Sub arachnoid block for emergency cesarean section in a pituitary dwarf.

Anaesthesia for parturient patients with dwarfism is an uncommon problem faced by anaesthesiologists. There is an ongoing debate regarding general versus regional anaesthesia in these cases. In many centers there is lack of facilities for epidural or continuous epidural anaesthesia. A primiparous dwarf woman of 27 years old having 124 cm height and 37 kg weight was admitted in Mymensingh Medical College Hospital for elective cesarean section due to cephalopelvic disproportion. She was diagnosed as a case of pituitary dwarf previously on antenatal checkup depending on both clinical and endocrine ground. After admission she suddenly developed respiratory distress with less foetal movement and presented in our department for emergency cesarean section. We have managed the case by sub-arachnoid block (SAB) using 7.5 mg (1.5 ml) of 0.5% heavy bupivacaine at a level of L3-L4 interspace having adequate level of block and analgesia. The case was managed successfully and uneventfully. In this presentation, the role of SAB and a management guideline has been highlighted.

Unguided percutaneous transthoracic fine needle aspiration cytology in the diagnosis of the peripheral lung lesions.

Percutaneous transthoracic fine needle aspiration cytology (PTFNAC) of lung was done in 614 cases at the department of Pathology of Institute of Diseases of Chest and Hospital (IDCH), Dhaka, during the period from July 1994 to July 1996. A definite diagnosis was possible in 417 cases (78.83%). More than half (57.65%) of the cases were proved to have malignant diseases. PTFNAC detected malignant lesion in these patients for the first time as because no other investigation was able to establish the diagnosis. Diagnostic accuracy was 74%. Only 12 (1.95%) patients developed pneumothorax and mild haemoptysis occurred in 23 (3.74%) patients. So unguided PTFNAC is a simple, time saving, safe and inexpensive method of diagnosis of peripheral lung lesions.