Lumbar interlaminar epidural injections in managing chronic low back pain with sciatica without using fluoroscopy

Objective: to find out the effectiveness of interlaminar parasagittal lumbar epidural injection without using flouroscopy in the management of low back pain with radiculopathy

Study design: descriptive case series

Place and Duration of study: Ziauddin University Hospital Karachi Clifton campus, from January 2013 to December 2014

Methodology: patients with lumbar back pain associated with unilateral sciatica for more than three months duration were included. Visual analogue scale [VAS] of 100 was used for pain severity assessment. Lumbosacral spine x-rays with skin surface marking were obtained before the procedure. Interlaminar parasagittal approach was used in lateral position with affected leg up. Follow up was done at 6 weeks, 3 months, and 6 months. During the course of 6 months, three injections were offered at any point of recurrence of pain with at least 2 to 3 weeks interval

Results: a total of 75 patients of both genders with the mean age of 45.03 +/- 14.35 year were included. Disc levels involved were L4/5 [53.33%], L5/S1 [38.66%], and L3/4 [8%]. Pre-procedural mean VAS score was 75.2 +/-15.99. In 65.33% patients sustained significant relief in pain noted at six months follow up. In 20% patients short term recovery observed with recurrence of pain in three months. No major complication was encountered during the procedure

Conclusion: interlaminar parasagittal epidural injection is simple, effective in relieving chronic low back pain associated with sciatica and does not need any special medical equipments and setup

Challenges in orthopedic surgery: an anesthesiologist's perspective

Orthopedic patients are different from general surgical patients in many aspects; just consider the age factor, as most of these patients report to the treating facility with age specific diseases. The patient concerns are also age specific, ranging from fear of being isolated from the parents, to pain and immobilization and even death. Both, the surgeon and the anesthesiologist have to deal with these concerns. Every age group also comes with its associated comorbid conditions and diseases. Here, it is mainly the anesthesiologist who has to face the music. Old patients have special problems related to comorbid conditions, e.g. hypertension, diabetes, heart disease and lung disease and poly-drug therapy, just to mention few. Perioperative optimization of these patients tests the professional competence of the anesthesiologists. The choice of anesthesia and successful management of perioperative complications will decide the fate of the patient. Regardless of the age, good postoperative nursing care and adequate pain relief will hasten recovery and reduce hospital stay

Chemical-based resistance in cotton "Gossypium SPP" to bollworms, pectinophora gossypiella and Erias insulana

The chemical resistance to the cotton boll worms; P. gossypiella and E. insulana was investigated in nineteen cottons, which included three Egyptian varieties of Gbarbadense and 16 varieties and traits of the upland cotton, G hirsutum. The nineteen cultivar lines were grown in the field in a random plot experiment and their infestation by the two boll worms was determined over two agricultural seasons. Flower buds, squars and boils, of resistant and susceptible cultivar lines were extracted for their contents of prominent secondary plant products; condensed tannins, flavonoids, and terpenoid aldehydes. The antibiotic activity of the extracts against several growth and developmental parameters of the two insects was determined in a laboratory feeding tests mixed with artificial diet. Information from laboratory and field infestation experiments correlated these allelochemicals to actual field resistance. The results show that different lines, each with insect resistance, possess different ratios of antibiotic compounds, which provide means for generation of lines with multiple factors -for resistance

Studies on organophosphorus compounds. XII[asterisk]: synthesis of bioactive heterocycles and hydrazones by using tris-dimethylaminophos-phoniodithioformate complex

Tris-dimethylaminophosphine reacted with carbon disulphide to produce the corresponding dithioformate complex 4, which was reacted in situe with hydrazonoyl halides 5a-c in the presence of potassium carbonate [K[2]CO[3]] forming the thiadiazaphosphinines 7a-c, respectively. Isolation of the complex 4 and its reaction with hydrazonoyl halides 8a-d in warm benzene led to the formation of the thiadiazoles 10a-d. Carrying out the reaction in chloroform with stirring produced the hydrazones 12a-d. The biological activity examination revealed that compounds 10b and 12a have significant antimicrobial activity against all tested microorganisms. Compounds 7b,c and 12b,c showed slight susceptibility for only the tested Gram positive organisms and they were incapable of inhibiting the growth of the examined Gram negative bacteria and fungi

