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While global patterns of human genetic diversity are increasingly well characterized, the diversity of human languages remains less systematically described. Here we outline the Grambank database. With over 400,000 data points and 2,400 languages, Grambank is the largest comparative grammatical database available. The comprehensiveness of Grambank allows us to quantify the relative effects of genealogical inheritance and geographic proximity on the structural diversity of the world's languages, evaluate constraints on linguistic diversity, and identify the world's most unusual languages. An analysis of the consequences of language loss reveals that the reduction in diversity will be strikingly uneven across the major linguistic regions of the world. Without sustained efforts to document and revitalize endangered languages, our linguistic window into human history, cognition and culture will be seriously fragmented. Genealogy versus geography Constraints on grammar Unusual languages Language loss Conclusion

Introduction: There is an increasing interest in using airway ultrasound to predict difficult intubation. Studies to date have excluded pregnant women in reporting airway measurements. We performed this study to compare the mean distance from skin to epiglottis in parturients to that reported in previously published studies. We also assessed the correlation of mean distance from skin to epiglottis with other elements of the airway examination. Methods: A total of 100 parturients were recruited from a tertiary hospital’s labor and delivery floor. Standard physical examination parameters were recorded in addition to the mean distance from skin to epiglottis for all subjects. The ratio of height-to-thyromental distance was used to classify airways as potentially favorable or unfavorable. Results: The average mean distance from skin to epiglottis in parturients was 19.9 ± 3.3 mm and followed a normal distribution. The mean distance from skin to epiglottis was moderately correlated with height and body mass index. There was no difference in mean distance from skin to epiglottis between subjects with favorable versus unfavorable airways as classified by ratio of height-to-thyromental distance. Conclusion: The typical mean distance from skin to epiglottis in parturients falls between previously published values in mixed populations. Previously published cut-off values using airway ultrasound to predict difficult intubation are not likely to apply to parturients.

Difficult airway management in the morbidly obese population is an important topic as the physiological changes of obesity can lead to grave consequences when oxygenation is not rapidly established following anaesthetic induction. The correlation between elevated body mass index and direct laryngoscopy is unclear, probably because excess adipose tissue has a variable distribution among morbidly obese patients. The reader will be able to identify the subset of morbidly obese patients where difficult airway management is indeed expected. In such patients, optimizing modifiable factors such as preoxygenation, apnoeic oxygenation, positioning, and minimizing atelectasis is of primary importance. Alternative strategies for tracheal intubation other than direct laryngoscopy are discussed in this chapter, as well as safe extubation strategies for the difficult airway.

Objective To report the patient selection, surgical technique, and outcomes of parotidectomy using local anesthesia under monitored anesthesia care (MAC). Methods A retrospective chart review was performed for patients undergoing parotidectomy under local anesthesia at an academic head and neck surgery center. Results Six patients deemed high risk for general anesthesia (GA) due to medical comorbidities or with a strong preference to avoid GA underwent parotidectomy using local anesthesia and MAC. Parotidectomy was performed for several indications, including benign tumors, malignant tumors, and chronic sialadenitis. Mean age of patients was 78.0 ± 7.9 years, and all had an American Society of Anesthesia score ≥ 2 and Charlson comorbidity index ≥4. Mean operative time was 102.8 ± 38.3 min, comparable to that of parotidectomy under general anesthesia. No major complications occurred. Minor complications included three cases of temporary postoperative facial nerve weakness limited to 1–2 lower division branches. At most recent follow up (10 to 48 months), all patients were medically stable and disease free. Conclusion In carefully selected patients, parotidectomy under local anesthesia is a viable treatment alternative that can be offered to patients. Successful outcomes require preoperative counseling, meticulous technique, and close collaboration with anesthesia colleagues.

Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) maintains oxygenation and blunts the partial pressure of carbon dioxide (PaCO2) rise in nonpregnant subjects during apnea. Physiologic changes of pregnancy may attenuate the utility of THRIVE. We present a nulliparous patient at 31 weeks' gestation undergoing tracheal dilation requiring general anesthesia without intubation utilizing THRIVE. Our data confirms prior reports in nonpregnant patients showing markedly extended time to desaturation. However, PaCO2 rise more closely mirrors classic apneic oxygenation in nonobstetric patients. The PaCO2 elevation and subsequent acidosis may limit the utility of THRIVE for prolonged apnea in pregnant surgical patients.

