bluuebunny/crossref_metadata_2025 huggingface dataset:
‘Fruit‐flavoured’ mask for isoflurane induction in children
Authors: Lewis R. P. , Jones M. J. , Eastley R. J. , Wandless J. G.
Published: July 2010

The effect of disguising the odour of isoflurane with fruit flavouring, upon the quality of inhalational induction, was studied in 41 children aged 3–10 years in a double‐blind, randomised trial. Facemasks were either lightly coated with fruit extract or moistened with water so that their appearance was identical to children, anaesthetist and observer. Children allocated to receive fruit flavouring were significantly quieter than the placebo group, but their degree of movement during induction was unchanged. The incidence of respiratory complications including breath‐holding, laryngospasm and coughing was similar in both groups. Overall impression of the quality of induction as assessed by the anaesthetist showed no difference between the groups. This simple, cheap modification of inhalational induction warrants further appraisal while the case for disguising the odour of isoflurane remains unproven.
Acetylcholinesterase ‐ a specific marker for cerebrospinal fluid
Authors: VANNER R. G.
Published: July 2010

An oedematous pre‐eclamptic patient received lumbar epidural analgesia during labour. Clear fluid leaked from the skin puncture site for 4 days. The fluid was analysed using protein electrophoresis for cholinesterase enzymes and was found not to contain the cerebrospinal fluid specific form of the enzyme, acetylcholinesterase. The sensitivity of this test was explored using serial dilutions of cerebrospinal fluid. It is now possible to say that the leaking fluid did not contain cerebrospinal fluid.
Sick sinus syndrome manifest after spinal anaesthesia
Authors: UNDERWOOD S. M. , GLYNN C. J.
Published: July 2010

A case of sick sinus syndrome which presented as a cardiac arrest following spinal anaesthesia is reported. The diagnosis of sick sinus syndrome, the cardiovascular effects of spinal anaesthesia and the anaesthetic management of patients with the syndrome are discussed.
Inspiratory muscle effort during nasal intermittent positive pressure ventilation in patients with chronic obstructive airways disease
Authors: ELLIOTT M. W. , MULVEY D. A. , MOXHAM J. , GREEN M. , BRANTHWAITE M. A.
Published: July 2010

Effective intermittent positive pressure ventilation can be achieved noninvasively using a nasal mask, but patient comfort may be compromised and respiratory effort increased unless the trigger threshold is low and the response time of the ventilator short. The effect of nasal ventilation upon inspiratory muscle effort and the functional characteristics of the trigger of a purpose‐built ventilator were evaluated in five patients with chronic obstructive airways disease. A measure of inspiratory muscle effort, the average pressure time integral per minute, decreased by at least 80% in four patients and by 50% in one. Only two patients had significant numbers of triggered breaths (17% and 47% of total) during I h of ventilation with settings as used at home. Therefore trigger function was evaluated when the patients were made to trigger the ventilator by slowing the control rate. A high resting end‐expiratory intrathoracic pressure decreased the effective trigger sensitivity so that a mean (SD) change in oesophageal pressure of 14.8 (4.8) cmH2O was required to lower mask pressure by 2.4 (0.3) cmH2O and activate the trigger. Even under these conditions of lowest trigger sensitivity inspiratory muscle effort was not increased compared to spontaneous ventilation.
Growth of micro‐organisms in solutions of intravenous anaesthetic agents
Authors: BERRY C. B. , GILLESPIE T. , HOOD J. , SCOTT N. B.
Published: July 2010

This controlled bench study compared the growth of bacteria and yeast in solutions of commonly used intravenous anaesthetic agents at room and body temperatures. Drugs presented in aqueous emulsions support both bacterial and fungal growth. Five out of the six solutions supported the growth of yeast. The one exception was chlormethiazole. Which is both fungicidal and bactericidal. Solutions of drugs which will support growth of micro‐organisms should be used with great care and they should not be stored or infused over prolonged periods.
Development of a subdural motor blockade
Authors: ASATO F. , NAKATANI K. , MATAYOSHI Y. , KATEKAWA Y. , CHINEN K.
Published: July 2010

We report an unusual development of motor blockade following the subdural injection of local anaesthetic during attempted continuous lumbar epidural anaesthesia. Four characteristic features of subdural block, extensive spread, segmental distribution, delayed onset, and short duration of motor blockade were all features of the case. The patient had gradual development of complete motor blockade in the left upper extremity, incomplete in the right upper extremity, but absence of motor blockade in the lower extremities. The duration of complete motor blockade was 10 min in the hand and 35 min in the arm. The spread of contrast medium in the subdural space revealed the extent and degree of motor blockade.
Anaphylactoid reaction following local anaesthesia for epidural block
Authors: THOMAS A. D , CAUNT J. A.
Published: July 2010

A potentially serious complication of epidural bupivacaine used for a repeat, elective Caesarean section is presented. The main features of this reaction were erythema, itching, generalised and pulmonary oedema. In addition, pulmonary oedema was subsequently noted in the baby. An immunological hypersensitivity to bupivacaine or lignocaine is the likely cause.
Anaesthetic log books
Authors: Strang T. I.
Published: July 2010

Since 1989, the Royal College of Anaesthetists has encouraged trainees to keep log books, although there is little information about the benefits of this practice as a part of anaesthetic training. A postal survey of all grades of trainee anaesthetist in the North West Region of England was conducted to obtain information about the present use of log books. The survey showed that log books are only used diligently by the more junior grades of anaesthetic staff. Although the practice of keeping a log resulted in an increased ability of the trainee to describe his clinical experience, the subsequent exploitation of this information to monitor or correct deficiences in training was disappointingly low.
Estimation of the correct length of tracheal tubes in adults
Authors: Patel N. , Mahajan R. P. , Ellis F. R.
Published: July 2010

