Effect of alpha 2u-globulin on serum concentration of gonadotrophins and testicular activity in oestrogen-treated rats

Adult male rats were given injections of oestradiol-17 beta (50 micrograms/100 g body wt per day) for 7 days. When they were killed 14 days after the last injection, serum levels of gonadotrophins and testosterone and weights of accessory sex organs were less, testicular 17 beta-hydroxysteroid dehydrogenase (17 beta-HSD) activity was suppressed and spermatogenesis was inhibited. Administration of alpha 2u-globulin (1.5 mg/day) for 14 days to oestrogen-treated rats and for 10 days to control rats resulted in increased concentrations of gonadotrophins and testosterone in the serum. Accessory sex organ weight and spermatogenesis appeared to be normal while 17 beta-HSD activity increased in oestrogen-treated rats after treatment with alpha 2u-globulin. It was concluded that alpha 2u-globulin has an effect on testicular function in oestrogenized rats by inducing gonadotrophin and testosterone synthesis.     

Efficacy and toxicity of intermediate-dose amphotericin B lipid complex as a primary or salvage treatment of fungal infections in patients with hematological malignancies

We treated 74 adults with a hematological malignancy and documented or suspected invasive fungal infection (IFI) with amphotericin B lipid complex (ABLC) at 3 mg/kg/day. Forty-five patients (61%) received upfront therapy and 29 patients (39%) received salvage therapy for their IFI. Forty-eight of 71 evaluable patients responded [complete responses in 40 (56%) and partial responses in 8 (11%)] and 15 (21%) died as a consequence of the IFI. Response rates in invasive aspergillosis were 33 out of 49 (67%) for probable/definite cases and 6 out of 11 (55%) for invasive candidiasis. In 40 patients with neutropenia-associated IFI, rapid neutropenic recovery ( < 10 days from study entry) was essential for response to therapy (90% vs. 32%, P < 0.01). Treatment was well tolerated, with 15% infusions followed by infusion-related adverse events, nephrotoxicity in 7% of patients and 11% of withdrawals due to toxicity. These data suggest that intermediate-doses of ABLC may be of similar efficacy than higher doses with less toxicity, making it a cost-effective alternative worthy of study in future trials.     

Intubating laryngeal mask for airway management in lateral decubitus state: comparative study of right and left lateral positions

Background. The intubating laryngeal mask has been used forthe emergency management of the airway in patients placed inthe lateral decubitus position. We have conducted this prospectivestudy to compare the feasibility of placement of an intubatinglaryngeal mask and blind tracheal intubation guided by the intubatinglaryngeal mask in patients placed in the right and the leftlateral positions. Methods. A total of 82 adults of both sexes with normal airways,scheduled for cholecystectomy, were allocated randomly to beplaced in either the right (n=41) or left (n=41) lateral positionfor the insertion of an intubating laryngeal mask and blindtracheal intubation guided by the intubating laryngeal maskunder balanced general anaesthesia. A sequence of standard manoeuvreswas performed after each failed attempt at intubating laryngealmask placement and intubation. Results. The intubating laryngeal mask was placed in all patientsat the first attempt. Ventilation of the lungs through the intubatinglaryngeal mask was possible in 40 patients (97.5%) from eachgroup after the first attempt at insertion (P=1). Followingadjustments, adequate ventilation could be achieved in all patients.The first attempt success rates of blind tracheal intubationwere 85.3% (35/41) and 87.8% (36/41) in the right and left lateralgroups, respectively (P=1). The remaining patients from bothgroups (except for one patient in the left lateral group whohad a failed intubation) were intubated at the second attempt. Conclusion. Insertion of the intubating laryngeal mask and blindtracheal intubation through it in the lateral position is feasiblein patients with normal airways. These procedures have a highand comparable success rate when patients are placed in theright and left lateral positions.     

Fluoroscope-aided retrograde placement of guide wire for tracheal intubation in patients with limited mouth opening

Passing a retrograde catheter/wire into the pharynx througha cricothyroid puncture can facilitate tracheal intubation indifficult situations where either a flexible fibre-optic bronchoscopeor an expert user of such a device is not available. Some mouthopening is essential for the oral and/or nasal retrieval ofthe catheter/wire from the pharynx. Two patients with temporo-mandibularjoint (TMJ) ankylosis and extremely limited mouth opening requiredgap arthroplasty of the TMJ under general anaesthesia. Becausewe did not have a flexible fibre-optic bronchoscope, we performedfluoroscopy-assisted nasal retrieval of the guide wire passedup through a cricothyroid puncture and subsequently accomplishedwire-guided naso-tracheal intubation. In the absence of a flexiblefibre-optic bronchoscope, this technique is a very useful aidto intubation in patients with limited mouth opening.     

