Anaesthetic Management of a Patient Presented As Acute on Chronic Ruptured Ectopic Pregnancy Posted for Emergency Laparotomy

Ruptured ectopic pregnancy is a form of obstetric hemorrhage which is the world leading cause of maternal mortality. A 22 year female admitted with chief complaint of abdominal pain and 2 months of amenorrhea and diagnosed as acute on chronic ruptured ectopic pregnancy. Emergency laparotomy was planned. Proper preanaesthetic check-up was done. There were no other comorbidities; no significant past and family history were present. Intra-operatively, fluid and PCV (patient's blood group was B-ve) replacement was done according to loss. Salphingoophorectomy was done and till then patient was vitally stable but just before closure, sudden hypotension, bradycardia, hemolysis were reported. After suspected blood transfusion reaction, PCV transfusion was stopped; iv line flushed with NS, Inj. Avil, Inj. Dexona and Inj. Hydrocort, Inj. Trenexa were given. Intra operative blood sample was collected and urgent ABGA, CBC, LFT, RFT, S. LDH were sent and patient was kept in OT for 1 hour after normal vitals and then shifted to ICU intubated. Monitoring core temperature, prompt use of measures to avoid hypothermia, using blood warmers, watch for hypocalcaemia, acidosis, and hyperkalemia go a long way in unmasking blood transfusion reactions. During operation, diagnosis becomes still more difficult and uncertain, because even when present, hypotension and oozing are easily attributed to events incident to anesthesia, operation or both. Thus hemolytic transfusion reactions occurring during operation are difficult to recognize early.

Mesocephaly to Brachycephaly shift as seen in Punjabi children.

Anthropometric Parameters are useful tools in evaluating growth and development. Cephalic Index helps in estimation of intracranial volume in vivo & thus the brain growth. This prospective longitudinal study was initiated to compare the ethnic variations in cephalic index in specific defined ethnic groups of Punjab Jat Sikh and Bania infants. It was observed that Jatsikh infants had a brachycephalic type of skull throughout the study whereas Bania infants displayed mesocephalic type of skull till 7th month of their lives and later on even they became brachycephalic in their skull shapes. It is apparent that the trend in replacing mesocephaly by brachycephaly in northern Indian children, wherein possibly Jatsikh children are ahead of Bania children in this process.

A comparative study of Head Circumference of Infants in two ethnic groups.

Anthropometric parameters serve as useful adjuncts to other observations in evaluating intrauterine as well as infantile growth and development. Determination of measurements with regard to Head Circumference of infants during first year of life is important for the assessment of physical growth. Range of anthropometric measurements in each parameter is different in different races. Earlier reported work indicates that socioeconomic and nutritional status affects the growth even within the ethnic groups. The present study is taken as a longitudinal study conducted periodically in infants (0-12 months) of two contrasting groups- Jat Sikh and Bania communities of Punjab belonging to similar socioeconomic status. Head circumference was measured with the help of measuring tape. Earlier studies indicated that racial factors of growth could be modified to some extent by improved socioeconomic status and nutrition. Since both groups compared in this study were belonging to similar socioeconomic status hence nutritional status of these groups was also similar. It was observed that Bania male as well as female infants had smaller head circumference as compared to their Jat Sikh counterparts. This change may be attributed to sedentary life style among the urban population.

Marchiafava-Bignami disease.

Marchiafava- Bignami disease is the symmetrical demyelination of the middle portion of the corpus callosum observed in people with chronic alcoholism. We report two male patients who had history of chronic alcoholism, different clinical presentation and MRI findings consistent with the diagnosis of Marchiafava-Bignami disease.

Alkaptonuria and intramedullary calcification.

Alkaptonuria is a rare disorder of metabolism caused by deficiency of homogentisic acid oxidase enzyme and characterized by triad of homogentisic aciduria (dark urine), relentlessly progressive arthritis and ochronosis. We have documented a case with typical features of alkaptonuria along with intramedullary calcification which has not been reported in the literature before.

Progressive multifocal leukoencephalopathy--as a presenting manifestation of AIDS.

Progressive multifocal leukoencephalopathy (PML) is an opportunistic demyelinating disease caused by the ubiquitous, usually non pathogenic JC Polyomavirus. We report a case of PML as a presenting manifestation of AIDS in a forty five year old man on the basis of clinical features and neuroradiology.

Importance of age in outcome of oesophagogastroduodenoscopy in open access endoscopy: a profile of patients in Sub-Himalayan region of North India.

