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Since the turn of the century, a remarkable expansion has been achieved in the range and effectiveness of products and strategies available to prevent, treat, and control malaria, including advances in diagnostics, drugs, vaccines, and vector control. These advances have once again put malaria elimination on the agenda. However, it is clear that even with the means available today, malaria control and elimination pose a formidable challenge in many settings. Thus, currently available resources must be used more effectively, and new products and approaches likely to achieve these goals must be developed. This paper considers tools (both those available and others that may be required) to achieve and maintain malaria elimination. New diagnostics are needed to direct treatment and detect transmission potential; new drugs and vaccines to overcome existing resistance and protect against clinical and severe disease, as well as block transmission and prevent relapses; and new vector control measures to overcome insecticide resistance and more powerfully interrupt transmission. It is also essential that strategies for combining new and existing approaches are developed for different settings to maximise their longevity and effectiveness in areas with continuing transmission and receptivity. For areas where local elimination has been recently achieved, understanding which measures are needed to maintain elimination is necessary to prevent rebound and the reestablishment of transmission. This becomes increasingly important as more countries move towards elimination., David Kaslow and colleagues examine the progress in reasearch for diagnostics, drugs, vaccines, and vector control in malaria elimination and eradication and propose a research agenda.

Age and rate of development of the preadult of the Mediterranean fruit fly, Ceratitis capitata (Wiedemann), can be estimated from its eye color by comparison with any color chart that has been standardized with the Hunter colorimeter. For >999 preadults excised from puparia on 1, 2, 3, or 4 d before eclosion (DBE), approximate values of mean eye color ( J ) were 37.50, 23.02, 7.52, or 2.13, respectively. Corresponding rates of pupal development were −5.17, −9.95, −14.73, and −19.50 J per day on 4, 3, 2, or 1 DBE.

1. Four cases of metacarpophalangeal dislocations of the fingers are presented. 2. The trapping elements of the little-finger dislocation are described. 3. With the techique described, open reduction is easy and the reduction is stable and does not require transfixation of the joint. 4. Dislocations of the fifth metacarpophalangeal joint, which cannot be reduced by closed means, can be reduced by open means by a volar approach that avoids blind transection of the fibrocartilaginous plate.

This study examined the inter-judge and intra-judge reliability of interpreting the presence or absence of averaged evoked responses. There is considerable variability on both of these measures. The only conclusion which can be made based on the data in this study is that the judges used in this study are not able to be reliably objective about the responses. If this conclusion is correct and can be generalized, the procedure as described in this study should be used with extreme caution. It would further appear that the procedure lacks a great deal of objectivity when conducted without specific objective criteria.

AROUND the turn of the century in this country the beginnings of specialization in anesthesia were apparent. More than a few physicians began to devote full time to this endeavor, and though nurse anesthetists were on the rise, several of the larger hospitals had appointed physicians to supervise anesthetic practice. This metamorphosis was reflected in Boston, as in other cities, but here perhaps could be discerned the outlines of anesthesiology – a brapch of medicine with a clearly defined clinical responsibility, upon a background of its own scientific interest. While the spark may have flickered and died in Boston, to . . .

With the recent development and distribution of hearing aids incorporated into eyeglasses, there has come an automatic reawakening of interest in providing binaural sound amplification for hard of hearing persons. Although the effort to achieve a practical binaural hearing aid has been long and persistent, it is only in the eyeglass models that many disadvantages and problems seem to have been minimized or eradicated. Mere logical reasoning seems basis enough for the thought that binaural hearing is more satisfactory than monaural; and if one were to give total credence to the claims and inferences of certain hearing aid manufacturers, it would seem that every person suffering from a binaural hearing loss should profit from sound amplification received in both ears. In recent months rather impressive testimonials have been appearing in trade journals supported by hearing aid manufacturers and dealers. 1,2,10,13 Among other things, binaural amplification is reputed to achieve the

IN three patients extremely prolonged renal failure developed after exposure to methoxyflurane (Penthrane). Their course and biopsy findings were unusual and similar enough to suggest a distinct syndrome. Renal failure persisted for several months to over a year on dialysis despite the absence of cortical necrosis. A number of renal abnormalities, ranging from an unusual diuresis to acute renal failure, are well documented as complications of methoxyflurane.1 Prolonged, acute renal failure has also been suggested,2 but this unusual – and extremely important – complication has not been documented in detail. Case Reports Case 1 (PBBH 9–67–09). A 53-year-old man was . . .

