Evaluation of inner ear congenital and developmental lesions by HRCT and MRI

To assess the role of HRCT and MR imaging in the evaluation of congenital and developmental anomalies of the inner ear and how the results could affect the management of such patients, 56 patients [43 males, 13 females, aged 7 days to 70 years] were examined by high resolution computed tomography and/or magnetic resonance imaging between July 2000 and May 2004 for assessment of inner ear abnormalities. Eighty-five developmental and congenital inner ear lesions were detected in 67 temporal bones and were classified into three groups: Group A, lesions involving the proper inner ear structures [23 lesions in 14 temporal bones of 10 patients]; Group B, lesions involving vascular structures [58 lesions in 49 temporal bones of 43 patients]; Group C, facial nerve lesions [4 lesions in 4 temporal bones of 3 patients]. It was concluded that HRCT is the gold standard imaging modality for assessing lesions involving the osseous labyrinth of the inner ear and vascular structures while MRI significantly improves the diagnosis of lesions involving the membranous labyrinth and related cranial nerves. Both imaging modalities significantly help the otologist in treating and establishing the proper management plan for these patients

Analgesic efficacy of single shot caudal block for circumcision

To assess the usefulness of caudal epidural block with bupivacaine for postoperative analgesia after circumcision in children at Children Hospital complex Multan. This study was earned out in Children Hospital Complex Multan from March 2008 to December 2008. One hundred boys, aged 2 to 10 years, ASA 1 status scheduled for elective circumcision. They received caudal epidural block with bupivacaine 0.25%, 0.5ml.kg-1, after induction of general anesthesia and studied for postoperative pain relief. Patients were excluded if they had local infection, preexisting neurological disease, bleeding diathesis or any analgesic ingestion in the preceding week.. Post-operative pain was assessed by Facial expression scale in small children. In older children pain assessment was done by clinical observation, by asking about pain and by dynamic pain score. Mean duration of analgesia was 10.43 +/- 3.4 hours. Time for micturition was 161.79 +/- 83.2 minutes while time to stand was 161.21 +/- 69.65 minutes. Hemodynamic and respiratory parameters remained stable during the observation period. Frequency of postoperative nausea and vomiting was 12% while urinary retention occurred in 2% patients. Caudal epidural block with bupivacaine 0.25% in a dose of 0.5 ml/kg-provides safe and effective postoperative pain relief in children undergoing circumcision and penile surgery, with very few complications

comparison of pressor respons following laryngeai mask airway vs laryngoscopy and endotracheal tube inserition

To test the hypothesis that laryngeal mask airway [LMA] insertion is associated with less pressor response as Compared to endotracheal intubation. A prospective, comparative study. Department of Anaesthesiology Intensive Care and Path Management, Nishtar Medical Institution Multan [Pakistan] from July 2007 to January 2008. 60 adult, ASA grades land II patients undergoing elective general surgery of less than one hour duration were divided in two groups with 30 patients in each. These patients were operated under general anaesthesia and either endotracheal tube [Group I] or LMA [Group II] was used to maintain the airway. The rise in heart rate, systolic and diastolic blood pressure was recorded before induction of anaesthesia and at one, three, five and ten minutes after insertion of laryngeal mask airway or tracheal tube and the results compared in both groups. A statistically significant rise in heart rate, systolic blood pressure and diastolic blood pressure was seen in group-I while statistically significant rise in heart rate only was seen in group-II subsequent to their insertion. Mean maximum increase was statistically more after laryngoscopy and endotracheal intubation than after laryngeal mask airway insertion. The duration of pressor responses was also longer after endotracheal intubation. Laryngeal mask airway is an acceptable alternative techinque offering advantages in terms of haemodynamic stability compared to tracheal intubation

Comparison of 0.5% lignocaine vs 0.5% lignocaine plus 0.25% tramadol in intravenous regional anaesthesia

To compare the quality, onset and duration of intravenous regional anaesthesia [IVRA] with 0.5% lignocaine plus tramadol and 0.5% lignocaine alone. A comparative, double blind, randomized, prospective study. Orthopaedic operating rooms, Nishtar Medical Institution, Multan, Pakistan, from June 2005 to June 2006. In our of 60 adult ASA class I and II patients undergoing upper limb surgeries in patients were divided in two groups having 30 patients in each. We used tramadol, a weak opioid as a component of IVRA with lignocaine to suppress intra-operative pain and enhance postoperative analgesia. Patients received IVRA with 40ml of 0.5% lignocaine to which either 100mg tramadol or saline was added. The onset of anaesthesia and recovery was compared by loss and regain of sensations. Tramadol with lignocaine was found to be significantly better for rapid onset and quality of anaesthesia compared to lignocaine alone and devoid of opioid related side effects. We conclude that tramadol as a component of IVRA is significantly better adjunct to lignocaine

PONV-A comparative study of meto-clopramide alone and with dexamethasone in strabismus surgery

