Neuron-specific enolase as a predictive biochemical marker for adverse neurologic outcome after cardiac surgery

Despite significant advances in cardio-pulmonary bypass [CPB] technology, surgical technique, and anaesthetic management, central nervous system complications occur in a large percentage of patients undergoing surgery requiring CPB. A major neurologic complication after otherwise successful surgery represents a devastating outcome for both the patient and the immediate family. The social and economic impact of unemployment and the requirement for long-term rehabilitation or institutional care are significant. Neuron-specific enolase [NSE] is a biochemical brain marker which can be used for the prediction of adverse neurologic outcome after cardiac surgery. This study included 60 adult patients of both sexes scheduled for elective cardiac surgery. Standard CPB technique with membrane oxygenator, nonpulsatile flow, and mean arterial pressure control was used. Neuropsychological evaluation was performed before surgery and post-operatively at discharge and after three months. Neuron-specific enolase[NSE] was measured after induction of anaesthesia, at end of CPB, 24 hours and 48 hours after CPB. After 5 days of surgery 21.8% of patients developed neuropsychiatric dysfunction. However, after 3 months only 10.9% of patients developed neuropsychiatric dysfunction. The NSE values at the end of surgery and 24 hours after surgery in patients who developed neuropychiatric dysfunction were significantly higher than those who did not develop neuropsychiatric dysfunction at 5 days and 3 months after surgery. The serum levels of NSE sampled at the end of surgery or 24 hours after surgery could be of a valid clinical predictor for adverse neuropsychiatric outcome in patients undergoing cardiac surgery

Air pollution related respiratory morbidity in central and north-eastern Bombay.

A study of 4 comparable communities in central & northeastern Bombay (2 each) among randomly matched 349 subjects in 1988-9, along with ambient sulfur dioxide (SO2), Nitrogen dioxide (NO2) & suspended particulate matter (SPM) air monitoring was carried out. The levels in winter were higher particularly for SO2 in Parel (upto 584 micrograms) in Maravali; Deonar showed lower pollution. There were inter-area differences for housing, income, residential history but age-sex differences were small; these were reduced by matching. Clinical respiratory symptoms were higher in Parel & Maravali (cough 12% and 11.2%, dyspnoea 17% & 13.3% respectively). Cardiac problems are commoner in Parel (11.0%). Smoker had cough more often but not dyspnoea. Maravali had a high prevalence for headache and eye irritation (9.5%). Those using kerosene suffered more than those using gas (22.2% as compared to 9.2%) Lung functions (FVC, FEVI) were lowest in Parel for males and in Maravali for females. Expiratory flow rates were lower at Dadar and then at Maravali. Despite lower SO2 pollution, Maravali residents suffered equally as in Parel. This may be due to added effect of diesel exhausts (NO2, SPM) or other unmeasured chemicals.

Evaluation of endoscopic variceal sclerotherapy in various grades of liver disease.

Forty four patients with portal hypertension of varying etiology, including 25 patients with an acute episode of variceal bleeding and 19 with past history of hematemesis, were followed up for eighteen months following endoscopic variceal sclerotherapy (EVS). Of 11 patients in Child's A group, two died of acute bleed, three were subjected to shunt surgery and the remaining six survived the follow-up period. Ten of 11 cases in Child's C did not survive more than six months in spite of sclerotherapy. We conclude that rebleed and death due to rebleed following EVS occur more commonly in patients with poor hepatic reserve (Child's C) as compared to patients in Child's A and B.