ROLE OF EPIDURAL MEDICATION IN LUMBOSCIATIC SYNDROME

Role of epidural medication through caudal route was studied in 109 patients having lumbago with or without sciatica to highlight the value of this mode of treatment which relieved symptoms in more than 70% of cases without hospitalisation and without being off work for long periods as in usual methods of conservative treatment.KEY WORDS: Epidural medication, Backache, Lumbago, Sciatica     

Influence of Malnutrition on Cognitive Development Assessed by Piagetian Tasks

ABSTRACT. Cognitive development of 1336 children (6–8 yr) was studied in relation to their nutritional status. Seven Piagetian tasks covering the mental process of a concrete operational period were given to each child to assess the cognitive development. Weschler intelligence scale for Indian Children was used to assess the IQ of each child. The percentage of malnourished children in stage I of development (preoperational) was significantly higher as that of wellnourished children. A higher percentage of children in the latter group was in stage III of development (concrete operation). In boys performance on all the tasks was influenced by undernutrition except for class inclusion. In girls this was true only for conservation of liquid, substance and ordinal relation. "he results of the regression analysis showed that nutrition was the only thctor weakly assdated with the poor performance of the children En various tasks. Further, the effect of nutrition was more pronounced in conservation tasks indicating poor verbal reasoning aud comprehension in malnourished children. Information was also collected regarding the parental education and occupation, socio-economic status, caste, economic sufficiency, psychosocial stimulation and home environment. However, these environmental factors did not inflnence the development of rnl children. This might be due to the fact that the population in the present study did not vary much with regard to these variables.     

Improvement of intraoperative somatosensory evoked potentials by ketamine

Many anaesthetics effect the latency and amplitude of somatosensory evoked potentials (SSEP). We present a patient who underwent two anterior/posterior spine fusions (A/PSF) at age 11 and 12 years old after resection of a spinal astrocytoma. She did have residual neurologic deficits of her lower extremities. SSEPs were unobtainable during the first surgery using an opioid-based anaesthetic. A ketamine-based anaesthetic was used for the second surgery and SSEPs were easily monitored. No other factors seem to have changed between the two surgeries. The anaesthetic management during each procedure is reviewed and the contributions of other factors to SSEP monitoring discussed.     

Lessons Learned from Balloon Aortic Valvuloplasty Experience from the Pre‐transcatheter Aortic Valve Implantation Era

Background: Balloon aortic valvuloplasty (BAV) has been used as a bridge to surgical aortic valve replacement (SAVR) in high‐risk patients with severe symptomatic aortic stenosis (AS). Such patients are now being referred for transcatheter aortic valve implantation (TAVI). We sought to study the indications and outcomes of BAV in patients with severe AS in the pre‐TAVI era. Methods: We analyzed consecutive patients with severe AS undergoing BAV from 1990 to 2005. In these patients with no immediate surgical option, BAV was attempted to temporarily improve hemodynamics, with a goal to improve general health of the patient, and ultimately AVR. Results : A total of 99 BAVs (eight repeats, one second repeat) were performed in 90 consecutive patients. Baseline ejection fraction was ≤25% in 36 (36%) patients. The 30‐day mortality rate was 17% (n = 17). Of the 99 patients, 27 (30%) underwent AVR. Average follow‐up of patients with and without AVR was 55 ± 57 months and 16 ± 23 months, respectively. The 6‐month and 1‐year survival rates in patients who underwent AVR were 81% and 78%, respectively, versus 57% and 44% in patients who did not undergo AVR (P = 0.024). Conclusion: BAV can be used successfully to clinically improve the health of some nonsurgical patients with severe symptomatic AS, and a proportion of these patients improve to a point where AVR can be performed. Bridging to TAVI will provide further options to high‐risk patients who cannot be bridged to conventional AVR. The role of BAV in bridging to TAVI merits further study. (J Interven Cardiol 2010;23:499–508)     

Review article: Risks of coronary artery calcification in chronic kidney disease: Do the same rules apply?

Atherosclerosis, once present, in the intimal and medial spaces of the blood vessel wall becomes calcified due to a variety of cellular and metabolic processes. Patients with chronic kidney disease (CKD) appear to have both accelerated and amplified vascular calcification compared with the general population. Calcium deposition within vascular tissue in the form of calcium hydroxyapatite crystals appears to be a permanent step in the mature atherosclerotic plaque, and to date has not been found to be reversible or modifiable with common treatments for atherosclerosis or dialysis management strategies. Densely calcified lesions with a circumferential arc of calcium around the vessel wall may be severely stenotic, however, are unlikely to develop symptomatic plaque rupture with an acute coronary syndrome. For that reason, the expected outcomes of atherosclerotic therapies in patients with CKD bone and mineral disorder have not followed the same rules of evidence. This paper will review the differences between the CKD and general population with respect to vascular calcification and the observed natural history in observational and interventional studies.     

Potentiation of Bromotrichloromethane Hepatotoxicity and Lethality by Chlordecone Preexposure in the Rat

Potentiation of Bromotrichloromethane Hepatotoxicity and Lethalityby Chlordecone (Kepone®) Preexposure in the Rat. Agarwal,A.K. and Mehendale, H.M. (1982). Fundam. Appl. Toxicol. 2:161-167.These studies were designed to provide dose-response relationshipsfor chlordecone (CD) potentiation of BrCCl₃ hepatotoxicity inmale rats using biochemical, functional and histopathologicalparameters. The influence of this interaction on BrCCl₃ lethalitywas also examined. Male Sprague-Dawley rats (175–200g)received a single ip dose of 1, 5,10,15 or 25 µL BrCCl₃/kgfollowing a 15 day dietary pretreatment of 0 or 10 ppm CD. Twentyfour hrs after BrCCl₃ challenge, biliary excretion of phenolphthaleinglucuronide (PG), bile flow, serum transaminases (SGOT and SGPT),serum ICD and OCT were examined as functional and biochemicalindices of hepatic injury. Effect of CD on 48 hr LD₅₀ of BrCCl₃was also examined using the method of moving averages. Withthe exception of 1 µL BrCCl₃/kg dose which had no effect,CD-BrCCI₃ combination resulted in potentiation of hepatotoxicityby all parameters examined. Activity of all the serum enzymeswas elevated in a dose related manner. A dose related decreasein the biliary excretion of PG and bile flow was observed. Theseeffects were more pronounced at the higher doses of BrCCl₃.Extensive centrilobular necrosis was observed in the animalsgiven CD-BrCC₃ combination and the necrogenic effect was moresevere at the doses of 15 µL and 25 µL BrCCl₃/kg.BrCC₃-lethality was increased 5-fold by CD as indicated by thedecreased LD₅₀- The results suggest that CD-induced BrCCl₃ toxicityis manifested both in the form of hepatotoxicity and lethalityand since the hepatic functional status is greatly compromised,the CD potentiatedhepatic failure is related to lethality.