Effects of preoperative methoxamine on blood loss and haemodynamic variables during transurethral prostatic resection under spinal anaesthesia

Thirty-six patients who presented for transurethral prostaticresection were allocated randomly to one of two groups. Patientsin group A were given methoxamine 10 mg i.m., 15 min beforespinal anaesthesia. Patients in group B acted as a control group.All patients received spinal anaesthesia. Preoperative administrationof methoxamine 10 mg i.m. decreased blood loss significantlyand improved haemodynamic stability compared with the controlgroup.     

Post-traumatic basal cell carcinomas

Two patients are described who presented with basal cell carcinomas occurring at the sites of a single injury sustained several years previously. The significance of injury in the aetiology of basal cell carcinoma is discussed.     

EXTRADURAL MORPHINE FOR THE RELIEF OF PAIN FOLLOWING CAESAREAN SECTION

Thirty patients took part in a double-blind trial to comparemorphine 10 mg i.m. with morphine 5 mg into the extradural spacefor pain relief following Caesarean section. With the extraduralroute the mean time to first analgesia was 7.95h compared with4.75 h for the i.m. route. The mean number of further dosesof diamorphine 7.5 mg required for pain relief in the first24h was 1.93 (±0.30) in the i.m. group and 1.46 (±0.31) in the extradural group. There was a small but definiteadvantage in the use of the extradural route for the initialdose of morphine. No serious side-effects were noted in eithergroup.     

Post-circumcision analgesia: comparison of topical analgesia with dorsal nerve block using the midline and lateral approaches

Forty-five patients undergoing circumcision were allocated randomlyto one of three study groups to compare topical analgesia withdorsal nerve block using the midline or lateral approach. Painscores, side effects and analgesic requirements were recordedafter surgery. Patients who received topical analgesia requiredsignificantly more fentanyl and had higher pain scores at the15-min observation period after operation. Fentanyl requirementsand pain scores were similar in patients who received a dorsalnerve block using either the midline or lateral approach. Theincidence of side effects after surgery was similar in all threegroups.     

PRELIMINARY, DERMATOLOGIC EIRST STEP CRITERIA FOR LUPUS ERYTHEMATOSUS AND SECOND STEP CRITERIA FOR SYSTEMIC LUPUS ERYTHEMATOSUS

Background. Comparisons of cases of systemic lupus erythematosus (SLE) with cases of rheumatoid arthritis and other rheumatologic disorders affords the basis of the 1982 revised criteria of the American Rheumatism Association (ARA) for classifying SLE cases. We address three questions: Do comparisons of LE cases with non-LE cases that have suggestive skin lesions yield criteria for use in dermatology clinics for primary classification of cases with photo distributions of skin lesions? Do comparisons of SLE with cutaneous LE cases yield the same or similar criteria to the revised ARA criteria for SLE? How should subacute cutaneous LE cases be evaluated for signs of significant systemic involvement? Methods. Discriminant analyses on 168 cases with skin lesions suggestive of LE were performed using data based on the ARA criteria for SLE and study factors for cutaneous LE suggested by the European Academy of Dermatology and Venereology. Results. These yielded two sets of criteria: (1) The 11 preliminary, dermatologic first step criteria (10 plus 1 for discoid lesions and histology) serve to classify cases as LE or non-LE. (2) The 11 preliminary, dermatologic second step criteria classify LE cases as cutaneous LE or systemic LE. Interestingly, 5 of 11 of these second step criteria differ from the 11 ARA criteria for systemic LE. These second step criteria afford a useful means of distinguishing between subacute cutaneous LE cases with or without significant systemic involvement. Conclusions. The study factors included in both the first and the second step criteria fall into three groups, notably clinical criteria, laboratory criteria, and “added study factors.” The latter factors distinguish between the groups compared (LE VS. non-LE and cutaneous vs. systemic LE) but not as well as the study factors included as “criteria.”     

Delayed profound respiratory depression after premedication with trimeprazine

Delayed, profound respiratory depression occurred in a 4-year-old boy, who had been premedicated with trimeprazine 4 h after tonsillectomy. This is a rare, but potentially fatal idiosyncratic reaction.     

TWO CASES OF BAROTRAUMA ASSOCIATED WITH TRANSTRACHEAL JET VENTILATION

Two patients suffered barotrauma whilst undergoing transtrachealjet ventilation (TTJV). In the first, TTJV was provided by aSanders injector and in the second it was given by a high frequencyjet ventilator. Barotrauma was a consequence of the expiratorypathway becoming blocked. The mechanism of barotrauma and amethod of airway pressure monitoring during TTJV are discussed.It is recommended that meticulous care is taken to ensure anadequate path for expiration when jet ventilation is used.