[Identification of bacterial strain at each episode of recurrent acute otitis media].

This study was undertaken to investigate whether each episode of recurrent acute otitis media (rAOM) is caused by the same strain of bacteria or different strains at each episode. Seventy infants less than 3-years of age, having experienced rAOM for a period shorter than 8 weeks, were selected and included in the present study. The total number of AOM episodes experienced by this group was 282. At each subsequent episode of AOM, otorrhea and nasopharyngeal swabs were taken for bacterial culture and determination of the MIC for antibiotics. When S. pneumoniae was identified, its serotype, and its pbp, ermAM, and mefE genes were also investigated to determine the bacterial species and strains. S. pneumoniae was the most frequently cultured bacteria with 26 penicillin-sensitive S. pneumoniae (PSSP), 65 penicillin-insensitive S. pneumoniae (PISP), and 50 penicillin-resistant S. pneumoniae (PRSP). H. influenzae was the next most frequently cultured bacteria of which 65 were sensitive to penicillin, 27 were found to be beta-bactamase-negative-ampicillin-resistant (BLNAR) and 17 were found to be beta-bactamase positive. Bacteria cultured from each pair of two successive episodes of AOM were compared as to the identity of the bacteria during the two episodes. In 150 out of 202 pairs (74%), the cultured pathogen was different. In 22 cases in which either PISP or PRSP was the pathogen detected in two consecutive AOM episodes, 15 cases (68%) were found in which the involved strain differed between the two episodes. This study indicates that the pathogen involved in rAOM is likely to differ at each episode of AOM, not only in cases caused by PSSP, but also in those caused by PRSP.

[Clinical application of laryngeal mask airway].

The laryngeal mask is a unique alternative to the face mask and endotracheal tube offering significant benefits to both anesthesiologist and patient. We have applied laryngeal mask, 1) to create an adequate airway in cases of difficult or impossible intubation, 2) to establish a pathway for the fiberoptic bronchoscope, 3) to clear the airway for eye operation, and 4) to maintain the airway in patients in the lateral position. Further study, however, is necessary to establish definite indication for its application.

Tracheal dilatation by halothane and enflurane in man.

The effect of halothane and enflurane on tracheal tone were studied in 21 patients during the induction of anesthesia. Endotracheal tube cuff pressure was used to measure tracheal tone. Anesthesia, maintained by nitrous oxide 70% in oxygen, was supplimented with succinylcholine drip infusion to immobilize the patient. Ventilation was controlled by a Volume-preset ventilator. In the halothane group, the initial cuff pressure was 14.8 +/- 1.3 (mean +/- SE) cmH(2)O but 10 min after 0.15 mg/kg of pancuronium injection, it increased to 21.7 +/- 2.3 cmH(2)O (control). Ten min after inhalation of 0.75% of halothane, cuff pressure decreased to 14.7 +/- 2.3 cmH(2)O (34 +/- 11% decrease from the control value). In the enflurane group, the initial cuff pressure was 17.6 +/- 1.8 cmH(2)O and it increased to 21.0 +/- 1.7 cmH(2)O (control) 10 min after pancuronium injection. Ten min after 1.7% of enflurane inhalation, cuff pressure decreased to 17.1 +/- 2.3 cmH(2)O (23.9 +/- 6% decrease from the control value). Halothane and enflurane produced similar tracheal dilatation in healthy individuals.