A prospective, cohort evaluation of major and minor airway management complications during routine anaesthetic care at an academic medical centre.

The aim of this study was to develop an audit tool to identify prospectively all peri-operative adverse events during airway management in a cost-effective and reproducible way. All patients at VU University Medical Center who required general anaesthesia for elective and emergency surgical procedures were included during a period of 8 weeks. Daily questionnaires and interviews were taken from anaesthesia trainees and anaesthetic department staff members. A total of 2803 patients underwent general anaesthesia, 1384 men and 1419 women, including 2232 elective patients and 571 emergency procedures, 697 paediatric and 2106 adult surgical procedures. A total of 168 airway-related events were reported. The incidence of severe airway management-related events was 24/2803 (0.86%). There were 12 (0.42%) unanticipated ICU admissions, two patients (0.07%) required a surgical airway. There was one (0.04%) death, one cannot intubate cannot oxygenate (0.04%), one aspiration (0.04%) and eight (0.29%) severe desaturations < Sp O2 50%. We suggest that our method to determine and investigate airway management-related adverse events could be adopted by other hospitals.

Polarity proteins and actin regulatory proteins are unlikely partners that regulate cell adhesion in the seminiferous epithelium during spermatogenesis.

In mammalian testis, spermatogenesis takes place in the seminiferous epithelium of the seminiferous tubule, which is composed of a series of cellular events. These include: (i) spermatogonial stem cell (SSC) renewal via mitosis and differentiation of SSC to spermatogenia, (ii) meiosis, (iii) spermiogenesis, and (iv) spermiation. Throughout these events, developing germ cells remain adhered to the Sertoli cell in the seminiferous epithelium amidst extensive cellular, biochemical, molecular and morphological changes to obtain structural support and nourishment. These events are coordinated via signal transduction at the cell-cell interface through cell junctions, illustrating the significance of cell junctions and adhesion in spermatogenesis. Additionally, developing germ cells migrate progressively across the seminiferous epithelium from the stem cell niche, which is located in the basal compartment near the basement membrane of the tunica propria adjacent to the interstitium. Recent studies have shown that some apparently unrelated proteins, such as polarity proteins and actin regulatory proteins, are in fact working in concert and synergistically to coordinate the continuous cyclic changes of adhesion at the Sertoli-Sertoli and Sertoli-germ cell interface in the seminiferous epithelium during the epithelial cycle of spermatogenesis, such that developing germ cells remain attached to the Sertoli cell in the epithelium while they alter in cell shape and migrate across the epithelium. In this review, we highlight the physiological significance of endocytic vesicle-mediated protein trafficking events under the influence of polarity and actin regulatory proteins in conferring cyclic events of cell adhesion and de-adhesion. Furthermore, these recent findings have unraveled some unexpected molecules to be targeted for male contraceptive development, which are also targets of toxicant-induced male reproductive dysfunction.

Skeletal metastases of unknown origin: a retrospective analysis of 29 cases.

The objective of this study was to assess the diagnostic strategy in identifying occult primary carcinomas in metastatic bone disease. The records of 29 patients seen between 1983 and 1993 were reviewed retrospectively. The patients had been evaluated nonuniformly with a wide array of diagnostic procedures. The primary tumor was identified in 22 patients antemortem, and in 2 patients postmortem. In 5 patients a diagnosis of the primary tumor was never obtained. Eleven of the primary tumors were carcinomas of the lung, 3 were prostatic carcinomas, 2 were carcinomas of the breast and 2 were malignant lymphomas. In 4 patients respectively a carcinoma of the kidney, the pancreas, the ovary or the stomach was found. One patient had a carcinoid tumor of the small intestine, and one had a retroperitoneal rhabdomyosarcoma. The average survival time after clinical onset of skeletal metastases was 12 months. We propose a flow sheet to evaluate this category of patients including a medical history, thorough physical examination, routine laboratory tests, chest radiography, bone scintigram, ultrasonography or computed tomography of the abdomen and biopsy of the most accessible metastasis. These tests allowed premortem diagnosis of the primary tumor in 75% of the cases. Biopsy should be considered the last test to be performed.