Commercially prepared oral midazolam syrup is effective in producing sedation and anxiolysis in doses as small as 0.25 mg/kg; there is a slightly faster onset with increasing the dose to 1.0 mg/kg. At all doses, 97% of patients demonstrated satisfactory sedation, whereas 86% demonstrated satisfactory anxiolysis when the face mask was applied.

The rate of anesthesia-related complications was low (1.3%) in our study. The significant risk factors were procedure duration, total propofol dose, the use of adjunct agents with propofol, and simulation (vs. radiotherapy).

BRITISH MEDICAL JOURNAL 8 MARCH 1975 561 sensorineural loss a few hours after the explosion and when there are no contraindications related to the other injuries. In less severe cases it is our practice to prescribe vasodilator drugs and steroids, which appear to improve the recovery, though there is no controlled statistical evidence for this. ConclusionsOur experience with blast injuries shows that the ear has excellent properties of recovery after exposure to blast, with a high rate of spontaneous repair of the tympanic membrane and improvement of sensorineural deafness. Unfortunately this does not happen in every case, and some patients are left with residual perforations and permanent sensorineural deafness, often accompanied by tinnitus.All of the E.N.T. surgeons in Belfast have been involved in the nrnagement of blast injuries of the ear, and we wish to express our gratitude for the generous and co-operative way in which they have agreed to our reviewing both their notes and their patients. Summary Impaction of foreign bodies in the oesophagus was analysed in 54 patients, 45 of whom were children. Of the 45 children 28 were aged 2-4 years. Coins were the most common foreign body in children (27 cases) while in adults a bolus of meat was most common (nine cases). In 41 children there was no predisposing factor, but an underlying mechanism was detected in 88% of the adults. The mechanisms were of three types: oesophageal (stricture), neuromuscular (myasthenia gravis), and extrinsic and mechanical (ankylosing spondylitis). In children most of the foreign bodies were impacted in the upper oesophagus at the cricopharyngeal junction, which is the narrowest part of the oesophagus, while in adults the foreign body was usually impacted at the site of the predisposing lesion or in the lower oesophagus. In all patients oesophagoscopy was performed under general anaesthesia to remove the impacted foreign body. Complications were more frequent in adults, mainly owing to the underlying condition. References

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Longitudinal functional neuroimaging demonstrated important effects of disease and treatment. Therefore, fMRI and DTI may be useful for characterizing the impact of retinoblastoma on the developing visual system and improving the prediction of visual outcome in survivors.

Objectives This study in children and young adults having cancer-related amputation aimed to examine the incidence of phantom limb pain in the first year after amputation and also the proportion of patients who had pre-amputation pain. Methods A retrospective review of medical records was undertaken. The proportion of patients with phantom limb pain was reported. Fisher’s exact test was used to examine the association between phantom limb pain and the presence of pre-amputation pain and between phantom limb pain and age (≤18 years vs. >18 years). Results 26 amputations were performed on 25 patients. During the year following amputation, 76% of patients had experienced phantom limb pain at some time. After 1 year, though, only 10% still had phantom limb pain. Pre-amputation pain was present in 64% of patients. Although both of our patients with PLP at 1 year were young adults (≥18 years) and both had pre-amputation pain, we found no statistically significant associations between age or the presence of pre-amputation pain with phantom limb pain. Discussion Phantom limb pain following cancer related amputation in children and young adults appears to be common but generally short lived in most patients.

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