Primary spinal extradural hydatid cyst.

We report a rare case of spinal cord compression caused by primary multiple extradural hydatid cysts.

The intubating laryngeal mask airway compared with direct laryngoscopy.

We have compared the ability of naïve intubators to intubate the trachea using a laryngoscope and an intubating laryngeal mask airway (ILMA) after receiving basic training, in a randomized, prospective, crossover study in 60 patients. Ventilation of the lungs via the ILMA was also compared with ventilation with a face mask. There was no significant difference in successful intubation between the techniques (38 of 89 with the ILMA and 33 of 93 with direct laryngoscopy; ns). In patients in whom participants failed in their intubation attempts with the ILMA, investigators achieved success in 89% (16 of 18). Satisfactory ventilation was more common with the ILMA (50 of 51) than with the face mask (43 of 60) (P = 0.0001). A total of 98% (89 of 91) of ILMA were inserted successfully, with a mean insertion time of 19.6 s, and 78% (69/89) of these insertions were achieved in less than 26 s. The ILMA may be useful for emergency oxygenation and ventilation, but these results do not support its use for intubation by those not trained in advanced airway management and ILMA use.

The Ig mutator is dependent on the presence, position, and orientation of the large intron enhancer.

Hypermutation at the Ig loci is confined to the area between the promoter and the intronic enhancer, which includes the rearranged variable region gene segment. We identified factors that contribute to the site-specificity at the heavy chain locus. We found that distance from both the promoter and the intronic enhancer is crucial in hypermutation. The presence of the enhancer is required, and, in contrast to its definition for transcriptional activity, its effect is orientation-sensitive.

Comparative evaluation of conservative management versus early surgical intervention in appendicular mass--a clinical study.

The management of appendicular mass seems to be taking turn with the availability of better antibiotics, care and anaesthesia. Quite a few workers turned to the other extreme of traditional conservative approach and reported acceptable results with immediate intervention during phlegmonous stage. But practically, surgeons still continue to adopt the same old regime. To alleviate this fear and circumvent the disadvantages of immediate intervention a midpath regime called early appendicectomy has been clinically evaluated. With this new approach in the present study preventing misdiagnosis (15%), no chance of recurrence as also of missing in the follow-up and shorter overall hospital stay with economy are some strong reasons to adopt this regime.

Evaluation of plasma serotonin concentration in acute appendicitis.

BACKGROUND: Due to lack of reliable biochemical/radiological markers, the diagnosis of acute appendicitis is based only on clinical features. METHODS: We estimated plasma serotonin levels in 48 patients with acute appendicitis (histologically proven), 27 patients with abdominal pain of other etiologies, and 20 healthy controls. RESULTS: The plasma serotonin levels were (mean +/- SD) 36.6 +/- 12.5 nmol/L, 12.5 +/- 3.6 nmol/L and 10.4 +/- 3.5 nmol/L in the three groups, respectively. The levels in patients with acute appendicitis were significantly higher (p < 0.001) than in the other groups, giving 93.8% sensitivity and 95.7% specificity to the test. CONCLUSION: Plasma serotonin level is a reliable marker of acute appendicitis, especially in the first 48 hours.

Stomach jolt--a possible mechanism for gastrosplenic injury in blunt abdominal trauma.

We report a 30-year-old man was involved in a road accident and had a gastric lesser curve tear and multiple splenic tears near the short gastric vessels. We believe that these resulted from sudden deceleration of a full stomach with sudden rise in intragastric pressure.