Gelofusine allergy--the need for identification jewellery.

A case of anaphylactoid reaction due solely to the use of Gelofusine in a patient with non-haemorrhagic hypovolaemia is presented, with a discussion on the management and the use of allergy identification jewellery.

Near fatal gas embolism during laparoscopic cholecystectomy.

Laparoscopic cholecystectomy has been greeted with enthusiasm by surgeons and patients alike. However, with the passage of time reports of complications related to this new approach are being published. We report an unusual complication of gas embolism in laparoscopic cholecystectomy. A high index of suspicion along with vigilant intraoperative monitoring will help in the early diagnosis and reduction of morbidity associated with gas embolism.

Practice variability and children's motor behavior.

This research investigated Schmidt's variability-of-practice prediction and the breadth-of-a-movement class. Schmidt's hypothesis was tested by varying the parameters of ball and distance in overarm throwing. Breadth-of-a-movement class was tested by employing two novel tasks not previously used in variability-of-practice designs. 203 kindergarten and first-grade subjects were randomly assigned to one of four conditions, three experimental and one control. Experimental subjects performed 45 trials in their respective training conditions, weight, distance, weight/distance, in one session. Two novel striking tasks were administered to all subjects pre- and posttest to assess the variability-of-practice hypothesis, and the generalizability of overarm throwing and striking. Variability-of-practice in the overarm throw appeared to strengthen the striking schemas of the kindergarten boys. Results suggest some support for the inclusion of throwing and striking in a single-movement class. The concept, breadth of movement class, however, requires further study.

Effects of special instruction and practice by preschool age children on performance of object projection and stability tests.

Four criterion measures were used to assess the vulnerability to change of two variables, stability and object projection, included in a perceptual-motor enhancement program for 60 boys and girls enrolled in a 20-wk., 20-session program, as were 36 male and female controls. Both samples ranged in age from 2 yr., 0 mo. to 5 yr., 8 mo., and all were within the normal range of development. Three beam-walking tests (the beam at different heights and angles) and the overhand throw comprised the criterion measures used for assessment of program effectiveness in stability and object projection. Stability measures were distance divided by time, and object projection scores were determined by velocity of the overhand throw. A three-factor analysis of covariance was utilized to determine significant main effects of age, sex, and treatment. No significant differences were observed. Analysis by age and sex were significantly different on the Inclined Beam test. Analysis by treatment yielded significant differences on the Inclined Beam test and the Overhand Throw. Analysis by age and by sex showed a significant difference in the performance of the Overhand Throw. In summary, performance status of the overhand throw by preschool age children can be improved beyond maturational expectations through guided instruction.

Familial abdominal aortic aneurysms.

The case histories of three brothers, the only siblings of one family, all of whom underwent surgery for the treatment of a previously asymptomatic ruptured abdominal aortic aneurysm, are recorded. The possibility of underlying constitutional and hereditary factors is discussed and the suggestion of a primary familial incidence of atheromatous, nondissecting aortic aneurysm is raised.

Re-routing of the track for the treatment of high anal and anorectal fistulae.

A transposition technique for the management of high anal and anorectal fistulae is described. The method involves re-routing the extrasphincteric portion of the track into an intersphincteric position with immediate repair of the external sphincter. The newly positioned intersphincteric fistula is then dealt with at a later date when the external sphincter is soundly healed. In this way the number of operations needed to deal with such a fistula may be reduced, a colostomy is not necessary, healing is more rapid and continence is preserved. Details of the first five cases dealt with in this way and their successful outcome are reported.

The use of Ligasure haemorrhoidectomy in patients taking oral anticoagulation therapy.

OBJECTIVES: To assess the safety of Ligasure haemorrhoidectomy in treating patients on long-term anticoagulation therapy. METHOD: Three patients taking warfarin underwent Ligasure haemorrhoidectomy for prolapsing haemorrhoids. RESULTS: Each had a successful procedure without complications. CONCLUSION: Ligasure haemorrhoidectomy can be safely performed in anticoagulated patients and reduces in-patient hospital stay.

Randomized clinical trial of Ligasure versus open haemorrhoidectomy.

BACKGROUND: Postoperative pain associated with open haemorrhoidectomy remains problematic. Haemorrhoidectomy performed using bloodless bipolar diathermy--Ligasure--may have advantages over conventional open haemorrhoidectomy in terms of operating time and postoperative pain. METHODS: Thirty-four patients were randomized to undergo Ligasure (18 patients) or diathermy (16) haemorrhoidectomy. The operating time, amount of pain and postoperative analgesic requirement, postoperative complications and overall patient satisfaction were documented. RESULTS: The median duration of operation was shorter in the Ligasure haemorrhoidectomy group (5.1 versus 9.2 min; P < 0.001). There was no statistically significant difference in the postoperative pain score, but the median analgesic requirement was lower in the Ligasure group (850 versus 1600 mg tramadol; P = 0.013). Patient satisfaction was similar in both groups. CONCLUSION: Ligasure haemorrhoidectomy is quick and bloodless and, although as painful as diathermy haemorrhoidectomy, is associated with a reduced analgesic requirement.