A comparative study of common ear morbidity pattern among the primary school children of an urban slum of Kolkata and rural area of Hooghly

A cross-sectional, clinical and epidemiological study was undertaken among 627 primary school children (rural 145, urban 482) to compare the common ear morbidity pattern between an urban slum of kolkata and a rural area of Hooghly. Middle ear pathology was found to be present in 20% and 12.6% among rural and urban students respectively. Cerumen in the external auditory canal was the commonest clinical finding in both the areas and was found to be present in 35.86% of rural and 30.70% of urban population respectively. Smoke nuisance, bathing in open ponds and overcrowding were some of the predisposing factors causing ear diseases, like chronic suppurative otitis media and serous otitis media.     

Epidemiological study of eclampsia in a referral teaching hospital

The present study is a retrospective analysis of 864 eclampsia patients managed at RG Kar Medical College and Hospital, Kolkata during the period January 1999 to December 2001. The incidence of eclampsia was seen in about 2.27% cases. Majority (51.97%) of eclampsia patients were between 20 and 29 years though 41.43% were below 20 years of age. They were mostly primigravida (88.19%) and Hindus (69.1%). About 44.56% were antepartum eclampsia patients. All the patients were treated with magnesium sulphate. Caesarean section rate is quite high (46.18%) in this present study. Maternal case fatality rate was 7.29%. Still birth rate was 9.92% with an early neonatal death rate of 14.15% resulting in a perinatal mortality of 24.07%. Ignorance regarding antenatal check-up, lack of transport and lack of early communication with tertiary hospital play an important role for high incidence of eclampsia in our developing country.     

Ophthalmomyiasis

Ophthalmomyiasis is a rare condition. Here two such patients, one of 70-year-old male farmer with history of neglected trauma presented with painful swelling with sinus of right orbit and the second one of 65-year-old female destitute who presented with fungating mass near the medial canthus of left eye with pain and bleeding are reported. All the maggots were removed after applying ether.     

Changing trends in the management of eclampsia from a teaching hospital

Eclampsia is a major source of both maternal and perinatal mortality. In the management of eclampsia, the role of magnesium sulphate as anticonvulsant and early delivery are well established. The present study is an analysis of maternal and perinatal outcomes after the introduction of magnesium sulphate and liberalisation of caesarean section over a period from August 2002 to September 2004. The observations were compared with statistics from the same hospital from 1995-1997. The incidenceof eclampsia has remained relatively constant but postpartum cases of eclampsia have increased. The case fatality rate of eclampsia has fallen from 11.3% to 5.3%. The perinatal mortality has also fallen from 54.8% to 24.3%. The caesarean section rate for eclampsia has increased from near 10% to 49.7%. Both maternal mortality and perinatal mortality are lowest in the caesaean section group. But the improved perinatal salvage in caesarean section babies may partially reflect the tendency to avoid caesarean section in gross prematurity. The ideal anaesthesia for eclampsia remains unknown but the results with use of general anaesthesia in all cases with precautions produced favourable results.     

Anthropometric indicators of body composition in young adults: relation to size at birth and serial measurements of body mass index in childhood in the New Delhi birth cohort

BACKGROUND: South Asians have a muscle-thin but adipose body phenotype and high rates of obesity-related disease. Adult body composition may be predictable in early life. OBJECTIVE: Anthropometric indexes of adult body composition were examined in relation to birth size and body mass index (BMI) during childhood. DESIGN: A population-based cohort of 1526 men and women aged 26-32 y in Delhi, India, who were measured sequentially from birth until 21 y of age were followed up. Adult weight, height, skinfold thicknesses, and waist and hip circumferences were measured. BMI and indexes of adiposity (sum of skinfold thicknesses), central adiposity (waist-hip ratio), and lean mass (residual values after adjustment of BMI for skinfold thicknesses and height) were derived. RESULTS: Mean birth weight was 2851 g. As children, many subjects were underweight-for-age (>2 SDs below the National Center for Health Statistics mean; 53% at 2 y), but as adults, 47% were overweight, 11% were obese, and 51% were centrally obese (according to World Health Organization criteria). Birth weight was positively related to adult lean mass (P < 0.001) and, in women only, to adiposity (P = 0.006) but was unrelated to central adiposity. BMI from birth to age 21 y was increasingly strongly positively correlated with all outcomes. BMI and BMI gain in infancy and early childhood were correlated more strongly with adult lean mass than with adiposity or central adiposity. Higher BMI and greater BMI gain in late childhood and adolescence were associated with increased adult adiposity and central adiposity. CONCLUSIONS: Birth weight and BMI gain during infancy and early childhood predict adult lean mass more strongly than adult adiposity. Greater BMI gain in late childhood and adolescence predicts increased adult adiposity.