Estimation of the correct length of a tracheal tube is extremely important and should be tailored to the needs of the individual patient. One hundred and eight patients who required tracheal intubation during anaesthesia were studied. The predicted length was estimated in each patient before induction of anaesthesia. The upper end of the cuff was aligned externally with the cricoid cartilage, while the more proximal part of the tube lay alongside the neck to the angle of the mandible. The tube was then curved fowards towards the upper incisor teeth, and the length at the teeth or gums was noted. The anaesthetist, who was unaware of the predicted length, intubated the trachea after induction of anaesthesia. The length of tube inserted was standardised in relation to the vocal cords, and the actual length of tube inserted was recorded. The estimated length was within 1.0 cm and 1.5 cm of the actual length in 91% and 97% of patients respectively.
A review of 2000 consecutive ICU admissions
Authors: COHEN A. , BODENHAM A. , WEBSTER N.
Published: July 2010

The working practices and outcomes from UK intensive care units are poorly documented to date. We have reviewed 2000 consecutive admissions to one intensive care unit in a tertiary referral centre with initially six, then eight beds. The study was a retrospective review of contemporaneous data collection within the period 1986–1990. Demographic details, referral source, admission time, admission diagnosis, APACHE II score, therapeutic interventions, and outcome were recorded. A high overall mortality in the intensive care unit (23%), proportional to APACHE II scoring on admission, was demonstrated. This reflects the referral of many patients who have, or who develop, multiple organ failure. Mortality was significantly higher in patients over the age of 40 years. A total of 69.5% of patients were admitted outside the hours 0800–1800 h on Monday to Friday and admissions peaked between 1200 and 2100 h, demonstrating the need for senior out‐of‐hours cover. These figures may be used to compare future mortality and work practices in this and other units. The report illustrates some of the advantages and disadvantages of one method of data collection. As it represents one unit only, care must be taken in extrapolating results to others. The liming of admissions suggests that a review of medical staffing practices would be useful.
Propofol and fentanyl act additively for induction of anaesthesia
Authors: BEN‐SHLOMO I. , FINGER J. , BAR‐AV E. , PERL A. Z. , ETCHIN A. , TVERSKOY M.
Published: July 2010

The induction dose‐response of propofol was compared with the dose‐response of its combination with fentanyl and with that of fentanyl alone in three groups of 60 women undergoing minor gynaecological surgery. Dose‐response curves were determined for each group using bootstrap and isobolographic analyses. Propofol was found to act additively with fentanyl for induction of anaesthesia. Twenty‐three percent of the ED50of fentanyl was required in combination with 75% of the ED50for propofol to achieve the ED50of the combination. This indicates that, for induction of anaesthesia, propofol and fentanyl are not synergistic.
Blood loss following tonsillectomy in children
Authors: THIAGARAJAN J. , BATES S. , HITCHCOCK M. , MORGAN‐HUGHES J.
Published: July 2010

One hundred and ninety‐eight children, aged 3 to 12 years, who were scheduled for tonsillectomy were randomly allocated to receive either diclofenac 1.0 mg.kg−1 or papaveretum 0.2 mg.kg−1 by intramuscular injection after induction of anaesthesia. There were no significant differences between the treatment groups in operating theatre blood loss, the frequency of bleeding on the ward, or the need for operative haemostasis. However, the incidence of above average bleeding in the recovery room was significantly higher in the diclofenac group (p < 0.05). Similarly, marked restlessness in the recovery room was more frequent in the diclofenac group (p < 0.01). In both treatment groups there was an association between bleeding and restlessness during recovery so the increased bleeding in the diclofenac group may not be a direct effect.
Audit of pre‐operative starvation
Authors: Maclean A. R. , Renwick C.
Published: July 2010

An audit of pre‐operative starvation at Huddersfield Royal Infirmary has been undertaken. It shows that both adults and children are starved for significantly longer than the hospital's official starvation policy requires. The mean starvation time for children was almost 10 h, which is longer than the 8 h required before hypoglycaemia becomes a risk. A review of the literature suggests that only 3 h of fluid withdrawal is necessary. Possible ways to improve pre‐operative starvation regimens are discussed.
The Bicore pulmonary monitor
Authors: PETROS A. J. , LAMOND C. T. , BENNETT D.
Published: July 2010

The Bicore CP‐100 pulmonary monitor offers the advantage of continuous pulmonary monitoring at the bedside. Using an easily placed oesophageal balloon catheter and a flow transducer within the ventilator system, intrathoracic pressures, airway pressures and airway flow can be measured, and from these the Bicore calculates 25 other respiratory variables. The monitor screen displays real time waveforms of airway pressure, airway flow, oesophageal pressure and inspired tidal volume, and with these data it should be possible to determine more accurately when patients can be weaned from mechanical ventilation. It should also be possible to assess objectively the onset of respiratory fatigue and failure so that intervention can take place at an earlier stage. To assess the ease of use and potential benefit, the Bicore was used to calculate the work of breathing while weaning eight patients from mechanical ventilation in a spontaneous breathing mode. The pressure support ranged from 20 cmH2O, 10 cmH2O and 5 cmH2O, to a continuous positive airway pressure of 5 cmH2O, all with a positive end‐expiratory pressure of 5 cmH2O, down to a single T‐circuit with no positive airway pressure or end‐expiratory pressure. The work of breathing while on a Veola Hamilton ventilator was found to be about the same, while receiving pressure support of 20 cmH2O compared to a continuous positive airway pressure of 5; the other forms of respiratory support increased the work of breathing significantly.
Anaesthesia and rheumatoid arthritis
Authors: SKUES M. A. , WELCHEW E. A.
Published: July 2010

