the 485 patients whom theassessors judged should not have been admitted to the coronarycare unit, 32(16 per cent) were judged to have been advisedadmission unnecessarily. Misinterpretation of the electrocardiographic results was apparentlythe reason for five of the 14 false negative errors and fourof the 32 false positive errors. The median time that patients who were eventually admitted tothe coronary care unit spent in the accident and emergency departmentwas 78 min.     

All-trans retinoic acid shows multiple effects on the survival, proliferation and differentiation of human fetal CD34+ haemopoietic progenitor cells

Summary. To evaluate the effect of all-trans retinoic acid (RA) on fetal haemopoiesis, we performed serum-free liquid and semisolid cultures using CD34⁺ cells purified from mid-trimester human fetal blood samples. RA, at both physiological (10^-n and 10^-12M) and pharmacological (10^-6 and l(r⁷M) concentrations, significantly (P<0.01) promoted the survival of fetal CD34⁺ cells in liquid cultures from day 3 onwards, by suppressing apoptosis induced by serum and growth factor deprivation. On the other hand, RA alone had no significant effect on the proliferation and differentiation of fetal haemopoietic progenitors. In the presence of optimal concentrations of recombinant interleukin-3 (IL-3), stem cell factor (SCF), granulocyte/ macrophage-colony stimulating factor (GM-CSF), and erythropoietin (Epo), low and high doses of RA induced striking differential effects on CD34⁺ cell proliferation in liquid cultures and colony formation in semisolid assays. In fact, 1CT^U M and 1CT¹²M RA were able to: (i) significantly (P<0.05) increase ³H-thymidine uptake by fetal CD34⁺ cells in liquid cultures, and (ii) variably promote the growth of pluripotent (CFU-GEMM, P<0.05), early (BFU-meg) and late (CFU-meg, P<0.01) megakaryocyte, granulocyte/macrophage (CFU-GM. P<001) and erythroid (BFU-E) progenitors in semisolid cultures. On the contrary, 10^-6 and 10^-7 M RA induced: (i) an overall inhibition (P<0.01) of CD34⁺ cell growth in liquid cultures; (ii) a marked suppression of BFU-E colony formation (P<0.01) at all Epo concentrations examined (0-002-4IU/ml); and (iii) a significant (P<0.()1) stimulation of CFU-GM with a shift from mixed granulocyte/ macrophage to pure granulocyte colonies, whereas it had little effect on the growth of CFU-GEMM, BFU-meg and CFU-meg. Our data, as a whole, demonstrate that RA has direct complex effects on the survival, growth and clonal expansion of fetal haemopoietic progenitor cells, mainly depending on the presence of recombinant cytokines, the type of progenitor and the concentrations of RA.     

The Group Therapy of Substance Abuse. By D. W. Brook and H. I. Spitz. The Haworth Press, New York. {pound}35.50. 480 pgs. ISBN 0 7890 1722 2

This book pools the knowledge, skills and expertise of a widevariety of clinicians to provide a comprehensive examinationof the different approaches, settings, uses and implicationsof group therapies in treatment of substance abuse. Each chapter,whilst elaborating on a theme as