Audiovisual reviews

Measurement of pH and PCO₂ By E.O. P arbrook , R.L. H ughes & G.D. P arbrook
Measurement of CO₂ in Gas Mixtures By E.O. P arbrook , R.L. H ughes , P.D. D avis & G.D. P arbrook
Oxygen Measurement 1 and 2 By E.O. P arbrook , W.G. A nderson , P.D. D avis & G.D. P arbrook
Films on epidural analgesia
Lumbar Epidural Analgesia in Obstetrics By L.E.S. C arrie & A.H. M ac L ennan
Thoracic Epidural Analgesia By P. G riffiths
Epidural Injections By G.M.J. W hite
Obstetric Analgesia by the Caudal Approach By F.P. M eehan     

Audiovisual reviews

Nursing Aspects of Central Venous Pressure Lines By J.V. DAWS ( Kent and Canterbury Hospital ). VHS/Beta videocassette. Colour. Buy from Graves Medical Audiovisual Library, Holly House, 22 New London Road, Chelmsford, CM2 98J. Ref. GVC 22VE/BE. 15 minutes. (1984). S. BOYLE
Management of the Adult Respiratory Distress Syndrome By D.R. DANTZKER ( University of Michigan ). Umatic videocassette. Colour. Buy from Oxford Educational Resources Ltd., 197 Botley Road Oxford, OX2 0HE. 30 minutes. (1982). W.G. ANDERSON
Clinical Physics and Measurement for Anaesthetists By G.D. PARBROOK, P.D. DAVIS AND E.O. PARBROOK ( Royal Infirmary, Glasgow). Tapeslide lectures. But or hire from Oxford Educational Resources Ltd., 197 Botley Road, Oxford, OX2 0HE. (1985).     

Intraoperative nerve stimulation: a simple, effective, and inexpensive alternative to standard devices

Many surgical procedures require intraoperative stimulation of peripheral nerves. Using a pair of conventional bipolar forceps and an anesthetic impulse generator (Stimlocator, Model SL3, B. Braun Australia Pty Ltd, Australia), we have developed a simple, effective, and inexpensive alternative to standard nerve stimulation devices that enables the accurate localization of motor fascicles intraoperatively. Bipolar forceps provide better control than a monopolar electrode, as the current generated across the nerve fibers generates an action potential that is then propagated down the axon. This inexpensive and reusable device is routinely used at Royal Children's Hospital, Melbourne, and its efficacy and ease of use has been demonstrated over a long period.     

Book reviews

Books review in this article:
The Quality of Care in Anesthesia By B etty L. G rundy and J.S. G ravenstein
Drags and Anesthesia-Pharmacology for Anesthesiologists Edited by M. W ood and A.J.J. W ood
Basic Physics and Measurement in Anaesthesia By G.D. P arbrook and E.O. P arbrook
Computers in Critical Care and Pulmonary Medicine. Volumes 1 and 2 Vol. 1 edited by S. N air . Pp. 427. Vol 2 edited by O. P rakash
Clinical Application of Blood Gases By B.A. S hapiro , R.A. H arrison and J.R. W alton
The Genesis of Contemporary American Anesthesiology By P. V olpnro and L.D. V andam     

Book reviews

Book reviewed in this article:
Advances in Anesthesia, Vol. 2 Edited by R.K. S toelting , P.G. B arash and T.J. G allagher
Clinics in Anaesthesiology. Chronic Pain: Management Principles Edited by S.F. B rena and S.L. C hapman
Clinics in Anaesthesiology. Neuromuscular Blockade Edited by J. N orman
Manual of Obstetric Anesthesia Edited by G.W. O stheimer
Basic Physics and Measurement in Anaesthesia, 2nd Edition G.D. P arbrook , P.D. D avis and E.O. P arbrook
Fluids, Electrolytes, Nutrition A. E ngquist
Basics of Anesthesia R.K. S toelting and R.D. M iller
Postoperative Pain. Understanding its Nature and How to Treat it J ane H osking and E. W elchew
Brief Review of Books Received by the Editor Health Equipment Information 146 July, 1985 Evaluation of Defibrillators     

