Modified retrograde intubation in a patient with difficult airway

We report a modified technique of retrograde endotracheal intubation in a patient with limited motility at the atlanto-occipital joint, temporomandibular joint, and cervical spine, presenting for closure of a large oronasal fistula. Despite more recent advances in intubation techniques and technology, retrograde intubation still deserves a place in the anesthetist's armamentarium for the management of the difficult airway.     

Septic complications after splenectomy for sickle cell sequestration crisis

Patients with sickle cell disease (SCD) are predisposed to infections. There is a paucity of recent information on the incidence of post-splenectomy infectious complications in these patients. The purpose of this study was to determine whether splenectomy increases infectious complications in SCD. Twenty-nine patients with SCD had splenectomy for sequestration crises at our hospital between 1988 and 1992; 16 of them received all of their follow-up care at our institution. These 16 charts were reviewed for infectious-related admissions, hospital days, days of IV antibiotics, positive cultures, and episodes of sepsis. For each patient, these parameters in the pre- and postoperative period were compared and expressed as number per year. The mean age at time of splenectomy was 2.5 ± 0.4 years and the mean follow-up was 4.5 ± 0.4 years. There was no significant difference in the pre- and postoperative periods for admissions, hospital days, days of IV antibiotics, positive cultures, or episodes of sepsis per year. There were also no operative deaths. The incidence of pre-splenectomy sepsis was 0.04 ± 0.03 episodes per year compared to 0.09 ± 0.04 (P = ns) episodes/year after splenectomy. Sepsis occurred at an average of 20.8 (range 2–30) months postoperatively; Streptococcus pneumoniae was the most common causative organism. The total mortality after splenectomy in SCD patients was 3.4% (1/29) over a nearly 5-year period. Although infections are common in children with SCD, there was no increase in infections or episodes of sepsis in SCD patients who underwent splenectomy. Accepted: 6 March 1997     

Teratogenic effects of polychlorinated dibenzofurans in combination in C57BL/6N mice

Polychlorinated dibenzofurans (PCDFs) are highly toxic environmental contaminants which have been involved in several incidents of human poisoning. Two congeners, 2,3,4,7,8-pentachlorodibenzofuran (4-PeCDF) and 1,2,3,4,7,8-hexachlorodibenzofuran (HCDF), have been shown to persist in the tissues of victims of accidental ingestion from Japan and Taiwan. The teratogenicity of these compounds, both alone and in combination, was assessed in C57BL/6N mice. Pregnant mice were treated with 10 ml/kg corn oil containing no PCDFs, 4-PeCDF (0-30 micrograms/kg), HCDF (0-300 micrograms/kg), or a combination of the two on gestation Days 10-13, followed by necropsy on gestation Day 18. Maternal and fetal toxicity were assessed and selected soft tissues were examined for abnormalities. Both chemicals caused hydronephrosis and cleft palate in the absence of any overt toxicity. Hydronephrosis occurred at doses approximately fivefold lower than those causing cleft palate. The combination of 4-PeCDF and HCDF was additive for terata based on responses predicted by probit analysis. In addition, the combination of 2,3,4,5,3',4'-hexachlorobiphenyl (0-60 mg/kg), a structurally related compound also present in PCDF poisoning victims, and 4-PeCDF appears additive. Thus, these chemicals, which cause toxic effects similar to those of 2,3,7,8-tetrachlorodibenzo-p-dioxin, are additive in the induction of fetal anomalies in the mouse.     