ObjectiveTo describe the use of balloon dilation with non-invasive ventilation in the treatment of pregnant patients with idiopathic subglottic stenosis.MethodsThe medical charts of four consecutive patients who underwent jet ventilation or high-flow nasal cannula oxygenation with balloon dilation for the treatment of idiopathic subglottic stenosis during pregnancy were reviewed.ResultsObjective improvement of subglottic stenosis was seen in all four cases, with end-result Myer–Cotton grade 1 lesions down from pre-procedure grade 3 lesions. Patients also reported subjective improvements in symptomatology, with no further airway issues. All patients delivered normally, at term.ConclusionLaryngeal dilation with continuous radial expansion pulmonary balloons using non-invasive ventilation for the treatment of idiopathic subglottic stenosis in pregnant patients is safe and efficacious, and should be the first line treatment option for this patient population. The improvement in symptoms, and lack of labour and pregnancy complications, distinguish this method of treatment from others reported in the literature.

To compare VOTE classification findings (velum, oropharyngeal-lateral walls, tongue base, and epiglottis) for drug-induced sleep endoscopy (DISE) among patients with obstructive sleep apnea (OSA) using 2 sedation protocols.Case series with chart review.Single tertiary institution.Patients with OSA who underwent DISE.A total of 216 patients underwent DISE between November 23, 2011, and May 1, 2015. DISE findings based on VOTE classification were compared between patients receiving the propofol- and dexmedetomidine-based sedation protocols.Patients with OSA (N = 216; age, 44.3 ± 11.7 years; body mass index, 27.9 ± 4.8 kg/m(2)) underwent DISE with intravenous administration of propofol (n = 52) or dexmedetomidine (n = 164). There were no statistically significant differences between the 2 groups in baseline apnea-hypopnea index, oxygen desaturation index, Mallampati score, tonsil size, Epworth Sleepiness Scale score, peripheral oxygen saturation nadir, age, sex, or body mass index. Patients in the propofol group had a significantly increased likelihood of demonstrating complete tongue base obstruction (75%, 39 of 52) versus partial or no obstruction (25%, 13 of 52) in the anterior-posterior dimension, as compared with the dexmedetomidine group (complete obstruction: 42.7%, 70 of 164; partial or no obstruction: 57.3%, 94 of 164; odds ratio: 4.0; 95% confidence interval: 2.0-8.1; P = .0001). Obstruction of other airway subsites was not significantly different.Use of propofol versus dexmedetomidine to induce sedation may have a significant effect on the pattern of upper airway obstruction observed during DISE. Randomized prospective studies are indicated to confirm these initial findings.

Everett et al. (2015) find a that complex tonal languages tend to be found in humid environments a correlation that holds up within different families and parts of the world. Despite the impressive statistical and experimental support for this causal claim, evidence is needed from natural language use, such as Chinese speakers changing their use of tone depending on humidity, before the claim can be considered well supported. There is otherwise a risk that this correlation could be an artifact of history of language families and language contact. To illustrate this, I show in a series of simulations that random selection of languages followed by language contact can create a positive global correlation between tone and humidity with as much as a 83 per cent probability, and a 47 per cent probability of holding within at least two different macro-areas. Language contact is additionally responsible for these correlations holding up when controlling for language relatedness, as I show that when using the random independent samples test employed by Everett et al., their result is still expected by chance as much as 60 per cent to 80 per cent of the time. I further show how contact can create correlations within families by a phylogenetic analysis of the evolution of tone in Niger-Congo and Sino-Tibetan. The number of tones that languages use correlates with humidity within five different global areas (Africa, Eurasia, South America, North America, and the Pacific), and within four different language families (Sino-Tibetan, Austro-Asiatic, Afro-Asiatic, and Niger-Congo). This is better statistical support than even for word order universals, which despite having some support when sampling from different macro-areas (Dryer 1992) do not seem to hold consistently within large language families (Dunn et al. 2011). In addition, the experimental evidence that they cite showing that dry air has …

This case describes the development of laryngeal chondronecrosis after use of the laryngeal mask airway (LMA). A 69-year-old male with prior laryngeal irradiation underwent total knee replacement with general anesthesia via LMA. Postoperatively, he developed laryngeal chondronecrosis, bilateral vocal fold immobility, and aspiration, necessitating tracheostomy and gastrostomy placement. He improved with hyperbaric oxygen therapy, intravenous antibiotics, and endoscopic repair of a residual fistula. Vocal fold motion returned and he was decannulated. Chondronecrosis of the larynx may occur with the use of the LMA, and caution should be used in patients with a history of prior laryngeal irradiation.

