Arterial oxygenation changes in valvular heart disease patients with cardiomegaly in different recumbent positions

BACKGROUND AND OBJECTIVE

We studied the effect of different recumbent positions (supine, left and right lateral decubitus), on arterial oxygenation in 42 valvular heart disease patients planned for cardiac surgery. All patients had cardiomegaly (cardiothoracic ratio > or = 0.5) in their chest X-rays. Their left ventricular end-diastolic diameter was also noted from the preoperative echocardiogram.

METHODS

Arterial blood gas analysis was performed in supine, left and right lateral positions after keeping the patient in a given position for 15 min. During this period all patients received 35% oxygen supplementation.

RESULTS

Arterial oxygen tension and haemoglobin saturation were significantly higher in the right lateral position (PaO2 = 120.6 +/- 29.5 mmHg, SaO2 = 98.1 +/- 1.4%) than in supine (PaO2 = 111.0 +/- 30.6 mmHg, SaO2 = 97.6 +/- 2.2%) and left lateral positions (PaO2 = 109.7 +/- 32.0 mmHg, SaO2 = 97.6 +/- 1.7%; mean +/- SD; P 0.05). The change in PaO2 and SaO2 with change of posture from left to right was significantly related to left ventricular end-diastolic diameter (r = 0.50 and r = 0.63, respectively; Pearson correlation). Repeated measures of analysis of variance with left ventricular end-diastolic diameter as a covariate showed a significant change in arterial PaO2 with posture (P = 0.011).

CONCLUSION

Right lateral posture improves arterial oxygenation in the valvular heart disease patient with an enlarged left ventricle. In the preoperative period, these patients may benefit from a right lateral posture when lying in bed.

Panniculitis-like T-cell lymphoma with fatal termination

A 58-year-old male presented with three weeks history of multiple subcutaneous nodules and fever. Histopathological feature of the nodule was characteristic of panniculitis. Three months later, the patient presented with carvical lymphadenopathy and compressive thoracic myelopathy and a diagnosis of diffuse mixed- cell lymphoma was established. Immunohistochemical study of subcutaneous lesions confirmed their T-cell origin. Chemotherapy was started but patient succumbed to his disease.

Interaction of radiation- and bleomycin-induced lesions and influence of glutathione level on the interaction

Radiation-induced exchange aberrations are thought to arise as a consequence of misrejoining of free ends of DNA double strand breaks (dsbs). In quiescent mammalian cells this process of misrejoining is prevalently taken up by the non-homologous end joining (NHEJ) process. In order to investigate the role of glutathione (GSH) in DNA dsb rejoining, the interaction of the lesions induced by bleomycin (Blem) and by radiation was studied since the lesions caused by both have similar and apparent rapid rates of repair. Endogenous GSH was depleted by buthionine sulfoximine (BSO) and chromosome aberrations (CAs) of human lymphocytes were scored from first cycle metaphases. Gamma radiation was administered 2 h after Blem treatment in combined studies. In the case of BSO, the treatment was given 3 h before Blem treatment. The BSO-treated samples showed higher sensitivity to radiation than BSO-untreated ones. Combined treatment of Blem and radiation induced higher frequency of CAs, in particular the exchange aberrations and interstitial deletions. However, such increased frequency of exchange aberrations was reduced drastically and the frequency of terminal deletions was increased significantly when combined treatment was given to BSO-pretreated cells. The consistent level of Ku70 protein in all the treated samples, with undetectable level of Rad51 in the G0-lymphocytes indicates the involvement of NHEJ pathway in misrejoining of DNA dsbs. It may be hypothesized that reduction in the frequency of exchange aberrations as induced by Blem + radiation combined treatment in BSO-treated samples could be because of reduced NHEJ pathway.

