Duplication 22q11.2 syndrome is the result of a microduplication of the same chromosomal region that is deleted in DiGeorge and Velocardiofacial syndromes. We describe a patient with dysmorphic features who was diagnosed with pre-B acute lymphoblastic leukemia, and developed cystinuria and pancreatitis during treatment. Duplication 22q11.2 has not been previously described in association with hematologic abnormalities. Chromosomal microarray technology was used to diagnose duplication 22q11.2 syndrome. In this era of advanced genomics, this technology has become an important method for helping to determine the molecular basis of diseases, best treatments and ultimately patient outcomes.

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Objectives: To analyse the clinical features and outcomes of patients with spider bites who presented to the Department of Emergency Medicine, Royal Hobart Hospital, Tasmania, Australia. Methods: A retrospective study of all patients with an emergency department discharge diagnosis of confirmed spider bite during a 5 year period was performed. Results: Twenty‐two cases were identified, 15 of which involved unidentified spiders. Most victims were in the 15–34 years age group and were bitten in the home. Identified spiders included: redback (Latrodectus hasselti), white‐tailed house (Lampona cylindrata), black house (Badumna insignis) and huntsman (Delena cancerides). Pain, swelling and erythema were the main presenting symptoms; main presenting signs were erythema, swelling, bite marks, local tenderness, lymphadenopathy and blistering. In 23% of cases, no clinical signs were detectable. Treatment consisted of antihistamines (36%) and antibiotics (32%). Four patients had signs consistent with necrotizing arachnidism; two of the four healed with hyperbaric oxygen after antibiotic treatment failed. Redback antivenom was administered to four patients. Three patients required in‐patient treatment for local complications. Conclusions: Most spider bites presenting to Royal Hobart Hospital were uncomplicated; redback bites were uncommon. Treatment strategies were ill‐defined and microbiological specimens were taken infrequently. Patients’ tetanus immunization status was poorly documented. There is a need for a national register of spider bites in Australia.

Purpose:We present the anesthetic management of a parturient with metastatic pancreatic carcinoid tumor. This included a multidisciplinary approach, invasive monitoring, epidural labour analgesia and ready access to drugs to manage a potential carcinoid syndrome. Clinical Features: The patient has given consent to the publication of this case report. A primiparus 29-yr-old woman with a singleton fetus at 32 weeks gestation was referred to the Anesthesia Preadmission Clinic. She had a non-surgical primary pancreatic, non-secreting carcinoid tumor with metastases to the liver. Examination revealed a well-looking woman with normal airway, cardiovascular and respiratory examinations. Other co-morbidities included wellcontrolled gestational diabetes. Her pregnancy had been uncomplicated to date. Obstetrics, oncology, endocrinology and clinical pharmacology were involved in the care of the patient. Serial ultrasounds of her liver, liver function tests and tumor marker chromogranin A were being regularly followed. The potential use of octreotide in the event of a carcinoid crisis had been discussed. An induction was planned at 38 weeks gestation. Epidural analgesia for labour was recommended to limit catecholamine release that could induce a carcinoid crisis. An arterial line was recommended for direct monitoring of blood pressure. Octreotide and the protocol for administration were made available in the delivery room. At the time of induction the liver function tests and abdominal ultrasounds had remained stable. A radial arterial line followed by a lumbar epidural was placed uneventfully prior to induction. Epidural analgesia was established with 0.1% ropivacaine and fentanyl 2 μg/mL. Use of epinephrine and ephedrine were avoided. Induction was achieved with artificial rupture of membranes, followed by oxytocin augmentation. The patient remained comfortable and her heart rate and blood pressure remained stable. The fetal heart rate was reassuring. The patient had a spontaneous vaginal delivery of a live infant. The patient remained stable post partum. Conclusion: Metastatic carcinoid tumors may release vasoactive substances causing carcinoid syndrome (bronchoconstriction, hemodynamic instability, arrhythmias, flushing, hyperglycemia), which may be life-threatening.1 Our goal in anesthetic management was to prevent a carcinoid syndrome with adequate epidural analgesia so as to avoid the stress-induced release of catecholamines during labor.2,3 Invasive blood pressure monitoring facilitated titration of epidural blockade and avoidance of hypotension and reflex sympathetic nervous stimulation. If the patient began to experience symptoms of carcinoid syndrome during the peripartum period,

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