Surface mapping of spike potential fields: visual vs. quantitative EEG analysis

Interictal EEG spike field potentials by visual and quantitative EEG analysis were studied in 17 patients with intractable localization related epilepsy. Quantitative EEG analysis was done using commercially available window based computer program (Focus) that displayed digitally acquired EEG data and performed spline mapping. Routine EEG localized 20 spikes. Fourteen spikes had excellent congruence between manual and computer generated mapping, 6 had good congruence, and 1 had fair congruence. This study clearly proves the usefulness of spline interpolation mapping technique in localizing and characterizing the epileptiform focus.     

Percutaneous transrenal hemodialysis catheter insertion

During the course of providing adequate access for hemodialysis, the majority of patients with end-stage renal disease will encounter episodes of catheter dependency. Although catheter-based dialysis is inferior to that obtained through native or synthetic arteriovenous conduits, it is often the only way to provide durable venous access into the central venous circulation system for large volume exchanges. Traditional sites for venous access such as internal/external, subclavian, and common femoral veins will eventually occlude. When alternative percutaneous access sites such as translumbar, transhepatic, and transazygous fail or become less desirable, other approaches become necessary. The authors report a successful case of transrenal access into the renal vein with consequent insertion of a tunneled catheter for hemodialysis in a patient with limited options.     

Clinical profile of falciparum malaria in a tertiary care hospital

Falciparum malaria presents with protean manifestations and is associated with a variety of complications and has a high mortality. One hundred and fifty-eight consecutive cases of falciparum malaria were studied with respect to the clinical presentation, complications, and response to treatment. The mean age of patients was 38.60 +/- 15.45 years and majority of them were males i.e., males being 110 (69.62%) and females being 48 (30.37%). The commonest presenting manifestations were fever with chill and rigor (98.10%), altered sensorium (48.10%), algid malaria (18.35%), and jaundice (27.21%). The other presenting features being oliguria (6.96%) and bleeding manifestations due to disseminated intravascular coagulation (DIC) (4.43%). The frequently encountered complications were anaemia (74.68%), jaundice (40.50%), cerebral malaria (45.56%), thrombocytopenia (40.50%) and renal failure (24.68%). Most of the patients i.e., 126 (79.74%) recovered with treatment and 32 (20.25%) succumbed. Higher mortality was associated with higher parasite count, presence of complications like anaemia, jaundice, renal failure, DIC, adult respiratory distress syndrome (ARDS), and septicaemia. Most of the deaths were encountered in patients where there was delay in clinical diagnosis, in the pre-hospital phase, and consequent presentation in multiorgan failure. Early diagnosis and institution of specific therapy were rewarding in the remaining patients in this series.     

Biochemical characterization of the minor immunophilins

OBJECTIVE: We present biochemical characterization of the previously described 14 kDa, 37 kDa, and 52 kDa immunophilins and a newly identified 5-8 kDa immunophilin. DESIGN AND METHODS: Proteins were tested for the following enzymatic activities-rotamase, G3PDH, protein kinase C, cAMP dependent protein kinase-and for the ability to inhibit calcineurin phosphatase when complexed with tacrolimus (FK506). RESULTS: The 5-8 kDa protein, like the other minor immunophilins, lacks rotamase activity. Since the 37 kDa possesses G3PDH activity, the 5-8 kDa protein, 14 kDa protein, and 52 kDa protein were all tested and found to lack G3PDH activity. Additional work shows that none of the minor immunophilins possess protein kinase C or cyclic AMP-dependent protein kinase activity and that the 37 kDa and 5-8 kDa and probably the 52 kDa proteins are capable of inhibiting calcineurin phosphatase when bound to tacrolimus.     

Omeprazole 40 mg once a day is equally effective as lansoprazole 30 mg twice a day in symptom control of patients with gastro-oesophageal reflux disease (GERD) who are resistant to conventional-dose lansoprazole therapy-a prospective, randomized, multi-centre study

BACKGROUND: Comparative studies of omeprazole and lansoprazole are scarce and even scarcer are comparisons of higher doses. Most of the comparative studies have assessed the effect of the two proton pump inhibitors (PPIs) on gastric acid secretion or gastric pH. Few studies have compared clinical end-points such as oesophageal healing and symptom control. AIM: To determine the clinical efficacy of omeprazole 40 mg daily as compared to lansoprazole 30 mg twice a day in symptom control of patients with severe symptomatic GERD. METHODS: Ninety-six patients who failed a standard dose of lansoprazole (30 mg once daily), were enrolled in a prospective fashion from three VA medical centres and were randomized to receive 6 weeks of either omeprazole 40 mg daily or lansoprazole 30 mg twice daily. Patients reported daily on symptom severity and frequency, antacid consumption and side-effects. RESULTS: Forty-six patients received omeprazole and 44 lansoprazole. Although not statistically significant, there was a consistent trend of better symptom control in the omeprazole group for daytime and night-time heartburn and acid regurgitation. There was no statistical difference between the two groups in mean antacid consumption overall and at the end of each of the 6 weeks of the study. In addition, there was no significant difference in the overall frequency of side-effects between the two groups nor for each individual side-effect. CONCLUSION: Omeprazole 40 mg once daily is equally effective and tolerated as lansoprazole 30 mg twice daily in symptom control of patients with GERD.     

Role of inhaled nitric oxide as a selective pulmonary vasodilator in pediatric cardiac surgical practice

Our aim was to assess the role of inhaled nitric oxide (NO) therapy in post operative cases of congenital heart defects who developed pulmonary arterial hypertensive (PAH) crisis and had no response with conventional management. From February '95 to January '97, inhaled NO therapy was used in 21 children. Age ranged from 2 months to 9 years (mean 5.6 years) and duration of therapy ranged from 1 to 13 days. Of 21 patients, 17 responded well with 5–20 ppm while 4 did not. The preoperative mean pulmonary systolic pressure was 88 mm Hg against mean systemic pressure of 96 mm Hg. Post operatively, their PA pressure reduced to 62 mm Hg, with systemic pressure of 98 mm Hg. After using inhaled NO, PA pressure dropped to 24 mm Hg (mean systolic) (p<0.007), after excluding the non responders. Of 4 non responders, two died due to irreversible pulmonary vascular disease and remaining two died due to residual defects. The study shows that inhaled NO is a selective pulmonary vasodilator, which is useful in postoperative PAH crisis and also reduces the transpulmonary gradient in single ventricle repair cases. It is safe and effective for prolonged use. It is very useful in Indian perspective, when more number of cases with congenital heart defects (CHD) alongwith severe PAH are encountered routinely.     

Probability of causation for radiation-attributable cancer in the Indian population.

Once a cancer is diagnosed in an individual with a history of radiation exposure, it may be required to know the probability that radiation exposure was the cause of the disease. The National Institute of Health, U.S., has generated radio epidemiological tables giving probability of causation for various radiogenic cancers for the population of the U.S. In this paper, the probability of causation has been calculated for the Indian population using two models: (1) the original National Institute of Health model, and (2) direct use of Japanese constant relative risk coefficients for solid tumors. In both cases, new risk coefficients based on DS86 dosimetry and extended follow-up for 35 y have been used. Calculations with new coefficients, based on the National Institute of Health model have been extended to the American population and compared with the results for the Indian population. These values are generally higher for the Indian population than for Americans because of the lower baseline incidence rates in India. Probability of causation values based on the constant relative risk model are independent of population characteristics.