Anaesthetic management of supratentorial tumor craniotomy using awake-throughout approach

The authors are reporting an anaesthetic management of patient presenting with left parietal lobe space occupying lesion and scheduled for Awake-craniotomy. Awake-throughout approach using scalp block was planned. Among techniques reported for keeping patient awake during the surgery, this one is really underutilized. The successful conduct requires thorough preoperative assessment and psychological preparation. We used powerpoint presentation as a preoperative teaching tool. The anatomical landmark technique was used to institute scalp block, where individual nerves were targeted bilaterally. Patient remained stable throughout and participated actively in intraoperative neurological monitoring. Postoperative period showed remarkable recovery, better pain control, and shorter length of stay in hospital

Frequency of hyperthermia in acute ischemic stroke patients visiting a tertiary care hospital

Objective: To determine the frequency of hyperthermia in acute ischemic stroke patients visiting a tertiary care hospital in a developing country

Study Design: Cross-sectional, observational study

Place and Duration of Study: Medical Wards of Civil Hospital, Karachi, from January to June 2013

Methodology: Patients aged > 18 years of either gender with acute ischemic stroke presenting within 24 hours of onset of symptoms were included. Written informed consent was obtained from all participants as well as approval of ethical review committee of the institute. Axillary temperature by mercury thermometer was monitored at the time of admission and after every 6 hours for 3 days. The data was analyzed using SPSS version 17.0 [SPSS Inc., IL, Chicago, USA]

Results: A total of 106 patients of ischemic stroke were included. The mean age of enrolled participants was 60.1 +/- 9.5 years. Among these, 61 [57.5%] were males and 45 [42.5%] females. Among all patients, 51.9% presented with loss of consciousness, 30.2% with slurred speech, 77.4% with limb weakness, and 9.4% with decrease vision. A total of 17 [16%] patients with ischemic stroke developed hyperthermia. When the prevalence of hyperthermia was stratified according to age, among patients of < 60 years of age, 26% developed hyperthermia compared to 7.1% in patients of > 60 years of age [p=0.008]. On gender stratification, among male patients, 14.8% developed hyperthermia compared to 17.8% in female patients [p=0.43]

Conclusion: It is concluded from this study that the frequency of hyperthermia in ischemic stroke was 16% and it should be looked for as it has significant impact on the outcome. The hyperthermia was significantly more common in younger adults as compared to older adults. However, gender had no influence on the prevalence rate of hyperthermia

Complications of acute peritoneal dialysis in children with acute kidney failure

Acute kidney injury is the sudden failure of kidneys to maintain body homeostasis and acute peritoneal dialysis is a life saving bedside mode of its management. However, complications like peritonitis, leakage, obstruction and malposition of catheter can occur during acute peritoneal dialysis. To document the immediate complications of acute peritoneal dialysis in children having acute kidney injury. Descriptive case series done at department of Pediatric Nephrology, National Institute of Child Health Karachi from July 2007 - July 2008. Children between 1 month to 14 years of age who had acute kidney injury and underwent acute peritoneal dialysis were included in the study. All had standard indications for dialysis, catheter insertion technique and manual exchanges. Data including age, gender, indications, cause of acute kidney injury and complications, were computed on SPSS - 10 and analyzed using descriptive statistics. A total of 126 children underwent acute peritoneal dialysis for various indications and among them 60 developed different complications. There were 34[56.6%] boys and 26[43.3%] girls with a mean age of 4.7 years. Indications for acute peritoneal dialysis were oligo-anuria in 52[86.6%], metabolic acidosis in 42[70%], fluid overload in 32[53.3%], uremia in 27[45%] electrolyte imbalance in 17[28.3%] and severe hypertension in 2[3.3%]. Etiologies for acute kidney injury were sepsis in 15[25%], renal calculi in 14[23.3%], congenital obstructive uropathy in 10[16.7%], acute gastroenteritis in 7[11.7%] and hypoplastic kidneys in 6[10%] cases. Mean duration of acute peritoneal dialysis was 5.2 days. Documented complications were peritonitis in 19[31.7%], catheter obstruction in 13[21.7%], leakage and catheter displacement in 11[18.3%], bleeding and other complications in 3[5%]. Acute peritoneal dialysis is a life saving procedure. Peritonitis, catheter obstruction, leakage and displacement were the common complications. Peritoneal dialysis for children should be available at all tertiary care hospitals and its staff should undergo regular training to manage the complications

