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The volume and pH of the gastric contents aspirated prior to anaesthesia were measured in 640 acute surgical patients. The material comprises 100 patients aged between 0 and 15 years, 415 between 16 and 60 years, and 125 between 61 and 93 years. The possible relation between the gastric contents and the patients' sex, age, weight, and surgical disease (abdominal or orthopaedic) was examined. Relations to fasting time, composition of meal (solid/liquid), the consumption of alcohol, the use of tobacco, the injection of analgesics, gastritis/ulcus anamnesis, nausea and pains were also calculated. The volume of gastric contents was higher in women than in men, and the number of potential risk patients among women was higher (p less than 0.02). However the difference is not considered to be of any clinical importance. In relation to body weight children have a relatively high volume of gastric contents, and these are more acid in children and young people than in grownups. If we delimit potential risk patients by means of the volume and pH of the gastric contents, there are for these reasons more risk patients among young than among elderly people. The groups with orthopaedic and abdominal diseases had the same number of potential risk patients, but the patients in the former group were younger than in the latter. Analgesics do not increase the number of risk patients; however, the number was higher among patients having pains (p less than 0.05). The consumption of alcohol did increase the number of risk patients (p less than 0.001). The length of fasting time also considerable influenced the volume of gastric contents in the acute surgical patient.

The cardiopulmonary response to maximal rowing exercise of short duration was studied in six healthy well-trained oarsmen. The lung diffusing capacity for carbon monoxide was significantly decreased below the pre-exercise value for 2.5 days post-exercise (P less than 0.05). Residual volume (RV) showed a significantly increased value at 30 min of recovery (P less than 0.01) with no change in total lung capacity. There was no significant change in transthoracic electrical impedance following exercise but a decrease may have been masked by the increased RV. The changes in the pulmonary parameters may reflect the occurrence of a transient interstitial lung oedema. Exercise-induced bronchoconstriction may be a part of the cardiopulmonary response as peak expiratory flow rate (PEFR) was significantly reduced at 30 min of recovery. The reason for the increase in pulmonary extravascular water volume may be a marked distension of the lung capillaries due to increased blood volume in the lungs and as a consequence increased vascular permeability. The changes may also be caused by impaired myocardial contractility indicated by a split impedance dZ/dt waveform, not previously described in healthy persons, which occurred in all six subjects immediately following exercise.

The effect of paracetamol on the postoperative employment of morphine was investigated in a double-blind clinically controlled investigation with a placebo. The operations concerned were elective gynaecological laparotomies and hip replacements. During the first 60 hours postoperatively, the employment of morphine was reduced significantly in the patients who received paracetamol. Reductions of 16, 22 and 26% were concerned. The differences between the various types of operation were not significant. Patients for joint replacements who had been treated preoperatively with non-steroid anti-inflammatory preparations did not have any significantly greater consumption of morphine postoperatively but the reduction in consumption of morphine in the paracetamol group was significantly greater with a saving of 43%. Patients who had received treatment with morphine preparations preoperatively had significantly greater consumption of morphine postoperatively but the additive analgesic effect of paracetamol remained unchanged at approximately 25%.

This study, which is part of a larger immunohistochemical investigation of blood-group antigens in non-neoplastic urothelium and bladder cancer, reports our findings on the expression of an antigen related to the cryptic Thomsen-Friedenreich antigen (beta Gal 1-3 GalNAc) of erythrocytes. De-waxed sections of 19 ureters and of 93 transitional cell tumours, either untreated or pretreated with neuraminidase, were subjected to an indirect immunoperoxidase staining, employing the monoclonal antibody 49H.8. Staining results were compared to Lewis-secretor types, morphology, and in tumours to the clinical course as regards recurrence rate and the development of either stroma invasive recurrence or papillomatosis as well. Ureters not subjected to neuraminidase were unstained, whereas urothelium in 12 of 19 ureters subjected to neuraminidase showed staining. Serial dilution of antibody disclosed quantitative differences related to the Lewis-secretor types. Lea+b- urothelium, i.e., non-secretor urothelium, had the highest end-point titers. Endothelium was unstained. Thirty-six of the 93 tumours showed staining without prior neuraminidase treatment, 31 showed staining after neuraminidase treatment only, while 26 were unstained. Staining correlated with the pathological stage and grade (p less than 0.05), but not with the clinical course (p greater than 0.05). The results do not support previous observations on the prognostic value of Thomsen-Friedenreich antigen determination in superficial bladder cancer.

We describe a case in which a repeat minitracheotomy (MT) could not be performed 2 months after the first. The cricothyroid membrane seemed calcified and histological examination showed scar formation with dystrophic calcification and heterotopic bone formation. Scar formation following MT may have caused these alterations making repeat access to the airway through the membrane impossible.

