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The inflationary non-invasive blood pressure monitor (iNIBP™) uses a new measurement method, whereby the cuff is slowly inflated whilst simultaneously sensing oscillations, to determine the diastolic blood pressure first and then the systolic pressure. It may measure blood pressure more quickly than the conventional non-invasive blood pressure monitor. We studied 66 patients undergoing general anaesthesia, comparing the time taken to measure the blood pressure between the two monitors at times when there were marked changes (increases or decreases by 30 mmHg or greater) in the systolic blood pressure. The median (IQR) [range]) time was significantly longer for the non-invasive blood pressure monitor (38.8 (31.5-44.7) [18.0-130.0] s) than for the iNIBP (14.6 (13.7-16.4) [11.5-35.5] s), p = 0.001, 95%CI for difference 22-25 s). We also studied 30 volunteers to evaluate the accuracy of the iNIBP, comparing it with the mercury sphygmomanometer. There was good agreement between the two monitors, with a mean difference of 0 (95% limit of agreement -12 to 11) mmHg for the systolic blood pressure. We also compared the degree of pain during cuff inflation between the automated non-invasive blood pressure and iNIBP monitors. Pain was significantly more for the non-invasive blood pressure monitor (22 of 30 volunteers had less pain with the iNIBP). We have shown that the iNIBP measured the blood pressure quicker than the conventional non-invasive blood pressure monitor and the speed of measurement was not significantly affected by marked changes in the blood pressure. [ABSTRACT FROM AUTHOR]

Summary: Klinefelter syndrome is a condition in which a male patient has one Y chromosome and one or more extra X chromosomes. It is the most common sex chromosome disorder. Klinefelter syndrome is distinguished by many clinical features, such as infertility, high gonadotropin and low testosterone levels, increased height, and sparse body and facial hair. We report the case of a 32‐year‐old man who visited our hospital complaining of male infertility. Semen analysis showed azoospermia, and chromosomal analysis revealed a 47,XY,i(X)(q10) karyotype, which is a rare variant of Klinefelter syndrome. No spermatozoon was found on microdissection testicular sperm extraction, and the testis biopsy histology showed only Sertoli cells and hyalinised seminiferous tubules. 47,XY, i(X)(q10) has an additional isochromosome made of the long arm of the X chromosome, which shares some features of classical Klinefelter syndrome in many aspects, but patients are usually shorter than average height and have normal intelligence. In addition, to the best of our knowledge, no successful sperm extractions from 47,XY, i(X)(q10) patients were reported in the literature. The reports of patients who have undergone microdissection testicular sperm extraction are very rare. Further reports and studies of this chromosomal abnormality are needed. [ABSTRACT FROM AUTHOR]

Abstract: This study is concerned with the consensus problems of multi‐agent systems with cooperative and antagonistic noisy interactions described by two‐layered network. That is, each agent is simultaneously influenced by the force of attraction and repulsion between each neighboring agents in cooperative and antagonistic layers. A distributed algorithm for achieving the consensus in a probabilistic sense is proposed and its sufficient conditions are clarified. The conditions tell us rigorous stopping rules which enable us to know the number of iterations that achieves consensus within a prespecified accuracy and probability. Some applications of consensus problems with cooperative and antagonistic interactions are shown through numerical examples. [ABSTRACT FROM AUTHOR]

The authors reflect on various supraglottic airways (SADs), and presents guidelines on how to properly choose among the available devices. Topics include introduction of the laryngeal mask airway (LMA) in clinical practice, incidence of pulmonary aspiration associated with the use of SADs, and efficacy of different SADs.

We studied 40 adult patients to see if cricoid pressure affected placement of the I-gel™. In a randomised crossover design, the i-gel was placed with and without cricoid pressure, and we compared the success rate of adequate ventilation through the i-gel, time to placement and the rate of optimal position of the device between the two circumstances. Cricoid pressure significantly decreased the success rate of adequate ventilation through the i-gel (40 vs 34 patients) (p = 0.041, 95% CI for difference 4-26%), and significantly decreased the rate of the optimal position (39 vs 17 patients) (p < 0.001). The time to achieve adequate ventilation was significantly longer (p < 0.001) with cricoid pressure than without (median difference 8 s; 95% CI for median difference 3-12 s). Cricoid pressure significantly decreases the success rate of ventilation through the i-gel, but the success rate of ventilation through the i-gel is reasonably high. [ABSTRACT FROM AUTHOR]

Consumption of raw or undercooked poultry products contaminated with Campylobacter has been identified as a risk factor for human campylobacteriosis. We determined whether slaughtering of Campylobacter-positive flocks was associated with contamination of chicken products derived from Campylobacter-negative flocks slaughtered at the same abattoir. The presence of Campylobacter was investigated in 22 broiler farms 1 week prior to slaughter and in one abattoir on nine separate slaughter days. A total of 600 bulk packed chicken products were tested, with 198 (33.0%) of the products found to be Campylobacter positive. Of the 350 chicken products originating from Campylobacter-positive flocks, 180 (51.1%) were contaminated with the bacteria. In contrast, only 18 (7.2%) of 250 chicken products derived from Campylobacter-negative flocks were contaminated. In 14 of these 18 products, the Campylobacter isolates were identical to isolates obtained from the flock slaughtered immediately prior to the Campylobacter-negative flock. Notably, on 4/6 slaughter days, Campylobacter-negative flocks were slaughtered prior to the positive flocks, and Campylobacter was absent from all chicken products originating from the negative flocks. These results suggest that implementation of logistic slaughter (where Campylobacter-negative flocks are slaughter first) significantly decreases the prevalence of Campylobacter-positive chicken products. [ABSTRACT FROM AUTHOR]

