Tension pneumocephalus following deep brain stimulation surgery with bispectral index monitoring.
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Anesthesia, General↗
Biomedical subjects
H Prabhakar
Publications and source records attributed to H Prabhakar.
Haemodynamic changes after intracisternal papaverine instillation during intracranial aneurysmal surgery.
Cerebral vasospasm remains a significant cause of mortality and morbidity after aneurysmal subarachnoid haemorrhage. Use of either intra-arterial or intracisternal papaverine as an alternative treatment of refractory cerebral vasospasm has been associated with various complications including haemodynamic instabilities. However, our search in literature did not reveal association of bradycardia and hypotension with the use of papaverine by either of these routes. Here, we describe a case of anterior communicating artery aneurysm with hydrocephalus. The patient underwent craniotomy and clipping of the aneurysm followed by third ventriculostomy. Instillation of papaverine at the surgical site caused significant haemodynamic changes possibly because of stimulation of hypothalamus in the third ventricle or vagal nuclei in the fourth ventricle, or even both. We recommend cautious use of intracisternal papaverine in such scenario especially when third ventriculostomy has been performed as an adjunct surgical procedure.
Administration, Topical↗
Lidocaine infiltration of the scalp does not completely abolish increased intraocular pressure due to skull pin insertion.
Insertion of skull pins results in haemodynamic perturbations, which can be blunted by local anaesthetic infiltration of the pin sites. No study has assessed the effects on intraocular pressure. General anaesthesia was induced in 71 patients undergoing cervical spine surgery with attachment of Gardner Wells tongs to the skull. Skull pins were attached five minutes after induction following either saline (group I, 35 patients) or lidocaine (group II, 36 patients) infiltration of scalp. Intraocular pressure, mean arterial pressure and heart rate were recorded before (baseline), immediately after, and 60 s following pin insertion and analysed statistically. Insertion of pins increased intraocular pressure in both groups (from 8.4+/-2.7 to 14.2+/-3.0 mmHg in group I, and from 8.8+/-2.3 to 12.7+/-2.7 mmHg in group II, P < 0.001), which persisted even at 60 s but the increase was significantly greater in group I. Insertion of pins significantly increased blood pressure in group I only. We conclude that lidocaine infiltration at the skull pin sites for Gardner Wells tong attachment fails to completely abolish increased intraocular pressure.
Adult↗
Pneumorrhachis presenting as quadriplegia following surgery in the prone position.
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Cervical Vertebrae↗
Bradycardia following hydrogen peroxide irrigation during posterior fossa surgery.
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Bradycardia↗
Sudden asystole during surgery in the cerebellopontine angle.
We report a case of a 40-year-old lady undergoing surgery for a tumor in the cerebellopontine angle. Intraoperatively, patient had a sudden asystole without prior warning sign of bradycardia. It could have been the severe form of trigeminocardiac reflex. The cardiac rhythm returned spontaneously once the surgical manipulation stopped. The remainder of the operation was uneventful and no complication occurred afterwards. The possible mechanism of the event is discussed.
Adult↗
Rupture of aorta and inferior vena cava during lumbar disc surgery.
Major vascular injury during lumbar disc surgery has been recognized as an unusual but well described complication. A potentially fatal outcome can be avoided by a high index of suspicion and an early diagnosis. We present a rare case of aortic and inferior vena caval injury in a 50-year-old female patient undergoing intervertebral disc surgery at lumbar one and two levels. A quick diagnosis and prompt management resulted in a favourable outcome for the patient.
Aorta, Abdominal↗
Intracranial pressure and haemodynamic changes during the tunnelling phase of ventriculoperitoneal shunt insertion.
