ABSTRACT
Acute liver failure with concurrent Hepatitis b and autoimmune hepatitis is an extremely rare case. We report a 25 year female presenting to our emergency with fatigue and somnolence, distention of abdomen, jaundice, melena and increased hair loss leading to alopecia. Physical examination revealed jaundice, an enlarged liver, ascites and tenderness of upper right abdomen. Laboratory tests revealed an increased level, bilirubin, GGT, increased INR and prothrombin time with elevated IgG levels, and the presence of anti-smooth muscle antibodies, Anti-nuclear antibodies and HBV infection markers. The patient was diagnosed with liver failure resulting from chronic active hepatitis B with an autoimmune component. The treatment consisted of steroids, azathioprine, vitamin K, low-protein diet and lactulose enemas. After undergoing a molecular test (HBV DNA 3.23 × 10 IU/mL and HBeAg reactive), the treatment was modified by adding tenofovir disoproxil fumarate. After one month the patient was discharged in good clinical condition, with the recommendation of continued tenofovir disoproxil fumarate and prednisone. In subsequent follow-ups, no clinical deterioration or abnormal biochemical liver function test results were found.
ABSTRACT
The study evaluated 60 adult patients of either sex belonging to ASA grade I & II, who were randomly allocated into 2 groups of 30 each; Group I-Proseal LMA group and Group II -ETT group. They were premedicated with inj. glycopyrrolate 5-10 mcg/kg and inj.butarphanol 2mg intramuscular 45 minutes prior to surgery. Patients were preoxygenated & anaesthesia was induced using oxygen + inj. propofol (2mg/kg) + isoflurane + inj. vecuronium bromide (0.1 mg/kg). PLMA or ETT was inserted as per group. Insertion characteristics i.e. ease of insertion and insertion time were noted. A 16Fr gastric tube was passed into the stomach in every patient and connected to continuous suction. Anesthesia was maintained with nitrous oxide, oxygen, isoflurane and inj. vecuronium bromide. Ventilation was set at 10 ml/kg and 15 breaths/min.The demographic data of both the groups were comparable. The mean age in this study was 42.2 years (22 females and 8 males) in Group I (PLMA) and 40.8 years (23 females and 7 males) in Group II (ETT). The mean BMI of patients in Group I was 22.7 kg/m2 and in Group II was 23.1 kg/m2. Insertion of device was graded as easy in 93% of patients in PLMA group and 96% of patients in ETT group. Mean time taken for successful placement of device in PLMA group was 15.83 s and in ETT group was 17.1 s, which was, however, statistically insignificant (p value = 0.095).The insertion of NGT through drain tube of PLMA was easier than via nose in ETT group. The mean insertion time taken to insert NGT through PLMA was significantly less (10.03 s) than via nose (12.7 s) in intubated patients.The anesthetic and peritoneal insufflation times in both groups were comparable. . The ventilation was adequate to maintain Sp02 of 99% - 100% in both the groups. Based on the study ,it may be said that ,Proseal laryngeal mask airway seemed to be a safe and effective alternative to endotracheal intubation in patients of laparoscopic cholecystectomy.