Ultrasound quantification of anterior soft tissue thickness fails to predict difficult laryngoscopy in obese patients.

Morbid obesity is associated with difficult laryngoscopy and intubation. In the general population, bedside indices for predicting difficult intubation (i.e.

Cavernous carotid injury during functional endoscopic sinus surgery: case presentations and guidelines for optimal management.

Background: Surgery in the parasellar and paranasal regions is technically challenging because of the complex anatomic relationships between the sphenoid sinus, cavernous sinus, optic nerve, and internal carotid artery. Normal anatomic variations and pathological changes can lead to disastrous outcomes including carotid artery injury.

Methods: We present two cases of carotid injury managed at our institution.

A qualitative study examining tensions in interdoctor telephone consultations.

Objective: Communication skills have gained increasing attention in medical education. Much of the existing literature and medical curricula addresses issues of doctor-patient communication. The critical importance of communication between health professionals, however, is now coming under the spotlight.

Effect of improvement in anemia on electroneurophysiological markers (P300) of cognitive dysfunction in chronic kidney disease.

Our aim is to study the effect of improvement in anemia on event-related potentials (ERPs; P300) as markers of cognitive dysfunction in predialysis and dialysis patients of chronic kidney disease (CKD). Thirty anemic patients of CKD (hemoglobin [Hb] < 9 g%), 15 in the predialysis group (Group A), and 15 patients on biweekly hemodialysis (Group B) were recruited for the study. Patients of uremic encephalopathy, dyselectrolytemia, and those with hearing problems were excluded.

Successful pregnancy in untreated limited Wegener's granulomatosis.

A thirty four year old female presented with upper and lower respiratory symptoms in the third trimester of pregnancy. After the delivery of a healthy baby, the symptoms progressed to involve multiple organ systems and eventually a diagnosis of limited Wegener's Granulomatosis (Carrington-Liebow syndrome) was made. The extremely rare combination of WG and pregnancy, especially the onset of disease in late pregnancy is discussed.

Linking of bone morphogenetic protein-2 to resorbable fracture plates for enhancing bone healing.

Objective: To test whether bone morphogenetic protein (BMP)-2 may be covalently linked to resorbable fracture repair plates using an ester-hydrolysis reaction and determining whether the linked compound can facilitate bone growth.

Study Design: Laboratory in vitro experiments.

Method: Resorbable fracture repair plates were partially hydrolyzed using varying concentrations of acid or base.

Doxapram only slightly reduces the shivering threshold in healthy volunteers.

We determined the effects of doxapram on the major autonomic thermoregulatory responses in humans. Nine healthy volunteers were studied on 2 days: control and doxapram (IV infusion to a plasma concentration of 2.4 +/- 0.

Candidemia--an under-recognized nosocomial infection in Indian hospitals.

Objective: To study the occurrence of candidemia as a nosocomial infection in a large Indian teaching hospital and to evaluate the predisposing factors for development of such infections.

Methods: One hundred and one hospitalized patients that developed signs and symptoms of nosocomial bloodstream infections were screened for candidemia and were analyzed for the various predisposing factors like the age of the patient, the duration of hospitalization before the development of fever, neutropenia, use of chemotherapeutic agents, central venous catheters, broad spectrum antibiotics, infection with HIV, diabetes mellitus, use of corticosteroids, administration of total parenteral nutrition, haemodialysis, use of mechanical ventilation, hematological or other malignancies, underlying disease, and any surgical procedure performed on the patient. Candidemic patients were followed up for outcome and the effect of nosocomial candidemia on mortality was assessed and analyzed statistically.

Core temperature measurements through a new airway device, perilaryngeal airway (CobraPLA).

Study Objective: The aim of this study was to test the hypothesis that the intraoperative pharyngeal temperatures obtained on the perilaryngeal airway (PLA), a novel airway device with a larger pharyngeal cuff (when inflated) than the laryngeal mask airway, are similar to tympanic membrane core temperatures.

Design: This study is a prospective, simultaneous device comparison.

Setting: This study was set at a university hospital.

A qualitative study of interphysician telephone consultations: extending the opinion leader theory.

Introduction: It has been suggested that the use of opinion leaders in the dissemination of information may be an effective method of changing clinical practice. Recent reviews on this topic, however, have found mixed results and have concluded that further research is needed to explore the circumstances that effectively utilize opinion leaders. We studied the interphysician telephone consultation, a situation in medical practice in which we see opinion leaders at work, to generate a grounded theory of opinion leader activity.

Laparoscopic repair of diaphragmatic hernias: experience of six cases.

Objective: Laparoscopic diaphragmatic hernia repair is increasingly performed in adults for congenital diaphragmatic hernias and chronic traumatic diaphragmatic hernias. This study reviewed our experience with laparoscopic diaphragmatic hernia repair to evaluate its safety, efficacy and outcomes.

