Journal of clinical and diagnostic research : JCDR
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Case Reports
Primary Pulmonary Ewing's Sarcoma: Rare Cause of Superior Vena Cava Syndrome in Children.
Ewing's sarcoma is a common malignant bone tumour presenting in children and young adults. Rarely extra- skeletal soft tissues and visceral organs can also be the site of origin of Ewing's sarcoma. ⋯ The diagnosis was confirmed pathologically both by light microscopy and immunohistochemistry. The patient was put on chemotherapy and surgery was planned but the patient expired within three days of starting chemotherapy.
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Laparoscopic cholecystectomy (LC) is conventionally performed under general anaesthesia (GA) in our institution. There are multiple studies which have found spinal anaesthesia as a safe alternative. We have conducted this study of LC, performed under spinal anesthesia to assess its safety and feasibility in comparison with GA. ⋯ SA as the sole anaesthesia technique is feasible, safe and cost effective for elective LC.
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Distraction techniques are often provided by nurses, parents or child life specialists and help in pain alleviation during procedures. The use of non pharmacological procedures to cope with pain behaviour is less costly and most of these procedures can be administered by a nurse. Hence, the aim of the present study was to assess and compare the analgesic effect of holding the child by a family member versus holding the child by a family member along with an animation distraction intervention on the level of pain perception during venipuncture in children up to seven years of age. ⋯ The study concluded that when during painful procedures like venipuncture if children are given any non-pharmacological intervention like animated distraction along with their family member it helps in managing the pain. In other words, it distracts/diverts the child's attention from pain and results in better cooperation of child during procedure.
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Feeling of pain is one of the most important emotional determinants which dominate the perception of females who undergo the process of labour and delivery. Patient controlled epidural labour analgesia (PCEA) is convenient and safer technique for this purpose. Very few studies compared clonidine and fentanyl with ropivacaine in labour analgesia in past. This study was undertaken to compare fentanyl and clonidine in PCEA. ⋯ Ropivacaine 0.125% was effective in decreasing labour pain without any motor blockade. Clonidine 1μg/kg was superior to fentanyl 2μg/ml as an adjuvant in PCEA for labour without any significant feto-maternal adverse effects.
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This anatomical study of the pectoral nerves and their innervation is to provide detail informations on the pectoral nerves and their variations in their course, to guide the cosmetic and plastic surgeons for their easy intra operative localization and to improve the understanding of the pectoral muscle innervation, which is very much required during breast reconstruction after modified radical mastectomy (MRM) in breast cancer; axillary dissection; removal of the pectoralis minor muscle, and in harvesting the pectoralis major for myocutaneous head and neck island flap surgeries. ⋯ In all the specimens, the medial pectoral nerve pierces the pectoralis minor muscle; but as a single trunk in 76%, and as dividing branches in 34% specimens. The extent of costal attachment of the pectoralis minor muscle found to be less than 6.0 cm in cases of the medial pectoral nerve piercing the pectoralis minor muscle as a single trunk. The medial pectoral nerve after piercing the pectoralis minor, ramify within the muscle supplying it, finally runs along the lateral aspect (lower border) of the pectoralis minor muscle to supply the lower portion or distal segment of the pectoralis major muscle. Similarly, the lateral pectoral nerve runs along the upper border (medial aspect) of the pectoralis minor muscle (98%) and then runs under surface of the pectoralis major muscle along with the pectoral branch of thoracoacromial artery, supplying the upper portion or most of the proximal 2/3(rd) of the pectoralis major muscle. Therefore, when the pectoralis minor muscle is removed in a modified radical mastectomy or during dissection between the two muscles, there is partial denervation of the pectoralis major muscle with partial atrophy and decrease in muscle mass. If the lateral pectoral nerve also injured along with the medial pectoral nerve, it can result in total denervation of the pectoralis major muscle with severe atrophy and fibrosis. In breast augmentation implants placing behind the pectoralis major muscle, it is found to be more advantageous if the pectoralis major muscle is partially denervated for the better projection and contour. The distance of the branches of the medial pectoral nerve and the lateral pectoral nerve in the pectoral muscles from the lateral margin of the sternum being 8.8-10.8 cm and 5.8-10.2 cm respectively. The proximal segment or upper portion of the pectoralis major muscle has got separate independent vascular and nerve supply; therefore, it can be safely used as a myocutaneous flap in surgeries of head and neck or anterior chest wall.