Balloon catheter contol of a ruptured abdominal aortic aneurysm in a patient with Cullen's sign.

A patient with Cullen's sign due to a ruptured abdominal aortic aneurysm is reported. At operation a balloon catheter was used to stop severe retroperitoneal bleeding and the aneurysm was replaced with a graft.

Does isolated rectal bleeding suggest colorectal cancer?

Rectal bleeding is associated with colorectal cancer, but does not occur in all cases and is usually a symptom of minor colorectal disorders. Colorectal cancer presents only Infrequently with rectal bleeding in isolation.

One year follow up of a randomized trial comparing Ligasure with open haemorrhoidectomy.

BACKGROUND: Ligasure haemorrhoidectomy is an effective treatment for prolapsing haemorrhoids, however, concerns exist regarding potential damage to the anal sphincters. METHODS: Patients previously included into a randomized trial comparing open and Ligasure haemorrhoidectomy were contacted by postal questionnaire to evaluate their overall satisfaction and continence at 12 months post operatively. RESULTS: Thirteen patients who underwent open and 17 who underwent Ligasure haemorrhoidectomy were evaluated. Three patients from the open group and 2 from the Ligasure group were unhappy with the result (P = 0.37) and minor incontinence was reported in 5 Ligasure and 2 open patients (P = 0.42). CONCLUSION: Patient satisfaction and post operative continence scores at 1 year post operatively are comparable for open and Ligasure haemorrhoidectomy.

Factors affecting the toxicity of Bacillus thuringiensis var. israelensis and Bacillus sphaericus to fourth instar larvae of Chironomus tepperi (Diptera: Chironomidae).

Laboratory bioassays (48h duration, 25+/-1 degrees C) were used to determine the toxicity of Bacillus thuringiensis var. israelensis (B.t.i.) and Bacillus sphaericus to fourth instar larvae of Chironomus tepperi, a major pest of rice in southern Australia. Bioassays were conducted using different combinations of larval ages and densities to determine if these factors affected toxicity. The effects of temperature and substrate type on B.t.i. toxicity were also investigated. Tests were conducted using a commercial B.t.i. formulation (VectoBac WDG, 3000ITU/mg), a spore/crystal mixture derived from the VectoBac WDG strain, and VectoLex WDG, a commercial B. sphaericus formulation (650ITU/mg). VectoBac WDG was highly toxic to fourth instar C. tepperi in bioassays using a sand substrate (LC(50) 0.46mg/L, older larvae); younger fourth instar larvae were more susceptible (LC(50) 0.20mg/L). Increasing larval densities (from 10 to 30 per bioassay cup) increased LC(50) values for both age groups, significantly so in the case of older larvae (higher density LC(50) 0.80mg/L). Use of a soil substrate increased the LC(50) value (older larvae, 10 per cup) to 0.99mg/L. Similar differences in toxicity relative to larval age and substrate type were found in bioassays using the B.t.i. spore/crystal mixture. VectoBac WDG and the spore/crystal mixture both showed similar (approximately 6-fold) declines in activity between 30 and 17.5 degrees C. At lower temperatures (between 17.5 and 15 degrees C), activity of the spore/crystal mixture declined much more rapidly than that of VectoBac WDG. VectoLex WDG showed very low toxicity to C. tepperi larvae, and the overall impact of larval age and density was relatively minor (LC(50) values 1062-1340mg/L). Autoclaving VectoLex WDG did not substantially reduce its toxicity (LC(50) 1426mg/L), suggesting that formulation additives (i.e., surfactants and other adjuvants) are responsible for much of the toxicity occurring at the high product concentrations required to cause C. tepperi mortality. Whilst VectoLex WDG was ineffective against C. tepperi, VectoBac WDG has the potential to provide selective control of this rice pest at economically viable application rates.

Regional injection of 5-fluorouracil and starch microspheres in colorectal cancer.

Experiments were undertaken to examine the effect of degradable starch microspheres (DSM) on the local distribution of 5-fluorouracil (5-FU) given by mesenteric arterial injection. Tritiated 5-FU (200 microCi) was injected into the inferior mesenteric artery of 8 perfused specimens of human large bowel containing adenocarcinoma and the concentration of 5-FU in local tissues and venous effluent was measured by scintillation counting. Metabolites of 5-FU were detected by radiochromatography. DSM (6 X 10(7)/mean diameter 40 micron) were injected in suspension with 5-FU (n = 7) and separately: before (n = 7) and after 5-FU (n = 7). Specimens given DSM retained 20% more cytotoxic than specimens given 5-FU alone (p less than 0.05). The concentration of 5-FU in tissues next to the primary tumour was increased when DSM were given in suspension with 5-FU, but higher concentrations were obtained when DSM were given last (p less than 0.05). Low concentrations were produced when DSM were given first. Concentrations in tumour tissue were not significantly increased by DSM.