No abstract

SummaryThe accurate detection and localisation of retained intraocular foreign bodies (IOFB) is important in the planning of subsequent surgical management. Using a porcine eye model, the authors have compared the relative detection rates of real time ultrasonography and plain roentgenograms for a variety of IOFBs. With an overall detection rate of 93%, ultrasonography appears to be a considerably more sensitive investigative tool than plain roentgenograms (40%) for the imaging of IOFBs, particularly those that are non-metallic.Ocular trauma remains the most common indication for enucleation in the young popu lation and the presence or absence of an intra ocular foreign body (IOFB) significantly affects the management of eyes that might be salvaged.

SummaryThirty healthy patients were randomised to receive either a single bolus dose of rocuronium 0.6 mg.kg-' or vecuronium 0.1 mg.kg-' during halothane anaesthesia. Onset time, duration 25, duration 75 and train-offour 70 were measured. The onset of neuromuscular blockade following rocuronium was more rapid than vecuronium ( p = 0.0001). AN other pharmacodynamic parameters were similar. During the first minute following injection of the neuromuscular blocking agent, the heart rate increased by 36% in the rocuronium group but remained stable in those patients who received vecuronium (p = 0.oooS). No adverse effects were noted in either group.

Metastatic disease to the breast from extra mammary sites is uncommon and has an incidence of 0.5 to 3%. It is important to make an accurate diagnosis as this has an impact on the therapeutic planning and management. Clinically, it can be difficult to differentiate between primary breast cancer and a metastatic disease. An incorrect diagnosis can lead to unnecessary surgical interventions. Immunohistochemistry has a significant role in identifying the primary origin of tumor and has to be considered in the presence of unusual cytologic patterns. We report three cases of metastatic disease to breast from primary lung tumors. The cases demonstrate the difficulties encountered in the diagnosis and the impact on the management of these patients.

Background Bisphosphonates have been shown to be effective agents in the treatment of postmenopausal osteoporosis.Because corticosteroid associated osteoporosis is often associated with increased bone turnover, the effect of intermittent intravenous infusions of pamidronate on this condition has been investigated. Methods Seventeen patients (five male) with chronic corticosteroid dependent lung disease (15 asthma, two sarcoidosis) were treated with infusions of 30 mg pamidronate once every three months for one year. These patients had been taking an average of 14 (range 7-5-40) mg prednisolone a day for an average of 14 (range 3-30) years. Bone density measurements, by dual energy x ray absorptiometry, and radiography of the dorsolumbar spine were carried out before and one year after treatment. Bone formation was assessed by measurement of serum alkaline phosphatase and bone resorption by measurement of the fasting urinary hydroxyproline : creatinine ratio at the same time as densitometry and radiography were performed. Results Pretreatment density of L2-4 and the neck of the femur was significantly lower in these patients compared with a cohort of 100 age and sex matched controls (L2-4 (mean (SEM)): 0-906 (0 050) g/ cm2 v 1-142 (0-016) glcm2; neck of femur: 0 793 (0 030) glcm2 v 0-936 (0-013)) glcm2.After treatment there was a significant fall in serum alkaline phosphatase activity from (mean (SEM)) 220 (16) UII to 174 (9) U/l (normal 80-280 Ul1) and in the fasting urinary hydroxyproline:creatinine ratio from (mean (SEM) 0-040 (0-006) to 0-024 (0-003) (normal <0-033). A significant rise was noted in L2-4 density to 0-927 (0 047) g/ cm2; mean rise of 3-4%). No change was noted in density of the neck of the femur. Conclusions Intermittent infusions of intravenous pamidronate would seem to be effective in both reducing turnover of bone and increasing bone density in corticosteroid induced osteoporosis associated with chronic lung disease. Longer term controlled studies are indicated. (Thorax 1992;47:932-936)