BACKGROUND AND OBJECTIVE: The tunnelling phase of ventriculoperitoneal shunt insertion is the most painful part but patients are often given inadequate opioid analgesic for fear of post operative delayed recovery and/or respiratory depression. This may result in an increase in intracranial pressure. METHODS: Twenty adults scheduled to undergo ventriculoperitoneal shunt insertion were administered standard anaesthesia. Monitoring included heart rate, electrocardiogram, end-tidal carbon dioxide, invasive blood pressure, and oxygen saturation. Intracranial pressure was monitored by placing the ventricular end of shunt catheter in the dilated lateral ventricle. Five minutes before tunnelling, fentanyl 1 microg kg(-1) was administered. Mean arterial pressure, heart rate and intracranial pressure were recorded during tunnelling and subsequently at 1-min interval for 5 min. Data were analysed using t-test and repeated measured test. RESULTS: Tunnelling caused significant increase in mean arterial pressure (from 81.4 +/- 11.0 to 110.9 +/- 15.3 mmHg, P < 0.05), intracranial pressure (from 21.4 +/- 8.1 to 29.2 +/- 12.5 mmHg, P < 0.05) and heart rate (from 74.4 +/- 13.8 to 94.1 +/- 17.8 beats min(-1), P < 0.05). Whereas, the increase in haemodynamic parameters persisted for 3 min post-tunnelling, elevated intracranial pressure lasted for 2 min. CONCLUSION: Tunnelling significantly increases intracranial pressure and blood pressure despite prior fentanyl administration. This may be deleterious in the presence of intracranial pathology.
Adolescent↗
Dengue haemorrhagic fever outbreak in October-November 1996 in Ludhiana, Punjab, India.
An epidemic of haemorrhagic fever broke out in Ludhiana in October and November 1996. Persons of all age groups were affected with preponderance of young adults. Haemorrhagic manifestations like rashes, epistaxis, bleeding from the gums and haematemesis were observed. The cause of fever was investigated. Serum samples collected at random from 71 patients were tested by ELISA for dengue types 1-4 IgM antibodies. These were positive in 96.7 per cent of cases. Immunoblot testing for IgM and IgG for all serotypes of dengue virus were positive in 90.2 and 73.2 per cent of the serum samples respectively. The haemorrhagic fever was serologically proven to be due to dengue virus.
Adult↗
Prevalence of multi-drug resistant Salmonella typhi in Ludhiana Punjab.
A total of 945 strains of S. typhi isolated from blood cultures during 1989 to 1994 were studied. Their antibiotic susceptibility showed 580 (61.4%) of strains to be multidrug resistant. The 464 strains tested for their susceptibility to ciprofloxacin were all sensitive to the drug. Twenty three (17.9%) of the 128 strains of S. paratyphi A were resistant to chloramphenicol. The sole isolate of S. paratyphi B was sensitive to all antibiotics tested.
Drug Resistance, Multiple↗
Prevalence of hepatitis A, B, C & D in Ludhiana.
172 sera were tested for serological markers of hepatitis A, hepatitis B, hepatitis C and hepatitis D to define the aetiology of acute viral hepatitis by Enzyme immunoassays. The viral aetiology could be decided in 60.5% (104/ 172) of patients. Hepatitis B infection was present in 34.9%, hepatitis A in 10.5%, hepatitis C in 9.3% and hepatitis D in 5.8% of cases. Delta hepatitis associated with HBsAg positive hepatitis was detected in 10% (6/60) of the patients. The aetiology remained undecided in 39.5% of patients.
Acute Disease↗
Predictive utility of clinical and stool parameters in bacterial diarrhoea in children.
A prospective one year study was conducted on children between the ages of 1 month to 5 years hospitalised in the pediatric ward of Christian Medical College, Ludhiana, with the aim of determining the predictive utility of certain clinical and stool parameters in diagnosing bacterial diarrhoea. Among the 204 children enrolled in the study, fever was observed in 40% in both the culture positive and negative groups. Clinical features such as abdominal distension, vomiting and oliguria although had low positive predictive values, their negative predictive values were high. Among the stool parameters, watery consistency and pus cells > 5 HPF were significantly more often observed in culture positive cases. The presence of mucus and pus cells > 5 HPF had good sensitivity (70-80%) but poor specificity (27-40%), while the reverse was true of blood (sensitivity 23%, specificity 89%). Again the positive predictive values were uniformly low while the negative ones were high. In conclusion the clinical and stool parameters were found to be more useful by their absence than by their presence in excluding a positive stool culture.