Campylobacter was isolated from 67 (47.2%) of 142 broiler flocks between September 2009 and February 2010. The prevalence of Campylobacter in broiler flocks was significantly lower during January and February than it was from September to December. Campylobacter colonization was more common in flocks that were not provided with a disinfected water supply, which was consistent with the findings of a previous study. The prevalence of antimicrobial drug-resistant Campylobacter spp. was investigated, and the minimum inhibitory concentrations of eight antimicrobial agents were determined for 122 Campylobacter jejuni isolates and 46 Campylobacter coli isolates from broiler flocks between 2007 and 2010. In this study, 29.5% (36/122) of C. jejuni isolates and 41.3% (19/46) of C. coli isolates were resistant to enrofloxacin (ERFX), whereas all isolates were susceptible to erythromycin. Furthermore, the ERFX-resistant isolates were tested for susceptibility to other classes of antimicrobial agents, and 55.6% (20/36) of ERFX-resistant C. jejuni isolates and 47.4% (9/19) of ERFX-resistant C. coli isolates were resistant to at least one of aminobenzyl penicillin, dihydrostreptomycin and oxytetracycline. To avoid an impact of antimicrobial drug-resistant Campylobacter spp. on the efficacy of antimicrobial treatment for human campylobacteriosis, prudent use of antimicrobial agents is a requisite. The use of antimicrobial agents should be accompanied by various approaches such as prevention of Campylobacter colonization in broiler flocks with the aim of lowering the occurrence of Campylobacter infection in humans. [ABSTRACT FROM AUTHOR]

We examined the influence of CYP2C19 polymorphisms on the antiplatelet effects of clopidogrel and ticlopidine. The platelet aggregation induced by 20 µmol/l adenosine diphosphate (ADP) and CYP2C19 single-nucleotide polymorphisms (*2 and *3) was determined in patients with coronary artery disease (CAD) who were taking aspirin alone (n = 21), aspirin plus clopidogrel (n = 97), or aspirin plus ticlopidine (n = 47). The degree of platelet aggregation in the clopidogrel group, although not in the ticlopidine group, depended on the CYP2C19 polymorphism, and the maximal platelet aggregation in poor metabolizers (PMs) taking clopidogrel was equivalent to that in the group taking aspirin alone. After being switched from clopidogrel to ticlopidine, all seven of the PMs showed markedly lower platelet aggregation. These results suggest that CYP2C19 polymorphisms have a profound impact on the antiplatelet effect of clopidogrel but not on that of ticlopidine. Ticlopidine may be an effective therapeutic option for CYP2C19 PMs. [ABSTRACT FROM AUTHOR]

Fifteen anaesthetists attempted to intubate the trachea of a manikin lying supine on the ground using the Airway Scope®, Airtraq® or Macintosh laryngoscope in three simulated conditions: (1) in room light; (2) in the dark and (3) in daylight. The main outcome measure was the time to ventilate the lungs after successful intubation; the secondary outcome was the success rate of ventilation within 30 s. In room light and in the dark, ventilation after successful tracheal intubation could always be achieved within 30 s for all three devices. There were no clinically meaningful differences in time to ventilate between the three devices. In daylight, time to ventilate the lungs for the Airway Scope was significantly longer than for the Macintosh blade (p < 0.0001; 95% CI for difference 27.5–65.0 s) and for the Airtraq (p < 0.0001; 95% CI for difference 29.2–67.6 s). Ventilation was always successful for the Macintosh and Airtraq laryngoscopes, but for the Airway Scope, only one of 15 participants could successfully ventilate the lungs (p < 0.0001). Therefore, the Airway Scope may have a role for tracheal intubation under room light or in darkness, but may not be so useful in daylight. In contrast, the Airtraq may have a role in both darkness and daylight. [ABSTRACT FROM AUTHOR]

A total of 1024 enterococci were recovered from faeces of healthy animals from 178 cattle, 178 pig and 156 broiler farms. Enterococcus faecium was the predominant species recovered (35.8%), followed by E. faecalis (31.3%) and E. hirae (25.6%). Oxytetracycline resistance was most frequently found among E. faecalis (85.9%), E. faecium (58.8%) and E. hirae (48.1%). Resistance rates to almost all antimicrobials were higher in E. faecalis than E. faecium and E. hirae. Isolates from cattle were more susceptible to the antimicrobials studied than those from pigs and broilers. VanA- or VanB-type vancomycin-resistant enterococci have not been found since the ban of avoparcin use 5 years ago. [ABSTRACT FROM AUTHOR]

