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On page 366, Prerana Shroff et al from Seth GS Medical College have described a ‘Comparative Study of epidural Tramadol v/s Bupivacaine for postoperative analgesics using disposable non-mechanical elastomeric balloon pump’. They found that local anaesthetic infusion via an elastomeric balloon pump can provide good analgesia without significant respiratory depression or haemodynamic alteration and nausea/vomiting. If some more studies like this can be done, it may be very helpful in private practice.

HIV infection can affect any system, but the most interesting lesions occur in the CNS. On page 370, Sachin Thorat et al from Bombay Hospital Institute of Medical Sciences have described ‘Neurological Manifestations in 102 patients admitted with Immunosuppression due to HIV infection’.

If in future, some more studies can confirm the impression of Rangnekar et al, from Gandhi Medical College, Bhopal, on the subject of ‘Recurrent abortions’ associated with cancer history in the same or preceding generations, on page 381, it might have to be taught to medical students to help history taking.

Invasive rheumatology must be encouraged and should be used more often in private practice for diagnostic purposes. Sangeeta Kulkarni (Bhide) et al from Terna Medical College, Navi Mumbai, on page 386, show the ‘Role of synovial fluid analysis and synovial biopsy in joint diseases’.

There is a lot of difference of opinion amongst the physiotherapists regarding good ‘Quadriceps Exercises’. On page 420, Sushil Sabnis et al from HBMG Hospital, Mumbai discuss the subject of ‘Quadriceps Exercises’.

Prem Sheth et al from Bombay Hospital Institute of Medical Sciences and Medical Research Centre, on page 427, report a rare case of intracranial tumour, which was ‘Choroid Plexus Papilloma’.

Ali Reza Shojai et al from MGM Medical College, Navi Mumbai, on page 434, report a very interesting case of ‘Obstructed hernia in male intersex’.

Devang Desai et al from Bombay Hospital, on page 443, present a report on ‘CT findings in a case of Tracheobronchopathia Osteochondroplastica’, which is very interesting to read.

Finally, total hip replacement is becoming extremely common. In this context, it will be interesting to read the article ‘Femoral artery injury secondary to total hip arthroplasty’ by Pawan Kumar et al from LTMG Hospital, on page 450.


Are atypical neuroleptics better than the old drugs?

Newer “atypical” neuroleptic drugs may not be better than typical neuroleptics in the management of the behavioural and psychological symptoms of dementia. Lee and colleagues reviewed five trials including 1570 patients, evaluating the four oral atypical antipsychotic therapies in patients with the disorder. They found that atypical antipsychotic drugs were superior to placebo, but not to typical antipsychotic drugs. Adverse events were common even with the new drugs and included extrapyramidal symptoms, somnolence, and abnormal gait.

BMJ, 2004; 329 : 75.