Women emerge from general anesthesia faster than men.

Interest in the speed with which patients recover post operatively, the type of deficits that anesthesia may induce in them and the overall profile of their physiologic and psychological states, has grown rapidly over the last two decades. Recovery from general anesthesia is dependent on factors governing drug sensitivity and drug disposition. In our study of 60 males and 60 females we have tried to find out if there is any significant difference in males and females, in their emergence from the effects of general anesthesia. This was a double blind study carried out in hundred and twenty patients, aged 18-70 years scheduled to undergo elective general surgical procedures. Patient recovery was observed continuously after the termination of anesthesia. Timings of initial wake up events were recorded by the anesthesiologist who was blinded to this study. The time from discontinuation of anesthesia to eye opening was 6.87 +/- 2.54 min (P < 0.001; t test) for women versus 8.78 +/- 2.66 min in men; time to respond to verbal command was 7.53 +/- 2.05 and 9.61 +/- 2.14 min in women and men, respectively (P < 0.001; t test). Considering the multitude of factors that may influence recovery, the gender effect appears to be a strong one. The difference could probably be explained by differences in physiology, enzyme activity etc. Investigators have noted that normal differences account for changes in function of the GABA receptor known to be important in the action of many anesthetics.

Clinico-histopathological correlation of skin and nerve in leprosy.

The histopathological features of skin tissue sections in patients clinically diagnosed as leprosy were correlated with the histopathological features of nerve specimens obtained from the same patients. Fifty untreated leprosy patients attending the Outpatient Department of the Department of Dermatology and Sexually Transmitted Diseases of Smt. Sucheta Kriplani and Kalawati Saran Children's Hospitals, New Delhi, India were included in the study. On correlating the histological features of skin and nerve tissue sections, concordant findings were found in 24 out of the 50 patients (48%) but discordance between the histopathological features of skin and nerve tissue sections were found in 26 out of 50 cases (52%). Of these 26 cases, the nerve tissue histology when compared with the skin histology showed features lower down the disease spectrum in 17 (34%) cases. Seven of the 50 patients (14%) showed histological features of leprosy higher in the disease spectrum in the nerve tissue sections than in the skin biopsy sections. One patient clinically LL leprosy demonstrated histopathological features of Histoid leprosy in the skin sections and LL in the nerve sections. The remaining one patient had features of TT leprosy in the skin tissue sections while the nerve tissue histopathology showed non-specific changes. Histological features of the skin tissue sections were consistent with the clinical diagnosis in 33 out of 50 cases (66%). When the clinical groups were correlated with the histological features of the nerve tissue sections, concordance was found in 30 of the 50 cases (60%). On comparison of the histological features of skin and nerve tissue sections with the clinical diagnosis, concordance was still lower i.e., 19 out of 50 cases (38%). Thus the histological features of the skin tissue sections correlated more frequently with the clinical diagnosis than did those of the nerve sections. The importance of neural histology lies in the fact that it shows a higher BI and a lower histological grading in some cases and if not performed the lapse can result in inadequate treatment, drug resistance and even relapse.

Pressure and volume changes of tracheal tube cuff following inflation with various inflating agents during nitrous oxide anesthesia.

The study was designed to investigate the changes in pressure and volume of a tracheal tube-cuff inflated with air, mixture of N2O + O2, saline and 4% lidocaine during nitrous oxide anesthesia. This study was conducted in 80 patients (33 male & 47 female). The pressure and volume of a tracheal tube cuff increased with air, decreased with mixture of N2O + O2 and almost remained the same with saline and 4% lidocaine. The complications were more in the air group.

Evaluation of invasive and non-invasive diagnostic modalities for Helicobacter pylori infection in children.

Invasive and non invasive tests for Helicobacter pylori performed on 31 children were evaluated as diagnostic modalities. Investigations included upper gastrointestinal endoscopy and endoscopic grasp biopsy (EGB) from antrum and corpus (for rapid urease test, impression smear, histology and culture), antral brushings, serum ELISA for IgG antibodies, rapid blood test, and IgG antibodies in unstimulated saliva. Our results suggested that amongst the invasive methods brush cytology was more sensitive than histology and impression smear. Best interpretation of urease test was possible at 4 hours incubation. Culture of EGB sample constitutes the most specific way to establish the diagnosis of infection but is not easy. Hence, non-invasive modalities like serum ELISA, rapid blood test and salivary ELISA can be used in children for the detection of H pylori infection.

Vimentin expression in breast carcinomas.

