Ultrasound-Guided Preoperative Fascia Iliaca Compartment Block for Pain Relief During Positioning for Spinal Anesthesia in Patients With Hip Fracture.

Background Fractures around the hip are common in the elderly. For surgical management, the subarachnoid block is the preferred anesthesia technique. Positioning these patients for anesthesia is challenging because of pain. Analgesia in the form of preoperative perineural anesthesia is gaining popularity. We observed the analgesic efficacy of preoperative ultrasound-guided fascia iliaca block, its efficacy during positioning for spinal anesthesia, pain scores, and anesthesiologist comfort while administering spinal anesthesia. Methodology An observational study was conducted on patients of 40 to 80 years under the American Society of Anesthesiologists (ASA) physical status I-III, requiring hip surgeries under spinal anesthesia. After pre-anesthetic evaluation, the purpose and protocol of the study were explained to patients, and informed consent was obtained. Pain score using the numeric rating scale (NRS) was recorded. Ultrasound-guided suprainguinal fascia iliaca block was performed using 30 ml of 0.25% levobupivacaine one hour before shifting to the operating room. Pain scores were reassessed. Spinal anesthesia was administered in the operating theatre in a sitting position. Pain during positioning was assessed. Results The mean NRS score reduced significantly after ultrasound-guided suprainguinal fascia iliaca block. The mean NRS score was 3.25 during positioning for spinal anesthesia compared to a pre-block score of 9.03, noting a statistically significant reduction (p=0.001). Conclusion Fascia Iliaca compartment block (FICB) helps alleviate the pain of hip fractures and makes positioning the subarachnoid block easier.

Massive left hemothorax following laparoscopic pyeloplasty.

Laparoscopic pyeloplasty is viable standard minimally invasive alternative to open pyeloplasty for the treatment of ureteropelvic junction obstruction. Intrathoracic bleeding is an extremely rare complication after laparoscopic urological surgery, but it should be suspected and promptly diagnosed in case of worsening hemodynamic status and respiratory parameters during the intra or post-operative course. We report a case of hemothorax complicating an otherwise uneventful LP in an 18-year-old girl.

Purification of diseased cells from Barrett's esophagus and related lesions by laser capture microdissection.

Barrett's esophageal adenocarcinoma (BEAC) arises from Barrett's esophagus (BE), a premalignant lesion caused by acid reflux (heartburn). Although the cancer is uncommon, its incidence is rapidly rising in western countries. Like most other cancers, BEAC cells also have elevated telomerase activity which maintains telomere length and supports continued proliferation of these cells. It is not clear if telomerase is activated early at premalignant (BE) stage, because reports of telomerase activity in Barrett's and normal esophagi have been controversial. We have shown that detection of telomerase and telomeres becomes easier and much more reliable if purified BE cells are used instead of tissue specimens. This chapter, therefore, emphasizes the importance of laser capture microdissection and provides the method to purify Barrett's esophagus related cells, using this technique.

Anaesthetic management of difficult airway due to retropharyngeal abscess.

A one-and-half-year old girl weighing 7.5 kg presented with a history of neck swelling, difficulty in swallowing and breathing. She was posted for incision and drainage on an emergency basis. Diagnosis was confirmed by neck X-ray and computed tomography scan as retropharyngeal abscess. Here we present the successful anaesthetic management of this child at JSS Medical College Hospital, Mysore.

Telomere maintenance in laser capture microdissection-purified Barrett's adenocarcinoma cells and effect of telomerase inhibition in vivo.

PURPOSE: The aims of this study were to investigate telomere function in normal and Barrett's esophageal adenocarcinoma (BEAC) cells purified by laser capture microdissection and to evaluate the effect of telomerase inhibition in cancer cells in vitro and in vivo. EXPERIMENTAL DESIGN: Epithelial cells were purified from surgically resected esophagi. Telomerase activity was measured by modified telomeric repeat amplification protocol and telomere length was determined by real-time PCR assay. To evaluate the effect of telomerase inhibition, adenocarcinoma cell lines were continuously treated with a specific telomerase inhibitor (GRN163L) and live cell number was determined weekly. Apoptosis was evaluated by Annexin labeling and senescence by beta-galactosidase staining. For in vivo studies, severe combined immunodeficient mice were s.c. inoculated with adenocarcinoma cells and following appearance of palpable tumors, injected i.p. with saline or GRN163L. RESULTS: Telomerase activity was significantly elevated whereas telomeres were shorter in BEAC cells relative to normal esophageal epithelial cells. The treatment of adenocarcinoma cells with telomerase inhibitor, GRN163L, led to loss of telomerase activity, reduction in telomere length, and growth arrest through induction of both the senescence and apoptosis. GRN163L-induced cell death could also be expedited by addition of the chemotherapeutic agents doxorubicin and ritonavir. Finally, the treatment with GRN163L led to a significant reduction in tumor volume in a subcutaneous tumor model. CONCLUSIONS: We show that telomerase activity is significantly elevated whereas telomeres are shorter in BEAC and suppression of telomerase inhibits proliferation of adenocarcinoma cells both in vitro and in vivo.

