The haemodynamic effects of diisopropyl phenol in cremophor EL at infusion rates of 50-55 and 100 micrograms kg-1 min-1 in combination with inhalation of 67% nitrous oxide have been studied during spontaneous and controlled ventilation in patients premedicated with morphine and atropine. Under all the conditions studied diisopropyl phenol supplementation of nitrous oxide anaesthesia was associated with a decreased arterial pressure (-20% to -31%) compared with the awake patient, related to a decrease in cardiac output (-27% to 29%) and an increase in systemic vascular resistance (+8% to +30%) during surgery, but to a decrease in cardiac output (-19%) and a decrease in systemic vascular resistance (-17%) during anaesthesia without surgery. Doubling the infusion rate of diisopropyl phenol caused no significant haemodynamic changes during either spontaneous or controlled ventilation. The haemodynamic manifestations of sympathetic nerve activity in response to laryngoscopy and intubation were poorly suppressed by diisopropyl phenol.

Artifical penile nodulesSir, A male 26 year old Filipino attended for non-specific urethritis. On examination of the genitalia, apart from urethritis, there were two nodules proximal to the glans penis which were soft in consistency. The patient related that these nodules were pieces of plastic which had been implanted one year before in Thailand. The patient was happy with them as they caused no discomfort.Implantation of beads under the penile skin to enhance coital excitement and orgasm of the sexual partner is common in the Far East and South East Asia.' Foreign bodies such as stones, plastic beads, glass and pearls are used for this purpose. They are known by different names such as 'bulletus' and 'chagan balls'.2 The number of objects implanted may vary from two to five and, usually, they cause no harm to the penis.

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Summary Thirty‐five patients were delivered by elective Caesarean section under general or epidural anaesthesia. For postoperative analgesia they received narcotic analgesics as required and either transcutaneous nerve stimulation or an inactive stimulator. The patients receiving an active stimulator following general anaesthesia had significantly less pain and required significantly less postoperative analgesia than their control group. The epidural patients did not receive any additional benefit from active stimulation, but had the same amount of pain and the same analgesic requirement as patients receiving active stimulation following general anaesthesia. The possible causes for the failure of transcutaneous nerve stimulation after epidural anaesthesia and their implications are discussed.