Tubeless field anaesthesia for surgical removal of an aspirated endoscopy capsule.

Capsule endoscopy is a safe, minimally invasive procedure used to investigate gastrointestinal bleeding of unknown origin that persists or recurs after a negative initial endoscopy. The most common adverse effects of capsule endoscopy include abdominal pain, nausea and vomiting. Capsule pulmonary aspiration, although a rare complication, has been reported in the literature. Most reported cases resolve without further medical intervention. In these cases, the capsule is either expelled by coughing, or it re-enters the oropharynx and is then swallowed. In a small number of cases, the capsule remains in the lung, unable to be expectorated. This requires prompt diagnosis and emergency bronchoscopic removal under general anaesthesia. Due to the smooth, rounded surfaces of the capsule, it may be difficult to grasp, and consequently extraction may be technically challenging. The existing literature contains limited documentation on anaesthetic and surgical approaches for managing an aspirated endoscopy capsule. In this case report, we present the management of an aspirated endoscopy capsule in a district general hospital, in which thoracic surgery was not available. Local resources were used to manage this potentially life-threatening complication without patient transfer. In our case, we provided a tubeless field to optimise surgical access. This facilitated the successful surgical extraction of the endoscopy capsule from the left main bronchus.

A pilot study to understand feasibility and acceptability of stool and cord blood sample collection for a large-scale longitudinal birth cohort.

BACKGROUND: Few data are available to guide biological sample collection around the time of birth for large-scale birth cohorts. We are designing a large UK birth cohort to investigate the role of infection and the developing immune system in determining future health and disease. We undertook a pilot to develop methodology for the main study, gain practical experience of collecting samples, and understand the acceptability of sample collection to women in late pregnancy. METHODS: Between February-July 2014, we piloted the feasibility and acceptability of collecting maternal stool, baby stool and cord blood samples from participants recruited at prolonged pregnancy and planned pre-labour caesarean section clinics at University College London Hospital. Participating women were asked to complete acceptability questionnaires. RESULTS: Overall, 265 women were approached and 171 (65%) participated, with ≥1 sample collected from 113 women or their baby (66%). Women had a mean age of 34 years, were primarily of white ethnicity (130/166, 78%), and half were nulliparous (86/169, 51%). Women undergoing planned pre-labour caesarean section were more likely than those who delivered vaginally to provide ≥1 sample (98% vs 54%), but less likely to provide maternal stool (10% vs 43%). Pre-sample questionnaires were completed by 110/171 women (64%). Most women reported feeling comfortable with samples being collected from their baby (<10% uncomfortable), but were less comfortable about their own stool (19% uncomfortable) or a vaginal swab (24% uncomfortable). CONCLUSIONS: It is possible to collect a range of biological samples from women around the time of delivery, and this was acceptable for most women. These data inform study design and protocol development for large-scale birth cohorts.

Use of antibiotic prophylaxis in elective inguinal hernia repair in adults in London and south-east England: a cross-sectional survey.

PURPOSE: Evidence regarding whether or not antibiotic prophylaxis is beneficial in preventing post-operative surgical site infection in adult inguinal hernia repair is conflicting. A recent Cochrane review based on 17 randomised trials did not reach a conclusion on this subject. This study aimed to describe the current practice and determine whether clinical equipoise is prevalent. METHODS: Surgeons in training were recruited to administer the Survey of Hernia Antibiotic Prophylaxis usE survey to consultant-level general surgeons in London and the south-east of England on their practices and beliefs regarding antibiotic prophylaxis in adult elective inguinal hernia repair. Local prophylaxis guidelines for the participating hospital sites were also determined. RESULTS: The study was conducted at 34 different sites and received completed surveys from 229 out of a possible 245 surgeons, a 93 % response rate. Overall, a large majority of hospital guidelines (22/28) and surgeons' personal beliefs (192/229, 84 %) supported the use of single-dose pre-operative intravenous antibiotic prophylaxis in inguinal hernia repair, although there was considerable variation in the regimens in use. The most widely used regimen was intravenous co-amoxiclav (1.2 g). Less than half of surgeons were adherent to their own hospital antibiotic guidelines for this procedure, although many incorrectly believed that they were following these. CONCLUSION: In the south-east of England, there is a strong majority of surgical opinion in favour of the use of antibiotic prophylaxis in this procedure. It is therefore likely to be extremely difficult to conduct further randomised studies in the UK to support or refute the effectiveness of prophylaxis in this commonly performed procedure.

