Atrioventricular block with lidocaine therapy

A case is presented of complete atrioventricular (A-V) block occurring after a 50 mg bolus injection of lidocaine. Base-line studies before administration of lidocaine showed evidence of trifascicular block manifested by complete right bundle branch block, left anterior hemiblock and a markedly prolonged H-V interval. Advanced A-V block and then complete A-V block distal to the His bundle developed after administration of lidocaine. Lidocaine should be used with caution in patients with trifascicular disease; if it is administered to such patients, insertion of a temporary pacemaker catheter should be considered.     

Liver structure and function following small bowel resection

The observation that patients with extensive small bowel resection have impaired hepatocellular function with reduced BSP clearance and fatty change in biopsies from the liver led to a systematic study of liver structure and function following proximal and distal small bowel resection in the rat.While anaesthesia and surgery impaired BSP clearance per se, small bowel resection further reduced BSP clearance with impairment of both uptake and excretion phases of BSP excretion.The increased BSP retention was more marked after distal than after proximal small bowel resection, but in both experimental groups the abnormalities of BSP excretion spontaneously returned to normal three to four weeks after surgery.Circulating liver enzymes were normal but serum alkaline phosphatase was significantly depressed, particularly after distal resection. Isoenzyme studies showed that the depression of serum AP was due to a reduced intestinal isoenzyme. While serum levels remained consistently depressed up to eight weeks after proximal resection, in parallel with mucosal regeneration, serum AP returned to normal two to four weeks after ileectomy.While these minor changes in hepatic structure and function would normally be of little clinical importance, the additional insult of hepatic dysfunction may well be important in malnourished patients after extensive small bowel resection.     

Clinical and hemodynamic aspects of single vessel coronary artery disease

Two-hundred consecutive patients with arteriosclerotic heart disease underwent complete clinical and hemodynamic evaluation. Fifty-two patients (26 per cent) had significant single vessel coronary artery disease and were compared to 148 patients with more extensive coronary artery disease and to a group of 14 normal patients. The single vessel disease group, when compared to the diffuse disease group, was characterized by a shorter duration of angina pectoris, lower frequency of a history of congestive heart failure or cardiomegaly, and a lower frequency of electrocardiographic (ECG) evidence of a transmural myocardial infarction. The combination of angina pectoris for three or more years with cardiomegaly was the only factor which completely separated the two coronary disease groups. Cardiomegaly, when present in single vessel involvement, was always due to left anterior descending (LAD) disease, together with an anterior infarction on ECG and left ventricular asynergy. The single vessel disease group included 32 patients with LAD disease, 17 with RCA, and 3 with circumflex artery involvement. Resting hemodynamics in these 52 patients (other than a higher left ventricular end-diastolic pressure and wall stress) were not significantly different from hemodynamics in a normal group. Patients with diffuse disease were characterized by many hemodynamic alterations and by left ventricular (LV) asynergy, when compared to the single vessel disease or normal groups. The diffuse disease group had a lower ejection fraction (EF) and an increased frequency of LV asynergy and coronary collateral circulation than did the LAD group. In the single vessel disease group LV asynergy did not correlate with the ECG. LV synergy, however, was not found in any patient in the LAD group with abnormal Q waves on ECG. The single vessel disease group included only five patients with increased end-diastolic volume (EDV) and all had LAD involvement, increased LV end-diastolic pressure, and decreased EF. The remaining 47 patients with normal LV-EDV revealed that the LAD group had abnormal pressure-volume relationships, indicating a decreased compliance of the left ventricle.     

Complete right bundle branch block with left axis deviations: significance of vectorcardiographic morphology

Sixty-five patients with a VCG pattern of complete right bundle branch block and left axis deviation (> ?30 degrees) were studied. There were 46 patients with counterclockwise rotation (Group A) and 19 patients with clockwise rotation (Group B) in the horizontal plane. His bundle electrograms were recorded in 24 Group A patients and in four Group B patients.The Group A patients were slightly younger (average age 69 years) than the Group B patients (average age 75 years). The incidence of previous myocardial infarction (Group A $\text{12}\text{46}$, Group B $\text{4}\text{19}$) and hypertension (Group A $\text{13}\text{46}$, Group B $\text{4}\text{19}$) were similar. Diabetes mellitus was slightly more common in Group B (Group A $\text{7}\text{46}$, Group B $\text{5}\text{19}$). Cardiomegaly (Group A $\text{16}\text{46}$, Group B $\text{12}\text{19}$) and congestive heart failure (Group A $\text{13}\text{46}$, Group B $\text{9}\text{19}$) were more common in Group B. Episodes of syncope (Group A $\text{19}\text{46}$, Group B $\text{4}\text{19}$) and prolonged H-Q interval (55 msec. or greater) (Group A $\text{19}\text{24}$, Group B $\text{2}\text{4}$) were more frequent in Group A patients. However, in individual cases there was no definite relationship between prolonged H-Q interval and syncope.It is concluded that this pattern represents a wide spectrum of disease and anatomical defects. The relationship of VCG morphology to clinical course does not appear to be close enough to predict the course of an individual patient or aid in clinical management.     