A review of the implications of rheumatoid arthritis on peri‐operative anaesthetic management is presented. Pre‐operative assessment should include a careful search for articular and systemic manifestations of the disease that may complicate intra‐operative care. Drug disposition may vary from the normal patient as a result of changes in serum protein binding, together with possible exaggeration of pharmacodynamic responses. Airway management presents one of the greatest challenges to the anaesthetist, and care in manipulation of the cervical spine is paramount.
Successful use of continuous veno‐venous haemofiltration to treat profound fluid retention in severe peripartum cardiomyopathy
Authors: BEARDS S. C. , FREEBAIRN R. C. , Lipman J.
Published: July 2010

The use of continuous veno‐venous haemofiltration after failure of conventional treatment in a patient with severe peripartum cardiomyapathy is described. Treatment with inotropes and diuretics failed to produce a diuresis despite the presence of severe fluid overload. Haemofiltration over a 9‐day period allowed removal of 171 of fluid with a concomitant improvement in haemodynamic function and a spontaneous diuresis.
Resistance to vecuronium
Authors: NORMAN J.
Published: July 2010

A 19‐year‐old epileptic patient taking carbamazepine was anaesthetised for a sigmoid colectomy. Such patients are reported to show a resistance to the actions of competitive neuromuscular blocking drugs, and a conventional dose of vecuronium (0.1 mg.kg−1) produced relaxation for only 18 min. Subsequently she received vecuronium 6.7 mg.h' which kept the first twitch of the train‐of‐four response at 30% of the control value. Antagonism with neostigmine 1.25 mg produced a rapid and full recovery. The report illustrates the usefulness of monitoring neuromuscular transmission whenever there is an anticipation of an altered response.
A split laryngeal mask as an aid to training in fibreoptic tracheal intubation
Authors: DARLING J. R. , KEOHANE M. , MURRAY J. M.
Published: July 2010

Thirty patients were randomly allocated to one of two groups in order to compare the use of a split laryngeal mask airway with the Herman II airway as aids to training in fibreoptic laryngoscopy. In both groups anaesthesia was induced with propofol and maintained with isoflurane in N2O/O2 (Fio2= 0.5). The fibreoptic laryngoscope was guided towards the larynx using the split laryngeal mask airway in group 1 and the Herman airway in group 2. The tracheas of all patients were successfully intubated at the first attempt and no patient's peripheral oxygen saturation decreased below 92%. Two min after intubation mean heart rate was significantly greater in group J (101 beat.min−1) than in group 2 (84 beat.min−1) (P < 0.05). The split laryngeal mask is a useful aid to training in fibreoptic intubation and may allow better airway control than the Berman II intubating airway.
What changes drug metabolism in critically ill patients? Two preliminary studies in isolated human hepatocytes
Authors: PARK G. R. , PICHARD L. , TINEL M. , LARROQUE C. , ELSTON A. , DOMERQUE J. , DEXIONNE B. , MAUREL P.
Published: July 2010

The metabolism of many drugs is abnormal in the critically ill patient. The causes of this are unknown, and investigation in patients is difficult. We therefore used isolated, cultured human hepatocytes to study the effects of hypoxia and induction on cytochrome P450 3 A, the cytochrome responsible for the metabolism of many drugs. When hepatocytes were exposed to 5% oxygen, the amount of 3 A produced, after induction with rifampicin, was five to 10 times less than the amount produced in 21% oxygen. In another study, we exposed isolated hepatocytes for 4 days to serum from five critically ill patients or from volunteers. At the end of this time, the functional ability of the hepatocytes to glucuronidate 14C progesterone was measured. Four of the five patients had a substance in their plasma that reduced the ability of the hepatocytes to glucuronidate progesterone. The nature of this substance and the reason that the serum from the fifth patient did not affect metabolism are unknown. This model is able to simulate the abnormalities which occur in critically ill patients. Further studies are needed to explain our observations and to identify the substances in the serum from critically ill patients that alter drug metabolism.
Air in the cavernous sinus following scalp vein cannulation
Authors: BROOK J. , MOSS E.
Published: July 2010

A 7‐month‐old infant was found to have air in the cavernous sinus during a CT scan under general anaesthesia. An anterior scalp vein had been used to administer atracurium and contrast. The anatomy and precautions to prevent air embolism during scalp vein cannulation are discussed.
A simple central venous puncture detector
Authors: TRIPATHI M. , PANDEY M. B.
Published: July 2010

During central venous cannulation, percutaneous venous puncture is performed blindly using a variety of surface landmarks on the body for different puncture sites. To avoid vessel transfixion and injury to adjacent structures, the earliest detection of venous puncture is essential. A simple central venous puncture detector is described, which not only efficiently detects entry of the needle into the vein but also prevents air embolism and blood spillage.
Sleeping positions adopted by pregnant women of more than 30 weeks gestation
Authors: Mills G. H. , Chaffe A. G.
Published: July 2010

