Objective: To compare the efficacy and safety of dexmedetomidine and propofol for hypotensive anesthesia in ENT surgeries in Indian phenotype. Materials and methods: A prospective, randomized, comparative study. The study population of 72 patients of Indian phenotype were randomly taken from random number table and divided into two groups with 36 patients in each group. Group D = dexmedetomidine (dexmedetomidine loading dose of 1 μg/kg dexmedetomidine diluted in 10 mL 0.9% saline infused over 10 minutes before induction of anesthesia, followed by infusion of 0.2–0.7 μg/kg/hour). Group P = propofol group (maintenance dose 100–150 μg/kg/hour). The infusions were titrated to maintain mean arterial pressure (MAP) between 55 and 65 mm Hg and hemodynamic stability. Results: In our study, we did not have hypotension or bradycardia that needed treatment. The heart rate and blood pressure were on the lower side in group D compared to group P. The awakening time was significantly short in group D than group P. The average doses of dexmedetomidine around 0.2 ± 0.04 μg/kg/hour and propofol around 140 ± 41 μg/kg/hour which are at the lowest end of the recommended doses of 0.2–0.7 μg/kg/hour and 100–300 μg/kg/hour for hypotensive anesthesia. These low doses may be the cause of no complications in the Indian population. Conclusion: In our comparative study done in Indian population, we observed that both dexmedetomidine and propofol have achieved desired hypotension in patients undergoing ENT surgeries to improve the operative field visibility by reducing the blood loss. Although achieved reduction in MAP was statistically nonsignificant, MAP was lower in dexmedetomidine than propofol. A significantly higher Ramsay sedation score in propofol group is suggestive of greater degree of sedation than dexmedetomidine, making it a better choice for hypotensive anesthesia.

Genomic integrity is required to maintain long life and prevent diseases associated with genomic instability such as “cancer.” The cell cycle is a compilation of well-organized, sequential molecular events, that lead to succession of DNA replication and segregation of replicated chromosomes. Cell cycle checkpoints are the strict regulatory mechanisms that monitor the order, integrity, and fidelity of the main events of the cell cycle. These include growth up to the acceptable cell size, replication, and integrity of the chromosomes, and their accurate segregation in due course of mitosis. Many of these mechanisms are highly conserved, while other studies on higher organisms have shown to control alternative cell fates with a significant impact on tumor suppression. Here, we take into consideration these different checkpoint pathways in a cell cycle and the consequences of their dysfunction on the fate of a cell.

Jervell and Lange-Nielsen syndrome represents a rare autosomal recessive cause of congenital deafness. The affected patients have prolongation of QT interval on electrocardiogram. These patients may present with cardiac arrhythmias, syncopal episodes, and predisposition to sudden death. These patients are predisposed to polymorphic ventricular tachycardia–torsades de pointes leading to syncope and sudden death. Surgical stress in the perioperative period, anxiety, loud sounds, and fear may trigger fatal arrhythmias. We are reporting anesthetic management of two pediatric patients posted for cochlear implantation surgery.

Pediatric brain is anatomically different from adult brain, and so are the pathophysiology and management of the pediatric head injuries. The physiologically immature brain of a child is more prone to cerebral edema and diffuses axonal injuries. The common delayed complications are formation of leptomeningeal cysts and postconcussion syndrome.¹ It is very rare to have posterior reversible encephalopathy syndrome (PRES) as a complication of traumatic brain injury (TBI) in children. Therefore, it was a diagnostic dilemma for us when bilateral occipital, frontal, and parietal hyperintensities on T2-weighted MRI (magnetic resonance imaging) images complicated the recovery of a child after TBI. We shall discuss the salient aspects of management and the role of MRI in pediatric TBI. The cause of PRES and differential diagnosis will also be explored. Key messages: Diagnosis of PRES in children with no known comorbidity requires a high degree of suspicion for early recognition with the use of MRI brain.

In patients with very low rectal tumors, intersphincteric resection (ISR) helps to preserve anal function. We hereby report our experience of evaluation and successful management in a rare case of rectal gastrointestinal stromal tumor (GIST), wherein we managed a case of rectal GIST with imatinib neoadjuvant followed by surgery and adjuvant therapy.

Background: Uterine fibroids are histologically benign tumors that originate from smooth muscle cells and usually seen in the genitourinary tract such as in the vulva, ovaries, urethra, and urinary bladder but may arise in nearly any anatomic site. Leiomyomas that become adherent to surrounding structures (e.g., the broad ligament, omentum, or retroperitoneal connective tissue) develop an auxiliary blood supply and lose their original attachment to the uterus, thus becoming “parasitic.” These lesions may manifest as extrauterine pelvic masses that compress the urethra, bladder neck, or ureter and may produce symptoms of varying degrees of urinary outflow obstruction or secondary hydroureteronephrosis. We herewith report the relationship of power morcellation and the development of parasitic fibroids in two patients after laparoscopic hysterectomy. Case description: Case 1: A 30-year-old patient presented to the hospital with an abdominal mass that was progressively increasing over a 2-year period. The histology of the mass showed interlacing bundles of benign smooth muscle fibers consistent with a leiomyoma. Surgical excision of the mass was done. Case 2: A patient of 41 years nulligravida presented to the hospital with complaints of pain in the abdomen, continuous dull aching type of pain that relieved on medication for 2 months, and a palpable mass per abdomen since 1 month. Ultrasound findings showed a large mass in pelvis posterior to uterus, likely indicating parametrial fibroid or ovarian fibroid. Total laparoscopic hysterectomy with open myomectomy treatment was done for the patient. Conclusion: Parasitic leiomyomas are caused following laparoscopic myomectomy or hysterectomy. Given the potential sequelae of retained fragments, careful attention to remove all residual specimens is warranted, and morcellation should be done in a containment bag.

Dyke–Davidoff–Masson syndrome (DDMS) is an important cause of intractable and drug-resistant seizures. It has varied clinical presentation and distinct neuroimaging features. Here, we describe a male patient presented with recurrent generalized tonic–clonic seizures, and cognitive deficit and characteristic neuroimaging features of marked sulcal all ventricular prominence seen on left side suggestive of hemiatrophy associated with mild calvarial thickening with pneumatization of sinuses seen on left side with dilatation of left petrous edge which is suggestive of DDMS. Early institution of neuroimaging in patients with intractable epilepsy will make early diagnosis and better outcome.