since none was given during dialysis. For technical reasons 35-40 minutes elapsed from the time parenteral feeding was stopped until dialysis was established.On the 13th day after admission, when dialysis had been in progress for some 50 minutes, she complained of drowsiness and rapidly became comatose. On that day 20 U soluble insulin had been added/I parenteral fluid, this amount having been calculated from her previous blood glucose concentrations and insulin requirements. Unlike on previous occasions, however, the infusion had been allowed to continue until dialysis was established.A capillary blood sample was taken and glucose concentration determined with Dextrostix (Miles Laboratories Ltd, Slough); this gave a negative result. Simultaneously a venous blood sample was sent to the emergency biochemistry laboratory, and the plasma glucose concentration was reported as < 1 mmol/l (18 mg/100 ml). She responded rapidly to a 50 ml intravenous bolus of 50% dextrose and suffered no permanent ill effect from the hypoglycaemic episode. Six weeks later she was discharged home having recovered full gastrointestinal and renal function but with residual paraplegia. DiscussionAddition of insulin to intravenous feeding solutions is established practice in many centres1 when stress from trauma or sepsis causes reduced use of exogenously supplied carbohydrate. Experience has shown that because the insulin is delivered as an additive to the hypertonic dextrose hypoglycaemia is not a problem even if the infusion is stopped abruptly.2 In the case reported, however, dialysis was already in progress when the infusion was stopped and the patient then had both a mildly raised blood glucose concentration owing to the infusion of 25% glucose and an appreciable blood concentration of exogenously supplied insulin. The solution used for dialysis contained no glucose and so a shift of glucose occurred across the semi-permeable membrane from the blood to the dialysate, resulting in a rapid reduction in the blood glucose concentration. The exogenous insulin, having too great a molecular size to cross the membrane, remained in the patient's circulation to reduce the blood glucose concentration further to critical hypoglycaemic levels.If the infusion is stopped 30-45 minutes before dialysis is started blood glucose and insulin concentrations are allowed to fall naturally and simultaneously so that even if dialysis subsequently depresses the blood glucose concentration there is insufficient residual exogenous insulin, with its physiological half life of 20-30 minutes,3 to have a pronounced hypoglycaemic effect.This case prompted us to make changes in our management of such patients, and we have not subsequently encountered this hypoglycaemic complication. the incidence of joint sepsis confirmed at reoperation within the next one to four years was about half that of patients who had had the operation in a conventionally ventilated room at the same hospital. When whole-body exhaust-ventilated suits had been worn by the operating team in a thea...

Certain inflammatory stimuli render cultured human vascular endothelial cells hyperadhesive for neutrophils. This state is transient and reversible, in part because activated endothelial cells secrete a leukocyte adhesion inhibitor (LAI). LAI was identified as endothelial interleukin-8 (IL-8), the predominant species of which is an extended amino-terminal IL-8 variant. At nanomolar concentrations, purified endothelial IL-8 and recombinant human IL-8 inhibit neutrophil adhesion to cytokine-activated endothelial monolayers and protect these monolayers from neutrophil-mediated damage. These findings suggest that endothelial-derived IL-8 may function to attenuate inflammatory events at the interface between vessel wall and blood.

Reporting of ECS is essential in accurate prognostication, and we advocate that all patients with OSCC and ECS should be grouped as pN3 on the basis of their prognosis. (c) 2009 Wiley Periodicals, Inc. Head Neck, 2010.

Implants placed in mandible were reliable, but failure rates in vascularized bone graft and maxilla were higher. Radiotherapy did not seem to prejudice implant survival, and hyperbaric oxygen had no demonstrable benefit in this series. Despite some persistent soft tissue problems and implant loss, most patients reached a successful prosthetic and functional outcome.

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(1987) Ultraclean air and antibiotics for prevention of postoperative infection: A multicenter study of 8,052 joint replacement operations, Acta Orthopaedica Scandinavica, 58:1, 4-13,

Objective: To compare health-related quality of life in patients having no neck dissection and those having a selective dissection, with particular reference to shoulder dysfunction.