Epidural blood patch for treatment of subarachnoid fistula in children

A subarachnoid-cutaneous fistula developed in two children after the placement of a catheter in the subarachnoid space for drainage of cerebrospinal fluid. The management of this iatrogenic complication with epidural blood patch is described.     

Solid state and solution conformation of Boc-L-Met-Aib-L-Phe-OMe

The conformation of the peptide Boc-L-Met-Aib-L-Phe-OMe has been studied in the solid state and solution by X-ray diffraction and ¹H n.m.r., respectively. The peptide differs only in the N-terminal protecting group from the biologically active chemotactic peptide analog formyl-L-Met-Aib-L-Phe-OMe. The molecules adopt a type-II ß-turn in the solid state with Met and Aib as the corner residues (øMet =- 51.8^o, øMet = 139.5^o, øAib = 58.1^o, øAib = 37.0^o). A single, weak 4 -> 1 intramolecular hydrogen bond is observed between the Boc CO and Phe NH groups (N—O 3.25 Å, N-H—O 128.4^o). ¹Hn.m.r. studies, using solvent and temperature dependencies of NH chemical shifts and paramagneti radical induced line broadening of NH resonances, suggest that the Phe NH is solvent shielded in CDCI₃ and (CD₃)₂SO. Nuclear Overhauser effects observed between Met Cα H and Aib NH protons provide evidence of the occurrence of Met-Aib type-II ß-turns in these solvents.     

A spectroscopic study of the interaction of allylisothiocyanate with mustard 12S protein

The intraction of allylisothiocyanate (AIT) with mustard 12S protein resulted in a change in the absorption spectrum of the protein below 280nm without any shift in the ^γmax. The spectrophotometric titration of mustard 12S protein after interaction with AIT suggested the involvement of phenolic groups. Upon interaction with AIT, a new band at 250nm appeared in the near ultraviolet circular dichroism spectrum of the protein. However, no change occurred in the far ultraviolet circular dichroism spectrum. Circular dichroism measurements with amino acids suggest the possible involvement of tyrosine residues in the interaction of AIT with mustard 12S protein.     

Diagnosing ascites: Value of ascitic fluid total protein, albumin, cholesterol, their ratios, serum-ascites albumin and cholesterol gradient

Abstract Ascitic fluid total protein, albumin, cholesterol, their ascites/serum ratios, serum-ascites albumin and cholesterol gradients were measured for their ability to differentiate cirrhotic, malignant and tuberculous ascites in 76 patients. The mean ± s.d. ascitic fluid total protein, albumin, cholesterol, their respective ascitic fluid/serum ratios in cirrhotic ascites were lower than malignant and tuberculous groups ( P < 0.001 for each). The difference between malignant and tuberculous groups was significant for ascitic fluid/serum total protein ( P < 0.05) and ascitic fluid/serum albumin ( P < 0.01) only. Mean serum-ascites albumin gradient in cirrhotics was higher than in the malignant and tuberculous groups ( P < 0.001 for each). The difference between malignant and tuberculous groups was significant ( P < 0.01). Mean ± s.d. serum-ascites cholesterol gradient in cirrhotics was higher than that in malignant and tuberculous groups ( P < 0.001 for each). The difference between malignant and tuberculous groups was also significant ( P < 0.01). Both serum/ascitic fluid total protein less than 0.5 and ascitic fluid cholesterol less than 55 mg/dL had 94% diagnostic accuracy for differentiating cirrhotic from malignant and tuberculous ascites. Serum ascitic fluid albumin gradient greater than 1.1 g/dL, ascitic fluid/serum albumin less than 0.65 and ascitic fluid albumin less than 2 g/dL had diagnostic accuracy of 92, 92 and 91%, respectively. Ascitic fluid total protein had diagnostic accuracy of 88%. None of the tests was able to differentiate between malignant and tuberculous ascites. Measurement of ascitic fluid cholesterol concentration is a simple method of differentiating cirrhotic from non-cirrhotic ascites.     

