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Purpose: To understand the anatomical relationships of the Esophageal-Tracheal Combitube (ETC) with the larynx, pharynx, esophagus and trachea., Methods: An extensive dissection of the neck and thorax of a 70-yr-old caucasian male cadaver was done to expose the larynx, pharynx, trachea and esophagus. The ETC was inserted following the manufacturer's recommendations. Effects of the ETC on the surrounding structures were observed with the ETC first inserted in the esophagus and then, in the trachea., Results: When inserted in the esophagus, the ETC produced marked bulging of the anterior wall of the esophagus and anterior displacement (4.5 cm) of the trachea. Inflation of the distal cuff of the ETC produced distension of the esophagus. When inserted in the trachea, the ETC also caused anterior protrusion., Conclusion: Protrusion of the anterior wall of the esophagus and distension resulting from inflation of the distal cuff could lead to esophageal injuries. These observations may explain the previously reported complications associated with the use of the ETC.

Purpose: To report four cases of subcutaneous emphysema, pneumomediastinum and pneumoperitoneum associated with the use of the Esophageal-Tracheal Combitube (ETC) during prehospital management of cardiac arrest., Clinical Features: Between September 1994 and April 1996, 1139 patients were resuscitated with the ETC and the semiautomated external defibrillator as part of the CPR protocol for prehospital management of cardiac arrest by basic emergency medical technicians. Eight of these patients presented with subcutaneous emphysema. Four of them, declared dead after arrival in the emergency room (ER), had autopsy studies. In two, autopsy revealed large (6 and 6.5 cm respectively) longitudinal transparietal lacerations of the anterior wall of the oesophagus. Multiple superficial lacerations of the oesophagus were also present in another patient, while no lesion of the airway or the oesophagus was found in the last patient., Conclusion: These cases suggest that subcutaneous emphysema, pneumomediastinum and pneumoperitoneum might be complications associated with the use of the ETC. At least in two cases, oesophageal laceration appears to be the mechanism by which these complications occurred.

Unlike most polymorphic markers in the Chlamydomonas eugametos and Chlamydomonas moewusii chloroplast DNAs (cpDNAs), the C. moewusii 6- and 21-kb extra sequences and the C. eugametos-specific CeLSU small middle dot 5 intron are transmitted to all of the few viable progeny in reciprocal crosses between the two green algae. To determine whether this unidirectional transmission pattern is due to gene conversion or to selection for F1 hybrid survival, we followed the inheritance of the parental alleles at the loci featuring these three deletions/additions and at several other polymorphic cpDNA loci in zygospore clones derived from high-viability crosses. The great majority of the zygospore clones examined inherited exclusively the long alleles from the mt- parent at the loci containing the three optional cpDNA elements, but as expected, they preferentially inherited the markers from the mt+ parent at most other loci. Our results therefore indicate that all three optional cpDNA sequences propagate themselves very efficiently by gene conversion in crosses between strains differing by the presence of these elements. The co-conversion tracts associated with these sequences are longer (>3 kb) than those previously reported for mobile elements spreading by gene conversion. Our results also revealed that less efficient gene conversion events occurred at two other cpDNA loci.

Whatever the technique used may be, the anesthesia for emphysematous patients is always a delicate one. With more and more anesthesiologists dedicated to the use of anesthesia for pulmonary surgery and who are applying the principles described in this article, many emphysematous patients, sometimes severely ill who otherwise would not be a candidate for usual anesthesia, may now profit from surgery for emphysema owing to the use of safe and efficacious anesthesia.

Objective: To report a patient with 2 consecutive reversible drug-induced liver disorders and the application of International Consensus Meeting Criteria for the screening and diagnosis of drug-induced liver disorders., Case Summary: An 88-year-old man in a chronic care institution developed abdominal discomfort and jaundice after finishing a 10-day course of trimethoprim/sulfamethoxazole therapy for a urinary tract infection (UTI). The jaundice and the symptoms resolved spontaneously and the final diagnosis was symptomatic drug-induced liver injury, mixed type. After 1 month, the same patient received a course of cefadroxil therapy for another UTI. He developed an asymptomatic drug-induced liver injury, mixed type. Six months later, the patient received oral penicillin therapy and then ciprofloxacin, with no change in his liver function test results., Discussion: To our knowledge, there are only a few other reports in the literature of a drug-induced liver injury with cefadroxil therapy; more cases are reported with trimethoprim/sulfamethoxazole than with cefadroxil. The criteria of an International Consensus Meeting were helpful to evaluate both incidences of liver injury in this patient with the aim of establishing the diagnosis and causality assessment. Additionally, the criteria were used to show that the patient had 2 separate liver injuries., Conclusions: Screening and diagnosis of drug-induced liver disorders depend on careful history taking and 5 specific biochemical liver tests. The evolution of the liver disorder induced by cefadroxil therapy probably was interrupted because of its early detection. Appropriate screening was done with the subsequent administration of new potentially hepatotoxic drugs.