Ten anaesthetists assessed the ease of tracheal intubation (time to see the glottis, to intubate the trachea and to ventilate), using the Pentax Airway Scope and Macintosh laryngoscope in a manikin, in three simulated circumstances of restricted laryngoscopy: (1) the patient lying supine on the ground; (2) the patient lying supine on the ground with the head close to a wall; (3) the patient confined to a car driver’s seat. For the Pentax Airway Scope, intubation was successful (within 2 min) in all three circumstances. For the Macintosh laryngoscope, intubation was successful in all cases in circumstance (1), eight in circumstance (2), and five in circumstance (3). In circumstances (2) and (3), the Pentax Airway Scope needed significantly shorter time to see the vocal cords (median [95% confidence interval] for difference: 4.5 [0.5–9.5] s in circumstance (2), and 12.5 [7.0–32.5] s in circumstance (3)), shorter time to intubate (median [95% confidence interval] for difference: 21.0 [5.5–38.5] s in circumstance (2), and 40.5 [17.5–64.0] s in circumstance (3)), and shorter time to ventilate the lungs (median [95% confidence interval] for difference: 18. 3 [4.5–36.0] s in circumstance (2), and 47.5 [16.0–84.5] s in circumstance (3)). These results indicate that, in situations where access to the patient’s head is restricted, the Pentax Airway Scope is more effective than the Macintosh laryngoscope. [ABSTRACT FROM AUTHOR]

Background and Objectives Morbidity and mortality from ABO-incompatible transfusion persist as consequences of human error. Even so, insufficient attention has been given to improving transfusion safety within the hospital. Materials and Methods National surveys of ABO-incompatible blood transfusions were conducted by the Japanese Society of Blood Transfusion, with support from the Ministry of Health, Labor and Welfare. Surveys concluded in 2000 and 2005 analysed ABO-incompatible transfusion data from the previous 5 years (January 1995 to December 1999 and January 2000 to December 2004, respectively). The first survey targeted 777 hospitals and the second, 1355 hospitals. Data were collected through anonymous questionnaires. Results The first survey achieved a 77·4% response rate (578 of 777 hospitals). The second survey collected data from 251 more hospitals, but with a lower response rate (61·2%, or 829 of 1355 hospitals). The first survey analysed 166 incidents from 578 hospitals, vs. 60 incidents from 829 hospitals in the second survey. The main cause of ABO-incompatible transfusion was identification error between patient and blood product: 55% (91 of 166) in the first survey and 45% (27 of 60) in the second. Patient outcomes included nine preventable deaths from 1995 to 1999, and eight preventable deaths from 2000 to 2004. Conclusion Misidentification at the bedside persists as the main cause of ABO-incompatible transfusion. [ABSTRACT FROM AUTHOR]

Unusual HLA-A‘null’ alleles because of an entire gene deletion were found in three apparently unrelated Japanese families with leukemia patients. Inclusion of the entire HLA-A gene in the deletion was confirmed by polymerase chain reaction direct sequencing of the surrounding regions of HLA-A. Further localization of the breakpoints of the HLA-A deletion at the centromeric and telomeric sides was performed, and these families were shown to possess the identical deletion. We then determined the genomic sequence of the HLA-A-deleted haplotype. Surprisingly, the haplotype turned out to carry an insertion of an SVA (SINE-VNTR- Alu) retrotransposon of 2 kb as well as the 14 kb deletion that included the entire HLA-A gene. [ABSTRACT FROM AUTHOR]

The objective of the present study was to determine whether selection of fluoroquinolone resistance could be easily induced in Campylobacter jejuni-colonized chickens by treatment with enrofloxacin of representative fluoroquinolones at the inherent dosage licensed in Japan (50 ppm in drinking water for 3 days). In the case of isolates from chickens of study 1, an increase in the population of susceptible isolates appeared after the cessation of treatment and maintained throughout the experiments. On the contrary, our results of study 2 demonstrated that administration of enrofloxacin generated a rapid increase of fluoroquinolone resistance in C. jejuni showing the mutation of Asp-90-Asn in the gyrA gene. Present results indicate that the enrofloxacin treatment for broilers at the inherent dosage is able to select fluoroquinolone resistance in C. jejuni. We conclude that whatever enrofloxacin dosage is used, an emergence of fluoroquinolone resistant of C. jejuni occurs. [ABSTRACT FROM AUTHOR]

The manufacturer of the Laryngeal Tube (VBM, Germany) states that the cuffs should be inflated until the intracuff pressure reaches 60 cmH2O or with a certain volume of air (60 ml for the size 3 and 80 ml for size 4). We studied 100 patients to investigate this. In addition, we examined whether the patient's height or weight could be a predictor of the required volume. Following insertion of a laryngeal tube, the cuff volume at the intracuff pressure 60 cmH2O was measured. The mean (SD) volume was 62 (7.2) ml for size 3 and 84 (11.2) ml for size 4. There was a correlation between the height of the patient and the cuff volume (correlation coefficient = 0.64; p < 0.01; volume (ml) = −86.5 + 1.02 height (cm)), and between the patient's weight and the cuff volume (correlation coefficient = 0.37; p < 0.01; volume (ml) = 45.3 + 0.558 weight (kg)). The required volume for size 3 was < 60 ml in nine of 27 patients (33%), and for size, 4 < 80 ml in 20 of 73 patients (27%). Our results support the manufacturer's recommended cuff volumes, but if the cuff is inflated with these fixed volumes (60 ml and 80 ml), the cuff would be overinflated in one-third of patients, increasing the theoretical risk of ischaemic changes to the oropharynx. Since the cuff volume is correlated with the patient's height or weight, the cuff volume should be adjusted to the patients' stature. [ABSTRACT FROM AUTHOR]