Antroduodenal motility, pH and gastric emptying rate were investigated before, during and after general anaesthesia with enflurane in 11 patients undergoing elective surgery not involving the abdomen. Motility was measured by manometry and the gastric emptying rate by the rate of paracetamol absorption. During anaesthesia gastric emptying rate was delayed in nine patients. General anaesthesia with enflurane nearly abolished the motility in the antrum. The duration of successive interdigestive motor complexes was reduced (P less than 0.001) mainly be a reduction in Phase II (P less than 0.01). The frequency of contractions was unchanged in the duodenum during Phase II and decreased during Phase III (P less than 0.01). The amplitudes of contractions were unchanged in the proximal part of the duodenum and decreased in the distal part (P less than 0.01). General anaesthesia with enflurane increased the gastric pH per- and post-operatively (P less than 0.01). Motility in the antrum was rapidly regained in the recovery period. General anaesthesia with enflurane seems to delay gastric emptying rate by affecting the motility in the gastric antrum. The acidity of the stomach contents is reduced.

Antibodies raised against tumour-associated antigens have been assessed for tumour selectivity using an indirect immunohistochemical peroxidase staining of formalin-fixed, paraffin-embedded tissue from colon carcinomas, colon polyps and normal mucosa. The following antibodies were used: 1) Unabsorbed polyclonal antibody to carcinoembryonic antigen (poly-CEA). 2) Monoclonal antibodies to CEA (mabs 3851 and 27). 3) Monoclonal antibodies to protein-bound carbohydrates (mabs C 216 and C 242) or to lipid- and protein-bound carbohydrates (C 50 and 19-9). These antibodies had been produced by hybridization of lymphocytes from mice, immunized with colon carcinoma cell lines or colon cancer tissue. All antibodies were used in one concentration only, preselected by initial titration experiments. No antibody was completely tumour-specific, but four antibodies, mabs 3851, 27, C 216 and C 242, showed statistically significant tumour selectivity. Using these antibodies, respectively 19, 19, 19, and 18 of 20 colon cancer were stained compared with 3, 4, 4, and 8 of 15 specimens of colon mucosa from normal controls. An increased frequency of staining was also noted in dysplastic polyps (statistically significant using mabs 3851 and C 216) and in dysplastic mucosa adjacent to a tumour (statistically significant using mabs 3851 and 27). The staining frequency of normal colon mucosa in cases of colon cancer did not differ from that in the normal controls. Poly-CEA and the anti-ganglioside mabs C 50 and 19-9 revealed no tumour selectivity. A pronounced goblet cell staining was seen using C 50, C 242 and 19-9.

The purpose of this retrospective study was to estimate the frequency and severity of anaesthetic complications in patients with Duchenne's muscular dystrophy (DMD). Forty-four boys with DMD were exposed to anaesthesia and surgery 84 times during a period of 22 years (1965-86). The procedures took place at 15 different hospitals. Retrospective examination of the case records showed: 19 cases with local analgesia without any complications, and 18 of 65 general anaesthetics with minor or more serious complications. In ten cases an increase in body temperature above 37.5 degrees C was seen, five had abdominal pain and dark-coloured urine after surgery, and three had a critical perioperative course with a resemblance to malignant hyperthermia. The complications were almost exclusively related to the use of succinylcholine. The use of succinylcholine was dispersed through all ages. Three out of the eight patients with severe complications occurred 1.5, 2.5 and 4 years before the neuromuscular disease was diagnosed. Thus an unusual course of anaesthesia in male children calls for further investigation. Although it has been stated before that succinylcholine is contraindicated in patients with Duchenne's muscular dystrophy, the drug continues to be used.

Forty six patients, who had to be subjected to diagnostic bronchoscopy under general anaesthesia (thiopental, pethidine, O2-N2O, suxamethonium) were ventilated using Wolf's injectomat (automated Sanders principle) in an attempt to find a setting for the apparatus that would provide normoventilation of the patient, independently of the diagnostic procedure. The first 24 patients were ventilated with the apparatus having a fixed setting: the latter being presumed to provide normo- or hyperventilation. This was confirmed and a steady state of PaCO2 was reached after ventilation for 10 min. This PaCO2 was well correlated with the vital capacity of the patients expressed factorially, in relation to the expected normal value. The investigation renders probable the observation that patients with a greatly reduced vital capacity (less than 50% of the normal value) can rarely be ventilated with the apparatus. On the other hand, a reduced FEV1 has little influence on the efficiency of the apparatus. The apparatus was adjusted in agreement with the above mentioned relation to vital capacity for the following 21 patients, in as much as the change in ventilation was carried out by a change in frequency, while the driving pressure of the apparatus and the inspiration time were maintained unchanged. Normoventilation was obtained in these patients independently of the fact that the bronchoscope was constantly open for the insertion of instruments.