through the compressed or narrowed portion of the trachea [2]. For this reason, fibreoptic endotracheal intubation is advisable.Ljunghall and colleagues showed that patients with HPT who were apparently asymptomatic preoperatively did not have defects of their neuromuscular transmission that were of clinical significance [5]. In asymptomatic pHPT neither consistent abnormality of neuromuscular transmission nor abnormal muscle structure was found [6]. On the contrary, Al Mohaya and colleagues reported a decreased response to both succinylcholine and atracurium in a patient with parathyroid adenoma [3].In patients there was a decreased duration of action of cis-atracurium. There was recovery of T1 to 25% of control at 26.9 min and repeated doses of cis-atracurium (0.03 mg kg 21 ) administered to maintain relaxation during surgery provided a clinical duration 10.2 6 0.8 min. Wuffel and colleagues reported that recovery index 25-75% and time to a TOF ratio of 0.70 of cis-atracutium were prolonged significantly by sevoflurane compared with total intravenous anaesthesia [7]. However, in our patient, increased minimum alveolar concentration (MAC) of sevoflurane did not result in significant effects on duration of or recovery from the block. On the contrary, recovery was considerably shorter in our patient. Intraoperative electrolytes and acid-base balance status were normal and normothermia was maintained.In conclusion, special attention should be paid to neuromuscular function monitoring in patients with pHPT. References1. Aguilera IM, Vaughan RS. Calcium and the anaesthetist.

Seven men and one woman (aged 20-70 years) with superior vena cava syndrome underwent diagnostic mediastinoscopy to elucidate the cause, which other, lesser procedures had not identified. Intraoperative frozen-section studies of the biopsy specimens revealed small-cell carcinoma (4 cases), large-cell carcinoma (1), squamous-cell carcinoma (1), large-cell lymphoma (1) and Hodgkin's lymphoma (1). Radiotherapy or chemotherapy was initiated within the following 24 hours in six cases. One of the tumors intraoperatively diagnosed as small-cell carcinoma was subsequently reclassified as lymphocytic lymphoma. Complicating hemorrhage from the right carotid artery required median sternotomy in one case and wound infection occurred in another. There was no mediastinoscopy-related mortality. Mediastinoscopy is useful and reliable in the diagnostic emergency posed by the superior vena cava syndrome.

Persistence of congenital bronchoesophageal fistulae into adulthood is rare. Three patients, one male and two female, of 52, 27 and 63 years of age, respectively, are reported. All three presented with chronic respiratory symptoms and coughing spells associated with ingestion. The barium swallow confirmed diagnoses. Treatment was surgical and consisted of excision of the fistulous tract, suture of the oesophageal and bronchial orifices and the interposition of a parietal pleura flap in two cases, and of biological glue in one. All three patients recovered and are free of symptoms.

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