Pneumatosis cystoides intestinalis confined to the small intestine treated with hyperbaric oxygen.

Pneumatosis cystoides intestinalis is a rare disease characterized by the presence of multiple intramural gas-filled cysts in the gastrointestinal tract. The etiology remains unknown, but the disease can present with profound disturbances of bowel function. We report the successful management of pneumatosis cystoides intestinalis of the small intestine with the use of hyperbaric oxygen.

Late onset nephrogenic diabetes insipidus following cessation of lithium therapy.

Lithium-induced diabetes insipidus occurs in up to one third of patients on long-term therapy. It usually manifests during the treatment course, often with preceding signs or symptoms. We wish to highlight a case in which diabetes insipidus developed many days after cessation of long-term lithium therapy. We seek to explain this delayed onset by a discussion of the molecular and genetic changes underlying the pathogenesis of lithium-induced nephrogenic diabetes insipidus.

Cricothyroidotomy: a short-term measure for elective ventilation in a patient with challenging neck anatomy.

Cricothyroidotomy is a well established technique of airway management in emergency situations where translaryngeal intubation cannot be achieved. This case report describes a case where cricothyroidotomy was used for elective ventilation for short period of 48 hours in a patient who had a vocal cord palsy, supraglottic oedema and inflammation. Surgical tracheostomy was considered the preferred option, but this was deemed impossible due to the challenging neck anatomy in this case.

Horner's syndrome following low-dose epidural infusion for labour: a cautionary tale.

While Horner's syndrome is a rare and occasionally reported complication of epidural 'top-ups' administered for labour and Caesarean delivery, the case reported here followed a low-dose epidural infusion of bupivacaine. Low-dose epidural infusions have generally been regarded as a safer alternative to bolus doses in labour. It is also the case that close supervision is deemed unnecessary in some centres where the mother is receiving such an epidural infusion. This case is reported in order to highlight the potential dangers of a low-dose regime which in spite of the lack of early warning signs may be associated with a high block.

Bilateral pleural effusions: unexpected complication after left internal jugular venous catheterization for total parenteral nutrition.

Bilateral pleural effusions occurred after total parenteral nutrition was administered via a left internal jugular venous line. The most likely explanation for the fluid passage into both pleural cavities was migration of the tip of the catheter from within the vein into the mediastinum. Fluid can pass into both pleural cavities via anatomical communications, yet to be described, which exist between the two pleural cavities.

Thiopentone and propofol: a compatible mixture?

The physical compatibility of thiopentone and propofol mixtures was investigated. The investigations used were macroscopic and microscopic observations, zeta potential and oil droplet size measurements. There was no evidence of instability in the mixtures. The thiopentone-propofol mixture has the potential advantage of reducing the pain on injection, provides synergistic interaction, does not prolong recovery when used for induction of anaesthesia, may reduce the incidence of convulsions and is cost-effective.