Accepted for publication 6th November, 1990 des convulsions gEndralisdes cloniques-toniques. La concentration simultan~e de sodium sErique (121 mEq . L-I), I' osmolaritE sdrique (265 mEq. L-t), la concentration sodique d'urine (87 mEq. L -t ) et I'osmolaritd urinaire (525 mEq. L -t ) ont suggdrE le syndrome de sEcrEtion inappropriEe d'hormone atttidiurEtique qui fut confirmE par I'Eldvation de la concentration sErique de I' arginine-vasopressine (A VP) de 14.5 pcg. ml -t (normle I-5 pcg" ml-t) mesurEe par radioimmunoessai. Il fia traitE par une dose intraveineuse unique de 30 mg de fi~rosEmide et la restriction hydrique qui amena graduellement une augmentation de la concentration du sodium sErique ~ la normale en dedans de det~ jours. I1 se sentait bien durant de son hospitalisation.Development of hyponatraemia and seizures due to inappropriate antidiuretic hormone (ADH) secretion on the day following surgery may be caused by the stress of surgery and/or the response to pain. t'2 Although the syndrome of inappropriate antidiuretic hormone (SIADH) secretion is a frequent complication of major surgery ,3-5 it has rarely been reported following minor surgery.Case report A ten-year-old, previously healthy Ethiopian Jewish boy, weighing 30 kg was admitted to the hospital with torsion of his right testis. Physical examination was otherwise normal, as were routine preoperative laboratory tests that included serum concentrations of sodium of 139 mEq. L-~, potassium of 4. I mEq. L-~, blood urea nitrogen of 13 mg. dl, glucose of 98 mg. dl-i and normal urinalysis. Anaesthesia was induced and maintained with halothane and 50% nitrous oxide in oxygen by mask, and incremental iv doses of fentanyl up to a total dose of 150 I~g. He breathed spontaneously and was stable haemodynamically, while detorsion and orchiopexy were performed without complication. Throughout the operation which lasted for one hour he received 120 ml Ringer's lactate CAN J ANAESTH 1991 / 38:2 / pp225-6

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The course of labour in 22 patients with antepartum fetal death who received epidural anaesthesia was evaluated as compared to 22 controls matched for parity and gestational age, who received narcotic pain relief. Both groups had similar preinduction cervical dilatation and the induction was performed by amniotomy and oxytocin infusion. The mean first stage of labour was 5.4 hours in the epidural group, and 8.7 hours in the controls (p = 0.0192). The mean cervical dilatation rate was 3.3 cm/hour and 1.0 cm/hour respectively (p = 0.0142). The second stage was similar in both groups. We conclude, that parturients receiving epidural anaesthesia may benefit both emotionally and physically from excellent pain relief and a shorter delivery process when going through the distressing experience of delivering a dead fetus.

Background: Patients with arteriosclerotic peripheral vascular disease and lower limb ischemia have painful ulceration or incipient gangrene of the lower limb with intractable rest pain. The arteriosclerotic changes may preclude any surgery other than amputation. Methods:We examined whether chemical sympathectomy could relieve pain, arrest gangrene and postpone amputation, even in diabetic patients.Results: Phenol lumbar sympathectomy was performed on 373 patients, of whom 226 (60.6%) were diabetic. Over 24-120 months of follow-up, 219 patients (58.7%) experienced total relief from pain and healing of gangrenous ulcers, although the treatment was unsuccessful in 154 patients. A favorable result was marked in diabetic patients who had rest pain and in non-diabetic patients who had digital gangrene or digital ulcers. Age and sex did not affect the results but heavy smoking did. Conclusion:Phenol sympathectomy should be considered as an alternative to surgical sympathectomy. Furthermore, the technique may be a precursor to and even an alternative to amputation in patients who have diabetes and advanced arteriosclerosis of the lower limb. journal of Cardiovascular Risk 1995, 2:467-469

We review current concepts about the clinical manifestations, diagnosis and treatment of patients with bronchiolitis obliterans (BO) with emphasis on clinical/pathological correlations and recent developments. BO is a relatively rare disease, but its incidence is probably higher than generally believed and is continuously rising, partly because of better recognition, but also because of increased exposure to industrial fumes, and its occurrence in lung transplantation. BO is characterized histologically by varying degrees of obliteration of the lumen of the respiratory bronchioles by organizing connective tissue often extending into the alveoli ('proliferative' BO with organizing pneumonia-BOOP) or by more extensive fibrosis and scarring of the more proximal, conductive bronchioles ('constrictive' BO). Diverse clinical conditions have been associated with the development of BO, notably viral and mycoplasma infection, toxic fume exposure and immune reactions in the setting of a collagen vascular disease, drug reaction or organ transplantation. The clinical course and features of BO may vary considerably according to the aetiology, histological pattern and stage of the disease. The most common presentation is that of a progressive dry cough and dyspnea, associated with diffuse patchy interstitial lung infiltrates on chest X-ray. In the more advanced cases, lung function tests show either restrictive or obstructive defects, depending on the extent of alveolar involvement, and hypoxemia without CO 2 retention. The diagnosis is often possible on clinical grounds, however, in a seriously ill patient uncertainty should be resolved by tissue diagnosis, preferably by open lung biopsy. Treatment is based on symptomatic therapy. The use of corticosteroids is controversial, but common. Patients with BOOP are exceptional, in that there may be no underlying condition (/ idiopathic / BOOP or cryptogenic organizing pneumonia-COP), a restrictive ventilatory defect is usual and the response to corticosteroids often remarkable.