Thrombo-embolism in patients with myocarditis

Myocarditis and dilated Cardiomyopathy continues to be an important cause of hospital admission in our part of the world. Systemic embolism due to thrombi in left ventricle is a rare but important complication of these patients. Study objectives: To determine the incidence, course and outcome of thrombo-embolism in children with dilated dysfunctioning heart due to acute myocarditis or dilated Cardiomyopathy. Design: A 5 year analysis [December 1999- Nov 04] of all children under 16 years of age admitted and diagnosed as having myocarditis or dilated Cardiomyopathy in a single tertiary care center. Patients and The charts and echocardiography records of all patients with dilated dysfunctioning heart and systemic thrombo-embolism were reviewed. Data was reviewed for mode of presentation, age, hospital course and outcome. Echocardiography data was reviewed with special reference to the size, function and presence of thrombus in LV. Of all admissions to the paediatric cardiology unit over the study period, myocarditis and dilated Cardiomyopathy was the underlying lesion in 405 patients. The mean age of patients was 2.1 +/- 4 years. Systemic embolism was the presenting feature in 28 [6.9%] patients [Group A]; while another 17 [4.2%] developed it during the hospital stay [Group B]. Another 5 patients had thrombus in the LV but did not develop embolism. All 50 patients showed seriously impaired LV function with mean ejection fraction [EF] for those with vs. those without thrombo-embolism was 17.5 +/- 5.5 vs. 20.0 +/- 6.9 [p = 0.08]. The groups were similar with respect to other baseline characteristics, co morbid illnesses, and drug therapies other than anticoagulants. In group A 26/28 patients presented with a stroke. Only 6 had a thrombus in LV at the time of admission. All 28 patients with or without LV thrombus were treated with heparin and then oral anticoagulant warfarin. There were two deaths. In group B, 3/17 patients had thrombus in the LV on echocardiography at presentation. They were started anticoagulation but still went on to develop a stroke. There were 2 deaths in this group as well. Conclusions: Myocarditis and dilated Cardiomyopathy is an important cause of hospital admission in our set up accounting for 15% of all admissions to a paediatric cardiology unit. These patients are at risk of developing thromboembolism, which may well be the presenting feature. The risk is higher in patients with lower ejection fraction of the LV. All patients with EF below 17% should be treated with prophylactic anticoagulation. A peripheral embolic event adds to morbidity and is related to poor long-term survival in this patient group

Prospective randomized study of bacteraemia and perianal infection in diathermy haemorrhoidectomy and injection sclerotherapy for haemorrhoids

One hundred and twenty patients were evaluated for the presence of haemorrhoids and randomized to diathermy haemonhoidectomy or injection sclerotherapy had preoperative blood culture taken. The clinical sequelae of bacteraemia and complications of surgery [sepsis or bleeding] were assessed prospectively. Twelve patients [17%] of 70 patients with diathermy haemorrhoidectomy and two patients [4%] of 50 who had injection sclerotherapy had positive blood culture for organisms after haemorrhoidectomy and sclerotherapy predominantly gram -ve and anaerobes. Transient postoperative pyrexia in several patients did not correlate with detected bacteria and settled spontaneously without treatment. There were no serious complications from either technique and consequences from proven bacteraemia