Profiles of attendees in voluntary counseling and testing centers of a medical college hospital in coastal karnataka.

RESEARCH QUESTION: What are the socio-demographic profile and risk behavior pattern of seropositive attendees in the voluntary counseling and testing center (VCTC)? STUDY DESIGN: Retrospective study. SETTING: VCTC in the outpatient complex of Kasturba Medical College Hospital, Mangalore, Karnataka. SUBJECTS: Records pertaining to all the 539 and 330 seropositive attendees during the years 2005 and 2006, respectively, were included in the study besides data from 2001 onwards in order to assess the time trend of human immunodeficiency virus (HIV). STUDY VARIABLES: Age, sex, marital status, religion, educational status, occupation, place of residence and pattern of risk behavior in relation to HIV/AIDS. STATISTICAL ANALYSIS: Analysis was done with SPSS version 11. Statistical test and Chi-square was done, and P < 0.05 was considered statistically significant. RESULTS: The time trend of VCTC attendees reveals a gradual increase except in 2006 showing a sharp decline. Seropositives were around 20% between 2001 and April 2007 with a sharp increase in 2006, i.e., 33.64%. Male seropositivity constituted 60-63%; 81-91% of seropositive attendees belonged to the age group of 15-50 years; 58-70% were married. Only about 3% were illiterates and 20-25% constituted 6(th)-12(th) pass-outs. With regard to occupational profile, about 17-27% were housewives, 19-21% were laborers/hotel workers and 7% were entrepreneurs. About 45% were from urban area and nearly one-third hailing from other districts in the border of Karnataka. About 25% were exposed to commercial sex workers; another 21-23% were involved in premarital sex and nearly 38% were indulging in heterosexual activities.

L-ascorbic acid ameliorates postnatal endosulfan induced testicular damage in rats.

The aim of the present study is to investigate the effect of L-ascorbic acid on postnatal exposure of endosulfan induced testis damage in the rat. Four groups of seven day old male Wistar rats were treated with 3, 6, 9 and 12 mg/kg endosulfan orally (10 pups/group), from postnatal day 7 to 60 at intervals of 24 h. For 2 more groups (n = 10/group), endosulfan (9 mg/kg and 12 mg/kg) was administered along with L-ascorbic acid (20 mg/kg). The sperm morphology, sperm count and sperm motility was analyzed in all the groups on postnatal day 70. Endosulfan significantly affected the testicular function enhancing the incidence of abnormal spermatozoa, decreasing the sperm count and sperm motility in a dose dependent manner. Abnormalities were of both head and tail and increase in their frequency was more than two-fold of the control value. Sperm count abruptly decreased in 12 mg/kg group and sperm motility decreased up to 50% of the control value. L-ascorbic acid has nullified the toxic effects of the pesticide significantly, but not to the control level. Endosulfan induces the testicular damage following postnatal exposure and L-ascorbic acid prevents the adverse effects considerably in the rat.

Interaction of Huntington disease protein with transcriptional activator Sp1.

Polyglutamine expansion causes Huntington disease (HD) and at least seven other neurodegenerative diseases. In HD, N-terminal fragments of huntingtin with an expanded glutamine tract are able to aggregate and accumulate in the nucleus. Although intranuclear huntingtin affects the expression of numerous genes, the mechanism of this nuclear effect is unknown. Here we report that huntingtin interacts with Sp1, a transcription factor that binds to GC-rich elements in certain promoters and activates transcription of the corresponding genes. In vitro binding and immunoprecipitation assays show that polyglutamine expansion enhances the interaction of N-terminal huntingtin with Sp1. In HD transgenic mice (R6/2) that express N-terminal-mutant huntingtin, Sp1 binds to the soluble form of mutant huntingtin but not to aggregated huntingtin. Mutant huntingtin inhibits the binding of nuclear Sp1 to the promoter of nerve growth factor receptor and suppresses its transcriptional activity in cultured cells. Overexpression of Sp1 reduces the cellular toxicity and neuritic extension defects caused by intranuclear mutant huntingtin. These findings suggest that the soluble form of mutant huntingtin in the nucleus may cause cellular dysfunction by binding to Sp1 and thus reducing the expression of Sp1-regulated genes.