Bacterial Infections↗
Shigella isolates in stool.
A total of 447 Shigella strains were isolated from stool samples during 1989-1991. Of these 270 (60%) were from children. Among the different species and serotypes Sh. flexneri 60 (13.4%) and Sh. sonnei Phage 139 (65%) were the most frequently isolated strains. 154 (34.4%) strains were resistant to three and 179 (40%) to more than three antibiotics. Some strains of Shigella were found to be resistant to furazolidine and neomycin.
Adult↗
Outbreak of gastroenteritis due to a new strain of non O group 1 Vibrio cholerae, in Ludhiana in May-August 1993.
The isolation of the new serotype 0139 of non 01 V. cholerae from an outbreak of gastroenteritis is reported. The study of 35 such isolates revealed their similarity with the El tor vibrios biochemically and by other characters. All were strongly haemolytic and 97.1 per cent of the strains showed a positive haemagglutination.
Cholera↗
Acinetobacter meningitis.
10,468 CSF samples from cases of meningitis in different age groups were cultured during 1988-1991. Acinetobacter calcoaceticus was isolated in 12 (5.6%) of 211 positive cultures. The strain were 100% resistant to ampicillin, cotrimoxazole and tetracycline 50% resistant to cephazolin gentamicin and kanamycin but 100% susceptible to chloramphenicol.
Acinetobacter↗
Physical factors contributing to the partition coefficient and retention time of 2',3'-dideoxynucleoside analogues.
Acquired immunodeficiency syndrome (AIDS) is an immunosuppressive disease characterized by an immune impairment and a high susceptibility to unusual forms of certain neoplasms. Since the brain is an important site of the infection, it is necessary to explore new classes of drugs that have the ability to penetrate across the blood-brain barrier, and the potency to suppress viral replication within the central nervous system (CNS). Therefore, the ability to predicate the lipophilicity of the potent anti-AIDS drugs may provide useful information about the potential of the drugs to enter CNS. In this paper, the correlations of log P (octanol-buffer partition coefficient) and log tR (retention time in HPLC; Rt was used by Balzarini et al.) with some physical constants like log MW (molecular weight), hydrogen bond forming ability (HB) of the substituents, and the substituent group dipole moments (mu) are analyzed. Good correlations of log P and log tR with log MW, HB, and mu have been obtained.
Antiviral Agents↗
Anaerobic bacterial flora of wound sepsis.
Two hundred specimens from wound infection (surgical and non-surgical) were cultured for the isolation of anaerobic and aerobic bacteria. Positive cultures were obtained in 174 (87%) and 26(13%) were sterile. Anaerobes were isolated from 31(17.8%), as single culture in 6(3.4%) and as mixed culture with aerobes in 25(14.3%). Amongst anaerobes, anaerobic cocci were predominant (45.9%). Of aerobes Staph pyogenes (35%) was predominant. Metronidazole was the most effective drug against anaerobes and gentamicin against aerobes. No significant difference was noted in antimicrobial susceptibility of anaerobes of surgical and non-surgical wounds. Among aerobes high resistance was observed in surgical wounds.
Bacteria, Aerobic↗
Haemagglutination antibody titres & immunoglobulin levels in cases of Plasmodium infection.
Malarial antibody estimation was done in patients with malaria (50), and fever (malaria negative, 50) and in 50 healthy controls who gave no history of malaria for the last one year, using the indirect haemagglutination test (IHA). Seropositivity was 78, 32 and 4 per cent respectively. Levels of IgG and IgM were found to be significantly higher in patients as compared to controls and a significant fall was observed in IgA levels in patients of malaria. Although the malarial antibody titre showed good correlation with IgG (P less than 0.01) and IgM (P less than 0.05) not all patients with a negative haemagglutination antibody titre had normal immunoglobulin levels.
Animals↗