Action of prolactin on the Harderian gland of the chick

The role of prolactin was explored in the Harderian gland of chicks by histological and karyodynamic investigations. Intramuscular injection of ovine prolactin (10 IU daily for 10 days) induced hyperplasia and hypertrophy in this gland. In addition prolactin possibly increased the secretory activity of the gland. The findings suggest that prolactin stimulates both mitosis and secretory activity in the Harderian gland of chicks.     

Efficacy of various methods in evaluation of eustachian tube function

In the present study 35 patients with preforated and 15 cases with intact ear drums, were studied and eustachian tube function was assessed by Saccharine test. Bortnick-Miller test, and manual impedance audiometry. The merits and demerits of one over the other were evaluated. It was observed thal more than one test when employed provides better information as every test has its own advantages and limitations     

Functional outcome following rehabilitation in chronic severe traumatic brain injury patients: A prospective study

Objective:

The objective was to assess functional outcome of rehabilitation in chronic severe traumatic brain injury (TBI) in-patients.

Setting:

The study was performed at university tertiary research hospital.

Study Design:

A prospective cross-sectional study

Materials and Methods:

Forty patients (34 men) with mean age of 30.1 years (range 6--60, SD 10.8), severe TBI (Glasgow coma scale 3--8, duration of coma > 6 hours, post-traumatic amnesia> 1 day postinjury) were admitted in rehabilitation unit minimum 3 months (mean 7.7±4.6 months, range 3--22 months) following injury falling in Glasgow outcome scale (GOS) of 3. Functional recovery was assessed using the Barthel Index (BI) score and disability rating scores (DRS).

Data Analysis:

Paired Student''s t-test was used for the assessment of functional recovery using mean BI scores at admission and discharge. The Wilcoxon nonparametric test was used for the assessment of functional recovery by comparing admission and discharge DRS scores.

Results:

Mean duration of stay was 30.8 days (range 18--91, SD15.6). Significant functional recovery observed in patients comparing BI and DRS scores at admission and discharge (mean BI admission 50.5±25.4, range 0--85 vs. mean discharge BI score 61.1±25.3, range 0--95, P<0.001, mean DRS admission score 7.57±4.1, range 2.5--21.0 vs. mean discharge DRS score 6.36±4.3, range 1.0-21.0, P<0.001).

Conclusion:

Patients with severe TBI continue to show functional recovery even in chronic phase with rehabilitation. They are left with significant residual physical and cognitive deficits and would require long-term care and assistance from care givers for the daily activities, as suggested by the mean DRS score at discharge.     

Subthalamic deep brain stimulation affects heading perception in Parkinson’s disease

Journal of Neurology - Parkinson’s disease (PD) presents with visuospatial impairment and falls. It is critical to understand how subthalamic deep brain stimulation (STN DBS) modulates...     

Intrapartum Amnioinfusion in Meconium-Stained Liquor: A Case–Control Study

Objective

The aim of this study was to investigate perinatal outcome and the rate of cesarean section (CS) following intrapartum amnioinfusion in women with meconium-stained amniotic fluid (MSAF).

Method

A total of 100 women at term in labor with meconium were randomized to infuse transcervical intrapartum amnioinfusion with saline (50) and routine obstetrical care (50). Perinatal outcome and obstetric outcome were recorded and analyzed in both groups by means of Chi-square test.

Result

The CS rate due to fetal distress was 40.0 % in the control group and 20.0 % in the study group. The difference was statistically significant (P < 0.01). Respiratory distress of the neonate was significantly less common in the study group than in the control group (4.0 % vs. 12 %; P = 0.0349).

Conclusion

Amnioinfusion in cases of meconium-stained liquor significantly improved neonatal outcome and CS rate without increasing any maternal and fetal complications.