Search

Optimal margins for ductal carcinoma in situ (DCIS) remain controversial in breast-conserving surgery (BCS) and mastectomy. We examine the association of positive margins, reoperations, DCIS and age.A retrospective study of histopathological reports (4489 patients). Margin positivity was defined as ink on tumor for invasive carcinoma. For DCIS, we applied 2 mm anterior and side margin thresholds, and ink on tumor in the posterior margin.The incidence of positive side margins was 20% in BCS and 5% in mastectomies (p 0.001). Of these patients, 68% and 14% underwent a reoperation (p 0.001). After a positive side margin in BCS, the reoperation rates according to age groups were 74% (49), 69% (50-64), 68% (65-79), and 42% (80+) (p = 0.013). Of BCS patients with invasive carcinoma in the side margin, 73% were reoperated on. A reoperation was performed in 70% of patients with a close (≤1 mm) DCIS side margin, compared to 43% with a wider (1.1-2 mm) margin (p = 0.002). The reoperation rates were 55% in invasive carcinoma with close DCIS, 66% in close extensive intraductal component (EIC), and 83% in close pure DCIS (p 0.001).Individual assessment as opposed to rigid adherence to guidelines was used in the decision on reoperation.

The European Leadership Forum (ELF) of the European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS) previously identified the need for harmonisation of breast reconstruction standards in Europe, in order to strengthen the role of plastic surgeons. This study aims to survey the status, current trends and potential regional differences in the practice of breast reconstruction in Europe, with emphasis on equity and access. A largescale web-based questionnaire was sent to consultant plastic and reconstructive surgeons, who are experienced in breast reconstruction and with understanding of the national situation in their country. Suitable participants were identified via the Executive Committee (ExCo) of ESPRAS and national delegates of ESPRAS. The results were evaluated and related to evidence-based literature. A total of 33 participants from 29 European countries participated in this study. Overall, the incidence of breast reconstruction was reported to be relatively low across Europe, comparable to other large geographic regions, such as North America. Equity of provision and access to breast reconstruction was distributed evenly within Europe, with geographic regions potentially affecting the type of reconstruction offered. Standard practices with regard to radiotherapy differed between countries and a clear demand for European guidelines on breast reconstruction was reported. This study identified distinct lack of consistency in international practice patterns across European countries and a strong demand for consistent European guidance. Large-scale and multi-centre European clinical trials are required to further elucidate the presented areas of interest and to define European standard operating procedures. Im Rahmen des ELF der ESPRAS wurde die Notwendigkeit standardisierter Richtlinien zur Brustrekonstruktion auf europäischer Ebene definiert. Ziel dieser Studie ist es, zunächst einen Überblick über den aktuellen Status, Entwicklungen und mögliche regionale Unterschiede der Brustrekonstruktion in Europa zu geben, wobei ein Schwerpunkt auf dem Angebot, der Verteilung und dem Zugang zur Brustrekonstruktion liegt. Es erfolgte eine internetbasierte Befragung von in der Brustrekonstruktion spezialisierten Plastischen Chirurgen, welche zusätzlich die nationalen Versorgungsstrukturen ihrer jeweiligen Länder überblicken. Geeignete Teilnehmer wurden über das ExCo der ESPRAS und nationale Delegierte von ESPRAS identifiziert. Die Ergebnisse wurden mit aktueller evidenzbasierter Literatur verglichen. 33 Teilnehmer aus 29 europäischen Ländern nahmen an der Studie teil. Im Vergleich zur Gesamtzahl durchgeführter Mastektomien war die Inzidenz der Brustrekonstruktionen in Europa relativ gering, vergleichbar mit anderen großen geografischen Regionen, wie z. B. Nordamerika. Die Verfügbarkeit und der Zugang zur Brustrekonstruktion war innerhalb Europas gleichmäßig verteilt, allerdings kann die geografische Region das Verfahren der Brustrekonstruktion (Eigengewebe vs. Implantat) beeinflussen. Deutliche Differenzen zeigten sich bezüglich Brustrekonstruktionen bei bestrahlten Patientinnen. Die Studie identifizierte ein ausgeprägtes Maß an Inkohärenz in den internationalen Standards zwischen den europäischen Ländern. Es besteht großer Bedarf für kohärente europäische Leitlinien. Europäische, multizentrische klinische Studien sollten initiiert werden, um eine evidenzbasierte Grundlage zu schaffen.

