Duodenal gangliocytic paraganglioma: A rare cause for gastrointestinal polyp

Duodenal gangliocytic paragangliomas are rare neoplasms often arising in the duodenum in close proximity to the ampulla of Vater. These neoplasms are considered to have a benign behavior with lymph node metastases being a rare phenomenon and distant metastases even more so. Although a standardized treatment has not been determined, a margin-free tumor resection seems to be the best treatment modality. We report herein the case of a 36-year-old female who presented with abdominal pain and was found to have a polyp in the second part of duodenum which was excised endoscopically. Histopathology and immunohistochemistry revealed characteristic features of this rare tumor.

General versus spinal anesthesia in percutaneous nephrolithotomy: A comparative study

Background: Percutaneous nephrolithotomy (PCNL) is usually done under general anesthesia (GA). However, it can be done under spinal anesthesia (SA) which can have advantages like less bleeding, less postoperative pain, low dose analgesic requirement and less drug intake. Aim: In our study, we had compared the efficacy and safety of general versus Spinal Anaesthesia in PCNL. Materials and methods: In prospective randomized study, 100 patients undergoing PCNL were randomly assigned into two groups; group A (n = 50) underwent PCNL under GA, by injecting thiopentone, succinylcholine and vecuronium and group B (n = 50) received SA, by injecting bupivacaine and fentanyl in spinal space L4 in sitting position. Thereafter, a urethral catheter was placed in lithotomy position, head of the table was tilted down for 5 to 10 minutes, and the level of anesthesia was checked. Then, PCNL was done by standard technique. Results: Hemodynamic stability was more in SA group. Heart rate and mean arterial pressure intraoperatively at 5, 10, 15 mins and at 60 mins and postoperatively at 0, 2 and 6 hours was significantly less in SA group (P < 0.05) as compared to GA group. The VAS score was 5.29±0.62 in GA group and 0.98±0.89 in SA group at 0 hour, 5.58±0.49 in GA group and 1.88±0.84 in SA group at 2 hours and 4.26±1.30 in GA group and 2.10±1.02 in SA group at 6 hours which was significantly Meena M, Mantan K, Saxena M, Dhawan S, Sethia S, Meena A. General versus spinal anesthesia in percutaneous nephrolithotomy: A comparative study. IAIM, 2017; 4(9): 59-66. Page 60 lower in SA group in comparison with GA group (P < 0.05). Mean analgesic requirement within 24 hours was lower in SA group (76±36.05) than GA group (140±28.57) and it was statistically highly significant (p<0.001). Postoperative nausea and vomiting was more in GA group than SA group. Conclusion: Spinal anaesthesia is a safe alternative to GA for PCNL with better pain relief, less analgesic requirement, less side effects.

Comparison of conventional dose and low dose infusion of dexmedetomidine on hemodynamic stress response, dose of induction agent and postoperative analgesia in patients undergoing laparoscopic cholecystectomy

Background and Aim: Anesthetic techniques are based on hemodynamic stability during anesthesia and surgery. Dexmedetomidine is centrally acting α2 agonist with sedative, sympatholytic and analgesic. Aim of this study was to compare effect of conventional dose with low dose infusion of dexmedetomidine on hemodynamic stress response, induction agent requirement & postoperative analgesia. Materials and methods: Single randomised prospective study done on 100 ASA Ι and ΙΙ patients aged 18-65 years scheduled for elective laparoscopy cholecystectomy under general anesthesia. Patients were divided in to two groups of 50 each, Group A: 1 µg/kg loading dose of Rolaniya SL, Dhawan S, Meera Kumari, Jain R, Pareek A, Sehtia S. Comparison of conventional dose and low dose infusion of dexmedetomidine on hemodynamic stress response, dose of induction agent and postoperative analgesia in patients undergoing laparoscopic cholecystectomy. IAIM, 2017; 4(7): 111-117. Page 112 dexmedetomidine I.V. started 15 min before procedure and infusion. 5 µg/kg/hr after induction and continued till end of surgery. Group B: 0.5 µg /kg/hr of dexmedetomidine I.V. started 15 min before procedure and continued till end of surgery. Results: Hemodynamic stability more in group B by avoiding complications like hypotension and bradycardia (p value < .05). Reduction of induction dose was more in group A than group B as compared to standard doses (P value <0.01). Hypotension and bradycardia were observed in 5 cases after 15 min of infusion in group A ( p value <.01). Mean VAS score in Group A was at 330 min was 3.10.39 and 3.150.94 at 210 min in group B. Conclusion: Low dose infusion of dexmedetomidine provides more hemodynamic stability. Requirement of induction agent was decreased more in group A than group B. Postoperative analgesia more in group A.