Background The use of flexible laryngeal mask airway (FLMA) in elective ear, nose and throat (ENT) surgery offers significant advantages, but is frequently considered inferior to tracheal intubation (TI) for ventilation and airway protection. We investigated the safety and success rate of intraoperative FLMA use with positive pressure ventilation (PPV), and the factors responsible for FLMA failure. Methods A 15-year single center retrospective study. FLMA failure was defined as the need for FLMA removal and TI, either during induction (primary failure), or after turning the patient over to the surgeon (secondary failure). Strict failure criteria included the inability to achieve and/or maintain all 3 essential FLMA functions, such as ventilation (tidal volume ≥6 mL/kg), airway protection from above the cuff (airway sealing pressure [ASP] >12 cm H2O), and separation of the respiratory and gastrointestinal tracts (absent gastric insufflation during PPV). Results In 685 patients, FLMA was successfully inserted in 94%. Secondary failure rate was 1.5%, with half of failures observed intraoperatively. The inability to seat FLMA during induction or FLMA dislodgment were the most common reasons for failures. The number of FLMA insertion attempts and low ASP were associated with FLMA primary failure and the need for TI. There were no complications. Conclusions The results suggest an acceptably low failure rate of use of FLMA with PPV in selected ENT surgical procedures. True intraoperative FLMA failure is uncommon. We advocate observing strict criteria for adequacy of FLMA placement, and close monitoring of FLMA function intraoperatively at all times.

This is the second of a two-part overview of the fundamentals of oncology for interventional radiologists. The first part focused on clinical trials, basic statistics, assessment of response, and overall concepts in oncology. This second part aims to review the methods of tumor characterization; principles of the oncology specialties, including medical, surgical, radiation, and interventional oncology; and current treatment paradigms for the most common cancers encountered in interventional oncology, along with the levels of evidence that guide these treatments.

Objectives: Bicuspid aortic valve (BAV) is associated with increased risk of aortopathy requiring surgery. However, to date, there is no clear consensus on aortic resection extent. Our objective was to study in BAV patients the evolution of ascending aortic (AA) ‘at-risk’ tissue, as defined by elevated wall shear stress (WSS) estimated using 4D flow MRI acquired at baseline and follow up. Methods: Eighteen BAV patients (49±15yrs) were included who underwent AA repair and MRI before surgery and at follow up (mean duration: 154±250 [7-977] days). For each patient and exam, 3D aortic systolic WSS was estimated from 4D flow MRI and at-risk tissue area was defined as the treatable region with high WSS, when compared to an atlas of physiologically normal values (as previously established in healthy controls). Results: The baseline sinus of Valsava and mid-AA diameters were both 4.5±0.6cm. Eight patients had severe aortic stenosis or regurgitation. Three patients had aortic valve replacement without aortic resection, 8 had AA repair without hemiarch repair, and 7 had AA and hemiarch repair. In the 8 AA repair patients, 3D area of elevated WSS increased at baseline from 25±29% to 52±37% at follow up, when expressed in percentage of the AA tissue remaining after surgery up from graft to the first branch (Figure). Little change in at-risk tissue area was observed in hemiarch repair patients. Conclusions: Our preliminary study demonstrates feasibility of 4D flow MRI to provide data regarding at-risk aortic tissue progression in BAV patients who underwent AA repair. Larger studies in a variety of clinical conditions are warranted to further understand the implications of these findings.