The aims of the Oncoplastic Breast Consortium initiative were to identify important knowledge gaps in the field of oncoplastic breast-conserving surgery and nipple-sparing or skin-sparing mastectomy with immediate breast reconstruction, and to recommend appropriate research strategies to address these gaps. A total of 212 surgeons and 26 patient advocates from 55 countries prioritised the 15 most important knowledge gaps from a list of 38 in two electronic Delphi rounds. An interdisciplinary panel of the Oncoplastic Breast Consortium consisting of 63 stakeholders from 20 countries obtained consensus during an in-person meeting to select seven of these 15 knowledge gaps as research priorities. Three key recommendations emerged from the meeting. First, the effect of oncoplastic breast-conserving surgery on quality of life and the optimal type and timing of reconstruction after nipple-sparing or skin-sparing mastectomy with planned radiotherapy should be addressed by prospective cohort studies at an international level. Second, the role of adjunctive mesh and the positioning of implants during implant-based breast reconstruction should ideally be investigated by randomised controlled trials of pragmatic design. Finally, the BREAST-Q questionnaire is a suitable tool to assess primary outcomes in these studies, but other metrics to measure patient-reported outcomes should be systematically evaluated and quality indicators of surgical morbidity should be further assessed.

Switchable lanthanide luminescence is a novel proximity-based binary probe technology wherein two oligonucleotide probes are labelled either with lanthanide ion carrier chelate or light-absorbing antenna ligand. A highly luminescent complex is formed when the two label moieties are brought in close contact by adjacent hybridization of the labelled probes to a target sequence. Herein we report how hybridization distance between the labelled probes and single nucleotide mismatches in the target sequence affect to the luminescence intensity of the complex formed from the label moieties. The highest luminescence intensity was observed when the probes were hybridized to full matched target at a distance of 4–10 nucleotides, a fact that indicates the lanthanide complex requires a certain space to be formed. At optimal hybridization distance between the labelled probes the maximal discrimination efficiency between a full matched and a single mismatched target was 1400-fold. Furthermore, computer-based modelling of the luminescent complex formation was in good agreement with the experimental results.

Ready to use dry-reagent PCR assays for Escherichia coli, Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas spp. and for broad-range bacteria detection were developed. The assays were based on novel switchable lanthanide probes that provide sensitive target DNA detection with exceptionally high signal-to-background ratio, thus enabling clear discrimination between positive and negative results. For example, sensitivity of three S. aureus and two S. pneumonia bacteria (colony forming units) per PCR assay was measured with fluorescence signal more than 30 times over the background signal level. The rapid and easy-to-use assays are suitable for routine clinical diagnostics without molecular biology expertise and facilities.

We have studied parameters affecting DNA hybridization and lanthanide chelate complementation based signal formation in a separation-free solid-phase assay suitable for spatial multiplexing. This binary probe assay system consists of two probes labeled either with a europium carrier chelate or a light harvesting antenna ligand. One probe was immobilized on the microtiter well bottom in a spot format while the other probe was free in solution. The probe concentration used in spotting, spacer length, and the choice and orientation of the either 3′- or 5′-end immobilized probe had a significant impact on signal-to-background (S/B) ratios. The highest ratio was achieved by saturating the spot with the 5′-end immobilized antenna ligand probe separated from the solid support with a 25 nucleotide poly dT spacer. The dynamic range of the assay for the synthetic Pseudomonas aeruginosa heat shock protein groES gene target was three orders of magnitude and the detection limit of 18 pM was obtained. The groES target sequence was also amplified from isolated genomic DNA of P. aeruginosa both with and without co-amplification of synthetic internal assay control (IAC) followed by successful detection of the groES amplification product although the co-amplification of IAC resulted in a slightly decreased groES signal. The homogeneous detection of spatially resolved probes on a solid-phase could enable an alternative way of multiplexing to closed tube nucleic acid assays.

