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Althesin anaesthesia alone had no significant effect on plasma cortisol concentration. When Althesin induction was followed by maintenance with N2O and halothane there was a statistically insignificant fall, but with N2O, pancuronium and I.P.P.V there was a tendency for plasma cortisol concentrations to rise. This, too, was statistically not significant. A significant elevation in the mean plasma cortisol concentration was only found in patients during abdominal surgery.

A review of 1,784 aspiration curettages of the endometrium in the office is presented. Thirty-eight adenocarcinomas of the endometrium were found and either adenomatous hyperplasia or atypical adenomatous hyperplasia was discovered in 105 cases. A malignant or premalignant condition was found in 9.2 per cent and diagnostic accuracy, as judged by long-term follow-up, was very good. Insufficient material for diagnosis was only rarely encountered and did not present diagnostic difficulty. This procedure is highly recommended for office evaluation of the endometrium.

Since surgeons rarely write articles about simple minor operations that are easily performed in the office, there is a great reliance on techniques learned in medical school or from other surgeons. Some of these techniques are cumbersome and make relatively major procedures of operations that can be performed quite simply.

Internal hemorrhoidectomy by elastic ligation is employed at Cleveland Clinic Foundation for the symptoms of annoying prolapse and/or painless anal bleeding in patients who have normal bowel function or who have irritable bowel under optimal management instruction. Results of this treatment in 286 patients selected at random are reported. The procedure was well accepted by more than 75 per cent of the patients, and two thirds of them reported little or no discomfort. Time lost from work was a small fraction of that which would have resulted had conventional excisional treatment been employed instead.

300 patients have been treated under a system of outpatient management for hernia, stripping and ligations of varicose veins, and operations of equivalent severity. The crux is close cooperation between hospital staff, general practitioner, and district nurse. Early follow-up shows a complication-rate of 10%, the main complications being delayed wound healing (4%) and chest infection (3%). Discharge from hospital had to be delayed for 24 hours or longer in 9 cases (3%) and a further 5 (2%) required to be readmitted. There were no serious complications. The withdrawal of less serious cases from the inpatient milieu has repercussions which demand a greater concentration of staff and resources for the care of the seriously ill. Provided that patients are carefully selected for outpatient surgery this is a highly satisfactory method of management which is feasible, safe, and efficient.

Summary Causes of scar formation following incision and drainage of an abscess have been discussed and a new surgical technique which has been illustrated by diagrams and documented by clinical case reports has been recommended. It is suggested that whenever the skin changes are noted at the most dependent part of the abscess, an incision at the centre should be avoided and drainage should be accomplished by approaching the abscess through the periphery via normal skin. Evacuation of the purulent material through the proper surgical approach, with prompt removal of the cause, leads to complete recovery without loss of time and without tissue deformity at the site of incision and resulting in minimisation of scar formation at the site.

Apneic oxygenation was studied in 13 patients undergoing Jako-Laryngoscopy with a pharyngeal catheter fur oxygen administration and 18 patients having minor surgical procedures with a cuffed endotracheal lube in place for oxygen administration. Arterial Poz,Pcoz, and pH, functional residual capacity

The traditional domain of the operating room nurse is the operating room suite in a hospital. But recent advances in health care delivery are changing this. Today the OR nurse may be working in a nonhospital facility offering outpatient surgery and postanesthesia observation. This article describes our experience as OR nurses at Surgicenter, an independently owned outpatient surgical facility in Phoenix.

Prior research on the treatment of phobias and the psychological preparation of children for operations suggested that the stressfulness of anesthesia induction might be ameliorated by a short motion picture showing children behaving calmly during induction. This was tested in a controlled experiment with 38 children undergoing minor elective operations. The anesthetics employed were standard combinations of halothane, nitrous oxide, cyclopropane and oxygen. Children who saw the film shortly before leaving for the operating room were judged to be significantly less upset than the controls while waiting to enter the operating room and while being readied for induction. The differences between the two groups during the induction itself were negligible.