ALTHOUGH expected to be increasingly rare, death and a considerable morbidity still follow the aspiration of gastric contents into the lungs in the anesthetic period. The exact rate of occurrence cannot be ascertained, for the accident is not officially reportable except perhaps to obstetric mortality commissions. Every physician probably will recall at least 1 such death in his practice. It is urgent, therefore, to call attention to the problem as being to a large extent preventable, and to narrate the anesthetic experience so far as it may pertain to other fields of medicine. Aspiration occurs in the comatose patient, in . . .

ANESTHESIA for obstetrics is well over a century old, but a review of methods used reveals few innovations in the past fifty years. Nevertheless, progress has been made through increased knowledge ...

A rapid, sensitive method for quantitative determination of octopamine (a biogenic amine found in both vertebrate and invertebrate nervous tissue) has been developed using reversed-phase high-performance liquid chromatography. The biogenic amine is extracted with perchloric acid from tissue homogenates and derivatized witho-phthalaldehyde (OPT) prior to chromatography. Separation of the fluorescent octopamine-OPT adduct from other biogenic amines was achieved using a μBondapak C18 reversed-phase column and isocratic elution with a methanol-(0.08 mol/liter) acetic acid (50∶50 by vol, pH 2.9) mobile phase. A variable wavelength fluorometer with an 8-μl flow cell was used for detection (excitation 340 nm, 418 nm secondary filter). Linearity ranged from 500 pg to 30 ng injected onto the column. Recovery of internal standard added to tissue homogenates averaged 65.4% with a standard deviation of 3.1%. The method has been used for the determination of octopamine in ganglia ofAplysia californica.

Chemical substances migrate outwards from within the body to the skin surface by diffusion from cutaneous capillaries across the epidermis. Heretofore, study of transepidermal chemical emissions have been restricted to substances which are in the vapor phase at skin surface temperature. We have investigated outward transcutaneous chemical migration of nongaseous chemicals by devising an occlusive transcutaneous chemical collection system, consisting of a tape-encased plug of gelled saline in which activated carbon is dispersed. Investigations of nine chemicals in ‘fuzzy’ rats, rhesus monkeys, and man provide data which are consistent with a general theory of outward transcutaneous chemical migration. This noninvasive continuous transcutaneous sampling technique provides a new method for investigating skin permeability in vivo and may provide a basis for convenient diagnosis and monitoring of chemical exposure.

One of the memorable advances in the relief of suffering took place in Boston on October 16, 1846. It was justly celebrated as the first public demonstration of the use of ether for anesthetization during the course of a surgical operation. As a result, the innovator and anesthetist, William Thomas Greene Morton, a dentist, achieved lasting renown. Likewise, a surgeon at the Massachusetts General Hospital, John Collins Warren, professor of surgery at the Harvard Medical Institution and its quondam dean, reaped the rewards for the surgery. Despite the controversy engendered by those who sought credit for this epoch-making occasion, the . . .

This latest volume,Modern Trends in Anaesthesia, represents a departure from the earlier purpose of presenting reports at infrequent intervals of progress in the specialty to anticipation of more frequent reviews on single aspects of topical interest. The first four chapters on nomenclature and presentation of pH data, measurement of pH and pCO2, effects of hypercapnia, and hyperventilation are presented rather well, as they have been written by men productive in these fields. The references are well chosen and authoritative. The succeeding two chapters on acid-base balance in hypothermia and acid-base changes due to cardiac bypass overlap are less lucid—possibly because of the contradictory nature of the work in this area. A section on trends in the biochemistry of anesthesia presents a potpourri of adrenocortical mechanisms, nutrition via the intravenous route, and biochemistry of massive blood replacement, the latter two subjects being controversial and still inconclusive. Nowhere is

IMPROVEMENTS in anesthetic technics have contributed in large part to the advance of cardiac surgery. On the other hand cardiac surgery has progressed so rapidly in the last decade that anesthesia has been hard pressed to keep abreast of the problems presented. Perhaps because of increased knowledge of the physiology of heart disease and the pharmacology of anesthetic agents, the reported results of anesthesia for cardiac surgery have been relatively good.1 2 3 In this clinic a great deal of surgery is accomplished in poor-risk patients, with excellent results. It is the purpose of this report, however, to review some of the . . .

