Intraoperative non invasive intracranial pressure monitoring during pneumoperitoneum: a case report and a review of the published cases and case report series.

Non-invasive measurement of ICP (nICP) can be warranted in patients at risk for developing increased ICP during pneumoperitoneum (PP). Our aim was to assess available data on the application of nICP monitoring during these procedures and to present a patient assessed with an innovative combination of noninvasive tools. Literature review of nICP assessment during PP did not find any studies comparing different methods intraprocedurally and only few studies of any nICP monitoring were available: transcranial Doppler (TCD) studies used the pulsatility index (PI) as an estimator of ICP and failed to detect a significant ICP increase during PP, whereas two out of three optic nerve sheath diameter (ONSD) studies detected a statistically significant ICP increase. In the case study, we describe a 52 year old man with a high grade thalamic glioma who underwent urgent laparoscopic cholecystectomy. Considering the high intraoperative risk of developing intracranial hypertension, he was monitored through parallel ONSD ultrasound measurement and TCD derived formulae (flow velocity diastolic formula, FVdnICP, and PI). ONSD and FVdnICP methods indicated a significant ICP increase during PP, whereas PI was not significantly increased. Our experience, combined with the literature review, seems to suggest that PI might not detect ICP changes in this context, however we indicate a possible interest of nICP monitoring during PP by means of ONSD and of TCD derived FVdNICP, especially for patients at risk for increased ICP.

Respiratory failure due to upper airway obstruction in children: use of the helmet as bridge interface.

Upper airway obstruction (UAO) can cause severe respiratory distress in young children by increasing inspiratory muscle load and decreasing alveolar ventilation, ultimately resulting in hypercapnia and hypoxemia which have long term negative cardiovascular effects. Although non-invasive continuous positive airway pressure (CPAP) improves gas exchange in these patients, use of conventional interfaces (nasal mask, nasal pillow and facial mask) may cause significant discomfort and lead to CPAP intolerance. We report five cases of children affected by UAO who experienced CPAP intolerance via application of conventional interfaces. Alternatively, we acutely applied helmet-CPAP which resulted in improved breathing pattern and gas exchange. Thereafter, patients received training with respect to a nasal CPAP interface, allowing successful long term treatment. In conclusion, these five clinical cases demonstrate that helmet-CPAP can be used acutely in children with UAO if compliance to conventional modalities is problematic, allowing for sufficient time to achieve compliance to nasal-CPAP.

Dermatofibrosarcoma protuberans metastasizing to lymph nodes: a case report and review of literature.

Dermatofibrosarcoma Protuberans (DFSP) is an uncommon cutaneous soft tissue tumor. It is locally invasive and is known to recur. Metastases are rare and occur most commonly to the lungs. Metastasis to lymph nodes is extremely rare with only a few case reports in literature. The management strategy for such lymph node metastases remains controversial because of rarity of the condition. We report a case of DFSP of the lower limb with definite inguinal node secondaries managed by loco-regional surgery. We recommend that block dissection of lymph nodes should be performed in all cases with secondaries. J. Surg. Oncol. 1999;72;178-180.

Serum lipid peroxide and other enzyme levels of patients suffering from thermal injury.

The levels of the lipid peroxidation product malondialdehyde (MDA) and the activity of transaminases and alkaline phosphatases were estimated in the sera of 25 thermally injured patients at various time intervals after injury. The level of MDA was increased during the early postburn period, whereas the activities of transaminases and alkaline phosphatase became elevated later after injury. It is concluded that an increased concentration of lipid peroxidation product (MDA) in the early postburn period may affect the spleen, liver and kidney, resulting in the release of enzymes into blood stream. Such damage may be checked by the antioxidants superoxide dismutase or allopurinol.

Genetic distance and heterosis in Indian mustard: developmental isozymes as indicators of genetic relationships.

The use of isozymes as indicators of genetic diversity and as markers for the selection of agronomic traits has been proposed in different crop species. The present investigation was conducted to study the use of isozyme-derived genetic distance between parents in predicting the F1 heterosis in Indian mustard. In addition, the interaction of isozyme-based diversity with quantitative trait and pedigree-based diversity measures, and its role in predicting hybrid heterosis has also been examined. Sixteen Indian mustard lines and their 48 crosses (12 × 4, line x tester crossing) were evaluated over two environments for isozyme and quantitative morphological characters. The results from this study suggest that the heterotic response to isozymic changes is more responsive in crosses derived from morphologically and pedigree-wise related parents in comparison to crosses derived from unrelated parents. It was possible to improve heterosis predictions by partitioning the isozyme-based genetic distance into general genetic distance and specific genetic distance and correlating the latter with the specific combining ability of morphological traits. The possible reasons for these observations are discussed.

Semen sponge for post-vasectomy confirmation of sterilization.

PIP: Due to various factors--shyness, failure of patients to return for follow-up, poor postal services--few sperm counts are conducted following vasectomies in India to assess the success of the operation. A semen sponge technique has been developed which overcomes most previous difficulties and objections. At the time of vasectomy, the patient is given a stamped envelope with a sponge piece. The patient is instructed to smear the sponge with a little semen after 12 ejaculations or after 3 months, to let the sponge dry, and then to mail it back to the health center. Laboratory procedures on the sponge at the health center are explained. If evidence of sperm are found, the patient is advised to continue use of contraception until a negative sponge is obtained. A comparative study was done using different blotting materials. Sponges were found to be the best material. Results from the dried sponges were found consistent with direct semen examination. The method has been found to be reliable and convenient.^ieng