Ratio of height to sternomental distance; A comparison of common upper airway tests for predicting difficult larygoscopy in elective surgery patients

Preoperative evaluation is important in predicting the risk of difficult airway management. Ratio of height to sternomental distance is a new test for predicting difficult laryngoscopy. Analytical cross - sectional study. Guilan University of Medical Sciences, Rash-lran. 1[st] Oct, 2009 to 30[th] Dec, 2010. 470 consecutive patients scheduled for elective surgery undergoing general anesthesia and requiring endotracheal intubation. The tests that were used to predict difficult laryngoscopy included: mouth opening range, body mass index [BMl], thyromental distance, sternomental distance, and neck movement range, ratio of height to thyromental distance, ratio of height to sternomental distance [RHSMD] and assessment of oropharyngeal view by modified Mallampati classification. After general anesthesia, glottic visualization was assessed during laryngoscopy using Cormack and Lehane classification. Multivariate analysis and 95 percent confidence interval with SPSS 14 statistical package were used to compare the results of study. Neck movement range /= 12.5 were valuable respectively. Odds ratio [95 percent confidence interval] of the neck movement range /= 12.5 and RHTIVID >/= 23.5 were 17.7[9.57 - 49.76], 12.28 [7.6 - 47.04], 12.22 [22.8-76.6], 9.35 [2.29 -10.52], 5.6 [0.08 - 0.89], 3.78 [0.022 - 0.595] respectively. RHSMD had the least false negative value. Cut off point of RHSMD >/= 12.5 and RHTMD >/= 23.5 was not different between men and women. RHSMD is a useful and valuable clinical screening test for predicting difficult laryngoscopy.

Difficult laryngoscopy; the predictive value of ratio of height to thyromental distance versus other common predictive tests of upper airway

Preoperative evaluation of anatomical landmarks and clinical factors helps to identify potentially difficult laryngoscopies; however, its predictive reliability is unclear. As the ratio of height to thyromental distance [RHTMD] is a newer upper airway predictive test for difficult laryngoscopy, the predictive value and odds ratios of RHTMD versus mouth opening, thyromental distance[TMD], neck movement, and oropharyngeal view [modified Mallampati] were evaluated. Data of 407 consecutive patients scheduled for elective surgery with general anesthesia requiring endotracheal intubation were collected and all five factors were assessed before surgery. Four senior anesthesiology residents, not aware of the recorded preoperative airway assessment, performed the laryngoscopy and grading [as in Cormack and Lehane's classification]. Difficult laryngoscopy [Grade 3 or 4] occurred in 94 patients [23.1%]. In the multivariate analysis, three criteria were found independent for difficult laryngoscopy [neck movement /= 24]. Neck movement [NM] /= 24 were valuable with lowest NPV. The multivariate analysis Odds ratio [95% confidence interval] of the NM, Mallampati class, IIG and RHTMD were 18.16 [9.634 - 34.265], 12.498 [6.744 - 23.16], 11.183 [6.571 - 19.03] and 3.123 [1.933 - 5.047] respectively.TMD

Serum C-reactive protein level as a biomarker for differentiation of ischemic from hemorrhagic stroke

Cerebrovascular accidents rank first in the frequency and importance among all neurological disease. Although a number of studies had shown increased level of the high sensitive C-reactive protein [hs-CRP] in patients with ischemic stroke, the association of increased hs-CRP with various type of stroke especially the assessment hs-CRP level in ischemic and hemorrhagic stroke have not been investigated. In the present study, we assessed the concentration of hs-CRP in patients with documented ischemic and hemorrhagic stroke in the first 24 hours of the onset of symptoms. Thirty-two patients with Ischemic and hemorrhagic stroke were evaluated at neurology department of Poursina Hospital. The presence of baseline vascular risk factors, including hypertension, diabetes mellitus, hypercholesterolemia, obesity, and smoking, was determined. The blood samples were then collected and routine hematology and biochemistry tests were done. hs-CRP levels were determined using a highly sensitive immunonephelometric method. In this cross sectional study, the age of patient varied from 45-85 years [Mean 70.9 +/- 9.4]. Serum level of hs-CRP in Ischemic patients were 18.92 +/- 11.28 and in hemorrhagic group was 2.65 +/- 1.7. This relationship was statistically significant [P<0.0001]. It might be concluded that hs-CRP might be considered as a usefully adjunct method for the initial diagnosis of the type of stroke

Comparison of preoperative computerized tomography scan imaging of temporal bone with the intra-operative findings in patients undergoing mastoidectomy

To compare the consistency rates of pre- and intra-operative radiological findings in patients with chronic suppurative otitis media CSOM. In a cross-sectional study, 80 patients with CSOM underwent pre-operative CT scanning and we compared the results with intra-operative clinical findings during mastoidectomy from 2000-2004 in the Otology Department, Amiralmomenin Hospital of Guilan Medical University, Rasht, Iran. Sensitivity, specificity, positive and negative predictive value of CT scan in tympanic and mastoid cholesteatoma, ossicular chain erosion, tegmen tympani erosion, dehiscence of facial canal, lateral semicircular canal LSCC fistula were assessed. Then, correlation between radiological findings and intra-operative findings were calculated. The mean age of the patients was 27.9 +/- 16.3 years. Mostly were males n = 57 [71.3%]. Correlation of preoperative radiological images with intra-operative clinical findings were moderate to good on tympanic cholesteatoma, mastoid cholesteatoma and ossicular chain erosion, but weak and insignificant in cases of tegmen tympani erosion, facial canal dehiscence and LSCC fistulae. Preoperative CT scan may be helpful in decision-making for surgery in cases of cholesteatoma and ossicular erosion. Despite of limitations radiological scanning is a useful adjunct to management of CSOM