Development of a tracheostomy scoring system to guide airway management after major head and neck surgery.

The use of elective tracheostomy in major head and neck surgery is well established, although practice varies between units. There is no published method that reliably predicts the need for tracheostomy. This paper describes the development of a surgical scoring system designed to achieve that aim. The system was devised using data obtained retrospectively from 148 consecutive major head and neck procedures. These procedures were grouped according to the airway management plan in place at the end of the procedure: elective extubation (group E, 52 procedures, 50 patients); elective overnight ventilation via an endotracheal tube (group ETT, 55 procedures, 52 patients); and elective overnight ventilation via a tracheostomy (group T, 41 procedures, 41 patients). 8 patients from group ETT required a late tracheostomy for either medical or surgical indications. Using statistical methods, a threshold score was defined above which the high risk of upper airway obstruction should prompt consideration of an elective tracheostomy.

Comparison of methods for isolating high quality DNA and RNA from an oleaginous fungus Cunninghamella bainieri strain 2a1

A number of protocols have been reported for efficient fungal DNA and RNA isolation. However, many of these methods are often designed for certain groups or morphological forms of fungi and, in some cases, are species dependent. In this report, we compared four published protocols for DNA isolation from a locally isolated oleaginous fungus, Cunninghamella bainieri strain 2a1. These protocols either involved the use of polyvinyl pyrrolidone (PVP), hexacetyltrimethylammonium bromide (CTAB) or without using PVB or CTAB. For RNA isolation, we tested two published protocols, one of which is based on TRI REAGENT (Molecular Research Center, USA) and another is simple method employing phenol for RNA extraction and LiCl for precipitation. We found that the protocol involving the use of CTAB produced the highest genomic DNA yield with the best quality compared to other protocols. In the presence of CTAB, unwanted polysaccharides were removed and this method yielded an average amount of 816 ± 12.2 μg DNA/g mycelia with UV absorbance ratios A260/280 and A260/230 of 1.67 ± 0.64 and 1.97 ± 0.23, respectively. The genomic DNA isolated via this protocol is also suitable for PCR amplification and restriction enzyme digestion. As for RNA isolation, the method involving phenol extraction and LiCl precipitation produced the highest yield of RNA with an average amount of 372 ± 6.0 μg RNA/g mycelia. The RNA appears to be relatively pure since it has UV absorbance ratios A260/280 and A260/230 of 1.89 ± 2.00 and 1.99 ± 0.03, respectively. Finally, we have demonstrated that this method could produce RNA of sufficient quality for RT-PCR that amplified a 600 bp fragment of Δ12-fatty acid desaturase gene in C. bainieri.

Measuring tracheal airway pressures during transtracheal jet ventilation: an observational study.

Tracheal airway pressures were measured via a transduced fibrescope during transtracheal jet ventilation in 10 patients. Ravussin transtracheal jet ventilation catheters were inserted under local anaesthesia. Following induction of general anaesthesia, tracheal airway pressures were measured at three anatomical levels during fibreoptic intubation. Overall pressure changes during transtracheal jet ventilation were small with the maximal pressure increase (13 mmHg) measured at the carina.

Endoscopic biliary endoprosthesis in the palliation of malignant obstruction of the distal common bile duct: a randomized trial.

A total of 52 jaundiced elderly patients who had malignant obstruction of the distal common bile duct and who required palliative biliary decompression were randomized to receive either an endoscopically placed biliary endoprosthesis (10 French gauge) or conventional surgical bypass. Patients within the two treatment groups were well matched and 51 were followed until their death. Patients treated with endoprosthesis had a significantly shorter initial hospital stay than those treated surgically. In the long term, overall survival in the two groups was similar and jaundice was relieved in over 90 per cent of patients. Despite more re-admissions to hospital for those patients treated endoscopically, the total time spent in hospital still remained significantly shorter in this treatment group compared with those subjected to surgery. The endoscopically placed biliary endoprosthesis is a valuable alternative to conventional surgical bypass in the palliation of extrahepatic biliary obstruction.

Afferent loop syndrome: a different picture.

A patient who had a 50% gastrectomy with a Billroth II gastrojejunostomy one and a half years previously, complained of recent severe weakness as the only symptom was found to have an iron deficiency anemia with a periumbilical mass. A gastrointestinal series showed a soft tissue density in the epigastric area which, by ultrasonography, was found to be fluid-containing. Laparotomy revealed obstruction of the afferent loop caused by a marginal ulcer.