Cranial subdural haematoma after spinal anaesthesia

Intracranial subdural haematoma is an exceptionally rare complicationof spinal anaesthesia. A 20-yr-old male underwent appendicectomyunder partial spinal and subsequent general anaesthesia. A weeklater, he presented with severe headache and vomiting not respondingto bed rest and analgesia. Magnetic resonance imaging showeda small acute subdural haematoma in the right temporo-occipitalregion. The patient improved without surgical decompression.The pathogenesis of headache and subdural haematoma formationafter dural puncture is discussed and the literature brieflyreviewed. Severe and prolonged post-dural puncture headacheshould be regarded as a warning sign of an intracranial complication. Br J Anaesth 2001; 86: 893–5     

Socio-Demographic and Maternal Determinants of Low Birth Weight : A Multivariate Approach

A community based study was Conducted in the rural areas of Udupi taluk, Karnataka state of South India to identify the socio-demographic, maternal and obstetric determinants of low birth weight. All singleton live births that occurred in the study area during a one year period (October 1991 to September 1992) were included. A total of 2919 singleton child-mother pairs formed the basis of the analysis. Information about social, demographic and economic conditions of the families; maternal factors such as age, parity, quality of antenatal care and previous obstetric history were collected by interviewing the mothers and family members and verifying the available medical records through the field investigators especially recruited and trained for this purpose. Data was analyzed using multiple logistic regression model. Primis, elderly mothers and mothers who had not received good quality antenatal care were found to be more at risk of having low birth weight babies. Other significant determinants were family custom, socio-economic status and environmental sanitation.     

Design,synthesis, and antimalarial evaluation of thiazole-derived amino acids

A series of thiazole-derived N-Boc amino acids were synthesized and evaluated as targeted potential antimalarials against plasmepsins II enzyme of malaria parasite Plasmodium falciparum. All the compounds showed moderate to good activity. Compounds 3f and 3g were found to have highest the 50% inhibitory concentration (IC₅₀) values (3.45 μM and 4.89 μM, respectively) against Plasmodium falciparum. The compounds docked to the active site of plasmepsin II. Most of the compounds were found to interact with the catalytic amino acids ASP34 and ASP214 of plasmepsin II. A good correlation was observed between binding energy and antiparasitic activity of the thiazole derivatives.     

Tubal Arias-Stella atypia

This case report brings to 20 the instances of gestational hyperplasia of oviduct recorded in North America since 1961. Presently associated with ectopic pregnancy, this endosalpingeal change is probably common; but it is focal and likely to be detected only by multiple histological sections.     

Pulsations of the ductus venosus blood velocity and diameter are more pronounced at the outlet than at the inlet.

OBJECTIVE: To test the hypothesis that the pulse wave emitted from the heart into the precordial veins is altered as it travels towards the periphery. STUDY DESIGN: Ultrasound diameter measurement and Doppler recording at the inlet and outlet of the fetal ductus venosus in 20 normal pregnancies (gestational age 19-41 weeks) were used to compare velocity patterns and diameters applying paired t-test and Spearman's rank correlation. RESULTS: There was a significantly lower pulsatility of the blood velocity in the ductus venosus at the inlet compared to the outlet, and, correspondingly, there was a significantly smaller diameter pulsation at the inlet than at the outlet. CONCLUSION: Both blood velocity and diameter pulsations are smaller at the inlet than at the outlet of the ductus venosus. The tapering shape of the vessel and the diameter differences at the junction with the umbilical vein are suggested to be important factors affecting the velocity waveform.     

Transcranial Doppler Ultrasound: A New Method of Monitoring Hemispheric Anesthetization During the Intracarotid Amobarbital Procedure

BACKGROUND: Electroencephalography (EEG) is traditionally used to assess the duration of hemispheric anesthetization and to monitor return of function in the anesthetized hemisphere during the intracarotid amobarbital procedure (IAP), but EEG changes are not consistently seen. The authors evaluated the role of continuous transcranial Doppler (TCD) monitoring as an alternative to EEG. METHODS: The authors performed both continuous TCD monitoring and EEG during the IAP in 10 patients with medically intractable partial epilepsy. Mean velocities were monitored continuously in both middle cerebral arteries (MCAs), and changes in MCA velocities on continuous TCD monitoring were time locked with the EEG changes. RESULTS: The average mean MCA velocities were within normal limits bilaterally (50-85 cm/s) in all patients at baseline. Mean MCA velocites increased in all patients to 95-115 cm/s at the start of the test when the patients were asked to raise their hands and start counting. After injection of sodium amobarbital, mean MCA velocities in all patients dropped dramatically on the ipsilateral side to values of 12-39 cm/s and returned to the baseline average value when the hemiparesis recovered. In 8 patients, the duration of delta activity on EEG coincided with the time interval during which the mean MCA velocities were low on TCD monitoring. In 2 patients, despite the presence of hemiparesis clinically and a drop in mean MCA velocities on the ipsilateral side on continuous TCD monitoring, EEG remained normal on the ipsilateral side. CONCLUSIONS: Continuous TCD monitoring may be a more sensitive method than EEG in determining the duration of hemispheric anesthetization during IAP. Because the items for assessment of memory are presented during the period of hemispheric anesthetization, TCD may be useful in more precisely defining the time window for memory testing.     

Glycaemic control and body mass index in late‐adolescents and young adults with Type 1 diabetes mellitus: a population‐based study

Aims Studies of children with diabetes up to the age of 15 years report deteriorating glycaemic control in the early teenage years. The aim was to investigate glycaemia and body mass index in older teenagers and young adults. Method A Scottish, regional, population‐based, cross‐sectional study of 255 young people (117 female, 138 male) with Type 1 diabetes, aged 15–25 years (mean ±sd 19.8 ± 2.8 years, diabetes duration: 8.8 ± 5.4 years) registered on a diabetes database. Glycaemic control, body mass index (BMI) and insulin regimens were assessed in three age groups [group 1 (n = 96) 15–18 years; group 2 (n = 74) 18.1–22 years; and group 3 (n = 85) 22.1–25 years]. Results Subjects in the oldest age group had a significantly lower mean HbA_1c than those in the youngest age group (8.8 ± 1.7 vs. 9.9 ± 1.9%; P < 0.001). Mean BMI was higher in group 3 (25.2 ± 3.4 kg/m²) compared with group 1 (23.9 ± 3.1 kg/m²; P < 0.001). HbA_1c levels were higher in the younger subjects and women. Lower HbA_1c levels were associated with a higher BMI (r = ?0.324, P < 0.001) in men only. Overall, 74% took three or more injections a day, of whom 60% were on basal/bolus therapy. The proportion on basal/bolus insulin therapy increased with age and duration of diabetes. Conclusion Compared with adolescents, young adults with Type 1 diabetes have better glycaemic control and higher BMI. This was associated with lower insulin requirements.