Critical phase distractions in anaesthesia and the sterile cockpit concept.

In aviation, the sterile cockpit rule prohibits non-essential activities during critical phases of flight, takeoff and landing, phases analogous to induction of, and emergence from, anaesthesia. We studied distraction during 30 anaesthetic inductions, maintenances and emergences. Mean (SD) noise during emergence (58.3 (6.2) dB) was higher than during induction (46.4 (4.3) dB) and maintenance (52 (4.5) dB; p<0.001). Sudden loud noises, greater than 70 dB, occurred more frequently at emergence (occurring 34 times) than at induction (occurring nine times) or maintenance (occurring 13 times). The median (IQR [range]) of staff entrances or exits were 0 (0-2 [0-7]), 6 (3-10 [1-18]) and 10 (5-12 [1-20]) for induction, maintenance and emergence, respectively (p<0.001). Conversations unrelated to the procedure occurred in 28/30 (93%) emergences. These data demonstrate increased distraction during emergence compared with other phases of anaesthesia. Recognising and minimising distraction should improve patient safety. Applying aviation's sterile cockpit rule may be a useful addition to our clinical practice.

Complications of cancer immunotherapy with levamisole.

In a group of 69 patients receiving levamisole the drug had to be discontinued in 15 (21-7%) because of intolerable but reversible side-effects including gastrointestinal upset, "flu-like" syndrome, central nervous system disturbances, and skin rash. Reversible agranulocytosis with life-threatening sepsis occurred in a patient receiving levamisole immunotherapy for colonic carcinoma. Neutrophils and platelets were both severely affected. Levamisole-dependent leucoagglutinins appeared with circulating immune complexes during the acute phase of the illness, suggesting an immune drug reaction.

Gas chromatography-mass spectrometry of trimethylsilyl derivatives of omega-amino acids.

The silylation of C4-C11 omega-amino acids and their hydrochlorides was carried out with N,O-bis(trimethylsilyl)acetamide. Di-TMS and tri-TMS derivatives were formed in the silylation of the hydrochlorides. The formation of the two derivatives is dependent on the reaction conditions, and the conditions under which only derivative arises reproducibly, are reported. This finding may be utilized in the quantitative analysis of amino acids.

Immune complexes in human melanoma: a consequence of deranged immune regulation.

Circulating immune complexes were detected in 62 individuals with malignant melanoma by precipitation with isolated human C1q and polyclonal rheumatoid factors. In 56 patients the C1q deviation assay showed low to moderate levels of complexes, with increased amounts with advancing stage of disease. Both heavy (greater than 19S) and intermediate (7S to 19S) varieties were present, and complexes containing tumor antigen-antibody or antibody-anti-antibody were identified. Complexes were found in the kidneys of one patient with malignancy and the nephrotic syndrome and in two further patients with melanoma in whom there were no clinical manifestations of nephrosis. Serial determinations in 51 patients showed slow cyclic variations in the levels of complexes and fluctuations in response to therapy. The coexistence of anti-antibodies, immune complex disease, and anergy in melanoma patients may indicate a deranged immune regulation consequent to chronic antigenic stimulation by the tumor.