Chemometric determination of the shelf life of opened cans using the migration of specific metals as quality indicators.

The aim of this work is the evaluation of quality indicators for the estimation of the shelf life of opened cans using the migration of specific metals as variables. For this reason the determination of targeted analytes such as: Cd, Pb, As, Cu, Cr, Ni, Fe, Mn and Sn in different canned samples (cardoon, tuna, green and red beans, corn, and fungi) by Electrothermal Atomic Absorption Spectrometry (Perkin Elmer, SIMAA 6000) was developed and validated. Statistical analysis was performed using SPSS version 22. Principal component analysis (PCA) and cluster analysis were performed in order to examine the correlation between the content of metals and metalloids and the storage time of opened cans. The results showed that there is a strong correlation between metal concentration and storage time, especially for Fe and Sn. The storage time ranged from hours to days and the vast number of collected data sets, led to reliable conclusions about the evaluation of a new shelf life indicator. Principal component analysis indicated the appropriate storage time for opened cans, where no significant migration was observed.

Maternal and umbilical cord oxygen content and acid-base balance in relation to general, epidural or subarachnoid anesthesia for term elective cesarean section.

PURPOSE: To compare maternal and neonatal oxygenation and acid-base status after elective cesarean section (CS) under different anesthetic techniques. MATERIALS AND METHODS: Three hundred and eighty parturients undergoing elective cesarean section were randomly assigned to receive general (GA, n =140), epidural (EA, n = 117) or subarachnoid anesthesia (SA, n =123). Blood gases, oxygen content, and acid-base status parameters were measured in maternal artery and umbilical cord vessels. Neonatal Apgar scores were also recorded. RESULTS: Umbilical artery pH, HCO3-, and actual base excess (ABE) were significantly higher in the GA compared to SA group (p < 0.001, p < 0.05, andp < 0.05, respectively). Umbilical vein ABE was lower in the SA compared to GA and EA groups (p < 0.05). Oxygen content in maternal artery was higher in the GA and EA groups compared to the SA group (p < 0.05). Neonatal oxygen content in both cord vessels was higher in the GA group compared to EA and SA groups (p < 0.05). Umbilical venous-arterial difference of PO2, oxygen content, and Apgar scores did not differ significantly among groups. CONCLUSION: Neonatal oxygenation and acid-base status values were better preserved when GA was administered for elective CS compared to regional modalities. Apgar scores and neonatal outcomes were not affected by the anesthetic technique.

Perioperative management of a parturient with hyponatraemia due to carbamazepine therapy.

We describe the perioperative management of an epileptic parturient who developed hyponatraemia due to carbamazepine therapy. Caesarean delivery was performed under combined spinal-epidural anaesthesia with a good outcome for both mother and neonate. The diagnostic and therapeutic approach, anaesthetic implications and maternal and neonatal risks for a patient with hyponatraemia complicating carbamazepine therapy are discussed.

Anaesthesia preference, neuraxial vs general, and outcome after caesarean section.

We investigated parturients' preference for neuraxial vs general anaesthesia, while they have experienced both techniques in the past. A total of 102 parturients who underwent elective caesarean section under general or neuraxial anaesthesia at different times completed a questionnaire comparing the two techniques. According to our results, 98% vs 51% (p < 0.001) of the women saw the baby and 51% vs 29% (p = 0.003) ambulated in the neuraxial and general anaesthesia groups, respectively, within the first 24 h postoperatively. Neuraxial anaesthesia was associated with less pain assessed by the Verbal Analogue Scale (VAS) (54 ± 21 vs 72 ± 20 p < 0.001), fewer days of hospital stay (4 ± 0.5 vs 5 ± 1.5, p = 0.001) and higher satisfaction scores (77 ± 18 vs 52 ± 24, p = 0.001) vs general anaesthesia. Finally, 80% of the women would choose neuraxial anaesthesia for a future caesarean section.

