An assessment of introducers used for airway management.

Different introducers are available to assist with tracheal intubation. Subtle differences in the design of introducers can have a marked effect on safety and performance. The Difficult Airway Society's Airway Device Evaluation Project Team proposal states that devices should only be purchased for which there is at least a case-control study on patients assessing airway devices. However, resources are not currently available to carry out a case-control study on all introducers available on the market. This study comprised a laboratory and manikin-based investigation to identify introducers that could be suitable for clinical investigation. We included six different introducers in laboratory-based assessments (design characteristics) and manikin-based assessments involving the participation of 30 anaesthetists. Each anaesthetist attempted placement in the manikin's trachea with each of the six introducers in a random order. Outcomes included first-time insertion success rate; insertion success rate; number of attempts; time to placement; and distance placed. Each anaesthetist also completed a questionnaire. First-time insertion success rate depended significantly on the introducer used (p = 0.0016) and varied from 47% (Armstrong and P3) to 77% (Intersurgical and Frova). Median time to placement (including oesophageal placement) varied from 10 s (Eschmann and Frova) to 20 s (P3) (p = 0.0025). Median time to successful placement in the trachea varied from 9 s (Frova) to 22 s (Armstrong) (p = 0.037). We found that the Armstrong and P3 devices were not as acceptable as other introducers and, without significant improvements to their design and characteristics, the use of these devices in studies on patients is questionable. The study protocol is suitable for differentiating between different introducers and could be used as a basis for assessing other types of devices.

Sternocleidomastoid pyomyositis.

INTRODUCTION: Pyogenic myositis (pyomyositis) represents a bacterial infection of striated muscle. Predominantly associated with tropical regions and commonly caused by Staphylococcus aureus, the incidence of cervical pyomyositis is rare. To our knowledge, we report the first case of group A streptococcal cervical pyomyositis in an immunocompetent British Caucasian patient. CASE PRESENTATION: A previously well 48-year-old Caucasian male presented with sore throat, left sided neck pain and swelling. He was a lifelong non-smoker with no recent travel or animal exposure. On admission, he was febrile with unilateral neck swelling. Random blood glucose was normal and an HIV test negative. CT imaging confirmed a large heterogeneous mass extending throughout the entirety of the left sternocleidomastoid muscle. The patient underwent exploration and drainage of a large intra-sternocleidomastoid neck abscess. Microbiology identified group A - streptococcus. Histology confirmed abscess formation in muscle with no acid-fast bacilli. The patient recovered well postoperatively and continues to do well. DISCUSSION: Cervical pyomyositis is a rare condition that if not treated appropriately may cause internal jugular vein thrombosis, sepsis and death. Pyomyositis requires a high index of suspicion and should be considered a differential diagnosis in any painful swelling in the head and neck region.

Customising the length of the Montgomery T-tube whilst retaining a bevelled edge.

BACKGROUND: The Montgomery T-tube is used in a number of conditions that require safe tracheal stenting. Specific lengths of T-tube limbs are occasionally needed in patients with complex airway anatomy or differing neck proportions; this requires customisation of the T-tube limbs. This is done either by pre-ordering customised T-tubes from the manufacturer (which needs to be planned ahead of time) or using a tube cutter in the operating theatre. However, the latter does not provide a 'factory like' bevelled edge when shortened, which increases the risk of mucosal trauma and granulation formation. OBJECTIVE: This paper reports a novel technique for customising the length of existing Montgomery T-tubes, with preservation of the bevelled edges. This technique can be easily performed with basic equipment available in operating theatres.

Adiponectin levels in south Indian children with type 1 diabetes mellitus and nondiabetic children and its correlation with anthropometry and glycemic control.

