Granulomatous hepatitis following open heart surgery with cardiopulmonary bypass.

BACKGROUND: Cardiopulmonary bypass (CPB) initiates an inflammatory cascade, predisposing the patient to a number of infections. The stress of surgery and anaesthesia further expose the patient to a variety of non-infectious complications. We report a group of patients who developed granulomatous disease after open heart surgery. METHODS: We retrospectively analysed a subset of patients who developed a syndrome of fever, jaundice and hepatomegaly after open heart surgery. We recruited age- and sex-matched controls who underwent open heart surgery during the same period (July 2002-July 2004). Details of demographic profiles, diagnostic evaluation and drug treatment were noted and compared between the two groups using the SPSS software. RESULTS: Five patients were identified to have the specific syndrome of high grade intermittent fever with jaundice and hepatomegaly with investigations revealing an intrahepatic cholestasis. A detailed evaluation revealed granulomas in tissue specimens of the bone marrow and/or liver in these patients. An extensive evaluation for an alternative aetiological agent was non-contributory. CONCLUSION: We found granulomatous hepatitis in 5 patients following open heart surgery and they were given conventional antituberculous therapy to which they responded. It is possible that in these patients, tuberculosis was re-activated from a dormant focus due to a period of transient immunodeficiency caused by an extracorporeal circulation.

Oral triiodothyronine in the perioperative management of central hypothyroidism.

Oral triiodothyronine (T3) has never been described in literature as a major form of perioperative therapy. This series highlights the role of oral triiodothyronine in the perioperative management of patients with overt hypothyroidism for semi-urgent surgeries. We describe 12 patients with central hypothyroidism occurring secondary to pituitary tumours manifesting with severe neurological symptoms that required early surgical intervention. These patients were managed without any significant complications by administering perioperative oral triiodothyronine.

Difficult laryngoscopy made easy with the use of left-hand laryngoscope blade.

In scenarios where difficult airway is anticipated as a result of a mass or any pathology in the right side of the upper airway, the plan of approach depends on the extent of difficulty assessed by various airway assessment tests/methods. If significant difficulty is suspected some of the available options include either an awake/sedated fibreoptic or blind nasal intubations. When the airway pathology involves part of the right side or exclusively the whole of the right side compressing the airway towards the left, there is no room to position a normal right or straight blade. A left-hand laryngoscope can be used in these types of cases where anatomy and contour of the blade manoeuvres the tongue and the right-sided lesion, thereby providing an unobstructed left-sided view of the larynx. The left-hand laryngoscope blade has been useful in converting the Cormack and Lehane grade III/IV laryngoscopies to grade II in our cases where the pathology was located exclusively on the right side of the airway. These cases suggest that there may be a role of left-hand laryngoscope in the management of difficult airway, particularly, in cases where there are right-sided mass lesions obstructing the airway.

Strong genetic structuring in a habitat specialist, the oxleyan pygmy perch nannoperca oxleyana

This study used allozyme and mitochondrial DNA variation to examine genetic structure in the Oxleyan Pygmy Perch Nannoperca oxleyana. This small-bodied freshwater fish has a very restricted distribution occurring only in some small coastal streams in south-east Queensland and northern New South Wales. It was expected that subpopulations may contain little genetic variation and be highly differentiated from one another. The results, based on allozyme and mitochondrial DNA control region variation were in agreement with these expectations. Allozyme variation was very low overall, with only one locus showing variation at most sites. The high differentiation was because a different locus tended to be polymorphic at each site. Mitochondrial variation within sites was also low, but some sites had unique haplotypes. The patterns of similarity among mitochondrial DNA haplotypes were not as expected from geographical proximity alone. In particular, although some northern sites had unique haplotypes, four sites spread along 200 km of coastline were remarkably similar, sharing the same common haplotype at similar frequencies. We suggest that these four streams may have had a confluence relatively recently, possibly when sea levels were lower, 8000-10 000 BP.