In February 2009, the UK government's Advisory Council on the Misuse of Drugs (ACMD) published a review of MDMA (ecstasy) which recommended a reclassification from the highest class A to the ‘intermediate category’ class B, on the basis of a review of recent scientific research. This became a matter of news attention alongside a recent journal article by Professor David Nutt, the chairman of the ACMD, in which ecstasy consumption was suggested to be no more dangerous than horse-riding. The home secretary Jacqui Smith rejected the recommendations and Professor Nutt was forced to apologise for making the comparison. Some sections of the media coverage around this topic contrasted the (implicitly irrational) political response to the review with the authority of the scientific evidence it represented, while other media accounts characterised Nutt either as an ‘out of touch’, or ‘immoral’ academic or as having a politically motivated social agenda. In this way, risk issues are played out in, and through, medi...

Purpose Radiosurgery requires precise lesion localization. Fiducial markers enable lesion tracking, but complications from insertion may occur. The purpose of this study was to describe complications of fiducial marker insertion into pulmonary lesions. Materials and Methods Clinical and imaging records of 28 consecutive patients with 32 lung nodules or masses who underwent insertion of a total of 59 fiducial markers before radiosurgery were retrospectively reviewed. Results Eighteen patients (67%) developed a pneumothorax, and six patients (22%) required a chest tube. The rates of pneumothorax were 82% and 40%, respectively, when 18-gauge and 19-gauge needles were used for marker insertion (P = 0.01). Increased rate of pneumothorax was also associated with targeting smaller lesions (P = 0.03) and tumors not in contact with the pleural surface (P = 0.04). A total of 11 fiducials (19%) migrated after insertion into the pleural space (10 markers) or into the airway (1 marker). Migration was associated with shorter distances from pleura to the marker deposition site (P = 0.04) and with fiducial placement outside of the target lesion (P = 0.03). Conclusion Fiducial marker placement into lung lesions is associated with a high risk of pneumothorax and a risk of fiducial migration.

This paper examines the responses of 37 participants in six focus groups to media representations of the health risks associated with mobile phone masts (‘base stations’) in the light of theoretical debates concerning non‐expert understandings of risks (variously characterised as ‘lay rationality’, lay epidemiology’, popular epidemiology’, ‘public knowledges’, ‘social rationality’ and ‘intuitive risk judgements’). In particular, the study discusses the extent to which two particular manifestations of such understandings – non‐mediated contextual and personal knowledges (‘multiple information sources’), and risk comparisons made between mobile phone masts and a variety of other perceived health risks – are prominent in respondents’ discursive constructions of risk. The paper suggests that analyses of risk responses such as these should differentiate clearly between classes of risks, and avoid suggestions that any particular type of risk response can be unproblematically mapped onto other risk scenarios.

Words and constructions regularly have multiple meanings, and it may be difficult delineating these meanings and whether they are instances of monosemy or polysemy. This paper discusses this problem with regard to some uses of ‘give’. Some uses fall under the definition of a literal meaning ‘cause someone to obtain something’ (e.g. give someone a present) while others are more figurative such as give someone a slap. A problem for delineating these different senses comes from ‘bridging contexts’ such as give someone a kiss, which can be marginally construed as ‘causing someone to obtain a kiss’ but also as a figurative usage meaning ‘kiss someone’. Evidence for this comes from syntactic tests such as the dative alternation (in which for example give a kiss to your mother is more acceptable than ?give a slap to your mother or *give a wash to the car), and polysemy tests such as zeugma, which yield contradictory results when applied to such bridging contexts. A hypothesis is that individual usages may be situated along a continuum, with no necessity for a sharp cut-off point between different senses. A way of representing this continuum is a semantic map in the sense of Cysouw (2010), with different individual uses separated by a certain ‘semantic distance’ reflecting semantic and syntactic behaviour. The ‘semantic map’ idea is suggested to be a solution to the general problem of how to delineate word senses, and in particular a semantic map which represents a ‘family tree’ of individual uses.

