Higher education: making an informed choice.

Potential students need to make informed choices when undertaking further study. Potential students should access different sorts of information regarding the institution of their choice. Potential students need to be aware of how service needs influence the choices available. Potential students should have a clear idea of what they are aiming for. Potential students should be aware of the differences between similar courses.

Visual display units and pregnancy outcome: a prospective study.

This paper presents the results of a prospective study of the impact of work with visual display units (VDUs) and associated ergonomic and stress variables on pregnancy outcome and infertility. An apparent relationship between VDU use and pregnancy outcome in retrospective data probably reflected the operation of recall bias. Prospective data did not reveal any evidence for an adverse effect of VDUs on pregnancy in this sample, or any mechanism by which such an effect could occur. There was no evidence for any effect of VDU use on infertility. Implications for working women and future research are also presented.

Severe preeclampsia: hemodynamic effects of lumbar epidural anesthesia.

The hemodynamic effects of lumbar epidural anesthesia (LEA) were evaluated in 11 patients with severe preeclampsia. All patients were receiving magnesium sulfate upon entry into the study. Hemodynamic measurements were obtained before and after LEA, at delivery, and 2 hr postpartum. Lumbar epidural anesthesia significantly reduced mean arterial pressure from 121.4 mm Hg to 97.7 mm Hg, without altering cardiac index, pulmonary vascular resistance, central venous pressure (CVP), or pulmonary capillary wedge pressure (PCWP). There was a slight but statistically insignificant decrease in systemic vascular resistance from 1078 to 900.7 dynes X sec X cm-5. Cardiac index and left ventricular stroke work index were elevated in these patients, suggesting hyperdynamic left ventricular function. There was poor correlation between PCWP and CVP in several patients. We conclude that LEA may be used safely in severe preeclamptic patients and that pulmonary arterial catheters may help guide appropriate therapy in preeclamptic patients with cardiac failure or oliguria refractory to modest fluid challenges.

Effect of acute sympathectomy by epidural anesthesia on the canine coronary circulation.

The effects of reversible sympathetic neural blockade of the canine myocardium under control conditions and in the presence of decreased coronary blood flow and after myocardial infarction were investigated in 17 dogs. A multiple-microsphere technique was used to measure distribution of blood flow in the myocardium. Epidural blockade was associated with the following changes in the ratio of endocardial to epicardial blood flow: under control conditions, no change; after 50 per cent decrease in coronary flow, 18 per cent increase in endocardial/epicardial ratio; after myocardial infarction at unrestricted coronary flow, 43 per cent ratio increase; after myocardial infarction and 50 per cent decrease in coronary flow, 76 per cent increase of endocardial/epicardial ratio. These effects appear to be independent of systemic factors, and may result from alterations in tone of transmural resistance vessels. In addition, cervicothoracic epidural blockade resulted in a decrease in systemic pressure and an increase in coronary vascular resistance as myocardial oxygen demand decreased. When systemic pressure was restored these effects were abolished. In the presence of myocardial infarction, epidural blockade had less effect on systemic pressure and left ventricular filling pressure was decreased. With decreased coronary flow, sympathetic blockade redistributed coronary blood flow, favoring sympathetic blockade redistributed coronary blood flow, favoring the endocardium in both the normal and the infarcted heart.

Peridurography with metrizamide: animal and human studies.

Metrizamide (300 mg l/ml) was tested for spinal peridurography in conscious dogs and humans. Epidural metrizamide was non-irritating in volumes up to 12 ml. Larger volumes caused mild discomfort in two patients. Radiographic contrast was satisfactory, and there were no sequelae. Peridurography with metrizamide (300 mg l/ml) appears to be a safe, useful diagnostic procedure in ambulant patients.