A comparison of the McGrath videolaryngoscope with direct laryngoscopy for rapid sequence intubation in the operating theatre: a multicentre randomised controlled trial.

Aspiration of gastric contents is a recognised complication during all phases of anaesthesia. The risk of this event becomes more likely with repeated attempts at tracheal intubation. There is a lack of clinical data on the effectiveness of videolaryngoscopy relative to direct laryngoscopy rapid sequence intubation in the operating theatre. We hypothesised that the use of a videolaryngoscope during rapid sequence intubation would be associated with a higher first pass tracheal intubation success rate than conventional direct laryngoscopy. In this multicentre randomised controlled trial, 1000 adult patients requiring tracheal intubation for elective, urgent or emergency surgery were allocated randomly to airway management using a McGrath™ MAC videolaryngoscope (Medtronic, Minneapolis, MN, USA) or direct laryngoscopy. Both techniques used a Macintosh blade. First-pass tracheal intubation success was higher in patients allocated to the McGrath group (470/500, 94%) compared with those allocated to the direct laryngoscopy group (358/500, 71.6%), odds ratio (95%CI) 1.31 (1.23-1.39); p < 0.001. This advantage was observed in both trainees and consultants. Cormack and Lehane grade ≥ 3 view occurred less frequently in patients allocated to the McGrath group compared with those allocated to the direct laryngoscopy group (5/500, 1% vs. 94/500, 19%, respectively; p < 0.001). Tracheal intubation with a McGrath videolaryngoscope was associated with a lower rate of adverse events compared with direct laryngoscopy (13/500, 2.6% vs. 61/500, 12.2%, respectively; p < 0.001). These findings suggest that the McGrath videolaryngoscope is superior to a conventional direct laryngoscope for rapid sequence intubation in the operating theatre.

[Long-term survival of patients with hypertension treated in general practice or at a specialized hypertension clinic. A 21-year observation study of 831 patients with hypertension]. / Langtidsoverlevelse ved hypertension behandlet i almen praksis eller i specialiseret hypertensionsambulatorium. Et 21-års observationsstudie af 831 hypertensionspatienter.

This article is based on a study first published in Blood Pressure. After an initial diagnostic and therapeutic assessment at a specialized hypertension clinic, 831 patients with primary hypertension were during a 15-year period allocated to continuing managing care either by their general practitioner or by the hypertension clinic. Survival was assessed in the two groups: general practice (n = 437, 223 males, 214 females) and specialized hypertension clinic (n = 394, 208 males, 186 females). Median observation times for both groups were 11 years. There were no significant differences between the groups concerning age at entry, pretreatment clinical status, pretreatment blood pressure or treated blood pressure level before allocation. Judged by a Cox' regression model, no difference in survival between the two groups could be registered. The leading cause of death in both groups was ischemic heart disease. Our results indicate that after the initial diagnostic assessment and adjustment of treatment, managing care in a specialized hypertension clinic offers no advantage concerning survival compared to managing care in general practice.

Twenty-one-year survival of primary hypertensive patients allocated to care in general practice or in specialized hypertension clinic. An observational study of 831 hypertensive patients.

After initial diagnostic and therapeutic assessment at a specialized hypertension clinic, 831 patients with primary hypertension were during a 15-year period allocated to continuing care management either by their general practitioner or by the out-patient department of the hypertension clinic. At a given date survival was assessed in the two groups: general practice (n = 437, 233 males, 214 females) and specialized hypertension clinic (n = 394, 208 males, 186 females). Median observation time for both groups was 11 years, the longest observation time was 21 years, 8 months. There were no significant differences between the groups concerning age at entry, pretreatment clinical status, pretreatment blood pressure or treated blood pressure level before allocation. The patients in the two groups had the same access to hospitalization when needed. Judged by a Cox regression model, no difference in survival between the two groups could be registered. No differences were found between the causes of death in the two treatment groups, the main cause of death in both groups being ischaemic heart disease. Our results indicate that after initial diagnostic assessment and adjustment, the management of treatment care in a specialized hypertension clinic offers no advantage concerning survival compared to management of care in general practice.

Clinical applicability of the immunomagnetic beads technique for serological crossmatching in renal transplantation.

The aim of the present prospective study was to investigate the clinical applicability of the immunomagnetic (IM) beads technique for serological crossmatching (XM) in renal transplantation. The IM XM were read after various periods of incubation, and the results were compared with those obtained by the conventional Kissmeyer-Nielsen (KN) technique. A total of 132 sera from 96 potential recipients were tested against cells from 62 donors. Eight-nine KN T-cell XM-negative renal allograft transplantations were performed, and the IM XM results were related to clinical 3-month follow-up data (incidence of primary non-function, never functioning grafts, graft losses and rejection episodes). The IM technique was clearly more sensitive than KN, and sensitivity increased markedly with increasing duration of incubation. KN-, IM+ reactions were predominantly found among sera from patients with panel-reactive antibodies (PRA, 2p less than 0.01), and thus probably caused by HLA antibodies. However, positive IM XM, appearing after more than 35 min of incubation, did not influence the overall clinical outcome in the observation period. With reading after exactly 35 min of incubation, XM results obtained by IM and KN techniques correlated well. Thus, we believe, that the IM XM technique will be as safe and effective in avoidance of hyperacute rejections as the conventional assay. In the present material, the incidence of primary nonfunction was significantly (2p = 0.0023) higher among PRA+ recipients compared to PRA- patients. To conclude, we recommended the IM technique with reading after exactly 35 min of incubation for easy, fast (70 min) and reliable XM, that is always possible to perform using peripheral blood.

