Efficacy & dose-response of intrathecal pentazocine for post-operative pain relief.

With a view to assess the efficacy of intrathecal pentazocine for post-operative pain relief, 60 patients randomly divided into 6 equal groups were administered graded doses (0, 1, 2, 3, 4 and 5 mg respectively) of pentazocine lactate, intrathecally along with 1 per cent bupivacaine. The duration of analgesia was found to be dose related till 3 mg. Higher doses did not increase the duration of analgesia nor were any untoward effects observed. It is concluded that intrathecal pentazocine is safe and effective for post-operative pain relief and 3 mg is the minimum effective dose without side effect.

Blunt trauma to the cervical portion of the trachea. A case report.

A case of closed injury to the cervical portion of the trachea, caused by a wheat-threshing machine, is reported. The patient presented with extensive subcutaneous emphysema, but without any respiratory distress. The unique problem faced during the management of an anterolateral tear of the trachea is highlighted.

Pathology of rabies: a light- and electron-microscopical study with particular reference to the changes in cases with prolonged survival.

Light- and electron-microscopical studies were conducted on necropsy material from six cases of rabies encephalitis including three with the unusual feature of surviving for over 14 days as a result of intensive medical care. This included administration of antiviral agents and interferon inducers and prevention of hypoxia by intermittent positive pressure ventilation. In all these cases, typical Negri bodies were demonstrated. Inflammatory reaction was absent or minimal. Unlike the cases with short survival where Negri bodies were infrequently seen and restricted mostly to the hippocampus, in cases with prolonged survival, they were present in large number, widely distributed throughout the grey matter of the brain. The associated inflammatory reaction in these cases, however, did not keep pace with the increase in number of inclusion bodies. Peripheral neuritis was observed in two of these cases, which also showed myelitis involving the cervical region and inflammation of dorsal root ganglia. One of them showed necrosis and severe inflammation of the lower cervical sympathetic ganglion. An electron-microscopical study conducted in four cases showed three forms of the inclusion body in the cytoplasm of neurons.

Intensive care in rabies therapy. Clinical observations.

Seven patients in India with dog-bite rabies were treated by intensive therapy. Hypoxia was prevented by intermittent positive-pressure ventilation facilitated by muscle relaxants and sedatives. Other measures, included maintenance of nutrition, correction of fluid/electrolyte and acid/base balances, antiviral agents, immunological stimulation, and intensive nursing care by immunised volunteer staff. The patients survived for from 1 to 17 days after the onset of clinical disease. When survival was prolonged (i.e., more than 2-4 days) by intensive care, the disease had diverse and serious effects, including fluctuations in temperature and blood-pressure, cardiac arrhythmia, and diabetes insipidus. Although none of the patients survived, advances in the use of this technique raised hopes that it may eventually be possible to save some patients.

Effect of ketamine on intracranial pressure in hydrocephalic children.

Intracranial pressure changes were observed in 10 children with hydrocephalus after ketamine administration. Three patients showed an elevation of pressure and a fall was observed in 7 patients. Two more patients who were given ketamine while under general anaesthesia and IPPV also showed a fall in pressure. No explanation is forthcoming at present for such an unusual response, but an altered cerebral vascular response in the presence of promethazine and general anaesthesia has been postulated.

Accidental intravenous injection of cetrimide. A case report.

An unusual case of cetrimide toxicity, probably the first of its kind to be recorded, is reported. It occurred after accidental intravenous injection in an infant and the management is discussed. Cardiac arrest, muscle paralysis, haemolysis and other complications were successfully treated.