In this report a novel wash-free method for multiplexed DNA detection is demonstrated employing target specific probe pairs and switchable lanthanide luminescence technology on a solid-phase array. Four oligonucleotide capture probes, conjugated at 3′ to non-luminescent lanthanide ion carrier chelate, were immobilized as a small array on the bottom of a microtiter plate well onto which a mix of corresponding detection probes, conjugated at 5′ to a light absorbing antenna ligand, were added. In the presence of complementary target nucleic acid both the spotted capture probe and the liquid-phase detection probe hybridize adjacently on the target. Consequently the two non-luminescent label molecules self-assemble and form a luminescent mixed lanthanide chelate complex. Lanthanide luminescence is thereafter measured without a wash step from the spots by scanning in time-resolved mode. The homogeneous solid-phase array-based method resulted in quantitative detection of synthetic target oligonucleotides with 0.32 nM and 0.60 nM detection limits in a single target and multiplexed assay, respectively, corresponding to 3× SD of the background. Also qualitative detection of PCR-amplified target from Escherichia coli is described.

This paper describes an integrated microsystem for rapid separation, enrichment, and detection of bacteria from blood, addressing the unmet clinical need for rapid sepsis diagnostics. The blood sample is first processed in an acoustophoresis chip, where red blood cells are focused to the center of the channel by an acoustic standing wave and sequentially removed. The bacteria-containing plasma proceeds to a glass capillary with a localized acoustic standing wave field where the bacteria are trapped onto suspended polystyrene particles. The trapped bacteria are subsequently washed while held in the acoustic trap and released into a polymer microchip containing dried polymerase chain reaction (PCR) reagents, followed by thermocycling for target sequence amplification. The entire process is completed in less than 2 h. Testing with Pseudomonas putida spiked into whole blood revealed a detection limit of 1000 bacteria/mL for this first-generation analysis system. In samples from septic patients, the system was able to detect Escherichia coli in half of the cases identified by blood culture. This indicates that the current system detects bacteria in patient samples in the upper part of the of clinically relevant bacteria concentration range and that a further developed acoustic sample preparation system may open the door for a new and faster automated method to diagnose sepsis.

We introduce a switchable lanthanide luminescence reporter technology based closed-tube PCR for the detection of specific target DNA sequence. In the switchable lanthanide chelate complementation based reporter technology hybridization of two nonfluorescent oligonucleotide probes to the adjacent positions of the complementary strand leads to the formation of a highly fluorescent lanthanide chelate complex. The complex is self-assembled from a nonfluorescent lanthanide chelate and a light-harvesting antenna ligand when the reporter molecules are brought into close proximity by the oligonucleotide probes. Outstanding signal-to-background discrimination in real-time PCR assay was achieved due to the very low background fluorescence level and high specific signal generation. High sensitivity of the reporter technology allows the detection of a lower concentration of amplified DNA in the real-time PCR, resulting in detection of the target at the earlier amplification cycle compared to commonly used methods.

We have developed switchable lanthanide luminescence-based binary probe technology for homogeneous detection of avidin, which is a tetrameric protein. Two different nonluminescent label moieties--a light-absorbing antenna ligand and a lanthanide ion carrier chelate--were conjugated to separate biotins, which is known as avidin's natural ligand. The assay was based on binding of the two differently labeled biotins on separate binding sites on the target protein and consequent self-assembly of a luminescent complex from the two label moieties. Specific luminescence signal was observed only at the presence of the target protein. The characteristics of the switchable lanthanide luminescence assay were compared to the reference assay, based on lanthanide resonance energy transfer. Both assays had a limit of detection in the low-picomolar concentration range; however, the lanthanide chelate complementation-based assay had wider dynamic range and its optimization was more straightforward. The switchable lanthanide luminescence technology could be further applied to generic protein detection, using reagents that are analogous to the proximity ligation assay principle.

Adverse reactions to ophthalmic patients during 9909 fluorescein angiographies during 9 years were registered. Nausea (4.6%) and vomiting (1.3%) were the most common untoward reactions. Allergic skin manifestations occurred in 48 patients, and 5 patients complained of shortness of breath. 56 patients (0.6%) felt dizzy during or immediately after the investigation. Nine patients complained of chest pain, three of whom developed myocardial infarction. Sixteen patients collapsed during the procedure. One healthy male, 42-year-old, collapsed after the injection of fluorescein during angiography, and electrocardiogram showed an asystole of 24 seconds. Otherwise, the electrocardiograms registered on 100 consecutive patients did not reveal any systematic changes in heart rate or rhythm during fluorescein angiography.

