A fulminant case of acute respiratory distress syndrome associated with Mycoplasma pneumoniae infection.

Acute respiratory distress syndrome (ARDS) caused by mycoplasmas is very rare. This report describes a severe case of atypical pneumonia due to M. pneumoniae in a formerly healthy young woman who developed high grade fever and cough leading to severe disseminated lung disease and finally to fatal ARDS. This case came into picture when killer atypical pneumonia, namely, SARS (severe acute respiratory syndrome), spread very fast from South-Asian countries to the rest of the world. Moreover, the clinical presentation and radiologic features of SARS bear resemblance to the syndrome of atypical pneumonia, which lead us to investigate this case into detail. We suggest that M. pneumoniae infections should be included in the differential diagnosis of pathogens causing ARDS, establishing an early diagnosis may have important therapeutic implications.

Evaluation of single-stage adjustable strabismus surgery under conscious sedation.

PURPOSE: To evaluate the feasibility and stability of ocular alignment after single-stage adjustable strabismus surgery (SSASS) performed under topical anesthesia. MATERIALS AND METHODS: Forty-five patients of concomitant exodeviations were randomized into three groups of 15 cases each and were operated with three different techniques: Group I - conventional surgery, Group II - two-stage adjustable suture technique with suture adjustment performed 6h postoperatively and Group III- SSASS under topical anesthesia and intravenous conscious sedation with midazolam and fentanyl. Intraoperative suture adjustment was done by giving a cross target to the patient on the ceiling at the end of the procedure. Surgical results were compared among the three groups at three months follow-up. Intraoperative hemodynamic parameters and patients' experience of the surgery (by questionnaire) were also compared. RESULTS: Mean preoperative deviation for distance in Groups I, II, III was -41.67 prism diopter (pd) +/-9.0, -38.93 pd +/-11.05 and -41.87 pd +/-8.91 ( P =0.6) respectively. At three months, mean correction achieved for distance was +31.87 pd +/-11.71, +35.47 pd +/-10.86 and +42.80 pd +/-10.71 respectively which was significantly different between Group III and Group I ( P =0.03). Intraoperatively all hemodynamic parameters remained stable and comparable ( P =0. 5) in all groups. Intraoperative pain ( P < 0.001) and time taken for surgery ( P < 0.001) was more in the SSASS group. Amount of exodrift was 10-12 pd, comparable in all three groups ( P = 0.5). CONCLUSIONS: SSASS, performed under topical anesthesia, is safe and has better outcomes than conventional recession-resection surgery for concomitant exodeviation. An overcorrection of about 10-12 pd is recommended to check the exodrift and achieve stable alignment.