Dialysis in public and private hospitals in Queensland.

BACKGROUND: Clinical outcomes for patients treated in public and private hospitals may be different. AIM: The aim of the study was to compare the characteristics and outcomes of patients receiving dialysis at public and private hospitals in Queensland. METHODS: Incident adult dialysis patients in Queensland registered with the Australia and New Zealand Dialysis and Transplant Registry between 1999 and 2009 were classified by dialysis modality at either a public or private hospital. Outcomes were dialysis patient characteristics and survival. RESULTS: Three thousand, three hundred and ten patients commenced dialysis in public hospitals, 1939 haemodialysis (HD) and 1371 peritoneal dialysis (PD). Seven hundred and ninety-three patients commenced dialysis in private hospitals, 757 HD and 36 PD. Compared with public HD, private HD patients were older, had more coronary artery disease and less diabetes, and were more likely to live in an urban area. Public HD patients were more likely to be obese and referred late to a nephrologist. Nearly all indigenous patients were managed in public hospitals. Private patients were more likely to have an arteriovenous fistula or graft at first HD (P < 0.001) but not after excluding late referrals (P = 0.09). Public hospitals provided longer HD sessions and more HD hours per week for all age groups except 75+ years. Compared with public hospital HD, patient survival adjusted for multiple variables was comparable for private hospital HD (hazard ratio 1.20 (95% confidence interval 0.98-1.46, P = 0.07)) but worse for public PD (hazard ratio 1.14 (95% confidence interval 1.05-1.24, P = 0.002)). CONCLUSION: Private HD patients are older and less likely to be diabetic than public patients. Patient survival is worse for public PD than public HD.

Continuous PC6 wristband acupressure for relief of nausea and vomiting associated with acute myocardial infarction: a partially randomised, placebo-controlled trial.

OBJECTIVES: To assess the effectiveness of continuous PC6 acupressure as an adjunct to antiemetic drug therapy in the prevention and control of nausea and vomiting in the first 24h after myocardial infarction (MI). DESIGN: Partially randomised, partially blinded placebo-controlled, exploratory clinical study. SETTING: Coronary Care Unit, Torbay Hospital, Torquay, Devon. PARTICIPANTS: A total of 301 consecutive patients (205 males, 96 females) admitted following acute MI. INTERVENTION: The first 125 patients recruited received no additional intervention. Subsequent patients were randomised to receive either continuous PC6 acupressure or placebo acupressure. OUTCOME MEASURES: (1) Incidence of post-MI nausea and/or vomiting, (2) severity of symptoms, (3) use of antiemetic drugs, over 24h. RESULTS: There were no significant differences between the groups for the whole 24-h treatment period. However, the PC6 acupressure group experienced significantly lower incidence of nausea and/or vomiting during the last 20h (18%), compared with the placebo (32%) or control (43%) groups (P<0.05). The severity of symptoms and the need for antiemetic drugs were also reduced in the acupressure group, but these differences were not statistically significant. CONCLUSIONS: Continuous 24-h PC6 acupressure therapy as an adjunct to standard antiemetic medication for post-MI nausea and vomiting is feasible and is well accepted and tolerated by patients. In view of its benefits, further studies are worthwhile using earlier onset of treatment.

A study of obstruent sounds in school-age children with speech disorders using electropalatography.