This follow-up study describes the 47 patients out of 1506 intracapsularly extracted cataracts (1505 patients) who presented with a psychotic reaction post-operatively. Matched non-psychotic cataract patients served as a control group. The mean age of both groups of patients was 78 years at time of surgery, female/male ratio was 39/8, and the mode of anaesthesia was local analgesia/general anaesthesia 16/31. The surgery had been performed in 1977–1979 and this follow-up examination in autumn 1983. Twenty-seven patients of the study group and 16 of the controls had died during the interval period. The difference between the groups was statistically significant. The patients of the study group were statistically significantly more dependent on nursing, and their mental performance, according to an orientation test, was more reduced, compared to the controls. Visual prognosis in the operated eye was unfavourable in the study group, versus the controls, mainly because of visual deprivation due to mental debilitation. Pre-operative vision did not predict future psychotic reaction.

Problems related to general anaesthesia of 109 consecutive vitrectomies performed on diabetic patients were retrospectively reviewed. On the morning of surgery a normal or a slightly reduced dose of the patient's regular insulin was administered subcutaneously. The amount of intravenous infusion, mostly 5% glucose, was calculated according to the pre-operative urine volume. After surgery, hypoglycaemic (less than 3 mmol/l) values were seen in less than 11% of the patients, and high glucose in less than 30%; 20% had a mild ketoacidosis post-operatively. Difficulties in tracheal incubation was encountered in 10%. Three patients complained of chest pain after surgery, and in one of them a myocardial infarction was diagnosed. Forty-one per cent of the patients complained of nausea or vomited in the afternoon after surgery, and 21% had difficulties in urination the night after surgery. Two of four patients with peritoneal dialysis complained of stomach pain post-operatively. There was no significant association between recurrent vitreous haemorrhage and blood glucose concentration or arterial blood pressure in the early post-operative period.

For a female-to-male transgender person, mastectomy is the most important procedure making the social interaction easier. Along with the size of the breasts, the quantity and quality of skin will influence the selection of surgical technique. Although complications are rare, corrective surgery is performed for as many as 40% of the patients. Of male-to-female transsexual persons, 60 to 70% opt for breast enlargement. Breast enlargement can be carried out by using either silicone implants or fat transplantation. Since the surgical procedures on breasts are irreversible, their implementation requires confirmation of the diagnosis of transsexualism by a multidisciplinary team.

A bioaffinity assay is described where anti-Stokes photoluminescence of inorganic lanthanide phosphors and time-resolved fluorescence of lanthanide chelates are measured from a single microtitration well without any disturbance from these label technologies to each other. Up-converting phosphor (UPC-phosphor) bioconjugate was produced by grinding the commercial, micrometer-sized UPC-phosphors to colloidal, submicrometer-sized phosphor particles and by attaching these phosphors to biomolecules. Experiments were carried out in standard 96-well microtitration plates to determine detection limits, linearity, and cross-talk of UPC-phosphor and europium chelate. In numbers of molecules the lower limits of detection for UPC-phosphor were roughly 3 x 10(3) particles in solution and 1 x 10(4) particles in solid phase, and for europium label same values were 9 x 10(6) and 9 x 10(7) molecules. Linearity of detection was for UPC-phosphor 5 orders of magnitude in solution and over 4 orders of magnitude in solid phase and for europium label over 5 orders of magnitude in solution and over 4 orders of magnitude in solid phase. The cross-talk between the two labels was practically nonexistent. In this study we show that up-converting anti-Stokes photoluminescent phosphors could be employed in bioaffinity assays as very potential labels with significant advantages either alone or together with long-lifetime lanthanide chelates.