The position adopted during sleep by 52 pregnant women and 31 age‐matched nonpregnant control subjects was studied. The pregnant group were all beyond the 30th week of gestation. In the pregnant group, 40 (77%) adopted a left tilt, 11 (21%) a right tilt and one (2%) was supine. In the control group, eight (26%) adopted a left tilt, 10 (32%) a right tilt, 12 (39%) were supine and one (3%) was prone. Closer analysis of the position adopted by the pregnant group showed: 33 adopted a full left 90° tilt, five a left 60° tilt, two a left 30° tilt, 11 adopted a full 90° right tilt and only one was supine. There was a significant difference between the sleeping positions of the pregnant and the control groups (p < 0.001). The majority of the pregnant group adopted a sleeping position that reduced the likelihood of aortocaval compression syndrome.
Brainstem auditory evoked response changes following electro‐acupuncture therapy in chronic pain patients
Authors: KUMAR A. , TANDON O. P. , DAM S. , TYAGI K. K.
Published: July 2010

Brainstem auditory evoked responses were recorded in 17 patients with chronic pain who had been given electro‐acupuncture therapy. The absolute peak latencies of waves I to V, and interpeak latencies and amplitudes of waves I and V were analysed before electro‐acupuncture and compared with values obtained during electro‐acupuncture and 5 min after its termination after one, five and 10 sittings. At these sittings the intensity of pain was recorded with the help of a 100 mm visual analogue scale. Each patient had 10 sittings given on alternate days. The absolute peak latencies of waves I, II, and III were delayed significantly (p < 0.05) after 5 and 10 sittings and amplitudes of wave V decreased significantly (p < 0.05) after 5 and 10 sittings. Visual analogue scores also decreased significantly (p < 0.01) during these sittings. It was established that before and after 10 sittings of electro‐acupuncture, there was a significant positive correlation between visual analogue scores and the amplitude of wave V (p < 0.01). There was a negative correlation between visual analogue scores and absolute peak latencies of wave III at 1, 5 and 10 sittings, suggesting that there is a definite interaction between the electro‐acupuncture neural mechanism and the generators of brainstem auditory evoked responses in the lower brainstem.
A preliminary clinical evaluation of magnetic stimulation of the ulnar nerve for monitoring neuromuscular transmission
Authors: Iwasaki H. , Igarashi M. , Namiki A.
Published: July 2010

The evoked motor responses to magnetic and electrical peripheral nerve stimuli were quantitatively assessed after vecuronium in 15 women undergoing gynaecological surgery. Anaesthesia was induced with thiopentone and fentanyl and maintained with intermittent doses of fentanyl and 66% nitrous oxide in oxygen. After immobilisation of both forearms in splints, the ulnar nerves were stimulated supramaximally every 10 s with a magnetic stimulator (Magstim Model 200®) and an electric stimulator (Myotest®) on opposite sides. The adduction forces of both thumbs to magnetic and electric stimuli were measured simultaneously before and after 0.06 mg.kg‐1 of vecuronium. After vecuronium administration the twitch responses to magnetic stimulation decreased more slowly than those to electric stimulation. The difference in the evoked responses between the two types of stimulation was approximately 20% overall and was significant 2 min after vecuronium administration (p < 0.05). The rate of recovery of the evoked twich responses was more rapid with magnetic than electric stimulation. It is concluded that magnetic stimulation of peripheral nerve is a useful technique for evaluating residual neuromuscular blockade.
Effects of surgical stimulation on midlatency auditory evoked potentials during general anaesthesia with propofol/fentanyl, isoflurane/fentanyl and flunitrazepam/fentanyl
Authors: SCHWENDER D. , GOLLING W. , KLASING S. , FABER‐ZÜLLING E. , PÖPPEL E. , PETER K.
Published: July 2010

During general anaesthesia, midlatency auditory evoked potentials are suppressed in a dose dependent manner by a number of general anaesthetics. The activating effects of surgical stimuli on midlatency auditory evoked potentials have been demonstrated during light inhalational anaesthesia, and indicate that midlatency auditory evoked potentials reflect the activity of the central nervous system and not only anaesthetic concentrations. We investigated the effect of surgical stimulation (skin incision, sternotoniy) on midlatency auditory evoked potentials under high dose opioid analgesia in 30 patients undergoing elective cardiac surgery. High dose opioid analgesia was maititained using fentanyl (1.2 mg.h−1) and combined with either propofol (4‐8 mg.kg−1.h−1) (group I, n = 10), isoflurane (0.6‐1.2 vol%) (group II, n = 10) or flunitrazepam (1.2 mg.h−1) (group III. n = 10). Midlatency auditory evoked potentials were recorded in the awake state, during general anaesthesia before skin incision, after skin incision and after sternotoniy. During general anaesthesia there were marked statistically significant increases in latencies and decreases in amplitudes of midlatency auditory evoked potentials in the propofol/fentanyl and isoflurane/fentanyl groups. In contrast, in the flunitrazepam/fentanyl group there were only small changes of midlatency auditory evoked potentials. The latencies of the early cortical potentials were similar to those in the awake state. After skin incision as well as after sternotomy no significant changes of midlatency auditory evoked potentials could be observed in any of the experimental groups. These results indicate that activation of the auditory pathway by surgical stimuli may be blocked when analgesia is provided by high dose fentanyl. Furthermore, midlatency auditory evoked potentials may be preserved during surgical analgesia as demonstrated in the flunitrazepam/fentanyl group, whereas they were suppressed during propofol/fentanyl and isoflurance/fentanyl. Propofol (4‐8 mg. kg−1.h−1) or isoflurane (0.6‐1.2 vol%) seem to be superior to flunitrazepam (1.2 mg.h−1) in their potency to suppress the auditory pathway during surgical analgesia with fentanyl.
Continuous measurement of systemic vascular resistance
Authors: O'DWYER J.P. , KING J. E. , WOOD C. E. , TAYLOR B.L. , SMITH G. B.
Published: July 2010

