Prospective Study of the Incidence of Transient Radicular Irritation in Patients Undergoing Spinal Anesthesia

Background: There is considerable controversy regarding the role of subarachnoid 5% hyperbaric lidocaine in the syndrome transient radicular irritation (TRI). This randomized, double-blinded, prospective study was designed to determine the incidence of TRI and identify factors possibly contributing to its development.

Methods: One hundred fifty-nine ASA physical status 1 or 2 patients undergoing outpatient knee arthroscopy or unilateral inguinal hernia repair were prospectively randomized to receive spinal anesthesia with 5% hyperbaric lidocaine with epinephrine (60 mg with 0.2 mg epinephrine for arthroscopy or 75 mg with 0.2 mg epinephrine for hernia repair), 2% isobaric lidocaine without epinephrine (60 mg for arthroscopy or 75 mg for hernia repair), or 0.75% hyperbaric bupivacaine without epinephrine (7.5 mg for arthroscopy or 9.0 mg for hernia repair) in a double-blinded fashion. On the 3rd postoperative day, patients were contacted by a blinded investigator and questioned regarding the incidence of postoperative complications including TRI, defined as back pain with radiation down one or both buttocks or legs occurring within 24 h after surgery. Postoperatively, time from injection to block resolution, ambulation, voiding, and ready for discharge were recorded by a postanesthesia care unit nurse blinded to the group assignment.

Results: The incidence of TRI was greater in patients receiving lidocaine than in those receiving bupivacaine (16% vs. 0%; P = 0.003). There was no difference in the incidence of TRI between the patients receiving 59% hyperbaric lidocaine with epinephrine and those receiving 2% isobaric lidocaine without epinephrine (16% vs. 16%; P = 0.98). The incidence of TRI was greater in patients undergoing arthroscopy than in those undergoing hernia repair (13% vs. 5%; P = 0.04). There was no difference in discharge times in patients receiving bupivacaine versus those receiving hyperbaric lidocaine with epinephrine (292 vs. 322 min; P = 0.61).     

Possible New Developments in Community Control of Iron-Deficiency Anemia

Two findings that may revolutionize the implementation of oral iron supplementation programs worldwide have recently come to light. The first is that weekly administration of oral iron to anemic Chinese preschool children improved iron status as much as daily dosing, producing only negligible side effects. The relevance of this finding is being examined in studies of pregnant women, adolescent girls, and preschoolers in eight countries in the WHO (World Health Organization)–UNU (United Nations University)–UNICEF study of weekly iron supplements. Hopefully, this phenomenon will vastly increase the coverage, feasibility, and effectiveness of supplementation programs, particularly in the developing world. The second finding, that daily oral iron given to iron-sufficient Indonesian toddlers appeared to decrease weight gain compared with a placebo group, had not been apparent in three other small studies. If verified, screening for anemia could be required for all young children in predominantly anemic populations before iron supplements are given. However, it may not be an issue if weekly dosing is adopted.     

A new procedure for calibrating the Video Imaging Technique for Assessing dermal Exposure to pesticides

Improvements in the calibration techniques used in a Video Imaging Technique for Assessing Exposure (VITAE) were examined. A series of standard curves measuring change in fluorescence with increased tracer deposition within narrow pre-exposure skin tone groupings on volunteer human subjects were developed. Nine highly linear curves were generated. Data from these curves were used to develop calibration curves which permitted the computerized correction of fluorescence based on the pre-exposure skin fluorescence. VITAE estimates of dermal tracer deposition were highly correlated with application rates (r²=0.98). The fluorescent tracer 4-methyl-7-diethylaminocoumarin was found to be stable for up to 48 h in a greenhouse environment when applied to chrysanthemum foliage or alpha-cellulose patches. The percentage of tracer which could be dislodged from chrysanthemum foliage was constant over 48 h. Improvements in the VITAE calibration techniques increase its value in providing full-body dosimetric estimates of dermal exposure to pesticides in enclosed environments.     

In situ saphenous vein bypass grafts: angiographic evaluation and interventional repair of complications

In situ saphenous vein grafts are being used with increasing frequency for bypass procedures involving the femoral and popliteal arteries. Complications of these procedures include anastomotic stenoses and persistent arteriovenous fistulae that may result in failure of the graft. Balloon angioplasty and embolotherapy with detachable balloons were employed successfully in three or four recent cases of patients with complications from in situ grafts. Tailored angiography is essential for evaluating in situ grafts, and interventional techniques are extremely useful for managing complications.     

"Cataplexy" and muscle ultrasound abnormalities in Coffin-Lowry syndrome.

The Coffin-Lowry syndrome is a rare cause of mental retardation recognised by its distinctive facial and digital features. We have observed an unusual, non-epileptic, cataplexy-like phenomenon in three subjects with the syndrome and we speculate that this feature may go unrecognised. We also provide evidence of neuromuscular dysfunction as part of the phenotype by showing abnormalities on muscle ultrasound in four gene carriers.