Use of transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) to facilitate the management of subglottic stenosis in pregnancy.

Subglottic stenosis is a rare condition. Diagnosis is often delayed as symptoms are attributed to other causes, such as asthma. This problem may be compounded in pregnancy when dyspnoea may be attributed to normal physiological changes. In respiratory compromise, surgical intervention may be required and airway management is challenging as endotracheal intubation may be traumatic or, in severe cases, impossible. Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) is a novel open-airway apnoeic technique using high-flow nasal oxygen. It does not expose the patient to the risks of jet ventilation, nor does it require the placement of an airway device to effectively oxygenate the patient. In pregnancy, elevation of maternal carbon dioxide is of particular concern as it may result in a worsening fetal acidosis. While THRIVE has been shown to provide some clearance of carbon dioxide, a patent airway is required for it to function effectively. In this case report we describe the management of a pregnant patient who underwent balloon dilatation for severe subglottic stenosis at 23 weeks' gestation using THRIVE and we summarise the evidence supporting the use of this new technique in pregnant women.

Panton-Valentine Leukocidin Staphylococcus aureus (PVL-SA) - an uninvited stowaway aboard a Royal Navy submarine.

The toxin Panton-Valentine Leukocidin (PVL) is a virulence factor produced by some strains of Staphylococcus aureus (S. aureus, SA) that destroys leucocytes. PVL-SA predominantly results in skin and soft tissue infections (SSTIs) but may also cause invasive disease, including necrotising pneumonia, which may affect healthy young individuals and has a high mortality. We describe a case of PVL-SA in a submariner who presented at sea and which resulted in a requirement to both alter the submarine's programme and undertake population screening. The case highlights many important issues pertinent to military populations including clinical and public health considerations.

Activation of the human immunodeficiency virus long terminal repeat by abrasion of the skin in transgenic mice.

Mechanical wounding was shown to activate the human immunodeficiency virus type 1 (HIV-1) long terminal repeat (LTR) in the skin of transgenic mice. Both noninvasive rubbing and scratching of the skin resulted in a range of 4- to 44-fold increased levels of luciferase reporter gene activities when assayed 24-48 h after wounding. Moreover, long-term noninvasive rubbing each day for 17 days resulted in similar increased levels of luciferase activity. Experiments were done to determine whether the HIV-1 LTR-luciferase transgene might be activated when pups were nursed on the mammary tissues of transgenic mice. Luciferase reporter gene activity in mammary glands skin following nursing was significantly higher than in skin from non-pregnant transgenic mice or transgenic mice 20 days post-conception, which suggests that the natural abrasive action of nursing resulted in activation of the LTR. These results may have implications for sexual transmission and maternal-to-infant transmission of HIV-1.

Mother, may I ...?

If you've been working in EMS for much more than a week, the title of this column probably evoked some sort of visceral response from you--and not a positive one. The phrase "Mother, may I...?" has long been attached to EMS systems that require EMTs and paramedics to call their base hospitals prior to performing most interventions or delivering medications. Where the rub comes in is that most field people I know would prefer a little more leeway, something like a "Mother, I'm going out now" type of system.

HIV-1 LTR activation model: evaluation of various agents in skin of transgenic mice.

Mice containing the HIV-1 long terminal repeat (LTR) regulating the expression of firefly luciferase reporter gene were investigated for their use as a model for activation of the LTR. As a limited test of this model, a number of different factors were screened for their ability to affect reporter gene activities in the skin. Reporter gene levels were increased in the skin by topical treatment of dimethylsulfoxide, retinoic acid, phorbol ester, ultraviolet light, and hydrogen peroxide, all of which have previously been shown to cause increased HIV production in cultured human cells. Topically applied arachidonic acid, histamine, ethanol, acetone, and methanol did not increase reporter gene activities. A lack of published reports on activation of HIV-1 in human cells by these agents suggests that they do not activate viral expression in human cells, which corroborates with the findings of this report. Minor forms of skin wounding and intraperitoneally administered psoralen plus ultraviolet light also increased reporter gene activities in skin. Control and test treatments could be performed on the same mouse and repetitive samples could be obtained from each treatment area. These transgenic mice might be useful as predictive models for regulation of the LTR in epidermal or dendritic cells.