We have successfully linked a standard patient monitor system (Hewlett pakard M1166A‐A66) with the Boxter Edwards critical‐Care Swan Gan‐ Intellicath continuous cardiac output catheter and the Vigilance continuous cardiac output minior system to porduce continuous values of systemic vascular resistance. Six cases are presented in which marked changes in indexed systemic vascular resistance were observed as a result of clinical interventions. The continuous derivation of systemic vascular resistance has much potential as a diagnotic and research tool as well as allowing rapid ac curate assessment of the response of patients to therapy.
Unilateral hypoglossal nerve paralysis following the use of the laryngeal mask airway
Authors: NAGAI K. , SAKURAMOTO C. , GOTO F.
Published: July 2010

We report a unilateral hypoglossal nerve paralysis following the use of a laryngeal mask airway in a 62 year‐old women with rheumatoid arthritis undegoing a shoulder joint replancement,. Cervical epidural anesthesia was vombined with general anaesthesia using nitrous oxide administrered via a larygeal mask airway with a the patient in the right lateral decubitus postion. The next morning, the patient was noted to have a right hypoglossal nerve palsy. compression of the nerve between the laryngeal mask airway cuff. distended with nitrous oxide, and the hyoid bone, was considered to be the cause ot the nerve paralysis.
Air inlets for infusion bottles
Authors: THORPE C. M. , SCOTT D. H. T.
Published: July 2010

We assessed the resistance to air flow in four comonly used air inlets. The Avon A81 ‘ and Codan air inlets provide the least resistance to flow, followed by the Baxter CO413 and lastly the Braun air inlet. The presence of a valve confers and advantage when rapid infusion of fluid is attempted . the valve in the inlet performed best out of the inlets tested.
A survey of pre‐operative optimisation of high‐risk surgical patients undergoing major elective surgery
Authors: Singh S. , Manji M.
Published: July 2010

Pre‐operative optimisation of high‐risk patients undergoing major elective surgery has been shown to decrease peri‐operative morbidity and mortality. It is also cost effective because of the resulting decrease in postoperative complications. A questionnaire was sent to 170 intensive care and high dependency units in Britain in order to quantify the number of units practising pre‐operative optimisation. There was a 91% response rate. Of the respondents familiar with the evidence advocating pre‐operative optimisation, 91% believe pre‐operative optimisation improves outcome but only 62% admit patients for such preparation. Moreover, only eight units (6%) admit more than 25% of eligible patients. The reasons given for not admitting such patients pre‐operatively are a lack of manpower, beds or both. This survey demonstrates the need for greater investment of resources into intensive care and high dependency units, so that clinicians can deliver high‐quality evidence‐based healthcare in accordance with the principles of clinical governance.
Compartment syndrome associated with the Lloyd Davies position
Authors: Turnbull D. , Mills G. H.
Published: July 2010

The Lloyd Davies position was developed to facilitate access to the pelvis for gynaecological, urological and colorectal procedures. Previous case reports have demonstrated that prolonged adoption (> 4 h) of this position has been associated with the development of bilateral compartment syndrome of the calves. All three patients reported here suffered severe bilateral calf pain despite the use of thoracic epidurals. All three cases required three‐compartment fasciotomies and, 6 months after surgery, were all still severely disabled as a consequence of the compartment syndrome. These case reports stress the dangers of use of the Lloyd Davies position for prolonged procedures and demonstrate that some patients are at risk after relatively short periods (< 3 h). Previous case reports and clinical studies have focused on the effect of limb elevation in stirrups on the arterial pressure in the lower limb. We review the pathophysiology of compartment syndrome and consider factors other than a decrease in arterial pressure that may predispose to compartment syndrome during adoption of the Lloyd Davies position.
Computerised dynamic posturography to assess recovery comparing general anaesthesia with sedation and local anaesthesia for day case nasal surgery
Authors: Makker R. , Bailey P. , Royston R. , Kulinskaya E.
Published: July 2010

Computerised dynamic posturography (CDP) can be used as an early marker of recovery to street fitness in patients undergoing ambulatory surgery. We studied three groups of patients undergoing nasal surgery. The goal of this study was to determine whether recovery, as assessed by CDP, is more rapid in patients having nasal surgery under sedation coupled with local anaesthesia or those having surgery under general anaesthesia. We further assessed the acceptability of sedation accompanied by local anaesthesia. A control group was included to determine if there is a learning curve to posturography. There was no difference between the two study groups in terms of balance. Balance was not significantly impaired at 3 h postoperative testing.
Oral midazolam premedication for day case breast surgery, a randomised prospective double‐blind placebo‐controlled study
Authors: Abdul‐Latif M. S. , Putland A. J. , McCluskey A. , Meadows D. P. , Remington S. A. M.
Published: July 2010