To compare steady-state magnetic resonance angiography (SS-MRA), using a blood pool contrast agent, with the established technique of time-resolved MRA (TR-MRA), in pulmonary vein mapping and left atrial patency.Twenty-one patients (12 males, age 58.3 ± 8.4 years; 9 females; 57 ± 10 years) undergoing pulmonary vein mapping were evaluated with TR-MRA (TWIST) and SS-MRA. Orthogonal measurements and areas for four veins per patient per technique were assessed by Friedman's test.Overall intertechnique mean difference for any pulmonary vein orthogonal measurement and area was 0.02 ± 0.34 cm (P = 0.705), and 0.2 ± 0.08 cm(2) (P 0.001). Interobserver correlation was strong for diameter and area measurements using the three methods with a range of 0.72-0.94, and 0.87-0.97, respectively. Left atrial appendage image quality score for TR-MRA was significantly lower than the other two methods (P 0.001). Both observers detected more stenosis on inversion recovery (IR)-True FISP compared to TR-MRA and IR-FLASH.SS-MRA with a blood pool agent compared favorably to the established technique of TR-MRA for quantitative assessment of pulmonary venous anatomy. SS-MRA offers greater spatial resolution than TR-MRA with increased confidence for ruling out left atrial appendage filling defect.

This case describes the development of laryngeal chondronecrosis after use of the laryngeal mask airway (LMA). A 69-year-old male with prior laryngeal irradiation underwent total knee replacement with general anesthesia via LMA. Postoperatively, he developed laryngeal chondronecrosis, bilateral vocal fold immobility, and aspiration, necessitating tracheostomy and gastrostomy placement. He improved with hyperbaric oxygen therapy, intravenous antibiotics, and endoscopic repair of a residual fistula. Vocal fold motion returned and he was decannulated. Chondronecrosis of the larynx may occur with the use of the LMA, and caution should be used in patients with a history of prior laryngeal irradiation.

To assess the impact of aortic valve morphology on aortic hemodynamics between normal tricuspid and congenitally anomalous aortic valves ranging from unicuspid to quadricuspid morphology.Aortic three-dimensional (3D) blood flow was evaluated by 4D flow MRI in 14 healthy volunteers with normal trileaflet valves and 14 patients with unicuspid (n = 3), bicuspid (n = 9, 3 "true" bicuspid, 3 right-left (RL), 3 right-noncoronary (RN) leaflet fusion, and quadricuspid aortic valves (n = 2). Data analysis included the co-registered visualization of aortic valve morphology with systolic 3D blood flow. The influence of valve morphology on aortic hemodynamics was quantified by valve flow angle.All RL-bicuspid aortic valve (BAV) were associated with flow jets directed toward the right anterior aortic wall while RN-fusion and unicuspid valves resulted in flow jet patterns toward the right-posterior or posterior wall. Flow angles were clearly influenced by valve morphology (47° ± 10, 28° ± 2, 29° ± 18, 18° ± 12, 15° ± 2 for unicuspid, true BAV, RN-BAV, RL-BAV, quadricuspid valves) and increased compared with controls (7.2° ± 1.1, P = 0.001).Altered 3D aortic hemodynamics are impacted by the morphology of congenitally malformed aortic valves.

To present a theoretical basis for noninvasively characterizing in vivo fluid-mechanical energy losses and to apply it in a pilot study of patients known to express abnormal aortic flow patterns.Four-dimensional flow MRI was used to characterize laminar viscous energy losses in the aorta of normal controls (n = 12, age = 37 ± 10 yr), patients with aortic dilation (n = 16, age = 52 ± 8 yr), and patients with aortic valve stenosis matched for age and aortic size (n = 14, age = 46 ± 15 yr), using a relationship between the three-dimensional velocity field and viscous energy dissipation.Viscous energy loss was elevated significantly in the thoracic aorta in patients with dilated aorta (3.6 ± 1.3 mW, P = 0.024) and patients with aortic stenosis (14.3 ± 8.2 mW, P0.001) compared with healthy volunteers (2.3 ± 0.9 mW). The same pattern of significant differences was seen in the ascending aorta, where viscous energy losses in patients with dilated aortas (2.2 ± 1.1 mW, P = 0.021) and patients with aortic stenosis (10.9 ± 6.8 mW, P0.001) were elevated compared with healthy volunteers (1.2 ± 0.6 mW).This technique provides a capability to quantify the contribution of abnormal laminar blood flow to increased ventricular afterload. In this pilot study, viscous energy loss in patient cohorts was significantly elevated and indicates that cardiac afterload is increased due to abnormal flow.