An attempt has been made to emphasize the importance of a neurologic complication of minor surgery. In the later decades of life the decreased adaptability and the presence of arteriosclerosis may be well tolerated until the patient is faced with the need of adjusting to a group of factors, each tending to contribute some degree of transient cerebral anoxia. The effect of these various stresses is cumulative and their sum total is capable of resulting in acute cerebral vascular insufficiency. Based on the physiologic changes involved, certain measures are suggested which would seem to lessen the risk of anoxic damage to the brain. As new drugs and technics steadily increase the human life span, physicians have a vital responsibility to try to keep the added years as free as possible of disabling neurologic symptoms. State hospitals filled with elderly patients who are psychotic due to cerebral vascular damage cannot be considered a tribute to medical progress. Until the problem of preventing the development of arteriosclerosis and hypertension is solved, no practical clinical means of postponing their effects even temporarily should be overlooked.

SUMMARY The blood concentration of Marcaine® after axillary nerve blocks, intercostal nerve blocks and lumbar epidural anaesthesia was determined in man. The blood concentration remained low when Marcaine was injected with adrenaline. Slow onset and long duration of anaesthesia coincided well with a slow increase to peak concentration, low peak concentration and slow decrease thereafter. ZUSAMMENFASSUNG Nach der Vornahme von Nervblockaden, axillar und intercostal, sowie lumbalen Epiduralanaesthesien wurde die Blutkonzentration von Marcain beim Menschen bestimmt. Wenn Marcain gemeinsam mit Adrenalin injiziert worden war, blieb der Blutspiegel niedrig. Langsamer Wirkungseintritt und lange Dauer der Anaesthesie waren in guter Ubereinstimmung mit dem lang-samen Anstieg zur Hochstkonzentration, der niedrigen Hochstkonzentration und dem langsamen anschliessenden Abfall derselben.

The effect of surgery, antiarrhythmic drugs, and atrial pacing on the atrioventricular conducting system was studied in 39 patients with bifascicular block. Twenty-nine patients underwent 38 operations, 23 of which were major. A temporary cardiac pacemaker was inserted prior to surgery in 13 cases. The remaining 25 operations were performed without prophylactic pacemakers. In no patient did heart block develop either during surgery or in the first postoperative week. Twelve patients with bifascicular block received digoxin and either quinidine or procainamide in the usual doses. In none was exacerbation of the atrioventricular conduction defect observed. Ten patients had His bundle recordings during atrial pacing performed at gradually increasing rates until second degree heart block developed. Only two patients developed atrioventricular block at pacing rates below normal, one proximal and one distal to the His bundle.

The use of dermabrasion for correction of acne scarring and treatment of actinic damaged skin is well known. The usefulness of this type surgery for the treatment of other conditions like seborrheic keratoses, lentigines, milia, tattoos, and superficial scars is explained.

1. Seventy patients with hypertension were subjected to postpartum curettement. 2. The essential hypertensive patients showed no improvement in blood pressure reading. 3. Forty-six of the 54 patients in the "pure" toxemic groups had a good response in blood pressure to normotensive levels. 4. Three of 8 patients with essential hypertension with superimposed toxemia had prompt return of blood pressure to prepregnancy levels. 5. No complications have been reported in this group except for excess vaginal bleeding in 4 patients. 6. This study tends to substantiate Hunter's 4 report.

Hypnosis has a limited place as a form of anaesthesia for minor surgical procedures. In a series of forty cases, no patient had previously been hypnotized or conditioned in any way, and a sufficient depth of trance was obtained in thirty-eight cases. The advantages and disadvantages of hypnosis are discussed.

General anaesthesia in the early stages of pregnancy may carry an increased risk of embryotoxicity. One hundred and six women scheduled for non-emergency surgery were interviewed preoperatively and their menstrual history taken. Forty-three (41 per cent) were considered to be using adequate contraceptive therapy. Thirty-one (29 per cent) of the patients could have been in the early stages of pregnancy, and of these women, 19 (61 per cent) were undergoing surgery of a minor nature. Simple history taking identified the women “at risk” and it is suggested that surgery could have been delayed without detriment in many cases.