Bioptome-assisted stent repositioning in the case of stent migration during balloon-expandable stenting for coarctation of the aorta.

Coarctation of aorta is commonly treated with endovascular interventions such as coarctation stenting. Migration of stent is the most dreaded complication of coarctation stenting. A 60-year-old lady with severe malaligned coarctation underwent endovascular stent placement. The expanded stent migrated to proximal aorta, which could be stabilized with a bioptome, re-positioned with a balloon and postdilated to its optimal size, resulting in a good outcome.

Major laparoscopic surgery under regional anesthesia: A prospective feasibility study.

BACKGROUND: Laparoscopic surgeries have attained the status of a gold standard for most of the abdominal pathology; we therefore performed this study to assess feasibility and safety of major laparoscopic surgeries like laparoscopic cholecystectomy (LC) and laparoscopic assisted vaginal hysterectomy (LAVH)/total laparoscopic hysterectomy (TLH) under regional anesthesia that is combined spinal epidural anesthesia (CSE) with normal pressure pneumoperitoneum using intrathecal fentanyl with bupivacain. METHODS: In a zonal government hospital, 50 patients were selected prospectively for LC and LAVH/TLH, under normal pressure (12 mmHg) pneumoperitoneum and under CSE over a span of fifteen months. Injection bupivacaine (0.5%) and 20 µg of fentanyl were used for spinal anesthesia. Plain bupivacaine (0.5%) was used for epidural anesthesia. RESULTS: We successfully performed the operations in 48 patients without major complications. CSE was converted to general anesthesia in two patients due to distressing shoulder tip pain. Age varied between 25 and 70 years. Duration of operation time (skin to skin) was between 50 and 170 min. Five patients had urinary retention and one developed localized pruritis. There was no incidence of respiratory depression, aspiration or headache. CONCLUSION: Laparoscopic surgeries with normal pressure CO2 pneumoperitoneum are feasible and safe under CSE. Incidence of postoperative shoulder pain was minimal due to use of intrathecal fentanyl and complications were less and easily manageable.

Levels of interleukin-18 and endothelin-1 in children with Henoch-Schönlein purpura: a study from northern India.

Henoch-Schönlein purpura (HSP) is an acute systemic vasculitis with unknown etiology, although several studies have found HSP to be related to cytokines such as tumor necrosis factor α, interleukin (IL)-1, and adhesion molecules. In the present study we determined the levels of cytokines such as IL-18 and endothelin-1 (ET-1) in children with HSP. Subjects were divided into three groups (group 1, 20 subjects with HSP; group 2, 10 subjects belonging to group 1 during their follow-up 4 to 6 months later; and group 3, 16 controls who were healthy siblings of the subjects). IL-18 and ET-1 levels were determined using enzyme immunoassay and expressed as mean ± standard deviation. We observed higher IL-18 levels in children with HSP (767.6 ± 145.1 pg/mL) than in controls (614.6 ± 66.54 pg/mL, p > 0.05), but IL-18 levels were found to be significantly lower in subjects with HSP in remission (502.7 ± 60.81 pg/mL) than in those who were in an active phase (1,050 ± 244.5 pg/mL, p < 0.05, n = 10). ET-1 levels were found to be significantly higher in subjects with HSP (1.93 ± 0.19 pg/mL) than in controls (1.10 ± 0.13 pg/mL, p < 0.05), although no significant difference was observed in ET-1 levels between subjects in group 1 (1.88 ± 0.30 pg/mL) and group 2 (1.91 ± 0.120, p > 0.05, n = 10). A positive correlation was observed between IL-18 and ET-1 levels in subjects with HSP (correlation coefficient [r] = 0.5254, p < 0.01). These results suggest that levels of IL-18 and ET-1 are worth monitoring during the clinical course of the disease, but caution must be exercised in extrapolating data based on small study samples.

Isoiridomyrmecin rich essential oil from Nepeta erecta Benth. and its antioxidant activity.

The essential oil composition of the aerial parts of Nepeta erecta Benth. (Family: Lamiaceae) from Uttarakhand, India was analysed by capillary gas chromatography (GC) and gas chromatography-mass spectrometry (GC-MS). A total of 34 constituents were identified representing 94.6% of the oil composition. Oxygenated monoterpenes (74.0%) constituted the major proportion of the oil, dominated by isoiridomyrmecin (70.6%) as a single major constituent. Other significant constituents were caryophyllene oxide (9.6%), ß-Bourbonene (2.0%), humulene epoxide II (1.7%) and linalool (1.0%). The in vitro antioxidant activity (AOA) was assessed using ß-Carotene bleaching assay, reducing power, 2,2-diphenyl-1-picrylhydrazyl (DPPH) radical scavenging and inhibition of lipid peroxidation methods. The oil was found to exhibit AOA by inhibiting ß-Carotene bleaching (54.6 ± 2.52%) and by scavenging DPPH free radical (IC(50) = 0.74 ± 0.12 mg mL(-1)). The AOA of the essential oil of N. erecta and its major compound isoiridomyrmecin has not been reported so far.

Chemical diversity in Himalayan Elsholtzia species.

The terpenoid composition of essential oils from the leaves of five Elsholtzia species, viz., E. eriostachya Benth., E. cristata Willd., E. polystachya Benth., E. flava Benth., and E. pilosa Benth., collected from the Himalayan region (India), was examined by GC, GC/MS, and NMR analyses. Comparison of the results with previous reports revealed new chemotypes. Cluster analysis was carried out in order to discern the similarities and differences within the essential-oil compositions at their subspecies/chemotype level. Based on the major constituents of the essential oils, six chemical groups were obtained.

Terpenoid diversity in the leaf essential oils of Himalayan Lauraceae species.

The leaf terpenoid compositions of nine Lauraceae species, viz., Neolitsea pallens, Lindera pulcherrima, Dodecadenia grandiflora, Persea duthiei, Persea odoratissima, Persea gamblei, Phoebe lanceolata, Cinnamomum tamala, and Cinnamomum camphora, collected from the Himalayan region (India) were examined by GC, GC/MS, and NMR analyses in order to determine the similarities and differences among their volatile constituents. Furano-sesquiterpenoids were the principal constituents of N. pallens, L. pulcherrima, and D. grandiflora. (E)-Nerolidol, limonene, beta-pinene, and alpha-pinene were the major constituents of P. duthiei; alpha-pinene, sabinene, and beta-caryophyllene were predominant in P. odoratissima, while the oils of P. gamblei and P. lanceolata possessed beta-caryophyllene as common major constituent. C. camphora and C. tamala were marked by the presence of camphor and cinnamaldehyde, respectively. Cluster analysis of the oil composition was carried out in order to discern the differences and similarities within nine species of six genera of Lauraceae.