News photographs can often provide troubling or problematic images. When Cho Seung Hui posted a package of videos, photographs and texts to the media in the midst of a shooting spree at Virginia Polytechnic Institute and State University (Virginia Tech) in April 2007 which left 32 dead, he provided them with pictures which were particularly controversial. These were the planned and orchestrated self-representations of a mass murderer, and were therefore immediately examined and interrogated for explanatory clues both by the police and the media. In this chapter, the ways in which these images were utilized in media discourses to explain the shootings is investigated via a content analysis of UK newspapers, with a particular emphasis on media effects as a frame of understanding. This framing occurred through the identification of the film Oldboy (Chan-wook Park, 2003), a ‘chilling horror-revenge movie’ (Hawkins 2009),1 as a potential influence on Cho both in terms of the shootings themselves and, in a more limited sense, in terms of the images he produced as part of his ‘multimedia manifesto’.

There has long been held an acceptance that morbidly obese patients present problems with airway management. This chapter will highlight arguments that both agree with and challenge this assumption. Recent studies question the correlation between elevated BMI and difficult direct laryngoscopy, probably because excess adipose tissue has a variable distribution among MO patients. The reader will be able to identify a subset of MO patients where difficult airway management is indeed expected. In such patients, maximizing oxygenation is of primary importance. This chapter will therefore also highlight best practice in terms of preoxygenation and recruitment maneuvers which minimize atelectasis. Suggested alternatives to direct laryngoscopy that achieve rapid intubation will be recommended.

Monitoring post cardiac transplant (TX) status relies on frequent invasive techniques such as endomyocardial biopsies and right heart cardiac catheterization. The aim of this study was to noninvasively evaluate regional myocardial structure, function, and dyssynchrony in TX patients. Myocardial T2-mapping and myocardial velocity mapping of the left ventricle (basal, midventricular, and apical short-axis locations) was applied in 10 patients after cardiac transplantation (49 ± 13 years, n = 2 with signs of mild rejection, time between TX and MRI = 1-64 months) and compared to healthy controls (n = 20 for myocardial velocity mapping and n = 14 for T2). Segmental analysis based on the 16-segment American Heart Association model revealed increased T2 (P = 0.0003) and significant (P0.0001) reductions in systolic and diastolic radial and long-axis peak myocardial velocities in TX patients without signs of rejection compared to controls. Multiple comparisons of individual left ventricular segments demonstrated reductions of long-axis peak velocities in 50% of segments (P0.001) while segmental T2 values were not significantly different. Systolic radial as well as diastolic radial and long-axis dyssynchrony were significantly (P0.04) increased in TX patients indicating less coordinated contraction, expansion, and lengthening. Correlation analysis revealed moderate but significant (P0.010) inverse relationships between myocardial T2 and long-axis peak velocities suggesting a structure-function relationship between altered T2 and myocardial function.

Recurring traits across languages have been argued to relate directly to constraints imposed by the brain. A particular case is Greenberg's word order universals (Greenberg 1966), which have been argued to reflect the demands of language acquisition (Baker 2001, Chomsky 2010) or of processing sentences (Hawkins 1983, Kirby and Hurford 1997). This paper argues that typological universals are indeed relevant to the study of the biological basis of language, but for a different reason, that they are created by the process of grammaticalisation. Recent historical evidence for the grammaticalisation explanation will be presented, concluding that explanations invoking processing or acquisition are misguided. Grammaticalisation involves the use of metaphor and the 'chunking' of constructions similar to the chunking of motor sequences (Bybee 2002), and hence the origin of language universals is argued to be in these properties of the mind rather than those proposed by innatist or functionalist linguists.