The laryngeal tube has a potential role in airway management during anaesthesia or cardiopulmonary resuscitation. In patients with unstable necks, the head and neck may need to be stabilised manually (manual in-line stabilisation), but it is not known whether this procedure affects the ease of insertion of the laryngeal tube. We studied, in a cross-over study, 21 adult patients to compare the success rate of ventilation through the laryngeal tube between the Magill position (a pillow under the occiput and the head extended) or the manual in-line position of the head and neck (without a pillow under the occiput). After induction of anaesthesia and neuromuscular blockade, the laryngeal tube was inserted in turn in the two positions. The ease of insertion was scored with four categories (easy, moderately difficult, difficult and impossible), and adequacy of ventilation through the device was assessed. Ventilation was adequate in all 21 patients in the Magill position, but only in two of 21 patients during manual in-line positionin (p < 0.01; 95%CI for difference: 68–94%). In the Magill position, insertion of the laryngeal tube was easy in 16 patients and moderately difficult in the remaining five patients; in the manual in-line stabilisation position, insertion was moderately difficult in two patients and impossible in the remaining 19 patients. Stabilisation of the patient's head and neck by the manual in-line method made insertion of the laryngeal tube either difficult or impossible. [ABSTRACT FROM AUTHOR]

Provides evidence that a higher increment of blood draw speed does not provide a higher concentration of total nuclear cells (TNCs) in blood products. Evaluation of the optimal procedure for apheresis to obtain sufficient peripheral blood mononuclear cells (PBMNC) by analyzing 129 apheresis procedures performed at the Chiba University Hospital in Japan.

Background: The laryngeal tube has a potential role during anaesthesia, but there have been only a few studies assessing its efficacy during the entire course of anaesthesia, and all previous studies used prototypes. We studied 100 patients to assess the efficacy of a new laryngeal tube during the entire course of anaesthesia.Methods: After induction of anaesthesia, the laryngeal tube was inserted (up to two times) and adequacy of ventilation was assessed. The airway pressure at which gas leaked around the device was measured. The device was used during anaesthesia, while ventilation was controlled. The device was removed after the patient had opened the mouth to verbal command. Any complications during and after anaesthesia were recorded.Results: Ventilation was possible at the first attempt in 90 patients, at the second attempt in another seven patients, and adequate ventilation failed after two attempts in three patients. Median (interquartile range) leak pressure was 28 (22-30) cmH2O. In all 97 patients, the laryngeal tube was used until the end of surgery. However, in two of the 97 patients the airway was partially obstructed during anaesthesia and it was necessary to reposition the device. The laryngeal tube was tolerated well during emergence from anaesthesia. No hypoxia, regurgitation, vomiting or laryngospasm occurred in any patient. On removal of the laryngeal tube, no blood was detected on the device and no apparent ischaemic changes to the tongue were observed in any patient. Post-operatively, six patients complained of a mild sore throat, and no patient complained of difficulty in swallowing or numbness of the oropharynx.Conclusion: The laryngeal tube can be useful for maintaining a patent airway during anaesthesia. [ABSTRACT FROM AUTHOR]

Summary To examine the education of trainees with regard to difficult airway management, we sent a questionnaire to all 89 Japanese University Departments of Anaesthesia (to be answered by a person who was responsible for teaching trainees) and all 280 Royal College of Anaesthetists' Tutors in the UK. The presence or absence of a formal training module for difficult airway management, timing and methods of training, types of airway devices that should be taught, and tutors' expertise with various techniques and devices were surveyed. Sixty-seven of the 89 Japanese tutors (75%) and 167 of 280 UK tutors (60%) replied to the questionnaire. Only 19 of 67 (28%) Japanese anaesthetists and 33 of 167 (20%) UK anaesthetists who replied, indicated that they had a difficult airway training module. In six Japanese departments (9%) and 115 (69%) UK departments, equipment for percutaneous transtracheal ventilation was readily available. Airway devices and techniques that tutors considered necessary to be mastered in the first 2 years of training, differed considerably between Japan and the UK, with notable differences in the use of gum elastic bougies and awake intubation. A training module for difficult airway management is often not provided and equipment for emergency transtracheal ventilation is often unavailable in both countries. [ABSTRACT FROM AUTHOR]

