Anaesthetic breathing circuit obstruction due to blockage of tracheal tube connector by a foreign body - two cases

Publisher's copy made available with the permission of the publisher© 1999 Australian Society of AnaesthetistsTwo cases are presented which illustrate the disastrous consequences possible when an anaesthetic breathing circuit is obstructed by a foreign body. Despite reports of previous similar cases, work practices and equipment manufacture or design continue to allow for such events to occur. The importance of both pre-anaesthetic testing of the entire circuit including attachments such as the tracheal tube connector and filters, and the removal of these parts should obstruction occur, is emphasised. Use of “clear” transparent breathing circuit components and opaque or brightly coloured packaging and caps which could potentially cause obstruction should decrease the incidence and facilitate the diagnosis of this problem.M.J. Foreman, D. G. Moye

Organic farming and gene transfer from genetically modified crops

This is the final report of MAFF/Defra project OF0157. Genetically modified (GM) crops cannot be released into the environment and used as food, feed, medicines or industrial processing before they have passed through a rigorous and internationally recognised regulatory process designed to protect human and animal health, and the environment. The UK body that oversees standards in organic farming, the United Kingdom Register of Organic Food Standards (UKROFS), has ruled that genetically modified (GM) crops have no role to play in organic farming systems. They, therefore, have concerns about the possibility and consequences of the mixing of GM crops with organic crops. The two main sources of mixing are through pollen and seed. Pollen from GM crops may pollinate an organic crop. Seed from a GM crop, or plants established from them, may become mixed with organic crops or their products. Minimising genetic mixing is an important feature of the production of all high quality seed samples of plant varieties supplied to farmers. Extensive experience has been obtained over many decades in the production of high purity seed samples. Crop isolation distances, and crop rotational and management practices are laid down to achieve this. These procedures for the production of seed of high genetic purity could be used for the production of organic crops. No system for the field production of seed can guarantee absolute genetic purity of seed samples. Very rarely long distance pollination or seed transfer is possible, so any criteria for organic crop production will need to recognise this. There has always been the possibility of hybridisation and seed mixing between organic crops and non-organic crops. Organic farming systems acknowledge the possibility of spray or fertiliser drift from non-organic farming systems, and procedures are established to minimise this. In practice, detecting the presence of certain types of GM material in organic crops, especially quantification, is likely to be difficult. Some seed used by organic farmers are currently obtained from abroad. After January 2001, or a modified deadline thereafter, UK organic farmers will be required to sow seed produced organically. There is little or no organic seed produced in the UK at present, so it has to be obtained from abroad. Seed obtained from outside the UK or the European Union, may have different seed production criteria. This may make it difficult to guarantee that it is absolutely free from any GM material. Organic farmers and/or GM crop producers will need to ensure that their crops are isolated from one another by an appropriate distance or barrier to reduce pollen transfer if the crop flowers. To reduce seed mixing, shared equipment will need to be cleaned and an appropriate period of time allowed before organic crops are grown on land previously used for GM crops. Responsibility for isolation will need to be decided before appropriate measures can be implemented. The report highlights the need for acceptable levels of the presence of GM material in organic crops and measures identified to achieve this

Prevalent low-grade dysplasia: the strongest predictor of malignant progression in Barrett's columnar-lined oesophagus

No abstract

The Use of Self-Expanding Plastic Stents in the Management of Oesophageal Leaks and Spontaneous Oesophageal Perforations

Leakage after oesophageal anastomosis or perforation remains a challenge for the surgeon. Traditional management has been operative repair or intensive conservative management. Both treatments are associated with prolonged hospitalisation and high morbidity and mortality rates. Self-expanding metallic stents have played an important role in the palliation of malignant oesophageal strictures and the treatment of tracheoesophageal fistulae. However, self-expanding metal stents in benign oesophageal disease are associated with complications such as bleeding, food bolus impaction, stent migration, and difficulty in retrieval. The Polyflex stent is the only commercially available self-expanding plastic stent which has been used in the management of malignant oesophageal strictures with good results. This review will consider the literature concerning the use of self-expanding plastic stents in the treatment of oesophageal anastomotic leakage and spontaneous perforations of the oesophagus