General versus neuraxial anaesthesia for caesarean section: impact on the duration of hospital stay.

We investigated retrospectively the duration of hospital stay of 1,619 women who received general (GA) (n = 582) or neuraxial anaesthesia (combined spinal-epidural [CSEA] (n = 614), epidural [EA] (n = 423)) for caesarean delivery over the years 2002-2005. Hospital stay was also analysed for the different obstetricians involved. Overall duration of hospital stay differed between 2002 and 2005 (p < 0.0001) but not between CSEA and EA (p = 0.460). Overall duration of hospital stay differed between neuraxial and GA group (p < 0.001). Duration of hospital stay of the GA group showed a progressive decrease between 2002 and 2005 (p = 0.002). Duration of hospital stay after neuraxial anaesthesia differed between 2002 and 2005 (p = 0.013) and among different surgeons (p < 0.001). Discharge rates from the hospital were shorter after neuraxial anaesthesia versus GA for the 3rd and 4th postoperative days (p < 0.001 and p < 0.001, respectively). Neuraxial anaesthesia for caesarean section seems to be associated with shorter duration of hospital stay than GA.

Melatonin premedication does not enhance induction of anaesthesia with sevoflurane as assessed by bispectral index monitoring.

INTRODUCTION: Exogenous melatonin has sedating and hypnotic actions. The present prospective double-blind randomised study investigated the effect of melatonin premedication on the induction of anaesthesia with sevoflurane. METHODS: 71 women of reproductive age, scheduled for a hysteroscopy, were randomised into the melatonin or the control group. 30 minutes before the induction of anaesthesia, patients in the melatonin and control groups sublingually received 9 mg of melatonin or placebo, respectively. In the operating room, patients were attached to a standard monitor and bispectral index (BIS) monitor. Anaesthesia was induced with 8 percent sevoflurane in oxygen via an anaesthetic system primed with 8 percent sevoflurane. BIS values were recorded every 30 seconds, during the first 300 seconds of sevoflurane administration. Inspired and expired sevoflurane concentrations, heart rate and oxygen saturation were also recorded at the same time intervals. Noninvasive blood pressure was recorded before and after the completion of measurements. RESULTS: BIS values (p-value is 0.725, F is 0.125, degrees of freedom [df] 1), inspired (p-value is 0.468, F is 0.535, df 1) and expired (p-value is 0.388, F is 0.756, df 1) sevoflurane concentrations, heart rate (p-values is 0.516, F is 0.427, df 1) and oxygen saturation (p-value is 0.401, F is 0.717, df 1), did not differ between the two groups, at any time point of measurement. Systolic blood pressure before (p-value is 0.131, t 1.530, df 67) and after measurement (p-value is 0.8288, t 0.218, df 54) as well as diastolic blood pressure before (p-value is 0.370, t 0.902, df 67) and after measurement (p-value is 0.764, t 0.302, df 54) did not differ between the two groups. CONCLUSION: Melatonin premedication under the present study design failed to enhance the induction of anaesthesia with sevoflurane.

A randomized study of maternal serum cytokine levels following cesarean section under general or neuraxial anesthesia.

