The oral manifestations of intestinal lymphangiectasia: case report.

Intestinal lymphangiectasia is a rare autosomal dominant disorder or acquired condition that leads to lymph obstruction, poor chyle transport, and concomitant problems of hypoproteinemia, lymphocytopenia, hypogammaglobulinemia, and peripheral edema. Patients develop diarrhea, steatorrhea, and hypocalcemia secondary to fat-soluble vitamin malabsorption. Treatment is a restrictive diet of low fat, medium chain triglycerides. Oral manifestations are gingivitis due to poor PMN function and enamel defects due to poor calcium absorption. A case of a 14-year-old boy with both gingival and enamel problems secondary to intestinal lymphangiectasia is reported.

Absorption and elimination of midazolam by submucosal and intramuscular routes.

The purpose of this investigation was to compare the rate of absorption and clearance time of midazolam (Versed) when administered by the submucosal (SM) route), and the intramuscular (IM) route in ten healthy adult volunteers, ranging in age from 25 to 35 years. Each subject received midazolam 0.08 mg/kg, to a maximum of 5 mg, by the SM and IM routes at two week intervals. Vital signs and arterial oxygen saturation levels were monitored every five minutes throughout the 180 minute study period. Blood samples (3 ml) were collected via an intravenous line, prior to midazolam administration and at 2, 5, 10, 20, 30, 45, 60, 90, 120, 150 and 180 minutes, centrifuged and analyzed by gas-liquid chromatography. The mean absorption rates and the mean elimination times of the two routes were not significantly different. The mean peak absorption was reached at 10 minutes by the SM route (80.4 ng/ml) and at 20 minutes (92.0 ng/ml) by the IM route, with considerable individual variability. Vital signs were stable throughout the study period in all subjects with both routes. All subjects reported pain at the injection site during SM injection which continued for up to 48 hours. No pain related to the IM injection was reported.

Anesthetic management of the pediatric patient with multiple congenital anomalies including severe hemifacial hypertrophy.

An anesthesia induction technique not widely utilized is described for a pediatric patient presenting with severe hemifacial hypertrophy, severe mental retardation, as well as a seizure disorder and other congenital anomalies. The anatomically and/or pathologically altered airway as well as other anomalies increase the risks of anesthesia.

Ketamine suppression of chemically induced convulsions in the two-day-old white leghorn cockerel.

Ketamine has been evaluated for convulsant properties in animals and humans with contradictory results. The present investigation evaluated the convulsant properties of ketamine in a previously unreported animal model. Two-day-old chicks were selected as test animals because they have incomplete blood-brain barriers and thus greater penetrance of xenobiotics affecting the central nervous system. Control and experimental animals were given a central nervous system stimulant, pentylenetetrazol (Medtrazol) at a dosage level (100 mg/kg) causing convulsions in 90% of animals. The effect of ketamine pretreatment was then observed for the: (1) number of animals convulsing; (2) time of onset of convulsions; and (3) mortality. Ketamine (100 mg/kg) significantly decreased the number of animals that convulsed and decreased mortality; 10 mg/kg of ketamine significantly prolonged the time of onset of convulsions. This study does not support the conclusion that ketamine is a convulsant. Ketamine has significant anticonvulsant properties in the young chick model.