To determine the efficacy of intravenous metoclopramide alone and in combination with dexamethasone in preventing postoperative nausea and vomiting [PONV] in patients undergoing strabismus surgery. Single blinded, randomized, interventional study. This study was conducted in the department of Anaesthesiology at Nishtar Hospital, Multan from October 2005 to October 2006. After the approval of the hospital's ethical committee, the study was conducted on 60 patients who were randomly divided into two groups, each group containing 30 patients. All of the patients were between 2-14 years of age and were A.S.A-I. Randomization was done by envelope draw method. The patients received either metoclopramide 150 micro g/kg or dexamethasone 150 micro g/kg with metoclopramide 150 micro g/kg combination IV, 30 minutes before the induction of anesthesia. General anesthesia was induced with thiopentone sodium, nalbuphine, succinylcholine and maintained with isoflurane and N[2]O+O[2] in both groups. PONV were evulated postoperatively. Patients in group II who received metoclopramide plus dexamethasone experienced significantly less PONV during the first 24 h after surgery. In this study, a single dose of metoclopramide plus dexamethasone [150 micro g/kg of each drug] produced better antiemetic effects after strabismus surgery than metoclopramide alone

Control of acute variceal haemorrhage a comparison of octereotide and baloon temponade

A multicenter prospective randomised control trial of patients with acute bleeding from oesophageal varices. Patients not fit for immediate sclerotherapy or band ligation because of severe torrential haemorrhage. This study was conducted at three centers of District Sialkot, i.e., Govt. Sardar Begum Hospital, Allama Iqbal Memorial Hospital, Memorial Christian Hospital from March 1999 to April 2002. The objective was to compare the efficacy and practicality of two commonly used techniques Octeriotide vs Balloon Temponade [BT] for the control of acute variceal haemorrhage. A total of 86 patients were studied in two groups, 46 in Balloon Temponade and 40 in Octeriotide infusion group. These patients presented with acute variceal bleeding. The diagnosis was confirmed by upper GI endoscopy. Stoppage of bleeding was achieved in 44 of 46 patients. Efficacy was 95.65% in Balloon group whereas this was achieved only in 37 of 40 patients. Efficacy was only 85% in Octeriotide group and in BT group complete stoppage of bleeding was seen in 40 [86.96%] whereas minor ooze present in 6[13.04%] at the end of 12 hours. In octeriotide group 25[62.50%] patients achieved complete stoppage of bleeding in [30%] and minor ooze was present, in 3 [7.5%]. No effect on bleeding after 12 hours infusion at 50 ug/hour. Balloon Temponade is the only certain way to control acute profuse variceal haemorrhage. This technique is especially valuable during the transport of patients. The efficacy of octeriotide is limited only to minor/moderately severe cases of variceal bleeding or in combination with balloon Tamponade when patients are bleeding from gastric' fundal varices or from portal hypertensive gastropathy

Pancreatic abscess

Pancreatic abscess is a relatively rare and potentially fatal disease. It is imperative to diagnose and treat it early and effectively; otherwise, it carries a high mortality rate. One such case is presented. Since the patient was very anaemic, toxic and cachectic the management initially was by repeated aspirations, under local anaesthesia, with ultrasound guidance. Finally operation i.e. Lapargstomy and necrotomy, lavage and drainage had to be done when the patient became relatively stable

Study of serum magnesium and its correlations in diabetes mellitus

Fasting concentrations of magnesium and related parameters were measured in 90 diabetic patients categorized into insulin treated [34], non-insulin treated [40] and untreated diabetics [16]. Compared with age and weight matched 40 control groups, serum concentrations of magnesium were significantly lower in untreated [p <.02] and overall diabetic patients [p < 0.05]. The concentration was the lowest in the insulin-treated group [p< 0.01]. There was significant increase in the values of urine magnesium/day in non-insulin treated [p < 0.02] and overall diabetics [p < 0.02] as compared to controls. Maximum urinary loss of magnesium [7.4 mEq/day, p <0.01] was found in patients of untreated diabetes mellitus. In all diabetics, serum magnesium concentrations were inversely related to serum glucose values [r = -0.61, p < 0.02] and in non-insulin treated and overall diabetics to insulin concentration [r = -0.21, p < 0.05 and r = -0.19, p < 0.05 respectively]. There was again a negative correlation of serum magnesium with glycosylated hemoglobin [HbAlc] in insulin treated [r= -0.61, p< 0.02] and overall diabetics [r = -0.45, p < 0.02]. Serum magnesium positively correlated with age [r = 0.36, p<0.02] and inversely related with ketone bodies [r=-0.28, p < 0.05] when results for all groups of diabetics were pooled

