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Our experience in children is consistent with a previous controlled clinical trial in adults and supports the efficacy and safety of cyclosporine for CIU. However, we recommend that it be reserved for those whose CIU that is resistant to conventional measures and that patients be carefully monitored with cyclosporine serum concentrations and measures of renal function.

Initially described as hysteria and then Munchausen’s stridor, we now recognise vocal cord dysfunction as several disorders. Exercise-induced and spontaneously occurring phenotypes exist that benefit from different treatments. The former appears to respond to pharmacological pre-treatment with an anticholinergic aerosol; vocal cord training is the recommended treatment for the latter. The differential diagnosis includes consideration of neurological and anatomical abnormalities. Recognition and effective treatment is important to avoid misdiagnosis that results in unnecessary and ineffective medical care.

Introduction:Diazepam is commonly used to treat acute childhood seizures, but difficulty gaining intravenous access and variability of absorption after rectal administration can limit its efficacy. Midazolam is a water soluble benzodiazepine that has a rapid onset of action after intranasal or buccal administration and provides an alternative to diazepam in the control of acute childhood seizures. Methods: A literature search was performed to identify papers comparing the efficacy and tolerability of midazolam and diazepam in the management of childhood seizures. Results: Intranasal or buccal midazolam are at least as effective as rectal or intravenous diazepam in controlling acute childhood seizures. In all robust studies reporting a significant difference, time to gain seizure control was shorter in patients treated with midazolam than those treated with diazepam, predominantly due to shorter drug administration time. The incidence of seizure recurrence was lower in patients treated with midazolam than diazepam. Respiratory depression was uncommon in both groups. Conclusion: Intranasal or buccal midazolam provides a safe, effective and acceptable alternative to intravenous or rectal diazepam in the management of acute childhood seizures. (Hong Kong j.emerg.med. 2010;17:196-204)

Patient: Male, 70Final Diagnosis: Cardiogenic shockSymptoms: Chest discomfort and intermittent palpitationsMedication: AmiodaroneClinical Procedure: IntubationSpecialty: CardiologyObjective:Unusual clinical courseBackground:Amiodarone is frequently used in emergency departments for treatment of arrhythmias. Incidence of several amiodarone-related adverse events is unknown. The literature is sparse for potentially life-threatening adverse effects of amiodarone.Case Report:We present a case of a male patient who presented with chest discomfort and rapid atrial fibrillation. He was known to have paroxysmal atrial fibrillation, which did not respond to initial beta-blocker treatment. The second-line drug amiodarone was given to the patient for rate control. He developed severe hypotension related to amiodarone and required inotropic support along with rapid-sequence intubation.Conclusions:Intravenous amiodarone can cause severe and refractory hypotension.