Myotonia is an intrinsic disorder of muscle, and not of the peripheral nerve or neuromuscular TABLE I. The myotonias Myotonic dystrophy (dystrophia myotonica, myotonia atrophies, Steinert's disease) Myotonia congenita (Thomsen's disease) "Classical" Thomsen's disease Myotonia fluctuans Acetazolamide responsive myotonia congenita Recessive generalized myotonia (Becker's) Paramyotonia congenita Hyperkalaemic periodic paralysis (adynamia episodica heredita) Acid-maltase deficiency (Pompe's disease) Schwartz-Jampel syndrome (chondrodystrophic myotonia)

We have used mivacurium in four myasthenic patients presenting for thymectomy. Supramaximal single twitch stimulation was applied to the ulnar nerve at the wrist and the force of contraction of the adductor pollicis was measured. After an initial bolus dose of 30 micrograms kg-1 (approximately one-fifth of the normal intubating dose), we observed a mean 37.5 (SEM 5.6)% reduction in evoked twitch tension. Neuromuscular block was increased with incremental doses and maintained with repeat bolus doses of 15 micrograms kg-1 at 25% recovery. The interval between maintenance bolus doses remained constant (mean 5.9 (0.7) min). Spontaneous offset was rapid with a mean recovery index (T25-T75) of 11.9 (2.1) min. Provided anticholinesterase therapy is withheld in the immediate preoperative period, mivacurium would appear to be a safe and appropriate neuromuscular blocker in this variably sensitive group of patients. The cumulative dose required to establish full neuromuscular block varied between 60 and 90 micrograms kg-1. A maintenance infusion, commencing at 3 micrograms kg-1 min-1, is recommended, guided by neuromuscular monitoring.

No abstract

'l'lic-iinniiiil confcrencc of tlic Triitlcs Union Congress, iintl t Iir Prcsiclcntiiil Adclrcss of Sir Jiiincs Jcnns nt tlic nicc!ting of tlic 'ljritish Associiitiori, Iinvc hroiiglit, our iiiintls 1):ick to t lie qiicstioii of iiiicniployn1e11t. i i n t l its ciiiiscs niid tlic possilditics of overcoming this socid evil. With tlic prcsrnt v:ist orniy of workless 0 1 1 t hr Uiicniploynicnt, Registers ivc Iinvr hccoriic too prone to throw iip OW linnds in liorror ns :it. n cii1:imity iinprcccdciitccl iii oiir iintioiinl history. I h t , tlirc ns t.liis cnliiniity is to tliosc niifortinintc I&gs whosc wcckly l\*iigc is rcdiicctl to tlic 1)nrcst sirbsistciicc Icvrl of Uncinploynicnt Insuriiiicc piiy or 'I'rnnsit.ion:il Dcncfit., and 1)iirrlcnsonic ns it is for tlic coiiiiniiiiity to Ilii\*c to siipport in idlcncss so Inrgc ii niiml)cr of ~woplc wlio slioiild properly hc occiipicd in iiicrciisirig riitlicr tiinn tliiniiiisliing iiiitioiiiil ~vcnltli, \vc inlist, not losc sight of the true 1)crq)cctivc of tlic prol)lcin or of its csscnt in1 ii1tiiii:itr solu1)ility.I 1i:it t.licrc 1i:is ncvtbr hcwi so large n niinil)cr of uiicniployccl :is during tlic Iilst fcw yciirs tlicrc ctiii, of coiirsc, l)c no clenyiiig ; Init. surely it is in rchtion to tlic coiirit.ry's ~~~p i i l i i t i o n :IS :t wliolc tliiit we should first consitlcr the problcni wlicn jutlging of its conil)nr:itivc niiignitiitlc. d\tlniittcdly, this is tliflicirlt to 110 wit11 iiny iicciiri~cy since the ciirliest rcgiiliir records ivc Iiiivc to go on iirc t.lic figiircs of n very liniitcci niimhcr of 'I'riitlcs Unions, ~vliicli wr(! lirst kept in 1Sti0, w l i i l c b clcliiiitc ollicinl rccortls were iiot ;iv:iil:iblc iintil i t very iniicli litter dntc. Scvcrtliclcss, \vc do kiimv tlint. i n thc reign of (?II~CII JSlizitbctJi thcrc ivcrc so ninny pcoplc t rniiiping from pincc to plncc i n n starving voiitlitioii, 1ool;iiig for worl; i i n t l tliiit tlic I)rol)lcni of t1c:iling with tlitwi l i d :issiiinctl sircli nlnrining proport ions tliiit. in 1601 tlic Poor ficlicf Act wns piisscd, providing for thc iippointmciit i n cvcry 1~wis1i of "four, tlircc, or t\vo siibstriIit,i:il Iio~iseliolclcrs," to he ciillcd oviwt'crs of thc poor. 11. wns t,hc tliity of thcsc o\'crsccrs, in conjunct ion ivitli t,lic cliurcliwnrtlcns, to set to lvor]; poor pcoplc \vlio 1i:itl 110 liiciilis of subsistcncc,

References