Sucralfate for posttonsillectomy analgesia

Pain is one of the most troublesome complications of tonsillectomy. The pain appears as throat pain, otalgia, or both, and continues until mucosal recovery on the tonsillar fossae is complete. Some surgical and hemostasis techniques may increase pain. Analgesics, antibiotics, steroids, and local and topical anesthetics are used to relieve posttonsillectomy pain, but none has the desired effectiveness. The pain reliever must not increase bleeding and must have minimal side effects. Sucralfate, a basic amino salt of sucrose octasulfate, binds to the matrix protein of a peptic ulcer and produces a protective barrier. Tonsillectomy leaves two large ulcerous wounds, and sucralfate may bind those wounds as it does peptic ulcers. In this controlled study, the efficacy of sucralfate on posttonsillectomy throat pain, otalgia, analgesic requirement, degree of strength, bleeding, body temperature, and mucosal recovery is investigated in 80 patients. Sucralfate is found to significantly reduce throat pain and analgesic requirement after surgery. (Otolaryngol Head Neck Surg 1998;119:700-4.)     

CHEMOPREVENTIVE EFFECT OF VITIS VINIFERA EXTRACT ON 12-O-TETRADECANOYL-13-PHORBOL ACETATE-INDUCED CUTANEOUS OXIDATIVE STRESS AND TUMOR PROMOTION IN MURINE SKIN

Vitis vinifera (grapes) is used as a fruit worldwide and known for its pharmacological properties. The present paper assesses the chemopreventive potential of Vitis vinifera against 12-O-tetradecanoyl-13-phorbol acetate (TPA)-mediated tumor promotion in 7,12-dimethyl-benz[a]anthracene (DMBA) initiated mice skin. Skin tumor initiation was achieved by a single topical application of DMBA (40 microg/animal/0.20 ml acetone) to mice. Two weeks after the initiation, promoting agent, TPA (5.0 microg/animal/0.2 ml acetone) was applied two times a week for 20 weeks. Pretreatment of Vitis vinifera 1h prior to each application of TPA resulted in protection against cutaneous tumorigenesis in dose-dependent manner. This inhibition was evident when tumor data was considered as the percentage of mice with tumor and the number of tumors per mouse. We have shown that typical application of Vitis vinifera prior to that of TPA resulted in significant inhibition against TPA-caused induction of epidermal ODC activity (P<0.001) and DNA synthesis. Application of Vitis vinifera at a dose level of 5.0 mg and 10.0 mg kg(-1) body weight in acetone prior to that of TPA treatment resulted in partial significant inhibition of oxidative stress in dose-dependent manner. The concomitant increase in the microsomal lipid peroxidation and xanthine oxidase activities were significantly reduced (P<0.001). In addition, the depleted level of glutathione and inhibited activities of antioxidant enzymes were recovered to the partial significant level. Hence, it can be suggested that Vitis vinifera can be used as a chemopreventive agent against oxidative stress and carcinogenesis.     

Verbal autopsy in Karachi slums: comparing single and multiple cause of child deaths

Background: Children dying in developing countries often havemore than one serious disease process. Identifying the singlemost important is difficult and risks omitting valuable information.We report patterns of childhood death in Karachi slums comparingsingle and multiple cause analysis. Methods: The Aga Khan University has developed primary healthcare programmes in Karachi slums where community health workersmaintain monthly surveillance of families with children agedunder five years. We investigated all deaths among childrenunder five from 1990 to 1992 when the overall IMR was 78. Weused a structured verbal autopsy questionnaire comprised ofverbatim and symptom check-list sections. Reviewers assignedup to four diagnoses per death. We compared analysis by single(main) cause and multiple (consolidated) causes per case. Results: Overall, the 431 cases had 627 causes of death; 156cases (36%) had more than one cause of death. By consolidatedanalysis, diarrhoea, malnutrition, low birth weight (LBW), acuterespiratory infection (ARI), and vaccine preventable diseasesplayed roles in 41%, 24%, 22%, 13%, and 2% of deaths, respectively.Proportionate mortality ratios by main cause (1 diagnosis perchild) analysis for the same diagnoses were: 39%, 1%, 8%, 11%,and 1%, respectively. Half of all child death occurred by age3 months. Eighty-three per cent (146/176) of fatal diarrhoeasyndromes were due to acute watery diarrhoea, and 41% (72/176)were associated with severe malnutrition (vs 21% [12/56] offatal ARI cases). Each verbal autopsy cost an estimated US$4.00,an annual cost of US$0.08 per programme child. Implications: Compared to single main cause analysis, consolidatedanalysis more completely assesses reasons for child death toguide programme response. We propose that health planning forpopulations with low vaccine coverage or common co-morbid conditions,such as malaria and anaemia, would particularly benefit fromanalysis of death seeking multiple causes.     

