Haemodynamic Studies During the Management of Severe Tetanus

Detailed invasive haemodynamic studies were performed in 27of 32 patients with severe tetanus. Nineteen had severe uncomplicatedtetanus and eight had associated major complications, chieflyinfection and pulmonary complications. The results were comparedwith those obtained from 15 healthy male volunteers who servedas controls. There were two deaths in 32 patients (mortality6.25 per cent). Severe tetanus without major complications wascharacterized by a high output hyperkinetic circulatory statewith tachycardia (heart rate 131 (19.2) beats/minute), increasedstroke volume index (43.1 (10.7) ml/m²), increased cardiac index(5.48 (0.94)1/min/m²) and a normal left ventricular stroke workindex (60.5 (15.9) g/m/m²). Volume loading demonstrated a significanthaemodynamic response and increased vascular capacitance. Evenso the maximum percent rise from baseline values of these indicesafter volume load was significantly higher in controls (p <0.001). Autonomic cardiovascular disturbances affected bothsympathetic and parasympathetic activity. Hypertension and tachycardiaalternating with hypotension and bradycardia were related tosudden fluctuations in systemic vascular resistance. Our studiessuggested some degree of myocardial dysfunction in patientswith severe uncomplicated tetanus. The haemodynamics of severetetanus were masked and altered by complicating infection, pneumonia,and atelectasis.     

Massive Rectal Bleeding Due to Intestinal Tuberculosis

Two cases of massive rectal bleeding due to tuberculosis of the intestine are described and 24 reported cases of massive rectal bleeding in intestinal tuberculosis are reviewed. Tuberculosis of the intestine, though uncommon should be considered as a cause for rectal bleeding.     

BOOK REVIEWS

Book reviewed in this article:
Walsh, K. Neuropsychology. A Clinical Approach 2nd Edition
WALSH, K.W. (1985) Understanding Brain Damage.
Ounstead, C, Lindsay, J. & Richards, P. Temporal Lobe Epilepsy–A Biographical Study 1948–1986 Clinics in Developmental Medicine No 103.
Milhorst, T. H. Cerebrospinal Fluid and the Brain Oedemas Neuroscience Society of New York     

Management of acquired cholesteatoma of the middle ear and the mastoid by combined approach tympanoplasty: a long-term view

Mastoid cavities following surgery for cholesteatoma of the middle ear and the mastoid can be subject to recurrent infections, life-long attendance for cavity cleaning and restrictions in social activity. These problems may be avoided with a successful combined approach tympanoplasty. One hundred and forty-one patients (151 ears) treated by combined approach tympanoplasty, followed over a period ranging from 5 to 23 yr were analysed. The results are presented with an average follow-up of 14.5 yr. A fixed retraction pocket, recurrent cholesteatoma or conversion to a cavity was regarded as a failure. Failures and evidence of future failures in the form of fixed retraction pockets occurred in the first 5 yr. By not including cases with a follow-up period of less than 5 yr, we have attempted to achieve stable long-term results, 73.5% of the cases were successful. The success rate could be improved further and should provide an acceptable method of treatment.     

Pseudomyoma Peritonei — Preoperative Diagnosis on CT Sean A Report of 2 Cases

The entity of pseudomyxoma peritonei was often diagnosed formerly on laparotomy. However, with the advent of sonography and computerised tomography it is now possible to suggest correct pre-operative diagnosis and thereby proper management. Such two cases diagnosed pre-operatively on CT are reported here.     

INDUCTION OF LABOUR WITH MISOPROSTOL – A PROSTAGLANDIN E1 ANALOGUE

The purpose of our study was to compare the safety and efficacy of intravaginal misoprostol versus existing hospital protocol of intracervical dinoprostone and oxytocin for cervical ripening and induction of labour. 200 patients with indication for induction of labour were randomly assigned to receive either intravaginal misoprostol or dinoprostone/oxytocin combination. In first group twenty five micrograms of misoprostol was placed intravaginally every 6 hours till the patient reached active stage of labour. In second group dinoprostone gel 0.5 mg was placed in the endocervix at night and oxytocin induction was started in the early morning. The average interval from start to induction of vaginal delivery was shorter in misoprostol group (1315±811 minutes) compared to dinoprostone/oxytocin group (1512±712 minutes) (p < 0.01). There was no significant difference in route of delivery. 18% of misoprostol treated patients and 23% of dinoprostone/oxytocin treated patients required Caesarean section. Complications such as uterine tachysystole were significantly higher in misoprostol group (p < 0.01) but it was not associated with increased incidence of uterine hyperstimulation. Perinatal outcome was similar in both groups.KEY WORDS: Induction of labour, Misoprostol