Spontaneous intracranial hypotension (SIH) is characterized by orthostatic headache (OH), low cerebrospinal fluid (CSF) pressure, and diffuse pachymeningeal gadolinium enhancement (DPME). We present here the case studies of two patients. One patient demonstrated a CSF leak in the mid-thoracic region, and recovered completely with conservative treatment. The other patient in whom leak could not be demonstrated, developed dementia, rapidly worsening encephalopathy, and became comatose, necessitating urgent epidural blood patch (EBP) with 25 cc of autologous blood, after which immediate and complete symptomatic relief was obtained. A second EBP was required a few days later and also provided complete and sustained clinical benefit, without subsequent recurrence. Both patients had OH and showed bilateral subdural fluid collections, DPME and “sagging” of brain on MRI. A high index of suspicion, recognizing the orthostatic nature of headache, and typical findings on contrast enhanced MRI should point to the diagnosis of SIH. EBP can be effective treatment in patients unresponsive to conservative measures.

Background: CPAP has become a useful in management of respiratory distress, especially in preterms. CPAP delivers a continuous distending pressure via the neonates pharynx to the upper and lower airways. The main indication for use of CPAP is RDS. Aim of study: To study the effectiveness of indigenous bubble CPAP in management of respiratory distress in newborn and to determine its outcome. Setting: Department of Pediatrics, MGM Medical College and MY Hospital, Indore during the period February-July 2005. Design: Prospective Observational Study. Method: This study was carried out on inborn neonates in the NICU of MY Hospital over a period of six months. Matched controls were taken from admissions during previous four months. It included the newborns developing respiratory distress with grunting and chest retractions within 6 hours of birth whose severity was measured by Silverman Anderson Score and oxygen saturation.Neonates with increasing Silverman Anderson Score or Oxygen saturation falling below 85%were taken on CPAP and their outcome studied. Result: There were 42 RDS cases in the study group of which 28 survived and 14 died. Indigenous BUBBLE CPAP was beneficial in managing babies with RDS. Conclusion: Indigenous BUBBLE CPAP is an effective and non-invasive way to provide ventilation in a setup with limited resources. It can be used to manage respiratory distress due to RDS, congenital pneumonia & MAS. It resulted in significant reduction in mortality but prognosis was bad in those who required CPAP >8 cm H 2 O.

BACKGROUNDThe transversus abdominis plane (TAP) block is a technique which blocks the sensory nerves supplying the anterior abdominal wall. This prospective cohort study was done to evaluate the effectiveness of TAP block for postoperative pain in patients undergoing total abdominal hysterectomy.