Background It has been suggested that morbidly obese parturients may require less local anesthetic for spinal anesthesia. The aim of this study was to determine the effective dose (ED(50)/ED(95)) of intrathecal bupivacaine for cesarean delivery in morbidly obese patients. Methods Morbidly obese parturients (body mass index equal to or more than 40) undergoing elective cesarean delivery were enrolled in this double-blinded study. Forty-two patients were randomly assigned to receive intrathecal hyperbaric bupivacaine in doses of 5, 6, 7, 8, 9, 10, or 11 mg (n = 6 per group) coadministered with 200 μg morphine and 10 μg fentanyl. Success (induction) was defined as block height to pinprick equal to or more than T6 and success (operation) as success (induction) plus no requirement for epidural supplementation throughout surgery. The ED(50)/ED(95) values were determined using a logistic regression model. Results ED(50) and ED(95) (with 95% confidence intervals) for success (operation) were 9.8 (8.6-11.0) and 15.0 (10.0-20.0), respectively, and were similar to corresponding values of a nonobese population determined previously using similar methodology. We were unable to measure ED(50)/ED(95) values for success (induction) because so few blocks failed initially, even at the low-dose range. There were no differences with regard to secondary outcomes (i.e., hypotension, vasopressor use, nausea, and vomiting). Conclusions Obese and nonobese patients undergoing cesarean delivery do not appear to respond differently to modest doses of intrathecal bupivacaine. This dose-response study suggests that doses of intrathecal bupivacaine less than 10 mg may not adequately ensure successful intraoperative anesthesia. Even when the initial block obtained with a low dose is satisfactory, it will not guarantee adequate anesthesia throughout surgery.

Background: The sphenopalatine ganglion block (SPGB) with local anesthetic is used to treat facial pain and headache of various etiologies; it has been widely used during functional endoscopic sinus surgery (FESS). The purpose of this study was to investigate whether preemptive SPGB may positively impact postoperative pain and functional outcomes after FESS. Methods: A prospective, double-blind, randomized, placebo-controlled study was performed. A total of 60 patients (18–70 years), undergoing general anesthesia for bilateral FESS, were randomly assigned to receive SPGB with either 2 mL 0.25% bupivacaine with epinephrine 1:100,000 (BP, treatment group) or normal saline (NS, control group). SPGB was performed preemptively 10 minutes before the start of surgery. Preoperative and postoperative (day 0, day 7, and day 30) visual analog pain scale, Sino-Nasal Outcome Test (SNOT-20), computed tomography (CT) and endoscopic scores were compared between the 2 groups. Results: A total of 29 patients were enrolled in BP, and 27 were enrolled in NS. Three patients withdrew from the study, and 1 was withdrawn by the investigator due to severe hypertension after induction of anesthesia. There were no differences in patient demographic characteristics between the study groups. On day 7, the mean visual analog pain scales were 1.12 ± 0.3 in NS and 0.48 ± 0.23 in BP (p = 0.053). There were no statistical differences in other outcome measures (SNOT-20, CT and endoscopic scores) between the 2 groups. Conclusion: A limited trend toward reduced postoperative pain after FESS was noted with bupivacaine compared to saline, but statistical significance was not achieved. Preemptive SPGB may offer sinonasal symptomatic benefits for patients undergoing FESS, but larger studies are warranted. © 2011 ARS-AAOA, LLC.

Chest wall lesions constitute a diverse group of thoracic diseases, including those of soft tissue and osseous origin. MR imaging, with its superior tissue-resolving capability and multiplanar image acquisition, is an important tool for assessing chest wall lesions. In this article, the authors review common and uncommon diseases of the chest wall, with an emphasis on the MR imaging characteristics of these diseases. Among the diseases they discuss are diseases of the soft tissue including lipoma, hibernoma, liposarcoma, hemangioma, and lymphoma. They also examine diseases of the osseous thorax, including benign osseous tumors, fibrous dysplasia, and aneurysmal bone cyst. In addition, they discuss such malignant osseous tumors as osteosarcoma and Ewing's sarcoma.

This paper presents a specific case study - a "campaign interaction" between the prime minister and a member of the public during a live BBC TV general election debate - in order to examine a number of issues around concerns over the "crisis in public communication" and political control of news information flows. In a wider political sense this episode, in which Tony Blair seemed to be unprepared for a question about family doctor appointment times, was a relatively minor element of a general election campaign dominatedby issues such as asylum policy and the Iraq war. Nevertheless, analysis of the ensuing news coverage suggests that election news agendas can be diverted away (at least temporarily) from the planned communications of political agents towards issues and themes publicised by non-official, non-expert sources, while also illustrating the ultimate reliance of the mediaon those official accredited sources. The role of the BBC in the case study also raises the issue of its position as a public service broadcaster, and the interaction between press and broadcasting in British political news coverage. Članek obravnava specifičen primer interakcije med predsednikom vlade in gledalcem predvolilnega televizijskega programa BBC, da bi razjasnil vrsto vprašanj o "krizi javnega komuniciranja" in političnem nadzorovanju informiranja. V političnem smislu je bila epizoda, v kateri se je pokazalo, da Tony Blair ni bil pripravljen na vprašanje o naročanju na zdravniški pregled, relativno nepomembna v primerjavi z vprašanji, kot sta azilna politika ali iraška vojna. Vendar pa analiza kaže, da se vsaj začasno lahko obide volilne vprašanja in teme, ki jih načrtujejo politični akterji, čeprav se mediji v zadnji instanci zanašajo na uradne vire. Vloga BBC v tej študiji sproža tudi vprašanje o položaju javne radiotelevizije ter odnosu med tiskom in radiotelevizijo v političnem novinarstvu v Veliki Britaniji.