Bactericidal capacity against Neisseria meningitidis of normal human serum and sera with functional deficiencies of the third and eight complement factor.

The bactericidal capacity of serum with C3 deficiency secondary to circulating C3 nephritic factor, serum with C8 deficiency and normal human serum were assessed in vitro against Neisseria meningitidis groups A-C. Normal human serum and C8-deficient serum, originating from a 28-year-old male with two episodes of meningococcal meningitis, showed significant bactericidal capacity against meningococci groups A and B. Against group C meningococci the C8-deficient serum revealed significant bactericidal capacity, whereas normal human serum showed no bactericidal effect. Serum with C3 deficiency, obtained from a 16-year-old female with two episodes of meningococaemia, showed no bactericial effect against meningococci groups A-C. Incubation of normal human serum and C8-deficient serum with isolated nephritic factor resulted in C3 depletion and abolished the bactericidal effect.

Discoid lupus erythematosus-like skin lesions in a patient with autosomal recessive chronic granulomatous disease.

A case of chronic granulomatous disease (CGD) in a 32-year-old female with two episodes of opportunistic infections is described. At the age of 29 the patient was suspected to be a carrier of X-linked CGD on the basis of discoid lupus erythematosus-like skin lesions. No respiratory burst activity, as measured by phorbol myristate acetate stimulated superoxide production, was observed in isolated neutrophils of the patient. Membrane-rich fractions elicited no superoxide production in the presence of NADPH. The neutrophil content of cytochrome b-245 was within normal range. Family investigations revealed neither cellular abnormalities nor any history of skin diseases or opportunistic infections in first degree relatives. The parents of the patient were first cousins. On the basis of family history and the in-vitro assessment of neutrophil function, the patient is believed to have autosomal recessive CGD. The presented case illustrates that lupus erythematosus-like skin lesions are not restricted to female carriers of X-linked CGD, but may also be found in the autosomal recessive type of the disease.

Prognosis in treated hypertension.

The aim of this study has been to demonstrate to what extent antihypertensive treatment reduces the survival gap between hypertensives and the general population. In 673 outpatients treated for arterial hypertension, the 10-year survival has been assessed by actuarial methods and compared with expected survival of a matched background population computed from the life tables of the Danish population. In primary hypertension WHO stage I, survival did not differ from that of the background population, a congruence which of course may be a mere chance but excludes any major difference. However, when severe organ involvement was present, as in WHO stage III and renal hypertension, treatment did not eliminate the survival gap. The survival rate did not differ between sexes or between patients with high and low body mass, but decreased with increasing age. Myocardial infarction was the most frequent single cause of death, whereas stroke accounted for less than 10% of all fatalities.

Survival of diabetic hypertensive patients.

Seventy-nine of 673 patients attending a hypertensive outpatient clinic were classified as diabetics at the first examination. These patients were age- and sex-matched to two control groups: nondiabetic hypertensives and the background population. Nondiabetic hypertensive patients had a significantly poorer survival than expected during a 10-year observation period; the survival of diabetic hypertensives was even poorer, although not significantly. No sex difference was observed in the survival rates of hypertensive diabetics, neither was a difference seen between insulin-dependent and non-insulin-dependent patients. Acute myocardial infarction was the most frequent cause of death in both diabetic (40%) and nondiabetic (42%) hypertensive persons.

Scintigraphic localization of occult gastrointestinal bleeding using a combination of 111In-labelled platelets and 99mTc sulphur colloid.

Repeated scintigraphy was performed for 6 days after the injection of autologous 111In-labeled platelets in a patient showing signs of recurrent occult gastrointestinal bleeding. Colonic activity was observed 142 h post injection, at which time a superimposed study using 99mTc sulphur colloid pinpointed the source of bleeding in the transverse colon.

Chronic granulomatous disease associated with chronic glomerulonephritis.

A boy with chronic granulomatous disease (CGD) developed glomerulonephritis at the age of 12 years. The glomerulonephritis progressed to terminal uraemia at age 15 when maintenance haemodialysis was started. The clinical course was complicated by pulmonary aspergillosis and Pseudomonas septicaemia from which he eventually died. The glomerulonephritis was of unknown origin, and a possible relationship between CGD and glomerulonephritis is discussed.

A radiometric whole blood test for chronic granulomatous disease.

Chronic granulomatous disease (CGD), caused by an inherited deficiency in the oxygen metabolism of granulocytes and monocytes, is often a diagnostic problem in patients with severe infections. CGD can be diagnosed by several methods, all requiring some knowledge of cell handling and specialized equipment. We describe a simple screening test for CGD, based on the production of 14CO2 from glucose-1-14C following stimulation of the granulocytes in whole blood with zymosan, CV: 14.8%, intraassay. The test can be carried out with equipment available in most routine laboratories and without expertise in granulocyte function tests.