Conventional radiography lacks sensitivity in early rheumatoid disease. MRI with its advantages of soft tissue discrimination and multiplanar imaging facility might detect earlier disease. This study compares the MR images and conventional radiographs of 11 rheumatoid patients' wrists and carpi. In all cases, erosions were more extensive and numerous on the MR images compared to plain radiographs. MR is useful in detecting early aggressive disease and in monitoring the response to treatments.
Inadequate airway management may be fatal. There are recommendations for airway difficulties, but the evidence favoring any specific strategy is limited. This study suggests that, in the lateral position, a laryngeal mask airway more rapidly and reliably establishes airway control than attempts at endotracheal intubation. It further suggests that placing a patient with an inadequate airway into the lateral position will hinder, not help, airway management.
A method of testing the location of an endotracheal tube, in the trachea or oesophagus, was subjected to trial. The test involves drawing back on the plunger of a 50 ml syringe connected with airtight fittings to the endotracheal tube connector, with the endotracheal tube cuff deflated. The ability to withdraw 30 ml of air confirms tracheal intubation. When marked resistance to withdrawal of the plunger occurs and on release the plunger rebounds to its original position the oesophagus has been intubated. The method was 100% accurate in fifty intubations, 25 tracheal and 25 oesophageal. The technique has been in routine use by one author for several years without giving an incorrect answer and enthusiastic use by other authors is producing the same result.
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