A new system for automatic monitoring and analysis of snores during the night is presented. Sound intensity and several snore frequency parameters allow differentiation of snorers according to obstructive sleep apnea syndrome severity (OSAS). Automatic snore intensity and frequency monitoring and analysis could be a promising tool for screening OSAS patients, significantly improving the managing of this pathology.

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Background: Spirometric parameters can be normal in many stable asthma patients, making a diagnosis difficult at certain times in the course of disease. Objectives: The present study aims to find differences and similarities in the acoustic characteristics of forced wheezes among asthma patients with and without normal spirometric values. Methods: Eleven chronic asthma patients (8 men/3 women) with moderate-to-severe airway obstruction (FEV₁ 48.4%), 9 stable asthma patients (6 males/3females) with normal spirometry (FEV₁ 84.0%) and a positive methacholine test and 14 healthy subjects (8/6) were enrolled in the study. A contact sensor was placed on the trachea, and wheezes were detected by a modified Shabtai-Musih algorithm in a time-frequency representation. Results: More wheezes were recorded in obstructive asthma patients than in stable asthma and control subjects: nonstable asthma 13.6 (13.3), stable asthma 3.5 (3.0) and control subjects 2.5 (2.1). The mean frequency of all wheezes detected was higher in control subjects than in either stable or non-stable asthma patients. The change in the total number of wheezes after terbutaline inhalation was more pronounced in nonstable asthma patients than in stable asthmatics and control subjects. Conclusions: This study confirms that wheeze recording during forced expiratory maneuvers can be a complementary measure to spirometry to identify asthma patients.

The present study was performed to compare R-R interval data and heart rate variability indices obtained from the Polar S810i and the Omega Wave Sport System for a total of 96 adults in a supine position. Data were simultaneously recorded with the Polar S810i and the Omega Wave Sport System and processed by unique software. Bland-Altman analysis for the R-R intervals shows minimal bias for free and paced breathing. No significant differences were observed for heart rate variability indices derived from the signal from both devices, except for the power of the high frequency band and the acceleration changes index during either free or paced breathing. Coefficients of correlations were all above 0.96. These data suggest that both systems are valid to record R-R interval signals and to obtain a valid analysis of heart rate variability. However, Omega Wave Sport System enables data to be collected without any artifacts making the analysis of heart rate variability easier than the analysis of Polar S810i. Nevertheless, Polar S810i continues to be more practical in clinical and applied situations due to the affordability of the device.

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SummaryFailed spinal anaesthesia for left total hip arthroplasty was followed postoperatively by dense motor paralysis and sensory deficit in the right leg. The patient had received a dose of subcutaneous heparin 1 h before the spinal anaesthetic was attempted. She died of pulmonary embolism on the ninth postoperative day. At autopsy extensive haematomyelia was found in relation to the needle track. Case reportAn overweight woman of 66 years (height 163 cm weight 87 kg) presented for a left Charnley total hip replacement. She had a history of deep vein thrombosis some 10 years previously, apart from which and notwithstanding her weight, she had remained in good general health. Her only medication was fenbufen for arthritis, which she had not taken for 1 week prior to the operation and co-codamol as required for pain. The patient was frankly advised of the danger of hip surgery but was keen to proceed because her arthritis was severely disabling and her pain constant. She had been waiting for surgery for some months and had been able to lose 8 kg in weight.Pre-operative laboratory investigations showed a haemoglobin of 12.9 g.dl ÿ 1 and platelets of 170 000 × 10 9 .l ÿ 1 . The patient's clotting function was not investigated.Despite the practical difficulties caused by her weight, regional analgesia was chosen. Premedication was with midazolam 5 mg intramuscularly and low-dose heparin was prescribed (5000 i.u. calcium heparin subcutaneously twice daily) the first dose being given 1 h pre-operatively.Spinal anaesthesia was attempted in the left lateral position with a 26G needle. It was extremely difficult to palpate the bony landmarks of the back but the subarachnoid space was located at the first attempt in what was believed to be the L 3-4 interspace and free flow of cerebrospinal fluid was observed. On injection of the local anaesthetic the patient complained of intense pain, described as sharp and stabbing in nature, down the left leg. The subarachnoid injection was abandoned and the needle withdrawn. A total of 0.3 ml of heavy bupivacaine 0.5% in 12% dextrose had been injected. The situation was discussed with the patient who was now pain free and it was decided to proceed with general anaesthesia. This was induced with thiopentone 250 mg and controlled ventilation with nitrous oxide, oxygen 30% and isoflurane 0.5% was facilitated with vecuronium. A total of 12 mg of morphine was administered during surgery. The operation was uneventful and the systolic blood pressure remained in the range 110-140 mmHg throughout. The duration of surgery was 90 min.The patient complained of moderate pain at the operative site and was given a further 5 mg of morphine intravenously in the recovery unit. Her immediate postoperative progress was otherwise unremarkable. The following morning when the patient awoke she complained that her right leg was numb and weak. Neurological examination confirmed this and neurological and neurosurgical opinions were sought. ᮊ 1997 Blackwell Science LtdOn physical examination a right-sided u...

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