A comparison of thiopentone-isoflurane anaesthesia vs propofol infusion in children having repeat minor haematological procedures.

We have performed a randomized, cross over study in 22 children suffering from acute leukaemia, who underwent repeated anaesthesia for bone marrow aspiration and lumbar puncture. For their first anaesthetic, the children (aged 3-10 years old) received, either a thiopentone/isoflurane anaesthetic or intravenous propofol, both supplemented with nitrous oxide. On a second occasion they received the alternative technique. Of those children receiving thiopentone/isoflurane, 32% had significant coughing during anaesthesia, two progressing to laryngospasm requiring 100% oxygen. None of the patients receiving propofol had a respiratory disturbance (P = 0.016). 68% of the children preferred the propofol anaesthetic. Only one child in the thiopentone/isoflurane group preferred this technique. Twenty-seven per cent had no preference. There was no significant difference in length of anaesthetic time (P = 0.07) or the time taken for recovery (P = 0.17) between the two groups. There was a large individual variation in propofol requirements and movement was common during stimulation of patients in this group, though this did not adversely affect the surgical procedure.

Treatment of glaucoma by use of transscleral neodymium:yttrium aluminum garnet laser cyclocoagulation in dogs.

Neodymium:yttrium aluminum garnet (Nd:YAG) laser energy was transsclerally applied to the ciliary body of 56 eyes of 37 dogs for treatment of glaucoma. Forty-four eyes were glucomatous at the time of treatment, and 12 normotensive eyes with ciliary cleft closure were treated prophylactically. Glaucoma was primary in 35 dogs and secondary in 2 dogs (1 eye in each dog). Energy was delivered by a general surgical Nd:YAG laser via a hand-held, 600-muc-diameter flexible quartz fiber. The mean (+/- SD) number of spots treated per eye was 35 (+/- 9.7), with mean energy per burst of 7.1 (+/- 2.6) J; mean total energy delivered to the eyes was 228 (+/- 81) J. Follow-up evaluation was available for 42 eyes from 2 to 4 weeks after treatment, and for 32 eyes from 12 to 24 weeks after treatment. Treatment success, defined as maintenance of intraocular pressure less than 25 mm of Hg, was achieved in 83% (20/24) of glaucomatous eyes evaluated between 12 and 24 weeks of treatment. Of 4 treatment failures, 3 were eyes devoid of uveal pigment. The consistent acute effects of treatment were conjunctival vascular congestion and blood-aqueous barrier disruption, recognized clinically by the presence of aqueous flare. Hyphema developed in 16% (9/56) of eyes; hyphema resolved without complication in all but 2 eyes. A common long-term complication of treatment was cataract formation, recognized in 37% (12/32) of eyes evaluated at 12 to 24 weeks. Cataracts were sufficiently dense to obstruct vision in 4 eyes. Phthisis bulbi was observed in 1 eye.(ABSTRACT TRUNCATED AT 250 WORDS)

Thunderclap headache: is it migraine?

In a prospective study, 14 out of 49 patients presenting to a Regional Neurosurgical Unit with sudden headache suggestive of subarachnoid haemorrhage had normal CSF and a normal CT scan: it did not prove possible, on clinical grounds alone, to distinguish these from those that had bled. We have now followed all these patients for a minimum of 18 months. Only one has had no further headache, 4 have had musculoskeletal pain, 5 psychogenic pain, and 4 migraine type symptoms. None went on to have an unequivocal subarachnoid haemorrhage, and we conclude that angiography cannot be justified in patients with this type of "thunderclap headache".

Response of the canine corneal endothelium to intraocular irrigation with saline solution, balanced salt solution, and balanced salt solution with glutathione.

The right or left anterior chamber of 12 dogs (ie, 24 eyes) was irrigated with 100 ml of 0.9% saline solution, balanced salt solution, or balanced salt solution with glutathione (8 eyes/solution) for 22 minutes. Changes in endothelial cell density and corneal thickness from pretreatment values were evaluated immediately after, and at 2 and 7 days after irrigation. Using specular microscopy and scanning and transmission electron microscopy, corneas were examined immediately after and at 2, 7, and 14 days after irrigation. Changes were not seen in endothelial cell density after irrigation with any of the solutions evaluated. Corneal thickness increased 4% immediately after irrigation with 0.9% saline solution and returned to normal by 1 week after irrigation; treatment with 0.9% saline solution was not associated with visible corneal edema. Ultrastructural changes attributable to differences in irrigating solution composition were not observed. The difference between the endothelium's response to limited irrigation with saline solution, balanced salt solution, and balanced salt solution with glutathione was small and irrigation with these solutions was not associated with permanent endothelial damage.

Improvement in the computer-assisted diagnosis of cerebral tumours.

Most applications of Bayes theorem in computer-aided diagnosis have been to situations involving the differential diagnosis of a small list of disease categories. In the case of the diagnosis of cerebral tumours, if each tumour type in each main anatomical situation is counted as a single diagnosis, there are about 100 possible disease categories. This paper investigates a method of incorporating expert prior information into the computer-aided diagnosis process so that this large number of categories can be handled.

Analytical electron microscopic study of mitochondrial inclusions in canine myocardial infarcts.

An analytical electron microscopic study, utilizing scanning transmission electron microscopy and energy-dispersive x-ray spectroscopy, was made of two types of mitochondrial inclusions identified in canine myocardial infarcts. The data were obtained from thin sections of tissues that were fixed in aldehyde, osmicated and embedded in epoxy resin. Calcium peaks of variable intensity were detected in inclusions which contained very electron-dense spicular material and which were localized to muscle cells at the peripheries of the infarcts. These findings indicate that the spicular inclusions represent early stages in the process of mitochondrial calcification in myocardial infarcts. In contrast, calcium or other trace elements were not detected in moderately electron-dense amorphous inclusions which were present in mitochondria of muscle cells throughout the infarcts. With the tissue preparative techniques employed, the possibility cannot be excluded that the amorphous inclusions contained calcium, either in small amounts or in a readily diffusable state, in vivo. The data, however, are in accord with the previously advanced hypothesis that the amorphous inclusions represent precipitates of denatured mitochondrial protein formed during the evolution of irreversible cellular injury. This study provides further evidence that analytical electron microscopy can yield important information regarding the nature of various inclusions occurring in normal and diseased tissues.