Pulse wave analysis as an experimental tool to clinical application: past and present (review).

Pulse examination by palpation of a peripheral artery against a bony prominence is the most commonly used and widely accepted method. However this is subjective and thus prone to errors. Although pulse waveform was recorded in the 19th century, it did not gain popularity because of inconvenience in using the recording instruments and the absence of a sound theory to explain the wave forms recorded. Sphygmomanometry for recording blood pressure gained popularity as it was easy to record and had a sound theoretical background. Sphygmomanometry provides two extreme values of blood pressure but does not give a true representation of the blood pressure changes occurring in the entire cardiac cycle. Recently there has been resurgence in the analysis of the graphical recording of the pulse wave. Photoplethysmography is becoming a widely accepted technique in assessing the volume pulse. The whole review is about historical background, non-invasive methods of pulse recording, relation of the digital volume pulse to the pressure pulse and the advantages of recording the pressure pulse.

Efficacy and Tolerability of Intramuscular Dexketoprofen in Postoperative Pain Management following Hernia Repair Surgery.

Objective. To evaluate the safety and efficacy of intramuscular dexketoprofen for postoperative pain in patients undergoing hernia surgery. Methodology. Total 202 patients received single intramuscular injection of dexketoprofen 50 mg or diclofenac 50 mg postoperatively. The pain intensity (PI) was self-evaluated by patients on VAS at baseline 1, 2, 4, 6, and 8 hours. The efficacy parameters were number of responders, difference in PI (PID) at 8 hours, sum of analogue of pain intensity differences (SAPID), and onset and duration of analgesia. Tolerability assessment was done by global evaluation and adverse events in each group. Results. Dexketoprofen showed superior efficacy in terms of number of responders (P = .007), PID at 8 hours (P = .02), and SAPID( 0-8 hours ) (P < .0001). It also showed faster onset of action (42 minutes) and longer duration of action (6.5 hours). The adverse events were comparable in both groups. Conclusion. Single dose of dexketoprofen trometamol 50 mg given intramuscularly provided faster, better, and longer duration of analgesia in postoperative patients of hernia repair surgery than diclofenac 50 mg, with comparable safety.

Initial experience of endobronchial silicon stents from a tertiary care centre in North India.

BACKGROUND: Central airway obstruction (CAO) is defined as obstruction of trachea and principal bronchi. Therapeutic rigid bronchoscopy with tracheobronchial stenting using silicon stents is a well established procedure in the management of such conditions. However, there is limited experience with this technique in India. METHODS: Between January 2010 and April 2010, Dumon stents were placed in four patients with CAO. Three patients had symptomatic tracheal stenosis while one patient had malignant obstruction at the carina. Rigid bronchoscopy under general anaesthesia was performed to relieve the CAO followed by placement of silicon stents. Pre- and post-stent placement symptom assessment was performed with a symptom-based visual analogue scale. RESULTS: Four patients underwent silicon stent placement in the tracheobronchial tree. Three patients had benign post-intubation tracheal stenosis and one had malignant tracheal obstruction at carina due to endobronchial growth. Significant improvement was achieved in all patients. There were no significant complications. CONCLUSIONS: Rigid bronchoscopy with silicon stent placement is an effective and suitable method of relieving the distressing symptoms due to benign or malignant airway obstruction.

Once daily calcineurin inhibitor monotherapy in pediatric liver transplantation.

This report describes a group of pediatric liver transplant recipients who have undergone once daily calcineurin inhibitor (CNI) monotherapy at Children's Memorial Hospital, Chicago, between January 1, 2001 and November 30, 2008. We defined success as normal liver enzymes at 1 year after dose change, with normal enzymes throughout all follow-up. Patients who did not meet the set criteria or had lost an organ to chronic rejection were not considered for this therapeutic strategy. There were 147 patients in our organ transplant tracking record (OTTR) who were > or = 5 years post liver transplant. Of these, 56 underwent reduced dose, once daily CNI monotherapy. Patients who met the set criteria were placed on once daily calcineurin inhibitor at half their previous dose. Fifty patients successfully achieved this dose change, while six patients failed at a mean of 3.7 +/- 3.2 months following the dosing change. The mean interval from transplant was significantly longer in those patients who were successful compared to those who failed dose change (p < 0.05). Importantly, there have been no graft losses. Reduced dose, once daily CNI monotherapy is safe in carefully selected recipients, with a longer interval post liver transplantation increasing the likelihood of success.