Book reviews

Neonatal Anaesthesia By D avid J. H atch and E dward S umner .
Anaesthesia and the Patient with Endocrine Disease Edited by B urnell R. B rown , J r .
The Quantitative Practice of Anesthesia. Use of Closed Circuit By H arry J. L owe and E dward A. E rnst .
Isoflurane (Forane). A Compendium and Reference By E dmond I. E ger .
Hazards and Errors in Anaesthesia By D.A. B uxton H opkin .
Preoperative Pulmonary Preparation. A Clinical Guide By P eter M.S. M argand , C harlie G. B rooks and J ames W. H unter .
Poisoning. Diagnosis and Treatment Edited by J.A. V ale and T.J. M eredith .
How to Understand Acid-base. A Quantitative Acidbase Primer for Biology and Medicine. By P eter A. S tewart .
An Introduction to Acupuncture Treatment and Anesthesia By M. Salim.
The Practice of Cardiology Edited by R obert A rnold J ohnson , E dgar H aber and W. G erard A usten .
An Atlas of Cardiology. Electrocardiograms and Chest X-rays By N eville C onway .
Pathologische Pulmonale Kurzschlussperfusion (Pathological Intrapulmonary Shunting) By H. K ämmerer , K. S tandkuss and E. K xaschik .
Progress in Respiration Research. Volume 15. Clinical Importance of Surfactant Defects Edited by P. V on W ichert .
Health Care Delivery in Anaesthesia Edited by R obert A. H irsch , W illiam H. F orrest , J r ., F rederick K. O rkin and H arry W ollman .
Immediate Prehospital Care. The Proceedings of the International Congress on Immediate Care, Brighton, England, October 1980 Edited by P eter J.F. B askett .
Papers Presented at the Second International Dental Congress on Modern Pain Control, July 1979, London Edited by P eter S ykes .     

Book reviews

Book Reviewed in this article:
Anesthesia and Cardiac Performance in Health and Disease By S. S himosato .
Fluid and Blood Therapy in Anaesthesia Edited by B urnell R. B rown J r .
Humidification of Anesthetic Gases By J. C halon , M. A li , H. T urndorf and G.K. F ischgrund .
Manual of pre-operative and postoperative care. Third edition By S.J. D udrick el al.
Modern Emergency Department Practice Edited by D avid K. B rooks and A nthony J. H arrold .
Brief reviews of books received by the Editor
New Anaesthetic Agents, Devices and Monitoring Techniques Edited by T.H. S tanley and W.C. P etty .
Anesthesiology, Continuing Education Review, Second edition. By S.J. S lack and T.J. D e K ornfeld .     

Current surgical management of oesophageal atresia and/or tracheo-oesophageal fistula

During the last 40 years, 579 babies with oesophageal atresia and/or tracheo-oesophageal fistula have been admitted to the Royal Children's Hospital (RCH), Melbourne. There are 393 survivors. Advances in the surgical management have contributed to lowering the morbidity and mortality rates. This paper describes current surgical management of each anatomical variant at RCH; specific reference is made to the problems of the long gap oesophageal atresia and prematurity.     

Book reviews

Book review in this Article
Manual of cardiorespiratory critical care F. G uzman , M.A. H edley B rown , M. B een , S. C ook , C. W ren, and D. R ichens .
Clinical respiratory physiology A.E. T aylor , K. R ehder , R.E. H yatt and J.C. P arker .
Fiberoptic airway endoscopy in anesthesia and critical care Edited by A. O vassapian .     

Plastic surgery management of soft tissue loss in meningococcal septicemia: experience of the Melbourne Royal Children's Hospital

Soft tissue necrosis associated with meningococcemia is a major challenge for any pediatric plastic surgery service. Records of patients treated by the Department of Plastic and Maxillofacial Surgery, Royal Children's Hospital, Melbourne, Australia, were reviewed. Two hundred fifty patients were treated for meningococcemia at our institution over a 40-year period. Of these, 31 patients suffered soft tissue necrosis. Three groups were identified: lesions that healed with nonoperative management (n = 12); those that required skin grafting, flaps, or minor amputations (n = 14); and those requiring major amputations (n = 5). When compared with a comparable control group of patients with documented meningococcemia who did not suffer tissue loss (n = 35), the best predictors for requiring surgery were the presence of metabolic acidosis on admission (P < 0.0005) and a progressive thrombocytopenia (P < 0.0005). Metabolic acidosis and progressive thrombocytopenia are predictive of the need for surgery for tissue loss and underline the evolving thrombotic nature of the disease.     

