Anaesthetic management during awake craniotomy in a 12-year-old boy

We present our approach to the preoperative preparation and anaesthetic management for awake craniotomy in a 12-year-old boy. Management included conscious sedation with a propofol infusion plus local anaesthetic infiltration of the scalp, periosteum, and dura. The complications which may be encountered during such procedures and their treatments are reviewed.     

Congenital teratomas of the neck and nasopharynx: A clinical and pathological study of 18 cases

Congenital teratomas of the neck and nasopharynx are unusual tumours that seldom metastasize. Due to their rarity, reviews often have relied upon compilations of isolated case reports. We report our experience of the early outcome of 18 cases (14 cervical, four nasopharyngeal) to demonstrate the high morbidity and mortality that these benign but critically placed lesions have because of local mass effects. Six patients (33%) either were stillborn or died of disease within 2 days of birth; of the survivors, four (22%) had significant respiratory obstruction requiring surgery. Tumour location and size rather than histologic grading were the most significant features affecting the immediate clinical course. All but one of the patients who underwent early surgical resection had a favourable outcome.     

Cervical Spine Disease and Dysphagia

Four cases of dysphagia associated with disease of the cervical spine have been presented. One of the patients had cervical spondylosis with osteophyte formation while the other three had Forestier's disease or ankylosing hyperostosis. Symptoms of dysphagia dominated the clinical picture and led to their referral for further management. Two patients underwent surgical procedures and one died in the postoperative period. Two patients were managed conservatively, one with antibiotics, and both did reasonably well. The literature of 40 cases published in the last 54 years has been reviewed. We suggest that dysphagia due to cervical spine disease while an uncommon complication of these bony growths, is by no means rare. The dysphagia may be due to bony protuberances into the hypopharynx or into the esophagus and may be accompanied by soft tissue inflammation. Although most patients have been treated surgically, there may be a role for anti-inflammatory or antibiotic therapy in the first instance as surgery is often morbid and sometimes fatal.     

Endothelial microparticles induce formation of platelet aggregates via a von Willebrand factor/ristocetin dependent pathway, rendering them resistant to dissociation

Endothelial microparticles (EMP) released from activated or apoptotic endothelial cells (EC) are emerging as useful markers for detection of EC dysfunction. Our recent observation that EMP carry von Willebrand factor (vWf) led us to investigate their interaction with platelets. EMP were incubated with normal washed platelets in the presence or absence of ristocetin, then platelet aggregates were measured by flow cytometry. In the absence of ristocetin, negligible EMP conjugated with platelets (< 5%) but in the presence of ristocetin (1 mg mL(-1)), EMP induced up to 95% of platelets to aggregate. EMP-platelet interaction was 80% blocked by anti-CD42b, or by 0.1 microm filtration to remove EMP. Platelet aggregates induced by normal plasma or high molecular weight vWf (Humate-P) dissociated 50% within 15-25 min following 1:20 dilution. In contrast, aggregates formed with EMP persisted two- to threefold longer with the same treatment, indicating greater stability. A similar degree of prolongation of dissociation was observed using plasma from thrombotic thrombocytopenic purpura (TTP) patients compared with normal plasma. Addition of EMP to plasma from severe von Willebrand disease restored his ristocetin-induced platelet aggregation. Multimer analysis of vWf on EMP showed unusually large vWf (ULvWf). In summary, EMP carries ULvWf multimers, promote platelet aggregates, and increase the stability of the aggregates thus formed.     

HLA-B27 and ankylosing spondylitis in the Mexican Mestizo population

Two previous surveys of ankylosing spondylitis (AS) in Mexican Mestizos found HLA-B27 frequencies of 68.6% and 78% and a relative risk (RR) of 37.05 and 120.88, respectively. We examined an additional group of Mexican Mestizos with AS and found an HLA-B27 frequency of 80.77% and a RR of 99.24. Our results are statistically comparable to the previous studies, and they suggest that the Mexican Mestizo is similar to the Spaniard in regards to AS and HLA-B27 association.