Epithelial malignancies expressing mesenchymal markers and their prognostic implications have been studied by various authors. In view of this, we studied fifty cases of breast carcinomas for vimentin expression and correlated the various clinical and histopathological parameters. Eighteen percent (9/50) of all breast carcinomas expressed vimentin. Vimentin positive tumours were predominantly larger in size (mean greatest diameter 5.43 cm), of higher TNM stage, node negative (55.56%), poorly differentiated (66.66%, p=0.0458) with high mitotic rate (>10/hpf, p=0.0000), Estrogen (88.88%) and Progesterone (77.77%) receptor negative thus pointing towards aggressive biological behavior. Interestingly 20% of well differentiated and 9.09% of moderately differentiated tumours also expressed vimentin. One vimentin positive case had pulmonary metastases despite being node negative while another well differentiated vimentin positive tumour showed skeletal muscle infiltration. Hence, we conclude that vimentin expression is an indicator of biologically aggressive tumours.

Kinking of epidural catheter--a case report.

Kinking of an epidural catheter with resultant failure to inject drug is a complication of lumbar epidural analgesia. Here, we report a case of kinking of epidural catheter 1 cm proximal to its tip after 20 days of insertion. It was inserted to a female for pain relief, suffering from carcinoma of the cervix.

Diagnostic modalities for gastroesophageal reflux.

OBJECTIVE: To evaluate commonly utilized diagnostic modalities to detecting Gastroesophageal Reflux (GER). METHODS: Sixty children aged 1-72 months (mean age 14.7 months) with symptoms suggestive of Gastroesosphageal Reflux (GER) were investigated and subjected to upper gastrointestinal endoscopy and esophageal biopsy (EB), gastroesophageal scintiscanning (GS) and 24 hour ambulatory pH monitoring. RESULT: GER was detected in 28 (46.7%) cases by one or more diagnostic modalities. Ambulatory 24 hour pH monitoring was positive in higher proportion (43.3%) of cases in comparison to other modalities, followed by EB (38.3%) and GS (30%). Considering 24 hour pH monitoring as the gold standard, esophageal biopsy was positive in 22/26 cases (84.6%) detected by 24 hour pH monitoring with a specificity of 97.1% as compared to 17/26 cases (65.4%) by gastroesophageal scintiscanning with a specificity of 97.1%. When compared with EB results, amongst various parameters measured during 24 hour pH monitoring, Reflux index (RI) ranked highest (sensitivity 95.6 % and specificity 89.2 %) followed by duration of longest episode > 20 minutes and Euler Byrne score. Oscillatory index, calculated from tracings of pH monitoring, even though ranked lower because of its low sensitivity helped to pick up 2 cases missed by EB and RI. CONCLUSION: Our results suggest that a combination of diagnostic modalities may be required to diagnose GER in young children. Ambulatory 24 hour pH monitoring appears to be the single best investigation and combining it with EB and/or GS can help to detect maximum number of cases.

Association of gastroesophageal reflux disease in young children with persistent respiratory symptoms.

Forty children aged between 3 months and 3 years (median age 14 months) with persistent respiratory symptoms beyond 4 weeks or recurrence of respiratory symptoms were investigated for gastroesophageal reflux (GER). Diagnostic tests included upper gastrointestinal endoscopy, oesophageal biopsy, gastroesophageal scintiscan and 24 h ambulatory oesophageal pH monitoring. GER was detected in 14 (35 per cent) of these patients; which included 38 per cent of the enrolled cases of recurrent bronchopneumonia, 40 per cent cases of reactive airway disease, and 22 per cent cases of persistent cough. Amongst the cases detected to have GER, the age of onset of respiratory symptoms was less than 1 year in 86 per cent of cases (p < 0.01), nocturnal symptoms of cough and wheeze were reported in 78 per cent (p < 0.05), and 86 per cent cases did not present with typical gastrointestinal symptoms (p < 0.01). Family history of asthma was absent in all cases of GER-related reactive airway disease (p < 0.01). Cases detected to have GER were followed for 3-6 months after starting anti-reflux therapy. A significant (p < 0.01) decrease was noticed in the number of further episodes in children with GER-related recurrent bronchopneumonia and reactive airway disease after starting anti-reflux therapy. Improvement was also noticed in nocturnal symptoms and nutritional status after anti-reflux therapy was started. Our results suggest that GER may be one of the possible contributing factors in any child with recurrent and persistent respiratory complaints. Early diagnosis and anti-reflux therapy in cases with GER-related respiratory complaints can result in significant improvement in symptoms.