The relationship between preintubation lidocaine and postanesthesia sore throat.

A sore throat is the most frequent adverse side effect of general anesthesia. The purpose of this study was to determine the relationship between intravenous lidocaine given during induction of general endotracheal anesthesia and postanesthesia sore throat. In addition, the study examined selected variables (bucking; gender; smoking; type of laryngoscope blade; and use of succinylcholine, condenser-humidifiers, or analgesic medication during the previous hour) in relation to the occurrence of postoperative sore throat. Variables typically associated with postoperative sore throat, including endotracheal tube lubricant, endotracheal tube cuff geometry, endotracheal tube size, local anesthetic spray to the trachea, traumatic intubation, postoperative mechanical ventilation, nasal intubation, nasogastric tubes, and nasal airways, were controlled. The researcher administered the visual analogue scale to 139 subjects at 21 to 27 hours following termination of the anesthetic in order to rate sore throat. A retrospective chart review provided data on the variables selected for study and those that were controlled. Chi-square and independent t-tests revealed that a decrease in the severity of the sore throat, as recorded on the visual analogue scale, was significantly related to use of intravenous lidocaine and condenser-humidifiers.

Munchausen syndrome with pulmonary manifestations.

Three patients with Munchausen's syndrome were seen with symptoms suggesting serious pulmonary disease. One patient, a student respiratory therapist, simulated respiratory failure which resulted in a tracheostomy and prolonged ventilator support. The second, a licensed practical nurse, feigned a lupus erythematosis syndrome, with alarming, simulated hemoptysis produced by slashing the posterior tongue with a razor blade. The third patient, a nurse, underwent exhaustive testing at three hospitals for profuse "hemoptysis" until she admitted she obtained the blood from her arm by venesection.

Transbronchoscopic lung biopsy in sarcoidosis. Optimal number and sites for diagnosis.

By obtaining five transbronchoscopic biopsies of the lung from each of the right upper and lower lobes, the diagnosis of sarcoidosis was made in 36 of 37 prospectively studied patients. The diagnosis was made in all ten patients with stage-1 disease, but seven of the ten showed diagnostic tissue from only one lobe. Only one of the ten biopsies was diagnostic in four of those patients with a stage-1 disease. In disease of stage 2 and 3, there was good correlation between diagnostic biopsies and the radiographic distribution of infiltrates. Biopsies from the predominantly rather than the lesser involved lobe proved the diagnosis in all of these patients, except for the two patients with nodular sarcoid. We conclude that ten biopsies are optimal for obtaining the diagnosis in stage-1 disease; however, five biopsies may be adequate in non-nodular disease of stage 2 and 3 if the biopsies are of the lobe predominantly involved on the roentgenogram of the chest.

Treatment of pulmonary melioidosis with combination of trimethoprim and sulfamethoxazole.

Treatment with a combination of trimethoprim and sulfamethoxazole proved lifesaving in a patient with pulmonary melioidosis after therapeutic failure occurred with other antibiotics to which the organisms were sensitive in vitro. Antagonistic interaction of drugs occurred when the combination of trimethoprim and sulfamethoxazole was given along with other antibiotics. The combination of trimethoprim and sulfamethoxazole should be considered a major addition to the pharmacologic armamentarium for the treatment of pulmonary melioidosis.