Methods: Between January 1999 and December 2002, four male and two female patients presented to us with diaphragmatic hernias, three with traumatic and three with congenital hernias.

Magnesium sulphate only slightly reduces the shivering threshold in humans.

Background: Hypothermia may be an effective treatment for stroke or acute myocardial infarction; however, it provokes vigorous shivering, which causes potentially dangerous haemodynamic responses and prevents further hypothermia. Magnesium is an attractive anti-shivering agent because it is used for treatment of postoperative shivering and provides protection against ischaemic injury in animal models. We tested the hypothesis that magnesium reduces the threshold (triggering core temperature) and gain of shivering without substantial sedation or muscle weakness.

Endoscopic totally extraperitoneal repair for occult bilateral obturator hernias and multiple groin hernias.

Introduction: An obturator hernia is a rare hernia that is bilateral in about 6% of patients. Most patients present with chronic pelvic pain although a few patients may present with features of intestinal obstruction. Only about 10% of obturator hernias are diagnosed preoperatively.

Endotracheal tube cuff pressure in three hospitals, and the volume required to produce an appropriate cuff pressure.

BACKGROUND: Cuff pressure in endotracheal (ET) tubes should be in the range of 20-30 cm H2O. We tested the hypothesis that the tube cuff is inadequately inflated when manometers are not used. METHODS: With IRB approval, we studied 93 patients under general anesthesia with an ET tube in place in one teaching and two private hospitals.

Bioactive suture: a novel immunotherapy for head and neck cancer.

Purpose: We have proposed to characterize the mechanism through which bioactive surgical sutures generate a T(H)1 immune response and to define the immune-stimulating half-life of the sutures.

Experimental Design: Bioactive sutures of interferon gamma (IFNgamma), interleukin 2 (IL-2), anti-CD3/CD28, anti-CD3/CD28 + IL-2, or anti-CD3/CD28 + IFNgamma sutures were used to stimulate lymphocytes from normal donors and from head and neck cancer patients in vitro over a 24-day period. Cell supernatants were analyzed by ELISA, and T cells were phenotyped to characterize the immune response generated.

Endoscopic management of a retroperitoneal hydatid cyst.

Hydatid cyst is a significant health problem in endemic regions. Although progress has been made in medical treatment and interventional radiology techniques, surgery is currently the treatment of choice. The hydatid cysts are known to occur at several unusual sites in the body.

The new perilaryngeal airway (CobraPLA) is as efficient as the laryngeal mask airway (LMA) but provides better airway sealing pressures.

The Laryngeal Mask Airway (LMA) is a frequently used efficient airway device, yet it sometimes seals poorly, thus reducing the efficacy of positive-pressure ventilation. The Perilaryngeal Airway (CobraPLA) is a novel airway device with a larger pharyngeal cuff (when inflated). We tested the hypothesis that the CobraPLA was superior to the LMA with regard to insertion time and airway sealing pressure and comparable to the LMA in airway adequacy and recovery characteristics.

Ectopic gallbladder: laparoscopic cholecystectomy.

An unusual case of ectopic retroplaced gall bladder is reported. In our patient, this congenital anomaly was detected on ultrasonography and confirmed by CT scan, MRCP, and ERCP. Laparoscopic cholecystectomy was performed without complications.

Block-dependent sedation during epidural anaesthesia is associated with delayed brainstem conduction.

Background: Neuraxial anaesthesia produces a sedative and anaesthetic-sparing effect. Recent evidence suggests that spinal cord anaesthesia modifies reticulo-thalamo-cortical arousal by decreasing afferent sensory transmission. We hypothesized that epidural anaesthesia produces sensory deafferentation-dependent sedation that is associated with impairment of brainstem transmission.

Dantrolene reduces the threshold and gain for shivering.

Unlabelled: Dantrolene is used for treatment of life-threatening hyperthermia, yet its thermoregulatory effects are unknown. We tested the hypothesis that dantrolene reduces the threshold (triggering core temperature) and gain (incremental increase) of shivering. Healthy volunteers were evaluated on 2 random days: control and dantrolene (approximately 2.

Combined procedures in laparoscopic surgery.

With advancements in minimal access surgery, combined laparoscopic procedures are now being performed for treating coexisting abdominal pathologies at the same surgery. In our center, we performed 145 combined surgical procedures from January 1999 to December 2002. Of the 145 procedures, 130 were combined laparoscopic/endoscopic procedures and 15 were open procedures combined with endoscopic procedures.

Covalent linking of proteins and cytokines to suture: enhancing the immune response of head and neck cancer patients.

Background: The immune system of advanced stage head and neck cancer patients is frequently suppressed. Poor immune function has been correlated with poor clinical outcome. Immunotherapeutic strategies have been previously attempted in an effort to enhance immune function and improve survival.