Dynamics of lithium ions in calcium bismuthate glasses

Ion transport in Li(2)O-CaO-Bi(2)O(3) glasses has been studied in the frequency range from 10 Hz to 2 MHz and in the temperature range from 293 to 543 K. The variation of the dc conductivity and the activation energy of these glasses with composition have been compared with those of binary lithium bismuthate glasses. It has been observed that the introduction of CaO in small amount does not effect the dc conductivity and the corresponding activation energy, but the larger amount of CaO changes them to some extent. The frequency-dependent conductivity has been studied using both conductivity and modulus formalisms. The values of the nonexponential parameter and frequency exponent are found to differ for the Li(2)O-CaO-Bi(2)O(3) glasses from those for the binary Li(2)O-Bi(2)O(3) glasses. The concentration of mobile Li(+) ions does not change appreciably with the change in the Li(2)O as well as CaO content in the compositions. The increasing amount of CaO in the glass compositions for fixed Li(2)O content points out that CaO dilates the glass network, enhancing the migration of Li(+) ions.

Virchows node: rare presentation of childhood hepatocellular carcinoma

Cervical (supra-clavicular) lymphadenopathy may not always be due to tuberculosis in children. Hepatocellular carcinoma in children even may present as supra clavicular lymphadenopathy (Virchow's node).

Guided tactile probing: a modified blind orotracheal intubation technique for the problem-oriented difficult airway

We present 'tactile probing', a guided approach to blind orotracheal intubation to secure a problem-oriented anticipated difficult airway in a 55-year-old male patient scheduled for elective surgical tracheostomy for a postradiotherapy translaryngeal carcinoma. Standard techniques to gain the airway were inapplicable in this case and awake flexible fiberoscopy-aided intubation had already failed.

Management of chronic hepatitis B with New Livfit in end stage renal disease

New Livfit (NLF) is a standardized, poly-herbal formulation that has been found useful in the management of hepatitis. The aim of this placebo-controlled study was to evaluate its usefulness against hepatitis B virus in the patients of end stage renal disease (ESRD). Patients were regularly evaluated at 6, 12, 24 and 36 weeks of therapy. With 36 weeks of treatment of NLF, there was rapid clearing of HBV-DNA in a significant number of patients. Significant seroconversion of the other markers of hepatitis B and restoration of the raised levels of ALT and AST was observed. The study suggests the potential usefulness of NLF in the control of HBV infection in the patients of ESRD prior to renal transplant.

Auditory function following spinal analgesia. Comparison of two spinal needles

BACKGROUND AND OBJECTIVE

Auditory impairment is among the lesser known complications of spinal analgesia. The aim of the present study was to determine the degree of vestibulocochlear dysfunction in patients undergoing spinal analgesia for lower abdominal surgery.

METHODS

Eighty patients who had received spinal analgesia for lower abdominal surgery were studied. Males were undergoing inguinal herniorraphy and the females tubectomy. Audiograms were performed before operation and on the second and seventh postoperative days. Hearing levels were measured from 250 Hz-8 kHz. In Group 1 (n = 40) a 22-gauge, cutting type of spinal needle (Howard Jones) was used. In Group 2 (n = 40) a 25-gauge, non-cutting spinal needle (Whitacre) was used.

RESULTS

Hearing loss >10 dB was noticed in three patients in Group 1 and none in Group 2. The mean hearing level was more reduced in Group 1 patients.

CONCLUSIONS

Use of cutting type spinal needle is associated with a greater decrease in mean hearing levels compared to the non-cutting type.

Monitoring of irrigation fluid absorption during percutaneous nephrolithotripsy: the use of 1% ethanol as a marker

This study was performed in 32 ASA I patients undergoing percutaneous nephrolithotripsy under general anaesthesia, using absorption of 1% ethanol as a marker to monitor irrigation fluid absorption. Various parameters of fluid absorption were studied and compared, including irrigation fluid volume, irrigation time, total volume of irrigation fluid absorbed and the rate of irrigation. The amount of irrigant used vs. the volume absorbed and the volume absorbed vs. total irrigation time were observed. Fluid absorption occurred in 78% of patients, and 28% absorbed volumes in excess of 1 l. The mean volume of fluid absorbed was 696.7 ml. The maximum fluid absorption was observed when the irrigation fluid volume, total irrigation time and irrigation rate exceeded 10 l, 30 min and 200 ml.min(-1), respectively. In conclusion, this study has shown 1% ethanol to be a safe, simple and cost-effective marker of fluid absorption during percutaneous nephrolithotripsy associated with minimal adverse effects.