Book reviews

Book review in this Article
Anaesthesiology: Proceedings of the Fifth World Congress of Anaesthesiologists, Kyoto, September 19–23, 1972 Edited by M. I yazaki , K. I watsuki and M. F uyita .
A Manual of Anaesthetic Techniques By W illiam J. P ryor and D avid C. T. B ush
Practical Points in Anesthesiology By D avid C. C. S tark with the assistance of R. B. ROBERTS.
Anaesthesia and Analgesia in Dentistry By R onald A. G reen and M ichael P. C oplans .
Anaesthesia and the E.M.O. System By J ohn V. F arman .
Anesthesia and Uncommon Diseases: Pathophysiologic and Clinical Correlations Edited by J ordan K atz and L eslie B. K adis .
Endocrines and Enzymes in Anesthesiology Edited by C arter M. B allinger and V erne L. B rechner .
Intractable Pain By M ark M ehta
Modern Hospital Hypnosis; Especially for Anaesthetists By D. L. S cott . Foreword by William W. Mushin.
T. B. B oulton Introduction to Acupuncture Anesthesia By W illiam C. L owe .     

Peptic stricture of the oesophagus: the role of oesophagogastrostomy.

Sixteen patients with severe peptic stricture of the oesophagus were treated by oesophagogastrostomy at the Royal Children's Hospital, Melbourne, during the period 1948 to 1968. It has been possible to obtain a follow up on all patients, so that the period of follow up has varied from seven to 24 years. Although the early postoperative results were promising, later problems occurred in over half of the patients, the major complication being recurrence of peptic stricture at the anastomotic site.     

Lower extremity alignment in children with spina bifida.

Our purpose was to describe the natural history of lower extremity alignment in spina bifida patients. We prospectively evaluated all spina bifida patients seen at the Children's Hospital in Seattle since 1971 and at the Royal Children's Hospital in Melbourne since 1979. Serial examinations were performed on 434 patients, ranging from birth to 23 years of age. The lower limbs of children with spina bifida had neutral alignment at birth that gradually increased to 6 degrees of valgus--a pattern different from normal children. Valgus greater than 10 degrees was observed in only 6% of patients, and the degree of angular deformity was not affected by walking, the use of an above-knee orthosis, or neurosegmental level. An above-knee orthosis to prevent malalignment does not appear to be warranted and continued ambulation does not significantly contribute to lower extremity deformity.     

Secondary esophageal surgery following repair of esophageal atresia with distal tracheoesophageal fistula

During the period 1948 through 1988, 498 patients with esophageal atresia and distal tracheoesophageal fistula were admitted to the Royal Children's Hospital, Melbourne. Fifty patients had a second operative procedure on the esophagus, for anastomotic stricture (30), recurrent fistula (15), both (4), and a postmyotomy diverticulum (1). During the same period, nine patients underwent esophageal replacement and 33 patients a Nissen fundoplication. Improvements in the technique of esophageal anastomosis, and in recent years the use of fundoplication to correct gastroesophageal reflux have led to a marked reduction in the need for secondary surgery to the esophagus after repair of esophageal atresia. Esophageal replacement is rarely required in esophageal atresia and distal tracheoesophageal fistula. One-layer end-to-end esophageal anastomosis using interrupted sutures resulted in the lowest rate of recurrent fistula and anastomotic stricture.     

Experience with extracorporeal membrane oxygenation in children more than one month old.

Extracorporeal membrane oxygenation (ECMO) has been used at the Royal Children's Hospital, Melbourne, in the treatment of children with life-threatening respiratory or cardiac failure since May 1988. The main indications for its use are, first, the disease is thought to be reversible, second, the child will survive with an acceptable quality of life and, third, the child has an 80% chance of dying without ECMO. Seven of eighteen children receiving ECMO have survived to leave hospital, and all are functionally normal: these results are similar to international results. It would appear that ECMO is a useful therapy for some children with otherwise fatal cardiorespiratory failure.     

Book reviews

Books review in this article:
Care of the Critically III Patient Edited by J ack T inker and M aurice R apin
Clinical Anesthesia Procedures of the Massachusetts General Hospital Edited by P.W. L ebowttz , L.A. N ewberg and M.T. G illette
Mannal of Anaesthesia (2nd edition) Edited by J ohn C. S now
Handbook of Intensive Care Edited by W.H. B ain and K.M. T aylor
Anaesthesia and Co-existing Disease Edited by R obert K. S toelting and S tephen F. D ierdorf
Applied Psysiology in Clinical Respiratory Care Edited by O mar P rakash
ABC of Brain Stem Death By C hristopher P allis
Management of Epidaral Analgesia in Childbirth (2nd Edition) By B.A. Waldron
Narcotic Analgesics in Anesthesiology Edited by L uke M. K itahata and J.G. C ollins     

Pulsatile immunoreactive and bioactive luteinizing hormone secretion in adolescents with chronic renal failure