BACKGROUND: Cytokines are significant mediators of the immune response to surgery and also play a role in parturition. The aim of the study was to investigate the impact of the anesthetic technique for cesarean section on plasma levels of cytokines IL-6 and TNF-alpha. METHODS: Thirty-five parturients scheduled for elective cesarean section were randomly assigned to general (n=18) or neuraxial (n=17) anesthesia. The general anesthesia group received thiopental 4 mg/kg, succinylcholine 1-1.5 mg/kg and 1% end-tidal concentration of sevoflurane in nitrous oxide and 50% oxygen. The neuraxial anesthesia group received intrathecal 0.5% levobupivacaine 1.8-2.2 mL and epidural fentanyl 1 microg/kg. Blood samples were taken for IL-6 and TNF-alpha immediately after positioning the parturient on the operating table, after uterine incision and before the umbilical cord clamping and 24h after surgery (T(1), T(2) and T(3) respectively). RESULTS: The two groups did not differ in IL-6 (P=0.15) or TNF-alpha (P=0.73) serum concentrations at any time point. In the general and neuraxial anesthesia groups, IL-6 serum concentrations were significantly higher in the third blood sample, T(3) (12.2+/-5.0 and 15.2+/-4.3 pg/mL), than in T(1) (0.41+/-0.38 and 0.29+/-0.10 pg/mL) and T(2) (0.37+/-0.47 and 0.24+/-0.05) respectively (P<0.001). Within each group, serum TNF-alpha concentrations did not differ significantly over time (P=0.44). CONCLUSIONS: Under the present study design anesthetic technique did not affect IL-6 or TNF-alpha concentrations in parturients undergoing elective cesarean section. Serum IL-6 levels increased 24 h postoperatively independently of anesthetic technique.

A combination of gabapentin and local anaesthetics attenuates acute and late pain after abdominal hysterectomy.

BACKGROUND AND OBJECTIVE: Gabapentin and local anaesthetics may decrease postoperative pain and analgesic needs. The aim of the study was to investigate the effect of the combination of these drugs on the analgesic needs as well as on acute and late pain after abdominal hysterectomy. METHODS: Sixty patients undergoing abdominal hysterectomy were randomly assigned to receive postoperatively oral gabapentin 400 mg 6 hourly for 7 days plus continuous wound infusion of ropivacaine 0.75% for 30 h or placebo capsules identical to those of gabapentin for 7 days and continuous wound infusion of normal saline for 30 h. Morphine consumption (PCA) for 48 h, paracetamol 500 mg plus codeine 30 mg (Lonalgal tablets) intake on days 3-7, visual analogue pain scores at rest and after cough during the first 7 postoperative days, the need for analgesics at home and the presence and incidence of pain after 1 month were recorded. RESULTS: The treatment group consumed less cumulative morphine over the first 48 h (31 +/- 13.2 mg vs. 50 +/- 20.5 mg in controls, P < 0.001) and less Lonalgal tablets on days 3-7 (z = 2.54, P = 0.011). The visual analogue score values at rest and after cough did not differ between the groups during the first 7 postoperative days. One month postoperatively, fewer patients in the treatment group experienced pain due to surgery than in the control group (17/27 vs. 21/24, P = 0.045). CONCLUSION: Gabapentin and continuous wound infusion with ropivacaine 0.75% decreased analgesic needs and late pain in patients undergoing abdominal hysterectomy.

Responses to mechanical and electrical stimuli are not attenuated by late pregnancy.

Pregnancy has been associated with increased pain threshold. This study investigates the responses to mechanical and electrical stimuli in pregnant and non-pregnant women. Thirty pregnant women were subjected before and four days after elective caesarean section under regional anaesthesia to mechanical and electrical stimuli on both forearms. Thirty nonpregnant women were subjected to the same stimuli at the same time points. The responses to mechanical stimuli were expressed in mm of the Visual Analogue Scale (VAS) and averaged for both forearms. The VAS scores obtained after the electrical stimuli were divided by the mA recorded when the stimulus was applied, expressed in mm/mA and averaged. The responses to mechanical stimuli recorded before and four days after application did not differ between the two groups (F = 0.884, df = 3,116, P = 0.452). In the pregnant group the VAS values before and four days after the caesarean section were 16.4 +/- 14.4 mm and 12.8 +/- 12.5 mm respectively. In the nonpregnant group the VAS values recorded four days apart were 17.5 +/- 14.3 mm and 13.4 +/- 11.9 mm respectively. The responses to electrical stimuli applied four days apart also did not differ between the two groups (F = 2.433, df = 3,116, P = 0.069). The VAS values obtained after the first and second application of the electrical stimulus were 0.914 +/- 0.606 mm/mA versus 0.586 +/- 0.410 mm/mA in the pregnant and 0.853 +/- 0.538 mm/mA versus 0.725 +/- 0.467 mm/mA in the nonpregnant group. These results, under the study conditions, do not support the hypothesis that late pregnancy is associated with increased antinociception in humans.