Effect of chronic low dose exposure to lead on male reproduction in rabbits

The present study aimed to investigate the effect of exposure to a low dose of lead for a long time on male reproductive performance. Therefore, 60 weaned white Newzealand rabbits were reared in automatic battery system, randomly divided into two groups; a control group that received distilled water and a treated group that received 100 micro g lead acetate micro g/ kg body weight orally/day. Libido, semen characteristics and mating performance were investigated in mature rabbits [20[th] - 35 [th] week after starting the experiment]. Blood samples and testes were collected after sacrificing at 4, 8,12,16, 20 and 36 weeks after the start of the experiment. Androstenedione, testosterone and estradiol-17 B levels were assayed [RIA] in blood plasma. Relative weight, total testosterone in homogenate and histopathological changes of the testes were recorded. Also, residual lead in blood and testes was determined. Results showed that plasma total testosterone and androstenedione levels were significantly lower in lead treated [114 and 7.2 ng/dl, respectively] than control [241 and 12.3 ng/dl, respectively] groups. Estradiol-17B level was not significantly different. Total testosterone concentration in testicular homogenate was significantly decreased in lead treated [3.68 +/- 0.68 micro g /100 mg] than that in control [17.47 +/- 3.71 micro g /100 mg] groups. Relative testicular weight, libido, sperm motility, sperm abnormalities, fertility% and average litter size was significantly lower than that of the control group while a significant increase of sperm abnormalities was noticed than that of control. All these results and others proved that even a marginal lead level could provoque reproductive disorders in male rabbits

Comparative study on the efficacy of prostaglandin F[2] and short-term norgestomet treatments as luteolytic agents in buffaloes

Induction of luteolysis in suboesterous buffaloes with palpable and functional cor pora lutea was applied. Different doses of prostaglandin F[2]alpha [lutalyse] were used through intramuscular [25 mg] and vaginal submucosa [12.5 and 7.5 mg] routes. Short-term [9-10 days] norgestomet [Synchro-Met-B] ear implants were also administered for comparison. The results showed that intramuscular injection of 25 mg PGF[2] alpha during summer inducd luteolysis in 70% of the treated animals, while injection of 12.5 mg PGF[2]alpha into vaginal submucosa of suboestrous buffaloes during summer also, resulted in luteolysis in 87.5%. Injection of 7.5 mg PGF[2] alpha into vaginal submucosa in suboestrus buffaloes during winter improved the rsponse [88.89%]. Application of Synchro-Met-B ear implants led to luteolysis in 90.90% of the treated buffaloes. In conclusion, injection of PGF[2] alpha into submucosa proved to be effective, economic and easily applied treatment of suboestrous and/or synchronization of oestrus in buffaloes

Scoring the early complications of episiotomy repair with different suture materials and antibiotics

Early post opisiotomy complications; pain, redness, oedema, gapping and granulation tissue overgrowth were assessed and scored on the 10th postopartum day. Each item was given a score ranging from zer up to 3 with a total score of 14. The score was developd to evaluate episiotomy repair with chromic catgut, Dexon, and vicryl, with use of either systemic or local antibiotic spray, on 120 primigravide. The score is simple and valuable. Postepisiotomy complications were statistically higher with use of chronic catgut than with vicryl or Dixon, while there was no statistical difference between vicry or dexon neither on the scond nor on the tenth postpartum days. There was no statistical difference between systemic and local antibiotic spray. The total cost of episiotomies repaired with chromic was higher than with Dexon and vicryl. The latter was the best due its association with fewer cases of resuturing, readmission and antibiotic use. We recommend repairing episiotomies with either vicryl or Dixon and the use of coal antibiotic spary

Some biochemical studies on serum and testes of rabbits after active immunization against inhibins

The present investigation was undertaken to clarify the influence of active immunization of male rabbits against inhibins on some biochemical parameters in serum and testes. Inhibins were extracted and partially purified from bovine follicular fluid [BFF]. The results revealed that, active immunization against inhibins led to a decrease in testicular acid and alkaline phosphatases, lactic dehydrogenase and hyaluronidase activities. Phospholipids and zinc concentrations in the testes were also decreased. This reflects an impairment in the testes function. Repeated injection of inhibin as immunogen resulted in an increase in serum total bilirubin, while serum enzymes activities of aspartate aminotransferase [AST], alanine aminotransferase [ALT] and alkaline phosphatase [ALP] were decreased. Sodium and potassium ions concentrations were not affected by immunization. Active immunization led to a decrease in serum total proteins, albumin, alpha globulin and A/G ratio, but beta and gamma globulins were increased

