Thoracic epidural anesthesia for modified radical mastectomy in a patient with cryptogenic fibrosing alveolitis: a case report

A case of advanced cryptogenic fibrosing alveolitis (CFA) with multiple bullae and extensive pulmonary fibrosis, scheduled for modified radical mastectomy for carcinoma of breast, is presented. This patient had ischemic heart disease, corticosteroid-induced hypertension, diabetes mellitus, and a difficult airway. Thoracic epidural segmental anesthesia was successfully given to this patient. Preoperative problems, perioperative management, and alternative anesthetic techniques are discussed.     

Tranquilizing,antihistaminic and purgative activity of Nyctanthes arbor tristis leaf extract

The decoction of the leaves of Nyctanthes arbor tristis Linn. (Harsingar) is widely used in Ayurvedic system of medicine for the treatment of sciatica, arthritis, fevers, various painful conditions and as laxative. In the present investigation, the water soluble portion of the alcoholic extract of the leaves was screened for some CNS activities (viz. hypnotic, tranquilizing, local anaesthetic, hypothermic, anticonvulsant), antihistaminic and purgative activities. The extract produced general depression of spontaneous motor activity, significantly increased pentobarbitone sleeping time though it had no effect on righting reflex. Furthermore higher doses of the extract abolished CAR without affecting motor coordination. Moreover the extract exhibited hypothermic effect and protected guinea pigs from histamine aerosol. These activities are common to major tranquilizers and support the usage of the plant by Ayurvedic physicians in aforementioned conditions. In addition significant purgative activity was also exhibited by the extract.     

Evaluation of Muscle Strength Among Different Sports Disciplines: Relevance for Improving Sports Performance

A pilot cross-sectional study among 262 service sportsmen belonging to different sports disciplines was carried out to evaluate various indicators of muscle strength, such as peak torque, peak torque to weight, time to peak torque, maximum power, explosive work etc., using isokinetic testing during flexion and extension of the knee joint in sitting positions at different angles. It was found that peak torque varied significantly among the various sports disciplines depending on the requirement of each sports discipline (p < 0.01). The relevance, advantages and limitations of the tests to enhance sports performance have been discussed. However, discussion has been restricted to review of western literature on the subject as no Indian studies in the field were available for comparison.Key Words: Isokinetic testing, Muscle strength, Peak torque, Sports     

An unusual cause of visual impairment in tuberculous meningitis

Impairment of vision is a devastating complication of tuberculous meningitis which may occur as a result of increased intracranial pressure, compression over the visual pathways or vasculitis. We herein present occurrence of neuroretinitis in a 35-year-old lady presenting with low grade fever and headache for one month, and associated with diminution of vision from 3 weeks. She was diagnosed as a case of definite tuberculous meningitis and initiated on anti-tuberculous treatment as per WHO guidelines with supplemental corticosteroids. Marked improvement in vision was observed and at 3 months of follow-up the patient was asymptomatic. Direct ophthalmoscopy, visual field analysis, fluorescein angiography, optical coherence tomography and magnetic resonance imaging of the brain were done to document the ophthalmological findings. Neuroretinitis, being an unusual cause of visual impairment in tuberculous meningitis, must be considered in patients without any evidence of raised intracranial pressure or compression, and with normal fluorescein angiography. We suggest that neuroretinitis may be added to list of causes of visual impairment in patients with tuberculous meningitis.     

Complete Transposition of Great Arteries with Cor Triatriatum: An Unusual Coexistence

The combination of complete transposition of the great arteries and cor triatriatum is extremely rare. We report three infants with this rare combination and discuss the anatomic details apparently unique to the combined lesion.     

Congenital myotonic dystrophy

Myotonic muscular dystrophy is the most frequent autosomal muscular dystrophy affecting adults and children. It affects multiple organ systems and is probably the best example of variable expressivity in a human disease. This article presents a patient with congenital myotonic dystrophy who had facial dysmorphism, hypotonia, talipes, feeding and respiratory difficulties in the neonatal period and later presented to us with developmental delay and had percussion myotonia. His mother had clinical and electrophysiological features of myotonia. Expansion of unstable CTG trinucleotide repeat in the myotonic protein kinase gene was demonstrated in both. The identification of this molecular defect allows its specific diagnosis in relation to other neuromuscular disorders as well as accurate prenatal diagnosis.