The Oesophago-Gastro-Duodenoscopy (OGD) is done in patients received by either open access system or the conventional system. The presenting complaints and OGD findings may differ among patients with age < 45 yrs and those who are more than 45 yrs old. The referral diagnosis, age, sex, and environmental factors have important implications on the chances of finding and objective abnormality on endoscopy in a patient. This study was aimed to evaluate to evaluate the profile of 1186 patients divided into younger (<45 yrs) and older age (45 or > 45 yrs) groups presenting for oesophago gastroduodenoscopy through open access referral system in sub-Himalayan region of North India. This is a retrospective study carried out on patients who underwent the OGD from Jan, 2004-Dec, 2004. The study was conducted in Indira Gandhi Medical College situated at a moderate altitude in North India. All patients presenting in Medical College during the study period for OGD were taken into study. The patients were divided into two groups based on age; less than 45 yrs and 45 yrs or more than 45 yrs. Their presenting complaint, age, sex, and OGD findings were recorded. The profile was compared between the two groups. A total of 1186 patients underwent OGD; the females were 451(38%) and males were 735(62%); 616(52%) were < 45 yrs old and 570(48%) of the patients were 45 yrs or older. In the group I 431(70%) had a normal endoscopy and 185(30%) showed abnormal endoscopic findings. In group II 302(53%) had a normal endoscopy, and 268(47%) had abnormal findings on endoscopy. Gastric ulcers, mass lesion/new growth were more common in elderly group, Gastro-esophageal reflux disease (GERD) was more common in younger group. The presenting complaints were similar in both groups. It is concluded that for the same presenting diagnosis the yield of OGD was more in patients > 45 yrs old. The positivity rate increased from 30% in < 45 yrs to 47% in the elderly cohort. So, all people >45 yrs should go for endoscopy at the first hint of upper GI pathology, or appearance of alarm symptoms.

Symmetrical peripheral gangrene due to viral gastroenteritis.

A case of multifactorial symmetrical peripheral gangrene due to viral gastroenteritis, shock, dopamine infusion, exposure to low temperature and nonlactose fermenters septicaemia is presented for its rarity and devastating consequences.

Sex determination in north Indians using mandibular canine index.

Teeth are an excellent material in living and non-living populations for anthropological, genetic, odontologic and forensic investigations. Amongst all teeth, the mandibular canines are found to exhibit greatest sexual dimorphism. Rao et al (1989) used the mandibular canine index for sex determination and found it to give satisfactory results. Muller et al (2001) concluded that Rao et al’s method can only be used in case of correct lower anterior dental alignment and by using the standard mandibular canine index of the local population. The present study endeavors to establish the effectiveness of mandibular canine index in predicting sex in North Indian population taking correct dental alignment into consideration. It was seen that with the standard mandibular canine index, it was possible to detect sex in North Indian population to an extent as high as 75%. This study establishes the existence of a statistically significant sexual dimorphism in the morphometry of mandibular canines in North Indian population.

Sevoflurane for induction and intubation in children undergoing congenital cardiac surgery.

The induction and intubation characteristics of sevoflurane were studied prospectively in 23 children, aged 3 months to 6 years (mean 24 +/- 20.25), undergoing repair of congenital cardiac defects. After premedication with syrup chloral hydrate (75mg/kg orally), anaesthesia was induced with 8% sevoflurane and 50% nitrous oxide in oxygen. Nasal endotracheal intubation was performed once the pupils were small and central, without the use of neuromuscular blocking agents or opioids. Characteristics of induction and intubating conditions were recorded. Induction time (from application of face mask to loss of eyelash reflex) was 43.7 +/- 4.57 secs (mean +/- SD). Mean intubation time was 149.1 +/- 15.6 secs. Intubating conditions were excellent in 21 patients (91.3%) and good in 2 patients (80.7%). Haemodynamic parameters (heart rate, rhythm, and systolic blood pressure) were recorded at loss of eyelash reflex, immediately before intubation and at 1, 3 and 5 min after intubation. All children remained haemodynamically stable throughout induction and there were no adverse airway events.

Mesangial proliferative glomerulonephritis in chronic obstructive pulmonary disease.

Ten patients of chronic obstructive pulmonary disease were studied for changes in ultrastructure of the glomeruli, serum immunoglobulin and complement levels. The glomeruli showed proliferation in the mesangium in 90% patients and electron dense deposits in the mesangium in 30% patients. IgA and IgG were usually elevated whereas complements were usually depressed in most of these patients. It is suggested that repeated respiratory infections in these subjects may be responsible for mesangioproliferative type of glomerulonephritis, high IgA and IgG levels. The complements are activated and they take part in immune complex formation getting deposited in mesangium.