This may account for the transient bronchospam or at least have contributed to it. Postoperatively, there were no thrombotic or respiratory complications, but graft function was delayed for 2 days and he was temporarily dialysed. He is now home and recovering well after a successful transplant. In summary, the pre-operative assessment of Anderson-Fabry disease should concentrate on end-organ damage to the heart, brain, lungs and kidneys. The older the patient, the more likely it is that they will have a significant degree of organ impairment that will require consideration before major surgery. Investigations should include urinalysis, 12-lead ECG, echocardiography, spirometry and a comprehensive renal assessment. Respiratory function should be carefully assessed in those who continue to smoke and pre-operative treatment with hydrocortisone should perhaps be considered. The need for bronchodilators must be anticipated and avoiding drugs and clinical interventions that are commonly associated with histamine release appears sensible. In elective cases we also advocate having a low threshold for noninvasive cardiac stress tests in those > 30 years of age and relevant symptoms.

Left ventricular assist devices (LVADs) provide mechanical support for left ventricular ejection in the failing heart. We describe the anaesthetic management of a patient with an LVAD requiring laparoscopic cholecystectomy. A 51-yr-old female patient with severe heart disease had a Heartmate II LVAD implanted 4 months before this proposed elective surgery. Maintaining haemodynamic stability in the perioperative period is essential in such patients. The case was managed successfully using invasive monitoring and anaesthesia with sevoflurane and remifentanil. The potential problems in management of patients with LVADs are highlighted and discussed. A team approach is essential.

Drs Sarkar, Eipe and Navarange et al. [1-3] raise very interesting points regarding the administration of animal products to patients with certain religious or vegetarian beliefs. As with all belief systems, there is a wide spectrum of adherence to the core tenets of that belief amongst individual followers. For example, some vegetarians eat gelatin-containing food or fish, whilst others, if fully informed of the amount of animal testing involved in drug development and treatment guidelines (drowning, traumatic brain injury care, etc.) may feel uncomfortable receiving any medical care. This means that any changes in anaesthesia practice based on details of patient beliefs would need to be individualised. This could be a good thing, and individualised care is something to aspire to in the National Health Service. As with all changes in practice, however, all aspects need due consideration. The suggested alternative to Gelofusine for vegetarians, Hindus, Muslims and Jews, is Voluven. Currently our hospital pays £5.64 for 1 litre of Gelofusine, and £9.34 for 1 litre of Voluven. Hospitals with large numbers of patients drawn from these groups will need to account for the extra costs involved, though perhaps a small proportion of their overall budgets. Other groups may consider the more far-reaching consequences of their requests. A recent article [4] reports the case of a Jehovah's Witness with life-threatening postoperative blood loss who was given erythropoietin with good recovery after a 24-day stay in the ICU. There have been similar situations in our institution. In recent years, three patients who had refused blood products on the basis of personal beliefs remained in our ICU on erythropoietin for up to 3 weeks. All these cases incurred costs of some tens of thousands of pounds for the prolonged stay in ICU. More importantly, perhaps, our unit has an average bed occupancy of 86%; so the prospect of elective surgical patients needing postoperative ICU being cancelled due to lack of beds is relevant. Indeed, some critically ill patients needing ICU treatment may be subject to the risks of transfer to another centre, the nearest 2 h away, to receive that treatment, because a bed may be occupied by a patient whose personal beliefs prevent him or her accepting the standard medical therapy. We believe that there should be further debate to consider the demands of the individual patient, weighed against the finite resources of the National Health Service.

Nonresonant Raman cross sections of ~10 -16 cm 2 per molecule are shown to be related to surface-enhanced Raman scattering (SERS) on colloidal silver clusters at near-infrared (NIR) excitation. The enhancement is found to be independent of cluster sizes between 100 nm and 20 μm. These experimental findings demonstrate that NIR SERS on colloidal silver clusters is an excellent technique for single molecule detection that is applicable for a broad range of molecules including "colorless" biomolecules, for example nucleotides in DNA sequencing. As an example, we present the detection of a single adenine molecule without any labeling based on its intrinsic surface-enhanced Raman scattering.

Infrared spectra of liquid H2O, D2O, and HDO from 0.7 to 10 μm have been obtained. The H2O spectrum is based on that of natural water, the D2O spectrum on that of heavy water containing approximately 99.6 weight per cent D2O. The HDO spectrum has been deduced from spectra of H2O-HDO-D2O mixtures by application of Beer's law. The spectra are presented in terms of logarithms of both an extinction length, L, the sample thickness that has unit optical density, and the molecular extinction coefficient, ϵ, plotted against logarithms of both wavelegnth and wave number. Vibration mode assignments have been made for most of the absorption bands observed. The spectral data obtained have been useful in the development of infrared monitoring instrumentation and methods of analysis for H2O-HDO-D2O mixtures in connection with the heavy water reactor research programs at the Chalk River Nuclear Laboratories.