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Summary Background Fluoroscopically guided cardiac catheterisation is an essential tool for diagnosis and treatment of congenital heart disease. Drawbacks include poor soft tissue visualisation and exposure to radiation. We describe the first 16 cases of a novel method of cardiac catheterisation guided by MRI with radiographic support. Methods In our cardiac catheterisation laboratory, we combine magnetic resonance and radiographic imaging facilities. We used MRI to measure flow and morphology, and real-time MRI sequences to visualise balloon angiographic catheters. 12 patients underwent diagnostic cardiac catheterisation, two had interventional cardiac catheteri-sations, and for two patients, MRI was used to plan radiofrequency ablation for treatment of tachyarrhythmias. Findings In 14 patients, some or all of the cardiac catheterisation was guided by MRI. In two patients undergoing radiofrequency ablation, catheters were manipulated with use of fluoroscopic guidance and outcome was assessed with MRI. All patients received lower amounts of radiation than controls. There was some discrepancy between pulmonary vascular resistance calculated by flow derived from MRI and the traditional Pick method. We were able to superimpose fluoroscopic images of electro-physiology electrode catheters on the three dimensional MRI of the cardiac anatomy. Interpretation We have shown that cardiac catheterisation guided by MRI is safe and practical in a clinical setting, allows better soft tissue visualisation, provides more pertinent physiological information, and results in lower radiation exposure than do fluoroscopically guided procedures. MRI guidance could become the method of choice for diagnostic cardiac catheterisation in patients with congenital heart disease, and an important tool in interventional cardiac catheterisation and radiofrequency ablation.

Summary Fifty ASA grade 1 children, who presented for dental outpatient extraction were studied. They were randomly allocated to two groups after induction: group 1 had conventional nasal mask anaesthesia and group 2 anaesthesia with a laryngeal mask. Group 2 had fewer hypoxic episodes and significantly better arterial oxygen saturations (p < 0.01). There was no difference between the groups as regards surgical access, difficulty of extraction or bleeding. The laryngeal mask appears to provide an alternative to conventional nasal mask anaesthesia, with better overall oxygenation and would seem particularly suitable for prolonged or difficult extractions.

The role of HSCT for T-LBL is not well defined. Most series are subject to referral bias and do not address the true impact of HSCT, especially as primary treatment. Since 1987 all patients in British Columbia with T-LBL have been considered eligible for HSCT as part of primary treatment. Between 6/87–12/03, 27 patients were diagnosed with T-LBL. Patients with > 25% involvement of the bone marrow were excluded. Characteristics: Age range 18–56 y (median 26); M:F 19:8; Ann Arbor stage I-II 6; III-IV 21; bone marrow involved 7/27; peripheral blood involved 2/27; CNS involved 1/27; LDH elevated 15/25; mediastinal mass 23/27. Initial treatment: All received an anthracycline-containing regimen similar to CHOP. All achieved at least a partial remission. HSCT: 23/27 (85%) proceeded to HSCT in first response. Source of stem cells: 4, related donor (2 marrow, 2 peripheral blood); 19, autologous (15, mafosphamide purged marrow; 1, 4-hydroperoxy-cyclophosphamide purged marrow; 1, unpurged marrow; 1, unpurged peripheral blood; 1, combined unpurged marrow and peripheral blood). Conditioning was cyclophosphamide (150 mg/kg) and TBI (750–1200 cGy) +/− etoposide 1.8 g/m2 in 22 of 23 patients. CNS prophylaxis with intrathecal methotrexate and cytarabine was planned for all patients. All 23 had maintained chemosensitivity at time of HSCT. Time from diagnosis to HSCT was 1.3–6.4 months (median 2.2). Reasons for not proceeding to HSCT 2 refused; 1 decided to wait until relapse; 1 did not have adequate organ function. Median follow-up of living patients was 33 months (range 4–142 months). Results: Overall survival (OS) and event free survival (EFS) at 3 years for all patients were 79% (95% CI 61–97%) and 75% (95% CI 57–93%); patients who underwent HSCT 85% (95% CI 70–100%) and 81% (95% CI 64–98%). 4 patients relapsed post HSCT at 2.2, 10.8, 11.7 and 40.4 months post HSCT. Sites of relapse: 2, mediastinum; 1, bone marrow; 1, mediastinum and bone marrow. One patient who received HSCT died of a treatment related complication (interstitial pneumonitis). Significant factors for improved survival post HSCT (univariate): Absence of bone marrow involvement [EFS at 3 years 92% vs 57% (p=0.026)]. Non-significant factors: normal LDH, stage I/II at diagnosis, age < 30 yrs. Conclusions: Patients with T-cell lymphoblastic lymphoma treated with a CHOP-like regimen achieve adequate control of disease to proceed to HSCT. HSCT as primary treatment results in excellent long-term disease free survival with acceptably low treatment related mortality. Bone marrow involvement at diagnosis, even though < 25%, predicts for a worse outcome.

Summary The anaesthetic problems we have encountered in eight patients with the mucopolysaccharidoses are described and the pathophysiology of this group of clinically progressive inherited diseases is reviewed with emphasis on the aspects of importance to the anaesthetist.

This report was the result of an attempt to compare the effects of a combined course of 5FU and x-ray therapy, and of x-ray therapy alone in the treatment of far advanced, inoperable cancer of the lung. CLINICAL STUDY