Adding collagen to adipose tissue transplant increases engraftment by promoting cell proliferation,neovascularisation and macrophage activity in a rat model

To clarify the effect of collagen addition to transplanted adipose tissue on angiogenesis, cell proliferation and tissue remodelling process and reveal whether collagen addition contributes to improving transplanted adipose tissue engraftment in rats. Adipose tissue was harvested from the inguinal and injected into the back of the rat, in addition to collagen. Engraftment tissue was harvested, semi‐quantitatively evaluated and underwent haematoxylin and eosin or Perilipin staining. Moreover, we evaluated viable adipocyte counts and neovascularisation. Macrophages were evaluated using flow cytometry, and the adiponectin or vascular endothelial growth factor (VEGF) mRNA was detected using real‐time polymerase chain reaction. By collagen addition to transplanted adipose tissue, higher engraftment rate semi‐quantitatively and a greater number of new blood vessels histologically were identified. Perilipin staining revealed a higher adipocyte number. The total cell, M1 macrophage and M2 macrophage count were higher. There was increased adiponectin mRNA significantly at week 4 compared to that at week 1 after transplantation. Note that the expression levels of VEGF mRNA increased. In rats, adding collagen enhanced cell proliferation, induced M2 macrophages, which are involved in wound healing, and promoted adipocytes and neovascularisation. Therefore, collagen addition to transplanted adipose tissue could increase the engraftment rate of adipose tissue.     

X-ray Fluorescence Analysis of Pigments in Gothic Frescoes,Coats of Arms,and Polychromy on Sculptures on the Triforium in St. Vitus Cathedral on the Territory of the Czech Kingdom in the 14th Century

Pigments in the paints used for the coats of arms, polychromy on sculptures, and pigments in frescoes characterize not only the epoch but also individual creators or groups of artists involved in their creation. X-ray fluorescence analysis is a non-destructive method suitable for determining the chemical composition of these artifacts. This article covers the results of measurements of selected objects, and compares them with similar objects from the territory of the Czech Kingdom in the 14th century.     

Reimagining care for young adults living with type 1 diabetes

Young adults living with type 1 diabetes often struggle to achieve what clinicians consider to be optimal levels of metabolic control. Despite the impact that this can have on a young person''s future risk of complications, there are relatively few studies reporting new ways of organizing or delivering care to this cohort. In this article, we explore some of the reasons why young adult diabetes care is challenging, and describe approaches to “re‐imagining” how care might be improved. The work is informed by the ‘Making Care Fit’ collaborative and by a program of research, entitled D1 Now, involving co‐design of a complex person‐centered intervention with young adults.     

A nucleic acid amplification test‐based strategy does not help inform return to work for healthcare workers with COVID‐19

ObjectiveThe objective of this study is to assess the utility of a nucleic acid amplification test‐based approach to shorten isolation of healthcare workers (HCWs) with COVID‐19 in the setting of the highly transmissible omicron variant.MethodsBetween December 24, 2021, and January 5, 2022, HCWs who tested positive for SARS‐CoV‐2 were retested with PCR at least 5 days since onset of symptoms.ResultsForty‐six sequential fully COVID‐19 vaccinated HCWs who had tested positive for SARS‐CoV‐2 underwent follow‐up testing. All the samples were confirmed as omicron variants and only four (8.7%) were negative in the follow‐up test performed at a median of 6 (range 5–12) since onset of symptoms.ConclusionsImplementation of a test‐based strategy is logistically challenging, increases costs, and did not lead to shorter isolation in our institution.     

Figure drawing size as a reflection of self-concept or self-esteem

In two independent studies, objective measures of self-concept and selfesteem were assessed relative to the primary indicators of self-esteem or selfconcept in human figure drawings, size, area, etc. The results of both studies showed that when groups were differentiated significantly on either self-concept or self-esteem, the size of a figure drawn was not related to the level of self-concept or self-esteem.     

Repression-sensitization and processing of favorable and adverse information

One hundred forty-two female Ss divided into repressors and sensitizers by their median score on the R-S scale received either a favorable or an unfavorable evaluation of themselves, both discrepant at a similar degree from their own self-evaluation. Sensitizers, in comparison to repressors, exhibited greater adoption of the negative evaluation and acceptance of its source, but less acceptance of the positive evaluation and its source. These results were explained as providing support for the contention that repressors and sensitizers differ in their willingness to assign negative vs. positive qualities to one's self and to endorse internal conflict rather than in their choice of defense mechanisms in the face of threatening information.