The requirement for high-performance reporter probes in real-time detection of polymerase chain reaction (PCR) has led to the use of time-resolved fluorometry of lanthanide chelates. The aim of this study was to investigate the applicability of the principle of lanthanide chelate complementation (LCC) in comparison with a method based on hydrolysis enhancement and quenching of intact probes. A real-time reverse transcription (RT) PCR assay for kallikrein-related peptidase 3 (KLK3, model analyte) was developed by using the LCC detection method. Both detection methods were tested with a standard series of purified PCR products, 20 prostatic tissues, 20 healthy and prostate cancer patient blood samples, and female blood samples spiked with LNCaP cells. The same limit of detection was obtained with both methods, and two cycles earlier detection with the LCC method was observed. KLK3 messenger RNA (mRNA) was detected in all tissue samples and in 1 of 20 blood samples identically with both methods. The background was 30 times lower, and the signal-to-background (S/B) ratio was 3 times higher, when compared with the reference method. Use of the new reporter method provided similar sensitivity and specificity as the reference method. The lower background, the improved S/B ratio, and the possibility of melting curve analysis and single nucleotide polymorphism (SNP) detection could be advantages for this new reporter probe. © 2013 Elsevier Inc. All rights reserved.

Background : The Electroretinogram (ERG) is used clinically to assess the function of retina. Anaesthetic agents are known to affect ERG, and as anaesthesia is often needed in children and uncooperative patients, knowledge about its effects is of clinical importance. Barbiturates selectively depress ERG components, and we compared thiopentone with propofol to assess if the latter preserved retinal function better. Methods : Ten pigs, average weight 17 kg ( SD ± 2 kg) were anaesthetized randomly with propofol 10 mg kg -1 or thiopentone 30 mg kg -1 . Anaesthesia was maintained by 65% nitrous oxide in oxygen and continuous infusion of the induction agent, i.e. 10 mg kg -1 h -1 of propofol, or 10 mg kg -1 h -1 for the first hour, then 5 mg kg -1 h -1 of thiopentone, with doses being based on pilot studies. After an interval of one week the programme was repeated using the other agent. After 40 minutes dark-adaptation, responses to single flashes of graded intensities from a xenon flashlamp were recorded at five-minute intervals. The a- and b-wave amplitudes and implicit times (time to peak), and a-wave slopes were determined. Results : The b-wave implicit time was significantly shorter during propofol anaesthesia than when using thiopentone. The effect was most pronounced at the lowest intensities (P < 0.01). No statistically significant differences were found in the amplitudes of the b-waves. The a-wave appeared at lower stimulus intensity (P < 0.05) and the a-wave slopes were significantly steeper (P < 0.01) during propofol anaesthesia. Conclusion : Propofol accordingly appeared to preserve the photoreceptor response better than thiopentone, and may therefore be considered to be more suitable for ERG recordings than thiopentone.

We have developed a homogeneous assay method in which the lanthanide ion carrier and light absorbing components of a luminescent lanthanide chelate are separated in two distinct molecules that can together form a luminescent mixed chelate complex. The separated label moieties were conjugated to oligonucleotides which were used as probes to detect a complementary target DNA. The background signal of the assay was very low, indicating the signal was highly dependent on the hybridization of the two probes on adjacent positions on the target oligonucleotide.

Dark adapted single flash and light adapted 30 Hz photopic flicker ERGs were recorded from a litter of seven Labrador Retrievers bred from parents affected with generalized progressive rod-cone dystrophy. After an initial increase of b-wave amplitudes from 5 weeks to 4 months similar to the controls, the b-wave amplitudes of the litter were significantly decreased (P less than 0.005) at 7 months. At 21 months the b-wave amplitudes were very low, although some response to 30 Hz photopic flicker was still left. The ERG changes indicated a late onset progressive rod-cone dystrophy which developed after maturation of the retina. The development of this photoreceptor dystrophy has not previously been described.

Early ultrastructural findings of a progressive photoreceptor dystrophy and corresponding ERG findings are reported in 3 Labrador Retrievers from a litter of 7 pups bred from 2 dogs clinically and electroretinographically affected with generalized progressive retinal dystrophy. The pups were euthanized at 5, 11 and 15 months post partum. The most prominent ultrastructural finding was photoreceptor dystrophy. At 5 months the outer nuclear layer (ONL) consisted of 8-10 layers and seemed reduced in thickness, pyknotic nuclei were seen in this layer. The receptor outer segments (OS) were short and swollen. Some disorientation of OS discs occurred. In the 11-months specimen 7-8 ONL layers were identified. Overall thinning of the neuro-retina had occurred and fewer receptors compared to the 5-months specimen were present. By 15 months the ONL was further reduced to about 4 layers. Enlarged internuclear spaces were present in the ONL as well as around inner segments (IS). Phagocytic cells were frequent among remains of OS. The pigment epithelium appeared normal. The dark adapted ERG b-wave amplitudes and photopic 30 Hz flicker responses were low in comparison to controls of the same breed, and decreased with age. The condition represents a progressive rod-cone dystrophy which shares similarities with primary receptor dystrophy in man such as retinitis pigmentosa.

