This study confirms previous observations that open shoulder stabilization using a subscapularis tenotomy may lead to atrophy and fatty infiltration of the subscapularis muscle, resulting in postoperative subscapularis dysfunction. As expected, arthroscopic procedures do not significantly compromise clinical subscapularis function and structural integrity. However, no significant differences were observed in the overall outcome.

Open reconstruction of anteroinferior chronic glenoid defects via a complete SSC tenotomy using an iliac crest bone grafting technique allows an anatomic reconstruction of the anteroinferior glenoid with good and excellent clinical results. The anterior approach may lead to atrophy and fatty infiltration of the SSC muscle despite an intact tendon. However, this did not affect the results in terms of stability.

The occurrence of auricular fibrillation in three patients; notes regarding onset, nature and duration of manifestations.Electro-cardiographic diagnosis, interpretation of and comparison with organic fibrillation.The onset of heart-block immediately following a convulsion in another patient. Discussion of subsequent course and treatment.Comment on the significance of these complications in relation to the safety of convulsive therapies.Observations on blood-pressure in some of the above cases.

SummaryPlasma buipoacaine concentrations were measured in 10 patients after lumbar sympathectomy using lOml or 20 mi of' 0.25% bupivacaine plain solution. A single needle technique was employed, positioned at the LJ level. Mean peak concentrations were greater in the larger volume group and were statistically signijcant at 20, 30, 60, 90 and 120min. Plasma bupivacaine levels peaked earlier in the smaller volume group. Some patients in the larger volume group still had plasma bupivacaine levels at or near peak values at 120min. No patient approached toxic plasma levels of bupivacaine. Key wordsAnaesthetic techniques, regional; lumbar sympathetic block. Anaesthetics, local; bupivacaine. Pharmacokinetics.Lumbar sympathectomy is a well established technique for the treatment of peripheral vascular disease and many chronic pain conditions. In the original description of the method, two or three needles were placed at different levels to ensure blockade of all lumbar sympathetic ganglia. More recently, it has been shown that a single needle technique produces satisfactory blockade [ 11. Pharmacokinetic analysis of bupivacaine concentrations after coeliac plexus and stellate ganglion blockade have been described previously [2,3]. Initial data from lumbar sympathectomy using large volumes of bupivacaine and a two needle technique have also been published [4]. We describe the pharmacokinetics for a single needle technique at the L3 level using two different volumes of bupivacaine 0.25%. MethodAfter approval by the district ethics committee, informed consent was obtained from 10, ASA 1-3, patients (5 male and 5 female) all undergoing unilateral lumbar sympathectomy for chronic pain conditions. A single needle technique was employed using a 22 G needle positioned at the L3 level, on the left or right, with the patient in the prone position.The needle was inserted lateral to the transverse process and advanced to the ventrolateral aspect of the L3 vertebral body. The correct prevertebral position was confirmed using X ray screening in two views (lateral and anterior-posterior) and by the injection of 1 ml of lopamidol contrast medium to ensure appropriate spread in the correct plane. A negative aspiration test for blood was performed. Two groups of five patients were selected each evenly matched for age and weight. In the first group, 10ml of bupivacaine 0.25% (25 mg) was injected (5 ml bupivacaine 0.5% and 5 ml lopamidol), in the second group, 20 ml of bupivacaine 0.25% (50 mg) was injected (10 ml bupivacaine 0.5% and 10 ml lopamidol). Hard copy radiographic films taken in the lateral plane were made after each injection.Thermistor temperature probes were attached to both feet of each patient in the recovery room. A rise in temperature in the appropriately treated foot of > 1°C was taken as further confirmatory evidence of satisfactory lumbar sympathetic block. Non-invasive blood pressure (Dinamap), oxygen saturation (Nellcor) and pulse rate were also monitored.

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