Outcomes after laser stapedotomy with and without preservation of the stapedius tendon

Our goal was to investigate the postoperative differences in hearing between patients who had their stapedius tendon sacrificed and those whose stapedius tendon was preserved during laser stapes surgery for otosclerosis. To that end, we performed a retrospective review by mailing extensive questionnaires to patients who had been operated on between 1994 and 1997. We also performed routine and special audiometric testing to augment the subjective data. Seventy-nine of 124 questionnaires (64%) were returned. Of the respondents, 75 patients had undergone additional pre- and/or postoperative audiometric testing, including tests to evaluate "hearing in noise" and to determine the "uncomfortable loudness level" (dynamic range). We found no statistically significant differences between the two groups with respect to their subjective responses and their audiologic test results. The responses to the questionnaire indicated that in most cases, hearing was improved by stapes surgery. We conclude that the stapedius tendon should be preserved whenever possible during stapes surgery, provided that it does not jeopardize the exposure or outcome.     

Long-term Impairment of Acquisition of a Spatial Memory Task following Isoflurane-Nitrous Oxide Anesthesia in Rats

Background: The authors demonstrated previously that isoflurane-nitrous oxide anesthesia attenuates performance improvement on an already-learned spatial memory task and that the effect persists for weeks. This experiment was designed to test the hypothesis that learning of new information is particularly susceptible to prolonged disruption after general anesthesia.

Methods: Six- (n = 5) and 20- (n = 5) month-old male Fischer 344 rats were anesthetized for 2 h with 1.2% isoflurane, 70% nitrous oxide, and 30% oxygen. Age-matched control rats received 30% oxygen and 70% nitrogen (n = 5 per group). Rats breathed spontaneously, and anesthetic and oxygen concentrations were measured. Spatial learning was assessed daily for 21 days on a 12-arm radial maze (RAM) beginning 48 h after anesthesia. In a post hoc experiment to examine locomotion, swim speed was assessed in a separate group of identically treated rats (n = 3 per group) for 4 days beginning 48 h after anesthesia.

Results: Aged rats were slower to complete the maze, made fewer correct choices before first error, and made more errors at baseline than young rats (P < 0.05). Anesthesia worsened maze performance in both age groups, as evidenced by increased time to complete the maze and a decreased number of correct choices before first error (P < 0.05), but there were no statistically significant differences in total number of errors. Interestingly, there were no age-by-anesthesia interactions. Aged rats swam slower than adult rats (P < 0.001), but there were no differences between the control and anesthesia groups.     

Non-specific abdominal pain: the resource implications.

Non-specific abdominal pain (NSAP) is responsible for a significant proportion of emergency surgical admissions with resultant resource implications. The extent of the problem was assessed in a consecutive group of 100 patients, aged between 15 and 35 years, admitted with lower abdominal pain to one general surgical firm. No less than 67 of these patients (67%) were diagnosed as having NSAP (13.29% of all general surgical admissions), most (75%) being female and having a mean hospital stay of 4.1 days. Only 11 patients (11%) had appendicitis and the remaining 22 had miscellaneous gynaecological, urological or gastrointestinal problems. Detailed analysis of the resources used revealed that the mean cost to the NHS of each case of NSAP was 807 pounds, the bulk of which was attributable to the hospital stay. Wider assessment of the problem (by means of postal questionnaire) suggests that the cost to the NHS in Wales is in the region of 6 million pounds per year and may be over 100 million pounds per year in the UK as a whole.     

Rotator cuff tear: clinical experience with sonographic detection

Between June 1986 and April 1988, 86 sonographic examinations of the shoulder were performed on patients suspected of having rotator cuff tears. Major sonographic diagnostic criteria included (a) a well-defined discontinuity usually visible as a hypoechoic focus within the cuff, (b) nonvisualization of the cuff and (c) an echogenic focus within the cuff. Seventy-five patients underwent both sonography and arthrography. Compared with arthrography alone, ultrasound examinations enabled detection of 92% of rotator cuff tears (24 of 26 tears), with a specificity of 84% and a negative predictive value of 95%. Correlation was obtained in 30 of these patients who underwent surgery for rotator cuff tear or other soft-tissue abnormality. In this group, the sensitivity of sonography for detection of a tear was 93%, with a specificity of 73%, while for arthrography sensitivity was 87% and specificity was 100%. These data indicate that sonography is a useful, noninvasive screening procedure for patients suspected of having rotator cuff injury.     

An historical sketch of splenic function and splenectomy

Ideas about the spleen's functions as a blood filter, reservoir, scavenger of red cells and immunologic communication center are traced from the ancients to the present.     

An instrument for serial sampling of intestinal juice

Summary A device has been develped to permit rapid, serial sampling of intestinal juice. Two tubes are fastened to a cup-shaped bubble trap. The cup together with its tubing is swallowed. The specimen of juice is aspirated into one of the tubes and is then removed by allowing air to flow into the tube below the specimen while suction is maintained above. The air is let in through the bubble trap by means of the second tube. Samples less than 0.5 ml. in volume can be delivered immediately through as much as 5 m. of tubing The sampling may be continuous or intermittent from any level of the small intestine or from the stomach.     

Fibreoptic studies of the aortic valve in dogs.

The study describes a method for visualisation of the aortic valve in the intact animal using a non-obstructive endoscopic system. Clearing of blood from the field of vision is achieved by the rapid injection of saline during a period of asystole.