Sevoflurane as a single anesthetic and physostigmine failure to enhance arousal.

AIM: Sevoflurane is recommended for inhalational induction of anesthesia. Physostigmine may antagonize general anesthetics. The study investigates sevoflurane as a single anesthetic and its possible antagonism by physostigmine. METHODS: In 60 women scheduled for breast lump excision, anesthesia was induced with 8% sevoflurane. After 3 min of sevoflurane inhalation, a laryngeal mask airway (LMA) was inserted. Anesthesia was maintained with spontaneous ventilation at end tidal sevoflurane 3%. Systolic and diastolic blood pressure, heart rate and end tidal CO(2) were recorded intraoperatively. After skin closure and at end tidal sevoflurane 0.9%, physostigmine 2 mg or normal saline was given. After 2 min systolic, diastolic blood pressure, heart rate and end tidal CO(2) were recorded and sevoflurane was discontinued. Time to eyes opening, LMA removal and verbal response was recorded. Patients were also assessed for orientation, sedation, sitting ability and the ''picking up matches'' test at 0, 15 and 30 min after LMA removal. RESULTS: Systolic, diastolic blood pressure and heart rate increased after laryngeal mask placement (P=0.0001, P=0.0001 and P=0.0001, respectively). Orientation, sitting ability and ''picking up'' matches were similar in the 2 groups. Sedation at 15 min was less in the control group (P=0.004). CONCLUSIONS: Sevoflurane can be used as a single anesthetic but its recovery is not enhanced by physostigmine.

Gabapentin attenuates the pressor response to direct laryngoscopy and tracheal intubation.

BACKGROUND: Laryngoscopy and tracheal intubation increase blood pressure and heart rate (HR). The aim of the present study was to investigate the effect of gabapentin when given before operation on the haemodynamic responses to laryngoscopy and intubation. METHODS: Forty-six patients undergoing abdominal hysterectomy for benign disease were randomly allocated to receive gabapentin 1,600 mg or placebo capsules at 6 hourly intervals starting the day (noon) before surgery. Anaesthesia was induced with propofol and cis-atracurium. Systolic, diastolic arterial blood pressures (SAP, DAP) and heart rate (HR) were recorded before and after the anaesthetic and 0, 1, 3, 5 and 10 min after tracheal intubation. RESULTS: SAP was significantly lower in the gabapentin vs the control group 0, 1, 3, 5 and 10 min after intubation [128 (27) vs 165 (41), P=0.001, 121 (14) vs 148 (29), P=0.0001, 115 (13) vs 134 (24), P=0.002, 111 (12) vs 126 (19), P=0.004 and 108 (12) vs 124 (17), P=0.001 respectively]. DAP also was lower in the gabapentin group 0, 1, 3, and 10 min after intubation [81 (18) vs 104 (19), P=0.0001, 77 (9) vs 91 (16), P=0.001, 71 (10) vs 84 (13), P=0.001 and 67 (10) vs 79 (12), P=0.004]. HR did not differ between the two groups at any time [82 (11) vs 83 (15), 79 (10) vs 80 (12), 86 (17) vs 92 (10), 82 (11) vs 88 (10), 81 (12) vs 81 (11), 77 (13) vs 79 (13), and 75 (15) vs 78 (12)]. CONCLUSION: Gabapentin, under the present study design attenuates the pressor response but not the tachycardia associated with laryngoscopy and tracheal intubation.

Pre-oxygenation enhances induction with sevoflurane as assessed using bispectral index monitoring.

