Electrocardiographic changes during and after isoflurane-induced hypotension for neurovascular surgery

We evaluated the effects of isoflurane anaesthesia and induced hypotension in 33 neurosurgical patients by electrocardiographic monitoring and serial cardiac enzyme measurements. An electrocardiogram (ECG) and serum enzymes were obtained preoperatively, intraoperatively and postoperatively in the recovery room and for three consecutive days. ECG leads II, V1 and V5 were monitored continuously during anaesthesia. Patients who had had a subarachnoid haemorrhage and a high incidence of abnormal preoperative ECG (42 per cent). Ten patients developed ECG changes intraoperatively, but these changes were unrelated to isoflurane-induced hypotension. Fifty-three per cent of patients developed an abnormal postoperative ECG. These abnormalities consisted mostly of nonspecific ST segment or T wave changes. At no time was there an elevation in cardiac enzyme activity. We found that nonspecific ECG changes are relatively common in patients undergoing vascular neurosurgical procedures. There was no enzymatic evidence of myocardial infarction and we can only speculate that these ECG changes are related to intracranial surgical manipulation.     

Success rate and duration of orthodontic treatment for adult patients with palatally impacted maxillary canines.

This study was undertaken to examine the success rate and the length of orthodontic treatment of impacted maxillary canines in adult patients. A sample of 19 adults (mean age, 28.8 +/- 8.6 years; range, 20-47 years), who had been treated for a total of 23 impacted maxillary canines, was compared with a younger control group (mean age, 13.7 +/- 1.3 years; range, 12-16 years). The control subjects were chosen for a similar degree of impaction difficulty by carefully matching the positions of the impacted canines in the 3 planes of space. The success rate among the adults was 69.5% compared with 100% among the younger controls. The lower success rate was due to 5 canines that had failed to erupt and 2 canines that had been partially extruded but could not be aligned in the arch. The duration of treating the overall malocclusion of the adults and young subjects did not materially differ. However, the adults showed significant increases in the duration and number of treatment visits required for resolving the canine impaction, in both the simpler and the more difficult cases. When further divided by age, all the failed canines were found in the older (over 30) adult subgroup. It was concluded that the prognosis for successful orthodontic resolution of an impacted canine in an adult is lower than that in a younger patient and that the prognosis worsens with age. Furthermore, when such treatment is undertaken, its successful completion should be expected to take considerably longer.     

Phenotypic variability of a distinct deletion in McLeod syndrome

The X‐linked McLeod neuroacanthocytosis syndrome strongly resembles Huntington's disease and has been reported in various countries world‐wide. Herein, we report two Chilean brothers with predominant psychiatric features at disease onset including schizophrenia‐like psychosis and obsessive compulsive disorder. Molecular genetic analysis revealed a small deletion in the XK gene (938‐942delCTCTA), which has been already described in a North American patient of Anglo‐Saxon descent and a Japanese family, presenting with seizures, muscle atrophy or chorea yet absence of psychiatric features. These findings argue against a founder effect and indicate a profound phenotypic variability associated with the 938‐942delCTCTA deletion. Our report supports the inclusion of McLeod syndrome in the differential diagnosis of Huntington's disease as well as acute psychosis in male subjects. © 2007 Movement Disorder Society     

The effect of observation time and contrast on visual acuity

Background: Field studies of the duration of fixation during daytime driving find that it is about 0.2 seconds on average. Thus, the time available to read traffic signs is often limited. There are other circumstances where time to read alphanumeric messages is limited. Data relating time of observation are needed for purposes of ergonomic design as the data available in the literature are limited and uncertain. Method: Visual acuity was measured using Landolt rings in negative contrast, which were presented on a computer screen with a background luminance of 32 cd/m2 for durations that varied between two and 0.02 seconds at three different contrasts. Resulte: Visual acuity depends on the log of the light dose reduced by a factor that may be related to absorption of the light by the eye media. For young observers, it was found that: VA = 0.57 (log C t) + 1.705, where C is the contrast and is expressed as δL/L, where δL is the difference between target and background luminances in cd/m2 and t is the observation time in seconds. Conclusion: This formula or the functions fitted to the data obtained can be used to calculate the increase in target size needed to allow for short observation times.     

The first 50 years of military radiology 1895–1945

Following the discovery of X-rays in 1895 by Wilhelm Röntgen the value to the military surgeon of the new technique was soon realised. The localisation of retained bullets by radiography avoided inappropriate exploration of the wound. The X-rays were first used on casualties from the Abyssinian War of 1896 and the developing radiological technology was progressively applied to military surgery. In addition the needs of warfare stimulated the development of all aspects of radiology.     

A high fidelity tissue-based cardiac surgical simulator.

OBJECTIVE: Issues concerning the training and certification of surgical specialists have taken on great significance in the last decade. A realistic computer-assisted, tissue-based simulator developed for use in the training of cardiac surgical residents in the conduct of a variety of cardiac surgical procedures in a low-volume cardiothoracic surgery unit of a typical developing country is described. The simulator can also be used to demonstrate the function of technology specific to cardiac surgical procedures in a way that previously has only been possible via the conduct of a procedure on a live animal or human being. METHODS: A porcine heart in a novel simulated operating theatre environment with real-time simulated haemodynamic monitoring and coronary blood flow, in arrested and beating-heart modes, is used as a training tool for surgical residents. RESULTS: Standard and beating-heart coronary arterial bypass, aortic valve replacement, aortic homograft replacement and pulmonary autograft procedures can be simulated with high degrees of realism and with the superimposition of adverse clinical scenarios requiring valid decision making and clinical judgments to be made by the trainees. CONCLUSIONS: The cardiac surgical simulation preparation described here would appear to be able to contribute positively to the training of residents in low-volume centres, as well as having the potential for application in other settings as a training tool or clinical skills assessment or accreditation device. Collaboration with larger centres is recommended in order to accurately assess the utility of this preparation as an adjunctive cardiothoracic surgical training aid.