SUMMARY In a prospective study, 50 of 1 505 (3.3%) patients undergoing cataract extraction during a three-year period developed postoperative psychiatric reactions. Old age and markedly deteriorated vision seemed to contribute to this complication, which in all cases was reversible.

The memory performance of 60 female patients, scheduled for either local or general anaesthesia and extraction of senile cataract, was investigated. Six subtests of the Wechsler Memory Scale and four items of memory tests according to Luria were performed. One week postoperatively there was a diminution in the performance of the Wechsler Memory Scale and Luria tests. Comparison of the pre- and postoperative diminutions between the local and general anaesthesia groups was statistically significant only in the Luria tests. According to this study general anaesthesia does not affect memory function more profoundly than local anaesthesia supplemented with tranquilizing and/or analgesic drugs. In this respect, the advantages of general anesthesia should be utilized, at least in patients without clearcut contraindications.

Eleven ophthal-moscopically healthy dark adapted dogs were examined by DC ERG technique with single flash full field illumination starting with near b-wave threshold blue (tests 1-3) and white (tests 4-6) stimuli of different intensity and ending with 30 Hz photopic flicker smuli (test 7) after light adaptation. All animals were anaesthetized using 2 different anaesthetic methods: Anaesthesia I (A I): Induction with thiopentone sodium, continued with halothane and nitrous oxide in oxygen. Anaesthesia II (A II): Praemedication with xylazine hydrochloride followed by anaesthesia with ketamine hydrochloride. A minimum interval of 1 week was kept between all anaesthesias. The a- and b-wave amplitudes and latencies were determined. Statistical analysis of results indicated that the a- and b-waves were elicited by weaker intensities in A II. In Tests 3-6 the a-wave was highly significantly (P < 0.001), higher in amplitude in AII than in A I. Differencies in b-wave amplitudes were not statistically significant (except Test 1). The b-wave latencies were longer in AI in Test 2 (using low intensity blue light). The a-wave latencies were slightly shorter in AII in Test 6 (using high intensity white light). In additional experiments the selective action of the different agents (except N(2)O) used in AI and AII was studied. Thiopentone alone given to 3 dogs seemed to depress the a-wave selectively. Halothane given separately to 3 dogs lowered both the a- and b-wave amplitudes. Ketamine given with a neuromuscular blocking agent to three dogs resulted in responses almost identical to those in AII. Xylazine with vecuronium given to 4 dogs resulted in responses with slighly depressed a- and b-waves in comparison to ketamine with vecuronium. The results indicate that when developing an animal model for the electrophysiologic study of human retinal dystropies, the actions of different anaesthetics upon the ERG components are of great importante.

SUMMARY Pancuronium bromide has proved to be a useful non-depolarizing long-acting neuromuscular blocking agent which is nearly three times (2.42) as potent as alcuronium chloride. Pancuronium bromide blockade can be reversed fairly quickly by anticholinesterase agents, and die patient recovers to the 90% level of muscle tone in 15-20 minutes. ZUSAMMENFASSUNG Pancuroniumbromid hat sich als brauchbarer nicht-depolarisierender langwirkender neuromuskularer Blocker erwiesen, der fast dreimal so stark (2,42) ist als Alcuroniumchlorid. Die Blockade durch Pancuroniumbromid kann mittels Anticholinesterasen ziemlich rasch aufgehoben werden; der Patient erreicht innerhalb von 15 bis 20 Minuten wieder 90% seines Muskeltonus.

