A primary cardiac sarcoma presenting with superior vena cava obstruction.

Superior vena cava (SVC) obstruction leads to a constellation of symptoms and signs that encompass the SVC syndrome. Today, malignancy accounts for 65% of all cases. The most common neoplastic causes are non­small cell lung cancer (50%), small cell lung cancer (25%), lymphoma, and metastasis. Primary cardiac tumors are an extremely rare cause of SVC obstruction. We describe the case of a 48-year-old man who presented with dyspnea, confusion, and facial swelling with cyanosis. The patient developed life-threatening airway obstruction after administration of anxiolytic. The diagnosis of SVC obstruction secondary to a primary cardiac sarcoma was established based on clinical, radiologic, and post-mortem findings. This is one of very few reported cases of a primary cardiac sarcoma causing SVC obstruction.

Admixture of ephedrine to offset side effects of propofol: a randomized, controlled trial.

STUDY OBJECTIVE: To determine whether adding ephedrine to propofol is as effective as adding lidocaine at reducing injection pain, and its effects on hemodynamics. DESIGN: Randomized, double-blinded, controlled trial. SETTING: District general hospital in the United Kingdom. PATIENTS: 156 adult, ASA physical status I, II, and III patients undergoing elective or emergency general anesthesia. INTERVENTIONS: Patients were randomized to one of three groups to receive one mL of 1% lidocaine per 20 mL of 1% propofol (Group L), 15 mg of ephedrine per 20 mL of propofol (Group E15), or 30 mg of ephedrine per 20 mL of propofol (Group E30). MEASUREMENTS AND MAIN RESULTS: Pain on injection, heart rate, and blood pressure at one-minute intervals for ten minutes were recorded. There was no significant difference in injection pain among groups. Group E30 had the least amount of hemodynamic change. CONCLUSION: Adding 30 mg of ephedrine to 20 mL of 1% propofol is as effective as adding lidocaine in preventing injection pain, and it results in a more stable hemodynamic profile.

Hypotension and ST depression as a result of disulfiram ethanol reaction.

A case report of a 27-year-old man who developed significant hypotension and ischaemic ECG changes as a result of a disulfiram ethanol reaction. He was treated with intravenous fluids and norepinephrine, which has been advocated as the pressor agent of choice. This case highlights the potential dangers of disulfiram, a drug that can be beneficial in the short term, but not proven to improve long-term outcome in the treatment of alcoholism.

Scottish urban versus rural trauma outcome study.

BACKGROUND: Outcome following trauma and health care access are important components of health care planning. Resources are limited and quality information is required. We set the objective of comparing the outcomes for patients suffering significant trauma in urban and rural environments in Scotland. METHOD: The study was designed as a 2 year prospective observational study set in the west of Scotland, which has a population of 2.58 million persons. Primary outcome measures were defined as the total number of inpatient days, total number of intensive care unit days, and mortality. The participants were patients suffering moderate (ISS 9-15) and major (ISS>15) trauma within the region. The statistical analysis consisted of chi square test for categorical data and Mann Whitney U test for comparison of medians. RESULTS: There were 3,962 urban (85%) and 674 rural patients (15%). Urban patients were older (50 versus 46 years, p = 0.02), were largely male (62% versus 57%, p = 0.02), and suffered more penetrating traumas (9.9% versus 1.9%, p < 0.001). All prehospital times are significantly longer for rural patients (p < 0.001), include more air ambulance transfers (p < 0.001), and are characterized by greater paramedic presence (p < 0.001). Excluding neurosurgical and spinal injuries transfers, there was a higher proportion of transfers in the rural major trauma group (p = 0.002). There were more serious head injuries in the urban group (p = 0.04), and also a higher proportion of urban patients with head injuries transferred to the regional neurosurgical unit (p = 0.037). There were no differences in length of total inpatient stay (median 8 days, p = 0.7), total length of stay in the intensive care unit (median two days, p = 0.4), or mortality (324 deaths, moderate trauma, p = 0.13; major trauma, p = 0.8). CONCLUSION: Long prehospital times in the rural environment were not associated with differences in mortality or length of stay in moderately and severely injured patients in the west of Scotland. This may lend support to a policy of rationalization of trauma services in Scotland.

Effect of patients' age on management of acute intracranial haematoma: prospective national study.

OBJECTIVE: To determine whether the management of head injuries differs between patients aged > or =65 years and those <65. DESIGN: Prospective observational national study over four years. SETTING: 25 Scottish hospitals that admit trauma patients. PARTICIPANTS: 527 trauma patients with extradural or acute subdural haematomas. MAIN OUTCOME MEASURES: Time to cranial computed tomography in the first hospital attended, rates of transfer to neurosurgical care, rates of neurosurgical intervention, length of time to operation, and mortality in inpatients in the three months after admission. RESULTS: Patients aged > or =65 years had lower survival rates than patients <65 years. Rates were 15/18 (83%) v 165/167 (99%) for extradural haematoma (P=0.007) and 61/93 (66%) v 229/249 (92%) for acute subdural haematoma (P<0.001). Older patients were less likely to be transferred to specialist neurosurgical care (10 (56%) v 142 (85%) for extradural haematoma (P=0.005) and 56 (60%) v 192 (77%) for subdural haematoma (P=0.004)). There was no significant difference between age groups in the incidence of neurosurgical interventions in patients who were transferred. Logistic regression analysis showed that age had a significant independent effect on transfer and on survival. Older patients had higher rates of coexisting medical conditions than younger patients, but when severity of injury, initial physiological status at presentation, or previous health were controlled for in a log linear analysis, transfer rates were still lower in older patients than in younger patients (P<0.001). CONCLUSIONS: Compared with those aged under 65 years, people aged 65 and over have a worse prognosis after head injury complicated by intracranial haematoma. The decision to transfer such patients to neurosurgical care seems to be biased against older patients.

The Drosophila STAT protein, stat92E, regulates follicle cell differentiation during oogenesis.

Signal transducer and activator of transcription (STAT) proteins are transcription factors that play a critical role in the response of a variety of eukaryotic cells to cytokine and growth factor signaling. In Drosophila, the STAT homolog encoded by the stat92E gene is required for the normal development of multiple tissues, including embryonic segmentation, imaginal discs, blood cells, male germ cells, and sex determination. We used multiple approaches to study the role of stat92E in oogenesis. Stat92E RNA expression is strongest in the differentiating follicle cells in the germarium, as determined by in situ hybridization. We generated an ethylmethane sulfonate-induced, temperature-sensitive allele, stat92E(F), in which the mutant protein contains a P506S substitution, located in the DNA binding domain. At the restrictive temperature, mutant females are sterile. Mutant ovaries have multiple defects, including fused egg chambers and an absence of interfollicular stalks cells and functional polar follicle cells. An analysis of mosaic clones, using an apparent null stat92E allele, indicates that Stat92E is required in the polar/stalk follicle cell lineage. We conclude that stat92E is necessary for the early differentiation of follicle cells and for proper germ line cell encapsulation during Drosophila oogenesis.