Antibiotic prophylaxis--Hobson's choice in burns management.

Antibiotic prophylaxis is a routine procedure in management of burns. As such it is a safe practice, yet unusual complications can occur with the use of even safest antibiotics and their emergency management may be life saving. Here we present a case of 35% second and third degree burns who was taken for a second sitting of stamp grafting for remnant raw areas, who was administered intraoperative prophylactic antibiotic, developed a series of unusual complications sequentially, which were life threatening. Prompt recognition of signs and symptoms of adverse reactions of the drug used and timely management resulted in the successful outcome. A good team effort by surgeon, anaesthetist and the physician was mandatory.

Comparative evaluation of fine needle aspiration cytology and biopsy of testis in diagnosis of male infertility.

Infertility has a fair degree of male factor contribution in its aetiology, hence needs complete evaluation of male partner especially the status of spermatogenesis. In the present study comparative evaluation of fine needle aspiration cytology (FNAC) and biopsy of testis showed 90% accuracy of FNAC in respect of histopathological diagnosis of spermatogenesis. FNAC is a safe, fairly accurate, outdoor investigation in infertile man and it is devoid of the complications of haematoma formation, suppression of spermatogenesis and antigenic stimulation as seen with testicular biopsy.

Tissue expander causing iatrogenic difficult intubation.

Difficulty during tracheal intubation may occur due to a number of anatomical factors and pathological conditions. These factors may be influenced by earlier surgical manoeuvres, so that difficulty may occasionally be encountered at subsequent operation. One such case of 'iatrogenic' difficulty, where a tissue expander beneath the anterolateral skin of the neck caused transient intubation problems, is reported.

Sigmoido-rectal intussusception.

Sigmoido-rectal intussusception is the least common type of intussusception seen in infants and children and is therefore usually misdiagnosed as rectal prolapse. Delay in diagnosis and treatment is due to lack of its awareness amongst surgeons, incomplete assessment of the prolapsed bowel at the anal orifice, and absence of classical traid of intussusception i.e. palpable abdominal mass, colicky abdominal pain, and bleeding per rectum.

Immunosuppression: tomorrow and beyond.

Balancing the benefits and side effects of immunosuppressive therapy is important in transplant patients. Several new agents appear to be safer, more effective, and more specific than the available standard immunosuppressive drugs. Many of the agents are likely to be used with present drugs.

Effect of alpha interferon on glucose and alanine transport by rat renal brush border membrane vesicles.

To investigate the pathogenetic mechanisms of interferon nephrotoxicity, we studied the effect of recombinant interferon alfa-2b on the uptake of 14C-D-glucose and 14C-L-alanine by rat renal brush-border-membrane vesicles. Interferon significantly inhibited 20 sec. sodium-dependent and 5 and 10 min. equilibrium uptake of both glucose and alanine. The inhibitory effect was dose dependent with maximum effect achieved at interferon concentration of 5 X 10(-8)M in the uptake media. The half-maximal inhibitory concentrations, IC50, of interferon on glucose uptake was 1.8 X 10(-8)M, and 5.4 X 10(-9)M on alanine uptake. Dixon plot analysis of uptake data was consistent with pure non-competitive inhibition. The inhibition constants, Ki, 1.5 X 10(-8)M for glucose uptake, and 7.3 X 10(-9)M for alanine uptake, derived from Dixon plots were in close agreement with the IC50s calculated from the semilog dose response curves. These observations reveal that direct interactions at the proximal tubule cell membrane are involved in the pathogenesis of interferon nephrotoxicity, and that its mechanism of nephrotoxicity is similar to that of other low molecular weight proteins.