No abstract

A photographic version of the Mallampati test was developed and applied to 242 pregnant patients at 12 weeks' gestation and again at 38 weeks' gestation. At 38 weeks the number of grade 4 cases had increased by 34% (P < 0.001). This is in agreement with other evidence which suggests that difficult laryngoscopy is slightly more frequent in obstetrics (1.7%) than in general surgery (1.3%). The increase in Mallampati score correlated with gain in body weight (r = 0.3, P < 0.001), which gives some support to the concept that fluid retention is the underlying cause. We conclude that pharyngeal oedema causes some hindrance to tracheal intubation in obstetrics, but not enough to explain the high failure rate reported. A case is made for rationalizing the management of difficult intubation. Our data also show that more research is needed on factors which affect Mallampati's test, particularly neck extension.

The results demonstrate that MR proctography under-reports pelvic floor abnormalities especially where there has been poor rectal evacuation.

Spinal epidural empyema is a very rare entity occurring with an estimated incidence of 1 per 10,000 hospital admissions. This condition has a reputation for presenting as a diagnostic challenge resulting in late diagnosis and delayed treatment. However, the cornerstones of treatment are prompt diagnosis and early treatment to prevent permanent paralysis and high mortality. We present a cluster of nine cases presenting to the neurosurgery unit over a 3-year period and discuss their relevant features in view of the most recent literature. The diagnosis of spinal epidural empyema was made with gadolinium-enhanced MRI in eight of nine cases. Staphylococcus aureus was isolated as the causative pathogen in all cases. All patients were treated with antibiotics. Eight patients had surgery for debridement and spinal decompression. One patient was treated successfully with antibiotics alone.

The results of this study suggest that ELAPE is not associated with deterioration in short-term outcomes or QOL when compared with LAPE or OAPE.