Comparative study of three different supraglottic airway devices in simulated difficult airway situations.

BACKGROUND: Supraglottic airway devices (SAD) provide an effective way for managing difficult airways. Numerous SADs have been developed in recent years. We compared three SADs utilizing simulated airways. The major aim of this study was to provide evidence for the efficacy of SADs in the management of simulated difficult airway situations. METHODS: The study utilized an airway simulation manikin (Laerdal SimMan® 3G) to assess feasibility and time to final placement of three different airway devices (the classic laryngeal mask airway [LMA], the Laryngeal tube [LT], and the EasyTube® [EzT]). Thirty anesthesiologists inserted each of the SADs under standard physiologic airway conditions (STD) as well as pathological airway conditions, including tongue edema (TE) and trismus combined with limited mobility of the cervical spine (TCS), mimicking a patient with cramps. RESULTS: In STD and TE, all participants were able to successfully place the LMA, LT, and EzT correctly. In TCS, one participant failed to place the LMA correctly, whereas six participants failed to place the LT correctly (P=0.031). Under STD and TE conditions, we found a significantly longer time to final placement with the EzT (P=0.001). Under TCS conditions, there was no significant difference between the tested SADs. Under STD conditions, the participants rated the LMA best (P<0.001). Under TE and TCS condition, the EzT was significantly higher rated (P<0.001). CONCLUSION: The EzT showed benefits in two difficult airway situations (TE and TCS) in a prospective manikin study amongst anesthesiologists.

The use of drotrecogin alfa in severe falciparum malaria.

We report the case of a 55-year-old male European who became septic after he returned from a four-week holiday to Uganda. Soon after; he was diagnosed with severe falciparum malaria and developed multi-organ failure. Due to the worsening condition of the patient, drotrecogin alfa (activated) was started, soon after which the patient's condition significantly improved. He returned home on day 36 after admission, without neurologic sequelae. Looking at those few cases of severe forms of malaria where drotrecogin alfa (activated) was successfully used, it should at least be considered for administration in patients with severe falciparum malaria with disseminated intravascular coagulation and cerebral involvement who do not respond to or deteriorate during standard treatment.

The Norwegian naturalistic treatment study of depression in general practice (NORDEP)-I: randomised double blind study.

OBJECTIVE: To evaluate the efficacy of emotional support and counselling combined with placebo or antidepressants with single or dual mechanism of action in the treatment of depression in primary care. DESIGN: Randomised double blind study. SETTING: Several locations in Norway. SUBJECTS: 372 patients with depression. MAIN OUTCOME MEASURES: Improvement (clinical remission) reported both by the patient (Montgomery Asberg depression rating scale) and the physician (clinical global improvement and impression scales). RESULTS: Intention to treat analyses showed 47% remission in patients randomised to placebo compared with 61% remission in patients randomised to sertraline (odds ratio 0.56, 95% confidence interval 0.33 to 0.96) and 54% in patients randomised to mianserin (0.75, 0.44 to 1.27). Women responded better than men (1.86, 1.17 to 2.96). Subgroup analyses showed that subjects with recurrent depression (n=273) responded more frequently to sertraline than to placebo (0.43, 0.23 to 0.82) than those having their first episode of depression (1.18, 0.39 to 3.61). Statistically significant interactions between type of drug treatment and history of depression were not shown by logistic regression. CONCLUSION: The combination of active drug and simple psychological treatment (counselling, emotional support, and close follow up over a 24 week period) was more effective than simple psychological treatment alone, in particular for those with recurrent depression. Overall, women may benefit more than men. If confirmed in future studies, the findings should lead to more differentiated treatment guidelines for depression in primary care.

[Computed tomography of the brain in suppurative meningoencephalitis]. / Komp'iuternaia tomografiia golovnogo mozga pri gnoinom meningoéntsefalite.

The studies made showed that one-tenth patient with purulent meningoencephalitis (PME) needs to be examined by axial computerized tomography (ACT) techniques. The following items are indications for ACT: apparent or progressive neurological symptomatology, protracted or relapsing course of PME, formation of the intracranial liquor hypertension, apparent changes in echoencephalography, and congestive disorders in the eyegrounds. Brain ACT permits finding a relevant policy of treating patients (surgery or conservative option) together with predicting the course and outcome of PME.

[The characteristics of computed study data on the brain in viral meningoencephalitis]. / Kharakteristika dannykh komp'iuternogo issledovaniia golovnogo mozga pri virusnykh meningoéntsefalitakh.

An analysis is presented of CT examination of the brain in viral meningoencephalitis in 113 patients with viral encephalitis. Pathological changes in the acute period were found in 65.4% of patients more frequently in the CSF system, rarer in the brain tissue (in herpetic encephalitis). During the early convalescence period 75% of patients showed dilated ventricles and external CSF spaces. The importance of CT examination in this kind of pathology is emphasized.

[The results of computed tomography in patients with traumatic epilepsy]. / Rezul'taty komp'iuternoi tomografii u bol'nykh travmaticheskoi épilepsiei.