Clinical Use of Cinacalcet in MEN1 Hyperparathyroidism

Background. Management of multiple-endocrine neoplasia type 1- (MEN1-) associated hyperparathyroidism is associated with high recurrence rates and high surgical morbidity due to multiple neck explorations. Cinacalcet, a calcimimetic agent licensed for the treatment of secondary hyperparathyroidism and parathyroid carcinoma, may provide a medical alternative for the management of these complex patients. Methods. A prospective audit was performed of eight patients; three males and five females, aged 20–38 at diagnosis. Two patients commenced cinacalcet as primary treatment and six had previous surgery. Six patients had complications of hyperparathyroidism: renal calculi, renal dysfunction, and reduced bone mineral density. All were commenced on cinacalcet 30 mg bd for MEN1 associated hyperparathyroidism; doses were subsequently reduced to 30 mg od in four patients. Results. Significant reductions were observed in serum calcium and PTH measurements. Serum calcium reduced by a median of 0.35 mmol/L (P = .012 Wilcoxon Signed Rank). Serum PTH levels decreased by a median of 5.05 pmol/L (P = .012). There was no change in urine calcium. Duration ranged from 10–35 months with maintenance of control. Cinacalcet was well tolerated by six patients; one experienced nausea and one experienced diarrhoea. Conclusion. Cinacalcet is an effective and well-tolerated medical treatment for the management of complex primary hyperparathyroidism

Rapid biotic homogenization of marine fish assemblages

The role human activities play in reshaping biodiversity is increasingly apparent in terrestrial ecosystems. However, the responses of entire marine assemblages are not well-understood, in part, because few monitoring programs incorporate both spatial and temporal replication. Here, we analyse an exceptionally comprehensive 29-year time series of North Atlantic groundfish assemblages monitored over 5° latitude to the west of Scotland. These fish assemblages show no systematic change in species richness through time, but steady change in species composition, leading to an increase in spatial homogenization: the species identity of colder northern localities increasingly resembles that of warmer southern localities. This biotic homogenization mirrors the spatial pattern of unevenly rising ocean temperatures over the same time period suggesting that climate change is primarily responsible for the spatial homogenization we observe. In this and other ecosystems, apparent constancy in species richness may mask major changes in species composition driven by anthropogenic change

A Pilot Study to Evaluate Haemostatic Function, following Shock Wave Lithotripsy (SWL) for the Treatment of Solitary Kidney Stones

Original Research ArticlePurpose: The number of patients undergoing shock wave lithotripsy (SWL) in the UK for solitary unilateral kidney stones is increasing annually. The development of postoperative complications such as haematuria and sepsis following SWL is likely to increase. Comparing a range of biological markers with the aim of monitoring or predicting postoperative complications following SWL has not been extensively researched. The main purpose of this pilot-study was to test the hypothesis that SWL results in changes to haemostatic function. Subsequently, this pilot-study would form a sound basis to undertake future investigations involving larger cohorts. Methods: Twelve patients undergoing SWL for solitary unilateral kidney stones were recruited. From patients (8 male and 4 females) aged between 31–72 years (median—43 years), venous blood samples were collected pre-operatively (baseline), at 30, 120 and 240 minutes postoperatively. Specific haemostatic biomarkers [platelet counts, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen, D-dimer, von Willebrand Factor (vWF), sE-selectin and plasma viscosity (PV)] were measured. Results: Platelet counts and fibrinogen concentration were significantly decreased following SWL (p = 0.027 and p = 0.014 respectively), while D-dimer and vWF levels significantly increased following SWL (p = 0.019 and p = 0.001 respectively). PT, APTT, sE-selectin and PV parameters were not significantly changed following SWL (p>0.05). Conclusions: Changes to specific biomarkers such as plasma fibrinogen and vWF suggest that these represent a more clinically relevant assessment of the extent of haemostatic involvement following SWL. Analysis of such markers, in the future, may potentially provide valuable data on “normal” response after lithotripsy, and could be expanded to identify or predict those patients at risk of coagulopathy following SWL. The validation and reliability will be assessed through the assessment of larger cohorts.The authors would like to acknowledge the Institute of Biomedical Science (IBMS) and the University of Chester (Research & Knowledge Transfer Office) for their financial support

Surveillance of Transmitted HIV-1 Drug Resistance in Gauteng and KwaZulu-Natal Provinces, South Africa, 2005-2009

Surveillance of human immunodeficiency virus type 1 transmitted drug resistance (TDR) was conducted among pregnant women in South Africa over a 5-year period after the initiation of a large national antiretroviral treatment program. Analysis of TDR data from 9 surveys conducted between 2005 and 2009 in 2 provinces of South Africa suggests that while TDR remains low (<5%) in Gauteng Province, it may be increasing in KwaZulu-Natal, with the most recent survey showing moderate (5%-15%) levels of resistance to the nonnucleoside reverse transcriptase inhibitor drug clas