The eating disorders literature has focussed on females and little is known of the male experience. The overall image this has generated suggests a young woman in conflict with socio-cultural pressures which associate thinness with beauty. Historical studies have examined anorexia nervosa from an entirely female focus while ignoring how diagnostic categories have shaped approaches to the male body. This paper will track the case of the male with anorexia nervosa through changing theories of causation and treatment approaches, from when the condition first emerged in 1873 to the present. In doing so, we gain a valuable new insight into how anorexia nervosa has been historically gendered and the far-reaching implications this has had for diagnosis and treatment of the male sufferer.Similarities between the sexes helped to establish male anorexia as a distinct category. However, this shifted focus away from important differences, which have yet unexplored implications in the assessment, diagnosis and management of disordered eating. Throughout history, there has been constant pressure to give a precise definition to anorexia nervosa, despite being fraught with medical uncertainties. This has resulted in inevitably harmful generalisations rooted in the dominant epidemiology. This paper reveals that anorexia nervosa is a truly global phenomenon which cannot be adequately constructed through exclusive studies of the female. There is consequently a pressing need to address the dearth of research examining eating disorders in males.

A best evidence topic was constructed using a described protocol. The three-part question addressed was: In patients undergoing cardiac surgery, does intravenous lidocaine exert a cardioprotective effect against postoperative myocardial ischaemia and reperfusion injury? Using the reported search, 461 papers were found, of which 5 studies represented the best evidence to answer the question. In 3 studies, lidocaine was associated with a postoperative fall in biomarkers of myocardial injury. An additional study lacked power, but the difference in biomarkers was marginally non-significant with a trend in favour of lidocaine. A final study evaluating ischaemic changes on continuous and 12 lead ECG found no benefit with lidocaine. The limited evidence suggests that lidocaine may be cardioprotective, although no study has demonstrated improvement in clinical outcomes. Furthermore, all trials were small studies with a multitude of dosing regimens in heterogenous patient populations. There is insufficient data to correlate dose with effect and not all studies measured plasma lidocaine concentration. The narrow therapeutic index and our current evidence base does not support lidocaine prophylaxis.

Recently, there has been increasing interest in alternative anesthetic and analgesic methods to the commonly used technique of local anesthetic wound infiltration and opioids including the utilization of truncal blocks. This is primarily due to the advanced degree of systemic disease inherent in patients who need S-ICD placement, increasing the risks of analgesic management primarily based on opioid therapy, such as bradycardia and respiratory depression, and our case correlates with at least one previous report. 1 The serratus block is a novel fascial plane block that targets the lateral cutaneous branches of T2-T12 intercostal nerves. 3 However, the serratus block does not anesthetize the anterior cutaneous branches of the intercostal nerves 4 ; therefore, a transversus thoracic plane block was added for the S-ICD placement to provide sufficient analgesia to the area around the sternum. We have since successfully performed a series of such blocks for S-ICD placement and plan a retrospective study to further understand the utility and reproducibility of using such blocks across a wide spectrum of patients. Our preliminary results indicate an increased role for truncal nerve blocks in cardiac procedures.

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