Improvement in postoperative pain relief by the addition of midazolam to an intrathecal injection of buprenorphine and bupivacaine.

Background And Objective: Intrathecal injections of the benzodiazepine midazolam have been reported to cause antinociception in animals and pain relief in human beings, including the potentiation of opioid analgesia. This study compared the efficacy of the addition of midazolam to a mixture of buprenorphine and bupivacaine used for spinal anaesthesia.

Methods: The study was prospective, randomized, and observer blinded.

Congenital cystic lesions in head and neck.

Congenital lesions by definition are present at birth; but certain congenital lesions of the head and neck, like branchial cysts and dermoid cysts, clinically present in childhood, early adulthood or late in life. A good history and a high degree of suspicion are the key to the adequate management of such lesions. Here we present a series of six case reports of congenital cystic lesions of the head and neck.

An unusual case of impacted oesophageal foreign body.

Impacted sharp foreign bodies in the oesophagus can be very difficult to manage. When attempts are made to remove such objects inappropriately, life-threatening complications such as oesophageal perforation can occur. We hare reported a rare case of impacted denture in the oesophagus where endoscopic removal was not possible due to the perforation already caused by the denture, sinee this would have caused an oesophageal laceration, which could have proved fatal.

Desmoplastic astrocytoma of infancy--a case report.

Desmoplastic cerebral astrocytoma of infancy (DCAI) is a rare tumor which shows spindle cells embedded in an extremely desmoplastic stroma. We describe a case of DCAI seen in the frontoparietal region of brain in a three-month-old infant. Microscopically classic histology of DCAI was seen.

Pigmented epidermal cysts.

There are few reports documenting the presence of melanin or melanocytes in epidermal cysts. One hundred and twenty five epidermal cysts from Indian patients were analyzed for the presence of melanin pigment and their sites were noted. A Masson's Fontana stain and immunohistochemistry for S-100 protein and HMB 45 was performed for localization of melanin and melanocytes within the epidermal cysts.

Non responding pneumonia with skin lesions.

Sweet's syndrome (acute febrile neutrophilic dermatitis) is characterised by classical skin lesions accompanied by fever and malaise. Systemic involvement may be present and lung involvement in Sweet's syndrome has been reported in the form of bilateral pulmonary infiltrates, bronchiolitis obliterans organising pneumonia and pleural effusion. There are dense papillary neutrophilic infiltrates on histopathology.

Giant cell pneumonitis induced by cobalt.

Cobalt alone and in combination with tungsten carbide known as hard metal is capable of causing lung damage. This may vary from development of pulmonary oedema to asthma and fibrosing alveolitis. We report a case of giant cell interstitial pneumonitis caused by exposure to cobalt dust which was not identified as the etiological agent initially and hence led to progression of the disease.

The melkersson - rosenthal syndrome as a rare cause of facial nerve palsy - a case report.

The Melkenson Rosenthal syndrome is the rarely encountered triad of intermittent facial paralysis, recurrent facial oedema and lingua plicata. The intervals between the recurrence of symptoms may vary in duration. The cause of this syndrome is yet unknown.

Round worm migration along ventriculoperitoneal shunt tract: a rare complication.

Though a ventriculoperitoneal shunt has been associated with myriads of unusual complications, so has been that with roundworms. A case of a three-year-old boy is presented who had an unusual complication of roundworm migration along the shunt tract that presented as shunt tract infection.

Cytologic diagnosis of a melanotic neuroectodermal tumor of infancy occurring in the cranial bones.

Melanotic neutroectodermal tumor of infancy (MNTI) is a rare, usually benign tumor commonly occurring in the maxilla. MNTIs at unusual sites like the cranium clinically mimic malignant small round cell tumors. Consequently, a correct preoperative cytologic diagnosis of MNTI at these sites helps in the surgical management of the patient.

Unusual cases of foreign bodies in air passage in children.

Tracheobronchial foreign bodies when not treated promptly continue to be a source of morbidity and mortality specially in the paediatric population. Chevaliar Jackson, through meticulous analysis of mechanical problems related to foreign bodies in the air and food passages and their solution, created a science of rehearsed and tested instrumental techniques for their extraction (Jackson and Jackson, 1936). They developed instruments to achieve remarkable results with an almost unbelievably low morbidity and mortality.

Flow volume loops: postural significance.

Upper airway obstruction is an important but often unrecognised cause of dyspnoea and ventilatory failure. Flow volume loop remains the most sensitive method to detect upper airway obstruction. We report a patient with Hashimoto's thyroiditis who showed evidence of upper airway obstruction on the flow volume loop only in the supine position.

Inverted Papilloma - An Unusual Presentation (Foreign-Body like).

Inverted papilloma of the nose is an uncommon, but, well document ed lesion of the mucosal lining of the nose and paranasal sinuses. The manifestation of this disease are usually unilateral nasal obstruction, mucopurulent nasal discharge, anosinia and occasional headache. It is very rare to she this condition presenting with dyspnoea and dysphagia due to its extension in the laryngopharynx.

Dental plaque: an unlikely reservoir of Helicobacter pylori.

Background And Aim: Dental plaque has been suggested as a reservoir for Helicobacter pylori, though data in this regard are conflicting. We evaluated the prevalence of H. pylori DNA in dental plaque using polymerase chain reaction (PCR).

Intercostal tube drainage of pleura: urosac as chest drainage bag.

Chest drainage bags are an alternative to underwater seal drainage. Urosac functions on the same principles and therefore can be used as a cheap and easily available substitute. 40 patients requiring intercostal tube drainage (ICD) were included in the study.

Tuberculoma of the mastoid.

Tuberculoma is a rare but known complication of tuberculosis. It rarely occurs in the mastoid bone. When it occurs in the middle ear cleft, it can lead to intracranial complications if there is a delay in the diagnosis and management.

Unconventional pedicle spinal instrumentation. The Bombay experience.

Study Design: A retrospective study of all patients who underwent spinal fusion between 1986 to 1989 with inexpensive, locally made unconventional pedicle spinal instrumentation systems was undertaken. Implants were made with passivated 316L stainless steel, and a single level of instrumentation cost +f430.

Objectives: To demonstrate that simple, cheap pedicle instrumentation systems are as effective as the conventionally available expensive systems, provided proper anterior column support is maintained.

Role of routine estimation of creatinine clearance in patients with liver cirrhosis.

Background: Frequent occurrence of renal dysfunction without azotemia in patients with decompensated cirrhosis, and its prognostic and therapeutic importance, are not well appreciated.

Methods: Creatinine clearance (CrCl), 24-hour urinary sodium excretion, fractional excretion of sodium, and urine flow were estimated in 68 non-azotemic uncomplicated cirrhosis patients; all these patients were followed up for a period of 6 months. Eighteen patients with ascites and edema were treated with large volume paracentesis without colloid replacement and renal function was evaluated before, and 48 hours and 7 days later.