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Backgound/aims: The aim of this study was to compare the efficacy and safety of 4% articaine with a mixture containing equal volumes of 2% lidocaine and 0.5% levobupivacaine without hyaluronidase for sub-Tenon's anaesthesia in phacoemulsification cataract surgery. Methods: The study was a prospective, randomised double-masked clinical trial of 65 patients allocated to receive either 4% articaine or a mixture containing equal parts of 2% lidocaine and 0.5% levobupivacaine. All patients had pre- and postoperative Hess charting to document ocular motility dysfunction. Ocular and eyelid movements were scored at 2 min intervals from 2 to 10 min after injection of the anaesthetic agent, and at the end of surgery. Complications related to injection, including pain, chemosis and subconjunctival haemorrhage, were recorded. Patients rated pain (none/mild/moderate/severe) during surgery. The operating surgeon masked to the anaesthetic agent assessed proptosis/chemosis at the start of the operation and the degree of ocular akinesia and analgesia at the end of surgery. Results: The articaine group demonstrated a rapid onset of ocular akinesia with a mean time to readiness for surgery (achieving a score of ⩽5) of 4.0 min compared with 10 min for the lidocaine/levobupivacaine group (p = 0.001). The effectiveness of block was significantly greater in the articaine group at all points (p<0.01). Surgeons rated ocular akinesia to be superior in the articaine group (p<0.001). Patients and surgeons rated the analgesic effect as comparable in either group. Eyelid scores, subconjunctival haemorrhage and chemosis were comparable in either group. Hess chart was performed on all patients pre- and postoperatively. There was no clinically significant motility disturbance in the articaine group, whereas one patient in the lidocaine/levobupivacaine group developed diplopia with abnormal ocular motility on the Hess chart. Conclusion: Articaine (4%) is a safer and a superior anaesthetic agent than a mixture of 2% lidocaine and 0.5% levobupicaine in achieving ocular akinesia for sub-Tenon's block in phacoemulsification cataract surgery. [ABSTRACT FROM AUTHOR]

The role of entrepreneurs in stimulating growth in the small business economy has received significant interest in the last three decades. This growing interest is prompted, in part, by the government's assumption that the establishment and expansion of existing small firms could be greatly enhanced by the promotion of entrepreneurial education programmes in colleges and universities. Whilst there has been significant interest in the role, type and effect of entrepreneurs in the economy, few studies have examined the effect of entrepreneurial programmes on the progression of an idea through to commercialisation. This is because such research, whilst seemingly desirable, is problematic. Evidence can be gleaned through the development of suitable conceptual frameworks and methods, to assess the role and impact of entrepreneurial programmes on the commercialisation of products or processes, and the enhancement of entrepreneurial capabilities. To address this problem, the research will examine different approaches and frameworks that have been developed and applied hitherto. The objective of this will be to highlight the difficulties in assessing the motivations, cognitive and behavioural changes of entrepreneurs. Also, the research will demonstrate the need to undertake adequate controls, which illustrate possible improvement in entrepreneurial capabilities, networks, and credibility in comparison to students that embarked on courses without entrepreneurial elements. The process will confine itself to business development within the higher education (HEI) context. The MSEC has as its remit to provide opportunity, education, awareness and training to foster entrepreneurship within science and engineering departments across four universities in Greater Manchester. This setting will provide a unique situation in which to investigate the development of germinal technology businesses from the inception of an idea to the point of incubation, prototype development and... [ABSTRACT FROM AUTHOR]

Inhaled nitric oxide is a specific pulmonary vasodilator. This study was undertaken to assess the effect on pulmonary arterial pressure of administering 100% oxygen compared with nitric oxide in oxygen. Thirteen mechanically ventilated children undergoing routine cardiac catheterization for the investigation of congenital heart disease were studied. Pulmonary arterial pressures were measured during inhalation of 30% oxygen (baseline), 100% oxygen, and nitric oxide (40 parts per million) in oxygen. In addition, in six children the pulmonary/systemic blood flow ratio and pulmonary vascular resistance were calculated using oxygen content, an assumed value for oxygen uptake, and the Fick principle. Results were compared using analysis of variance and the Wilcoxon signed-rank test. Pulmonary arterial pressure decreased from a mean value of 29.5 mmHg (SD 15.1) to 25.6 mmHg (SD 9.3), p=0.048, after increasing the inspired oxygen fraction from 0.3 to 1.0. The addition of nitric oxide caused a further reduction to 22.9 mmHg (SD 7.9), p=0.0001. There was no change in systemic arterial pressure or heart rate during the study period, but a small increase occurred in the mean methemoglobin level (1.1% to 1.3%) p=0.039. Changes in the pulmonary/systemic blood flow ratio and pulmonary vascular resistance ( n=6) were not significant. Nitric oxide in oxygen appears to be a more potent pulmonary vasodilator than oxygen alone in pediatric patients with congenital cardiac defects. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article on the anaesthetic fluid localisation's real-time visualization after incisionless sub-Tenon block.

Minimisation of radiation exposure with cardiac imaging reduces the potential of secondary side effects. Radiation exposure from myocardial perfusion scintigraphy and computed tomography coronary angiography ( CTCA) was compared. Overall doses were low with both modalities. Doses were lower in the CTCA group, but by only a small difference of 1.1 m Sv. Radiation exposure should not be the primary consideration when choosing between these two modalities. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article that featured the discovery of cannula, a modern anesthesia approach deliver to the sub-Tenon's space published in the previous issue.

A 3 year old child with known pulmonary haemosiderosis suffered acute circulatory collapse secondary to raised pulmonary vascular resistance. Nitric oxide inhalation produced a profound improvement in circulatory parameters and gaseous exchange. Nitric oxide may have a therapeutic role in acute pulmonary hypertensive crisis. [ABSTRACT FROM AUTHOR]

A response by K.G. Allman, A.D. Theron and D.B. Byles is presented to a letter to the editor about their article "A New Technique of Incisionless Minimally Invasive Sub-Tenon's Anaesthesia" in a previous issue of the journal.