Pituitary cryoablation.

Transphenoidal ablation of the pituitary gland by the injection of alcohol is used for the relief of wide-spread cancer pain. A technique is described in which a cryoprobe is passed through a transphenoidal needle and a number of lesions produced within the gland. It is suggested that this method of pituitary ablation may prove to be as effective but accompanied by fewer complications than the injection of alcohol.

The use of phenothiazines and tricyclic antidepressants in the treatment of intractable pain.

The use of trifluoperazine and amitriptyline in the treatment of pain is described. Of 12 patients who were suffering chronic pain from various causes, 8 obtained a major degree of relief from the use of this combination of drugs.

Cardiac arrest temperature: the effect of ethyl alcohol and carbon dioxide on baboons.

The effect of high inspired carbon dioxide concentrations and i.v. ethyl alcohol on the temperature at which cardiac arrest occurred was studied in chacma baboons. Alcohol-treated baboons developed cardiac arrest at a temperature of 24.3 degrees C (SD +/- 0.85) and control animals at 27 degrees C (SD +/- 1.30). There were no signs of cardiac failure before the occurrence of ventricular fibrillation.

Persistent abdominal pain. Treatment by lumbar sympathetic lysis.

The organic and psychological problems of patients suffering from chronic abdominal pain are described and three case histories of patients who had undergone multiple surgery for their abdominal pain are presented. All three were treated by lumbar sympathetic lysis, resulting in relief of their pain. The possible reasons for this success are discussed.

Cardiac arrest temperature: the effect of ethyl alcohol and carbon dioxide on rats, guinea-pigs and isolated rat hearts.

1. Previous clinical and experimental reports have suggested that the systemic administration of ethyl alcohol permits lower body temperatures before the onset of hypothermic cardiac arrest. 2. In the investigations described here, the effect of ethyl alcohol on the temperature at which cardiac arrest occurred in rats, guinea-pigs and isolated rat hearts was studied. Comparison was also made of the difference between pulmonary ventilation with air and with 5% carbon dioxide in oxygen. 3. The results demonstrated that both the administration of ethyl alcohol and ventilation with 5% carbogen reduced the cardiac arrest temperature of rats. Ethyl alcohol did not influence the cardiac arrest temperature of guinea-pigs nor of isolated rat hearts.

The influence of ethyl alcohol on cerebro-spinal fluid pressure.

The effect of ethanol on the cerebro-spinal fluid pressure of six baboons is described. A biphasic response is shown to the intravenous infusion with a mean pressure fall of 3.1 mmHg. It is suggested that both the diuretic effect and the effect of alcohol on cerebral blood flow may be factors involved in the pressure fall.

Rupture of the uterus: the preventable factors.

A review of 50 cases of ruptured uterus revealed that important measures to prevent this serious complication are: good antenatal care; careful attention to patients who have had a previous Caesarean section; the correct management of cephalopelvic disproportion in the multigravida; the recognition of the serious hazards of internal version in the management of transverse lie; and careful attention to detail in the use of oxytocin in the multigravida. The factors that were regarded as critical in maintaining a low maternal mortality rate in rupture of the uterus are also reviewed.

Pituitary cryoablation. The results of treatment using a transphenoidal cryoprobe.

Pituitary ablation by the injection of alcohol through a transphenoidal needle has been practised for a number of years. In order to reduce the complications resulting from the spread of alcohol to neighbouring structures, a cryoprobe has been constructed which can be passed up through the needle into the gland and a series of localised lesions produced. The degree of pain relief is as good if not better than that obtained with alcohol. Only one instance of temporary blurring of vision resulted and hormonal disturbances were not seen. No difference was observed between the results obtained from the treatment of hormone-dependent and hormone-insensitive tumours. Pain caused in one patient by a benign tumour was unsuccessfully treated.

Analgesic effect of ethyl alcohol.

The analgesic properties of ethyl alcohol administered i.v. were investigated, using elevation of the pain threshold for applied somatic stimuli as an index. Alcohol proved markedly superior to saline in this respect and produced an effect equivalent to that of i.v. morphine.