As a source of hematopoietic stem cells for transplantation, the use of peripheral blood stem cells (PBSCs) has become routine and comparable to that of the use of bone marrow. Recently, elderly patients with hematological malignancies also have been allowed to receive minitransplantations with nonmyeloablative conditioning regimens under sufficient PBSC infusion. As a result of these minitransplantations, elderly donors have been chosen increasingly from the siblings of elderly patients. We analyzed factors influencing the condition of CD34+ cells in the first days of collection in 49 healthy donors from July 1995 to January 2001. The median dose of recombinant human granulocyte colony-stimulating factor was 8 μg/kg/day (range 8 ∼ 10) over 3 days. The target number of CD34+ cells used in this study was ≧ 3 × 106 cells/kg of recipient body weight. The median apheresis volume was 12 L. Except for one 60 year old man, we obtained an adequate number of stem cells. In the regression analysis, a negative correlation was seen between donor age and the number of CD34+ cells/kg of recipient body weight per 12 L volume (Y = aX + b; a = -0.07507; b = 6.629996; r = -0.50985; p = 0.000252). Significantly higher apheresis results were obtained in donors younger than 45 years compared with donors 45 years old and older (p < 0.0227). There were no correlations among the number of CD34+ cells, donor body weight, and the number of leukocytes in peripheral blood on the first day of apheresis. [ABSTRACT FROM AUTHOR]

Summary We studied the reasons for difficulty with tracheal intubation over a fibrescope, and whether cricoid pressure facilitated intubation, in 50 patients. After induction of anaesthesia and neuromuscular blockade in 10 patients (phase 1), we attempted to clarify the reasons for difficulty in advancing a tracheal tube over an orally-inserted fibrescope, by observing through another fibrescope that was inserted nasally into the pharynx. In the next 40 patients (phase 2), we studied the effect of cricoid pressure on the success rate of tracheal intubation over the fibrescope. After a fibrescope (with a tracheal tube over it) had been inserted orally into the trachea, patients were randomly allocated to receive either criocoid pressure or sham pressure, and the success rate of intubation within 60 s was assessed. In phase 1, the tube was advanced into the trachea without difficulty in three of 10 patients. In the remaining seven patients, the tube impacted on the epiglottis in one patient and on the arytenoid cartilage in another two patients, and the tube migrated into the hypopharynx in the remaining four patients. In phase 2, tracheal intubation was successful within 60 s in seven of 21 patients (33%) without cricoid pressure, compared with 12 of 19 patients (63%) when cricoid pressure was applied (95% CI for difference 2–59%; p = 0.04). We conclude that cricoid pressure facilitates fibrescope-aided tracheal intubation. [ABSTRACT FROM AUTHOR]

Aim: Dmo1 (Diabetes Mellitus OLETF type I) is a major quantitative trait locus for dyslipidaemia, obesity and diabetes phenotypes in the Otsuka Long Evans Tokushima Fatty (OLETF) rat strain. To evaluate possible metabolic and pathological improvements generated by correction of the Dmo1 genetic pathway, we produced congenic lines, in which both OLETF Dmo1 alleles are replaced by the F344-derived genome. Methods: Congenic animals were produced by introgressing F344-derived Dmo1 alleles into the OLETF rat. Congenic animals of the fourth generation (BC4) were intercrossed to obtain F1 animals (BC4:F1). Animals of the next generation, BC4:F2, were used for this study. We used 23 BC4:F2 males harbouring homozygous replacement of the OLETF Dmo1 region with the F344-derived genome. Seven animals with OLETF-derived Dmo1 alleles were used as controls. Results: Dmo1 -F344/F344 congenic rats showed significant decreases in body weight, abdominal fat weight, serum triacylglycerols, total cholesterol, food consumption and blood glucose after glucose loading (13%, 39%, 45%, 27%, 18% and 27% respectively; p < 0.05) compared with Dmo1 -OLETF/OLETF animals. Furthermore, histopathological analysis of the kidney showed that mesangial sclerosis, hyalin deposits and deposition of PAS-positive substance were significantly lower in Dmo1 -F344/F344 animals (p < 0.05). Conclusion: Improvements in metabolic parameters and histopathological scores show that correction of the Dmo1 genetic pathway in the diabetic and mildly obese OLETF rat strain produces wide-ranging therapeutic effects. Thus, this pathway might represent a new drug target also applicable to humans. [ABSTRACT FROM AUTHOR]

There has been considerable interest in using safeguarded needles to reduce needlestick injury. In a randomised design, we studied the efficacy and safety of two such needles (the Insyte AutoGuard and the Protective Acuvance), by comparing them with a conventional catheter needle (Insyte), for intravenous cannulation (18 G) in 150 patients and for intra-arterial cannulation in another 150 patients (20 G). For intravenous cannulation, the success rates were similar in the three groups but insertion of the AutoGuard or Acuvance catheter was significantly more difficult than the conventional catheter. For the Acuvance, the back-flow of blood into the chamber was sometimes too slow. For intra-arterial cannulation, insertion of the AutoGuard was significantly more difficult than the other two devices, mainly because the backflow chamber of the AutoGuard was too short so that the chamber often filled with blood before cannulation. Insertion of the Acuvance was significantly more difficult than the conventional catheter. For both intravenous and intra-arterial insertion, handling of the withdrawn needle was judged significantly safer in the AutoGuard group than the other two groups, whereas there was no significant difference in the safety between the Acuvance and conventional groups. In five subjects from the AutoGuard group, blood splashed on retraction of the needle. Blood contamination during needle withdrawal occurred frequently in the control and Acuvance groups, but rarely occurred in the AutoGuard group. Therefore, the AutoGuard needle is more suitable for intravenous cannulation, and the Acuvance is more suitable for intra-arterial cannulation. [ABSTRACT FROM AUTHOR]