Xenon-flash d.c.-electroretinograms were recorded from dark adapted, rod-cone degenerate homozygote affected (n = 6), heterozygote carrier (n = 3) and control retinas (n = 4) at 3 and 4 months of age, starting at 0.6 log units below control PII threshold. One log unit higher stimuli were necessary to evoke PII in heterozygote and affected retinas compared to controls. Unique to the heterozygotes, double peaked PII responses that were evoked by −2 log relative units intensity stimulation were significantly (P = 0.028) lower in amplitude than those of controls. PII amplitudes of homozygotes were significantly (P = 0.005) lower in amplitude than those of controls at both ages examined in response to −2 and 0 log relative intensity stimulation. No differences were found in scotopic threshold response amplitudes or times to peak between the three groups. Homozygote affected PII times to peak were significantly (P = 0.005) shorter in relation to controls at −2 log units. Findings suggest that heterozygotes exhibit an impaired retinal function which can be demonstrated at 3 and 4 months in this mutant. Copyright © 1996 Elsevier Science Ltd

Four boys belonging to a group of children affected by a rare form of muscular dystrophy with eye and brain involvement, termed the "muscle, eye and brain disease" (MEB), were anaesthetized for various eye examinations and surgery. On some occasions succinylcholine was used during anaesthesia and the initially elevated serum creatine kinase (CK) values increased from a range of 122 to 1200 units.L-1 to a range of 4350 to 9690 units.L-1 22 hours after anaesthesia. CK values after anaesthesia without succinylcholine remained at the initially elevated levels. Rectal temperatures of the children were normal. These findings suggest that succinylcholine should be avoided in patients with MEB disease.

Methohexitone (10 mg/kg) was administered before 464 general anaesthesias for 317 children following intramuscular atropine and pethidine for various ophthalmological procedures. Approximately 70% of the children were asleep when anaesthesia was continued or started, usually with halothane in nitrous oxide and oxygen. Although the dose of methohexitone used here was smaller than that recommended in the literature, the results of the study did not greatly differ from earlier investigations in which no other premedication was given but where 20 mg/kg methohexitone was used.

Ten patients (one male and nine females), aged 33.2+/-12.0 years, were given electrophysiological studies before and during general anaesthesia. A mixture of thiopentone sodium, halothane, and nitrous oxide was used for anaesthesia. Electroretinogram (ERG) and visual evoked potentials (VEP) were recorded with scalp electrodes, and an averaging technique was used to improve signal-noise ratio. The recordings were made under standard conditions 15 to 20 min after induction of the anaesthesia. The amplitudes of the a- and b-waves of the ERG were significantly diminished whereas their latencies remained unchanged. The peak-to-peak amplitudes of the early components N1 and P2 of the VEP were significantly lowered, and the latencies of N0, P1, and N1 were prolonged by anaesthesia. These modifications are suggested to reflect metabolic changes in the sensitive layers of the retina and in the optic tract.

With atracurium and vecuronium, spontaneous recovery of residual neuromuscular blockade monitored electromyographically during 0.5% isoflurane anaesthesia was studied in 60 patients undergoing plastic surgery. After thiopentone, in random order, either atracurium 0.5 mg kg-1 or vecuronium 0.1 mg kg-1 was administered and isoflurane added to N2O and O2 mixture. Following spontaneous recovery of both the single twitch amplitude (T1) to 75% of the control value and the train-of-four ratio (TOF ratio) to 75%, incremental doses of the relaxant were given to maintain the T1 at less than 10%. Before the end of surgery, the blockade was again permitted to recover spontaneously. During the initial spontaneous recovery, the mean recovery time of T1 from 25% to 75% (the recovery index) with atracurium was longer (P less than 0.001) than that with vecuronium (13.2 min and 10.1 min, respectively) but, during the second recovery, the mean recovery index was shorter (P less than 0.05) with atracurium than with vecuronium (16.1 min and 19.8 min, respectively). The recovery time from T1 75% to TOF ratio 75%, indicating the recovery rate of residual neuromuscular blockade, with atracurium was about 15 min after both the initial and the second recoveries. With vecuronium, the respective recovery times were significantly (P less than 0.001) longer (25.6 min and 38.5 min, respectively). It is concluded that with vecuronium there is slower spontaneous recovery of residual neuromuscular blockade than with atracurium.

