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Background and purpose Intracranial haemorrhage in neurosarcoidosis (NS-ICH) is rare, poorly understood and the diagnosis of NS may not be immediately apparent. Methods The clinical features of three new NS-ICH cases are described including new neuropathological findings and collated with cases from a systematic literature review. Results Cases: (i) A 41-year-old man with headaches, hypoandrogenism and encephalopathy developed a cerebellar haemorrhage. He had neuropathological confirmation of NS with biopsy-proven angiocentric granulomata and venous disruption. He responded to immunosuppressive therapy. (ii) A 41-year-old man with no history of hypertension was found unconscious. A subsequently fatal pontine haemorrhage was diagnosed. Liver biopsy revealed sarcoid granulomas. (iii) A 36-year-old man with raised intracranial pressure headaches presented with a seizure and a frontal haemorrhage. Hilar lymph node biopsy confirmed sarcoidosis, and he was treated successfully. Systematic review: Twelve other published cases were identified and collated with our cases. Average age was 36 years and M:F = 2.3:1; 46% presented with neurological symptoms and 31% had CNS-isolated disease. Immediate symptoms of ICH were acute/worsening headache or seizures (60%). ICH was supratentorial (62%), infratentorial (31%) or subarachnoid (7%). Forty percent had definite NS, 53% probable NS and 7% possible NS (Zajicek criteria). Antigranulomatous/immunosuppressive therapy regimens varied and 31% died. Conclusions This series expands our knowledge of the pathology of NS-ICH, which may be of arterial or venous origin. One-third have isolated NS. Clinicians should consider NS in young-onset ICH because early aggressive antigranulomatous therapy may improve outcome. [ABSTRACT FROM AUTHOR]

Background: The induction of general anaesthesia is associated with the greatest cardiovascular changes in elderly patients. Induction can be performed either intravenously or with gaseous induction. Sevoflurane has advantages over propofol for induction of anaesthesia in the elderly, since the lower reduction in mean arterial pressure with sevoflurane is both statistically and clinically significant. This prospective randomized controlled trial investigated the cardiovascular benefits of co-induction of anaesthesia with 0.75 mg kg-1 propofol and 8% sevoflurane, when compared with 8% sevoflurane alone in patients requiring surgery for fractured neck of femur. Method: In total, 38 patients aged 75 or over were allocated into the two groups, receiving either 0.75 mg kg-1 of propofol followed by 8% sevoflurane or 8% sevoflurane alone. Vital signs were recorded until successful insertion of a laryngeal mask. Induction times, induction events and patient satisfaction scores were also recorded. Results: Results showed that there were no differences in the cardiovascular parameters between the two groups. Induction times were faster in the propofol and sevoflurane group (62 vs. 81 s; P = 0.028). The postoperative questionnaire showed that the majority of patients in both groups were satisfied with the induction process. Conclusions: We concluded that 0.75 mg kg-1 of propofol followed by sevoflurane induction is an acceptable alternative to sevoflurane induction. It is associated with similar haemodynamic variables, faster induction times and is very well tolerated. [ABSTRACT FROM AUTHOR]

This paper describes the orthodontic treatment of 2 cases that were presented by the winner of the William Houston Medal of the MOrth of the Royal College of Surgeons of Edinburgh at the June 2003 diet of the examination. The cases were also successful presented for the British Orthodontic Society MOrth Cases Prize 2003. [ABSTRACT FROM AUTHOR]

Objectives: To compare (i) the in vivo release of fluoride from fluoridated elastomers to the in vitro release, and (ii) the residual fluoride content of the elastomers after 1 week in the mouth with and without fluoride toothpaste and mouthrinse. Design: A prospective, longitudinal, cross-over study. Subjects and method: Six subjects were recruited by poster to take part in the study. Each subject had one premolar in each quadrant to which a bracket could be fixed and exemplary oral hygiene. Elastomers were then placed on these brackets. Intervention: the study was divided into two parts: (i) subjects used oral hygiene products with fluoride and (ii) oral hygiene products with fluoride were excluded. Both groups of elastomers were left in the mouth for 1 week. After collection the elastomers were stored in distilled water. Main outcome measures: The amount of residual fluoride in the ligatures after they have been placed in the mouth for 1 week was compared with the emulative fluoride release in vitro over 1 week and 6 months. Results: Only 13 per cent of the total amount of fluoride in fluoridated elastomers was released during the first week in vitro, compared with 90 per cent in vivo. there was a significantly greater amount (P = 0.001) of residual fluoride when the elastomers were in the mouth for 1 week in the presence of fluoride toothpaste and mouthrinse, than when fluoride supplements were excluded. Conclusions: (1) Higher levels of fluoride are lost from the fluoride elastomers in vivo than in vitro during the first week. (2) A significantly greater amount of residual fluoride was released from the elastomers placed in the mouth when fluoride toothpaste and mouthrinse were used. [ABSTRACT FROM AUTHOR]

Comments on several issues related to anesthetics in Great Britain. Patency of foramen ovale between two atria; Case of localized abdominal pain following sympathetic blockade with bretylium; Use of intra-aortic balloon pumps in the treatment of critically-ill cardiac patients.