Postspinal headache in young and elderly patients

In two randomised, double-blind studies of elderly patients with a mean age of 68.9 (range 21-88) years and young patients, mean age 29.4 (range 20-40) years, the effect of needle size on the incidence of postspinal headache was compared. The two needle groups, 20- and 25-gauge, were comparable in both studies with regard to number, sex, age and type of surgery. The incidence of postspinal headache in young patients was 27.6% when a 20-gauge needle was used and 12.6% with a 25-gauge needle. There was no significant difference in either the incidence of headache in the elderly patients (10.8% and 7.8%, respectively) or between the sexes. It is concluded that it does not matter if a 20- or a 25-gauge needle is used for spinal analgesia in elderly patients with regard to postspinal headache, but if spinal analgesia is indicated in young patients a fine needle is preferred.     

Familial Down''s syndrome A cytogenetical and genealogical study of twenty-two families

The pedigrees and cytology of 22 families with Down's syndrome in more than 1 member are presented. In 10 families the patients were sibs, in 6 families cousins or more closely related, and in 6 families they were more distant relatives. Inherited 13–15/21 translocation was the cause of multiple occurrence of Down's syndrome in 4 families. In the other families the patients were found to have the standard trisomy 21 karyotype. No isolated translocations were observed and no other translocation type was found. In one family a ‘marker’D chromosome and in another family a small Y chromosome were observed. One patient showed possible mosaicism with trisomy 21 and a few normal cells.     

EFFECTS OF GIVING WATER 20-450 ML WITH ORAL DIAZEPAM PREMEDICATION 1-02 H BEFORE OPERATION

We have studied the volume of water which should accompany diazepam10mg oral premedication given 1–2 h before induction ofanaesthesia in 75 patients undergoing elective gynaecologicallaparoscopy. Twenty-five patients were given 20 ml (group A),25 patients 150 ml (group B), and 25 patients 300–450ml of water (group C). There were no differences between thegroups in gastric fluid volume and acidity. All groups reporteda reduction in thirst and dryness of the mouth after water intake,while only group B reported significant anxiolysis. Eight patientsin group C experienced augmented diuresis, compared with nopatients in groups A and B. We conclude that 150 ml is the idealamount of water given with oral prernedication 1–2 h beforeanaesthesia. (Br. J. Anaesth. 1993; 71: 503–506)     

The impact of legal termination of pregnancy and of prenatal diagnosis on the birth prevalence of Down syndrome in Denmark

A considerable reduction in number of livebirths for mothers over 35 was observed in Denmark from 1960 to 1980. Birthrates for those aged 35–39 fell by 58.8%, for those aged 40–44 by 78%. In 1979–1980 100 infants with Down syndrome were born among 116757 newborns, a birth prevalence of 0.86 per 1000, which was significantly lower than the incidence of 1.17 per 1000 when the prenatally diagnosed cases were included. The reduction was noticeable for the age group over 35 where it fell to 1.89 per 1000 for mothers 35–39 and 6.48 per 1000 for mothers over 40.
The utilization of prenatal diagnosis was 72 per 100 livebirths for women 35 and older in the Copenhagen area and 56 per 100 livebirths for the rest of the country, with differences in different areas.
The number of induced abortions for women 35 years and older was 9265 against 6597 livebirths. The estimated number of Down syndrome cases averted by unrestricted abortion was 61, twice the number prevented by amniocentesis (31), with the greatest impact for mothers over 40.
An increased risk of Down syndrome for the age group 35–39 was observed when liveborn and prenatal cases were considered together showing an incidence of 6.89 per 1000, with the highest incidence in the Copenhagen area, 8.70 per 1000, more than double the incidence of 3.04 observed in Copenhagen from 1960 to 1971, for the same age group.     

THE EFFECTS OF PHARMACOLOGICAL TREATMENT ON PULMONARY FUNCTION IN CHILDREN WITH EXERCISE-INDUCED ASTHMA

Abstract. Bolme, P., Eriksson, M., Freyschuss, U. and Winbladh, B. (Department of Paediatrics, Karolinska Institute, St. Göran's Children's Hospital, Stockholm, Sweden). The effects of pharmacological treatment of pulmonary function in children with exercise-induced asthma. Acta Paediatr Scand, 69: 165, 1980.—The effects of two therapeutic regimens were investigated in eleven boys and eight girls (8–13 years) with a history of exercise-induced asthma (EIA), who reacted with subjective signs of EIA and a decrease in FEY_1.0 exceeding 10% after an exercise test. A test program (TP) including complete spirometry, bicycle ergometer and treadmill exercise tests preceded and followed by dynamic spirometry at one and five min after exercise, was performed before and after each treatment period. In 12 patients with sporadic medication before the trials, continuous peroral treatment with a combination of a ß₂-stimulating drug and a xanthine derivative for three weeks did not significantly improve TP data. In 13 children (six from the above group) who were already on continuous treatment as above, addition of disodium cromoglycate (DSCG) inhalations for 3–4 weeks improved the response to acute administration of a β -receptor stimulatory aerosol but did not influence EIA. Seven of the children continued their DSCG treatment for one year. Minor improvement of EIA provoked by cycling but not by treadmill was seen after this. The ventilatory effort in relation to working intensity was lowered. No significant differences were found between treadmill running and cycling in provoking asthma.