Interscalene brachial plexus block for shoulder surgery in a patient with arthrogryposis multiplex congenita

A five-year-old child with severe arthrogryposis multiplex congenita and malnutrition underwent surgery for chronic osteomyelitis of the head of the left humerus. The child had typical features of arthrogryposis multiplex congenita, including a difficult airway. Propofol was used for induction and maintenance. Spontaneous respiration was maintained with a nasal airway. Analgesia was provided with an interscalene brachial plexus block placed using a nerve stimulator. No opioid was given. The child had an uneventful recovery with good postoperative analgesia. The anaesthetic implications of arthrogryposis multiplex congenita are discussed.     

Genomic Partnering - Fifth Annual CHI Meeting: emerging and early-stage companies. Genome Tri-Conference. 23-24 February 2002, Santa Clara, CA, USA

The 2002 Genome Tri-Conference was a medium-sized meeting, with an approximate attendance of 400 to 500 delegates. This event held three conferences back to back, addressing three different aspects of current developments in the area of genomics, ie, genomic partnering, human genome discovery and gene functional analysis. Several new aspects of genomics, such as clinical genomics and chemical genomics, were discussed.     

Itraconazole versus terbinafine in the management of onychomycosis: an overview

Ever since the introduction of itraconazole and terbinafine in the management of onychomycosis, there has been a revival of interest in the latter. In order to comprehend the intricate emerging scenario, an endeavor has been made to form a distinct outline in the shape of an overview on several of their facets. The review, therefore, envisages forming and facilitating instant decision-making.     

Immune response to an indigenously developed hepatitis-B (Shanvac-B) vaccine in a tribal community of India

Hepatitis-B infection is highly endemic among the primitive tribes of Andaman and Nicobar Islands, India. A pilot project of hepatitis-B vaccination using indigenously developed (Shanvac-B) was initiated among the Nicobarese tribe in Car Nicobar Island. The 936 individuals negative for HBsAg and anti-HBs were administered three doses of the vaccine at 0, 1 and 6 months. The vaccine was found to be safe and efficacious with sero-protection rates of 49.1, 86.9 and 96.7% after first, second and third dose. Considering the high endemicity of the infection and small number of the tribal population, it is necessary to initiate hepatitis-B vaccination programme for this community. Since the vaccine was found to be cost-effective, it could be adopted for hepatitis-B vaccination in this community.     

Intestinal myiasis due to Musca domestica: a report of two cases

Myiasis is the infestation of live human and vertebrate animals with dipterous larvae, which, at least for a certain period, feed on the host's dead or living tissue, liquid body substances, or ingested food. Intestinal myiasis is usually an accidental phenomenon, which occurs due to the ingestion of eggs or larvae present in food. Usually the patient is asymptomatic and the larvae are excreted harmlessly in the feces. In some cases, however, the passage of larvae may be associated with symptoms. The present paper describes two such cases.     

A novel ultrasound method for evaluation of collateral development in limb ischemia

Although clinical studies are underway to evaluate the effectiveness of angiogenesis, there are no validated, non-invasive methods to assess peripheral collateral development. This study was performed to validate a novel ultrasound-based method of assessing collateral formation in a pig model of hindlimb ischemia. Ultrasonography of predefined ultrasound planes was performed on 12 pigs immediately after ligation of the right common femoral artery, and 7, 14, 28 and 42 days thereafter. A custom software program was used to evaluate both color Doppler (CD) and power Doppler (PD) images to generate flow indices. Collateral development was observed with ultrasound as early as 7 days post-arteriectomy and increased dramatically by 28 days. Areas of persistent ischemia resulting from inadequate collateral formation were easily quantified in all images. Collaterals detected on ultrasound were confirmed by angiography and histology, and tissue perfusion by a fluorescent microsphere method. As demonstrated with color and power Doppler measurements, collateral formation is initiated early after ischemic injury in this large juvenile animal model of angiogenesis. This non-invasive method is useful to quantify blood flow, visualize angiogenesis and determine areas of persistent lower limb ischemia, and may have an important role in evaluating new approaches to modulate angiogenesis.     

Hilar-lymphadenopathy predictive of cutaneous sarcoid

A case of hilar lymphadenopathy, a cardinal sign of extra-cutaneous sarcoidosis, is being described in detail. It continued to be a diagnostic dilemma until the appearance of several papules and/or nodules over the face, front and back of the upper chest. The diagnosis was clinched by demonstration of non-caseating, epithelioid naked granuloma and affirmative response to oral administration of prednisolone in dosage of 40 mg a day.     

Economic and health consequences of selling a kidney in India

Context  Many countries have a shortage of kidneys available for transplantation. Paying people to donate kidneys is often proposed or justified as a way to benefit recipients by increasing the supply of organs and to benefit donors by improving their economic status. However, whether individuals who sell their kidneys actually benefit from the sale is controversial. Objective  To determine the economic and health effects of selling a kidney. Design, Setting, and Participants  Cross-sectional survey conducted in February 2001 among 305 individuals who had sold a kidney in Chennai, India, an average of 6 years before the survey. Main Outcome Measures  Reasons for selling kidney, amount received from sale, how money was spent, change in economic status, change in health status, advice for others contemplating selling a kidney. Results  Ninety-six percent of participants sold their kidneys to pay off debts. The average amount received was $1070. Most of the money received was spent on debts, food, and clothing. Average family income declined by one third after nephrectomy (P<.001), and the number of participants living below the poverty line increased. Three fourths of participants were still in debt at the time of the survey. About 86% of participants reported a deterioration in their health status after nephrectomy. Seventy-nine percent would not recommend that others sell a kidney. Conclusions  Among paid donors in India, selling a kidney does not lead to a long-term economic benefit and may be associated with a decline in health. Physicians and policy makers should reexamine the value of using financial incentives to increase the supply of organs for transplantation.      

Clinico-immunological profile of juvenile rheumatoid arthritis at Chandigarh

OBJECTIVE: To study the clinical and immunological profile of children with juvenile rheumatoid arthritis (JRA). DESIGN: Retrospective hospital based study. SETTING: Tertiary level center of North India. SUBJECTS:74 patients attending the Pediatric Rheumatology and Immunology Clinic over last 5 years. RESULTS: The patients were aged between 9 months to 12 years with male female ratio of 1.8:1. Eleven (14.9%) patients had systemic onset JRA, 28 (37.8%) had polyarticular onset type and 35(47.3%) had pauciarticular onset type JRA. Uveitis was present only in one patient and rheumatoid nodules were present in 4(5.4%) patients. Rheumatoid factor was positive in 2(2.7%) and antinuclear antibody was present in one patient only. HLA-B27 was positive in 4 children. Two patients developed amyloidosis. CONCLUSION:The clinico-immunological profile of JRA at Chandigarh appears to be some what different from that reported from other centers in India.