Development of a hospital-based dental phobia clinic

The formation of a hospital-based dental phobia clinic requires little initial outlay in terms of capital. It can provide badly needed care by accessing a group of patients that have not been able to receive dental care. A dental phobia clinic cam provide an additional facet of training to house staff and attending staff, using existing facilities. The hospital environment provides an appropriate setting for this specialized kind of care.     

Is diagnostic curettage harmful in women with unexplained infertility?

Summary. Diagnostic curettage as part of the investigation of the woman with unexplained infertility has not been considered a hazardous procedure. Two similar groups with unexplained primary infertility were examined laparoscopically: 53 patients had undergone diagnostic curettage as part of the investigation; 142 had not. None had an antecedent history suggestive of pelvic inflammatory disease. The incidence of laparoscopically detected chronic pelvic inflammatory changes in both groups was compared and was found to be 50.9 and 13.4% respectively ( P <0.001). It was concluded that diagnostic curettage may be more hazardous in women with unexplained infertility than was believed previously.     

Cerebral blood flow and metabolism during adenosine–induced hypotension in patients undergoing cerebral aneurysm surgery

The effects of adenosine-induced hypotension on cerebral blood flow (CBF), cerebral metabolic rate of oxygen (CMRO2), and cerebral lactate production, together with systemic haemodynamics, were studied in 10 patients undergoing cerebral aneurysm surgery in neurolept anaesthesia with controlled hyperventilation. CBF changes were determined in six of the patients with a retrograde thermodilution technique in the jugular vein. Hypotension was induced with a continuous infusion of adenosine in the superior vena cava. The dose range was 0.06-0.35 mg/kg/min, and this caused a 42% reduction in mean arterial blood pressure (MABP) from 79 +/- 4 to 46 +/- 1 mmHg (10.5 +/- 0.5 to 6.1 +/- 0.1 kPa) through a profound reduction in systemic vascular resistance (SVR), which amounted to 61%. No significant change occurred in CBF. Whole body AV-difference of oxygen was decreased by 37%, and cerebral AV-difference by 28%, corresponding to reductions in whole body oxygen uptake and CMRO2 of 16 and 17%, respectively. Cerebral AV-difference of lactate did not change. In the posthypotensive period MABP was increased by 10%, together with a minor increase in CBF (15%). It is concluded, that adenosine-induced hypotension at MABP levels between 40-50 mmHg (5.3-6.7 kPa) does not affect cerebral oxygenation unfavourably, and may even offer a protective effect by reducing cerebral oxygen demand. The slight CBF increase in the posthypotensive period was probably secondary to an increase in MABP together with a blunted autoregulation, but in no case was this effect considered to be harmful for the patient.