Relationship between severe obesity and depth to the cricothyroid membrane in third-trimester non-labouring parturients: a prospective observational study.

BACKGROUND: Severely obese parturients have increased 'cannot intubate, cannot oxygenate' risk during Caesarean section under general anaesthesia. Front-of-neck access (FONA) at the cricothyroid membrane (CTM) is definitive management; however, attempted FONA can fail. Point-of-care ultrasonography may provide useful information about CTM depth to aid FONA in obesity. This study determined the difference in CTM depth between severely obese and non-obese parturients, utilising ultrasonography. METHODS: In this prospective observational study, two anaesthetists performed airway ultrasonography on 15 severely obese (BMI >45 kg m-2) and 15 normal-weight (BMI ≤25 kg m-2) parturients in the third trimester, using the transverse and longitudinal planes, sniffing and extended head positions, and nil and firm transducer pressures. The primary outcome was CTM depth (millimetres) measured in the transverse plane with the head extended and nil transducer pressure. Secondary outcomes included CTM depth measurements using other factor configurations. Intra-class correlation coefficients assessed the inter-observer reliability. RESULTS: CTM depth measured in the transverse plane with head extended and nil transducer pressure was significantly greater in severely obese parturients, mean 18.0 mm (95% confidence interval 16.3-19.8), vs 10.6 mm (8.81-12.4) in non-obese (P<0.001); mean difference 7.4 mm (4.9-9.9; P<0.001). CTM depths were increased in the severely obese group regardless of scanning plane, head and neck position, or transducer pressure (all P<0.001). There was excellent inter-observer reliability. CONCLUSIONS: Cricothyroid membrane depth is significantly increased in severely obese vs normal-weight parturients independently of scanning plane, head and neck position, or transducer pressure.

Surgical management of a retroperitoneal pelvic desmoid tumour involving the sacrifice of external iliac vein and internal iliac vessels.

•Retroperitoneal pelvic desmoid tumours are rare with limited publications.•A rare case of a retroperitoneal pelvic desmoid tumour is discussed.•Excision was challenging requiring the sacrifice of some of the iliac vessels.•No other case reports document a surgical excision requiring this.•To date our patient suffers minimal morbidity and has had no recurrences.

The role of computed tomography in the diagnosis of arterial gas embolism in fatal diving accidents in Tasmania.

Four cases of fatal diving accidents in Tasmania are presented, highlighting the role of CT in the investigation of diving fatalities. The CT technique allows rapid diagnosis when arterial gas embolism (AGE) is suspected. The traditional method of investigation, underwater autopsy, is a difficult procedure that requires specialized training in which the subtle diagnosis of AGE may be completely missed. Facilities for performing underwater autopsies are normally available only in tertiary referral centres, and therefore the diagnosis of AGE may be missed due to lack of facilities. The use of CT in the diagnosis of AGE in divers was first utilized in the early 1980s but has still not become widely adopted in forensic practice. This radiological technique has the advantage of being sensitive, quick, reliable, readily available and provides a permanent record. For hospitals that do not have a resident forensic pathologist, a CT scan can be easily performed and interpreted to eliminate the possibility of AGE. There are a number of pitfalls in the diagnosis of AGE with CT, particularly intravascular gas production following postmortem fermentation and off-gassing. Awareness of these pitfalls will help the radiologist in making a correct diagnosis of AGE.

Adrenal lesions in a large kindred with multiple endocrine neoplasia type 1.

OBJECTIVE: To review the prevalence and natural history of adrenal lesions occurring in patients from a single kindred with multiple endocrine neoplasia type 1 (MEN-1). DESIGN: Case series. SETTING: Tertiary referral center. PATIENTS: Medical records of 33 patients from the Tasman 1 MEN-1 kindred who had undergone abdominal computed tomographic (CT) scanning were reviewed. In 30 patients, the results of abdominal ultrasonographic examinations were available for correlation with CT scan. Computed tomographic and ultrasound scans of 18 patients were reviewed by a radiologist blinded to the patients' clinical details. Three patients underwent adrenalectomy, and the histopathologic material was reviewed. MAIN OUTCOME MEASURES: Computed tomographic and ultrasound scans. RESULTS: Adrenal lesions were detected in 12 patients (36%) by CT scan examination. Ultrasound imaged 58% of these lesions. Pancreatic lesions were present in all cases of adrenal disease. Follow-up was available for 8 patients with adrenal disease. Over 5.5 years, 6 patients (75%) had stable disease, 1 patient had an adrenal lesion that enlarged by 5 mm, and 1 patient had a lesion that enlarged by 50 mm. Adrenal histopathologic material was available in 3 patients. Macronodular cortical hyperplasia was present in 2 patients and a cortical adenoma present in 1 patient. Another kindred had bilateral macronodular cortical hyperplasia at autopsy. CONCLUSIONS: Adrenal lesions are common in MEN-1 and occur in association with pancreatic disease. Abdominal CT scan is more sensitive than ultrasonographic examination in detecting adrenal disease. Primary hypersecretory syndromes of the adrenal glands appear to be rare, and the majority of lesions follow an indolent clinical course.

[Skin testing with the components of analgesics in patients with anaphylactoid hypersensitivity reactions to mild analgesics]. / Hauttestung mit Schmerzmittelinhaltsstoffen bei Patienten mit anaphylaktoiden Unverträglichkeitsreaktionen auf "leichte" Analgetika.

In 282 patients presenting with adverse reactions to mild analgesics, prick tests were performed with components of analgesic drugs; in some of them, commercial preparations were also tested. In 19 patients (7%), a total of 40 conclusively positive immediate reactions was found: there were 22 reactions to pyrazolone derivatives, 14 reactions to commercial preparations, and one singular reaction to phenacetin, phenobarbital, carbromal and vitamin B1, respectively. Cross-sensitivity to different pyrazolone derivatives was observed in only 5 of 15 patients with a positive reaction to at least one of these substances. One of the patients with a positive immediate reaction and 2 further individuals developed positive test reactions after 4 to 24 h. Within 117 patients who gave a clear-cut history of anaphylactoid reactions to mild analgesics, there were conclusive immediate prick test results in 15 cases (13%). In these patients, the diagnostic relevance of the prick test increased with the severity of symptoms in the history, and a conclusive immediate reaction was obtained in 25% of those with full shock in the history.