Magnesium depletion in diabetic pregnant mothers

The serum magnesium concentrations were determined in 18 diabetic pregnant woman and 15 normal control pregnant females. Mean serum magnesium [+ SD] was significantly lower in diabetic pregnant women [1.5 +/- 0.08 mEq/L] than in the control pregnants [1.7 +/- 0.05 mEq/L]. Serum magnesium correlated best with blood glucose concentrations [r= -0.32, P<.001]. Magnesium of diabetics with 2% glycosuria was found to be lower significantly than those with 1% glycosuria or no glycosuna. Other significant associations were also observed with age and serum albumin

Effect of anticonvulsant drugs on monovalent cations

Sixty patients receiving anticonvulsant drugs like tegretol 9 Carbamazepine and 61 age-matched controls were studied to determine the disturbances in sodium and potassium levels. There was a significant difference in sodium level the mean serum sodium levels of the subjects [138.8 +/- 0.6 mEq/L] and the controls [141.7 +/- 0.4 mEq/L]. Thirteen [21.7%] of the subjects, but none of the controls, had sodium levels 135 mEq/L. But the mean values of potassium [4.3 +/- 0.02 mEq/L], were not significantly changed as compared to controls. The risk of hyponatremia increased with age subjects 30 years old had four times the prevalence of hyponatremia as those < 30 years old

Inter relation between magnesium and glucose metabolism in Diabetes mellitus

The serum magnesium concentrations of 116 diabetic patients and 58 control subjects were measured by atomic absorption spectrophotometry. Mean serum magnesium was significantly lower in diabetic patients [0.74.0.07 mmol/l] than in the control subjects [0.81 iO.06 mmol/l]. Thirty one [36%] diabetics had values below those of all control subjects except one. Serum magnesium correlated best with serum glucose concentrations [n= 0.28, p <0.001]. Other significant associations were also observed with glycosuria, insulin treatment and oral hypoglycaemic therapy

Hypomagnesaemia during diabetic pregnancy: a risk factor for ischaemic heart disease

Interrelations between magnesium and other appropriate factors were studied in 18 pregnant diabetic women and 15 control pregnant females. Serum magnesium [ +/- SD] was significantly lower in diabetic pregnant women [1.5 +/- 0.08 mEq/L] than the control pregnants [1.7 +/- 0.05 mEq/L]. Serum magnesium correlated best with blood glucose concentrations [r= -0.32, P< 0.001]. Magnesium of diabetics with 2% glycosuria was found to be lower significantly than those with 1% glycosuria or no glycosuria. Other significant associations were also observed with age and serum albumin

Hypomagnesaemia in non-insulin dependent diabetic patient and the effect of metabolic control

Serum magnesium levels in relation with improved metabolic control, were studied in 25 Type II diabetic patients before and two months after the initiation of insulin therapy or intensified treatment with oral hypoglycaemic agents. Magnesium levels were significantly lower [P< 0.001] in diabetic patients than in the control. After two months of antidiabetic therapy, metablic control was significantly improved as documented by reduced H[b]A1[c] [glycosylated haemoglobin] levels in both insulin treated patients [P< 0.001] or the patients on oral hypoglycaemic agents [P< 0.002]. However, magnesium levels remained unchanged in the insulin treated groups as well as in patients on oral hypoglycemic agents. This study shows that even marked improvement of glycaemic control does not correct hypomagnesaemia in Type II diabetes

Antihypertensive, antilipemic and antidiabetic properties of garlic [allium sativum]

The daily use of 5 grams of garlic for one month, has been found to be associated with significant fall in blood pressure and serum total cholesterol in hypertensive and hypercholesteremic patients respectively. Significantly decreased levels of LDL-cholesterol and increased levels of HDL-cholesterol were also observed in hypercholesteremic cases. However, the effect of garlic extract [Lasona Capsules] on blood glucose in diabetics, was negligible

Study of lipoproteins in patients of myocardial infarction at BV hospital, Bahawalpur

Serum lipids, lipoproteins, relative body weights and blood pressures were assessed in 108 male and 20 female survivors of the first attack of myocardial infarction of various age groups. The majority of patients fell in the middle aged category. The mean age and weights of patients and controls were fairly similar. Generally, there was a significant rise in the mean values of blood pressure, serum cholesterol, triglycerides, VLDL and LDL in cases of myocardial infarction. Patients of various age groups studied were also found to have significantly higher levels of VLDL- cholesterol and significantly lower levels of HDL-cholesterol than those of control groups

Effect of oral and injectable contraceptives on weight, blood pressure and serum lipids

The weight, blood pressure and serum lipids were measured in 57 women taking oral contraceptives and 45 women taking injectable contraceptives. Compared with age matched control group of 30 normal women oral contraceptive users showed significantly increased values of blood pressure, cholesterol and triglycerides but the values of weight and total lipids were not significant. The difference in the mean values of all these paramenters in group of women on injectable contraceptives, was almost comparable with the normal controls. It is suggested that oral contraceptive drugs should be used with particular care and with proper investigations of the females before and during the therapy