SummaryIn two randomised, double-blind studies of elderly patients with a mean age of 68.9 (range 21-88) years and young patients, mean age 29.4 (range 20-40) years, the effect of needle size on the incidence of postspinal headache was compared. The two needle groups, 20-and 25-gauge, were Headache is a common complication of spinal analgesia and depends on posture. Any attempt to sit or stand elicits a severe and often circumferential headache, which is relieved by lying down. This postspinal headache seems to be related to subdural hypotension attributable to a continued leakage of cerebrospinal fluid (CSF) though the dural hole made by the needle. ' The reported incidence varies widely, between 1.2% and 46%.'-13 It is suggested use of small-diameter needles is followed by a lower incidence of headache and therefore fine-gauge needles are generally recommended. However, only one of these studies was performed in a randomised, double-blind fashion.The purpose of the present studies was to evaluate the effect of needle size on the incidence of postspinal headache in young and old patients. Both studies were designed as randomised, double-blind trials. Study 1 involved a homogeneous groop of patients who were admitted for elective total hip replacement, while study 2 involved a homogeneous group of young patients between the ages of 20 and 40 years, who all were mobilised on the first day after operation. MethodsThe two studies involved 400 consecutive patients. The inclusion criteria for study 1 was admission for elective total unilateral hip replacement, while for study 2 patients had to be aged between 20 and 40 years and admitted for either elective or acute orthopaedic, lower abdominal or urogenital surgery. Exclusion criteria were any contraindication to local analgesia, migraine or chronic headache and request for general anaesthesia. The patients were randomly allocated in a double blind manner to either a 20-gauge (Mediplast) or a 25-gauge (Vygon) needle group. All patients were visited before operation by one of the authors. The possibility of postspinal headache was not mentioned during this visit and the nurses in the wards were instructed not to inform the patients. The authors as well as the patients were blinded with respect to needle size.Premedication consisted of diazepam 5-1 5 mg orally. Spinal anaesthesia was performed by the department anaesthetists, but did not include the authors. The midline approach in the third or fourth lumbar interspace was used with the patient in the lateral recumbent position. Four millilitres of isobaric plain bupivacaine 0.5% was used throughout. The needle was then withdrawn and the patient immediately turned supine. Ephedrine 50 mg was injected intramuscularly in all cases. An intraveneous infusion was established before dural puncture and one litre of saline given during surgery. Peroperatively sedation in the form of phenobarbitone 50-100 mg intravenously was given if required. The patients in study I were interviewed by one of the authors on the fourt...

To investigate the relationship of hemoglobin A1c (HbA1c) to average blood glucose concentration and to birth weight of infants of diabetic mothers, HbA1c was determined in 42 consecutive insulin-dependent pregnant diabetic women in the third trimester. HbA1c correlated significantly to the average blood glucose levels in the preceding 8 wk (r = 0.73, P less than 0.001). No correlation was found between HbA1c and the relative birth weight ratio (RBWR) for all newborn infants. However, in the major subgroups of pregnancies, White class B and C without prognostically bad signs in pregnancy (PBSP), HbA1c in the third trimester significantly correlated to RBWR (r = 0.59, P less than 0.01). In a subgroup of six pregnant diabetic women in whom HbA1c and blood glucose concentrations frequently were determined from the 13th to the 33rd gestational week, a relationship between HbA1c and the average blood glucose concentration of the preceding 8 and 12 wk in the individual pregnant subject was established. In spite of this correlation, HbA1c was found to be a poor predictor of the average blood glucose concentration in the individual patient. This indicates that HbA1c cannot satisfactorily describe the degree of diabetes control without simultaneous determinations of blood glucose. HbA1c determinations were found to be of value as an additional indicator of the quality of regulation during ambulatory control in diabetic pregnancy because an increase in HbA1c suggested an impairment of diabetic control. The perinatal mortality and morbidity of the infants of diabetic mothers were satisfactory in this series, as only one perinatal death, one nonserious malformation, and two cases of mild respiratory distress syndrome occurred among the 43 infants.

A case of primary endometrioid carcinoma in endometriosis in an operation scar is described.

Megavoltage radiation therapy and radical prostatectomy are at present the only curative treatments for prostatic carcinoma. Because a high complication rate appeared to follow radiotherapy, all patients with prostatic carcinoma presenting to a Danish provincial hospital between 1975 and 1980 were reviewed. Of 31 radiation-treated patients, 23 had serious complications. No recurrence was noted in eight patients. Twenty-three had a recurrence despite radiotherapy but 11 of these patients had no local recurrence. In view of the high level of complications following radiation therapy and the high incidence of latent carcinomas in the prostate gland, a cautious approach to radiotherapy is recommended.

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