Transtracheal jet ventilation in a porcine model

Hypoxemia is a frequent event during difficult airway management. We propose to use transtracheal jet ventilation (TTJV) early during the management of complex difficult airway scenarios. The objective of this porcine study is to highlight the benefit of oxygenation via prophylactic TTJV. Eighteen pigs (Sus scrofa) were divided into two equal groups. In Group A, pigs were anesthetized and no lung ventilation was conducted following administration of succinylcholine and prior to tracheal intubation. Group B, after induction of anesthesia, received transtracheal ventilation using 100% oxygen. In both groups intubation was performed after waiting 90 seconds. All intubations were achieved in less than 30 seconds. Post-intubation arterial blood gases demonstrated significant hypoxemia in Group A (PaO2 22.6 + 5.8 mm Hg), while in Group B oxygenation substantially improved (PaO2 470.3 + 17.0 mm Hg). The arterial CO2 retention was associated with mild respiratory acidosis (pH 7.26 ± 0.05) in Group A only. These findings prove that prophylactic TTJV can improve oxygenation and allow extra time for definitive management of difficult airway

Compliance and Appropriateness of Driver Vision Regulations in Ireland

Driving is a highly complex task which relies heavily on vision for successful execution. There are currently 2,820,528 holders of driving licences in Ireland. Holders of a driving license must meet the standards for vision as set out by the Road Safety Authority Slainte agus Tiomáint document. Visual acuity and Visual Field measurements are specified as the minimum standard. If there is reason to believe that these measurements are inadequate, it is required that the subject undergo a more detailed examination. Currently, drivers must undergo a vision screening when applying for their first license, and additional vision screening is not required until they reach 70 years of age. During this interval, licenses have 10 yearly renewal intervals. It is well known that a person’s vision changes with age. These changes may be normal and age-related, or pathological and disease related. Either Way, these changes can have a significant detrimental effect on both unaided vision and corrected acuity, and therefore their ability to meet the driving standards (either with or without refractive aides). It is our aim to assess the vision of a sample population of drivers with respect to the current vision standards for driving, and to critically evaluate the appropriateness of the standards currently in place

Osteoblastoma of the thyroid cartilage treated with voice preserving laryngeal framework resection

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/99105/1/lary23972.pd

Polymyositis:is there anything left? A retrospective diagnostic review from a tertiary myositis centre

OBJECTIVE: The current classification criteria for idiopathic inflammatory myopathy (IIM) retain PM as a major disease subgroup. However, evolution in the understanding of IIM has suggested that many of these patients could be better described as having an alternative diagnosis. In the present study, we apply the latest understanding of IIM subtyping to retrospectively review PM diagnoses in a large cohort of IIM patients.METHODS: Within a previously reported cohort of 255 patients from a UK tertiary myositis clinic, 37 patients classified as PM according to both the EULAR/ACR IIM criteria and expert opinion were identified. Clinical data and complementary tests were reviewed, and consensus decisions regarding final classification were reached in each case.RESULTS: Nine (9/37, 24.3%) patients remained classified as PM, 3.5% (9/255) of the original cohort; these PM patients were seronegative for myositis antibodies, responsive to immunosuppression, and in 4/7 (57.1%) patients where muscle biopsy was performed had HLA-1 upregulation and endomysial inflammatory infiltrates. Immune-mediated necrotizing myopathy (5/37, 13.5%) and connective tissue disease overlap myositis (7/37, 19%) were the main alternative diagnoses. The remaining patients were diagnosed as: unspecified myopathy (6/37, 16%), dermatomyositis (2/37, 5%), cancer-associated myopathy (3/37, 8.1%), and non-inflammatory myopathy (1/37, 3%, myofibrillar myopathy). Four patients (4/37, 10%) had insufficient data available to confidently reclassify.CONCLUSION: Our study confirms that PM can now be considered a rare IIM subgroup. A thorough examination, complete myositis autoantibody panel, and careful interpretation of the biopsy results is recommended to confirm the correct IIM sub-type.</p

Polymyositis:is there anything left? A retrospective diagnostic review from a tertiary myositis centre

OBJECTIVE: The current classification criteria for idiopathic inflammatory myopathy (IIM) retain PM as a major disease subgroup. However, evolution in the understanding of IIM has suggested that many of these patients could be better described as having an alternative diagnosis. In the present study, we apply the latest understanding of IIM subtyping to retrospectively review PM diagnoses in a large cohort of IIM patients.METHODS: Within a previously reported cohort of 255 patients from a UK tertiary myositis clinic, 37 patients classified as PM according to both the EULAR/ACR IIM criteria and expert opinion were identified. Clinical data and complementary tests were reviewed, and consensus decisions regarding final classification were reached in each case.RESULTS: Nine (9/37, 24.3%) patients remained classified as PM, 3.5% (9/255) of the original cohort; these PM patients were seronegative for myositis antibodies, responsive to immunosuppression, and in 4/7 (57.1%) patients where muscle biopsy was performed had HLA-1 upregulation and endomysial inflammatory infiltrates. Immune-mediated necrotizing myopathy (5/37, 13.5%) and connective tissue disease overlap myositis (7/37, 19%) were the main alternative diagnoses. The remaining patients were diagnosed as: unspecified myopathy (6/37, 16%), dermatomyositis (2/37, 5%), cancer-associated myopathy (3/37, 8.1%), and non-inflammatory myopathy (1/37, 3%, myofibrillar myopathy). Four patients (4/37, 10%) had insufficient data available to confidently reclassify.CONCLUSION: Our study confirms that PM can now be considered a rare IIM subgroup. A thorough examination, complete myositis autoantibody panel, and careful interpretation of the biopsy results is recommended to confirm the correct IIM sub-type.</p

Lower Postsurgical Mortality for Individuals with Dementia with Better-Educated Hospital Workforce

Surgical patients age 65 and over with Alzheimer’s disease and related dementias (ADRD) were more likely to die within 30 days of admission and to die after a complication than those without ADRD. Having better-educated nurses in the hospital improved the likelihood of good outcomes for all surgical patients, but had a much greater effect in individuals with ADRD. Specifically, a 10% increase in the proportion of nurses with a Bachelor of Science in Nursing (BSN) degree or higher was associated with 10% lower odds of death and 10% lower odds of dying after a complication for surgical patients with ADRD

Correlation of Radiographic and Pathologic Findings of Dermal Lymphatic Invasion in Head and Neck Squamous Cell Carcinoma

No abstract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78081/1/21232_ftp.pd