BACKGROUND: Several methods may enhance the inhalational induction of anesthesia. In this randomized double-blind study, we evaluated the speed of induction of anesthesia with sevoflurane with or without pre-oxygenation. METHODS: Fifty-four patients scheduled for hysteroscopy received for 10 min air or 100% oxygen via a facemask followed by > or = 7% sevoflurane in 100% oxygen. During the first 300 s of sevoflurane administration, bispectral index (BIS) values were recorded every 30 s in all patients. In 14 patients, seven in each group, BIS, endtidal CO(2), tidal volume, respiratory rate, SpO(2), and heart rate were recorded every minute during the pre-induction period and every 30 s during the first 5 min of sevoflurane administration. RESULTS: The BIS, endtidal CO(2), tidal volume and respiratory rate did not differ between the oxygen or air breathing groups (P = 0.696, P = 0.999, P = 0.388, and P = 0.875, respectively), though the oxygen group exhibited lower tidal volumes by 16-20%. The SpO(2) and heart rates were higher in the oxygen breathing group (P < 0.001 and P = 0.042, respectively). During sevoflurane administration, BIS values were lower in the oxygen group vs. the group breathing air, in particular at 90, 120, 150, 180 and 210 s (P = 0.001, P = 0.001, P = 0.001, P = 0.001 and P = 0.030, respectively). The endtidal CO(2) and the tidal volumes between the groups did not differ. The two groups differed in the SpO(2) and the heart rates during induction (P = 0.004 and 0.003, respectively). CONCLUSIONS: Before sevoflurane administration, breathing 100% oxygen for 10 min enhances induction of anesthesia with sevoflurane.

Gabapentin attenuates late but not acute pain after abdominal hysterectomy.

BACKGROUND AND OBJECTIVE: Gabapentin has been suggested to decrease acute postoperative pain. We evaluated the effect of gabapentin on pain after abdominal hysterectomy. METHODS: Sixty patients scheduled for abdominal hysterectomy were randomized to receive orally gabapentin 400 mg 6 hourly or placebo. Treatment started 18 h preoperatively and continued for 5 postoperative days. Pain (visual analogue score) and consumption of morphine for 48 h and of oral paracetamol/codeine were recorded after 2, 4, 8, 24 and 48 h and on days 3-5 postoperatively. After 1 month, patients were interviewed by phone for pain, and analgesic intake after hospital discharge. RESULTS: Morphine consumption (mean +/- SD) was 35 +/- 15.7 mg in the control and 28 +/- 12.1 mg in the gabapentin group (P = 0.21). Median number (range) of paracetamol 500 mg/codeine 30 mg tablets taken during days 3-5 was 1.0 (0-6) in the control and 2.0 (0-9) in the gabapentin group (P = 0.35). The visual analogue scores at rest and after cough did not differ between the two groups (F = 0.92, df = 1, P = 0.34 and F = 0.56, df = 1, P = 0.46, respectively). One month after surgery, 22/27 (81%) of the control group and 9/25 (36%) of the gabapentin group reported pain in the surgical area (chi(2) = 11.15, P = 0.002), while 11/27 (41%) of controls and 7/25 (28%) of gabapentin patients consumed analgesics for pain (chi(2) = 0.93, P = 0.39). The intensity of pain was decreased in the gabapentin group (chi(2) = 12.6, P = 0.003). CONCLUSIONS: Gabapentin has no effect on immediate pain after abdominal hysterectomy but decreases pain 1 month postoperatively.

Spread of subarachnoid block, intraoperative local anaesthetic requirements and postoperative analgesic requirements in Caesarean section and total abdominal hysterectomy.

