No abstract

summary Two hundred and fifty three patients were examined before surgery for cervical spine disease. The grade of glottic visibility was determined at direct laryngoscopy, using the classijication proposed by Cormack and Lehane. The overall prevalence of dificulty (grades 3 and 4) was 20%. Patients with disease that includes the occipito-atlanto-axial complex have a higher prevalence of dificulty than those with disease below the axis vertebra. Occipito-atlanto-axial disease is associated with poor mandibular protrusion. The best single predictor of difficulty was reduced separation of the posterior elements of thejrst and second cervical vertebrae on lateral radiographs. The Mallampati examination was the best single predictor on physical examination. The Mallampati may be an indicator ofpoor cranio-cervical extension. Dificulty was rare inpatients with class A mandibular protrusion, and invariable in patients with class C protrusion.

IOP increases when anesthetized patients are placed in the prone position.

An operation which combined anterior fransoral decompression with posterior occipitocervical fixation was used in 68 rheumatoid patients with irreducible anterior neuraxial compression at the craniocervical junction. Fibre-optic laryngoscopy with nasotracheal intubation was less hazardous than tracheostomy. The patients underwent surgery in the lateral position to allow access both to the mouth and to the back of the

Ninety-six cases of anterior globe perforation in children less than 16 years old, requiring surgical repair, were reviewed. Seventy-three patients were male and 23 female, with a mean age of 9 years 4 months. Perforation involving just the cornea was associated with a good visual prognosis unless: it involved the visual axis, resulting in corneal scarring and/or significant astigmatism (> 3.0 DS); it involved greater than one-quarter of corneal diameter; or there was non-compliance with spectacles/patching in patients younger than 8 years old. Injuries involving the lens in those younger than 8 years were associated with a far worse prognosis due to the problems of correcting aphakia. Surgical delay and method of injury did not affect prognosis. Some patients fail to re-attend and greater patient/parent education prior to discharge is recommended.

A patient suffered cardiovascular collapse and died during surgery for prolapsed intervertebral disc. At postmortem a tear was found in the abdominal aorta.

While the neuropathology of kuru is well defined, there are few data concerning the distribution of disease-related prion protein in peripheral tissues. Here we report the investigation of brain and peripheral tissues from a kuru patient who died in 2003. Neuropathological findings were compared with those seen in classical (sporadic and iatrogenic) Creutzfeldt–Jakob disease (CJD) and variant CJD (vCJD). The neuropathological findings of the kuru patient showed all the stereotypical changes that define kuru, with the occurrence of prominent PrP plaques throughout the brain. Lymphoreticular tissue showed no evidence of prion colonization, suggesting that the peripheral pathogenesis of kuru is similar to that seen in classical CJD rather than vCJD. These findings now strongly suggest that the characteristic peripheral pathogenesis of vCJD is determined by prion strain type alone rather than route of infection.

SummaryFifty female patients were studied to compare the view of the larynx at direct laryngoscopy under general anaesthesia with and without cricoid pressure applied. We also compared the view using the standard technique of cricoid pressure with that using cricoid pressure in an upward and backward direction and further investigated whether these views were improved with a firm foam rubber neck support. The order in which the types of cricoid pressure were applied was randomised and also blinded with a drape over the neck. Cricoid pressure was simulated on weighing scales after each case and a mean force of 3.2 kg was applied. The majority of views at laryngoscopy (95%) were grade 1, with too few grade 2 and 3 views for statistical comparison. Both types of cricoid pressure applied without neck support were more likely to give a better view than no cricoid pressure (p < 0.01) and cricoid pressure in an upward and backward direction was more likely to give a better view at laryngoscopy than the standard technique (p < 0.01). Neck support during the standard technique of cricoid pressure did not improve the view of the larynx at laryngoscopy. Cricoid pressure is likely to improve the view at laryngoscopy which may be further improved by applying it in an upward and backward direction.Keywords Larynx; cricoid pressure. Intubation; tracheal. ...................................................................................... Correspondence to: R. G. Vanner Accepted: 17 February 1997 Cricoid pressure is routinely used to prevent regurgitation of gastric contents into the pharynx during the induction of general anaesthesia in all the Maternity Units recently surveyed in the UK [1]. However, it has been suggested that the use of cricoid pressure may make tracheal intubation more difficult [2, 3]. It is not clear whether poor technique alone is responsible or whether correctly applied cricoid pressure may also cause difficulty with intubation. Although it is well known that a degree of pressure on the front of the larynx can improve the view at laryngoscopy [4] it is not known whether correctly applied cricoid pressure, at a force that would prevent regurgitation, alters the view at laryngoscopy.Neck support has been recommended to improve the view at laryngoscopy during the application of cricoid pressure by preventing the head flexing on the neck, either with a bimanual technique [5] or with a cuboid of foam rubber [6]. Bimanual cricoid pressure has been adopted widely [1, 7] despite the lack of evidence supporting this hypothesis; indeed one recent study showed no improvement in the view at laryngoscopy when comparing bimanual with single handed cricoid pressure [8].If the arch of the cricoid cartilage is pushed in an upward (cephalad) direction [9], or the whole larynx is moved in an upward direction [10, 11], the view at laryngoscopy is improved compared with the view with no external manipulation. Therefore, cricoid pressure applied in an upward and backward direction with enough force to prevent reg...