Laryngeal edema associated with the ProSeal™ laryngeal mask airway in upper respiratory tract infection

PURPOSE: We report an unusual case of vocal cord edema associated with the use of a ProSeal laryngeal mask airway (PLMA) in an adult patient with an undiagnosed upper respiratory tract infection (URTI). CLINICAL FEATURES: A 55-yr-old woman had fixation of a radial fracture under general anesthesia with muscle relaxation. She developed audible wheezing 30 min after PLMA insertion. Bronchoscopic examination revealed significant vocal cord edema. Adequate ventilation was possible at increased airway pressures, and the administration of dexamethasone 4 mg iv produced clinical resolution of the stridor and airway obstruction. The patient admitted to having mild symptoms of an URTI on postoperative questioning. CONCLUSION: Airway hyperreactivity secondary to the URTI is the most likely etiological factor; other possibilities include trauma from insertion and chemical irritation. Although pediatric studies suggest that the LMA-Classic carries less risk than endotracheal intubation in the presence of URTI, this case report demonstrates that caution is still warranted when using supraglottic airways. The PLMA permitted effective ventilation despite increased airway resistance; nevertheless its role in patients with URTI is unclear. It is possible that the bulkier cuff design of the PLMA, compared to that of the LMA-Classic, may have partly contributed to the development of edema in this setting.     

吸虱和其啮齿动物宿主的关系—偕同进化的证据

采自贵州省猪尾鼠的吸虱具有特殊的形态。李氏欣奇虱独自成为一科。双叶盲鼠虱隶拟血虱科。拟血虱科中的拟血虱属和钩板虱属均寄生于鼹科,裂虱属和盲鼠虱属则寄生于睡鼠科和刺山鼠科。后者曾被置于睡鼠科。研究食虫目动物的吸虱将可能对吸虱与其宿主动物的偕同进化提供更多的证据。     

Hepatitis B infection in prostitutes

The prevalence of HBV markers in prostitutes is known to be higher than that of the normal population of similar age range in previous studies. This study showed a significant correlation between the duration of prostitution and the prevalence of HBV antibodies amongst the prostitutes. The prevalence of HBV antibodies doubled after the first year of prostitution. A two-year follow-up study of these prostitutes showed that 37% of HBsAg positive prostitutes lost the HBsAg. The seroconversion rate of HBsAg negative prostitutes was 10% during this two-year period. Early immunization against HBV infection should be considered in this high risk group in view of these findings.     

MR of primary extraosseous Ewing sarcoma.

We present MR imaging findings of a 15-year-old girl with a history of chronic back pain, proved by biopsy to be caused by primary extraosseous Ewing sarcoma, extending into the spinal epidural space. We also demonstrate the involvement of the adjacent structures and encroachment on the intervertebral foramina.     

CEREBRAL BLOOD-FLOW VELOCITY AND INTERMITTENT INTRACRANIAL PRESSURE ELEVATION DURING SLEEP IN HYDROCEPHALIC CHILDREN

The clinical importance of intermittent intracranial pressure (ICP) elevations during sleep in hydrocephalic children is unclear. Eight studies of continuous ICP monitoring with simultaneous cerebral blood-flow velocity (CBFV) measurements were recorded during sleep in seven hydrocephalic children aged between one and 10 years. ICP was measured directly through a frontal reservoir. There were two main patterns of CBFV change in response to raised ICP: a progressive decrease in mean flow velocity and increase in resistance index, suggesting impaired haemodynamic compensation to ICP elevation due to reduced circulatory reserve in patients with limited intracranial compliance; and an increase in mean flow velocity with raised ICP, suggesting that appropriate haemodynamic compensation with increased blood-flow can occur to maintain adequate cerebral perfusion in those with sufficient circulatory reserve. Simultaneous CBFV and ICP measurements may help to identify those with reduced circulatory reserve who are at greater risk of ischaemic insult from episodic increases in ICP.     

Isolation and characterization of a penicillinase from Pseudomonas cepacia 249.

Pseudomonas cepacia has an inducible beta-lactamase which is responsible for its novel ability to catabolize beta-lactam compounds. The gene encoding this enzyme, penA, was cloned from a genomic library of P. cepacia 249 on the broad-host-range cosmid pLAFR. This separated the penA gene from the gene encoding a second beta-lactamase in P. cepacia 249. Expression of penA was inducible in an Escherichia coli host strain by low levels of penicillin. The 33,500-molecular-weight enzyme had penicillinase activity not inhibited by clavulanic acid or sulbactam and was highly active against piperacillin and azlocillin. In comparison with other inducible beta-lactamases produced by gram-negative organisms, the penA enzyme had many properties which were similar to those of the penicillinase produced by Alcaligenes faecalis. It was unlike the ampC-type cephalosporinase produced by Pseudomonas aeruginosa.     

Childhood convulsive status epilepticus: epidemiology, management and outcome

Convulsive status epilepticus (CSE) in childhood is a medical emergency and its aetiology and outcome mean that it should be studied separately from adult CSE. The incidence in developed countries is between 17 and 23/100,000 with a higher incidence in younger children. Febrile CSE is the commonest single group with a good prognosis in sharp distinction to CSE related to central nervous system infections which have a high mortality. The aim of treatment is to intervene at 5 min and studies indicate that intravenous (i.v.) lorazepam may be a better first-line treatment than rectal diazepam and i.v. phenytoin a better second-line treatment than rectal paraldehyde. An epidemiological study strongly supports the development of prehospital treatment with buccal midazolam becoming a widely used but unlicensed option in the community. More than two doses of benzodiazepines increase the rate of respiratory depression without obvious benefit. The 1 year recurrence rate is 17% and the hospital mortality is about 3%.