Role of topical lignocaine during carotid endarterectomy.

Forty carotid endarterectomies were undertaken in 34 patients. Operations were prospectively randomized to periarterial application of either 1 per cent lignocaine (n = 19) or normal saline (n = 21), and detailed measurements taken of intraoperative pulse rate and blood pressure. Patients receiving lignocaine demonstrated a lower pulse rate, and lower systolic and mean blood pressures than those receiving placebo, with significance in relation to clamp application and shunt removal (P < 0.05). It was particularly noticeable that patients receiving lignocaine demonstrated less intraoperative variation in pulse rate and blood pressure. Topical lignocaine stabilizes pulse rate and blood pressure during carotid endarterectomy.     

Adenolipoma of the breast

We here report a patient with an adenolipoma of the breast. The radiological features appeared to be characteristic. On mammography the mass was surrounded by a radiolucent ring and on ultrasonography the lesion was revealed as a well-defined, hypoechoic, lobulated and solid mass.     

Anatomic considerations of pin placement in the proximal tibia and its relationship to the peroneal nerve.

Peroneal nerve impalement is a recognized complication of percutaneous placement of wires, which is gaining increased usage with the application of the techniques of Ilizarov, Monticelli, and Spinelli. Dissections of the peroneal nerve in the proximal tibia were performed in ten anatomic specimens (20 legs) to define (1) its relationship to palpable landmarks, (2) distribution of major branches to the musculature, and (3) safe zones of placement of percutaneous wires in the proximal tibia. The anterior recurrent tibial nerve was frequently in an area of risk where it courses proximally in the anterior compartment. A safe zone is located anterior to the palpable portion of the fibular head and up to 2 cm distal to the tip of the fibular head.     

Fetal lumbar spine: measuring axial growth with US

Ultrasound (US) can be used to visualize vertebral segments, suggesting a quantitative means of studying vertebral column growth in utero and thus a means of detecting developmental abnormalities. US images of the lumbar spine were obtained in 128 clinically normal fetuses between the gestational age of 11 through 41 weeks. A large-aperture, dynamically focused US system capable of regional magnification was used. Average lumbar spacing was calculated from distance between centrums of at least four lumbar bodies. The average distance between lumbar centrums increased nearly linearly throughout the second and third trimesters (r2 = 0.98). Enhanced anatomic display implies new capabilities for recognizing developmental abnormalities antenatally.     

Hypertension in the emergency department

Hypertensive emergencies are now rare and are recognized by the deleterious effect on end-organs. Prompt, efficacious treatment is critical, and the current drug of choice for most episodes is sodium nitroprusside. Hypertensive urgencies are more common than are emergencies, and are distinguished by diastolic pressures greater than 115 mm Hg without end-organ dysfunction. Although there are many efficacious agents, one excellent choice is nifedipine.