Background. Cutaneous metastases may cause considerable discomfort as a consequence of ulceration, oozing, bleeding and pain. Electrochemotherapy has proven to be highly effective in the treatment of cutaneous metastases. Electrochemotherapy utilises pulses of electricity to increase the permeability of the cell membrane and thereby augment the effect of chemotherapy. For the drug bleomycin, the effect is enhanced several hundred-fold, enabling once-only treatment. The primary endpoint of this study is to evaluate the efficacy of electrochemotherapy as a palliative treatment. Methods. This phase II study is a collaboration between two centres, one in Denmark and the other in the UK. Patients with cutaneous metastases of any histology were included. Bleomycin was administered intratumourally or intravenously followed by application of electric pulses to the tumour site. Results. Fifty-two patients were included. Complete and partial response rate was 68% and 18%, respectively, for cutaneous metastases <3 cm and 8% and 23%, respectively, for cutaneous metastases >3 cm. Treatment was well-tolerated by patients, including the elderly, and no serious adverse events were observed. Conclusions. ECT is an efficient and safe treatment and clinicians should not hesitate to use it even in the elderly.

In the past decade, the neuroradiological diagnosis and treatment of cerebrovascular diseases has undergone significant advances. With the introduction of varying diagnostic and interventional neuroradiological techniques and advances in the materials used for endovascular treatment, increasingly complex diagnostic and therapeutic neuroradiological procedures are being performed on extremely sick patients. As the interventional neuroradiology field expands, the neuroanaesthetist will become more involved in management of patients undergoing neuroradiological procedures. This produces challenges for the neuroanaesthetist, and understanding the anaesthetic implications of the current developments in neuroradiology is important in the management of these patients. This review provides an overview of diagnostic and therapeutic neuroradiological procedures, with special reference interventional neuroradiology, and the anaesthetic management of patients undergoing these procedures.

The authors' single-site multidisciplinary team has successfully treated complex and recurrent vascular anomalies with acceptable complication and recurrence profiles. These findings represent the authors' experience and provide a reference for the management of these challenging lesions.

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Editor-As someone who regularly performs spinal anaesthesia in orthopaedic and obstetric patients, I read with particular interest the recent article by Luck and colleagues. 1 I was disappointed that in this era of litigiousness, the authors still routinely insert a spinal needle at the second lumbar interspace. We know from previous studies that even experienced anaesthetists are actually one space above the space they think they are at. 2 Thus, routinely aiming to place a spinal needle at L2-L3 risks placing the needle at L1-L2 or above thus risking injury to the conus medullaris. I think this article sends out the message that performing spinal anaesthesia at L2-L3 is routine. I now routinely recommend to trainees that spinal anaesthesia should not be performed above L3-L4, unless there are exceptional circumstances. In fact, I recommend that they choose L4-L5 as the default space for performing a spinal block as technically they are no more difficult to perform and block height is not affected by giving the spinal solution at L4-L5. It will be interesting to see the results of the National Audit on Regional Anaesthesia in January of 2009 which will give us an indication of what the national practice is regarding spaces at which spinals are performed and their relative risks.