Delayed or arrested pubertal development is common in children with chronic renal failure (CRF). Normal puberty is initiated by the onset of episodic nocturnal secretion of luteinizing hormone (LH) containing an increasing proportion of bioactive hormone. To test the functional integrity of the hypothalamo-pituitary axis in CRF we measured immunoreactive (i-LH) and bioactive (bio-LH) plasma LH concentrations at 15-min intervals from 2000 to 0700 hours in 65 pubertal patients aged 10–23 years [46 boys/19 girls; 20 on conservative treatment (CT), 13 on dialysis (D), 32 with transplants (TP)]. i-LH was determined by radio-immunoassay and bio-LH by a mouse Leydig cell assay. Peak detection was performed by the cluster analysis computer programme. The mean (±SD) number of i-LH (in both sexes) and bio-LH pulses (in boys) per profile, and the mean peak area of i-LH (in both sexes) and bio-LH (in girls) were higher in TP than in CT or D patients. The ratio of bio-LH to i-LH increased during puberty in CT (G1 vs G4/5, 0.3±0.5 vs 1.8±0.,4) and TP (0.6±0.7 vs 1.8±0.7) but remained low in male D patients (0.4±0.7 vs 1.1±0.8). The ratios were subnormal, however, even in mature TP patients compared with healthy adults. The bio-LH/i-LH ratio and the bio-LH peak area best predicted integrated nocturnal testosterone concentrations in TP but not in uraemic male patients. The data demonstrate that in adolescents with CRF, secretion of LH is tonic rather than pulsatile and bioactivity of the hormone is reduced. Both phenomena may contribute to the delay of sexual maturation. In TP patients the pulsatile pattern of LH secretion is restored and bioactivity increases. Corticosteroid treatment may be responsible for the incomplete normalization of the bio-LH/i-LH ratio in CRF.Further participating centres of CSPCRF Participating clinical centres and study group members: University Children's Hospital Heidelberg, FRG (F. Schaefer, K. Schärer, C. Seidel), Children's Hospital, Medical School Hannover, FRG (G. Offner). The Hospital for Sick Children, Great Ormond Street, London, UK (T. M. Barratt, G. Hamill, S. Lederman, R. S. Trompeter), Istituto Gaslini, Genoa, Italy (F. Perfumo), Royal Free Hospital, London, UK (L. Rees), UCLA Center for the Health Sciences, Los Angeles, USA (R. N. Fine), Evelina Children's Hospital, Guy's Tower, London, UK (S. Rigden). The Hospital for Sick Children, Toronto, Canada (D. Geary), University Children's Hospital, Cologne, FRG (D. Michalk) Participating laboratories: D Division of Clinical Biochemistry, Hope Hospital, University of Manchester, UK (R. Mitchell, W. R. Robertson), Department of Pharmacology (D. Haack, P. Vecsei), Division of Gynaecological Endocrinology, University of Heidelberg, FRG (I. Gerhard, K. Klinga)     

Gliomas of the optic nerve and chiasm in children.

This paper reviews the clinical features, management, and prognosis of patients with gliomas of the optic nerves and chiasm who have received treatment at the Royal Children's Hospital, Melbourne, between 1954 and 1977. The relationship of this tumour to other neoplasms in the region is discussed, and emphasis is placed on the natural history of the disease. The controversy concerning the exact nature of this lesion is summarized, and an attempt is made, in the light of this evidence and from the reviewed series, to formulate an appropriate overall plan of management of these patients.     

Appendicitis in the first year of life: a rare but predictable cause of intraperitoneal pus in infants

Appendicitis is the most common antecedent to peritonitis throughout life. Although quite uncommon during the first year of life, appendicitis is a recognizable entity, and beyond the neonatal period, remains the most common cause of peritoneal suppuration. The Royal Children's Hospital in Melbourne has experienced three cases of appendicitis in the first year of life since 1970. Clinical features helpful in diagnosis are presented, and management guidelines are discussed. When pus is suspected or found in an infant's abdomen, the general surgeon would be wise to presume the cause is appendicitis, despite its rarity.     

Bardet-Biedl syndrome: review of anaesthetic problems

Bardet-Biedl syndrome is a rare syndrome characterized by obesity, mental retardation, polydactyly, retinitis pigmentosa and hypogenitalism. These children frequently require multiple anaesthetics for diagnostic and therapeutic measures. The anaesthetic management of a child with the syndrome is described. Eight cases presenting between 1974 and 1990 at the Royal Children's Hospital in Melbourne are reviewed. The anaesthetic problems associated with this syndrome include obesity with consequent difficulty with venous access, placement of local anaesthetic blocks and induction of anaesthesia due to behavioural activity.