Fourteen female patients 27.7 +/- 10.0 years of age were studied by electrophysiological means before and during general anaesthesia. A mixture of thiopentone sodium, enflurane and nitrous oxide was used for anaesthesia. Electroretinogram (ERG) and visual evoked potentials (VEP) were recorded with electrodes placed on the lower lid and scalp and an averaging technique was used. The recordings were made under standard conditions with the pupils dilated, the eyes adapted to the dark and after 15-20 min stable anaesthesia. The latency of the a-wave did not change, whereas the b-wave was delayed (P less than 0.01). The amplitude of the a-wave tended to decrease; however, an increase of amplitude was also present. Therefore the change was not significant. The b-wave was unchanged. Changes induced by anaesthesia were often noted in the shape of P130, where a change from V to W-form took place or the reverse. The latencies of the late components N180 and P220 were increased during anaesthesia (P = 0.006 and P = 0.001, respectively). No statistically significant change occurred in the N180 and P220 amplitudes. The amplitudes of N60 and P130 became smaller (P = 0.002 and P = 0.0003, respectively) during anaesthesia. The effect of enflurane on the components of the VEP seems to indicate a cortical site of action.

SUMMARY One hundred fifty elderly female patients undergoing cataract extraction were divided into three groups. Fifty patients were premedicated with droperidol, pethidine and atropine; another group of 50 patients with pethidine and atropine. They were operated on under local anesthesia. The control group consisted of 50 patients premedicated with pethidine and atropine, and they were given general anesthesia. Postoperative nausea and vomiting were registered until noon the next day. Comparison of different groups showed that droperidol decreases the occurrence of postoperative sickness.

Characteristics, and the occurrence of other diseases, and complications related to diabetes mellitus of 91 consecutive diabetic patients who underwent vitreous surgery in 1979-1985 were examined. The mean age of the patients was 40 years (median 37, range 19-74), and the mean duration of diabetes 23 years (range 5-44). All, but one, had insulin therapy. Abnormalities in the cardiovascular and/or renal function were found in 89 of the 91 patients (98%). Signs of cardiovascular disease were observed in 58 patients (64%): 42% had elevated blood pressure (greater than or equal to 150/100 mmHg), 46% were on antihypertensive therapy, 14% had a history or signs of ischaemic heart disease, 12% had been digitalized, 7% had a history of cerebral ischaemia, and 8% had had surgery for gangrene of the lower limb. Signs of nephropathy were recorded in 64 patients (70%); 6 of them were on dialysis therapy, and two had received a kidney transplant. Symptoms possibly related to autonomic neuropathy e.g. postural hypotension, urinary tract symptoms, and gastric discomfort were found in 27%. Nine patients (10%) had some kind of thyroid disease, and two of them signs of multiple autoimmune endocrinopathy. The percentage surviving decreased from 96% at one year to 80% after 5 years of follow-up.

The effect of prior administration of tubocurarine (5 mg) or alcuronium (3 mg) on changes in cardiac rate and rhythm caused by the second dose of suxamethonium (1 mg/kg) during halothane-nitrous oxide-oxygen anaesthesia was studied in 60 patients. Tubocurarine and, particularly alcuronium were found to prevent bradyarrhythmias caused by the second dose of suxamethonium. These non-depolarizing relaxants had a moderate stabilizing action on the cardiac rhythm also during intubation and the commencement of artificial ventilation. The relaxation obtained by the first dose of suxamethonium (1 mg/kg) was sufficient to permit quiet intubation in all cases. The use of a non-depolarizing muscle relaxant prior to suxamethonium during halothane-nitrous oxide-oxygen anaesthesia is recommended. ZUSAMMENFASSUNG Bei 60 Patienten wurde die Wirkung einer Voraus-injektion von Tubocurarin (5 mg) oder Alcuronium (3 mg) auf Veranderungen der Herzfrequenz und des Herzrhythmus, verursacht durch eine Zweitdosis von Suxamethonium (1 mg/kg) wahrend einer Halothan-N2O-Narkose untersucht. Es zeigte sich, das Tubocurarin und insbesondere Al-curonium Bradyarrhythmien verhinderten, die sonst nach der Zweitdosis von Suxamethonium auftreten. Diese nicht-depolarisierenden Relaxantien hatten auch wahrend der Intubation und des Beginns der kunstlichen Beatmung eine masiggradig stabilisie-rende Wirkung auf den Herzrhythmus. Die durch die erste Dosis von Suxamethonium (1 mg/kg) erzielte Erschlaffung war in allen Fallen ausreichend fur eine glatte Intubation. Die Vorausgabe eines nicht-depolarisierenden Muskelrelaxans vor Suxamethonium wahrend einer Halothan-N2O-O2-Narkose wird empfohlen.