Summary. A 57-year-old male carpenter living in Sagamihara, Kanagawa Prefecture, visited the Department of Dermatology of Kitasato University Hospital because an ulcer which appeared in his left forearm around May 1992 had spread gradually. An oval, shallow ulcer measuring 39 mm × 18 mm was found on the flexor aspect of the left forearm. Histopathological examination showed partial ulceration on the epidermis and marked cell infiltration throughout the entire dermal layer with an abscess in the centre and granulomatous reactions around it. PAS-positive spores were present between infiltrating cells and in giant cells in abscess and in granulomatous reactions. The skin lesion rapidly disappeared after beginning treatment with 125 mg day-1 terbinafine and only a slight redness remained 14 weeks after starting the treatment. At this time the culture was negative. We conducted immunohistochemical examinations of the affected skin before, during and after starting treatment with terbinafine and studied local expression of cytokines at the affected lesion. [ABSTRACT FROM AUTHOR]

Focuses on the issues raised against the use of Laryngeal Tube manufactured in Germany concerning its potential to produce oropharyngeal ischaemia when the intracuff pressure was inflated to 60 centimeter H[sub 2]O. Potential role of the laryngeal tube in airway management; Pressure exerted by the cuff of the laryngeal tube on the oropharynx; Incidence of ischemic changes.

Background: In patients with unstable necks, the neck should be stabilized during induction of anaesthesia, but this may make tracheal intubation difficult. Awake intubation may produce straining, which could be detrimental to the unstable neck.Methods: We studied 20 patients with unstable necks to examine the efficacy of insertion of the intubating laryngeal mask under conscious sedation (to minimize the possibility of losing a patent airway and to facilitate fibrescope-aided intubation) followed by tracheal intubation through the laryngeal mask after induction of anaesthesia (to reduce stress response to intubation). After the patient had been sedated with midazolam (up to 5 mg) and fentanyl (up to 100 microg), the intubating laryngeal mask was inserted. General anaesthesia was then induced with sevoflurane and tracheal intubation attempted.Results: In all patients, tracheal intubation through the laryngeal mask succeeded without airway obstruction. Neither insertion of the mask under conscious sedation nor tracheal intubation after induction of anaesthesia caused straining, and only two patients moved upper extremities at intubation. Insertion of the laryngeal mask did not significantly alter blood pressure or heart rate. Tracheal intubation significantly increased blood pressure and heart rate, but the increase was considered to be small.Conclusions: In the patient with an unstable neck with a low risk of pulmonary aspiration, insertion of the intubating laryngeal mask while the patient is sedated may minimize difficulty in obtaining a patent airway before tracheal intubation and may facilitate a fibrescope-aided tracheal intubation; subsequent induction of anaesthesia before tracheal intubation may minimize stress response to intubation. [ABSTRACT FROM AUTHOR]

Replies to the a commentary by J.R. Maltby, M.T. Beriault and N.C. Watson on the incidence of gastric distension and ventilation during laparoscopic cholecystectomy, published in volume 56 of the journal 'Anaesthesia.' Increase in stomach secretions during surgery; Regurgitation during emergence from anesthesia; Estimated incidence of pulmonary aspiration.

Focuses on the advantages and disadvantages of using the Arrow Flex Tip Plus epidural catheter in epidural anesthesia administration. Easiness of inserting the Arrow catheter with a lower incidence of paraesthesia or penetration of epidural veins; Presentation of a clinical case which shows difficulty of removing an Arrow epidural catheter immediately after insertion.

The Vital View laryngoscope (Vital Signs, NJ, USA) consists of a plastic disposable blade containing a fibrelight and a non-disposable handle; there is therefore no need to sterilise the blade and no concern about disintegration of the fibrelight. In a random cross-over design, we compared the Vital View laryngoscope with a conventional metal fibrelight laryngoscope (Welch Allyn, NY, USA) in 100 patients. The Vital View laryngoscope produced a brighter field than the metal laryngoscope (p < 0.001), whereas there was no significant difference in the view of the glottis or the success rate of tracheal intubation. In no patient did any problem occur, such as damage to the laryngoscope blade or loss of light during laryngoscopy. In another 10 patients, prevention of light emission from the side of the laryngoscope blade reduced the brightness (p < 0. 01). This indicated that the brightness of the Vital View laryngoscope is produced by light emission not only from the tip of the blade but also from the side of the blade. Therefore, the disposable Vital View laryngoscope can be used as effectively as a conventional non-disposable laryngoscope. [ABSTRACT FROM AUTHOR]

Presents several letters which focused on topics that are related to medical care and anesthetics. Exposure of nurses to radiation on intensive care units; Effect of sedation on desaturation; Use of pulse oximetry in monitoring during anesthesia.

