[Onset of a fulminant malignant hyperthermia crisis. Case report of a 74-year-old patient with previously subclinical central core disease]. / Erstmanifestation einer fulminanten malignen-hyperthermie-krise. Fall eines 74-jährigen patienten mit bislang subklinischer "central core disease".

Malignant hyperthermia (MH) is a latent, autosomal dominant inherited syndrome of skeletal musculature which results in excessive hypermetabolism induced by halogenated anesthetic agents and depolarizing muscle relaxants and is caused by an uncontrolled intramuscular calcium release. This case report focuses on the description of symptoms of a fulminant MH crisis. A possible link between central core disease (CCD) and the clinical severity of MH crisis is postulated in this paper.

Laser doppler flowmetry in combined needle acupuncture and moxibustion: a pilot study in healthy adults.

Laser Doppler flowmetry (LDF) (DRT 4/Moor Instruments Ltd, Devon, UK) was used in this pilot study for monitoring the effects of an invariable acupuncture pattern on microcirculation of the skin before, during, and after combined needle acupuncture and moxibustion in 12 healthy volunteers (mean age 35.2 +/- 4.4 years, range 26-41 years, four female and eight male). According to the standards of traditional Chinese medicine (TCM), this acupuncture pattern is assumed to be unspecific and non-therapeutic. Flux decreased during the treatment period (p<0.05) compared to the control phase before combined needle acupuncture and moxibustion. After the removal of the needles, flux did not return to the initial control value. No significant differences between mean arterial blood pressure, heart rate, skin temperature or gender were detected. A prediction of individual incidences and kinds of acupuncture effects in our healthy volunteers was not possible. Modern monitoring techniques like LDF could be a method to separate responders from non-responders to acupuncture in peripheral microcirculatory disorders. Further studies on patients with peripheral microcirculatory disorders are necessary in order to demonstrate the value of LDF in detecting responders/non-responders in combination with therapeutic acupuncture patterns according to TCM.

Fiberoptic intubation in 327 neurosurgical patients with lesions of the cervical spine.

In patients with lesions of the cervical spine, direct laryngoscopy for endotracheal intubation entails the risk of injuring the spinal cord. In an attempt to avoid this complication, the authors used flexible fiberoptic nasal intubation in a series of 327 patients with cervical lesions undergoing elective neurosurgical procedures. The nasal route was preferred for laryngeal intubation because it is easier than the oral route and a restraining collar or halo device does not impair the intubating maneuver. Bronchoscopic intubation was possible in all patients. In 12 patients (3.6%), anatomic abnormalities prevented transnasal insertion of the endotracheal tube, and transoral fiberoptic intubation was necessary. Endotracheal intubation was graded as slightly difficult in 85 patients (26%). The minimal peripheral oxygen saturation during intubation exceeded 90% in 289 patients (88%). In the other 38 patients, the mean O2 saturation was 84.2+/-4.3% (range, 72-89%). Intubation was well tolerated by all patients and none had recall of the procedure. Cervical stabilizers did not have to be removed for intubation in any patient. None of the patients had postoperative neurologic deficits attributable to the intubation procedure. The authors consider fiberoptic transnasal intubation to be a useful alternative to direct laryngoscopic tracheal intubation in patients undergoing elective surgical procedures on the cervical spine to avoid potential injury to the cervical spinal cord.