Topical anaesthesia of the skin: a review

The ability to provide painless venepuncture and venous cannulation is a major advance in paediatric practice. Topical local anaesthesia of the skin can allow such procedures to be carried out with little or no discomfort in children of all ages. This has obvious psychological benefits for children, particularly those subjected to repeated procedures. The techniques for anaesthetizing the skin to be effective and safe must be based upon an understanding of the anatomy and physiology of the skin, the pharmacology of local anaesthetic agents and their behaviour when applied to the skin. Although eutectic mixture of local anaesthetics (EMLA cream) (Astra Pharmaceuticals) is the market leader, promising new preparations are being evaluated with the aim of decreasing the onset time of effective analgesia. New clinical applications for topical anaesthesia of the skin are appearing and it is likely that these will be increasingly used in the future.     

I.V. ANAESTHESIA WITH PROPOFOL USING A TRAGET-CONTROLLED INFUSION SYSTEM: COMPARISON WITH INHALATION ANAESTHESIA FOR GENERAL SURGICAL PROCEDURES IN CHILDREN

We studied 40 children undergoing general surgical procedures.They were allocated randomly to receive induction of anaesthesiawith propofol 3–5 mg kg^-1 followed by maintenance withhalo-thane and an appropriate regional block, or induction andmaintenance of anaesthesia with a computerized, target-controlledinfusion of propofol with a regional block. All patients breatheda mixture of 67% nitrous oxide in oxygen via a laryngeal maskairway. Both techniques provided adequate anaesthesia and operatingconditions. There were no significant differences between thegroups in heart rate, mean arterial pressure and end-expiredcarbon dioxide concentration during anaesthesia. There was nosignificant difference in the recovery times of the two groups.(Br. J. Anaesth. 1993; 70: 542–545) ^*Present Address: Military Hospital, Aldershot, Hants GUII 2AN.     

Glomerulonephritis after ventriculo-atrial shunt

We describe five patients with glomerulonephritis (GN) associatedwith cerebrospinal fluid shunt insertion to relieve hydrocephalus.A ventriculo-atrial (V-A) shunt had been placed on average 12.5years prior to the diagnosis of nephritis (range 0.5–21years). Four patients developed membranoproliferative glomerulonephritis(MPGN) with associated hypocomplementaemia. A single patientdeveloped focal proliferative glomerulonephritis. Coagulasenegativestaphylococci were cultured in four patients, either from bloodor from the shunt. Four patients had their shunts removed, twoof whom also received antibiotics. The other patient receivedantibiotics alone for infective endocarditis due to staphylococcalbacteraemia which originated in the shunt. All patients hadsubstantial renal impairment at the time of diagnosis (GFR,glomerular filtration rate, 20–45 ml/min). There was significantimprovement in renal function after appropriate treatment; fourof the five patients doubled their GFRs and two patients regainednormal function.     

Amiodarone pulmonary toxicity: its radiological features

Two cases of pulmonary toxicity associated with chronic ingestion of amiodarone are presented. Special emphasis is given to the radiological features which may aid in the clinical diagnosis of this disorder.     

Pointers to the diagnosis of gastric lymphoma on computed tomography

The computed tomographic features of 12 patients with primary gastric non-Hodgkin's lymphoma and a further seven patients with gastric involvement by disseminated non-Hodgkin's lymphoma have been reviewed. In eight of these 19 patients there were clefts within the area of gastric wall involved by lymphoma where oral contrast medium passed to within 2 mm of the serosal surface in and amongst areas of gastric wall thickening (maximal thickness ranging from 18 to 40 mm). In three of these patients some clefts extended beyond the expected margin of the stomach to enter into, and be contained by, a composite soft tissue mass of stomach, spleen and splenic hilar nodes. Awareness of these features, which are in keeping with the known range of macroscopic pathological appearances in non-Hodkin's lymphoma, may help the radiologist to recognize this potentially curable disease.     

Postoperative nausea and vomiting in paediatric surgical inpatients

A prospective study of postoperative nausea and vomiting (PONV) was conducted in 415 children presenting for inpatient surgery. The overall incidence of PONV was 18.1%. The highest incidence was in children undergoing ENT procedures and increased with age. Avoidance of intraoperative opioids and the use of local anaesthesia and/or non-steroidal anti-inflammatory drugs reduced the incidence of nausea and vomiting postoperatively.     

Unilateral Breast Edema in Congestive Heart Failure - A Mimic of Diffuse Carcinoma

Mammography in a patient with congestive heart failure showed unilateral skin thickening and a reticular pattern mimicking diffuse carcinoma. Resolution after treatment of the heart failure established the abnormality as secondary to dependent edema.     

0.5 Tesla cine-magnetic resonance angiography is a poor screening test for atheromatous renal artery stenosis in chronic renal failure

SUMMARY: A prospective comparative study of 0.5 Tesla cine-magnetic resonance arteriography (MRA) versus standard arteriography (SA) was performed in 42 patients with clinical suspicion of atheromatous renal artery stenosis (ARAS), all of whom had chronic renal failure (average creatinine for 42 patients was 269.2±103.4 μmol/L). MRA was performed on a Philips 0.5 Tesla T5 release III, (London, UK) using T1 gradient echo cine, and 3D phase contrast. SA was performed as an aortic flush, with or without selective renal studies, via the femoral artery. Intravenous digital subtraction angiography was performed (instead of a flush procedure) in two patients with severe femoral atheroma. One radiologist reported the MRA's, another reported the SA's; both were blinded to the results of other scans. MRA correctly identified the number of renal arteries in 31 of the 42 patients (75%); accessory arteries could not be visualized. Using SA as the gold standard', MRA had a sensitivity of 90% and a specificity of 54%, with regard to detection of significant (>50%) ARAS lesions. MRA had a negative predictive value of 70%, and a positive predictive value of 82%. MRA was well tolerated by all patients, oral sedation being needed for just three. We conclude that 0.5 Tesla MRA has only limited usefulness as a non-invasive screening test for ARAS, demonstrating fair sensitivity, comparable to other screening methods, in the context of significant renal impairment. However, specificity was poor, due to seven false positives. Improving the signal to noise ratio by using signal-enhancing media, or using a more powerful magnet, are likely to yield more accurate information.     

Oscillometric and intra-arterial blood pressure measurements in the neonate: a comparison of methods

ABSTRACT. A number of methods exist to measure neonatal blood pressure, one of which involves oscillometric principles. This method is the functional basis of the Dinamap 847 which has been studied for accuracy and reproductibility in 398 paired comparisons with direct arterial measurements in nine neonates. The correlation between the Dinamap and direct arterial pressure values were excellent, although for systolic blood pressure the Dinamap tends to underestimate by 2.4 ± 3.9 mm Hg. The present study has shown the Dinamap to be a clinically reliable instrument for measuring neonatal blood pressure.