Teratomas in infancy and childhood.

A 10-year-experience with 42 cases of teratomas in paediatric age group is presented. The commonest type of teratoma was sacrococcygeal followed by ovarian and retroperitoneal teratomas. An analysis of clinical profile, malignant potential, management, prognostic factors and follow up is discussed with review of literature.

Positive correlation between menthol content and in vitro menthol tolerance in Mentha arvensis L. cultivars.

Menthol is a highly valued monoterpene produced by Japanese mint (Mentha arvensis) as a natural product with wide applications in cosmetics, confectionery, flavours, beverages and therapeutics. Selection of high menthol yielding genotypes is therefore the ultimate objective of all genetic improvement programmes in Mentha arvensis. A positive correlation was observed in the present study between menthol content in oils of evaluated genotypes and the level of tolerance to externally supplied menthol of explants of these genotypes in culture medium. The easy use of this relationship as a selectable biochemical marker opens the practical applicability of large scale in vitro screening of the germplasm, clones and breeders' material for selection of elite genotypes.

Reflux oesophagitis in acid peptic disease (a fibre-optic endoscopic study).

This study is based on entry criteria of visual findings of the upper gastro-intestinal fibre-optic endoscopy performed on 100 patients suffering from acid peptic disease (dyspepsia). The diagnostic criteria and grading of reflux oesophagitis advocated by Savary and Miller have been adopted. Reflux oesophagitis was found in 43 cases having grade I oesophagitis in 48.84%, grade II in 32.56%, grade III in 14.00% and grade IV in 4.60% cases. Reflux oesophagitis was associated with hiatus hernia in 23.26%, chronic gastritis in 9.30% of cases. The age varied from 16-80 years with almost equal incidence of male and female, and the severity of the disease increased with the advancement of age. Endoscopy is advised in every case of dyspepsia before any treatment is initiated.

The efflux of nor-epinephrine from platelets in genetic hypertension.

Platelets have been used as a model of sympathetic neurons to study the storage of nor-adrenaline in normotensive individuals belonging to families with essential hypertension for at least two generations. The efflux and initial efflux rate (K) of noradrenaline was determined in 36 young relatives (mean age 29.2 years) and in 20 young controls with no family history of hypertension (mean age 26.5 years). From the groups of relatives all those with definite hypertension had been excluded. Efflux and efflux rate K was significantly higher in young relatives (50.82 +/- 3.84 and 28.2 +/- 6.3) than in the controls (39.2 +/- 0.71 and 15.2 +/- 4.8). Of the relatives 25.2% had higher K values than any of the controls.

Use of captopril as an isolated agent for the management of stable angina pectoris--a double blind randomised trial.

