A prospective, double-blind study was conducted to compare the effect of pressure at the P6 (Neikuan) point with placebo as an antiemetic in children. Sixty-six patients, ages 3-12 yr, undergoing outpatient surgery for correction of strabismus, were allocated randomly to receive either bilateral P6 acupressure or placebo during the perioperative period. The study was designed to detect a 50% difference in the incidence of postoperative vomiting between the two groups, with a 90% power of achieving a statistically significant result at the 5% level (two-tailed). The incidence of postoperative vomiting for the placebo group was 58% before discharge from hospital, 73% at home and 82% in the first 24 h after surgery. The corresponding results for the acupressure group were 58% before discharge, 71% at home and 94% in the first 24 h. These differences were not significant; P6 acupressure did not reduce the incidence of postoperative vomiting in children undergoing strabismus surgery.

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Over a 3-year period haemofiltration and dialysis was provided for 18 patients who developed renal failure after operation for ruptured abdominal aortic aneurysm (AAA). Four of the patients underwent operation elsewhere and were transferred when renal failure was diagnosed. The median duration of renal support in the 11 survivors was 24 days, while the seven patients who died received support for a median of 11 days. By 3 months after operation eight of the 11 survivors were independent of dialysis. Renal support was life saving in eight of 91 patients operated on in Oxford for ruptured AAA and reduced the 30-day operative mortality rate from a potential 47 per cent to an actual 38 per cent. Haemofiltration and haemodialysis for acute renal failure after surgery for ruptured aortic aneurysm is clinically justified and results in the long-term survival of most patients.

This study compared the analgesic eflectiseness of local injiltration of bupivacaine with caudal extradural bupivacaine in thejirst 48 hours ufter haemorrhoidectomy. Surgical and anaesthetic protocol was rigidly standardised. The caudal group had significantly less pain in the Jirst 6 hours after haemorrhoidectomy. and on jirst bowel opening, when compared to those who received local infiltration of bupivacaine. There was no signi$cant difference between the two groups with respect to further analgesic requirements, complications, time to first bowel action, and duration of hospital stay. The de5nite advantage of caudal extradural bupivacaine.for haemorrhoidectomy must be balanced against the rare but potentially serious complications associated with its use.

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SummaryThis study compared

Left ventricular volume reduction surgery (LVVR) for end-stage dilated cardiomyopathy is a surgical option used selectively but with unclear long-term results. Increasing numbers of reports are appearing in the literature. These should be pooled into an international registry through collaborative efforts that allow for more effective analysis. Furthermore, high priority must be given to identify subgroups of patients who will potentially gain most benefit from LVVR. Basic science may add invaluable data and in this article w e describe h o w intraoperative myocardial biopsies from patients with idiopathic dilated cardiomyopathy were utilized t o isolate myocytes in an effort t o determine differential physiological characteristics at the cellular level. The result showed various degrees of contractile anomalies in response t o electrical stimulation associated with defective calcium handling as reflected by measurements of calcium transients. It is hoped that this approach may be extended t o preoperative catheter biopsy t o gain information that will facilitate patient selection t o avoid unnecessary surgical failures. (J Card Surg 1999; 14:3845)