Acute respiratory compromise due to bilateral pneumothoraces in a patient with Rett syndrome.

This is a case of acute respiratory distress in a nine-year-old with severe Rett syndrome who required immediate anaesthetic assistance in the emergency department and during her subsequent hospital stay. Rett syndrome is a rare inherited neurodevelopmental disease that more commonly affects females. It is characterised by a period of normal development up to between six and 18 months of age, followed by a gradual but progressive loss of developmental skills leading to severe cognitive and physical decline. Other features include autistic-type behaviour, oral-motor and autonomic dysfunction and gastrointestinal disturbance. Patients can present for elective surgery for scoliosis correction, ear, nose and throat procedures or placement of a gastrostomy. They can also present acutely, either with an un-associated condition or due to aspiration from a poor gag or swallow. This report highlights the specific risks relevant to anaesthesia in patients with Rett syndrome, especially in considering the association with bilateral apical bullae and pneumothorax which could impact on the ventilation strategy.

Roles of instrumented farm-scale trials in trade-off assessments of pasture-based ruminant production systems.

For livestock production systems to play a positive role in global food security, the balance between their benefits and disbenefits to society must be appropriately managed. Based on the evidence provided by field-scale randomised controlled trials around the world, this debate has traditionally centred on the concept of economic-environmental trade-offs, of which existence is theoretically assured when resource allocation is perfect on the farm. Recent research conducted on commercial farms indicates, however, that the economic-environmental nexus is not nearly as straightforward in the real world, with environmental performances of enterprises often positively correlated with their economic profitability. Using high-resolution primary data from the North Wyke Farm Platform, an intensively instrumented farm-scale ruminant research facility located in southwest United Kingdom, this paper proposes a novel, information-driven approach to carry out comprehensive assessments of economic-environmental trade-offs inherent within pasture-based cattle and sheep production systems. The results of a data-mining exercise suggest that a potentially systematic interaction exists between 'soil health', ecological surroundings and livestock grazing, whereby a higher level of soil organic carbon (SOC) stock is associated with a better animal performance and less nutrient losses into watercourses, and a higher stocking density with greater botanical diversity and elevated SOC. We contend that a combination of farming system-wide trials and environmental instrumentation provides an ideal setting for enrolling scientifically sound and biologically informative metrics for agricultural sustainability, through which agricultural producers could obtain guidance to manage soils, water, pasture and livestock in an economically and environmentally acceptable manner. Priority areas for future farm-scale research to ensure long-term sustainability are also discussed.

The fate of metronidazole and tis implications in chemotherapy.

1. [14C]Metronidazole was rapidly absorbed from the gastro-intestinal tract of rats giving maximum blood levels of radioactivity, equivalent to 6-4 and 6-7 mug metronidazole per ml blood, 1 h after oral dosing. 2. There was rapid equilibration between blood and most tissues, although radioactivity was concentrated in the liver, kidney, gastro-intestinal tract and vaginal secretions. 3. The half-life of clearance of radioactivity from the majority of tissues was between 3 and 4 h, although it was longer in the skin (8 h) and gastro-intestinal tract (14 h). 4. Fourteen radioactive excretion products were detected in rat urine and all the major products were identified. These all contained a nitro group and represented 97 degrees of the total radioactivity excreted in urine. 5. Unchanged metronidazole was secreted throughout the entire length of the gastro-intestinal tract and into the vagina of rats. 6. A hypothesis has been proposed to explain the high clinical efficacy of metronidazole in treating trichomonal and amoebic infections.

The treatment of soil infested with the human whipworm, Trichuris trichiura.

The soil fumigants methyl bromide, chloropircrin and Basamid or mixtures of Basamid and chloropicrin proved to be of no use in filling T. trichiura ova in soil. However, on untreated plots the eggs died at a rate such than only 20% of the ova remained viable after 18 months.

Trichuris trichiura infestations in the United Kingdom and treatment with difetarsone.

Stool specimens were examined for the parasite Trichuris trichiura from 1,860 patients in 17 hospitals for the mentally subnormal in the U.K. It was found in 10 of these hospitals, and an overall incidence of 13.2% was recorded. Most cases occurred in the South, where the overall incidence was 36.3%.Difetarsone was used in the treatment of infestations in two hospitals, and proved to be very well tolerated, cure rates of 81 to 88% being obtained.

Human studies with "high dose" metronidazole: a non-toxic radiosensitizer of hypoxic cells.

The serum concentrations of the radiosensitizer metronidazole have been determined in mice for both oral and intraperitoneal doses of the drug and these have been related to radiosensitization studies in murine tumour systems. In preliminary work before a possible clinical trail the serum metronidazole concentration/time curves have been determined in 7 patients using single doses of metronidazole of up to 15 g. The data suggest that a linear relationship exists between the metronidazole dose expressed in mg/kg and the peak serum concentration. The possibility of achieving radiosensitization of tumours in patients after tolerable doses of metronidazole is discussed in relation to enhancement ratios determined for in vitro and in vivo systems. It is concluded that predictions from in vitro systems give values that are probably too optimistic.