Effect of tamaron [organophosphorus] on fertility with reference to steroids, thyrotorophic and thyroid hormones secretion in female rats

Mature female rats were treated with methamidophos [Tamaron of Bayer Co., West Germany] daily through drinking water at a rate of 100 ppm daily for 9 [short-term] and 45 [long-term] days. The results revealed that methamidophos reduced the fertility in rats where it led to death and resorption of the embryos. Methamidophos led to a decrease in blood estradiol and progesterone in short-term treated rats. While, in long-term treated rats, there was an increase in estradiol and a decrease in progesterone concentrations. Treatment of rats with methamidophos did not alter thyrotrophic hormone [TSH] concentration, while thyroxine [T4] and triiodothyronine [T3] concentrations were decreased

Early repair of acute ligamentous injuries of the knee

A follow up study of 24 patients with recent ligament tears of the knee is presented. The patients were operated upon within two weeks after injury by primary repair. The lesions in the present study include 12 cases with various tears of Medial Collateral ligament [MCL] [three of these having associated medial meniscus detachment]. There were nine cases with combined MCL and Anterior Cruciate Ligament [ACL] tears [associated medial meniscus in two].Three patients presented with combined MCL on PCL tears[with one case having in addition a detached medial meniscus]. In all six cases with meniscal injuries with the exception of one the detached medial meniscus was resutured.Despite the persistence of grade1+ and 2 + instability postoperatively in eight patients. The functional outcome is encouraging. Eighteen patients obtained satisfactory [excellent and good] end results whereas only six cases had fair or poor results.The end results were closely related to the severity of the lesions present in each case. The importance of early surgical repair of injuried knee ligmaments is stressed. The necessity for reinforcing the repair particularly of ACL tears has been discussed

Effects of prolactin on release and clearance of PMSG and HGG in rats

Administration of prolactin [2.5 i.u.] and antiprolactin serum [0.2 ml diluted antiprolactin serum, 1:3 in saline] twice daily for 5 days to study the relationship between both hormones and gonadotrophins resulted in 1- Prolactin increased pituitary HCG but not serum HCG-like activities. 2- Administration of prolactin to castrated rats increased serum HCG more than their controls, while their pituitary HCG remained unchanged in comparison with those intact treated ciontrol rats. 3- Injection of prolactin to Castrated rats decreased both pituitary and serum PMSG when compared with their castrated controls. 4- Administration of antiprolactin serum esulated in increased pituitary PMSG, but complete disappearance of pituitary and serum HCG. At the same time increased serum PMSG. 5- The clearance of PMSG in intact control rats was more rapid than HCG. This indicates that tflere is an initial uptake of PMSG followed by HCG. While prolactin inversed the above results. 6- Clearance of PMSG from the circulation was more rapid than HCG in the antiprolactin serum treated rats. 7- Anti-LTH serum caused rapid clearance of both serum HCG and PMSG. While prolactin decreased clearance of both serum HCG and PMSG

Nutritional and physiological studies on onion allium cepal: 1 Effect on blood constituents

The results indicated that onion with 1% and 2% additions per kg diet caused a significant decrease in the number of red blood cells, packed cell volume and haemoglobin content of the blood. On the other hand it increased the number of while blood cells. Blood smears were prepared from control and treated rats. They were stained with new methylene blue and modified wright's stains for detection of Heinz bodies and reticulocytes. No evidence could be noticed for the presence of Heinz bodies or reticulocytes in the blood of rats as a result of adding onion to its feed. The glucose level in the blood of treated animals was significantly lower than its level in the control ones. Total protein was increased in the serum of the treated rats. The cholesterol content in the serum of rats was highly significant increased in the fourth group in which 3% onion per kg diet was added to the feed of rats when compared with cholesterol level in the serum of control animals