Significance of early postoperative fever in children

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A randomized trial to assess childhood circumcision with the Plastibell device compared to a conventional dissection technique

A randomized trial of routine circumcision in children using the Plastibell device is described and compared to a dissection suturing technique. One hundred children were studied with a mean age of 4.7 years. The device was applicable to all boys up to the age of 8, and a few older. General discomfort was carefully assessed and slightly less common after plastibell circumcision, but dysuria more so. No serious complication was encountered with either method; infection was slightly more common after the conventional procedure. Cosmetic results were similar for both methods. It is concluded that the Plastibell device is a satisfactory method for circumcising children of this age.

Concentration-dependent morphologic effects of cytochalasin B in the aqueous outflow system

Cytochalasin B at concentrations of 1, 5, 10, 15, 20, or 40 microgram/ml was continuously exchange-perfused into the eyes of nine living Macaca mulatta monkeys while intraocular pressure (IOP) was maintained at 25 mm Hg for 30 min. Pressures were then slowly reduced to 4 mm Hg to permit blood to reflux into Schlemm's canal as a tracer, and the eyes were fixed while maintained at 4 mm Hg IOP. Tissues were examined in all eyes by light and transmission electron microscopy. At concentrations of 1, 5, and 10 microgram/ml cytochalasin B, the integrity of the endothelial lining of the trabecular wall of Schlemm's canal was maintained. At 15 microgram/ml cytochalasin B, 6% of the length of the endothelial lining was disrupted; at 20 microgram/ml, 54%; and at 40 microgram/ml, 83%. There was a washout of extracellular material at the site of breaks and also a reflux of blood from Schlemm's canal into the trabecular meshwork in the same regions.

Cardiovascular effects of tubocurarine in man

The cardiovascular effects of tubocurarine in patients anaesthetised with thiopentone or ketamine have been compared, using volume-pulse finger plethysmography, electrocardiography, sphygmomanometry and impedance cardiography for the clinical assessments. Tubocurarine potentiates the arterial hypotensive effect of thiopentone and reverses the hypertensive action of ketamine. It also prevents the dysrhythmic (adrenergic) reaction of the heart to orotracheal intubation and has less effect on the positive chronotropic and inotropic reactions thereto. Hypotensive doses of tubocurarine in patients anaesthetised with thiopentone do not prevent reflex constriction of the finger blood vessels in response to surgical stimuli (orotracheal intubation) which means that the drug is not a sympathetic ganglion blocker in man. It is concluded that tubocurarine is a myocardial depressant which acts, like verapamil, as a calcium ion antagonist.

The effect of lorazepam on the vasoconstriction of fear

Volume-pulse digital plethysmography performed under ideal conditions on relatively fit adults has shown that lorazepam 4 mg intravenously abolishes the vasoconstriction of fear and restores the digital vasodilatation of the tranquil mind. The sedative effect of the drug is prolonged and is associated with several hours of anterograde amnesia from the time of its administration. The drug has no effect on the vasoconstrictor reaction to cold, pain, noise or other forms of adrenergic stimuli. Lorazepam seems to modify or prevent the psychomotor reactions which may complicate ketamine anaesthesia.

The cardiovascular effects of ketamine in man

The arterial hypertension of ketamine is prevented by verapamil, a calcium ion antagonist. This indicates that ketamine is a direct myocardial stimulant acting by increasing the availability of calcium across the cell membranes of the myocardial and the Purkinjé systems. The positive chronotropic action of ketamine is not reversed by verapamil. Both the chronotropic and the inotropic effects of ketamine are prevented by halothane which acts partly by increased vagal tone and partly by what appears to be a verapamil-like depression of calcium availability. Ketamine blocks the reflex sympathetic response of the peripheral blood vessels to surgical stimuli. The site of the block within the sympathetic reflex arc has not been identified. It is not at the alpha adrenoceptor level. The clinical implications of the findings have been discussed.