We conducted a randomised prospective double‐blind placebo‐controlled study to assess the efficacy of oral midazolam premedication in 50 ASA I and II female patients scheduled to undergo day case breast surgery. Anxiety was assessed using 100‐mm visual analogue scales (VAS) and The State‐Trait Anxiety Inventory (STAI) psychometric questionnaire. Midazolam premedication did not significantly reduce either VAS or STAI score, although heart rate and systolic arterial pressure immediately before induction of anaesthesia were significantly lower in patients who received midazolam (p = 0.006 and 0.039, respectively). Induction of anaesthesia was achieved with a lower dose of propofol (p = 0.0009) and excellent (Grade I) conditions for insertion of a laryngeal mask airway were achieved more often after midazolam premedication (p = 0.038). Arterial desaturation during induction of anaesthesia and insertion of a laryngeal mask airway occurred more often in patients who received placebo (p = 0.022). There was a good correlation between VAS and STAI used to assess the anxiolytic effects of premedication. (Spearman coefficient 0.58, p < 0.0001).
Tracking the early acquisition of skills by trainees
Authors: Harrison M. J.
Published: July 2010

A form of sequential analysis has been developed to track performance of tracheal intubation by novice intubators. One hundred and nineteen trainees completed logbooks during their attachment to the Departments of Anaesthesia and these data were used to produce rates of success for sequential attempts at the procedure. A grid was created from this on which future trainees could report their performance. A boundary drawn on the grid can be used as a trigger to indicate the need for more basic instruction.
Biological and clinical characterization of recurrent 14q deletions in CLL and other mature B‐cell neoplasms
Authors: Reindl Lena , Bacher Ulrike , Dicker Frank , Alpermann Tamara , Kern Wolfgang , Schnittger Susanne , Haferlach Torsten , Haferlach Claudia
Published: July 2010

14q‐deletions have been repeatedly described in mature B‐cell neoplasms, but not yet characterized in a larger cohort. Based on chromosome banding analysis, the present study identified 47 del(14q) cases in 3054 mature B‐cell neoplasms (1·5%) (chronic lymphocytic leukaemia [CLL]: 1·9%; CLL/prolymphocytic leukaemia [PL]: 9·0%; others: 0·2%). Interphase fluorescence in situ hybridization was performed with probes for 14q22.1, 14q24.1, 14q32.33, and IGH@ (14q32.3). The del(14q) had heteregeneous size but showed a breakpoint cluster at the centromeric site in 14q24.1 (62% of cases). At the telomeric side, the most frequent breakpoint was within the IGH@ locus (14q32.3) between IGH@ 3′‐flanking and IGHV (IgVH) probes (45%). In 16 cases (34%), breakpoints occurred within 14q24.1 and 14q32.3. Eighty‐one percent of del(14q) cases showed 1–3 additional cytogenetic alterations (in 45%, +12), and 56% were IGHV‐unmutated. In all cases (16/16) with breakpoints in 14q24.1 and 14q32.3, a B‐CLL immunophenotype was found. Clinical follow‐up in 32 del(14q) patients was compared to 383 CLL and CLL/PL patients without del(14q). While 3‐year‐overall survival did not differ significantly, time to treatment was significantly shorter in the del(14q) cohort (21·0 months vs. 80·1 months, P = 0·015). In conclusion, the del(14q) is a rare recurrent alteration in diverse mature B‐cell neoplasms, shows variable size but distinct clustering of breakpoints, and is associated with short time to treatment.
Interferon-α increases monocyte migration via platelet–monocyte interaction in murine intestinal microvessels
Authors: Higashiyama M , Hokari R , Kurihara C , Ueda T , Nakamura M , Komoto S , Okada Y , Watanabe C , Kawaguchi A , Nagao S , Miura S
Published: July 2010

The aim of this study was to investigate the effect of interferon (IFN)-α on recruitment of platelets and monocytes within the murine small intestinal venular endothelium. Monocytes were isolated from bone marrow of C57B6 mice. Platelets were collected from murine blood. Rolling and adhesion to submucosal microvessels in the small intestine were examined under an intravital fluorescence microscope after injection of fluorescein-labelled monocytes or platelets. In some mice, IFN-α (5 × 105U/kg) was administered intraperitoneally. After treatment with an antibody against P-selectin, changes in monocyte and platelet migration were also investigated. Changes in monocyte migration under the condition of thrombocytopenia were also investigated. Platelets and monocytes interacted with murine intestinal microvessels, although only few platelets and monocytes showed migration behaviour. Intraperitoneal injection of IFN-α enhanced the migration of both platelets and monocytes in the intestinal microvessels. Pretreatment with anti-P-selectin attenuated the increase in migration of platelets and monocytes induced by administration of IFN-α. Thrombocytopenia decreased the rolling ratio of monocytes, suggesting that the effect of IFN-α on migration was P-selectin-dependent, derived from both the endothelium of microvessels and platelets. The results of this study suggest that IFN-α acts as a potent proinflammatory agent via its stimulatory effect on the endothelium–platelet–monocyte interaction in intestinal microvessels by a P-selectin-dependent mechanism.
Expression of vimentin and high‐molecular‐weight cytokeratin (clone 34ßE12) in differentiating reactive renal tubular cells from low‐grade urothelial carcinoma cells in voided urine
Authors: Ohsaki H. , Hirakawa E. , Nakamura M. , Norimatsu Y. , Kiyomoto H. , Haba R.
Published: July 2010

H. Ohsaki, E. Hirakawa, M. Nakamura, Y. Norimatsu, H. Kiyomoto and R. Haba

Expression of vimentin and high‐molecular‐weight cytokeratin (clone 34ßE12) in differentiating reactive renal tubular cells from low‐grade urothelial carcinoma cells in voided urine

Objective:  Reactive renal tubular cells show features of an atypical repair reaction. Differentiation between reactive renal tubular cells and low‐grade urothelial carcinoma (LG‐UC) cells can therefore be a diagnostic challenge based on morphology alone. In this study, we evaluated the diagnostic utility of vimentin and a high‐molecular‐weight cytokeratin antibody (clone 34ßE12) in differentiating reactive renal tubular cells from LG‐UC.