We studied the ability of high-volume, low-pressure tracheal tube cuffs (Portex Soft Seal, Portex Profile, Mallinckrodt Lo-Contour and Mallinckrodt Hi-Lo tubes) to prevent leakage of fluid into the airway, in a model trachea and lung. Five tubes (7.0 and 8.0 mm internal diameter) of each type were used. Each tube was inserted into the model trachea and the cuff inflated until the intracuff pressure reached either 20, 30 or 40 cm H2O. The model lung was ventilated with a tidal volume of 700 ml and respiratory rate of 14 breath.min-1 at a compliance of 20 cm H2O. Ten millilitres of 0.01% methylene blue solution were infused over the cuff and the volume of fluid leaking past the cuff over 5 min was measured. The leak volume for the Soft Seal tube was less than that for the Profile or Lo-Contour tubes at all intracuff pressures (all p<0.05). Compared with the Hi-Lo tube, the volume leaking past the cuff for the Soft Seal tube was greater at an intracuff pressure of 20 cm H2O (p<0.05), whereas there was no significant difference between these two tubes at an intracuff pressure of 30 or 40 cm H2O. We conclude that the cuff of the Portex Soft Seal tube prevented leakage of fluid significantly more than that of the Portex Profile or Mallinckrodt Lo-Contour tubes, and to a similar degree to that of the Mallinckrodt Hi-Lo tube. [ABSTRACT FROM AUTHOR]

Deals with a study which examined the ability of high-volume, low-pressure tracheal tube cuffs to prevent leakage of fluid into the trachea and lung. Description of the cuffs used in the study; Methods; Results; Discussion.

Presents guidelines for irradiation of blood and blood components to prevent post-transfusion graft-vs.-host disease in Japan. Irradiation of blood stored for 14 days; Recommended transfusion of irradiated blood for cardiosurgery, cancer surgery, elderly recipients and severe trauma; Importance for blood collected within 72 h to be irradiated.

Discusses advancements in the cuff volume and appropriate size of laryngeal masks. Use of laryngeal masks in the management of anesthetized patients; Applications of laryngeal masks in adenotonsillectomy; Pros and cons of laryngeal masks in clinical practice.

We studied the efficacy of the laryngeal tube (VBM, Germany) during intermittent positive-pressure ventilation in 50 patients. After induction of anaesthesia and neuromuscular blockade, a size 4 laryngeal tube was inserted for patients of height 155 cm or greater. After insertion of the laryngeal tube, its pharyngeal and oesophageal balloons were inflated to an intracuff pressure of 60 cmH2O. An Ambu self-inflating bag was attached to the laryngeal tube and the lungs were ventilated manually at 15 breath.min-1. It was possible to ventilate the lungs at the first attempt in 47 patients (94%). The airway pressure at which air leaked around the laryngeal tube exceeded 18 cmH2O in 41 patients (82%), and was > 30 cmH2O in 25 (50%). Median [interquartile range (range)] leak pressure was 30 [20–30 (6 to > 30)] cmH2O. Median [interquartile range (range)] tidal volume was 587 [533–653 (133–800)] ml or 8.8 [8.2–10.6 (1.9–12.6)] ml.kg-1. We conclude that the laryngeal tube has a potential role in airway management during intermittent positive-pressure ventilation for anaesthesia or cardiopulmonary resuscitation. [ABSTRACT FROM AUTHOR]

Summary The protective activity of Mycoplasma hyopneumoniae inactivated vaccine prepared from sedimented whole cells and cell-free culture supernates was evaluated experimentally using hysterectomy-produced, colostrum-deprived pigs in which mycoplasmal pneumonia had been induced. The culture supernate vaccine containing less than 101 colour-changing units (CCU)/0.2 ml of M. hyopneumoniae significantly (P < 0.05) reduced the percentage of lung lesions compared to controls (3.2 ± 3.9 vs. 12.2 ± 2.2 %), whereas the sedimented whole cells vaccine containing 1010 CCU/0.2 ml of organisms provided variable protection (18.7 ± 16.5 vs. 12.2 ± 2.2 %). Serum from the pigs vaccinated with culture supernate reacted with six protein bands of 97, 89, 65, 46, 42 and 41 kDa by immunoblot analysis. From these results, we conclude that vaccination with culture supernate of M. hyopneumoniae can provide protection against M. hyopneumoniae infection and that these antigens in the culture supernate may be closely related to the reduction of lung lesions. [ABSTRACT FROM AUTHOR]

We studied 40 anaesthetised and paralysed patients, in a randomised manner, to compare the ease of tracheal intubation either using a Macintosh laryngoscope and gum elastic bougie (group C) with the ease of tracheal intubation through the intubating laryngeal mask using a fibreoptic bronchoscope (group L), during manual in-line stabilisation of the patient's head and neck. In both groups, a maximum of 120 s was allowed for attempts at tracheal intubation. The ease of placement of the intubating laryngeal mask or tracheal intubation was assessed using a 100-mm visual analogue scale (VAS). In patients in whom tracheal intubation succeeded, time for intubation was measured. The intubating laryngeal mask was placed successfully in 19 of 20 patients, with the median VAS of 18 mm (95% CI: 13-32 mm). The success rate of tracheal intubation in group L (17 patients) was significantly higher than in group C (nine patients) (p < 0.01), tracheal intubation in group L was significantly easier than intubation in group C (p < 0.001; 95% CI for difference in VAS: 18-68 mm) and time taken for tracheal intubation was significantly shorter in group L than in group C (95% CI for difference: 8-50 s). [ABSTRACT FROM AUTHOR]

