Journal of the Indian Medical Association
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The aim of present study is to report our experience concerning the effectiveness, quality of analgesia, ease of performance, complications and safety of spinal anaesthesia in children undergoing infra-umbilical surgery. An open, non-comparative study was performed on 40 children aged 5-15 years undergoing elective infra-umbilical surgery. After parents' written consent and premedication, spinal anaesthesia was induced with hyperbaric bupivacaine (5mg/ml), 0.4mg/kg for children up to 15 kg body weight and 0.3mg/kg for >15 kg via L3-L4 or L4-L5 interspace in lateral decubitus position. ⋯ The dose of intrathecal bupivacaine used was 4-9 mg. No evidence of cardiovascular instability, postdural puncture headache, transient neurological symptoms, urinary complication was observed. Spinal anaesthesia with hyperbaric bupivacaine using 26-gauge hypodermic needle provides safe and effective analgesia for paediatric infra-umbilical surgery with high success rate.
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Pyogenic spinal epidural abscess Is an uncommon Infectious occurrence. Clinical prospects of pyogenic spinal epidural abscess are graver if not promptly diagnosed and treated appropriately. A case of spinal epidural abscess has been presented with sinus tract formation at L4-L5 level, of pyogenic aetiology that progressed to paraplegia over the course of the disease. ⋯ Histopathological analysis revealed the acute suppurative nature of the abscess. Citrobacter kasori was isolated on pus culture. Pyogenic epidural abscess with causative organism being Citrobacter kasori has least been documented.
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Case Reports
Anaesthetic management of a patient with motor neuron disease posted for microlaryngeal surgery.
Motor neuron disease (MND) typically affects upper and lower motor neurons without any sensory involvement. Regional anaesthesia is preferred in motor neuron disease patients to avoid aspiration and possibility of prolonged postoperative ventilation following general anaesthesia. As microlaryngeal surgery in a motor neuron disease patient needed airway protection, it was decided to perform the surgery under general anaesthesia with awake intubation following airway block and avoiding muscle relaxant agents completely to minimise unnecessary complications. The patient was allowed spontaneous breathing while maintaining anaesthesia and stable haemodynamic condition with combination of anaesthetic and analgesic agents accordingly throughout the operation.
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Breast cancer is second most common cancer in Indian women. It is often curable by various treatment modalities when detected in early stage. Prognosis and selection of therapy in breast cancer depends upon various factors including clinical parameters, histopathological subtype and molecular characteristics of primary tumour. ⋯ Significant patients had breast lump > 4 cm in size. Infiltrating duct carcinoma not otherwise specified (NOS) was the most common histological type showing predominantly microscopic grade II as per Nottingham's Modification of Bloom Richardson grading system. Immunohistochemistry showed 75% ER positivity, 66.66% PR positivity and 25% Her-2/neu positivity.
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A national consultation was organised in January 2012, in order to reconcile between global and national guidelines, to review the evidence base and update the RNTCP guidelines in consensus with Indian Academy of Paediatrics. The consultation had come up with wider recommendations in diagnosing and treating paediatric tuberculosis patients which has been incorporated in the programme.