Methods:  We evaluated voided urine cytology and surgical specimens from 40 patients with renal disease, and 17 patients with LG‐UC. All slides were stained with vimentin and 34ßE12.

Results:  In the reactive renal tubular cells in voided urine cytology, vimentin showed strong cytoplasmic staining in 39/40 (97.5%) cases, but all were negative for 34ßE12. LG‐UC cells showed positive staining for 34ßE12 in 3/17 (17.6%) cases, whereas none were positivity for vimentin. The reactive renal tubular cells of histological specimens in the renal disease group demonstrated positive for vimentin in all 40 cases and all were negative for 34ßE12. The LG‐UC group showed abnormal staining for 34ßE12 in 4/17 (23.5%) cases, whereas none were positive for vimentin.

Conclusions:  Vimentin expression in urine cytology can help to distinguish reactive renal tubular cells from LG‐UC. However, 34ßE12 does not appear to be a useful adjunct to distinguish these two groups in voided urine cytology.
A MULTIDISCIPLINARY DIAGNOSTIC/GENETIC STUDY ON THE 105 PATIENTS WITH MENTAL RETARDATION OF THE E.S. LE GRANGE SCHOOL
Authors: Hof J. Op't , Venter P. A. , Toit Joan L. Du , Gericke G. G. , Dawson Bronwen , Coetzee D. J. , Mienie L. J. , Marais C. H. , Reinecke C. J.
Published: July 2010

A comprehensive genetic/diagnostic survey was undertaken at a special school for the mentally retarded involving 105 patients. Cytogenetic, biochemical and clinical investigations were undertaken to establish the contribution of the genetic factors to the problem of mental retardation. Apart from obtaining information about specific children, identifying families at risk, and providing genetic counselling in nearly 50% of cases, data was obtained which could be compared with other similar surveys. According to the aetiological grouping of the patients, 6.7% could be attributed to perinatal damage, 17.1% to chromosomal defects, 4.8% to biochemical disorders, 5.7% to other genetic causes, 12.4% to other prenatal damage, 1.9% to infections, and 51.4% to unknown causes. No individual with the marker X syndrome was found in this group.
Computer‐assisted linguistic analysis of an autistic adolescent's language: implications for the diagnosis of Aspberger's syndrome and atypical psychoses
Authors: KING K. , FRASER W. I , THOMAS P. F.
Published: July 2010

ABSTRACT. This study illustrates the use of a computer‐assisted linguistic analysis technique to compare the spoken language of an adolescent, diagnosed in childhood as autistic, with that of normal and schizophrenic individuals. A distinctive profile, in keeping with accounts in the literature of autistic speech, was noted to be radically different from that found in linguistic analysis of schizophrenic speech. This distinctive profile was mirrored by her written linguistic analysis. Changes indicative of some improvement in language function were seen on re‐recording after 5 years. Implications of this technique for differential diagnosis of Aspberger's syndrome and atypical psychoses are mentioned.
The American mental retardation service system
Authors: ROWITZ L.
Published: July 2010

ABSTRACT. Significant changes have occurred in the United States in the last 30 years relative to the delivery of services to mentally retarded people. This paper explores the development of community service options in the United States since the late 1950s. The development of these new services is viewed relative to concerns with both deinstitutionalization and normalization. From the vantage point of the mid‐1980s, the paper also explores the importance of information on the continuum of care cycle of mentally retarded individuals throughout the life cycle as an important guide to the understanding of how the American mental retardation service system functions.
The use of testicular volume as a clinical marker for cytogenetic disorders in mentally retarded males
Authors: KIRKILIONIS A. J. , POZSONYI J. , SERGOVICH F. R.
Published: July 2010

ABSTRACT. The testicular volumes (V) of 817 adult (non‐Down's syndrome) institutionalized males were calculated. The mean testicular volume was 19.5±15.8 ml, comparable to the normal adult male mean of 17–19 ml. However, the number of institutionalized males with V≤25 ml and V≤10 ml was increased approximately fourfold over the normal male population. Resident adult males were grouped into three categories based on their testicular volumes: (1) V≤25 ml (macro‐orchid); (2) V≤15 ml (micro‐orchid); and (3) 15 < V < 25 ml (‘normal’). An equal number of randomly selected males from each category were cytogenetically screened for the fra(X) syndrome as well as for non‐fra(X) chromosome abnormalities. The overall frequencies of these disorders were 3.1% and 3.9%, respectively. The fra(X) syndrome was found in a significantly higher percentage of macro‐orchid males (10.3%) as compared to males with either micro‐orchidism (1.2%) or normal testicular volume (1.2%). There was no significant difference in the distribution of either fra(X) negative non‐specific XLMR or non‐fra(X) chromosome abnormalities among resident males from these three categories. Testicular volumes ≥25 ml, especially those exceeding 40 ml, were thus shown to be useful clinical markers in the diagnosis of the fra(X) syndrome. Reduced testicular volume was not a useful clinical marker in the evaluation of other non‐Down's syndrome chromosome abnormalities.
Twenty‐six years later: a woman with tetra‐X chromosomes
Authors: BERG J. M. , KARLINSKY H. , KOROSSY M. , PAKULA Z.
Published: July 2010

