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Combitube has been included in the American Society of Anesthesiologists (ASA) difficult airway algorithm for the emergency management of patients who can be neither intubated nor ventilated. The main advantages of the Combitube are minimal training required for its use and blind insertion with 90% success rate upon first attempt. The authors report a case of torrential oral bleeding in which the airway was secure and isolated by Combitube. The pharyngeal cuff of the Combitube was overinflated so as to create a tamponade effect to control otherwise uncontrollable and inaccessible oral bleeding.

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The ultrastructure of skeletal muscle and activity of some enzymes of energy metabolism were studied to assess the effect of a deficiency of dietary energy and subsequent nutritional rehabilitation in 24 young, growing, healthy rhesus monkeys. Electron microscopy of muscles on energy-deficient animals showed thinning of myofibrils with widening of interfibrillar space and enlargement and accumulation of mitochondria at subsarcolemmal level. There was an apparent significant reduction in the fiber size. Muscle samples from each animal were analyzed for enzymes representative of glycolysis (phosphofructokinase [PFK] and lactate dehydrogenase [LDH], citric-acid cycle (isocitric dehydrogenase [ICDH] and citrate synthase [CS] and regeneration of ATP (creatine kinase [CK]. PFK and LDH activities were significantly augmented in energy-deficient animals. The increase in LDH activity resulted from a large increase in MU (skeletal muscle) LDH subunit. The activities of CS and ICDH were reduced. No alteration of CK in muscle and serum was observed. The morphological structure and enzyme activities returned to normal after nutritional rehabilitation.

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Continuous vesical irrigation with 1 per cent alum solution was performed without anesthesia in 9 patients in whom massive bladder hemorrhage persisted despite evacuation of clots and normal saline irrigation for at least 24 hours. Hematuria ceased promptly in all patients, although the effect was transient in 3. No side effect was observed. Biopsy of the tumor subsequent to alum irrigation showed no alteration in the histological characteristics. Biopsy of the normal-appearing bladder mucosa also showed no evidence of epithelial damage. Ultrastructure of the tumor in 1 patient in whom transurethral resection was performed 2 weeks after alum irrigation revealed well preserved nuclear chromatin, thus, suggesting that whatever changes occur after alum irrigation are short-lived.

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A case of type-I congenital dyserythropoietic anaemia (CDA) in a Hindu child is described. The clinical and haematological features were characteristic, and the erythroblasts in the bone marrow revealed unusual ultrastructural abnormalities along with ultrastructural abnormalities in platelets and metamyelocytes.

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The histological abnormalities of amoebic colitis have been well described but their evolution over a period of time has not been clearly examined. To study this, three- to four-week-old guinea-pigs were inoculated intracaecally with 80,000 to 100,000 Entamoeba histolytica trophozoites, left untreated and killed at 3, 5, 8, 11, 14 and 21 days, when the caecum was removed and the tissue sectioned and stained with H & E and PAS. Although there was considerable variation in the type of histological abnormality seen on different days of the experiment, there was a definite pattern of evolution. Initially there was diffuse infiltration of the lamina propria by lymphomononuclear cells in the presence of an intact surface epithelial lining. This was followed firstly by superficial and then by deep ulceration of the mucosa. Mucosal invasion by the trophozoites was seen only at this stage and was accompanied by tissue necrosis; the most severe abnormalities occurred on day 11. The final development was regenerative activity which was first noted on day 11, and became more prominent subsequently. The presence of cellular infiltrate in the lamina propria in the absence of trophozoites and damage to the surface epithelium, suggests that these abnormalities are not the direct effect of amoebae. It is suggested that the initial damage is caused by an enterotoxin; the trophozoites enter the mucosa only when there is a break in the surface epithelium. Once within the tissues, trophozoites aggravate the damage by their ability to phagocytose and to release cytotoxic enzymes.

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A case of an infiltrating myxopolypoid tumor of the uterus is presented. Histologically, the tumor revealed spindle-shaped cells with mitotic counts ranging between 1-4/hpf, myxoid stroma, and multinucleated giant cells mimicking syncitial giant cells of pregnancy trophoblast. Conventional light microscopic methods failed to establish the histogenesis of the tumor. At the ultrastructural level the tumor showed three main cellular components; myoblasts, myofibroblasts and collagen-producing fibroblasts. On the basis of light microscopic and electron microscopic findings, the tumor was labelled myxoid leiomyosarcoma. This variant of leiomyosarcoma is rare. This is the seventh case reported in the international literature.

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In the University Teaching Hospital, Lusaka, Zambia, 45 strains of various non-typhoidal Salmonella species were isolated from 2990 samples of stools, blood and C.S.F. About 93% of the 45 strains were isolated from infants less than two years old. S. heidelberg was the most common species isolated from stools and revealed a multi-drug resistant character. Only S. typhimurium and S. bovis-morbificans were isolated from blood and C.S.F.

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