Studies have reported high adiponectin levels in children with type 1 diabetes mellitus (T1DM). Adiponectin has been found to have anti-atherogenic action and other protective functions. We wanted to estimate adiponectin level in south Indian T1DM children and compare it with that of non-diabetic children and study its correlation with anthropometry and glycemic status. Sixty children with T1DM and forty non-diabetic children of age less than 15 years were analysed. Mean adiponectin level was higher in T1DM group than in non diabetic group (p < 0.001) irrespective of the age group or sex. Negative correlation was observed between SFT- triceps and adiponectin in diabetic and control group. Multiple regression coefficient analysis of various parameters showed SFT- triceps as a statistically significant predictor of adiponectin level (p = 0.001). We conclude that, children with T1DM had higher adiponectin level than non-diabetic children. Low SFT- triceps measuremet may be a predictor of higher adiponectin level.

Long-term stenting for chronic frontal sinus disease: case series and literature review.

OBJECTIVE: The frontal sinus outflow tract consists anatomically of narrow channels prone to stenosis. Following both endonasal and external approach surgery, up to 30 per cent of patients suffer post-operative re-stenosis of the frontal sinus outflow tract, with recurrent frontal sinus disease. This paper proposes the surgical placement of a long-term frontal sinus stent to maintain fronto-nasal patency, as an alternative to more aggressive surgical procedures such as frontal sinus obliteration and modified Lothrop procedures. DESIGN: We present a series of three patients with frontal sinus disease and significant co-morbidity, the latter making extensive surgery a significant health risk. We also review the relevant literature and discuss the use of long-term frontal sinus stenting. RESULTS: These three cases were successfully treated with long-term frontal sinus stenting. Stents remained in situ for a period ranging from 48 to over 60 months. CONCLUSION: Due to the relatively high failure rates for both endonasal and external frontal sinus surgery, with a high post-operative incidence of frontal sinus outflow tract re-stenosis, long-term stenting is a useful option in carefully selected patients.

Kawasaki disease in south India: a prospective, case-control study.

AIM: To describe the clinical and laboratory profile of Kawasaki disease in south India and compare patients with normal and abnormal cardiac status. METHODS: This was a nested case-control study. All patients admitted to Kanchi Kamakoti CHILDS Trust Hospital, Chennai with Kawasaki disease between January 2002 and March 2006 were included. They were stratified into two groups: cases, who had abnormal echocardiography (ECHO), and controls, who had normal ECHO. All clinical and laboratory investigations, results of echocardiography and management were recorded and follow-up was organised. RESULTS: Of 56 patients, 36 (64.3%) were boys and 58.9% were under 3 years of age. Only 17.9% had an atypical presentation. Oral cavity changes and cervical lymphadenopathy were the most common clinical parameters and were detected in 85.7%. Thrombocytosis and elevated CRP on admission were seen in 41% and 100%, respectively. Echocardiography was abnormal in 27 (48.2%). Apart from raised CRP, which was higher in those with cardiac abnormality, the clinical and laboratory profiles were similar in the two groups. CONCLUSION: Kawasaki disease is not uncommon in south India. The clinical and laboratory profiles were similar between those with and without cardiac echocardiographic abnormality.

Charge order superstructure with integer iron valence in Fe(2)OBO(3).

Solution-grown single crystals of Fe(2)OBO(3) were characterized by specific heat, Mössbauer spectroscopy, and x-ray diffraction. A peak in the specific heat at 340 K indicates the onset of charge order. Evidence for a doubling of the unit cell at low temperature is presented. Combining structural refinement of diffraction data and Mössbauer spectra, domains with diagonal charge order are established. Bond-valence-sum analysis indicates integer valence states of the Fe ions in the charge ordered phase, suggesting Fe(2)OBO(3) is the clearest example of ionic charge order so far.

Microvascular free tissue transfer in the management of squamous cell carcinoma of the tongue during pregnancy.

We describe a 36-year-old patient with a stage III carcinoma (pT2N1M0) of the tongue that presented in the second trimester of pregnancy. It was treated by primary excision and reconstruction with a free flap. To our knowledge this is the first reported case of successful microvascular free tissue transfer for oral cancer during pregnancy.