ABSTRACT. A 26‐year follow‐up of the first reported female with tetra‐X chromosomes is presented. Mental and physical manifestations, and their variability, are considered with reference to this woman and other documented examples of the uncommon chromosomal aberration concerned.
The socio‐familial background and prevalence of medical aetiological factors in children attending ESN/M schools
Authors: LAMONT M. A.
Published: July 2010

ABSTRACT. A study of 169 mildly mentally retarded children included consideration of social class, medical risk factors, sibship position, family size and parental education. Ninety‐four (56%) children were from social class IV or V. Medical risk factors were identified in 71 (42%) children overall: the prevalence fell from 55% in social class II to 30% in social class V. Prenatal factors were identified in 22 children of whom 14 were third or later born in their sibship: this may reflect increased maternal age at birth. Perinatal events had been reported in 41 children, 20 of whom were in social class III; there was no clear relationship to sibship position. Seven of eight postnatal events had occurred in children in social class II or III. Children in social class IV or V did not appear to be at increased risk of retardation from environmental medical events. First born children were over‐represented in the survey, with a minor shift towards fourth or later‐born children. Average family size was 3.25 children (general population 2.0 children). The prevalence of medical risk factors was lowest (18%) in children from large sibships in social class V. Both parents of 86 children had had educational problems: this included 13 children in social class III. Thirty‐eight (33%) of these children had medical risk factors, compared with 43/83 (51%) in children where at least one patient had achieved average education. Thirty children had no medical risk factor, nor any history of parental learning difficulty.
Studies on experimentally induced hyperphenylalaninemia
Authors: PUESCHEL S. M. , BOYLAN J. , ELLENBOGEN R.
Published: July 2010

ABSTRACT.The administration of several compounds thai can increase plasma phcnylalanine levels and or inhibit phcnylalanine hydroxylase in rats was studied in order to determine iheir usefulness in inducing a phenylketirtiuria‐like state. The results of this investigation revealed that 4′5 um/10 g p‐chlorophenylalanine is more el'lective lhan L‐phcnylalaninc, a‐methylphenylalanine, trimelhoprim, Hactrim and Scptra, since the lormer auii Mukl julidiiced both adequate hyperphenylalaninemia and marked inhibition of hepatic phenylalanine hydroxylase activity. In addition, a 24‐h study provided important insights into the changing diurnal patterns of specified biochemical parameters.
Peer relationships of mildly retarded young adults living in the community
Authors: KOLLER H. , RICHARDSON S. A. , KATZ M.
Published: July 2010

ABSTRACT. Socializing with peers and opposite‐sex relationships were examined in two subsets of a mildly mentally retarded (MMR) young adult population living in the community: those who were no longer receiving MR services and those who were attending day centres for MR adults. The MMR young people not receiving services had fewer best friends and socialized significantly less often than a nonretarded comparison population. The MMR males not receiving services also had fewer opposite‐sex relationships than comparisons but this difference was not significant for the females. At age 22, these MMR young people continued to see friends from school significantly less often than comparisons, indicating a possible detrimental effect of special schooling on later socializing with peers. The MMR young people at the day centres socialized more often but this was done almost wholly with others who were MR. Within the MMR study population, the young women not receiving services socialized with peers the least, less than the young women at the day centres and less than the young men not receiving services, but they were married most often.
Urinary levels of biogenic atnine metabolites in mentally retarded children
Authors: NALINI K. , AROOR A. R. , RAO A.
Published: July 2010

ABSTRACT. Urinary total catecholamines, their metabolites and metabolite of serotonin were estimated in 32 mentally retarded children and 15 controls. Levels of total catecholamines. MHPG and 5‐HIAA were not significantly different from controls. However, the mean VMA and HVA excretion in mentally retarded children was significantly increased compared to the control group. It is concluded that an altered metabolism of dopamine is involved in mental retardation.
Auditory P300 response in the assessment of Alzheimer's disease in Down's syndrome: a 2‐year follow‐up study
Authors: MUIR W. J. , SQUIRE I. , BLACKWOOD D. H. R. , SPEIGHT M. D. , ST CLAIR D. M. , OLIVER C. , DICKENS P.
Published: July 2010

ABSTRACT. Sixty‐five subjects with Down's syndrome were followed up and retested 2 years after the initial recording ni auditory P300 (P3) event‐related potential described in a companion paper (Blackwood et al., 1988). The number of subjects showing clinical evidence for Alzheimer's type dementia had increased by a further 14%. In subjects showing clinical deterioration over a period of 2 years, 78% (7/9) had an increase in P3 latency which was three standard deviations or greater than the group mean. None of the 20 fragile‐X group retested showed significant change after 2 years. The results suggest that P3 change may be a sensitive index of the onset of Alzheimer's type dementia in Down's syndrome.
Computer‐assisted linguistic analysis of two mentally retarded psychotic female's texts
Authors: FRASER W. I. , KING K. , THOMAS P.
Published: July 2010

ABSTRACT. Prompted monologues from a schizophrenic and manic mentally handicappedfemale were analysed using a computer program designed to generate 118 syntactic variables. The procedure was repeated after several years. The linguistic profiles and their change over time were characteristic of chronic schizophrenia and mania, respectively: the schizophrenic‐illness‐based profileshowed further linguistic disintegration; the manic‐illness‐based profile showed linguistic recovery, mirroring clinical improvement.