In this double blind randomised placebo controlled study, we investigated the antianginal efficacy of oral captopril in 33 patients of angiographically documented coronary artery disease (chronic stable angina). Apart from sublingual nitrates, all other antianginal drugs were withdrawn. Patients were then evaluated both subjectively by questionnaire and objectively by treadmill stress test. No patient had more than mild hypertension and all patients had good left ventricular function. One group of patients received oral captopril while the other group was given placebo. A repeat assessment was done after six weeks and the results compared with baseline. Anginal attacks decreased from 20.11 +/- 1.86 per week on placebo to 9.92 +/- 1.38 (p < 0.01) on captopril as also the number of sublingual nitrates (18.84 +/- 3.01 to 11.14 +/- 2.94, p < 0.01). Assessment by the treadmill stress test showed that in comparison to the pretreatment test, captopril therapy resulted in a significantly increased exercise duration (6.26 +/- 0.21 to 6.98 +/- 0.31 minutes, p < 0.05), total work done (6.76 +/- 0.26 METS to 7.48 +/- 0.29 METS, p < 0.05). In addition there was a significant increase in time to angina (6.16 +/- 0.18 to 6.85 +/- 0.24 min, p < 0.05) and time to 1mm ST depression (5.18 +/- 0.26 to 6.46 +/- 0.30 min, p < 0.01). We conclude that captopril is an effective monotherapy for patients with chronic stable angina and has both antianginal as well as anti-ischemic effects, possibly secondary to direct coronary vasodilation.

Modified cephalic vein guide wire technique for permanent pacemaker implantation.

This report describes a modified cephalic vein guide wire technique used for implantation of 18 consecutive pacemakers using bipolar leads. The modified technique appears to be a safe and simple procedure for single chamber permanent pacing. Its use may also be extended in implanting dual chamber pacemakers.

Sites of right ventricular outflow tract obstruction in tetralogy of Fallot--a retrospective study.

Fifty one angiographically proved cases of tetralogy of Fallot (TOF) in the age group of 5-50 years were analysed retrospectively for the level(s) of right ventricular outflow tract (RVOT) obstruction. Mean age was 18.1 +/- 11 yrs. Subvalvular stenosis was found to be the commonest site of RVOT obstruction in 49 (96.1%) patients. Evidence of valvular pulmonary stenosis was seen quite commonly (42/51, 83.9% cases), mostly in association with obstruction at other sites. Supravalvular stenosis was also seen in 17 (33.3%) cases. Higher incidence of pulmonary valvular involvement in patients with TOF, in higher average age of patient population may represent valvular involvement to be an acquired phenomenon.

The efflux of nor-epinephrine from platelets in essential hypertension.

The precise role of sympathetic nervous system in initiation and/or maintenance of essential hypertension is unclear even today. Platelets have been used as a suitable model for studying neuronal turnover of biogenic amines. The present study comprised of hypertensive subjects (23) and normotensive controls (10). Hypertensive subjects exhibited significantly enhanced norepinephrine efflux from platelets at both 30 minutes and 60 minutes (p less than 0.001). The percent norepinephrine efflux from platelets correlated with diastolic (r = 0.66 and 0.76) and mean arterial blood pressure (r = 0.54 and 0.65) but not with systolic blood pressure. The norepinephrine efflux rate (K) similarly correlated with diastolic and mean arterial blood pressure in hypertensive subjects studied. From the above findings it appears that operative sympathetic nervous system activity is enhanced in essential hypertension. The enhanced efflux of norepinephrine from platelets may also indicate activated state of platelets in hypertension. Both could be important in genesis and complications of essential hypertension.

Clinical relevance of vegetations in infective endocarditis.

Two-dimensional echocardiograms of 58 patients with infective endocarditis were examined to determine if presence and/or size of vegetations on echocardiogram were predictive of morbidity and mortality. Group 1 (38 patients) with one or more vegetations, had a significantly higher rate of complications (emboli, congestive heart failure, need for surgery and death) than group 2 (20 patients) without vegetations (p less than 0.001). Analysis of morphologic characteristics of the vegetations in group 1 was of no predictive value for complications in individual patients. In contrast, patients whose echocardiograms demonstrated vegetations on aortic valve had a significantly higher incidence of heart failure, embolisation, surgery and death than those with vegetations on mitral valve. Thus, the detection of vegetations on initial echocardiogram clearly identifies a subgroup at risk for complications, more so if vegetations are present on the aortic valve, but the vegetations size does not predict an adverse clinical outcome.