Sinus Rhythm Mapping in a Canine Model of Ventricular Tachycardia

The relationship between electrograms recorded during sinus rhythm and the activation sequence during ventricular tachycardia induced by programmed stimulation was investigated in a canine model of myocardial infarction. Thirteen dogs were studied 3 days (n = 10) or 14 days (n = 3) after coronary occlusion. Sixty-three unipolar electrograms were simultaneously recorded with a sock electrode array connected to a digital recording system, and analyzed by computer. Bipolar electrograms were recorded sequentially from the same sites with an analog recorder. Categories of unipolar electrograms were defined with reference to the QRS complex during sinus rhythm as follows: Class A included electrograms with an intrinsic deflection inscribed within the QRS complex, class B included those which did not exhibit any intrinsic rs deflection, and class C included those with an intrinsic deflection inscribed later than QRS. The epicardial distribution of each class of electrograms was significantly different between the preparations with, and those without inducible tachycardia (72% versus 63% of electrograms being in class A, 20% versus 35% in class B, and 8% versus 2% in class C; p less than 0.005). When tachycardia was inducible, class C epicardial electrograms were located in an area extending across the region of infarction, which corresponded to the common reentrant pathway of figure-of-eight patterns mapped during tachycardia. When ventricular tachycardia was not inducible, class B electrograms were recorded all over this region. The morphology of bipolar electrograms had no predictive value in identifying the common reentrant pathway. These results support the view that the inducibility of reentrant tachycardia is dependent upon critically located delayed activity detected during sinus rhythm by unipolar recordings.     

Metastatic Carcinoma Simulating Linitis Plastica of the Colon

Reported herein is the case of a 70-year old woman with metastatic breast carcinoma presenting as linitis plastica of the ascending colon. The breast tumor was diagnosed nine years previously. The clinical, roentgenographic and pathologic features of colonic linitis plastica and the preoperative diagnostic difficulties are discussed. There is no difference in the morphologic features of primary and secondary linitis plastica. The latter may result from anaplastic carcinoma of the stomach, gallbladder or breast.     

Pattern of upper gastrointestinal haemorrhage in northern India—An endoscopic study of 316 patients

Three hundred and sixteen patients with acute upper gastrointestinal haemorrhage were studied prospectively and consecutively. The most frequent cause was variceal bleeding due to portal hypertension (36%), followed by peptic ulceration (24%) and gastric erosions (19%). Variceal haemorrhage tended to be severe and had a high individual mortality rate. Associated acute mucosal lesions with portal hypertension were strikingly less frequent when compared with the experience from the West. Seven per cent of patients died of bleeding alone and an equal number of an associated systemic disorder or complication. Splenomegaly was present in all patients with a variceal haemorrhage due to non-cirrhotic portal hypertension. However, in patients with portal hypertension due to cirrhosis splenomegaly was present in 63%. Endoscopy altered the clinical diagnosis in 13.2% of patients. Based on previous experience oesophago-gastro-duodenal endoscopy has been a useful tool in the management of acute upper gastrointestinal haemorrhage.     

Congenital Narrowing of a Pulmonary Vein: Slit‐like Pulmonary Vein Ostium

We report the case of a 60‐year‐old female with a history of refractory paroxysmal atrial fibrillation. Preablation contrast enhanced pulmonary vein computed tomography (CT) scan demonstrated a slit‐like narrowing of the left inferior pulmonary vein ostium. The narrowing measured approximately 3 mm, with poststenotic dilation. The patient had no prior history of ablation. The patient subsequently underwent segmental antral isolation of all four pulmonary veins and cavo‐tricuspid isthmus ablation with bidirectional block. The diagnosis of preexisting congenital pulmonary vein stenosis had an impact on the type of ablation procedure performed (antral rather than ostial) and will affect the interpretation of postablation CT scans. (PACE 2013; 36:e150–e152)