Topical ibuprofen for skin analgesia prior to venepuncture

The analgesic effect of topical ibuprofen was investigated in ten volunteers. There were no significant differences in visual analogue scale pain scores for pinprick after 15 and 60 mm of application of ibuprofen, placebo and EM LA cream. Comparison of visual analogue scale scores for venous cannulation after similar durations of ibuprofen and EMLA creams found significantly (p < 0.014) lower scores for EMLA at 60min. We do not consider ibuprofen cream to be clinically useful for venous cannulation.     

Acute stridor as a presentation of bilateral abductor vocal cord paralysis

We report the case of a 48-year-old woman, referred to the Intensive Care Unit with community-acquired pneumonia, who was noted to have stridor of acute onset. Subsequent indirect laryngoscopy revealed bilateral abductor vocal cord paralysis, secondary to unsuspected carcinoma of the oesophagus, requiring immediate tracheostomy. We highlight the importance of visualisation of the vocal cords in cases of stridor of uncertain aetiology.     

Optic disc swelling in Crohn's disease

Purpose: To provide a review of the causes of optic disc swelling in patients suffering from inflammatory bowel disease. Methods: Two illustrative cases of bilateral optic disc swelling are presented: one in a patient known to have Crohn's disease and the other in a patient whose investigations revealed the disease. The possible causes of optic disc swelling in inflammatory bowel disease, based on a literature review, are tabulated and discussed with reference to the presented cases. Results/Conclusions: Optic disc swelling is a rare complication of inflammatory bowel disease. Previously reported cases have been attributed to peripapillary inflammation, optic disc ischaemia or intracranial hypertension. Postulated causes of optic nerve ischaemia include a local vasculitis or general hypercoagulability. The underlying aetiology of intracranial hypertension is often elusive. Older studies suggest a relationship between corticosteroid treatment and/or iron deficiency anaemia, while modern imaging emphasises the need to exclude dural venous sinus thrombosis.     

Recurrence of stage I thymoma 32 years after total excision

Malignant thymomas are invasive and recur frequently, but noninvasive thymomas rarely do so. We report on a case of recurrent thymoma in a 50-year-old white man, 32 years after total excision of a stage I thymoma. We stress the importance of long-term follow-up in all patients.     

Cardiovascular Effects of Propofol in Dogs with Dilated Cardiomyopathy

Background: The authors tested the hypothesis that propofol improves left ventricular diastolic function in dogs with dilated cardiomyopathy by reducing left ventricular preload and afterload.

Methods: Seven dogs were instrumented for left ventricular and aortic pressures, aortic blood flow, and subendocardial segment length. Left ventricular afterload and contractility were quantified with aortic input impedance and preload recruitable stroke work, respectively. Diastolic function was evaluated with a time constant of left ventricular relaxation (tau); segment-lengthening velocities and time-velocity integrals during early left ventricular filling (dL/dtE and TVI-E, respectively) and atrial systole (dL/dtA and TVI-A, respectively); and a regional chamber stiffness constant (K). Dogs were paced at 240 beats/min for 18 +/- 3 days, and hemodynamics were recorded in sinus rhythm in the conscious state. Anesthesia was induced with propofol (5 mg/kg) and maintained with propofol infusions at 25, 50, and 100 mg [center dot] kg sup -1 [center dot] h sup -1, and hemodynamics were recorded after 15 min of equilibration at each dose.

Results: Propofol decreased mean arterial pressure, left ventricular end-diastolic pressure, and K but did not change heart rate. Propofol reduced total arterial resistance and increased total arterial compliance derived from aortic input impedance. Propofol also reduced preload recruitable stroke work. The lowest dose of propofol decreased tau. Propofol decreased dL/dtE and TVI-E and reduced the dL/dt-E/A and TVI-E/A ratios.     

The effect of nurses' background on performance of nursing home resident oral health assessments pre- and post-training

The purpose of this study was to determine the effect of nurses' background on their accuracy in determining oral health status and treatment need of newly admitted nursing home residents before and after tutoring. Eighteen nurses examined SO nursing home residents before and after an in-service training lecture. Examinations performed by a dentist served as reference. Background items evaluated were: regularity of each nurse's own dental visits; years since graduation from nursing school; length of experience in an LTC facility; and training received in oral health care. At the second evaluation, nurses greatly improved the % agreement on ail items. The results of this study indicate that, regardless of background characteristics, the combination of training, the presence of the dentist, and knowledge that they were in a study appeared to improve nurses' performance on the assessment. Before training, more experienced nurses were better able to determine hard tissue abnormalities than their less experienced counterparts; before training, neither group performed well in assessing soft tissue lesions. Therefore, improvements in basic nursing training in this area appear to be necessary.     

Radiologic diagnosis of oat cell cancer in a high-risk screened population

A screening program of 10,040 cigarette-smoking men over 45 years of age was undertaken in an attempt to achieve earlier diagnosis, thereby increasing the cure rate, of oat cell lung cancer. Of the 155 men who were found to have lung cancer, 27 (17%) had confirmed oat cell cancer. Only one case was diagnosed at the first examination. The other 26 cases (called incidence cancer) were diagnosed by subsequent examinations. In 24 of the 26 patients, the tumor was not found until it was advanced (Stage III), and of these patients, only one is alive at 21 months follow-up. Two tumors were diagnosed as oat cell carcinoma at an early stage (Stage I), and both patients are alive with no evidence of disease at seven and 24 months. The screening program used in this study did not succeed in detecting oat cell cancer at an early stage.     

Teaching guided fibreoptic nasotracheal intubation

An anaesthetic technique suitable for training in fibreoptic intubation is described. It uses a capped oropharyngeal airway which leaves the nose free for fibreoptic intubation and allows the airway to be maintained and ventilation to be controlled if necessary. An assessment is made of the technique after 50 fibreoptic intubations with the Olympus LF-1 fibrescope. There were no failed intubations and no serious complications.