1/5. Profound bradycardia and hypotension following spinal anaesthesia in a patient receiving an ACE inhibitor: an important 'drug' interaction?An 86-year-old man on whom a transurethral resection of prostate was performed under spinal anaesthesia developed profound bradycardia and hypotension with disturbance of consciousness during transfer to the recovery room. Initial treatment with atropine produced rapid improvement in cardiovascular and cerebral function. A further hypotensive episode (without bradycardia) occurred approximately 1 h later but responded rapidly to methoxamine. The patient made a full recovery during an overnight stay on the High Dependency Unit. Possible mechanisms for this event are discussed, with the proposal that the concomitant administration of captopril and the relative unavailability of angiotensin ii may have significantly contributed to the problem.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
2/5. Clinical hyperthermia of prostate cancer using magnetic nanoparticles: presentation of a new interstitial technique.The aim of this pilot study was to evaluate whether the technique of magnetic fluid hyperthermia can be used for minimally invasive treatment of prostate cancer. This paper presents the first clinical application of interstitial hyperthermia using magnetic nanoparticles in locally recurrent prostate cancer. Treatment planning was carried out using computerized tomography (CT) of the prostate. Based on the individual anatomy of the prostate and the estimated specific absorption rate (SAR) of magnetic fluids in prostatic tissue, the number and position of magnetic fluid depots required for sufficient heat deposition was calculated while rectum and urethra were spared. Nanoparticle suspensions were injected transperineally into the prostate under transrectal ultrasound and flouroscopy guidance. Treatments were delivered in the first magnetic field applicator for use in humans, using an alternating current magnetic field with a frequency of 100 kHz and variable field strength (0-18 kA m(-1)). Invasive thermometry of the prostate was carried out in the first and last of six weekly hyperthermia sessions of 60 min duration. CT-scans of the prostate were repeated following the first and last hyperthermia treatment to document magnetic nanoparticle distribution and the position of the thermometry probes in the prostate. nanoparticles were retained in the prostate during the treatment interval of 6 weeks. Using appropriate software (AMIRA), a non-invasive estimation of temperature values in the prostate, based on intra-tumoural distribution of magnetic nanoparticles, can be performed and correlated with invasively measured intra-prostatic temperatures. Using a specially designed cooling device, treatment was well tolerated without anaesthesia. In the first patient treated, maximum and minimum intra-prostatic temperatures measured at a field strength of 4.0-5.0 kA m(-1) were 48.5 degrees C and 40.0 degrees C during the 1st treatment and 42.5 degrees C and 39.4 degrees C during the 6th treatment, respectively. These first clinical experiences prompted us to initiate a phase I study to evaluate feasibility, toxicity and quality of life during hyperthermia using magnetic nanoparticles in patients with biopsy-proven local recurrence of prostate cancer following radiotherapy with curative intent. To the authors' knowledge, this is the first report on clinical application of interstitial hyperthermia using magnetic nanoparticles in the treatment of human cancer.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
3/5. Mental nerve anaesthesia as a result of mandibular metastases of prostatic adenocarcinoma.Three cases of mental nerve anaesthesia as a result of metastatic deposits from prostatic carcinoma are presented. They were referred to Consultant Oral and Maxillofacial Surgeons by alert GDPs. This highlights the fact that dental surgeons must be aware that systemic illness may manifest in the mouth and appropriate referral is essential.- - - - - - - - - - ranking = 1keywords = anaesthesia (Clic here for more details about this article) |
4/5. Technical note: interstitial laser photocoagulation for the treatment of prostatic cancer.Interstitial laser photocoagulation (ILP) is a new percutaneous technique for local ablation of deep-seated tumours. We have applied this to treat a focal abnormality in a patient with prostatic carcinoma, under local anaesthesia and sedation. Transrectal ultrasound and computed tomography (CT) were used to guide three 18G needles, inserted transperineally, into the abnormal area. A thin (0.8 mm outer diameter) optical fibre was passed down each needle, so that the tip of the fibre lay within the tumour. The other end of the fibre was connected to a portable diode laser, which was activated at 2 W for 500 s. Real-time monitoring with ultrasound showed a gradually enlarging echogenic zone around the fibre-tip and a marked increase in colour Doppler signal; the echogenicity and Doppler signal decreased within a few minutes of completing treatment. Dynamic CT treatment 10 days later showed the treated area as a non-enhancing, avascular zone. Biopsies from this region confirmed the presence of necrosis. There were no complications. ILP appears to be a safe and effective way of ablating areas of focal abnormality in the prostate.- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |
5/5. paraplegia following transurethral surgery.We have presented a case of paraplegia following spinal anaesthesia administered for a transurethral prostatic resection. Further investigation revealed a metastatic peridural compressive lesion at the level of T4. We have discussed some of the contributory factors involved, chiefly the lumbar puncture (perimedullary vascular engorgement, alterations in C.S.F. dynamics) and the possible role of intra-operative water intoxication (swelling of spinal cord cells).- - - - - - - - - - ranking = 0.2keywords = anaesthesia (Clic here for more details about this article) |