This chapter examines a particular aspect of British news coverage of two ‘food scares’ — BSE/vCJD1 (also known as ‘mad cow disease’) and salmonella infection in eggs. It focuses on the sub-section of news that can be described as ‘service journalism’ in order to examine the possibility that such coverage might provide progressive alternative perspectives to those which are part of a dominant ‘official’ discourse. In terms of the themes of this collection, the question is whether audiences are justified in putting their trust in service journalism; does it address the ‘problems of everyday life’ (in this case, food scares) as (sub-) political issues demanding collective, and therefore political forms of response, or as individualised problems requiring only consumption-based responses; does it address audiences primarily as citizens, or as consumers? In particular, I want to examine the arguments of Eide and Knight (1999) who suggest that despite the tendency of service journalism to ‘individualize problems’, it is ‘amenable to politicisation’ due to its focus on the same kinds of issues that are dealt with by the social movements and pressure groups which drive ‘subpolitics’ (1999, p. 525; see also Beck, 1994, pp. 22–3). They theorise their arguments via Habermasian notions of the public sphere (Habermas, 1989) and Ulrich Beck’s risk society thesis (1992b; 2000) and suggest a hybrid social identity in which citizen, consumer and client roles interact.

Background: Nitrous oxide (N2O) is frequently used to supplement more potent anesthetic agents. One side-effect of N2O is its ability to expand an air-containing space. We investigated if N2O adversely affected operating conditions by distending normal bowel during laparoscopic bariatric procedures. Methods: 50 morbidly obese patients were divided into 2 study groups. Group 1 patients were ventilated with a halogenated anesthetic/oxygen/air mixture, while Group 2 received a halogenated anesthetic/oxygen/N2O mixture. At 30, 60, and 90 min intervals during the operation, the surgeon was asked if N2O was being used. Results: The surgeons responded correctly only 42% (30 min), 50% (60 min), and 48% (90 min) of the time. In Group 2 (N2O) patients, they incorrectly answered that N2O was not being used 88% (30 min), 68% (60 min), and 68% (90 min); and in Group 1 (air) patients, they incorrectly answered that N2O was being used 28% (30 min), 32% (60 min), and 36% (90 min) of the time. Conclusion: We found that using N2O did not cause noticeable bowel distention during laparoscopic bariatric procedures of relatively short duration.

Background: The effect of patient position on the view obtained during laryngoscopy was investigated. Methods: 60 morbidly obese patients undergoing elective bariatric were studied. Patients were randomly assigned into one of two groups. In Group 1, a conventional "sniff" position was obtained by placing a firm 7-cm cushion underneath the patient's head, thus raising the occiput a standard distance from the operating-table while the patient remained supine. In Group 2, a "ramped" position was achieved by arranging blankets underneath the patient's upper body and head until horizontal alignment was achieved between the external auditory meatus and the sternal notch. Following induction of general anesthesia, tracheal intubation was performed using a Video MacIntosh® laryngoscope. The laryngoscopy and intubation sequences were recorded onto videotape. Three independent investigators, unaware as to which position the patient had been in at the time of tracheal intubation, then viewed the videotape and assigned a numerical grade to the best laryngeal view obtained. Results: The "ramped" position improved the laryngeal view when compared to a standard "sniff" position, and this difference was statistically significant (P=0.037). Conclusion: The "ramped" position is superior to the standard "sniff" position for direct laryngoscopy in morbidly obese patients.