Midazolam as a sole sedative for computed tomography imaging in pediatric patients

Objective: To evaluate the efficacy and adverse effects of i.v. midazolam as a sole agent for sedation in children for computed tomography (CT) imaging. Materials and Methods: Prospective clinical trial in which 516 children under ASA classification II–IV (273 boys and 243 girls) in the age group of 6 months to 6 years for elective CT scan were enrolled over a 17‐month period. Patients were administered i.v. midazolam 0.2 mg·kg^?1 and further boluses of 0.1 mg·kg^?1 (total 0.5 mg·kg^?1) if required. Measurements included induction time, efficacy, side effects, complications, and degree of sedation. Sedation was graded on the basis of Ramsay sedation score (RSS) as over sedated (RSS 5–6), adequately sedated (AS, RSS 3–4), under sedated (RSS 1–2), or failed if the procedure could not be completed or another agent had to be administered. Results: Of the 516 procedures, 483 brains, 16 chests, and 17 abdomens were scanned with a mean duration of 4.75 ± 1.75 min with a mean dose of 0.212 mg·kg^?1 of i.v. midazolam. Four hundred and sixty‐five (90.12%) patients were AS in 5.9 ± 0.7 min while 40 (7.75%) patients required additional boluses. Of these 40 patients, 24 (4.65%) required a single bolus, 12 (2.32%) required two boluses, whereas the remaining four (0.78%) required three boluses. In 11 (2.13%; P < 0.0001) patients, the scan could not be completed satisfactorily. Side effects were seen in 46 (9.11%) patients in the form of desaturation, hiccups (seven patients, 1.38%), and agitation (four patients, 0.79%). Desaturation (SpO₂ 90–95%) was seen in 35 (6.93%) patients, which was corrected by topical application of oxygen. None of the patients exhibited any complications such as pulmonary aspiration or need to maintain airway. The patients were kept under observation for 1 h after the procedure. Conclusion: The level of sedation achieved in children with midazolam 0.2 mg·kg^?1 is adequate for imaging with minimal side effects, no airway complications, and fast recovery. It can be recommended as the sole agent for sedation in pediatric patients for CT imaging.     

ANTISMOOTH MUSCLE AND ANTIPARIETAL CELL ANTIBODIES IN INDIANS WITH ALOPECIA AREATA

Background. Alopecia areata is suspected to be an autoimmune disease. We studied 104 consecutive patients with alopecia areata for the presence of autoantibodies and associated autoimmune diseases. Methods. A detailed history and examination was carried out in all patients to look for associated atopy, diabetes mellitus, hypertension, rheumatoid arthritis, vitiligo, lupus erythematosus, and thyroid disorders, etc. in the patients or their family members. Venous blood for estimation of fasting and postprandial blood glucose was collected in 30 patients, especially in those with family history of diabetes mellitus. Antimitochondrial (AMA), antismooth muscle (SMA), antinuclear antibodies (ANA), antiparietal cell antibody (PCA), and antibody against thyroid microsome (TMA) were detected employing indirect immunofluorescence on a composite section of rat liver, stomach, kidney, and human thyroid. Skin biopsy was processed for direct immunofluorescence by a conventional technique. Results. Disseminated discoid lupus erythematosus, lichen planus, urticaria, psoriasis, and seronegative spondylarthritis were associated with alopecia areata in one case each. Anti-smooth-muscle-antibodies and PCA were found in 36 (34.6%) and 44 (42.3%) patients respectively, followed by TMA in 8 (7.7%), AMA in 6 (5.7%), antithyroglobulin antibodies in 3 (2.8%), and ANA in 2 (1.9%) patients. The incidence of SMA was higher in men with alopecia areata (P< 0.001). Direct immunofluorescence carried out in 24 patients did not reveal significant findings, except for occasional immunoglobulin deposits around hair follicles and blood vessels. Conclusion. Alopecia areata in India is associated more often with antismooth muscle and antiparietal cell antibodies.