BACKGROUND: Pregnancy is associated with a higher spread of subarachnoid anaesthesia and increased pain threshold. The study was designed to assess the spread of subarachnoid block and the intra- and postoperative analgesic requirements in pregnant vs non-pregnant women. METHODS: We assessed the level of subarachnoid anaesthesia after 1.8 ml of hyperbaric lidocaine 5% and the postoperative analgesic requirements in women undergoing Caesarean section and undergoing abdominal hysterectomy (30 each group). Intraoperatively epidural ropivacaine was given as required. All patients received 10 ml of ropivacaine 0.2% epidurally 2, 10, and 24 h after operation and the VAS pain score was assessed. They also had access to patient controlled analgesia i.v. morphine. RESULTS: Duration of surgery was 64 (13.7) vs 127 (33.8) min (P<0.0001) in the pregnant and non-pregnant groups. Ten minutes after subarachnoid injection, sensory block was higher by three dermatomes in the pregnant group (P<0.0001). Time to first ropivacaine dose was 37 (19.7) vs 19 (12.2) min (P<0.001) and the ropivacaine normalized for the duration of anaesthesia was 0.8 (0.6) vs 1.3 (0.5) mg(-1) (P=0.001) in the pregnant and non-pregnant groups, respectively. The time between the first and second ropivacaine dose was similar in the two groups (P=0.070). Fewer pregnant women (81 vs 100%) required ropivacaine intraoperatively (P=0.017). The VAS scores were similar but parturients consumed more i.v. morphine (33 (14) vs 24 (12) mg, P=0.016) during the first 24 h after operation. CONCLUSIONS: Pregnant patients exhibited a higher level of subarachnoid sensory block and required more i.v. morphine after operation.

Needling of the extra 1 point decreases BIS values and preoperative anxiety.

Acupuncture has anxiolytic effects. We investigated the effect of acupuncture on the Bispectral Index (BIS) values and anxiety. Fifty patients were randomly assigned to group A to receive acupuncture for 15 minutes on the extra 1 point (yintang) or to group C, where they received the same treatment on a control point located 2 cm lateral to the end of the right eyebrow. BIS values were recorded before acupuncture; during acupuncture every 30 seconds for 15 minutes and every 30 seconds for 90 seconds when the acupuncture treatment was accomplished. Anxiety level was assessed before and after acupuncture by a verbal score scale (VSS) (0 = no anxiety, 10 = worst anxiety). BIS values were significantly decreased during acupuncture when applied on the extra 1 point (p = 0.0001) but not on the control point. Acupuncture application significantly decreased the VSS values within the A group (p = 0.027) and in the C group (p = 0.0001), when compared to the baseline (pre-acupuncture) VSS values. However, no differences were found between the two groups regarding BIS or VSS values. In conclusion, needling the extra 1 point preoperatively significantly decreases the BIS values and the VSS for anxiety but needling of a control point decrease only VSS values.

Spinal and epidural versus general anesthesia for elective cesarean section at term: effect on the acid-base status of the mother and newborn.

OBJECTIVE: To compare general, epidural and combined spinal-epidural anesthesia with respect to short-term outcome of newborns delivered by elective Cesarean section of healthy parturients with normal pregnancies. STUDY DESIGN: A total of 238 eight pregnant women admitted to our institution between January 1998 and July 2002, for whom elective Cesarean section was planned after 38 weeks' gestation, were grouped according to the kind of anesthesia used for the procedure. Maternal characteristics, birth weight, Apgar scores, and maternal and umbilical artery (UA) acid-base parameters were analyzed. RESULTS: Maternal pH was significantly lower and pCO2: and pO2 were significantly higher in the general anesthetic group, compared to the other two groups (7.38 +/- 0.03 vs. 7.43 +/- 0.02 and 7.43 +/- 0.05, respectively; 35.03 +/- 3.88 mmHg vs. 29.25 +/- 5.05 mmHg and 29.64 +/- 4.16 mmHg, respectively; and 224.56 +/- 86.77 mmHg vs. 151.28 +/- 38 mmHg and 157.36 +/- 53.51 mmHg, respectively, p < 0.05). The pH of the UA was higher in the general anesthetic group, compared to the spinal-epidural group (7.29 +/- 0.02 vs. 7.26 +/- 0.06, p < 0.05). The pO2 as well as O2 saturation of the UA were higher when general anesthetic was administered, compared to the two regional modalities (15.60 +/- 5.48 mmHg vs. 9.29 +/- 4.41 mmHg and 9.20 +/- 4.06 mmHg, respectively; and 17.37 +/- 9.79% vs. 7.87 +/- 4.98% and 6.90 +/- 5.22%, respectively, p < 0.05). UA O2 saturation fell to zero in some cases in the combined spinal-epidural group, without an evident effect on fetal well-being. No fetal acidemia was noted in any group. Neonatal outcomes were similar in the three groups studied. CONCLUSIONS: Type of anesthesia does not influence short-term outcomes in infants born via elective Cesarean section, although differences in acid-base status of both the mother and especially the newborn recommend careful use of spinal anesthesia.

