EFFECT OF CERTAIN ANAESTHETIC AGENTS ON THE ACTIVITY OF RAT HEPATIC {delta}-AMINOLAEVULINATE SYNTHASE

The activity of -aminolaevulinic acid synthase (E.C. 2.3.1.37 [EC] )(the rate-limiting enzyme for haem and porphyrin biosynthesis)has been measured in the rat liver after the repeated administrationof anaesthetic agents in vivo. The activity of the enzyme wasincreased by Althesin, chlordiazepoxide, enflurane, etomidate,lignocaine, methohexitone, methoyflurane, pentazocine and thiopentoneand decreased by procaine. No significant changes in activityoccurred after the administration of amethocaine, atropine,bupivacaine, diazepam, droperidol, halothane, ketamine, morphine,nitrous oxide, pethidine, phenoperidine, prilocaine and propanidid.It is suggested that those anaesthetic agents which inducedactivity of the enzyme should not be administered to patientswith an acute porphyria.     

Exsanguination in a Jehovah''s Witness

A case is reported in which death occurred after a patient's adamant refusal to accept blood transfusion, despite prompt control of blood loss. The management of this situation is discussed. Reconstitution of the circulating volume was followed by survival for 2 hours after surgery. The haemoglobin level fell to 1.8 g/dl.     

Atrial Flutter Secondary to Hypokalemia

Electrophysiologic studies support significant hypokalemia as a cause of atrial flutter in a patient without manifest heart disease. Atrial flutter, reproducibly initiated and terminated by rapid atrial pacing during hypokalemia, was not inducible after potassium correction. In an individual with existing atrial conduction disease, hypokalemia may generate both non-uniform atrial refractoriness and atrial premature beats, and it may facilitate the development of atrial flutter as a re-entrant arrhythmia.     

EARLY CARCINOMA TONGUE – SURGICAL OPTIONS

A retrospective analysis of 127 surgically treated cases of T-1, T-2 carcinoma of oral tongue during the period 1987-1990 was undertaken. 68.5 per cent (87) underwent hemiglossectomy and 31.5 per cent (40) underwent wide excision. There were loco-regional recurrences in 22 per cent (27). In the hemiglossectomy group 9 per cent (8 of 87) had local recurrences compared to 25 per cent (10 of 40) of wide excision group, (P = 0.01). Mean disease free survival was 40 months and 33 months for hemiglossectomy group and wide excision group respectively, (P = 0.006). It is seen that local recurrences are significantly less for the hemiglossectomy group compared to the wide excision group.KEY WORDS: Disease free survival, Early cancer, Recurrence, Surgery, Tongue     

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     

Artificial Intelligence and Liability in Medicine: Balancing Safety and Innovation

Policy Points

• With increasing integration of artificial intelligence and machine learning in medicine, there are concerns that algorithm inaccuracy could lead to patient injury and medical liability.
• While prior work has focused on medical malpractice, the artificial intelligence ecosystem consists of multiple stakeholders beyond clinicians. Current liability frameworks are inadequate to encourage both safe clinical implementation and disruptive innovation of artificial intelligence.
• Several policy options could ensure a more balanced liability system, including altering the standard of care, insurance, indemnification, special/no‐fault adjudication systems, and regulation. Such liability frameworks could facilitate safe and expedient implementation of artificial intelligence and machine learning in clinical care.

     

Acute and Chronic Changes in Pulmonary Functions among Indian Textile Workers

An epidemiological study was carried out in three textile millsof Ahmedabad. A total of 214 cotton dust exposed and 184 controlsubjects were examined for pulmonary function tests. Pulmonaryfunction tests included forced vital capacity and forced expiratoryvolume in one second. The pulmonary function tests were carriedout before starting the shift and after 7 hours of exposureon a vitalograph spirometer. The study shows that among thecotton dust exposed workers byssinotics behave distinctly andshow the maximum acute and chronic changes in pulmonary functions.It seems that the effect of cotton dust exposure on the byssinoticsubjects is more predominant than the effect of smoking. Requests for reprints should be addressed to: J. R. Parikh, National Institute of Occupational Health, Ahmedabad-380016, India     

CO2 LASER – A NEW TOOL IN THE SURGEONS ARMAMENTARIUM

One hundred and sixty five patients, treated with carbondioxide (CO₂) laser for benign and malignant lesions of the head and neck were studied. Alveolo-buccal complex (68/165) had the majority of benign and malignant tumors followed by larynx (23/165) and tongue (21/165). All lesions were widely excised, none were reconstructed and all defects healed well with minimal scarring. The post-operative morbidity was minimal and the hospitalization period was 1 to 5 days. Complications were not serious and could be managed easily. This study confirms the usefulness of CO₂ laser surgery for both benign and malignant conditions in head and neck.KEYWORDS: Carbondioxide laser, Head and neck, Malignant neoplasm, Premalignant lesions