Sciatic nerve neuritis of no cause in primary total hip replacement: A case series.

Neuritis of the sciatic nerve is a rare complication of total hip replacements. It is characterized by symptoms of neuropathic pain with or without motor and or sensory symptoms. Causes include direct intra-operative trauma or mechanical lengthening of the nerve. Cases of sciatic nerve neuritis without an organic cause however, are rarer still. We present two cases of sciatic nerve neuritis post total hip replacement with no identified organic cause. Whereas the reversal of the underlying cause has shown improvement in symptoms, in cases without an organic cause our experience advocates close observation and conservative management with spontaneous resolution of symptoms.

Time- and concentration-dependent effects of dissolution products of 58S sol-gel bioactive glass on proliferation and differentiation of murine and human osteoblasts.

Bone loss is a significant clinical problem, and treatments utilizing donated graft material are limited. To meet future demands in the healthcare industry, there has been a shift of outlook toward the use of bioactive materials for tissue regeneration. A number of in vivo and in vitro studies have highlighted the potential of the bioactive glass ceramic 45S5 Bioglass as a synthetic regenerative scaffold. The application of sol-gel processing techniques has led to the synthesis of mesoporous bioactive glasses with greater textural and compositional variety. In this study, we evaluated the effects of supplemented tissue culture medium containing up to 203 ppm silica prepared by static soaking of particles of 58S sol-gel bioactive glass (58% SiO(2), 33% CaO, 9% P(2)O(5)) on the in vitro proliferation and differentiation of murine and human primary osteoblasts. These extracts had a higher silica content than those used previously in studies of 45S5 Bioglass, because of the faster rates of ion exchange permitted by the higher surface area-to-volume ratio of mesoporous glass. We found that osteoblasts from both species increased their proliferation in response to the glass-conditioned medium. In addition, the extent to which supplemented medium could alter cell differentiation varied with time in culture. Proliferation induced by supplemented medium paralleled effects induced by treatment with basic fibroblast growth factor, a known mitogenic growth factor for osteoblasts. Bone nodule formation was also increased by exposure to the glass-conditioned medium and this effect was positively correlated with the dose of glass used to prepare the medium. Apoptosis was stimulated by glass-conditioned medium in murine osteoblasts, but inhibited in human osteoblasts. These data demonstrate the bioactive effects of dissolution products derived from sol-gel materials on primary osteoblasts and complements in vivo studies that indicate the suitability of this material as a bone graft substitute.

Obstructive sleep apnoea syndrome in children.

Obstructive sleep apnoea syndrome in children is a complex disorder characterised by repeated nocturnal episodes of increased upper airway resistive load. It is most commonly associated with adenotonsillar hypertrophy and more children are now presenting for adenotonsillectomy. These children may pose different anaesthetic problems to those having surgery for recurrent infection alone and anaesthetic morbidity and mortality has been reported. In addition, due to the varied symptomatology of the condition, children with unrecognised obstructive sleep apnoea syndrome may present for incidental surgery. This is of importance as patients with undiagnosed obstructive sleep apnoea syndrome may experience additional peri-operative morbidity when undergoing incidental surgery. This article aims to review the aetiology, pathophysiology, clinical presentation and anaesthetic management of children with obstructive sleep apnoea syndrome.

The effect of subhypnotic doses of propofol on the incidence of pruritus after intrathecal morphine for caesarean section.

The effect of subhypnotic doses of propofol on intrathecal morphine-induced pruritus was studied in a prospective, randomly allocated, double-blind controlled trial. Fifty-eight women undergoing elective lower segment Caesarean section for a singleton fetus received spinal anaesthesia with 2.5 ml hyperbaric 0.5% bupivacaine and 0.2 mg of preservative-free morphine. They then received propofol 1 ml (10 mg) or Intralipid 1 ml (control group) intravenously after delivery. Pruritus was assessed using a five-point verbal rating scale at hourly intervals for 8 h. A second dose of their allocated treatment drug was administered at the first recording of significant pruritus. The pruritus score was reassessed after 5 min and the treatment was repeated if pruritus remained. There were no differences between the groups in the onset of pruritus or its successful treatment. No adverse side-effects were associated with this dose of propofol. There were no differences in the incidence of post-operative nausea and vomiting between the two groups. Subhypnotic propofol is not an effective treatment for intrathecal morphine-induced pruritus in women following Caesarean section.

Towards early defibrillation--a nurse training programme in the use of automated external defibrillators.

It is essential that all health care professionals are regularly trained in the practice of basic life support (BLS). In most cases of cardiac arrest, the chances of a favourable outcome depend not only on efficient BLS, but also on the early use of defibrillation. In a hospital environment, the first responders are most likely to be members of the nursing staff. The potential advantage of these personnel being able to perform early defibrillation, as well as BLS, is considerable. We describe an initiative in which instruction in the use of automated external defibrillators (AEDs) was introduced into routine BLS training sessions, with the aim of developing this capability. Using specifically-acquired training aids, 43 nurses and nine other members of the non-medical staff were trained in 12 teaching sessions over a period of 4 months. Refresher training was carried out after 6 months and 37 nurses were retrained during six sessions using a similar syllabus. The programme was well-received by all students, and a higher than expected level of motivation and competence was achieved. Throughout retraining all nurses appreciated the key importance of early defibrillation. We conclude that, although the initial workload is high, it is entirely feasible to augment BLS training for health care professionals with instruction in the use of AEDs. We recommend that this potentially life-saving tuition programme be widely adopted.

Epidural infusions of bupivacaine and diamorphine in labour.

Three different concentrations of bupivacaine, 0.125%, 0.062% and 0.031%, all with diamorphine 0.0025%, were given as an epidural infusion at 10 ml.h-1 to 63 mothers in labour. When the three infusions were compared, significant differences were found in maternal requirements for top-ups and the degree of motor block, but there were no differences in the pain scores. The reduced motor block was not associated with a reduction in the instrumental delivery rate.

Thymoma in a Royal Air Force pilot--an unusual cause of chest pain.

The case history of a pilot with an anterior mediastinal tumor is described. Histology showed this to be a lymphocytic thymoma. An associated peripheral T-cell lymphocytosis was present; total white cell count (WCC) was elevated for 7 years prior to diagnosis and continued for 2 years post-resection. This has not been previously described in association with a cytologically benign non-invasive thymoma. The pathology of thymomas and the implications in this case are discussed.