Renin-aldosterone system alterations during abdominal gynaecological operations under general or combined general and epidural anaesthesia.

Alterations of plasma renin-activity and aldosterone levels were comparatively studied in 41 premenopausal patients who were subjected to total abdominal hysterectomy. Twenty-one women received general anaesthesia (group A) and 20 received a combination of general and epidural anaesthesia (group B). Five blood specimens were drawn from each patient in order to determine plasma aldosterone levels (PA) and plasma renin activity (PRA) by radioimmunoassay (RIA). The rise of PA levels in group A occurred 30 min after the initiation of surgery and at that time there was a statistically significant difference as compared with the epidural anaesthesia (EA) group (p < 0.001). PRA levels in both groups showed a rise of limited statistical significance at 30 minutes after the initiation of surgery (p < 0.05). During the remaining time intervals, group A did not show any significant changes, whereas group B showed a reduction of limited statistical significance (p < 0.05). General anaesthesia for gynecological abdominal surgery without the use of volatile agents significantly increases plasma aldosterone levels. Combined anaesthesia does not totally inhibit intraoperative hyperaldosteroism but it is much slower and is of great advantage for the patient.

Spread of serious disease-producing M3 clones of group A streptococcus among family members and health care workers.

Streptococcus pyogenes causes a variety of diseases ranging from mild pharyngitis to severe toxic shock syndrome (TSS) and acute rheumatic fever. Since 1987 there has been a resurgence of severe group A streptococcus infections including TSS, necrotizing fasciitis, and myositis. Using molecular and serotyping procedures, we recently studied two clusters of group A streptococcus disease that occurred within separate family units. The first cluster involved two family members (one with TSS and one with necrotizing fasciitis) and three health care workers who attended one of the index patients. The second cluster included a mother (with necrotizing fasciitis of the hand) and her three children. Group A streptococci isolated from individuals within both cluster groups were serotype M3;T3/13/B3264, and pulsed field gel electrophoresis revealed that all isolates except one had identical fingerprints of Sma I-digested chromosomal DNA. The findings demonstrate the potential for spread of serious group A streptococcus disease among individuals and the need for barrier protection when health care workers are exposed to secretions from infected individuals.

A comparative study of propofol and thiopental as induction agents for elective caesarean section.

Twenty women for elective caesarean section received either propofol 2.3 mg/kgr or thiopental 4.4 mg/kgr for induction of general anaesthesia. Maintainance was similar for both groups. Mean arterial pressure and heart rate were recorded non-invasively before anaesthesia, during intubation, one and five minutes after intubation. There were no significant differences in haemodynamic response between the two groups. During intubation heart rate rose in both groups, but remained increased five minutes after tracheal intubation only in the thiopental treated women (p less than 0.05). There was no significant neonatal depression as assessed by Apgar Scores and blood gas analyses. Propofol appears to be a suitable alternative to thiopental as an induction agent for obstetric anaesthesia.