Acute Lymphoblastic Leukaemia in Adults in the Northern Region of England - A Study of 75 Cases

Over a ten-year period we have studied 75 cases of adult acutelymphoblastic leukaemia (ALL) Sixty of the cases were seen from1979 to 1984 and represent an unselected series of all knowncases in a region of 3 000 000 people. Study of these patientshas given further insight into the heterogeneous, clinical andcytological nature of adult ALL. Three protocols have been usedand results are presented indicating that conventional approachesto treatment in this disease are unsatisfactory. Not all patientscould be entered on protocols but these patients are includedto give the overall perspective of this disease in clinicalpractice. A new strategy is proposed which envisages abandoningtraditional maintenance chemotherapy in favour of either allogeneicmarrow transplant or autologous transplant in first remissionin the post-consolidation phase. Preliminary results of thisflexible approach are given.     

CHANGE IN THE WORK OF BREATHING IMPOSED BY FIVE ANAESTHETIC BREATHING SYSTEMS

Measurements of pressure and flow in five anaesthetic breathingsystems were studied with various fresh gas flows (FGF) usingvolunteers, and mechanically simulated breathing. Pressure measurementswere made at the patient connection and in the neck of the reservoirbag. A pneumotachograph was used to measure flow in the patientconnection. The change in the work of breathing imposed by thecircuit was derived from the pressure-volume graph and apportionedto stages of the breathing cycle. All the systems studied increasedthe work of breathing. Expiratory work was always increasedmore than inspiratory work. The additional work imposed on expirationand the total extra work imposed on breathing were further increasedat FGF greater than the minimum clinical requirement.     

Anxiety as a Potential Factor Affecting Maternal Attachment

Many factors may influence the initial mother–infant interactions. This exploratory study investigated the impact of one factor, anxiety, on maternal attachment in 30 married primigravidas. Observations of mother-infant interactions and scores from the Taylor Manifest Anxiety Scale were used. Results indicated that highly anxious mothers had low attachment scores. Mothers with high attachment scores had low anxiety ratings. In addition, affectionate behaviors were found to decrease as caretaking behaviors increased.     

Human volunteer studies of Alfentanyl (R39209), a new short-acting narcotic analgesic

Alfentanyl is a new narcotic analgesic with a rapid onset and very short duration of effect, and a potency about one third of that of fentanyl. The respiratory effects of 1.6, 3.2 and 6.4 micrograms/kg Alfentanyl were studied in a randomised controlled trial in five volunteers. Alfentanyl 6.4 micrograms/kg induced a significant increase in respiration at 1 minute, then significant depression of mean minute volume 3 and 4 minutes after slow intravenous injection, compared with saline control, and pre-injection values. Mean end-expired carbon dioxide concentration was increased after Alfentanyl 6.4 micrograms/kg, significantly from 2 to 9 min after injection, and highly significantly at 3, 4 and 5 minutes. Examination of the effect on expired CO2 concentration at 4 minutes reveals a highly significant dose-response relationship with the three doses of Alfentanyl. The transient effect of ALfentanyl was confirmed by the fact that no change in mean ventilatory response to carbon dioxide was demonstrable 30 or 50 minutes after any dose. When Alfentanyl was given 1 minute before testing the ventilatory response to carbon dioxide the response curves showed a highly significant dose-related shift to the right. There were no significant changes in heart rate or blood pressure after Alfentanyl, but the drug produces the typical subjective effects of the opiates.