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A 61-year-old woman experienced a cardiopulmonary arrest immediately after the retrobulbar injection of a mixture of 2 ml of 0.5% bupivacaine HCl, 2% mepivacaine HCl, and hyaluronidase. The patient was immediately resuscitated but remained unconscious for a total of 20 minutes. All neurologic deficits resolved completely over the two hours following the cardiopulmonary arrest and no adverse sequelae were noted. We assumed that this cardiopulmonary arrest was precipitated by the local anesthetic being transported via retrograde flow through the ophthalmic artery and then by antegrade flow through the internal carotid artery to the thalamus and other midbrain structures.

Although investigators have explored the effects of chronic illnesses on social functioning during the course of treatment, much less is known about the impact of treatment outcome on social functioning. In this study we examine whether the outcome of treatment for chronic pain in a pain clinic exerts a significant effect on the eventual social functioning. The findings indicate that a more favorable outcome is associated with increased marital satisfaction, a heightened desire for sex, and an increased desire and ability for recreational activities. These findings have implications for family practitioners as they assess social functioning after treatment for chronic pain.

The authors evaluated the antiemetic properties of transdermal scopolamine (TDS) in healthy patients undergoing elective cesarean section and receiving epidural morphine for postoperative analgesia. Prior to administration of anesthesia, 203 patients had either TDS or a placebo study patch applied behind one ear. All patients were hydrated with lactated Ringer's solution iv and given 2.0% lidocaine with 1:200,000 epinephrine epidurally for surgical anesthesia. Following delivery of the infant, 4 mg of morphine sulphate was injected through the epidural catheter. After the operation patients were evaluated by "blinded" observers at 2, 4, 6, 8, 10, 24, and 48 h for nausea, vomiting, retching, pain relief, itching, and adverse effects. In addition, medications received were noted. No differences were found between the groups in terms of severity or incidence of pain, or requests for analgesic or antipruritic medication. Although there was no difference between the groups in the first 2 h, patients with TDS had significantly less nausea, vomiting, and retching than patients in the placebo group in each time interval between 2 and 10 h. Additionally, the TDS group required less antiemetic medication. There was no difference in the frequency of retching or vomiting between groups. Side effects were minimal and equal in both groups. The authors conclude that TDS results in a decreased incidence of nausea and vomiting in patients who have delivered by cesarean section and received epidural morphine. TDS appears safe for continuous antiemetic administration.

Uterine perforation and deep embedding by an intrauterine device (IUD) require exact determination of its location as a necessary step to safe and effective retrieval. Six cases of uterine perforation and four of embedding by an IUD were studied with ultrasonography (US) and hysterography. While US findings suggested the correct diagnosis of perforation in five of the six cases, hysterography yielded more exact diagnostic information. Deep embedding could only be diagnosed with hysterography. A classification of the types of perforation and an algorithm for diagnosing ectopic IUD are presented. Undue reliance on the sonographic appearance of an IUD in the center of the uterine image may lead to hazardous attempts at transvaginal removal of a device that is partly intramural. In this study, hysterography offered the most precise diagnostic information.

Charts from 2929 consecutive parturients were reviewed. Twenty-four had platelet counts less than 100,000/microL in the peripartum period. Seventeen of the 24 had predisposing causes for thrombocytopenia, including preeclampsia (nine), immune thrombocytopenia purpura (two), infection (three), placenta accreta (one), abruption (one), and excessive surgical bleeding (one). Seven had asymptomatic thrombocytopenia of unknown origin. Fourteen of the 24 thrombocytopenic patients received regional anesthesia, and none had permanent sequelae. Based upon this retrospective review, peripartal thrombocytopenia (15,000-99,000/microL) did not increase the risk of neurologic complications after a regional anesthetic. There have been no reports in the literature of spinal or epidural hematomas in parturients after regional anesthesia, except for one patient with a spinal ependymoma.

We did not observe the reported alarm reaction of the top smelt Atherinops affinis (Ayres) when presented with a methanol extract of whole top smelt; we interpret the reaction as an experimental artifact. Rather, a methanol extract of top smelt is an attractant, as is methanol extract of shrimp.