Aeromonas sobria endophthalmitis

Background: Aeromonas sobria causes a rare Gram-negative bacterial water-borne infection. It has been found in waters of North Queensland and South-east Asia. Of all Aeromonas species, A. sobria is the most virulent and invasive and has been reported to cause soft tissue infection and corneal ulcer.
Methods: A 14-year-old Caucasian male from North Queensland presented following a penetrating eye injury in which a water bird (cormorant species) had pecked his eye while he was fishing. A fulminant endophthalmitis developed despite treatment with intravenous, intravitreal and topical antibiotics and initial wound repair. Enucleation was performed.
Results: Aeromonas sobria was isolated from the vitreous aspirate.
Conclusion: Aeromonas sobria infection should be suspected in water-contaminated penetrating eye injuries. The prognosis in this case was poor.     

Total intravenous anaesthesia for laparoscopy

Two techniques of total intravenous anaesthesia for laparoscopy were compared in 80 patients. Group 1 received alfentanil, propofol and vecuronium, and Group 2 alfentanil, midazolam, ketamine and vecuronium. Haemodynamic stability after induction and the pressor response to tracheal intubation were significantly different. There was no significant difference in recovery times between the two groups and little difference in other postoperative sequelae.     

Entonox for casualties at 1000 m: use of nitrous oxide analgesia in Nigeria at moderate altihnle

Analgesia with nitrous oxide and oxygen (Entonox) has been found to give adequate pain relief for 90 minor casualty procedures in over 90% of cases at moderate altitude. It was self administered except in six patients. Children between 6 and 10 years of age comprised 14% of patients, and the majority of the remainder were young adults. Additional analgesia was required in 11 patients, with no increase in complications. Complications were few; drowsiness occurred in 9%, dizziness was troublesome in one patient, but there was no nausea or vomiting and no one became unconscious. In situations where trained personnel are scarce, and where supervision can only be given at the time of the procedure and even at moderate altitudes Entonox is a clinically effective safe analgesic.     

Growth hormone treatment of short children born small for gestational age or with Silver–Russell syndrome: results from KIGS (Kabi International Growth Study), including the first report on final height

The response to growth hormone (GH) therapy was studied in children born small for gestational age (SGA; n = 593) and in those with Silver–Russell syndrome (SRS; n = 127) using data from KIGS (Kabi International Growth Study). For the SGA patients, median birth weight was -2.6 SD scores (SDS), treatment was started at a median age of 9.2 years, at a time when median height was -2.8 SDS while median target height was -1.4 SDS. For the SRS patients, median birth weight was -3.1 SDS, treatment was started at a median age of 7.0 years, at a time when median height was -3.4 SDS with a median target height of -0.1 SDS. GH treatment increased height SDS in both SGA children and patients with SRS; in 16 SGA patients treated to (near) final height with GH (median dose, 0.7 IU/kg/week), height minus target height SDS was -2.0 at the start of treatment and -1.0 at final height. In conclusion, the results obtained in KIGS indicate that GH treatment of short children born SGA is effective in increasing final height above the predicted height and in achieving the target height.     

Intra-operative collapse or death related to the use of acrylic cement in hip surgery

Six intra-operative deaths and two episodes of near-fatal hypotension occurred in 52 consecutive Hastings procedures (insertion of metal prosthesis grouted in acrylic cement) for subcapital fracture of the femoral neck. This high complication rate was identified by a system of clinical audit undertaken by members of the anaesthetic department.