Presents several correspondence on anesthesia. Use of a cuffed oropharyngeal airway and Aintree catheter in a difficult airway; Comment on the article in the successful use of the intubating laryngeal mask in a patient with fixed flexed neck and deviated trachea; Comments on the target of the grading system on anesthetists.

One possible method of reducing the incidence of needle-stick injury is to use needles with safeguard mechanisms. The needle of the Insyte AutoGuard intravenous cannula can be retracted into the safety barrel. One hundred patients were randomly allocated to receive either an 18-gauge conventional Insyte intravenous cannula (group C) or the AutoGuard cannula (group AG) to assess the ease of use and efficacy of the AutoGuard device. It was possible to insert the cannula into the vein within two attempts in all patients; there was no significant difference between two groups with respect to ease of insertion. No problems, such as inadvertent withdrawal of the needle, occurred during insertion in any patient. Handling the withdrawn needle was judged significantly safer in group AG than in group C (p < 0.001). Blood contamination often occurred where a withdrawn needle was placed in group C, whereas no blood stain was detected in any case in group AG (p < 0.001). The AutoGuard cannula provides safer handling of a withdrawn needle without reducing its ease of insertion. [ABSTRACT FROM AUTHOR]

We studied the efficacy of the cuffed oropharyngeal airway in 100 patients. Insertion of the airway after induction of anaesthesia with propofol was easy in 95 of 100 patients, moderately difficult in four patients and failed in one patient. Complications, such as coughing, gagging or body movement, occurred during induction and insertion in 15 patients. Insertion of the airway was not associated with tachycardia or hypertension. Manual ventilation through the airway was easy in less than 30% of patients immediately after insertion. Manual ventilation became easier after adjusting the position of the patient's head, neck or jaw. During spontaneous breathing, adjustment of the head, neck or jaw was required in 30% of patients. Complete airway obstruction occurred in one patient after insertion of the device and in two patients during maintenance of anaesthesia. The airway was left in place during emergence from anaesthesia in the remaining 97 patients. No complications occurred in 91 patients and coughing occurred in the remaining six patients before or during removal of the airway. No regurgitation, vomiting or laryngospasm occurred in any patient at any time. Therefore, the cuffed oropharyngeal airway has a potential use in anaesthetised patients who are breathing spontaneously. [ABSTRACT FROM AUTHOR]

Sixty patients were randomly allocated to one of three groups and the incidences of respiratory complications which occurred during emergence from anaesthesia were compared under the following three circumstances: tracheal extubation after the patient had regained consciousness (awake group); tracheal extubation while the patient was still anaesthetised (anaesthetised group); and the use of the laryngeal mask during emergence from anaesthesia (mask group). In the mask group, the laryngeal mask was inserted under deep anaesthesia before tracheal extubation and the lungs were ventilated through the laryngeal mask after tracheal extubation. In the awake group, straining (bucking) occurred in 18 patients and desaturation (arterial oxygen haemoglobin saturation < 95%) in two patients. In the anaesthetised group, airway obstruction occurred in 17 patients and desaturation in one of these patients. In the mask group, ventilation through the laryngeal mask was temporarily difficult immediately after tracheal extubation in one patient and coughing occurred before removal of the mask in three patients. No respiratory complications occurred in two patients in the awake group, three patients in the anaesthetised group and 16 patients in the mask group. The incidence of respiratory complications during recovery from anaesthesia was significantly lower in the mask group than in the other two groups (pooled) (p << 0.001). Therefore, the use of the laryngeal mask after tracheal extubation decreases the incidence of respiratory complications during recovery from anaesthesia. [ABSTRACT FROM AUTHOR]

One possible method of reducing the incidence of needle-stick injury is to use needles with safeguard mechanisms. The needle of the Insyte AutoGuard intravenous cannula can be retracted into the safety barrel. One hundred patients were randomly allocated to receive either an 18-gauge conventional Insyte intravenous cannula (group C) or the AutoGuard cannula (group AG) to assess the ease of use and efficacy of the AutoGuard device. It was possible to insert the cannula into the vein within two attempts in all patients; there was no significant difference between two groups with respect to ease of insertion. No problems, such as inadvertent withdrawal of the needle, occurred during insertion in any patient. Handling the withdrawn needle was judged significantly safer in group AG than in group C (p < 0.001). Blood contamination often occurred where a withdrawn needle was placed in group C, whereas no blood stain was detected in any case in group AG (p < 0.001). The AutoGuard cannula provides safer handling of a withdrawn needle without reducing its ease of insertion. [ABSTRACT FROM AUTHOR]