Systemic lupus erythematosus presenting as acute lupus pneumonitis in a young female

Acute lupus pneumonitis is a rare initial presentation of systemic lupus erythematosus (SLE). We report a 19-year-old female presenting with fever and recurrent hemoptysis with radiological evidence of parenchymal lung involvement with mild pleural effusion. Subsequent development of malar and discoid rash with anti-nuclear antibodies (ANA) and anti-dsDNA positivity clinched the diagnosis. Her clinical signs and symptoms resolved with a course of intravenous pulse methyl-prednisolone along with radiological resolution.KEY WORDS: Acute lupus pneumonitis, hemoptysis, systemic lupus erythematosus     

STABILIZATION OF THORACOLUMBAR SPINAL INJURIES

Spinal Cord injury cases are being managed in Base Hospital Delhi Cantt since Oct. 97. 27 cases of thoracolumbar injuries were admitted in this hospital during the period Oct 97 to Aug 99. 20 patients underwent surgical treatment (9 thoracic and 11 lumbar) and 7 were treated conservatively. All these operations were done within 3 weeks following trauma, and methylprednisolone therapy was instituted in those who reached the hospital early. Contraindications to surgery included stable fracture, bed sores, any focus of sepsis and generalized bone disorders. Transpedicular fixation with Dyna-lok system was done in 10 cases, universal spinal system was applied in 6 cases and Harrington instrumentation was carried out in 4 cases. Decompression laminectomy was done in all cases. Patients with incomplete cord injury showed neurological improvement and early rehabilitation was possible after surgery.KEY WORDS: Harrington instrumentation, Pedicle screw and plate, Spine trauma, Thoracolumbar fractures     

Cognitive impairment after transurethral resection of the prostate (TURP)

Purpose: It has been suggested that cognitive impairment may occur following transurethral resection of the prostate (TURP) operations due to the effects of anaesthesia or hyponatraemia or both. The aim of the study was to investigate whether TURP was associated with long-term memory complaints or cognitive impairment. Method: Patients who had received a TURP or transurethral resection of a bladder tumour (TURT) in the previous 10 months were sent a questionnaire on memory problems and mood. Seventy-six TURP patients and 38 TURT patients returned the completed questionnaires. A sample of each patient group (30 TURP, 29 TURT) was assessed on standardized tests of cognitive abilities. Results: There was no significant difference between the TURP and TURT patients on the Everyday Memory Questionnaire completed by themselves or by a family member (p?>?0.05). On formal cognitive testing there were no significant differences between the groups, except on the overall grading of the Kendrick Assessment Scales of Cognitive Ageing, in which TURP patients performed at a significantly lower level than TURT patients. Conclusions: The results suggest that patients are no more likely to complain of memory problems following a TURP than with any other operative procedure. There was a slight difference in cognitive abilities but this did not indicate significant impairment of cognitive function.     

Anticonvulsants in central pain

Treatment of central neuropathic pain (CP) following lesions of the CNS is a great challenge to the clinician. Preclinical and clinical studies indicate that neuronal hyperexcitability in damaged areas of the central nervous system plays a major role in the development of CP. Anticonvulsants are thought to act by increasing gamma-aminobutyric acid-mediated inhibition, decreasing abnormal neuronal hyperexcitability by modulating sodium and calcium channels or by inhibiting excitatory amino acid actions. The resulting inhibition of excess neuronal activity is thought to be the basis for the use of anticonvulsants in epilepsy as well as neuropathic pain. Both first-generation anticonvulsant drugs (e.g., phenytoin, benzodiazepines, valproate and carbamazepine) and second-generation anticonvulsant drugs (e.g., lamotrigine, gabapentin and topiramate) are used in CP conditions. However, few randomised controlled trials on the treatment of this condition have been published. Present suggestions for anticonvulsant treatment of CP are lamotrigine as the first choice, followed by gabapentin or carbamazepine/oxcarbazepine. These compounds are considered as effective as the antidepressant amitriptyline.