A comparative study between a calcium channel blocker (Nicardipine) and a combined alpha-beta-blocker (Labetalol) for the control of emergence hypertension during craniotomy for tumor surgery.

We compared the efficacy of the combination of enalaprilat/labetalol with that of enalaprilat/nicardipine to prevent emergence postcraniotomy hypertension. A prospective, randomized open labeled clinical trial was designed to compare the incidence of breakthrough hypertension (systolic blood pressure [SBP] > 140 mm Hg) and adverse effects (hypotension, tachycardia, and bradycardia) between the two drug combinations. Secondarily, the effects of the drugs on SBP, mean blood pressure, and diastolic blood pressure were evaluated over the course of the study. Forty-two patients received enalaprilat 1.25 mg IV at dural closure followed by either multidose nicardipine 2 mg IV or labetalol 5 mg IV to maintain the SBP below 140 mm Hg. SBP was similarly controlled in both groups. There was a marginally smaller incidence of failures and adverse effects with labetalol. Blood pressure profiles were similar for both groups.

Küntscher nailing of femoral fractures associated with Austin Moore's prosthesis.

The management of fractures occurring below the tip of an Austin Moore prosthesis varies greatly. Four cases are presented which provides difficulties have been overcome. The new method involves the insertion of a Küntscher nail posterior of the stem of the prosthesis.

The jammed Küntscher nail: a method of releasing the nail and report of a case.

A case of jamming of a Küntscher nail is presented and the technique of longitudinal splitting of the femur by which the nail was released is described. The possible causes of jamming are summarized and some precautions are suggested to avoid this dilemma. Other methods of dealing with a jammed nail are reviewed.