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HIS MALE INFANT was born at 41 weeks' gestation to a 20-year-old, gravida 3, para 2 woman with an unremarkable medical history, normal prenatal test results, and no smoking, drug use, or other harmful habits. Pregnancy was complicated by decreased fetal movements during the last week of gestation. An ultrasound performed the morning before delivery revealed severe hydrocephalus. A previous ultrasound performed at the 20th week showed no abnormalities. The infant was delivered by emergency cesarean section without complications or need for resuscitation. Apgar scores were 7 and 9 at 1 and 5 minutes, respectively. His birth weight was 4054 g (Ͼ95th percentile for age), length was 51 cm (75th percentile), and head circumference was 40 cm (Ͼ95th percentile). He was transferred to the neonatal intensive care unit for further evaluation and management. On physical examination the infant had normal vital signs. He had marked macrocephaly, a full anterior

Background Coronavirus disease 2019 increased the numbers of patients requiring prolonged mechanical ventilation, with a subsequent increase in tracheostomy procedures. Coronavirus disease 2019 patients are high risk for surgical complications. This review examines open surgical and percutaneous tracheostomy complications in coronavirus disease 2019 patients. Methods Medline and Embase databases were searched (November 2021), and the abstracts of relevant articles were screened. Data were collected regarding tracheostomy technique and complications. Complication rates were compared between percutaneous and open surgical tracheostomy. Results Percutaneous tracheostomy was higher risk for bleeding, pneumothorax and false passage. Surgical tracheostomy was higher risk for peri-operative hypoxia. The most common complication for both techniques was post-operative bleeding. Conclusion Coronavirus disease 2019 patients undergoing tracheostomy are at higher risk of bleeding and peri-operative hypoxia than non-coronavirus disease patients. High doses of anti-coagulants may partially explain this. Reasons for higher bleeding risk in percutaneous over open surgical technique remain unclear. Further research is required to determine the causes of differences found and to establish mitigating strategies.

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Severe concavity of the lateral crura can lead to an unsightly aesthetic deformity of the nasal tip and narrowing of the external nasal valve. Concurrently if the lateral crura are structurally weak, this can lead to a functional issue. We report a previously undescribed technique of combining a lateral crural reversal with a turn-in flap. This achieves dual goals of aesthetic improvement and structural reinforcement, without the need for grafting.

In spite of the numerous investigations directed to stcdy lymph propulsion, wide discrepancy exists about the mechanisms of action of drugs altering thoracic duct lymph flow (1-3). During our previous studies on the transport of calcium by the lymph we observed that between the onset of a hypocalcemic challenge produced by ethylenediaminotetracetate infusion and the return of serum calcium to normal levels, thoracic duct lymph flow (TDLF) was markedly increased (4). Further experiments determined that the rise in serum calcium that followed hypocalcemia was responsible for the increase in TDLF. The purpose of this investigation was that of analyzing and quantifying such a response.Methods and Materials. Experiments were performed in adult mongrel dogs of both sexes divided in groups of five animals each. They were fed achow containing all essential nutrients in their adequate proportions and tap water ad lib. One group of these animals was parathyroidectomized three days prior to the experiment. The success of the ablation was assessed by the fall in total serum calcium. Whole milk was administered ad lib postoteratively to the parathyroidectomized animals to prevent tetany. The amount of milk consumed varied from animal-to-animal but it was helpful in slowing down the general deterioration observed in parathyroidectomized dogs.On the morning of the experiments, dogs were anesthetized with intravenous pentobarbital in successive doses to the point of apnea. This level of anesthesia was maintained throughout the experiment by additional pentobarbital doses in order to avoid changes in respiratory rate, depth ' This work was supported by a grant from The John A.Hartford Foundation, Inc. and rhythm, which can alter TDLF. Animals were intubated with a cuffed endotracheal tube connected to a positive pressure ventilator (Bird). Respiratory rate was regulated to produce a panting-type of respiration (45/min at 15 cm of water of maximum inspiratory pressure). The right femoral artery and vein were dissected at the groin and catheterized with a polyethylene catheter advanced to the abdominal aorta and the inferior vena cava levels, respectively. Pressures were recorded using transducers and a multichannel apparatus.The thoracic duct was exposed over the left side of the neck, ligated at its entrance into the jugular vein and catheterized with a 'polyethylene catheter. Lymph was allowed to flow by gravity into a fraction collector. Lymph flow was expressed as ml of lymph/kg body wdmin. After a period of stabilization during which blood pressure and lymph flow were found to be constant, a bolus dose of a 10% solution of calcium gluconate in water was injected and calculated to provide 0.5 mg of ionic calcium/kg body wt. The same amount of calcium was reinjected when lymphatic flow and aortic blood pressure (A3P) returned to a new steady baseline. In two additional groups of intact and parathyroidectomized animals, a solution of 0.9% sodium chloride in water was injected in volumes equal to those calculated for calcium gluc...

Objectives The aim of this study was to assess the efficacy of a new emergency department intervention for the management of epistaxis, aiming to reduce epistaxis admissions. Design Tranexamic acid (TXA) (500mg/ml) soaked NasoPore® packing was in the pathway for epistaxis which did not terminate following 10 minutes of simple first aid. The pathway was utilised for adult patients presenting with non-traumatic, anterior epistaxis. Pre- and post-implementation admission rates and re-attendance rates were recorded by retrospective audit at a large central London hospital. Results Epistaxis admissions were reduced by 51.7% (p<0.05) following the implementation of the TXA-soaked NasoPore® pathway. Conclusions The significant reduction in epistaxis admissions demonstrates that this intervention is beneficial for patient outcomes. This has the potential to be introduced in other A&E departments and also pre-hospital settings.

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