Mantoux test has limited utility in diagnosing active genital tuberculosis during the childbearing age. However, in infertile women with positive a Mantoux test, laparoscopy may be advocated early.
quality and quantity of anaesthesia care. The goal is to recruit volunteers to serve, one at a time, as teachers (not as providers) of anaesthesia at an already established overseas anaesthesia teaching program and to recruit enough volunteers so as to provide continuous teaching assistance, 12 months of the year for four years, all in the same department.The overseas program with which OTP will be associated for four years starting in 1991 is the anaesthesia program at the University of Zambia's teaching Hospital in Lusaka. A similar OTP affiliation with another overseas anaesthesia program will be initiated elsewhere starting in 1992 and continuing for three years.Enquiries about the program may be addressed to the undersigned. Pulmonary oedema associated with airway obstructionTo the Editor: Dr. Lang et al. have described the pathogenesis of pulmonary oedema associated with airway obstruction as multifactorial and ascribe a dominant role to the negative intrapleural pressure developed during obstruction, i This is debatable. The Pi-max is the maximum inspiratory pressure measured at the mouth after complete expiration to residual volume and sustained for a one second period. 2 In a healthy male of less than 50 yr it is 127 cm of water or nearly 10 mmHg 3 and this will be the intrapleural pressure achieved, at least initially, following obstruction of the trachea.Unpressurized aircraft take passengers up to 12,000 feet where the barometric pressures and hence the airway pressures during most of the respiratory cycle would be in the range of 483 mmHg. 4 These airway pressures are much lower than a healthy subject can achieve during Mueller's manoeuvre during obstruction. Despite this, passengers in such aircraft do not develop pulmonary oedema. This is because at high altitudes the subject hyperventilates to compensate for the low oxygen content of air and hence tries to maintain a near normal alveolar oxygen content. 4 Obviously hyperventilation cannot maintain the airway pressure above the altitude barometric pressures (483 mm). Hence it can be surmised that if pulmonary oedema does not develop it is due to the alveolar oxygen content being maintained above a particular threshold and alveolar pressures even at that value do not precipitate oedema. Hypoxia could have been the cause of pulmonary oedema in cases with airway obstruction described in the article.Thus, probably, hypoxia plays a major role in the loss of capillary integrity and pulmonary edema in airway obstruction rather than the negative intrapleural pressures.
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