Color doppler evaluation of cerebral-umbilical pulsatility ratio and its usefulness in the diagnosis of intrauterine growth retardation and prediction of adverse perinatal outcome.

OBJECTIVE: The aim of our study was to evaluate the usefulness of the pulsatility index (PI) of the umbilical artery (UA) and that of the fetal middle cerebral artery (MCA), as well as the ratio of the MCA PI to the UA PI (C/U ratio), in the diagnosis of small-for-gestational-age (SGA) fetuses and in the prediction of adverse perinatal outcome. MATERIALS AND METHODS: The study population comprised 90 pregnancies of 30-41 weeks gestation that had been diagnosed clinically as intrauterine growth retardation (IUGR) over a period of 1 year. The UA PI and the MCA PI as well as the C/U ratio were calculated. RESULTS: Of the 90 pregnancies in the study, 24 showed abnormal UA PI. Among these, 21 (87.5%) were SGA and 19 (79.2%) had adverse perinatal outcome. Of the four of the 90 pregnancies that showed abnormal MCA PI, all were SGA and had adverse perinatal outcome. Similarly, of the 20 out of 90 pregnancies that showed abnormal C/U ratio (<1.08), all 20 (100%) were SGA and had adverse perinatal outcome. The results were correlated with parameters of fetal outcome. CONCLUSION: INFERENCES DRAWN FROM THE STUDY WERE: (1) The C/U ratio is a better predictor of SGA fetuses and adverse perinatal outcome than the MCA PI or the UA PI used alone, (2) The UA PI can be used to identify IUGR per se and (3) The MCA PI alone is not a reliable indicator for predicting fetal distress.

Lumboperitoneal shunts: review of 409 cases.

BACKGROUND AND AIMS: A prospective study was carried out to evaluate the lumboperitoneal shunt procedure. MATERIAL AND METHODS: Four hundred and nine patients having communicating hydrocephalus were selected for the procedure during a 10-year period from March 1992 to February 2002. The average follow-up was 45.34 months. RESULTS: Tubercular meningitis (TBM)-related hydrocephalus was detected in 285 patients. Forty per cent of the patients were less than 15 years of age. Glasgow Coma Scale (GCS) of less than 8 was seen in 40% patients and 14.9% patients were in GCS 13-15. At the time of discharge 56.7% patients improved in their GCS to 13 -15 and 14.9% were in GCS 8 or less. The overall mortality was 5.13% and shunt-related mortality was seen in 2% patients. Shunt malfunction requiring revision was seen in 32 patients (7.8%) and the total number of shunt revisions was 44 (11%). Shunt infection was noted in 3.4% patients. CSF leak at the lumbar end occurred in 12 patients. Four patients required conversion of LP shunt to VP shunt. CONCLUSIONS: Lumboperitoneal shunt is an effective shunting procedure in communicating hydrocephalus.

Hashimoto's encephalopathy: response to plasma exchange.

We report a case of 52-year-old female with steroid-unresponsive Hashimoto's encephalopathy. She underwent plasma exchange that resulted in marked clinical improvement.

Computer ethics and cyber laws to mental health professionals.

The explosive growth of computer and communications technology raises new legal and ethical challenges that reflect tensions between individual rights and societal needs. For instance, should cracking into a computer system be viewed as a petty prank, as trespassing, as theft, or as espionage? Should placing copyrighted material onto a public file server be treated as freedom of expression or as theft? Should ordinary communications be encrypted using codes that make it impossible for law-enforcement agencies to perform wiretaps? As we develop shared understandings and norms of behaviour, we are setting standards that will govern the information society for decades to come.