Establishing Obstetric Anesthesiology Practice Guidelines in the Republic of Armenia: A Global Health Collaboration.

Background: Disparity exists in anesthesia practices between high- and low-to-middle income countries, and awareness has been raised within the global health community to improve the standards of anesthesia care and patient safety. The establishment of international collaborations and appropriate practice guidelines may help address clinical care deficiencies. This report's aim was to assess the impact of a multiyear collaboration on obstetric anesthesia practices in the Republic of Armenia.

A feasible, acceptable and effective way to teach health care workers in low- and middle-income countries a method to manage acutely ill obstetric women.

Maternal mortality is unacceptably high in Sub Saharan Africa, which accounts for 56% of all maternal deaths (WHO, 2012). Most maternal deaths are avoidable but with prompt recognition and timely intervention it is not inevitable that acute or critical maternal illness deteriorates to fatality (Firth and Ttendo, 2012). This paper discusses a project to provide multidisciplinary training in Maternal-Acute Illness Management (M-AIM) in a low resource setting in order to actively address the third delay to women accessing emergency obstetric care: prompt receipt of effective care on reaching a medical facility.

Which vasopressor for caesarean section?

One of the longest running debates in obstetric anaesthesia surrounds the prevention and treatment of maternal hypotension during caesarean section. Anaesthetic techniques have evolved and maternal mortality and morbidity is markedly reduced, but hypotension remains a problem, particularly following neuraxial blockade. Despite over 30 years of research no definitive consensus has been reached on the best treatment strategy and particular controversy surrounds the use of vasopressive agents.

A national survey of the provision for patients with latex allergy.

The prevalence of latex allergy has increased since the 1980s. As latex is found throughout hospitals and operating theatres, careful planning is required for latex-allergic patients who present pre-operatively. We conducted a postal survey of 269 departments of anaesthesia in England and Wales; responses were received from 208 (77%).

Inherited Creutzfeldt-Jakob disease in a British family associated with a novel 144 base pair insertion of the prion protein gene.

A case of familial Creutzfeldt-Jakob disease associated with a 144 base pair insertion in the open reading frame of the prion protein gene is described. Sequencing of the mutated allele showed an arrangement of six octapeptide repeats, distinct from that of a recently described British family with an insertion of similar size. Thirteen years previously the brother of the proband had died from "Huntington's disease", but re-examination of his neuropathology revealed spongiform encephalopathy and anti-prion protein immunocytochemistry gave a positive result.

A critical appraisal of in-patient neurological services in a subregional centre.

A computer database was established for the medical audit of admissions to the North Manchester General Hospital neurology unit. Over a six-month period, 277 patients completed 300 hospital stays. A higher proportion of patients were admitted from the North Manchester District compared with the peripheral districts served by the unit, suggesting that more neurology in these areas was performed by general physicians.

Deficiencies in anti-acetylcholine receptor antibody measurement in myasthenia gravis.

In a retrospective case note study of 86 patients with myasthenia gravis, 60 had an anti-acetylcholine receptor antibody assay performed by the regional immunology laboratory. Antibody was detected in 38% which compares with 66-93% in other series. Whilst the use of staphylococcal protein A to precipitate the antibody-receptor complex, rather than anti-human immunoglobulin, may be partly responsible for this low sensitivity, other methodological problems are likely to exist.

Magnetic resonance imaging with gadolinium-DTPA enhancement in the differentiation of benign from neoplastic cord cavitation.

A patient with an extensive spinal cord glioma is presented. The lumbar mass and cervical cavity associated with the tumour were demonstrated by myelography and computed tomography. Magnetic resonance imaging provided greater detail than these conventional imaging modalities without exposure to ionising radiation and was of considerable additional value in the planning of surgery.

Relative efficacy of intravenous methylprednisolone and ACTH in the treatment of acute relapse in MS.

To compare the efficacy of high-dose intravenous methylprednisolone with intramuscular ACTH in the treatment of acute relapse in multiple sclerosis, we undertook a double-blind, randomized, controlled study involving 61 patients. There was a marked improvement in both groups in the course of the study, but no difference between them in either the rate of recovery or the final outcome. High-dose IV methylprednisolone is a safe alternative to ACTH in the management of acute relapse in MS.

Modifications of a force plate system for equine gait analysis.

A force plate system for measurement of the vertical component of the force applied by a horse's limb on ground contact was modified. The modifications included use of steel supporting posts for improved durability and an additional strain gauge on each arm of the Wheatstone bridge for increased sensitivity and temperature compensation. Data from clinically normal horses are provided to indicate the performance obtained with these modifications of the force plate system.

Icarus's syndrome: new hazards in flight.

The British Hang Gliding Association accident report for 1975 reported two deaths. The remaining cases were predominantly limb fractures. The major causes of the injuries were inexperience, high wind speed, turbulence, and stalling.

Abetalipoproteinaemia. A case report with pathological studies.

The clinical and pathological features of a case of abetalipoproteinaemia in a 38-year-old patient are described in detail. A feature not previously recorded was a marked reduction in the velocity of ocular horizontal saccadic movements. Pathological studies revealed an active chronic demyelinating process.

Eosinophilic leukaemia terminating with an encephalopathy.

A 52-year-old man developed an illness which lasted for 2 years until its fatal termination. It comprised in chronological order: mild asthma, skin irritation, mature eosinophilia in the peripheral blood, and finally an encephalopathy. The diagnostic problem of distinguishing between eosinophilic leukaemia and an eosinophilic leukaemoid reaction is discussed.