Contributions of lower limb and abdominal compression to ventilation inhomogeneity in hypergravity

Gravito-inertial load in the head-to-foot direction (Gz) and compression of the lower body half by an anti-G suit (AGS) are both known to influence ventilation distribution in the lungs. To study the interaction of Gz and AGS and to asses the separate contributions from lower limbs and abdominal compressions to large and small-scale ventilation inhomogeneities nine males performed SF6/He vital capacity (VC) single-breath washouts at 1, 2, and 3 Gz in a centrifuge, with abdominal and/or lower limbs compressions. SF6/He and (SF6-He) phase III slopes were used for determination of overall and small-scale ventilation inhomogeneity. Closing volume and phase IV height were used as measures of large-scale inhomogeneity. VC decreased marginally with G-load but markedly with lower limbs compression. Small-scale ventilation inhomogeneity increased slightly with G-load, but substantially with AGS pressurization. Small-scale ventilation inhomogeneity increased with AGS pressurization. Large-scale inhomogeneity increased markedly with G-load. Translocation of blood to the lungs might be the key determinant for changes in small-scale ventilation inhomogeneity when pressurizing an AGS.     

Topiramate-valproate-induced hyperammonemic encephalopathy syndrome: case report

A 15-year-old boy with inverted duplication of chromosome 15 was admitted for acute onset of irritability, increasing sleepiness, and worsening of seizures. He had been on valproate and other anti-convulsants. However, he was found to have hyperammonemia within 2 weeks after the addition of low-dose topiramate to valproate. He recovered within 7 days after discontinuation of valproate. Topiramate was tailed off. The reintroduction of valproate monotherapy caused hyperammonemia again without clinical features of encephalopathy. He also developed anticonvulsant hypersensitivity syndrome following the use of phenytoin. We propose the term topiramate-valproate-induced hyperammonemic encephalopathy syndrome to include the following features: excessive sleepiness or somnolence, aggravation of seizures, hyperammonemia, and absence of triphasic waves on electroencephalography in any individual on simultaneous topiramate-valproate therapy. The ammonia level ranged from 1.5 to 2 times normal. The serum valproate level might be within the therapeutic range. The possible mechanism is topiramate-induced aggravation of all the known complications of valproate monotherapy. This condition is reversible with cessation of either valproate or topiramate.     

G tolerance and pulmonary effects of removing chest counterpressure during pressure breathing

BACKGROUND: In agile fighter aircraft positive pressure breathing is commonly used as part of the anti-G ensemble. To optimize G protection and prevent over-distention of the lungs, increased airway pressure is balanced by applying a counterpressure to the chest. The aim was to investigate the efficacy of chest counterpressure. METHODS: Three series of experiments were performed using the anti-G ensemble of the 39 Gripen aircraft (AGE-39) and exposing the subjects to 20-s G time profiles; in the first (n = 12) up to +8.0 Gz, in the second (n = 9) up to + 9.0 Gz, and also to simulated aerial combat maneuvers (SACM). Central and peripheral vision, arterial and airway pressures, pressure in the lower portion of the esophagus, and chest wall distension were measured. In the third series, six subjects were exposed to up to +7.0 Gz and esophageal pressure was measured in the upper thorax. In all series, two conditions were compared: with and without pressurized chest bladder. RESULTS: During the 20-s profiles arterial and esophageal pressures, chest wall distension, and visual impairment were similar with and without pressurized chest bladder. Upper esophageal pressure was slightly higher by 10-24% with than without chest bladder (p = 0.03). During SACM, time to exhaustion and the level of perceived exertion were similar with and without pressurized chest bladder. SUMMARY: The results suggest that the chest counterpressure can be removed from the AGE-39 without diminishing G tolerance or G endurance or significantly increasing the risk of lung parenchyma disruption.     

Insecticide resistance in Alabama and Florida mosquito strains of Aedes albopictus

The susceptibility of four strains of Aedes albopictus (Skuse) to permethrin, deltamethrin, resmethrin, chlorpyrifos, malathion, propoxur, fipronil, imidacloprid, spinosad, and Bacillus thuringiensis variety israelensis (Bti) was determined. The HAmAal and MAmAal strains were collected in 2002 and 2003, respectively, from Huntsville and Mobile, AL, and the VBFmAal and SFmAal strains were collected in 1998 from Vero Beach and southern Florida, respectively. The HAmAal strain showed a 22-fold elevated level of resistance to deltamethrin compared with the susceptible Ikaken laboratory strain, whereas the VBFmAal strain showed a six-fold lower sensitivity to deltamethrin compared with Ikaken. However, comparison of resistance ratios for deltamethrin at LC50 and LC90 (21-fold) and the gradual slopes of dose-response curves indicated that the field population of this mosquito strain was heterogenous in response to deltamethrin. All four mosquito strains showed elevated levels of resistance to chlorpyrifos, with resistance ratios from 10 to 33. Nevertheless, except for the relatively low resistance to deltamethrin and chlorpyrifos, all mosquito strains showed a similar susceptibility or lower tolerance to the remaining insecticides tested compared with the susceptible Ikaken strain, even though some, such as permethrin, resmethrin, malathion, and Bti, have been used in the field for a long time, especially in Alabama. These results indicate that the development of resistance to insecticides in Ae. albopictus is slow and conventional insecticides, such as permethrin, resmethrin, malathion, and Bti, and relatively new insecticides, such as fipronil, imidacloprid, and spinosad, may all be valuable for the management of this important mosquito.     

Cervical stump cancer: a study of 14 cases

Case report. This is a report on 14 patients with cervical stump cancer, aged 30 to 68 years old (median = 53 years), seen in a public university hospital. Over a 15-year period, 363 cases of cervical cancer were treated, of which fourteen (3.85%) were in the cervical stump. The time interval between subtotal hysterectomy and the diagnosis of the neoplasm varied from 9 days to 27 years (median = 9.3 years). 28.6% of the patients were in stage I, 42.9% in stage II and 28.6% in stage III. Fibromyoma was the major reason for the subtotal hysterectomy. Three patients underwent Wertheim-Meigs surgery, 1 in association with radiotherapy, and the other 11 patients had radiotherapy alone. The survival ranged from 12 to 120 months (median = 53.3 months). Conclusion. Subtotal hysterectomy should be avoided whenever possible in populations with restricted access to screening programs for cancer of the uterine cervix.     

Hot cooking oil burns: a 20-year experience

Hot cooking oil burns resulted in 316 admissions to the Burns Unit at The Royal Brisbane Hospital between January 1, 1981, and December 31, 2000. Notable demographics of this group were a male:female ratio 1.74:1 and that 24% of all patients were between the ages of 16 and 20. Workplace burns accounted for 6% of admissions only, but these tended to be of a larger total body surface area involvement. The mean duration of admission was 8.5 days, with 40% of patients undergoing surgical débridement and split-skin grafting. Two hundred thirty-nine patients had 5% or less TBSA burned, most commonly involving the hands, legs, feet, and the forearms. No patients in our study died. The proportion of patients undergoing débridement and grafting increased from zero patients at commencement of this study to a peak of 82.5% in 1998. We believe this reflects changing practice with earlier excision and grafting trying to achieve the best functional and cosmetic results. The lack of predisposing factors and the accidental nature of these burns mean appropriate prevention strategies are paramount to decreasing the number of burns of this type. Suggestions discussed include school-based education programs, warning labels included in product information, and mandatory fire blankets within the home.