Computerized tomography in 134 patients with traumatic epilepsy allowed to reveal different changes in the brain tissue, meninges and CSF spaces. Early stages were characterized by signs of meningeal adhesions. With increased duration of the disease these changes were supplemented by signs brain atrophy in the form of dilatation of the subarachnoidal spaces, internal hydrocephalus. CSF cysts were diagnosed in 5 patients, porencephaly in 2, ischemia foci in the brain in 9 patients.

[Status of cerebral ventricles and meninges in subarachnoid hemorrhage (clinico-pathomorphological studies)]. / Sostoianie zheludochkov i obolochek golovnogo mozga pri subarakhnoida'lnykh krovoizliianiiakh (kliniko-patomorfologi- cheskoe issledovanie).

Long-term investigation of 64 patients with subarachnoidal hemorrhages (SH), 24 of which had subsequently died, and 2 series of experiments of animals with a single or repeated intracysternal infusion of various doses of autologous blood, yielded the description of the response of the meninges and ventricles at different terms after SH. The brain ventricles were measured by axial computer tomography and echoencephalography. A index of CSF resorption resistance and CSF pressure were determined. The cerebral meninges from experimental animals and autopsied human ones underwent the histological examination. The authors discuss the mechanisms of development of liquor dynamic disorders at different terms after SH.

Withdrawal reactions to diazepam in combined imipramine/diazepam treatment of primary nonagitated depressed outpatients.

Twenty-seven outpatients who had primary nonagitated depression that had been treated for 3.5 months with imipramine were included in the study. Of these, 14 patients were given additional diazepam treatment (10 mg/day) and 13 patients got placebo. The additional medication was stopped, and withdrawal reactions were observed after two weeks. The depression scores (both global evaluation and CPRS) increased significantly in the diazepam group, without any changes in the placebo group. Eleven patients in the diazepam group and four in the placebo group reported their condition as impaired after discontinuing their additional medication. Four patients in the placebo group and none in the diazepam group reported improvement. The level of working activity decreased significantly in the diazepam group and increased in the placebo group. The serum level of imipramine decreased in the placebo group (P = 0.07), but not in the diazepam group. Serum levels of desipramine decreased significantly in both groups (P less than 0.05). Our study indicates that the discontinuation of diazepam, even when given in moderate dosage over a relatively short period of time, may cause withdrawal reactions in combined antidepressant/diazepam treatment. This may be caused by a possible tendency for the depression to become chronic. Such chronicity may be the reason for secondary dependency to diazepam.

Comparison of the serum levels in primary non-agitated depressed out-patients treated with imipramine in combination with placebo, diazepam or dixyrazine.

Sixty-three non-agitated depressed out-patients were selected according to the Feighner-Robins-Guze criteria for primary depressions for a double-blind, between-patient randomized study for an 8 week duration. All the patients were treated with imipramine following a fixed dose schedule for the first 2 weeks and thereafter according to clinical response (100-200 mg/day). This treatment was combined with either placebo, diazepam (10 mg/day) or dixyrazine (50 mg/day). The serum concentration of imipramine both at 2 weeks and later was significantly higher (P less than 0.05) in the group treated with dixyrazine than in the other two groups. In the group treated with diazepam, the serum levels of imipramine and desipramine were significantly lower than in the placebo group. The serum concentrations of diazepam, desmethyldiazepam and dixyrazine were almost unchanged during the study. No significant correlation was found between the dosage and the serum concentration of imipramine or desipramine. The change in mean CPRS-score correlated neither with the imipramine nor with the desipramine serum levels, it did correlate but negatively with the degree of side effects. The degree of side effects correlated positively with the serum concentration of desipramine.

A double blind study in out-patients with primary non-agitated depression treated with imipramine in combination with placebo, diazepam or dixyrazine.

Sixty-three out-patients suffering from primary non-agitated depression were included in a double-blind, between-patient randomized study. All patients were treated with imipramine (100-200 mg-day) combined with either placebo, diazepam (10 mg/day) or dixyrazine (50 mg/day) for 8 weeks. The clinical efficacy assessed with a subscale of CPRS was significantly (p1 less than or equal to 0.05) better for the imipramine-dixyrazine combination than for the imipramine-diazepam or imipramine-placebo combination. Serum concentration of imipramine was significantly higher (p1 less than or equal to 0.05) in the group treated with dixyrazine than in the other two groups. Further, serum concentration of imipramine in the diazepam group was significantly lower (p1 less than or equal to 0.05) than in the placebo group. At the end of the study, 67% in both the placebo and the diazepam group and 86% in the dixyrazine group were practically symptom-free.

[Agenesis of the corpus callosum]. / Ageneziia mozolistogo tela.

Clinical follow-up of 9 patients with agenesis of the corpus callosum is analysed. It is established that the pleomorphism of the clinical manifestations in agenesis of the corpus callosum is determined by the concomitant cerebral lesions. Pneumoencephalography should be considered the method of choice in the diagnosis of agenesis of the corpus callosum because it demonstrates the changes in the ventricular system characteristic of this anomaly and the changes in the cerebrospinal fluid channels attendant to it. A decrease in the distance between the inferior sagittal sinus and the internal cerebral vein and in the distance between the pericallosum artery and the internal cerebral vein are pathognomonic angiographic signs. No pathognomonic changes in the bioelectric activity of the brain in agenesis of the corpus callosum were detected.