Malignant hyperthermia (MH) is rarely associated with specific myopathies or musculoskeletal abnormalities. Three clinical investigations of MH associated with either non-specific myopathies or congenital disorders in three separate families are presented. Two of these cases also show evidence of exercise-induced rhabdomyolysis. In each case MH susceptibility was confirmed by in vitro contracture testing of quadriceps muscle. DNA sequence analysis of each kindred revealed the presence of a common novel mutation that results in an arginine401-cysteine substitution in the skeletal muscle ryanodine receptor gene (RYR1). Haplotype analysis using chromosome 19q markers indicated that the three families are likely to be unrelated, providing confirmation that the MH/central core disease region 1 of RYR1 is a mutation hot spot.

Using venous occlusion impedance plethysmography, leg blood flow was measured in seventeen men undergoing transurethral prostatectomy under either amethocaine spinal anaesthesia (SAB) or nitrous oxide-halothane general anaesthesia (GA). Mean leg blood flow doubled (206% of preoperative control value) fol/owing induction of SAB, remained elevated throughout surgery (146% of control at the end of operation) and had returned to pre-operative levels (94%) by two hours postoperatively. Under GA, mean blood flow rose gradually during surgery to 136% of control by the end. However, mean blood flow was only 28% of control at one hour postoperatively, rising to 66% of control by two hours. Analysis of variance showed a significant difference in blood flow changes between the two groups (Greenhouse Geisser P= 0.005). The early postoperative fall in leg blood flow in the GA group might be important in the aetiology of postoperative deep vein thrombosis.

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Perianal fistula (PAF) formation in dogs is a frustrating and painful disease, occurring primarily in German shepherd dogs. Ciclosporin has become the recommended treatment of choice yet may be associated with numerous adverse effects. This case report describes the successful treatment of two cases of PAF with oclacitinib.

We audited the total number of perioperative epidural techniques performed at Christchurch Hospital, New Zealand, for three years, before and after The Lancet published the MASTER Anaesthesia Trial in 2002. We also looked specifically at the number of epidural anaesthetic and analgesic techniques performed in combination with general anaesthesia for colonic surgery over the same period. In both cases we found a statistically significant fall in epidural rate in the years after the publication (P<0.001). A subsequent survey of local specialist anaesthetists, who have worked throughout this period, revealed the majority (75%) were knowingly performing fewer epidural techniques and that the findings of the MASTER Anaesthesia Trial had influenced their decisions.