Pressor responses following insertion of laryngeal mask airway in patients with controlled hypertension: comparison with tracheal intubation.

The present study was undertaken in patients with controlled hypertension to determine the pressor responses following insertion of laryngeal mask airway (LMA) as compared to endotracheal intubation. Two hundred patients with controlled hypertension of either sex, belonging to ASA II undergoing elective surgical procedures of 11/2 to 2 hours duration, were studied in a randomised manner into two equal groups: A(n =100) and B(n = 100) depending on whether LMA or endotracheal tube was used. General anaesthesia and controlled ventilation was undertaken according to standard procedure. Baseline and preinsertion values of heart rate, systolic blood pressure, and diastolic blood pressure were recorded and repeated at 1, 2 and 3 minutes after insertion of LMA or endotracheal intubation. The results showed that increase in systolic and diastolic blood pressure following endotracheal intubation (group A) was much more as compared to LMA (group B) (p<0.01). Heart rate also increased from baseline value in endotracheal intubation group than in LMA (P<0.05). To conclude insertion of LMA was associated with lesser pressure response as compared to endotracheal intubation in patients with controlled hypertension. It is an effective method to avoid laryngoscopic pressor response during endotracheal intubation in hypertensive patients.

Solitary fibrous tumour: a diagnostic dilemma.

Solitary fibrous tumour (SFT) is a rare spindle cell neoplasm arising at pleural and extrapleural sites. Five cases of SFT diagnosed at our institution over a five year period were reviewed. Haematoxylin and eosin stained histological sections, immuno-histochemical markers including CD34 and electron microscopy were the different methods used to study these tumours. Three histological features were consistently observed in all the tumours: the tumours were composed of short spindle cells separated by dense collagen bands and arranged in alternate hypocellular and hypercellular areas. CD34 positivity was seen in all the cases. SFT's have been reported to behave in an unpredictable fashion and hence prolonged follow up is essential. Histology, CD34 positivity and electron microscopy are useful tools in diagnosing SFT. While the pleural tumours can be diagnosed based on histology, this must be substantiated by ancillary techniques in case of extrapleural tumours.

Myelomatous pleural effusion.

Serous effusions in multiple myeloma are uncommon but a myelomatous pleural effusion occurring in these patients is extremely rare. Here we report a rare case of a 38 years lady who was diagnosed to have multiple myeloma and subsequently developed pleural effusion. The myelomatous nature of the effusion was first diagnosed on cytology and subsequently confirmed by a pleural biopsy. The pleural effusion showed an initial response to chemotherapy but subsequently recurred.

T- cell prolymphocytic leukemia - a rare case.

T- cell Prolymhocytic leukemia (T-PLL) is a rare mature post-thymic T-cell malignancy that is usually reported in the elderly and follows an aggressive course. A 68 year old male presented with a history of weakness and weight loss of two months duration. Clinical examination revealed pallor, enlarged cervical and axillary lymph nodes and splenomegaly. He also had a maculo- papular skin rash. There was marked leucocytosis, anemia and thrombocytopenia (WBC 445 x 103 sub/ml, Hb 8.5 gm/dl, Platelet 25 x 103 sub/microl) with 60% prolymphocytes in the peripheral blood. Bone marrow was hypercellular with an excess of prolymphocytes. Flow cytometric analysis of the bone marrow showed positivity for CD2, CD3, CD4, CD5 and CD 7. T- PLL is a rare T cell disorder with characteristic clinical and laboratory features. Currently, no optimal treatment exists although there has been some success with 2'- deoxycoformycin or Campath-1H.