Challenge to pediatric anatomical variation : Can we draw the ideal line on the pediatric I-gel?

Objective

I-gel is a noncuff type of laryngeal airway mask. No horizontal line has yet been determined as an ideal position for pediatric sizes because of the variability in length of the oropharyngeal–laryngeal arch in children. We investigated whether there is a correlation between insertion length and patient body weight or height for the pediatric I-gel sizes from 1.5 to 2.5.

Methods

With parental informed consent, we planned to maintain the airway of 130 children aged from 7 months to 13 years by using the I-gel device under general anesthesia. The following two parameters were evaluated: (1) distance between the teeth and the connector wing; (2) insertion length (distance from the distal end of the gastric tube to the teeth). Size selection was determined on the basis of patients’ body weight. We identified the relationship between each parameter and height or weight.

Results

Average insertion length became gradually longer with increasing height and weight. Spearman’s R between insertion length and height or weight was 0.8. There was more correlation with height than with weight in pediatric size 2.5.

Conclusion

Results suggested that it is possible to draw an ideal line on the I-gel with sizes 1.5 and 2 only.

     

Successful esophageal bypass operation for esophagobronchial fistula following chemotherapy for malignant lymphoma: a case report

A 72-year-old man with non-Hodgkin’s lymphoma at the tracheal bifurcation node received combination chemotherapy and subsequently developed a fistula in spite of remission of the lymphoma. Conservative therapy did not heal the fistula formation, and we chose bypass surgery using a gastric tube without thoracotomy. Ten months postoperatively, there is no evidence of lymphoma relapse and the patient lives a normal life. We consider this procedure as an available treatment for esophagobronchial fistula in case of failure to cure fistula communication by conservative therapy.     

The dorsal occult ganglion of the wrist and ultrasonography

In five cases of suspected occult ganglion on the back of the wrist, an ultrasonographic examination was performed. This revealed a small hypoechogenic area on the dorsal aspect between the scaphoid and the lunate or just dorsal to the lunate. Exploration of this area in three cases confirmed the presence of an occult ganglion. In the other two cases, further aspiration revealed traces of mucinous jelly at the tip of the needle.     

Casual C peptide index: Predicting the subsequent need for insulin therapy in outpatients with type 2 diabetes under primary care

BackgroundEvaluation of residual beta cell function is indispensable in patients with type 2 diabetes as it informs not only diagnoses but also appropriate treatment modalities. However, there is a lack of convenient biomarkers for residual beta cell function. Therefore, we evaluated endogenous insulin level as a biomarker in outpatients who were being treated with insulin therapy and in patients who were introduced to insulin therapy after 4 years.MethodsData of 174 outpatients with type 2 diabetes (50% male) whose glycemia was moderately controlled (glycated A1c 7.3% [5.2%–14.8%]) were reviewed. Twenty patients whose estimated glomerular filtration rate was lower than 30 ml/min/1.73 m² were excluded from the evaluation of endogenous insulin level with both casual C‐peptide index (C‐CPI) and urinary C‐peptide/creatinine ratio (determined at any time, generally 1–2 h after breakfast). Patients were stratified based on the provision of insulin therapy.ResultsC‐CPI and UCPCR were significantly lower in the insulin‐treated patients than in the insulin‐untreated patients (0.9 vs. 2.2, p < 0.0001; 24.7 vs. 75.5, p = 0.0003, respectively). Moreover, C‐CPI were significantly lower in the insulin‐requiring patients for 4 years than in the insulin‐unrequiring patients (1.0 vs. 1.7, p = 0.0184). The multivariate logistic regression analysis revealed that both indicators of insulin secretion influenced the requirement for insulin therapy, but C‐CPI could serve as the most convenient and useful biomarker for not only current insulin therapy requirements (p = 0.0002) but also the subsequent requirement for insulin therapy (p = 0.0008).ConclusionsC‐CPI could be determined easily, and it was found to be a more practical marker for outpatients; therefore, our findings would have critical implications for primary care.     

Polymorphism in the gene coding for the immunodominant antigen gp43 from the pathogenic fungus Paracoccidioides brasiliensis

The gp43 glycoprotein is an immune-dominant antigen in patients with paracoccidioidomycosis (PCM). It is protective against murine PCM and is a putative virulence factor. The gp43 gene of Paracoccidioides brasiliensis B-339 is located in a 1,329-bp DNA fragment that includes two exons, a 78-bp intron, and a leader peptide-coding region of 105 bp. Polymorphism in gp43 has been suggested by the occurrence, in the same isolate or among different fungal samples, of isoforms with distinct isoelectric points. In the present study we aligned and compared with a consensus sequence the gp43 precursor genes of 17 P. brasiliensis isolates after sequencing two PCR products from each fungal sample. The genotypic types detected showed 1 to 4 or 14 to 15 informative substitution sites, preferentially localized between 578 and 1166 bp. Some nucleotide differences within individual isolates (noninformative sites) resulted in a second isoelectric point for the deduced protein. The most polymorphic sequences were also phylogenetically distant from the others and encoded basic gp43 isoforms. The three isolates in this group were from patients with chronic PCM, and their DNA restriction patterns were distinct in Southern blots. The nucleotides encoding the inner core of the murine T-cell-protective epitope of gp43 were conserved, offering hope for the development of a universal vaccine.     

Characterization of N-acylation of Go alpha purified from bovine retinas.

Heterogeneous N-terminal acylation has been identified in several retinal proteins localized predominantly in the outer segments of the photoreceptor cells, but it is still unclear whether such a unique heteroacylation is determined by a photoreceptor cell-specific factor or not. Here, we characterized the N-terminal modification of bovine retinal Go alpha, which seems to be involved in the neural activities and is not detected in the photoreceptor outer segments. In the proteolytic fragments of immunoaffinity-purified retinal Go alpha, we found a single N-terminal peptide modified with myristate, and concluded that retinal Go alpha is purely myristoylated, just like brain Go alpha. This result indicates that the heteroacylation has a more restricted origin in the retina, and supports the idea that it is a photoreceptor cell-specific modification.