Resembling certain members of the animal species, more than a few new drugs, while demonstrating admirable familial traits, also indulge in streaks of abnormal behavior. The volatile inhalation anesthetics provide no exception to this rule although early in the history of use, their deviations are apt to be concealed in the complications of surgery. Over the last 15 years chemists have concentrated on the synthesis of new halogen-substituted hydrocarbons in an effort to eliminate undesirable features of the primordial anesthetics. The result has been the introduction into clinical anesthesia of several compounds incorporating the most wanted characteristic — inertness, therefore . . .

In the light of recent investigations I have undertaken to re-examine the thesis that prolonged anaesthesia may be shocking Discussion was confined to the pharmacological properties and manner of administration of anaesthetics, although it is recognized that many effects cannot be distinguished from those produced by operation Not only may anaesthetics alter physiology intra-operatively, but their physical properties suggest that retention in the body can extend untoward effects into the postoperative period As an example of postanaesthetic shock the instance was cited of postoperative hypotension refractory to vasopressor drugs Some of the common abnormalities underlying this condition were enumerated, and each subsequently exammed for possible anaesthetic complicity

THE chief dissatisfaction with spinal anesthesia centers about the neurologic complications that are probably indigenous to the method. In an attempt to clarify this problem we undertook a long-term study of this technic.1 The results were encouraging. In 89 per cent of 10,098 spinal anesthetics followed for six months to five years, there was no case of severe progressive neurologic disease. The major share of the lesser sequelae were related to lumbar puncture2 and are largely preventable by a careful technic. Certain minor neurologic defects were noted; none were progressive, and none of any consequence.3 These, too, it is believed, . . .

Excerpt INTRODUCTION Patients with heart disease generally fare well when operated on under present day anesthesia technics.1, 2The postoperative morbidity is higher in cardiacs,3but circulatory ar...

Extensive data indicate that the loss of hearing acuity observed with increasing age may be attributed to presbycusis or to the effects of exposure to noise. The problem of differentiating between these two causes of hearing loss is complicated by the many variables in exposure and susceptibility to noise.In this discussion, the author reviews methods for measuring noise and detecting susceptibility to noise, the types of acoustic trauma, and criteria for judging noxious noise.With the establishment of programs for conserving hearing, the relative effects of noise and age on hearing should be better understood.

• The cardiovascular responses to manipulation of the abdominal viscera were studied in 68 patients undergoing laparotomy. The anesthesia most frequently used was nitrous oxide in combination with ether and other agents, and continuous recordings were made of the pressure in the brachial artery, the electrocardiogram, electroencephalogram, and intrathoracic pressure. The common response, obtained in 55 patients, was arterial hypotension with or without bradycardia. No one area or maneuver could be depended on to elicit this response. It was not explained by purely mechanical factors such as occlusion of veins. It appeared to be a reflex response to the stimulation of localized receptors, which must be assumed to be more frequent in the upper part of the abdomen and on the parietal, rather than the visceral, peritoneum.

"I was proceeding to apply more [chloroform] to the handkerchief, when her lips, which had been previously of good colour, became suddenly blanched, and she sputtered at the mouth, as if in epilepsy. I threw down the handkerchief, dashed cold water in her face, and gave her some internally, followed by brandy without, however, the least effect, not the slightest attempt at a rally being made. We laid her on the floor, opened a vein in her arm, and the jugular vein, but no blood flowed. The whole process of inhalation, operation, venesection, and death, could not, I should say, have occupied more than two minutes." 1 In 1848, thus wrote surgeon T. M. Meggison, who gave the anesthetic, while Mr Lloyd began to excise a toenail from the foot of Hannah Greener, a healthy girl of 15 years. After postmortem examination and the inquest, Sir John Fife, distinguished surgeon

THE inhalation anesthetic fluroxene (Fluoromar, 2,2,2,-tri-fluoro-ethyl vinyl ether), has just been considered hepatotoxic.1 Recently, a patient taking phenobarbital and diphenylhydantoin died of massive hepatic necrosis after fluroxene anesthesia – conditions suggestive of an acquired enhanced sensitivity to the anesthetic.2 Case Report An obese 69-year-old woman with grand-mal epilepsy since the age of 15 that had been effectively controlled with diphenylhydantoin (Dilantin), 300 mg per day, and phenobarbital, 120 mg per day, had also received phenylbutazone (Butazolidin) for osteoarthritis. At 65 years of age a gastric ulcer was treated conservatively. Four months before admission ulcer symptoms recurred, 1 week before she . . .