In this study EPG was used to investigate the articulatory characteristics of voiceless coronal obstruent targets /s, f, tf, t/ in ten children with functional articulation disorders. Perceptually based judgements of /s, f, tf/ revealed a variety of distortions, including palatal, lateralised and dental articulations. Their productions of /t/ were judged to be acceptable. From the EPG data, it was observed that individual children produced abnormal and often idiosyncratic tongue-palate contact for sounds which were heard as distorted. Some common trends were identified, for example, palatal fricatives and affricates were produced with constriction and a groove configuration in the posterior region of the palate. Lateralised articulations were generally associated with complete contact across the palate, increased tongue-palate contact and, for some children, incomplete lateral seal was observed. Place of articulation (as revealed by EPG) varied for coronal targets heard as lateralised. Some children produced these sounds with contact in the alveolar region, others had palatal contact and one child had contact in the velar region. These differences in place of articulation had not been identified from an auditory-based analysis. One child was heard to produce dental fricatives and affricates, and the EPG patterns were found to have an asymmetrical groove configuration in the anterior region of the palate. The clinical implications of the findings are discussed.

Cross-linguistic study of lateral misarticulation using electropalatography.

This paper reports on some preliminary aspects of a collaborative cross-linguistic study of normal and disordered Japanese and British English speech. The investigation compares lateralised productions of parallel s which are abnormal in the two languages. EPG and acoustic recordings were made of four Japanese and four British subjects. The EPG patterns were classified according to certain criteria, such as the presence or absence of complete constriction between the tongue and the hard palate, and the area and location of this contact. Findings revealed that lateralised articulations varied between individual speakers, but that Japanese and English productions were broadly similar. Acoustically, misarticulations in both languages were characterised by a lower frequency of peak energy than would be expected in normal productions.

The application of electropalatography (EPG) to the remediation of speech disorders in school-aged children and young adults.

Electropalatography (EPG) is one of a number of computer-based biofeedback techniques being applied increasingly and apparently successfully to the treatment of speech pathologies. This paper briefly examines the function of such biofeedback systems within the remediation process and looks in particular at the features of the EPG system which render it a useful therapeutic tool. Details are summarised of a project initiated to evaluate the use of EPG in the management of a large group of speech-disordered children and young adults. Successful applications of the technique are presented by examining the different types of motor speech skill which subjects acquired during intervention. These are summarised as the establishment of completely new articulatory patterns, the inhibition of abnormal lingual patterns, and the modification of temporal or spatial aspects of one or several existing patterns. Possible reasons for the success of EPG as a therapeutic technique, and issues concerning subject selection, are discussed.

A preliminary comparison of the effects of halothane and isoflurane on nasal mucosal blood flow.

The differing effects of halothane and isoflurane on nasal mucosal blood-flow was investigated by means of laser-doppler flowmetry in a total of fourteen patients who received one of these inhalational agents during anaesthesia. A trend towards lower nasal flux was seen in the halothane group but, due to insufficient numbers, significance could not be demonstrated. These changes in flux appeared not to be related to the falls in perfusion pressure which were seen in both groups of patients and were thought to be due to locally vasoactive effects.

An experimental study of the effectiveness of different techniques of questioning mentally handicapped child witnesses.

In response to recent changes in the Home Office recommendations concerning police interviewing of mentally handicapped persons, an experiment was carried out to investigate the usefulness of different interviewing techniques with mildly mentally handicapped children. Previous research carried out with children of normal intelligence (Dent & Stephenson, 1979) indicated that their recall of an incident was most accurate when unprompted. Theoretical research in the field of mental handicap suggested that such children's recall would be poorest when either unprompted or when heavily prompted, and that some form of intermediate cueing of recall may prove optimal. The experiment described here investigated the accuracy of recall of a live incident by a group of children with IQs ranging from 50 to 70 points in response to one of the following methods of elicitation: free recall, general questions and specific questions. As predicted, the general questions produced recall that was optimal in terms of completeness and accuracy.