Hydrogen peroxide--a party trick from the past?

Hydrogen peroxide solutions are found in almost every operating theatre and are used by many surgical specialties, often with little knowledge of their inherent risk. We reviewed the literature and evidence related to the use of hydrogen peroxide in surgery. We found little evidence supporting the use of hydrogen peroxide solutions intraoperatively, a large number of reports of sometimes-fatal oxygen embolism and other evidence of tissue toxicity. We conclude that the use of hydrogen peroxide as an antiseptic has no direct benefit, but is associated with significant risk, and therefore should be reconsidered.

Suicide among young rural Australians 1964-1993: a comparison with metropolitan trends.

The study tested hypotheses that from 1964 to 1993: (1) suicide rates among Australian 15- to 24-year-old males rose more sharply in rural than metropolitan areas; (2) firearm suicide rates among 15- to 24-year-old males, declining throughout Australia recently, rose continuously in rural areas; (3) suicide rates among 15- to 24-year-old females did not change significantly in either metropolitan or rural areas. Suicides of those aged 10-24 years recorded by the Australian Bureau of Statistics (ABS) were classified according to the subject's residential grouping. Rates were calculated using ABS population data corresponding to these groupings. Results were analysed using log-linear analysis and chi-square statistics. The results supported the first two hypotheses, but not the third. Suicide rates for 15- to 24-year-old males rose by a factor of 2.2 in metropolitan areas, by 4-fold in towns with populations between 4,000 and 25,000, and by 12-fold in towns with populations less than 4,000. Male firearm suicide rates continued to rise in rural areas, and the greatest proportion of deaths in those locations were by firearms, though male hanging rates increased most in recent years in all locations. Female youth suicide rates did not change overall, but in towns with populations less than 4,000, they increased 4.5-fold. Possible explanations for this epidemic, which are mostly speculative and require confirmation, are discussed.

Low-dose maintenance clozapine treatment in the prophylaxis of bipolar affective disorder.

A chronically relapsing middle-aged man with bipolar affective disorder responded poorly to different forms of conventional pharmacotherapy, including depot antipsychotic medication and lithium. The addition of clozapine to lithium, even at doses as low as 25mg/day, led to a stabilisation of his mood. The withdrawal of low-dose clozapine led to a relapse within a few days. It is concluded that maintenance low-dose clozapine should be considered in bipolar disorders resistant to other treatments.

'Dialysis related arthropathy': a survey of 95 patients receiving chronic haemodialysis with special reference to beta 2 microglobulin related amyloidosis.

Ninety five patients receiving chronic haemodialysis (CHD) were surveyed to determine the prevalence of rheumatic disease and, where possible, its aetiology. At least three distinct rheumatic syndromes were identified--a group of patients with a syndrome consisting of large and medium joint synovial swelling, restricted hips and shoulders, tenosynovitis, carpal tunnel syndrome, and bone cysts due to deposition of beta 2 microglobulin related amyloid (AM beta 2m); a second group with erosive azotaemic osteoarthropathy; and a third group with age related degenerative disease of small, large, and axial joints. The data presented suggest that in patients receiving CHD (a) the prevalence of AM beta 2m deposition and the associated syndrome increases with duration of dialysis, but in patients who have been dialysed for more than 10 years the risk of developing AM beta 2m is related to age; (b) AM beta 2m deposition in subchondral cysts, but not synovium, causes joint destruction; also, AM beta 2m may be more prone to deposition in synovium of joints already damaged by other processes; (c) in the absence of synovial iron deposition synovial AM beta 2m is not associated with an inflammatory infiltrate; (d) hyperparathyroidism and perhaps other factors such as synovial iron deposition are probably more important than AM beta 2m as causes of peripheral joint degeneration and destructive spondyloarthropathy in patients receiving CHD.

Magnetic resonance imaging of a colloid cyst of the third ventricle.

A case of an isodense non-enhancing colloid cyst of the third ventricle which was not easily diagnosed by computed tomography is described. The patient underwent magnetic resonance imaging which clearly showed a colloid cyst of the third ventricle with accompanying obstructive hydrocephalus. Such lesions are potentially life-threatening if undiagnosed. It is suggested that magnetic resonance imaging has an important role to play in rapidly and clearly demonstrating the location, size and complications of such lesions when there is doubt about the aetiology of obstructive hydrocephalus of the lateral ventricles on computed tomography.

Diagnosis of internal jugular vein thrombosis.

Six patients, aged 14-83 years, were shown by computed tomography (CT) to have thromboses of the internal jugular vein. In all cases, medical attention was sought only after a delay (4-21 days). In no case was the provisional clinical diagnosis correct, with working diagnoses ranging from abscess to neoplasm. A wide variety of likely causes was discovered, including venous catheters, local malignancy, infective cervical adenopathy, and polycythemia. CT showed distended veins with enhancing walls, low-attenuation intraluminal filling defects, and swelling of the adjacent soft tissues. Four of the six patients also underwent ultrasound examinations, which showed the veins to be distended and nonpulsatile, with internal echoes. Both modalities proved reliable and accurate. Because of the subtle and often non-specific clinical findings, it is likely that more clinically unsuspected cases will be encountered by the radiologist.

Two cases of Kartagener's syndrome.

Two cases of the syndrome of bronchiectasis, chronic sinusitis and dextrocardia with situs inversus (Kartagener's syndrome) are described. This rare disorder may be important in further understanding of cilial function in humans.