The simultaneous use of three ventilatory techniques to maintain oxygenation in a patient undergoing tracheal laser resection of tumour

Patients undergoing subglottic airway surgery present a challenge to both anaesthetist and surgeon, and often a balance between surgical access and method of ventilation has to be struck. We report a case in which a 38-year-old female with a large mediastinal mass causing distal tracheal obstruction underwent tracheal laser resection. In order to maintain oxygenation throughout she required simultaneous transnasal humidified rapid-insufflation ventilatory exchange, supraglottic high-frequency jet ventilation and suprastomal manual jet ventilation through her tracheostomy stoma. Where the use of one technique alone failed, the simultaneous use of all three maintained oxygenation and facilitated surgical access for the duration of the procedure.

Successful ageing in an area of deprivation: part 1--a qualitative exploration of the role of life experiences in good health in old age

OBJECTIVES

To determine the life histories and current circumstances of healthy and unhealthy older people who share an ecology marked by relative deprivation and generally poor health.

STUDY DESIGN

In-depth interview study with a qualitative analysis.

METHODS

Matched pairs of healthy and unhealthy 'agers' were interviewed face-to-face. Healthy ageing was assessed in terms of hospital morbidity and self-reported health. Study participants consisted of 22 pairs (44 individuals), aged 72-89 years, matched for sex, age and deprivation category, and currently resident in the West of Scotland. All study participants were survivors of the Paisley/Renfrew (MIDSPAN) survey, a longitudinal study commenced in 1972 with continuous recording of morbidity and mortality since. Detailed life histories were obtained which focused on family, residence, employment, leisure and health. This information was supplemented by more focused data on 'critical incidents', financial situation and position in social hierarchies.

RESULTS

Data provided rich insights into life histories and current circumstances but no differences were found between healthy and unhealthy agers.

CONCLUSIONS

It is important to understand what differentiates individuals who have lived in circumstances characterized by relative deprivation and poor health, yet have aged healthy. This study collected rich and detailed qualitative data. Yet, no important differences were detected between healthy and unhealthy agers. This is an important negative result as it suggests that the phenomenon of healthy ageing and the factors that promote healthy ageing over a lifetime are so complex that they will require even more detailed studies to disentangle.

Successful ageing in an area of deprivation: part 2--a quantitative exploration of the role of personality and beliefs in good health in old age

OBJECTIVES

This paper presents further analysis of a study aimed at examining the determinants of good health and successful ageing in an area of deprivation. In this paper we report findings from the quantitative data related to two of the original eight research questions: (1) To what extent can health in old age be attributed to psychological/personality variables? and (2) What is the role of religious beliefs and 'spirituality' in healthy ageing?

STUDY DESIGN

In-depth interview study in which standardized measures of personality and beliefs were administered, along with measures of beliefs devised for the study.

METHODS

One hundred matched pairs of healthy and unhealthy 'agers' were interviewed face-to-face. Healthy ageing was assessed in terms of hospital morbidity and self-reported health. The sample comprised 106 males and 94 females (53 male matched pairs and 47 female matched pairs) ranging in age from 70 to 90 years of age with the majority (n=165) falling into the 71-80 age group and the remaining 35 in the 81-90 age group. All study participants were survivors of the Paisley/Renfrew (MIDSPAN) survey, a longitudinal study commenced in 1972 with continuous recording of morbidity and mortality since. Questionnaires assessing extraversion, neuroticism, psychoticism, health locus of control, sense of coherence, optimism, and religiosity were filled in by participants during the interviews.

RESULTS

Compared to the unhealthy group, the healthy participants were less neurotic, more likely to endorse an internal locus of control belief and less likely to endorse a powerful others locus of control belief, and to report a greater sense of coherence. The unhealthy group scored higher on the religiosity/spirituality measure devised for this study.

CONCLUSIONS

The findings are interesting in that, although they cannot address the issue of cause and effect, the very fact that the personality traits measured in this study were linked to health status in old age, further strengthens the argument that in general practice and hospital settings, an understanding of personality aids practitioners in dealing with patients. Finally, with the growing body of evidence that personality traits have a high degree of heritability, the routine gathering of information on personality traits would aid epidemiologists in their understanding of the determinants of healthy and successful ageing.

Stabilisation of the unstable fractured zygomatic arch with a Kirschner wire

Although relatively uncommon, isolated fractures of the zygomatic arch can sometimes be difficult to stabilise following reduction. We present a simple method of stabilisation using a Kirschner wire.

The Chief Scientist reports. ... Mental health hearings for elderly people with dementia

The aim of the study reported here was to examine the feasibility of mental health hearings, modelled along the lines of the Children's Hearings, for handling legal and ethical problems that arise in managing the personal and financial affairs of elderly people with dementia. The study involved interviews with professionals, as well as a postal survey. The findings indicated that technically irregular solutions to problems were commonplace. Over half of the professionals surveyed thought that mental health hearings would help solve disputes.

The management of zygomatic complex fractures--results of a survey

A study was undertaken to investigate the current practices in the UK in the management of zygomatic complex fractures. The results are presented and discussed with reference to recent literature on the subject.

Reconstruction of the infraorbital margin with a composite microvascular free flap

A technique for reconstruction of the infraorbital bony rim and overlying soft tissues following ablative surgery is described using an osseofasciocutaneous radial forearm free flap. The advantages of this type of reconstruction are outlined.

Frontal sinus carcinoma presenting as acute sinusitis

Primary carcinoma of the frontal sinus is extremely rare. The aetiology of the tumour remains obscure, and even with rapid diagnosis and radical surgery the prognosis remains very poor.

Actinomycosis of the tongue. A diagnostic dilemma

Actinomycosis of the tongue is an uncommon form of this well known but little seen bacterial disease. A review of the literature is presented and a report of a case which is believed to be the first from the British Isles in recent years. The clinical appearance mimicked a deep seated malignant tumour with induration, limitation of tongue movement and pain. A Tru-Cut biopsy was obtained which revealed a diagnosis of actinomycosis. Treatment was with oral phenoxymethylpenicillin for 3 months.