Short-term improvement in leg pain and sensory deficits was observed in patients with sciatica due to a herniated nucleus pulposus with both epidural bupivacaine and steroids. All long-acting steroids had no statistically significant difference between their efficacy in pain relief but methylprednisolone and triamcinolone were more effective by the second injection as compared to dexamethasone which required a third injection in a significant number of cases. Differences between methylprednisolone and triamcinolone were insignificant. Complications were negligible and temporary.

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Noninvasive positive pressure ventilation (NIPPV) delivered by nasal route or facemask is increasingly being used in the management of patients with acute respiratory failure. 45 patients (29 males,16 females) with a mean age of 68.32 years (range 29 to 82 years) having acute onset hypoxemic and/or hypercapnic respiratory failure who were managed with NIPPV in a tertiary care centre of Armed Forces were analyzed retrospectively. Patients with hemodynamic instability, coma and uncooperative patients were excluded from study. Etiology of acute respiratory failure was acute exacerbation of chronic obstructive pulmonary disease (COPD) in 29 patients, adult respiratory distress syndrome (ARDS) in 4 patients, severe kyphoscoliosis in 2 patients, interstitial lung disease (ILD) in 4 patients, lung contusion with pneumonia in 1 patient, thoracoplasty in 1 patient and difficult weaning in 4 patients. Initial resting arterial blood gases showed mean arterial oxygen tension (PaO2) 61 mmHg (range 45 to 78 mmHg), mean arterial carbon dioxide tension (PaCO2) 75.2 mmHg (range 32 to 127 mmHg) and mean arterial pH-7.26 (range 7.03 to 7.45). Mean inspiratory positive airway pressure (IPAP) was 14 cm H2O (range 10 to 20 cm H2O). Mean expiratory positive airway pressure (EPAP) was 5.8 cm H2O (range 4 to 8 cm H2O). On an average, NIPPV was required for 5.4 days (range 2 to 15 days) prior to discharge. 11 patients required long term intermittent NIPPV along with domiciliary oxygen therapy. 9 patients died out of which 4 patients had advanced interstitial lung disease. NIPPV has been found useful in acute respiratory failure due to acute exacerbations of COPD, thoracic wall abnormalities and ARDS. It has not been found useful in hypoxemic respiratory failure due to interstitial lung disease and diffuse interstitial pneumonia.

We managed two cases of facial palsy following trauma, who were decompressed via posterior tympanotomy approach. Both cases improved following surgery. Investigations, surgery and post op management are discussed. We conclude that posterior tympanotomy approach can be used for facial nerve decompression till first genu.

Background: Splanchnic hypoperfusion in sepsis leads to translocation of bacteria from gut and development of multi-organ dysfunction syndrome (MODS), with increased mortality in critically ill patients. Gastric tonometry can detect this hypoperfusion by measuring carbon dioxide tension (PgCO 2 ) and intramucosal pH (pHi) from gastric mucosa. Therapeutic intervention aimed at improving gut perfusion can improve the outcome and prognosticate the mortality in sepsis patients. Methods: 100 patients with clinical diagnosis of sepsis were included and divided into two groups of 50 each. Group A patients were managed traditionally without gastric tonometry and in Group B gastric tonometry was used for therapeutic intervention. The intramucosal PCO 2 , pHi, end tidal carbon dioxide tension (EtCO 2 ) and (PgCO 2 -EtCO 2 ) differences were monitored at 0, 12 and 24 hours interval. Result: Overall mortality in Group A was 64% and 54% in Group B. In Group B 45% patients developed MODS and 54% died with low pHi. As an index of mortality low pHi had a sensitivity of 70% and specificity of 65%. Conclusion: There is a good correlation between mortality prediction on the basis of pHi and PgCO 2 -EtCO 2 difference and actual mortality in critically ill patients. The gastric tonometer should be used to predict mortality and guide resuscitation in septicemia.