Automated percutaneous lumbar discectomy in patients suffering from prolapsed intervertebral disc: a prospective study

Background: A variety of minimally invasive techniques [chemonucleolysis, laser, automated percutaneous discectomy, percutaneous manual nucleotomy] have been invented over the years, as treatment of low back pain related to disc disease. Automated percutaneous lumbar dissectomy [APLD], being one of these techniques, is a modality in which removal of nucleus pulposus, reduces intradiscal pressure thus relieves the nerve root compression and subsequently reduces radicular pain. This technique was introduced by Onik in 1985, referred to as 'automated' since it involves a mechanical probe, working by a 'suction and cutting action for removal of the nucleus pulposus

Methodology: After meeting the inclusion criteria, minimal invasive procedure - APLD, performed in between 2012 to 2015 on 120 patients on outdoor basis. Radicular discogenic pain was confirmed by MRI and clinical finding, procedure is being performed using nucleotome under fluoroscopic guidance

Result: Based on patient satisfaction, 72 [60%] patients had excellent pain relief [75 - 100%], 34 [28.3%] had good pain relief [51-74%] whereas 14 [11.7%] patients had poor pain relief. Two [1.6%] patient developed discitis, which was the only complication and it resolved within fifteen days without sequelae

Conclusion: Percutaneous decompression [APLD] techniques for intervertebral disc herniation are safe and cost-effective techniques with significant and long lasting results concerning pain reduction and mobility improvement. They can be proposed as initial treatment or attractive alternatives prior to major surgery

observational study of the risk factors and incidence of invasive fungal infections in ICU patients

The fungal infections have become a persistent health problem, still always remain under reported. A change in species distribution has been observed now a days with the emergence of many non-albicans candida species. Our study aimed at evaluating the incidence of invasive Candidiasis [Candida albicans and non-albicans] and to assess the risk factors and predictors of mortality in seriously ill patients. This prospective, observational study was conducted at Division of Intensive Care Unit, Institute of Medical Science, BHU, Varanasi [India], during the period of 2009 to 2011. Patients with >8 out of 16 risk factors, e.g. prolonged antibiotic use, IV cannulation, steroid use etc, Candida scores [CS] > 2, Age >12 years and ICU stay >2 days were included in the study. Those with Candida scores > 3 were prophylactically given fluconazole. A case report performa was completed for each patient, including demographic characteristics, dates of hospital and ICU admission and of discharge, vital sign status at discharge, previous treatment with antibiotics or immunosuppressive agents, presence of risk factors. Patients were followed till discharge from the ICU or death. Candida was isolated from blood in 53/206 patients. The P-value calculated in five risk groups, e.g. diabetics, patients receiving TPN, neutropenic patients, HIV and malignancy was significant [P<0.05]. For all other risk factors P-value was >0.05. Over half of the Candida isolates recovered from blood were non-albicans species. The overall mortality in candidaemia patients was 37/53 [69.81%]. Mortality was low with Candida tropicalis [57.7%] but number of patient was high among candida species. Multiple risk factors were found to be associated with invasive fungal infection in critically ill patients. In the ICU population studied, candidemia was due to non-albicans spp. The importance of Candida scores on predicting mortality was also observed

Sedation with propofol during combined spinal epidural anesthesia: comparison of dose requirement of propofol with and without BIS monitoring

Bispectral [BIS] monitoring provides an objective, non-invasive measure of the level of consciousness in sedated patients. Sedation has been shown to increase patient satisfaction during regional anesthesia. Propofol is extensively being used as a sedative, providing sedation while patients remain cooperative and can be easily aroused. In this study, we sought to determine whether BIS is a useful adjunctive manoeuvre to reduce the sedative dose of propofol by using BIS. Forty patients of ASA grade I and II, weighing between 30 to 60 kg, undergoing elective gynecological surgery of about 60 minutes duration were included in the study, and randomly divided into two groups. All patients received combined spinal epidural anesthesia [CSEA]. The patients in Group-P [n=20] received propofol without BIS monitoring and those in Group-PB [n=20], received propofol under BIS monitoring. Total doses of propofol consumed in all patients were calculated and compared using paired t-test. A p-value <0.05 was considered to be significant. The mean total dose of propofol consumed was 130.25 mg +/- 46.95 without BIS monitoring [Group-P] compared to 68.49 mg +/- 12.59 in patients [Group-PB] in which BIS was used to monitor the desired sedation level [P< 0.001]. Mean dose to reach required level of sedation was also reduced [68.35 +/- 21.10 vs 29.01 +/- 9.45, P< 0.001]. Use of BIS during propofol infusion reduces requirement of propofol for sedation during regional anesthesia