Cerebellar stem cells act as medulloblastoma-initiating cells in a mouse model and a neural stem cell signature characterizes a subset of human medulloblastomas.

Cells with stem cell properties have been isolated from various areas of the postnatal mammalian brain, most recently from the postnatal mouse cerebellum. We show here that inactivation of the tumor suppressor genes Rb and p53 in these endogenous neural stem cells induced deregulated proliferation and resistance to apoptosis in vitro. Moreover, injection of these cells into mice formed medulloblastomas. Medulloblastomas are the most common malignant brain tumors of childhood, and despite recent advances in treatment they are associated with high morbidity and mortality. They are highly heterogeneous tumors characterized by a diverse genetic make-up and expression profile as well as variable prognosis. Here, we describe a novel ontogenetic pathway of medulloblastoma that significantly contributes to understanding their heterogeneity. Experimental medulloblastomas originating from neural stem cells preferentially expressed stem cell markers Nestin, Sox2 and Sox9, which were not expressed in medulloblastomas originating from granule-cell-restricted progenitors. Furthermore, the expression of these markers identified a subset of human medulloblastomas associated with a poorer clinical outcome.

Effect of pneumoperitoneum on intracranial pressure during supratentorial craniotomy: a case report.

Laparoscopic surgery has become the method of choice for many procedures previously performed by open techniques. However, its use in patients with a potentially decreased intracranial compliance warrants caution. We report a case of combined glioma excision and laparoscopic cholecystectomy procedures with evaluation of the effects of pneumoperitoneum on ICP and operative field. The clinical implications, safety and recommendations of conducting laparoscopic surgeries in neurosurgical patients are discussed. Performing pneumoperitoneum in patients with marginal intracranial compliance needs interdisciplinary discussions and ICP monitoring is mandatory.

Bradycardia following negative pressure suction of subgaleal drain during craniotomy closure.

We report bradycardia (50 beats/min) in a patient, following application of negative pressure (50 mmHg) suction to the subgaleal drain, after an uneventful clipping of an anterior communicating artery aneurysm. This episode recurred even with application of a lesser negative pressure of 23 mmHg. It was noted that the time lag between application of suction pressure and the occurrence of bradycardia increased, from 10 sec in the former to 50 sec in the later instance. None of these episodes were associated with changes of blood pressure. Moreover, there was a temporal association between the intensity of negative pressure applied and the time of occurrence of bradycardia. This phenomenon is possibly due to intracranial hypotension causing reverse brain herniation that bears a relationship with the intensity of negative pressure applied. We recommend that negative pressure suction is avoided during skin suture and applied gradually, after the closure.

Can propofol precipitate pancreatitis in patients with Cushing's syndrome?

We encountered two cases of acute pancreatitis in patients with Cushing's disease following transnasal transsphenoidal hypophysectomy. In both cases propofol was used in bolus doses, and is thought to be the probable factor for its development. Since elevated cortisol levels in Cushing's disease poses a threat for pancreatitis, there is a possibility that patients with Cushing's disease might be more prone to acute pancreatitis following propofol administration. Anaesthesiologists and physicians dealing with the management of Cushing's disease need to be aware of this possibility.

Status of soil transmitted helminthiasis in UT of Lakshadweep.

Soil Transmitted Helminthes (STH) survey in UT of Lakshadweep was conducted during February-March 2004. The survey was undertaken using WHO sampling methodology and Kato-Katz technique for stool sample examination. A total of 387 stool samples were examined of whom 322 samples (83.2%) were found positive for one or more STH. Maximum prevalence (100%) was found in Kavaratti Junior Basic School. Thirty children (7.8%) had high intensity of infection. In Kadmat Junior Basic School high intensity TT infection was 8.9%, For AL highest intensity of infection was found among Kavaratti Senior Basic School (7.0%). Mass anthelminthic chemotherapy of all school children was advocated.

