A qualitative analysis of patients reasons for choosing neobladder or ileal conduit after cystectomy for bladder cancer.

A neodymium:yttrium, aluminum, garnet (Nd:YAG) laser was used via the instrumentation port of a standard thoracoscope for the sealing of air leaks, ablation of bullae, transection of adhesions and partial parietal pleurectomy in 13 patients with intractable pneumothorax. The mean duration of tube thoracostomy prior to treatment was 10 days (range 4 to 21 days). All patients had intractable air leakage. Three patients had chronic lung collapse of over 50% despite adequate chest drainage. All cases were treated with thoracoscopic laser. The source of air leakage was found to be ruptured bullae in 11 cases and a lung tear in 2 cases. In five cases the bullae were multiple. In 11 cases the air leakage stopped within 24 h of treatment, with a single self-limiting episode of recurrent air leakage. In two of the cases of chronic pneumothorax the lung failed to expand because of sizable bronchopleural fistulae. They required thoracotomy stapling of bullae and limited thoracoplasty. The mean duration of tube thoracostomy after thoracoscopic laser in the 11 successfully treated patients was 2.72 days (range 1 to 5 days). We conclude laser-assisted thoracoscopy is a useful therapeutic option when treating persistent air leakage. In most cases this method prevents prolonged periods of tube thoracostomy and obviates thoracotomy. In cases of chronic collapse of the lung with bronchopleural fistulae this technique may not be successful.

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A minimal increment methohexitone technique in conservative dentistry: a comparison with treatment under local analgesia. Anaesthesia, 26, 3. 13. LASSEN, N.A. (1959) Cerebral blood flow and oxygen consumption in man. The incidence , prevention and treatment of dysrhythmias during anaesthesia for oral surgery. British Journal of Anaesthesia, 44, 904. 15. TUOHY, 0. (1968) Cardiac arrhythmias during oral surgical procedures. Pain on injection and subsequent thrombophlebitis are frequently reported after intravenous diazepam In order to evaluate the possibility of preventing these side effects, the incidence of pain on injection and clinical thrombophlebitis were investigated prospectively following the administration intravenously of diluted and undiluted diazepam or lorazepam, a new benzodiazepine derivative with properties similar to diazepam. Muterials and methods Five hundred and forty-one ASA Class 1 and 2 patients, between the ages of 18 and 70 years, served as subjects for the study. Patients sensitive to benzodiazepines were excluded, as were patients scheduled for cardiac or neurosurgical procedures. No patient received any sedative or narcotic prior to premedication on the day of surgery and no restrictions were made on the type of anaesthesia used. Approximately I hour prior to surgery, patients were brought to a pre-operative waiting area where intravenous fluids were started using a vein on the dorsal aspect of the hand or forearm with a 16 gauge indwelling plastic cannula. All drugs were administered through the cannula. The drugs investigated were diazepam (7.5 o r 10 mg) or lorazepam (2 o r 4 mg) either undiluted, o r diluted in 20 o r 40 ml of 5% dextrose and Ringer's lactatesolution. Acontrol group of 240 patients received undiluted morphine (5 o r 10 mg) o r fentanyl (0. 05 o r 0.1 mg) because of their common use in clinical practice and their lack of known irritation to veins when injected intravenously. All medications were administered double-blind and given at a constant rate over 1 minute into the intravenous tubing during which time each patient received 71 ml solution in addition to the study drugs. If there were n o spontaneous responses by the patient, he was asked if he felt any discomfort. A trained nurse observer made all observations and the responses were graded :-t (pain free), + + (slight pain), and + + + (severe pain). Postoperative evaluations were made 24 hours ~~ ~