Clinicopathological Study of Renal Amyloidosis

Study included 13 cases of renal amyloidosis.Oedema, feet and face was the commonest manifestation (100%), two patients (18.18%) also presented with loose motions, ascites and pain in abdomen and one patient had ankylosing spondylitis and cervical spondylitis. On clinical grounds only one case was diagnosed as primary amyloidosis of light chain type, who presented initially with cervical lymphadenopathy and 4 years later with nephrotic syndrome. About 72.72% cases had some chronic disease in the terms of tuberculosis, ankylosing spondylitis, chronic ulcerative colitis, lepromatous leprosy, rheumatoid arthritis and one patient had carcinoma caecum. Congo red stain was positive in both, light chain deposit disease (LCDD) and amyloidosis but polarizing microscope showed mixed birefringence (red, green, yellow) only in amyloidosis. In AFOG and PAS stain, amyloid appeared negative, only peripheral portion revealed blue and pink staining and central area appeared as cutout spaces. Congo red and methyl violet stains and potassium permanganate treatment was not helpful in distinguishing AL amyloidosis from secondary amyloidosis. Hence immunohistochemistry and myeloma profile is a must. It might be possible that in light chain amyloidosis, treatment with methotrexate and prednisolone may improve survival.

Neonatal bartter syndrome

A pre-term baby girl was born following a pregnancy complicated by severe polyhydramnios at a gestational age of 36 weeks. She was initially suffering from respiratory distress consistent with idiopathic respiratory distress syndrome, and altered electrolyte imbalance with hyponatremia, hypokalemia and hypochloremic metabolic alkalosis. However, during the third week of life when she had dehydration along with significant electrolyte imbalance, Bartter's syndrome was considered which was supported by findings of high renin and aldosterone levels. Treatment was done by correction of electrolytes and dehydration along with indomethacin. The drug was well tolerated. The infant showed correction of electrolyte imbalance. The features of this case suggest an extreme form of Bartter's syndrome presenting from the early days of life. The syndrome is reported because of it's rarity and alerts pediatricians to the antenatal and neonatal variant of Bartter's syndrome

Pattern of admissions to neonatal unit

To document the number, disease pattern and outcome of patients admitted to neonatal unit. Descriptive study. The study was conducted in the Neonatal Unit of National Institute of Child Health, Karachi, Pakistan from 1st January 2001 to 31st December 2001. The data of all the admitted neonates was analyzed for age and weight at the time of admission, sex, duration of stay, cause of admission and outcome. A total of 1984 neonates were admitted during study period. Among them 62.1% were males, 17.54% were admitted within 6 hours of their life, and 51.36% within 72 hours of birth. The low birth weight accounted for 55.4% admissions. Neonatal infection was the major cause of admission [45.21%] comprising 30.64% cases of septicemia, 9.82% of pneumonia and 4.73% of meningitis. Other causes of admission were birth asphyxia [18.85%], neonatal jaundice [13.15%], pre-term [6.87%], meconium aspiration syndrome [3.67%], hemorrhagic disease of newborn [2.21%], diarrhea [2.11%] and hyaline membrane disease [1.05%]. 48.53% were discharged with satisfactory condition, 25.5% died and 25.85% left against medical advice [LAMA] and or discharged on request [DoR]. Low birth weight [LBW], infections and birth asphyxia were the major causes of neonatal admission