Status of soil transmitted helminthic infections in India--observations on sample surveys using Kato-Katz technique.

Results of surveys conducted in eight different ecologically homogenous zones in the country, using WHO sampling design methodologies and Kato-Katz technique are presented in this communication. Hilly and coastal areas had high STH prevalence ranging from 34%-36% with total epg ranging from 53,952-4,67,976. Apart from this, Chitradurga urban area had STH prevalence of 39.6% with epg of 81,792. However, except in few cases, in all these surveyed areas, intensity of STH infection was found to be light. A national programme for control of soil transmitted helminthic infections is advocated.

Uptake and transport of copolymer biodegradable microspheres by rabbit Peyer's patch M cells.

In this study, we demonstrate the role of M cells in uptake of poly(D-L-lactic-co-glycolic acid) (PLGA) microspheres and transport into rabbit Peyer's patches. Microspheres 1 to 10 microns in diameter composed of 50:50 lactic acid:glycolic acid were instilled into intestinal segments containing jejunal or ileal Peyer's patches, and uptake by M cells was examined by electron microscopy. PLGA microspheres visualized as electron-lucent, spherical particles were taken up by M cells by pseudopod-like extensions of the M cell apical membrane and translocated to the pocket region containing mononuclear leukocytes within 60 min. These results indicate that PLGA microspheres can be directed to M cell apical surfaces for delivery to immunocompetent cells in gut-associated lymphoid tissues.

Development and validation of capillary electrophoresis assay for ribonuclease A.

A quick and reproducible capillary electrophoresis assay was developed and validated for bovine pancreatic Ribonuclease A (Rnase A). Effects of separation buffer pH and concentration as well as separation power were evaluated on Rnase A samples in phosphate buffered saline in the 5-100 micrograms ml-1 concentration range. The separation variables yielded significant influence on peak elution, with phosphate buffer (pH 2.5; 0.2 M) at separation power of 2 W providing an optimum peak at about 4 min. The peak sharpness and detection limit was further improved by a base/sample/acid injection technique. The optimized method showed good linearity with inter- and intraday RSD of peak area in the 2-5% range. Heat, as well as guainidine hydrochloride denatured samples, showed loss of enzymatic activity, changes in tyrosine fluorescence and abnormal electropherograms. The assay was also compared to a bicinchoninic acid assay that is routinely used for protein quantitation, and found to have greater sensitivity and reproducibility.

Enteral immunization and challenge of volunteers given enterotoxigenic E. coli CFA/II encapsulated in biodegradable microspheres.

The development of a safe and effective vaccine against enterotoxigenic Escherichia coli (ETEC) would be useful for travellers and for young children in endemic areas. A feasibility study of an enteral ETEC vaccine prototype consisting of colonization factor antigen II (CFA/II), containing two component antigens CS1 and CS3, encapsulated in biodegradable polymer microspheres (BPM) was conducted in healthy volunteers. Ten adult volunteers swallowed intestinal tubes on days 0, 7, 14 and 28; after collection of jejunal fluid samples, 1 mg of CFA/II in BPM was administered via the tube. Volunteers kept a diary of symptoms after each dose. Secretory IgA in jejunal fluids, serum responses and circulating antibody-secreting cells (ASC) were measured before and after vaccination. The vaccine was well tolerated. Five of ten volunteers developed IgA anti-CFA/II ASC by 7 days after the last dose of vaccine; these same five vaccinees had IgA anti-CS3 ASC, and three of these five vaccinees had IgA anti-CS1 ASC. Five of ten vaccinees developed rises in jejunal fluid sIgA anti-CFA/II with peak GMT of 1:42. About 8 weeks after the first dose of vaccine, ten vaccinees and ten unvaccinated control volunteers underwent challenge with 10(9) c.f.u. ETEC E24377A (O139:H28 LT+ST+CS1+CS3+). Ten of ten controls and seven of ten vaccinees developed diarrhoea (p = 0.11, 30% vaccine efficacy). Two of the three protected vaccinees had the highest numbers of ASC and highest sIgA titres during the course of immunization, suggesting that these responses were protective and that this vaccine development strategy has merit. Future studies with higher dosages and a different dosing schedule are planned.