Neurologic changes during awakening from anesthesia.

Transient hyperreflexia, the Babinski reflex, and other transient neurologic signs may follow anesthesia in healthy persons. The authors describe the appearance and durations of these signs and relate them to anesthetic agent, time following cessation of anesthesia, and state of arousal. Twenty-nine neurologically normal male patients undergoing superficial operations were anesthetized with halothane-nitrous oxide, enflurane-nitrous oxide, or nitrous oxide-narcotic. During awakening, patients experienced transient hyperreflexia and shivering following all anesthetic techniques. Quadriceps hyperreflexia occurred in three of eight patients after halothane-N2O, seven of 12 patients after enflurane-N2O, and no patient after n2O-narcotic anesthesia. Sustained ankle clonus and upgoing plantar responses were observed most frequently following enflurane-N2O (50 percent of patients). Following halothane-N2O, ankle clonus was observed in 12.5 per cent of patients and upgoing plantar responses in 25 per cent of patients. Neither sign occurred after N2O-narcotic anesthesia. Shivering, too, was observed most frequently following enflurane anesthesia (66 per cent of patients). There were equal reductions of body temperature in shivering and nonshivering patients. In every patient, regardless of the anesthetic used, the lash reflex and the pupillary response to light returned to normal with the return of consciousness as measured by the response to verbal commands. It is concluded that the neurologic profile during awakening from general anesthesia is most abnormal following enflurane-N2O, compared with halothane-N2O and N2O-narcotic anesthesia. Abnormalities are found most frequently when patients are poorly responsive to verbal commands. Although their incidence diminishes with time, abnormal responses to neurologic examination may persist for 40 min or more after cessation of anesthesia.

Air pollution and urban factors in relation to cancer mortality.

Age adjusted mortality rates for the 1969-1971 adult population in the United States reveal a consistent pattern of 13% excess cancer mortality in the metropolitan counties with central cities compared to non-metropolitan counties. Only 14% of all cancer death exhibit a different pattern. A detailed analysis of cancer mortality in Cuyahoga County, (Cleveland), Ohio, during the years 1969-1971, shows that apart from cancer mortality of the respiratory tract, general air pollution characteristics correlate secondarily with mortality, compared with socioeconomic factors.

Plasma insulin response to arginine stimulation in children and adolescents with constitutional short stature according to sex, age, sexual development and skinfold thickness.

The plasma insulin response to a standard arginine stimulation test was studied in 247 children and adolescents (177 males and 70 females) with constitutional growth retardation as compared with the response obtained in a matched group of 42 normal subjects and a group of 57 obese subjects. When the insulin response was related to pubertal ratings in the children and adolescents with growth retardation, it was found that the mean fasting levels and mean peak response both rose with the progression of puberty. This tendency was more pronounced in the females. When the insulin response was related to the degree of adiposity as measured by the degree of subscapular skinfold thickness, it was found that the greater the adiposity, the greater was the mean response, with the females showing higher levels than the males in each group. Even when the response in the two sexes was compared in subjects of a similar age and skinfold thickness, the females had a higher mean peak insulin response than did the males.

The prevalence of long-term illness among the elderly in a general practice.

A retrospective study was performed to assess the prevalence of long-term illness in all patients aged 65 years and over in the practice of one family physician. Of 191 patients (10,6% of the practice population), 87% suffered from at least one illness and the mean prevalence rates were 2 129 diagnoses per 1 000 males and 1 955 for females. Fifty-eight per cent of the women and 14% of the men were widowed. The prevalence rates of 16 diagnostic categories are presented and compared with their prevalence among the general population. The findings are discussed with reference to the need for functional assessment and for prevention or relief of disability, so as to enable the individual to remain reasonably independent. The implications are discussed in relation to the need for the family physician to undertake increased responsibility for the comprehensive medical care of the elderly.